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Region-dependent bone loss in the lumbar spine following femoral fracture in mice.

We previously showed that after femur fracture, mice lose bone at distant skeletal sites, including the lumbar vertebrae. This bone loss may increase the risk of subsequent vertebral fractures, particularly if bone is lost from high-strain bone regions, which are most commonly found adjacent to the superior and inferior endplates of the vertebral body. To determine regional bone loss from the lumbar spine following femur fracture, we evaluated the cranial, center, and caudal portions of the L5 vertebral bodies of Young (3 month-old) and Middle-Aged (12 month-old) female C57BL/6 mice two weeks …

Percutaneous vertebroplasty of the cervical spine performed via a posterior trans-pedicular approach.

OBJECTIVES: Percutaneous vertebroplasty (PV) of the cervical spine has been traditionally performed with a trans-oral or antero-lateral approach. The posterior trans-pedicular approach (PTPA) has been sporadically reported. Therefore, the aim of this study is to retrospectively assess the technical feasibility, safety, and clinical outcomes of cervical PV performed with a PTPA. METHODS: All consecutive patients undergoing PV in cervical levels with PTPA (under general anesthesia and computed tomography [CT] guidance) from January 2008 to November 2019 were identified. The following data were …

Intra-operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery.

A 15-year-old boy with cerebral palsy and epilepsy presented for a posterior spinal fusion as part of staged repair of thoracolumbar scoliosis. Total intravenous anaesthesia was induced and maintained with propofol, remifentanil and ketamine. Following prone positioning, cervical traction was applied. Polyuria developed intra-operatively, from 4 to 18 ml.kg-1.h-1. There was a corresponding rise in plasma sodium concentration from 132 to 145 mmol.l-1. Haemodynamic stability was maintained with boluses of Hartmann's solution and a noradrenaline infusion. Given the possibility of diabetes insipid

Adult Bicycle Collisions: Impact of Helmet Use on Head and Cervical Spine Injury.

BACKGROUND: No states currently require adult bicycle riders to wear helmets. Opponents of a universal helmet law argue that helmets may cause a greater torque on the neck during collisions, potentially increasing the risk of cervical spine fracture (CSF). This assumption has not been supported by data for motorcyclists. Therefore, we sought to evaluate the risk of CSF and cervical spinal cord injury (CSCI) in helmeted bicyclists (HBs) versus nonhelmeted bicyclists (NHBs) involved in collisions. We hypothesize that in adult HBs, there is an increased incidence of CSF and injury but lower rates…

Sagittal alignment of the cervical spine: do we know enough for successful surgery?

Over the past decade, there has been growing interest in the sagittal alignment of the cervical spine and its correlation to clinical outcomes. It is now known that cervical lordosis is not universally physiological and should not be pursued in all patients undergoing surgery. Rather, it is increasingly understood that it is how these angular parameters (lordosis or kyphosis) interact with translational parameters that is reflective of overall cervical spine and whole spine balance, which in turn impacts patient outcomes. This review synthesises currently available evidence relating to the sag…

Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study.

BACKGROUND: Lumbar disc degeneration (LDD) is a condition associated with recurrent low back pain (LBP). Knowledge regarding effective management is limited. As a step towards the identification of risk, prognostic or potentially modifiable factors in LDD patients, the aim of this study was to explore the hypothesis that intrinsic lumbar spine shape is associated with LDD and clinical outcomes in symptomatic adults. METHODS: 3 T MRI was used to acquire T2-weighted sagittal images (L1-S1) from 70 healthy controls and LDD patients (mean age 49 years, SD 11, range 31-71 years). Statistical Shape…

Vertebral artery dissections with and without cervical spine fractures: Analysis of 291 patients.

OBJECTIVES: Vertebral artery dissections occur when tears in the intimal layer of the vertebral artery and are associated with trauma, infection, and spontaneous etiologies. We aimed to identify differences in predisposing factors and outcomes in vertebral artery dissections associated with cervical spine fractures compared to those not associated with cervical spine fractures. PATIENTS AND METHODS: We conducted a retrospective chart review of patients with vertebral artery dissections who presented to our institution at the time of dissection and had a minimum of 3 month follow-up and collec…

[Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis].

OBJECTIVE: To analyze the characteristics of lumbar spine-pelvic structure in degenerative lumbar spondylolisthesis and its significance in degenerative lumbar spondylolisthesis(DLS). METHODS: The clinical data of 45 patients with simple degenerative L4, 5-segment lumbar spondylolisthesis (spondylolisthesis group) admitted from April 2015 to January 2017 were retrospectively analyzed, which were compared with 50 healthy people with complete physical examination data in the same period(control group). Statistical analysis of the lumbar spine-pelvic structure parameters of the subjects through …

National trends in lumbar spine decompression and fusion surgery in Finland, 1997-2018.

Background and purpose - During recent years, spine surgery techniques have advanced, the population has become older, and multiple high-quality randomized controlled trials that support surgical treatment for degenerative spinal stenosis and spondylolisthesis have been published. We assess the incidence and trends in spine fusion and decompression surgery in Finland between 1997 and 2018.Patients and methods - We used nationwide data from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients aged 20 years or over in Finland (5.5 million inhabit…

Lumbar spine abnormalities and facet joint angles in asymptomatic elite junior tennis players.

BACKGROUND: Lumbar spine abnormalities, in particular stress fractures to the pars interarticularis, are common in elite junior tennis players, though the difference in prevalence between males and females remains unclear. Further, facet joint orientation appears to be a possible option for recognizing which players might go on to present with a pars stress fracture. Given the link between pars stress fractures and low back pain in tennis players, it appears logical to explore the link between facet joint angle and pars abnormalities. Thus, the purpose of this study was to describe the prevale…

Smoking Is Associated With Longer Intensive Care Unit Stays in Spine Trauma Patients.

OBJECTIVE: To determine the impact of smoking on intensive care unit (ICU) outcomes in patients who underwent operative fixation for spine trauma. DESIGN: Retrospective cohort study. SETTING: Single academic level I trauma center. PATIENTS: One hundred eighty-one consecutive surgical spine trauma patients from January 2010 to December 2014 requiring ICU stay. INTERVENTION: Patients with smoking history compared to patients with no previous smoking history. MAIN OUTCOME MEASUREMENTS: ICU length of stay, postoperative complications. RESULTS: There were 297 spine trauma patients identified,…

Hereditary spherocytosis: a risk factor for thigh pressure myonecrosis in posterior spine surgery.

The objective of this study was to make surgeons aware of a potential pressure complication in posterior spine surgery for patients with hereditary spherocytosis (HS) and to present a plausible hypothesis for injury. Posterior spine surgery is common practice for adolescent idiopathic scoliosis (AIS). Common, less severe surgical risks include pressure ulcers; while rare, more severe pressure complications include rhabdomyolysis and compartment syndrome. In patients with HS, a familial hemolytic disorder with altered red cell deformability, it is unknown if their red cell disorder is an additi…

Platysma sparing approach to anterior cervical spine surgery: A less exposure surgery technique.

IntroductionAuthors aim to demonstrate the surgical technique and outcomes of using a platysma sparing approach to anterior cervical spine surgery.MethodsMedical records of 496 prospective patients, group 1 (259 patients) with an outpatient platysma muscle-sparing approach. Group 2 (237 patients) with inpatient standard muscle-splitting approach.ResultsIntergroup comparison showed statistical significant improvement in VAS neck and NDI scores p = 0.009 and p = 0.012 and surgical operative time and estimated blood loss, p = 0.003 and p = 0.006 respectively.ConclusionThis anatomy sparing techniq…

Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series.

OBJECTIVE: To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. METHODS: Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. RESULTS: In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a hea…

Anti-Tumor Effects of Low Dose Zoledronate on Lung Cancer-Induced Spine Metastasis.

Zoledronate (Zol) is an anti-resorptive/tumoral agent used for the treatment of many cancers including spinal bone metastasis. High systemic administration of a single dose is now the standard clinical care, yet it has been associated with several side effects. Here, we aimed to evaluate the effects of lower doses Zol on lung cancer and lung cancer-induced bone metastasis cells over a longer time period. Human lung cancer (HCC827) and three bone metastases secondary to lung cancer (BML1, BML3 and BML4) cells were treated with Zol at 1, 3 and 10 µM for 7 days and then assessed for cell prolifer

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… Herein, we demonstrate that low dose Zol impairs the ability of the lung cancer cell line and spine metastasis cells of lung cancer origin to proliferate, migrate and invade 3D matrix and enhances cell apoptosis. … Spine J. 2016;6:482–496. doi: 10.1055/s-0035-1564807. 16. Santini D., Barni S., Intagliata S., Falcone A., Ferrau F., Galetta D., Moscetti L., La Verde N., Ibrahim T., Petrelli F., et al. Natural History of Non-Small-Cell Lung Cancer with Bone Metastases. Sci. …

A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs.

BACKGROUND: A paucity of randomized trials have compared prophylactic dose of unfractionated heparin (UFH) versus low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolic events in spinal surgery. Our objective was to determine the most prevalent chemoprophylactic techniques in spine surgery. METHODS: The Accreditation Council for Graduate Medical Education was queried for all neurosurgical residency programs, which were subsequently sent an electronic survey about prophylactic UFH versus LMWH in spine surgery for (1) degenerative/deformity, (2) traumatic, and (3) neopl…

Motivational Interviewing: Improving Confidence With Self-care Management in Postoperative Thoracolumbar Spine Patients.

Patients undergoing thoracic or lumbar spine surgery often lack confidence with self-care management of symptoms contributing to disability, such as pain, lack of sleep, depression, and immobility. The purpose of this pilot study was to examine whether a targeted motivational interview, focused on evidence-based recommendations to manage postoperative symptoms related to thoracolumbar spine surgery, would improve patient confidence with self-care management of their symptom-related disability. A quasiexperimental, 1-group, pretest-posttest design was used on a convenience sample of 15 adult su…

Steel rod impalement injuries involving the spine: A case report and literature review.

Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old …

Posterior Sacrococcygeal Plexus: Application to Spine Surgery and Better Understanding Low-Back Pain.

OBJECTIVE: The sacral dorsal rami form the posterior sacrococcygeal plexus (PSCP), which has been scantly studied. This study's goal was to … detailed anatomy might help in better understanding low-back pain, targeting pain sources and guide spine surgeons for avoiding injury to these nerves.