An infected Andersson lesion presented with incomplete paraplegia in a patient with ankylosing spondylitis. A unique case report with literature review.

Introduction: A relatively rare and unknown entity in patients with ankylosing spondylitis is the Andersson lesion (AL). It was first described by Andersson in 1937 as destructive vertebral or disco-vertebral lesion of the spine without history of trauma. AL may result from inflammation or stress fracture of the rigid spine, while there is no evidence for an infectious origin.

Tibia Tuberosity Fracture and Patellar Tendon Rupture Combination in a Pediatric Patient: Case Report and Narrative Review.

A combination of tibial tuberosity (TT) fracture (TTF) along with patellar tendon (PT) rupture (PTR) is rare. We report a 15-year-old male who presented to our ED with acute knee pain and an inability to actively extend the knee after jumping during a basketball game. Diagnosis of simultaneous PTR is crucial as it changes clinical management.

Late Onset Atraumatic Ceramic Head Fracture of a Hybrid Ceramic Bearings Total Hip Arthroplasty.

Ceramic head fracture is a major complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and though new generation ceramics have lowered the rates, although it is still a great concern. We report a case of late onset (more than 10 years after surgery) ceramic head fracture of a hybrid ceramic bearings to emphasize on its unusual clinical manifestation. Furthermore, we highlight the late onset presentation and also the rarity of this complication with this particular hybrid ceramic bearings.

Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation.

Total hip arthroplasty constitutes the operation of the century, although not without complications, which require revision surgery due to loosening, infection, dislocation, and wear. Hereby, we report a rare case of acetabular shell wear misdiagnosed as a dislocation. Patients who underwent total hip arthroplasty with ultra-high molecular weight polyethylene are more vulnerable to excessive wear, and close monitoring can prevent this catastrophic sequence.

Femoral Bowing and Femoral Neck-Shaft Angle Evaluation Can Reduce Atypical Femoral Fractures in Osteoporotic Patients: A Scientific Report.

Bisphosphonates (BPs) are the mainstay of osteoporosis treatment due to their safety and efficacy. There is evidence that BPs medication may be complicated by atypical femoral fractures (AFFs). Prolonged administration of BPs is even more strongly associated with AFFs.

Three-level lumbar Ponte osteotomies with less invasive pelvic fixation improve spinal balance, quality of life and decrease disability in adult and elderly women with moderate adult spinal deformity.

Purpose: To report on quality of life and radiological changes of Ponte osteotomies (POs) with long fixation for primary and revision surgery, in elderly women with adult spinal deformity (ASD).

Methods: Sixty-seven (67) women, aged 69 ± 7 years, received 3 POs, spinopelvic fixation plus TLIFs. Forty-nine (73%) patients received primary and 18 (27%) revision surgery.

Trifocal Femoral Fracture Treated With an Intramedullary Nail Accompanied With Compression Bolts and Lag Screws: Case Presentation and Literature Review.

Ipsilateral combined fractures of the proximal femur, femoral shaft, and distal femur occur rarely with few published cases in the literature. These injures are classified as type 4 combined femoral fractures according to the classification of Lambiris et al. We present a rare case of a combined injury including an ipsilateral intertrochanteric fracture, a mid-shaft transverse femoral fracture, and a Y-shaped intra-articular fracture of distal femur in a 36-year-old man following a traffic accident.

Successful Closed Reduction of a Jeffery Type 2 Radial Head Epiphysiolysis -A Case Report with Literature Review.

Introduction: Radial neck fractures in children are rare injuries, accounting for approximately 5-8.5% of all pediatric elbow fractures; even rarer is the Jeffery type 2 injury, which was described by Jeffery in 1950 and occurs during the automatic reduction of a previous posterior elbow subluxation or dislocation. Only few cases and case small series have been reported on this rare injury, but there is no report on the achievement of closed reduction of the radial head.

A unilateral less invasive posterolateral approach for disc debridement and titanium cage insertion supplemented by contralateral transfascial screw fixation for high-morbidity patients suffering from septic thoracolumbosacral spondylodiscitis.

Purpose: This case series reports on the efficacy and safety of a less invasive posterolateral approach for septic thoracolumbosacral spondylodiscitis in high-morbidity patients.

Methods: Twenty consecutive severe sick (ASA > III) patients (14 men and 6 women), with an average age of 64 ± 14 years, suffering from septic subacute and chronic thoracolumbosacral spondylodiscitis were selected to undergo a one-stage less invasive unilateral posterolateral disc space debridement, supplemented by an ipsilateral titanium cage implantation and pedicle screw fixation plus a contralateral transfascial pedicle screw fixation.

Results: Two high-risk patients with severe comorbidities (ASA stage IV and V, respectively) died on days 1 and 8 postoperatively because of non-surgical complications such as massive lung embolism and acute myocardial infract, respectively.

Unique Migration of a Septic Loosened Metal-on-metalCementless Total Hip Arthroplasty: A Case Report and Literature Review.

Introduction: Total hip arthroplasty (THA) is one of the most successful and cost- effective surgical procedures developed during the last century. Although, chronic infection accompanied with granulomatous allergic reaction from Cobalt (Co),Chromium (Cr) debris after metal-on-metal (MoM) THA implantation can cause severe osteolysis, with subsequent loosening and migration of the implants. There are many cases with intrapelvic migration of these implants, however to best of our knowledge, there is no report of a complete horizontal migration (on frontal plane) of the whole THA prosthesis without disassembly accompanied with severe bone destruction.

Anisocoria after Posterior Spine Surgery: A Rare but Disastrous Complication - A Case Report and Literature Review.

Introduction: Ocular complications after spine surgery in prone position are very rare and are described centrally in elective surgeries with long duration. The most well-known ocular complications are vision loss and acute angle-closure glaucoma. To the best of our knowledge, anisocoria after prone spinal surgery has never been reported previously in literature.

Adult Monteggia Lesion with Ipsilateral Distal Radius Fracture: A Case Report and Review of the Literature.

Introduction: Monteggia lesion is a well-known injury that constitutes 0.7% of forearm fractures-dislocations. The combined presentation of Monteggia injury with ipsilateral distal radius fracture is an extremely rare lesion, especially in adults.

Late Onset Disassembly of a Modular Neck-stem Component after Cementless Hip Replacement without Dislocation: A Case Report and Review of Literatures.

Modular femoral prostheses are characterized by a second neck-stem junction. This modularity provides many clinical benefits including hip offset restoration, intraoperative leg length and anteversion adjustment. Although, this extra junction in modular femoral prostheses can contribute to catastrophic consequences like fracture, cold welding, corrosion and fretting of the modularity.

Percutaneous Injection of Strontium Containing Hydroxyapatite versus Polymethacrylate Plus Short-Segment Pedicle Screw Fixation for Traumatic A2- and A3/AO-Type Fractures in Adults.

Introduction: Polymethacrylate (PMMA) is commonly used in vertebroplasty and balloon kyphoplasty, but its use has been associated with complications. This study tests three hypotheses: (1) whether strontium hydroxyapatite (Sr-HA) is equivalent to PMMA for restoring thoracolumbar vertebral body fractures, (2) whether the incidence of PMMA leakage is similar to that of Sr-HA leakage, and (3) whether Sr-HAis is resorbed and substituted by new vertebral bone.

Materials And Methods: Two age- and sex-matched groups received short percutaneous pedicle screw fixation plus PEEK implant (Kiva, VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA) filled with either Sr-HA (Group A) or PMMA (Group B) after A2- and A3/AO-type thoracolumbar vertebral body fractures.

Multi-foci Osteomyelitis of Thoracic Spine with Pleural Effusion and Fatal Outcome. A Unique Case Presentation and Review of the Literature.

Introduction: A case of thoracic vertebral osteomyelitis due to (SE) in an immunocompetent patient is reported. This is the third case in the literature of SE thoracic vertebral osteomyelitis, but the first one with this multi-foci presentation and finally fatal outcome due to meningoencephalitis. Further data that makes our case unique are the absence of fever (body temperature: 37.

Low back pain and sciatica prevalence and intensity reported in a Mediterranean country: ordinal logistic regression analysis.

The objective of this retrospective cross-sectional study was to estimate the 6-month prevalence and severity of low back pain and sciatica in a representative sample of an adult Mediterranean population. The study group comprised a sample of 674 adults aged 20 years or older from a mainly (74.8%) urban population.

Posterolateral versus circumferential instrumented fusion for monosegmental lumbar degenerative disc disease using an expandable cage.

Background: Theoretically, 360° instrumented fusion has been considered to offer better radiological correction than PLF. Despite numerous publications, this correlation is still weak with several controversies in the relative literature.

Purpose: This prospective randomized study was designed to compare the radiological segmental results, complications and outcome of 360° instrumented fusion with the use of a single diagonal expandable PLIF device versus posterolateral pedicle screw fixation in monosegmental lumbar DDD and to show that the use of an novel expandable cage is associated with low PLIF-related complication rate compared to conventional cages reported previously.

Factors affecting low back pain in adolescents.

Study Design: Prospective multifactorial study on low back pain (LBP) in adolescents.

Background Data: Most studies on LBP have focused on adults although many investigations have shown that the roots of LBP lie in adolescence. Several mechanical, physical, and behavioral factors have been associated with nonspecific LBP in adolescents.

Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures.

Study Design: Prospective randomized study. OBJECTIVES.: To compare the results of the combined anterior-posterior surgery (Group A) with posterior "short-segment" transpedicular fixation (SSTF) (Group B) in mid-lumbar burst fractures.

Correlative analysis of reliability and validity of plain radiology, MOS short-form health survey and surgical examination in making decision for treatment of chronic low back pain patients.

The aim of this study was to determine inter- and intraobserver agreement between spine surgeons and orthopedic radiologists in recognizing distinct degenerative pathology on plain lumbosacral roentgenograms; to estimate the validity (sensitivity and specificity) to make a surgical decision by correlating Short form-36 Health Survey (SF-36) scores and roentgenographic degenerative pathology; and to determine the intra- and interobserver agreement between radiologists, surgeons, and authors in making a surgical decision for treatment on the basis of distinct roentgenographic pathology, SF-36 scores, clinical findings derived from physical examination, or combined. The authors followed three routes to objectively assess the reliability and validity of the surgical decision in chronic low back pain patients: First, 100 consecutive male patients who suffered from low back pain were examined by the authors physically, using imaging techniques (including plain roentgenograms, CT-scan, or/and MRI), and SF-36 survey. Two senior orthopedic radiologists and two senior spine surgeons were asked to read blinded a set of 100 roentgenograms of the lumbar spine in two sessions.

Correlative analysis of the results of surgical treatment of thoracolumbar injuries with long Texas Scottish rite hospital construct: is the use of pedicle screws versus hooks advantageous in the lumbar spine?

This is a prospective, randomized study to compare the efficacy of two similar "long-segment" Texas Scottish Rite Hospital instrumentations with the use of hooks in the thoracic spine and pedicle screws versus laminar hook claw in the lumbar spine for thoracolumbar A3, B, and C injuries. Forty consecutive patients with such thoracolumbar fractures (T11-L1) associated with spinal canal encroachment underwent early operative postural reduction and stabilization. The patients were randomly sampled into two groups: Twenty patients received hooks in "claw configuration" in both the thoracic and the lumbar spine (group A), and 20 patients received hooks in the thoracic vertebrae and pedicle screws in the lumbar vertebrae (group B).

Neurological deterioration due to cord and cauda compression at the site of laminar hook insertion : Immediate complication of Texas Scottish Rite Hospital instrumentation for lumbar vertebral fracture.

We report an unusual case of a 71-year-old female patient with incomplete paraplegia who experienced neurological deterioration a few hours after the insertion of TSRH (Texas Scottish Hospital Rite) laminar hooks for correction and stabilisation of a fracture of the first lumbar vertebra. Combined CT-myelography revealed significant encroachment of the hooks on the spinal canal, associated with compression of the spinal cord and cauda. The hardware was removed a few hours after the first operation.