Osteomyelitis in an Unusual Location With an Atypical Presentation: A Case Report and Review of the Literature of Scapular Osteomyelitis in Pediatric Patients.

Bacterial osteomyelitis of the scapula is rare in pediatric patients. When it occurs, it usually affects young infants and patients often exhibit fever and functional limitation of the extremity. We present a case of a 12-year-old boy with subacute bacterial scapular osteomyelitis and a normal physical examination.

Implementation of Febrile Infant Management Guidelines Reduces Hospitalization.

Unlabelled: The clinical management of well-appearing febrile infants 7-60 days of age remains variable due in part to multiple criteria differentiating the risk of a serious bacterial infection. The purpose of this quality improvement study was to standardize risk stratification in the emergency department and length of stay in the inpatient unit by implementing an evidence-based clinical practice guideline (CPG).

Methods: The Model for Improvement was used to implement a CPG for the management of well-appearing febrile infants, with collaboration between pediatric emergency medicine and pediatric hospital medicine physicians.

Calculated Decisions: PECARN Pediatric Head Injury/Trauma Algorithm.

The PECARN Pediatric Head Injury Prediction Rule is a well-validated clinical decision aid that allows clinicians to safely rule out the presence of clinically important traumatic brain injuries.

Efficacy of intraoperative monitoring of transcranial electrical stimulation-induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery: clinical article.

Object: Deltoid muscle weakness due to C-5 nerve root injury following cervical spine surgery is an uncommon but potentially debilitating complication. Symptoms can manifest upon emergence from anesthesia or days to weeks following surgery. There is conflicting evidence regarding the efficacy of spontaneous electromyography (spEMG) monitoring in detecting evolving C-5 nerve root compromise.

The use of rigid internal fixation in the surgical management of cervical spondylosis.

In the surgical management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation.

An aneurysmal bone cyst in the cervical spine of a 10-year-old girl: a case report.

Study Design: An aneurysmal bone cyst in the neural arch of the fourth cervical vertebra of a 10-year-old girl is reported, along with a brief review of the literature on the topic.

Objective: To report the presentation and diagnosis of this disorder along with a discussion of the major pitfalls of treatment.

Summary Of Background Data: An aneurysmal bone cyst occurs commonly in the second decade, with a predilection for the lumbar spine.

Osteogenic potential of adult human stem cells of the lumbar vertebral body and the iliac crest.

Study Design: Marrow was aspirated from the vertebral body (VB) and iliac crest (IC) of patients undergoing lumbar spinal surgery, following an approved protocol. Progenitor cells were isolated using standard culture conditions and their osteogenic potential evaluated.

Objective: To evaluate the osteogenic potential of mesenchymal stem cells (MSCs) isolated from the bone marrow of the human VB.

Proposal of a modified, treatment-oriented classification of odontoid fractures.

Background Context: The classification scheme of odontoid fractures described by Anderson and D'Alonzo is the one most commonly used. However, uncertainty exists in the distinction between Type II and "shallow" Type III fractures. Moreover, fractures at the base of the odontoid (Anderson and D'Alonzo Type II) include a spectrum of injury patterns.

Evaluation of a novel pedicle probe for the placement of thoracic and lumbosacral pedicle screws.

Background: Pedicle screw instrumentation is common in the lumbar spine and is gaining acceptance in the thoracic spine. The pedicle is generally cannulated with a gearshift probe or curette. SafePath (Mekanika, Boca Raton, FL) is an alternative pedicle probe designed for pedicle cannulation.

Postoperative wound infections of the spine.

Postoperative spinal wound infections occur in 1 to 12% of patients. The rate of infection is related to the type and duration of the procedure, comorbidities, nutritional status, and various other risk factors. Antibiotic prophylactic therapy has been clearly shown to decrease the rate of infection dramatically after lumbar surgery.

Morphologic evaluation of cervical spine anatomy with computed tomography: anterior cervical plate fixation considerations.

The computed tomography (CT) studies of the cervical spine from 50 males and 50 females were reviewed to provide morphometric data on a variety of anatomic parameters relevant to anterior cervical reconstruction and fixation. Measurements were made of the vertebral body width and midsagittal anteroposterior (AP) diameter and the distance between the medial borders of the longus coli muscles. Distances between adjacent endplates were also measured, both at their midpoint and at the anterior margin.

Pathophysiology and pharmacologic treatment of acute spinal cord injury.

Background Context: The past three decades have witnessed increasing interest in strategies to improve neurologic function after spinal cord injury. As progress is made in our understanding of the pathophysiologic events that occur after acute spinal cord injury, neuroprotective agents are being developed.

Purpose: Clinicians who treat acute spinal cord injuries should have a basic understanding of the pathophysiologic processes that are initiated after the spinal cord has been injured.

Development of a New Zealand white rabbit model of spinal pseudarthrosis repair and evaluation of the potential role of OP-1 to overcome pseudarthrosis.

Study Design: Posterolateral lumbar fusions were performed in nicotine-exposed, New Zealand white rabbits. Animals that developed a pseudarthrosis were then regrafted with no graft, autograft, or osteogenic protein-1 (OP-1).

Objectives: To establish a model of pseudarthrosis repair and to evaluate the ability of OP-1 to induce fusion in this model.

Similarities and differences in the treatment of spine trauma between surgical specialties and location of practice.

Study Design: Questionnaires administered to practicing orthopedic and neurosurgical spine surgeons from various regions of the United States and abroad.

Objectives: To determine similarities and differences in the treatment of spinal trauma.

Summary Of Background Data: Spinal trauma is generally referred to subspecialists of orthopedic or neurosurgical training.

Bone graft alternatives for spinal fusion.

Bone grafting to achieve fusion is frequently performed in spinal surgery. Autograft is the gold standard bone graft material. However, due to limitations of supply and morbidity associated with the harvest of autograft, alternatives are being considered.

Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis.

The radiographs of 35 consecutive adult patients with isthmic spondylolisthesis who underwent a transforaminal lumbar interbody fusion (TLIF) with one or two Brantigan carbon fiber cages and pedicle screw instrumentation were evaluated. Anterolisthesis, disk space height, and slip angle were measured in preoperative and postoperative standing neutral radiographs. Anterolisthesis was reduced and disk space height was increased with the TLIF procedure.

Indications, techniques, and outcomes of posterior surgery for chronic low back pain.

This article summarizes a number of issues surrounding the diagnosis, indications, and techniques of posterior lumbar spine surgery for chronic low back pain. It would not be entirely unjustified for a spine surgeon to adhere to a totally avoidant approach to chronic low back pain, rationalized by a reasonably legitimate nihilism regarding the presently available means of diagnosing and surgically managing low back pain [64]. Judging by the number of lumbar fusions performed in North America and the tremendous intellectual and financial investment currently being made in technologies to enhance spinal fusion, such an approach is evidently not achieving wide-spread acceptance on this continent.

Muscle contusion injury and myositis ossificans traumatica.

In athletic competition, muscle contusion injury is a frequent and debilitating condition. Found in traditional contact and noncontact sports, contusions also can occur to the nonathlete by simple falls and accidents. The injury consists of a well-defined sequence of events involving microscopic rupture and damage to muscle cells, macroscopic defects in muscle bellies, infiltrative bleeding, and inflammation.

Muscle contusion injuries: current treatment options.

Muscle contusion is second only to strain as the leading cause of morbidity from sports-related injuries. Severity depends on the site of impact, the activation status of the muscles involved, the age of the patient, and the presence of fatigue. The diagnosis has traditionally been one of clinical judgment; however, newer modalities, including ultrasonography, magnetic resonance imaging, and spectroscopy, are becoming increasingly important in both identifying and delineating the extent of injury.

The effect of anabolic steroids and corticosteroids on healing of muscle contusion injury.

The effect of an anabolic steroid (nandrolone decanoate, 20 mg/kg) and a corticosteroid (methylprednisolone acetate, 25 mg/kg) on healing muscle injured with a drop-mass technique in a reproducible muscle contusion injury model in the rat was studied. Healing was determined by measuring active contractile tension in each muscle and histologic analysis. At day 2, the corticosteroid group showed significant improvement in both twitch and tetanic strength relative to the controls.

Cerebral blood flow changes in response to elevated intracranial pressure in rabbits and bluefish: a comparative study.

In mammals, the cerebrovascular response to increases in intracranial pressure may take the form of the Cushing response, which includes increased mean systemic arterial pressure, bradycardia and diminished respirations. The mechanism, effect and value of these responses are debated. Using laser-Doppler flowmetry to measure cerebral blood flow, we analyzed the cardiovascular responses to intracranial pressure raised by epidural infusion of mock cerebrospinal fluid in the bluefish and in the rabbit, and compare the results.

Glucose-dependent turnover of the mRNAs encoding succinate dehydrogenase peptides in Saccharomyces cerevisiae: sequence elements in the 5' untranslated region of the Ip mRNA play a dominant role.

We have demonstrated previously that glucose repression of mitochondrial biogenesis in Saccharomyces cerevisiae involves the control of the turnover of mRNAs for the iron protein (Ip) and flavoprotein (Fp) subunits of succinate dehydrogenase (SDH). Their half-lives are > 60 min in the presence of a nonfermentable carbon source (YPG medium) and < 5 min in glucose (YPD medium). This is a rare example in yeast in which the half-lives are > 60 min in the presence of a nonfermentable carbon source (YPG medium) and < 5 min in glucose (YPD medium).