Depression in children with abdominal pain in the emergency department.

Objective: This cross-sectional study examined depression and associated impairment in youth presenting to a pediatric emergency department (PED) with abdominal pain.

Methods: Participants were 11-17 years old, presenting to a PED with idiopathic abdominal pain. Participants completed demographics, pain, pain-related impairment, and depression surveys.

Postoperative pain following posterior iliac crest bone graft harvesting in spine surgery: a prospective, randomized trial.

Background Context: Postoperative pain at the site of bone graft harvest for posterior spine fusion is reported to occur in 6%-39% of cases. However, the area around the posterior, superior iliac spine is a frequent site of referred pain for many structures. Therefore, many postoperative spine patients may have pain in the vicinity of the posterior iliac crest that may not in fact be caused by bone graft harvesting.

Reducing catheter-associated urinary tract infections: a quality-improvement initiative.

Background: Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs.

Methods: An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates.

Extreme Lateral Interbody Fusion (XLIF) in the Thoracic and Thoracolumbar Spine: Technical Report and Early Outcomes.

Background: Previous studies have demonstrated the distinct advantages of thoracoscopically assisted spinal fusion compared to traditional open thoracotomy. However, these techniques are limited by a steep learning curve, prolonged operative time, and lack of three-dimensional visualization of the surgical field.

Objective: The objective of this study was to describe our initial experience with an adaptation of the extreme lateral interbody fusion (XLIF) technique allowing access to the anterior aspect of the thoracic and thoracolumbar spine with specific reference to (1) early pulmonary complications, (2) non-pulmonary complications, and (3) ability of this technique to successfully achieve spinal decompression and fusion at the operative level.

History of spinal osteotomy.

Spinal deformity is one of the oldest known diseases with descriptions documented many of the earliest civilizations. Historical treatments have had little efficacy, especially in adults. However, in the modern era, there has been a rapid expansion of new technologies and surgical techniques aided by advances in supportive care that now allow the spinal surgeon to have powerful tools to correct spinal deformity.

Operative and nonoperative treatment of cervical disc herniation in National Football League athletes.

Background: Limited evidence exists to guide clinical decision making regarding cervical disc herniations in professional athletes playing for the National Football League (NFL) in the United States.

Purpose: To describe the presentation and treatment outcomes of cervical disc herniations in NFL athletes with a focus on safety and return to sport.

Study Design: Case series; Level of evidence, 4.

Incidence, diagnosis, and management of sacral fractures following multilevel spinal arthrodesis.

Background: Fractures of the sacrum are a rare complication following instrumented spinal fusion, with only 34 cases previously reported in the literature. Previous series have generally been limited to less than five cases.

Purpose: The purpose of this study is to determine the incidence of sacral fractures caudal to instrumented spinal fusion constructs, identify risk factors for fracture and for failure of conservative management, and describe strategies for surgical treatment of these fractures.

Management of postoperative spinal infections.

Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure.

Lower preoperative Hounsfield unit measurements are associated with adjacent segment fracture after spinal fusion.

Study Design: Retrospective case-control study.

Objective: To determine the association of Hounsfield unit (HU) measurements with adjacent segment fractures after spinal fusion.

Summary Of Background Data: Adjacent segment fracture is a potentially devastating complication after spinal fusion surgery in osteoporotic patient.

Fractures of the sacrum after chemoradiation for rectal carcinoma: incidence, risk factors, and radiographic evaluation.

Purpose: Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients.

Methods And Materials: Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision.

Factors influencing segmental lumbar lordosis after lateral transpsoas interbody fusion.

Objective: Although contributions to sagittal alignment have been characterized for anterior, posterior and transforaminal lumbar interbody fusion, sagittal alignment after lateral transpsoas interbody fusion (LTIF) has not yet been characterized. This study examined the ability of LTIF to restore lumbar lordosis and identified factors associated with change in sagittal alignment.

Methods: Twenty-nine patients and 67 levels were studied.

The effect of omega-3 fatty-acid supplements on perioperative bleeding following posterior spinal arthrodesis.

Purpose: To investigate the effect of omega-3 fatty-acid supplements (n-3FA) on bleeding during posterior spinal arthrodesis.

Methods: We reviewed all one- or two-level posterolateral lumbar decompression/fusions with or without interbody fusion by five surgeons within 3 years. Patients taking n-3FA preoperatively were matched 1:2 with controls based on procedure, surgeon and operative time.

Indirect foraminal decompression after lateral transpsoas interbody fusion.

Object: Lateral transpsoas interbody fusion (LTIF) permits anterior column lumbar interbody fusion via a direct lateral approach. The authors sought to answer 3 questions. First, what is the effect of LTIF on lumbar foraminal area? Second, how does interbody cage placement affect intervertebral height? And third, how does the change in foraminal area and cage position correlate with changes in Oswestry Disability Index (ODI) and 12-Item Short Form Health Survey (SF-12) scores?

Methods: Included patients underwent LTIF with or without posterior instrumentation and received preoperative and postoperative CT scans.

Postoperative infections of the lumbar spine: presentation and management.

Purpose: Postoperative surgical site infections (SSI) are a frequent complication following posterior lumbar spinal surgery. In this manuscript we review strategies for prevention, diagnosis and treatment of SSI.

Methods: The literature was reviewed using the Pubmed database.

Long-term outcomes after posterior spine fusion for adolescent idiopathic scoliosis.

Purpose Of Review: To summarize recent literature regarding long-term follow-up after spinal fusion for patients with adolescent idiopathic scoliosis. In particular, this review includes a review of research which provides insight into long-term results after fusion using pedicle screw stabilization, a relatively new technique for which long-term follow-up is only recently available.

Recent Findings: The literature increasingly uses patient-derived questionnaires to report outcomes.

Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures.

Reduction of bone turnover with bisphosphonate treatment alters bone mineral and matrix properties. Our objective was to investigate the effect of bisphosphonate treatment on bone tissue properties near fragility fracture sites in the proximal femur in postmenopausal women with osteoporosis. The mineral and collagen properties of corticocancellous biopsies from the proximal femur were compared in bisphosphonate-naive (-BIS, n = 20) and bisphosphonate-treated (+BIS, n = 20, duration 7 ± 5 years) patients with intertrochanteric (IT) and subtrochanteric (ST) fractures using Fourier transform infrared imaging (FTIRI).

Bone tissue composition varies across anatomic sites in the proximal femur and the iliac crest.

The extent to which bone tissue composition varies across anatomic sites in normal or pathologic tissue is largely unknown, although pathologic changes in bone tissue composition are typically assumed to occur throughout the skeleton. Our objective was to compare the composition of normal cortical and trabecular bone tissue across multiple anatomic sites. The composition of cadaveric bone tissue from three anatomic sites was analyzed using Fourier transform infrared imaging: iliac crest (IC), greater trochanter (GT), and subtrochanteric femur (ST).

Omega-3 and fish oil supplements do not cause increased bleeding during spinal decompression surgery.

Study Design: Retrospective case-control study.

Objective: The purpose of this study was to assess whether preoperative use of fish oil supplements increases intraoperative blood loss and postoperative bleeding complications during lumbar decompression surgery.

Summary Of Background Data: Omega-3 fatty acids (n-3FA) are widely used as over-the-counter supplements because of well-established cardioprotective and antiplatelet effects.

Salvage of lumbar pseudarthrosis with customized large-diameter pedicle screws: report of two cases.

Study Design: A report of two cases using custom-manufactured pedicle screws for revision spinal arthrodesis for pseudarthrosis in the setting of widely dilated pedicle screw tracts.

Objective: To present surgical outcomes of a previously unreported treatment for pseudarthrosis with widely dilated pedicle screw tracts.

Summary Of Background Data: Techniques for revision of lumbar pseudarthrosis with severe screw loosening and widely dilated pedicle screw tracts represent a challenging clinical scenario.

Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy.

Background Context: Recurrent herniation of the nucleus pulposus (HNP) frequently causes poor outcomes after lumbar discectomy. The relationship between obesity and recurrent HNP has not previously been reported.

Purpose: The purpose of this study was to investigate the association of obesity with recurrent HNP after lumbar microdiscectomy.

Empirical evaluation of the inter-relationship of articular elements involved in the pathoanatomy of knee osteoarthritis using magnetic resonance imaging.

Background: In this cross-sectional study, we conducted a comprehensive assessment of all articular elements that could be measured using knee MRI. We assessed the association of pathological change in multiple articular structures involved in the pathoanatomy of osteoarthritis.

Methods: Knee MRI scans from patients over 45 years old were assessed using a semi-quantitative knee MRI assessment form.

Transforaminal Thoracic Interbody Fusion (TTIF) for Treatment of a Chronic Chance Injury.

Multiple anterior and posterior approaches to the thoracic disc space have been reported. However, we are not aware of any previous reports describing a transforaminal approach for thoracic disc release and interbody cage placement. In this case report, we describe a method to perform transforaminal thoracic interbody fusion (TTIF), which is an adaptation of an established lumbar fusion technique (transforaminal lumbar interbody fusion).