Failure of Surgical Equipoise in Posterior Cord Syndrome Myelopathy.

We suggest that a clinical diagnosis of posterior cord syndrome indicates primary posterior decompression in cervical spondylotic myelopathy cases. We present two unique cases of failed anterior decompression in neutrally aligned necks with compressive myelopathy and a literature review. Two recent cases of cervical spondylotic myelopathy that failed to respond after anterior surgical decompression and fusion surgery were observed at our institution.

Charcot Arthropathy of the Spine.

Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a progressive disease process in which the biomechanical elements of stability of the spine are compromised because of the loss of neuroprotection leading to joint destruction, deformity, and pain. Initially thought to be associated with infectious causes such as syphilis; however in the latter part of the century, Charcot arthropathy of the spine has become associated with traumatic spinal cord injury. Clinical diagnosis is challenging because of the delayed presentation of symptoms and concurrent differential diagnosis.

Internal lumbar disc derangement with instability catch from monosegmental discopathy. The forgotten mechanical and kinetic surgical back pain syndrome.

Study Design: This is a retrospective cohort experience reported with concurrent survey PROM outcomes.

Objective: To describe the results of open PLIF reconstruction for a select group of mechanical back pain patients who have mono- or bi-segmental discopathy on MRI imaging, a clinical history of repeated severe and disabling acute mechanical back pain symptoms, and the irregular lumbar motion pattern in returning erect from the flexed position known as the "instability catch".

Summary Of Background Data: The literature of fusion surgery for back pain relief in "mechanical" back pain reveals inconsistent results and in the majority presents only a vague description of these syndromes.

Normal Anatomy of the Lumbar Sublaminar Ridge in the Lateral Recess with Potential Implications to Surgical Technique in Degenerative Spinal Stenosis: A Cadaveric Study.

Study Design: This is an anatomic study using cadaveric material.

Objective: To provide anatomic descriptions of the normal lumbar sublaminar ridge in the lateral recess and its potential to impact on the exiting nerve root there, with implications to surgical technique in lumbar spinal stenosis.

Summary Of Background Data: The lateral extent of the sublaminar ridge-the bony, superior insertion site of the ligamenta flava-and its topological relationship to the nerve root are not described in the literature.

C2 Vertebral Corpectomy for Kyphosis Malunion of Remote Dens Fracture with Atlantoaxial Ankylosis and Myelopathy: A Case Report at 15 Years of Follow-Up.

Case: We report a unique case of compressive myelopathy caused by late kyphosis angulation of a previously operated dens base fracture nonunion challenged by age-related ankyloses of the lateral articulations C1 to C2 and a solid posterior fusion mass.

Conclusions: Posterior column shortening such as commonly practiced for progressive kyphosis or myelopathy may be precluded at the atlantoaxial level for potential vascular risk to the vertebral artery. A standard anterior cervical approach and the application of basic surgical spine care principles lead to a simple solution in the unique and highly complex anatomy of our case.

Radiographic outcomes of transosseous intradiscal screw fixation in lumbar reconstruction-Imaging results of an experience with an alternative in fixation of the unexpectedly osteopenic spine.

Objective: To present the results of a new alternative in the technique lumbar pedicle screw reconstruction in osteopenic bone. Pedicle screw fixation is compromised in osteopenic bone and adjunct fixation commonly requires incremental technology that can increase cost and risk, and which may not commonly be available. Readily available low cost techniques are desirable.

Description and Results of a Comprehensive Care Protocol for Overnight-Stay Spine Surgery in Adults.

Study Design: This is a prospective cohort study.

Objective: The aim of this study was to define the probability of successful morning-after discharge after adult spine surgery achieved with a standard care protocol as applied to patients with a large variety of common degenerative spine disorders.

Summary Of Background Data: Qualifying criteria for ambulatory or overnight-stay adult spine surgery are not well defined in either the spine or anesthesia literature.

Acute Traumatic Quadriplegia in Adults: Predictors of Acute in-Hospital Mortality.

Aim: To assess the in-hospital mortality rate in adult patients suffering acute traumatic complete quadriplegia and determine the possible predictors of mortality in these patients.

Material And Methods: A review of all complete quadriplegics treated from January 1996 through March 2004 in a regional spine injuries unit measuring in-hospital mortality and other factors that might contribute to increased mortality. Multivariate logistic regression analysis was performed to explore these possible predictors of mortality.

Solitary C1 Posterior Fixation for Unstable Isolated Atlas Fractures: Case Report and Systematic Review of the Literature.

Study Design A systematic review of the literature. Objectives To review the published results to date of motion-preserving direct reconstruction of C1 ring fractures with combined coronal plane displacement of at least 7 mm (rule of Spence) and so at risk for Dickman type I or II disruption of the transverse atlantal ligament (TAL). Methods A structured literature review prompted by successful management of a typical case.

Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Mounted Police Officer: Case Report and Literature Review.

Study Design Case report and review of the literature. Objective To present a unique case of L5 radiculopathy caused by a sacral stress fracture without neurologic compression. Methods We present our case and its clinical evolution and review the available literature on similar pathologies.

Dexamethasone Perioperative Coanalgesia in Lumbar Spine Fusion: A Controlled Cohort Study of Efficacy and Safety.

Purpose: A 48-hour trial of dexamethasone coanalgesia became our standard practice in May 2008. This is our research Ethics Board-approved review of this experience to date with attention to perioperative narcotics use and pain scores for the first 48 hours after surgery as well as length of stay (LOS), wound healing complications, and infections in the first 6 months, compared with the historical precedent control cohort.

Methods: Surgical case logs identified cases of 1- and 2-level elective lumbar decompression and fusion surgery performed since protocol initiation (cases) and for a like period beforehand (controls).

Teriparatide treatment of a glucocorticoid-associated resorbing nonunion of a type III odontoid process fracture: a case report.

Study Design: This is a unique case report.

Objectives: To describe a successful case of Teriparatide treatment of odontoid nonunion.

Summary Of Background Data: Animal models suggest that this drug may enhance fracture healing, and there are 3 similar cases previously published elsewhere.

Uncovertebral anatomic midline targeting for cervical disc arthroplasty.

Study Design Prospective observational cohort. Objective To document the accuracy of uncovertebral anatomic targeting in positioning cervical disc arthroplasty. Summary of Background Data Disc arthroplasty implants depend on midline placement for optimum mechanical function.

Spinal epidural hematoma.

Spinal epidural hematoma is a rare condition that usually presents with acute, severe pain at the location of the hemorrhage, with radiation to the extremities. It can rapidly develop to include progressive and severe neurologic deficit. The pathophysiology often remains unclear.

Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study.

Background Context: Pressure-injected and in situ curing bone cements have been studied as alternatives in augmenting lumbar pedicle screw fixation but are frequently found to leak outside the confines of the target vertebra.

Purpose: The objective is set to determine the mechanical efficacy of a porous granular/particulate calcium phosphate (CP) bone augmentation product (Skelite) applied manually without pressurized injection in this application.

Study Design/setting: The biomechanical analysis compared the axial pullout strength and insertional torque of augmented and nonaugmented pedicle screws in cellular polyurethane foams.

Tranexamic acid for hemostasis in the surgical treatment of metastatic tumors of the spine.

Study Design: This is a retrospective study of sequential cohorts.

Objective: To assess the efficacy of tranexamic acid in decreasing operative blood loss and the need for intraoperative transfusion in metastatic spine surgery.

Summary Of Background Data: Significant published data have established the efficacy of antifibrinolytic drugs in limiting surgical bleeding during heart surgery and total joint replacement.

Nonbridging external fixation for fractures of the distal radius.

Objective: To assess the feasibility of using standard components from the small AO external fixator set to support fractures of the distal radius with a construct incorporating distal fixation in the periarticular radius fragment that would allow for primary mobilization of the wrist joint during fracture healing.

Methods: In a prospective pilot study of a nonbridging external fixator in early 2001, 6 consecutive cases of fracture in the distal radius presenting at a tertiary care centre, the Hamilton General Division of Hamilton Health Sciences, were compared with 6 historical controls treated with a standard bridging construct immobilizing the wrist. Both groups were or had been treated with closed reduction and external fixation of the distal radius under fluoroscopic control.

Assessment of stability of the cervical spine in blunt trauma patients: review of the literature, with presentation and preliminary results of a modified traction test protocol.

Objective: To review the reported efficacy of various imaging techniques in assessing stability of the neck in blunt trauma patients, and to present the protocol and preliminary results of a modified traction test protocol.

Design: This is a prospective cohort study.

Setting: A regional trauma unit in Southern Ontario.