Effects of Anticoagulant Medication on Bone-Healing.

»: A substantial proportion of patients undergoing orthopaedic care are prescribed some form of anticoagulant medication, whether for perioperative venous thromboembolism prophylaxis or chronic anticoagulation in the setting of a cardiac or other condition.

»: An abundance of preclinical data suggests that many commonly used anticoagulant medications may have a harmful effect on bone-healing.

»: The orthopaedic surgeon should be informed and mindful of the added variable that anticoagulation may play in the outcomes of fracture treatment and bone-healing.

The most influential publications in cervical myelopathy.

Management of cervical myelopathy (CM) has continued to evolve through a better understanding of the long-term outcomes of this diagnosis as well as improved diagnostic guidelines. More recent literature continues to expand the field, but certain publications can be distinguished from others due to their lasting impact. Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to CM.

An epidural steroid injection in the 6 months preceding a lumbar decompression without fusion predisposes patients to post-operative infections.

Background: To determine if the timing of a lumbar epidural steroid injection (LESI) effects rates of post-operative infection in patients receiving a non-fusion lumbar decompression (LDC) due to degenerative disc disease (DDD). Lumbar pain due to DDD can frequently be temporized or definitively treated with epidural injections. While there is ample literature regarding the infection risks associated with corticosteroid injections prior to hip/knee replacements, there are few studies relating to the spine.

The effect of surgically implanted metallic bullet fragments on the intervertebral disc using a canine model☆.

Purpose: To characterize the gross, histologic, and systemic changes caused by implantation of metal fragments commonly used in commercial bullets into the intervertebral disc.

Background Context: Long-term complications of retained bullet fragments in the spine have been documented in the literature; however, the impact of different metal projectiles on the intervertebral disc has not been described. This study was performed to assess the local effects of the metallic bullet fragments on the intervertebral disc and their systemic effects regarding metal ion concentrations in serum and solid organs.

Characteristics and Patterns of Metastatic Disease from Chordoma.

Chordoma is a rare, slow-growing malignant tumor arising from notochordal remnants. A retrospective review of patient records at two major referral centers was undertaken to assess the incidence, location, and prognostic factors of metastatic disease from chordoma. 219 patients with chordoma (1962-2009) were identified.

National Trends in Ambulatory Surgery for Intervertebral Disc Disorders and Spinal Stenosis: A 12-Year Analysis of the National Surveys of Ambulatory Surgery.

Study Design: A descriptive epidemiology study.

Objective: The aim of this study is to investigate changes in the utilization of ambulatory surgical procedures performed for intervertebral disc disorders and spinal stenosis between 1994 and 2006 in the United States.

Summary Of Background Data: Understanding trends in the utilization of ambulatory spine surgery may improve health care delivery in the Unites States.

Case reviews of infections of the spine in patients with a history of solid organ transplantation.

Study Design: Retrospective clinical case series.

Objective: To report on the epidemiological, microbiological, and clinical characteristics of spinal infections in patients who have undergone solid organ transplantation.

Summary Of Background Data: Spine infections remain a therapeutic challenge, particularly in patients who are immunocompromised.

Surgical management of lumbar degenerative spondylolisthesis.

Lumbar degenerative spondylolisthesis (DS) is a common cause of low back pain, radiculopathy, and/or neurogenic claudication. Treatment begins with a trial of nonsurgical methods, including physical therapy, NSAIDs, and epidural corticosteroid injections. Surgical treatment with decompression and fusion is recommended for patients who do not respond to this initial regimen.

Biomechanical analysis of four- versus six-screw constructs for short-segment pedicle screw and rod instrumentation of unstable thoracolumbar fractures.

Background Context: Conventionally, short-segment fusion involves instrumentation of one healthy vertebra above and below the injured vertebra, skipping the injured level. This short-segment construct places less surgical burden on the patient compared with long-segment constructs, but is less stable biomechanically, and thus has resulted in clinical failures. The addition of two screws placed in the fractured vertebral body represents an attempt to improve the construct stiffness without sacrificing the benefits of short-segment fusion.

Sacrectomy and adjuvant radiotherapy for the treatment of sacral chordomas: a single-center experience over 27 years.

Study Design: Retrospective cohort (case only).

Objective: To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy.

Summary Of Background Data: There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood.

Efficacy of linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus discitis: a controlled animal model.

Study Design: A rabbit model was used to assess the efficacy of linezolid and vancomycin for the treatment of discitis due to methicillin-resistant Staphylococcus aureus (MRSA). Nontreated controls were used for comparison.

Objective: The purpose of this study was to determine if there was a therapeutic difference between using linezolid and vancomycin in the treatment of MRSA discitis.

Oncologic and functional outcome following sacrectomy for sacral chordoma.

Background: Sacral chordoma is a rare, low to intermediate-grade tumor that poses substantial challenges in terms of timely diagnosis and adequate treatment. Few studies have examined the oncologic and functional outcomes of patients treated for sacral chordoma.

Methods: The clinical records of sixteen patients who had undergone sacrectomy for chordoma between 1985 and 2001 were evaluated retrospectively.

Infections of the spine in patients with human immunodeficiency virus.

Background: Musculoskeletal infections in patients with the human immunodeficiency virus (HIV) have been described. However, the prevalence, specific characteristics, and outcomes of spinal infections in these patients have not been studied in a large group of patients to our knowledge.

Methods: The computerized records of all patients discharged with the diagnosis of spinal osteomyelitis, discitis, epidural abscess, or tuberculosis from our institution from October 1994 through September 2000 were reviewed.

Antifungal penetration into normal rabbit nucleus pulposus.

Study Design: A rabbit model was used to assess the penetration into the nucleus pulposus of 3 commonly used antifungal medications: amphotericin B, amphotericin B lipid complex, and fluconazole.

Objectives: The purpose of this study was to quantitate the penetration of antifungal medications into the normal rabbit nucleus pulposus.

Summary Of Background Data: Fungal infections of the spine are rarely, if ever, treated with medical management alone.

Cervical spine and spinal cord injuries: recognition and treatment.

Cervical spine injuries are frequently encountered in any practice treating patients in the emergency department or outpatient trauma victims. When upper or lower cervical spine injuries are suspected, immediate immobilization, physical and neurologic examination, and radiographic evaluation are imperative. For spinal cord injuries, knowledge of microscopic and cellular pathology helps to determine appropriate management.

Surgical options for the treatment of cervical spondylotic myelopathy.

Cervical spondylotic myelopathy is a disease of the cervical spinal cord that results from circumferential compression of the degenerative cervical spine, often in a congenitally narrow spinal canal. Surgical recommendations must be based on patient characteristics, symptoms, function, and neuroradiologic findings. ACDF is an excellent option for one- or two-level spondylosis without retrovertebral disease.

Orthopaedic recertification.

This report summarizes a symposium presented at the 2001 Annual Meeting of the American Orthopaedic Association that was designed to assess the current status of recertification by the American Board of Orthopaedic Surgery (ABOS) and to determine how it will change in the near future. Recertification is a process whereby the general public is assured of quality medical care by a competent and knowledgeable physician. As a professional organization, we have an obligation to provide quality care.