Delayed percutaneous intradiscal hydrogel herniation causing neurological injury after minor trauma: illustrative case.

Background: Percutaneous intradiscal hydrogel injection has been used to treat low-back pain (LBP) due to degenerative disc disease with or without mild radicular pain. Complications from these procedures are underreported. In this case lesson, the authors present a rare case of a patient with herniated intradiscal hydrogel following a minor trauma leading to neurological injury.

Collagen integrity of the annulus fibrosus in degenerative disc disease individuals quantified with collagen hybridizing peptide.

Introduction: Degenerative disc disease (DDD) is accompanied by structural changes in the intervertebral discs (IVD). Extra-cellular matrix degradation of the annulus fibrosus (AF) has been linked with degeneration of the IVD. Collagen is a vital component of the IVD.

A comparative cohort study of surgical approaches for adult spinal deformity at a minimum 2-year follow-up.

Study Design: This study was a retrospective multi-center comparative cohort study.

Materials And Methods: A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion.

Wound Closure and Wound Dressings in Adult Spinal Deformity Surgery From the AO Spine Surveillance of Post-Operative Management.

Study Design: An e-mail-based online survey for adult spinal deformity (ASD) surgeons.

Objective: Wound closure and dressing techniques may vary according to the discretion of the surgeon as well as geographical location. However, there are no reports on most common methods.

L5-S1 Pseudoarthrosis Rate with ALIF Versus TLIF in Adult Spinal Deformity Surgeries: A Retrospective Analysis of 100 Patients.

Objective: Lumbosacral pseudoarthrosis is a common complication following adult spine deformity (ASD) surgery. This study assessed the reoperation rate for L5-S1 pseudoarthrosis in the ASD population. Compared with transforaminal lumbar interbody fusions (TLIFs), we hypothesized that anterior lumbar interbody fusion (ALIF) would result in lower rates of L5-S1 pseudarthrosis.

Unexpected intraoperative positive culture (UIPC) in presumed aseptic revision spine surgery: a systematic review and meta-analysis.

Background Context: Unexpected intraoperative positive culture (UIPC) has recently become increasingly common in revision spine surgery, being implicated as an etiological factor in revision spine surgery indications such as implant failure or pseudoarthrosis.

Purpose: Utilizing the available literature, this study aimed to investigate the prevalence of UIPC, and its clinical importance in patients following presumed aseptic revision spine surgery.

Study Design: Meta-analysis and systematic review.

IL-1Ra deficiency accelerates intervertebral disc degeneration in C57BL6J mice.

The expression of Interleukin-1ß (IL-1ß) and its antagonist and Interleukin-1 receptor antagonist (IL-1Ra) are correlated with greater human intervertebral disc (IVD) degeneration, suggesting that elevated IL-1β activity promotes disc degeneration. Many in vitro studies support such a mechanistic relationship, whereas few in vivo investigations have been reported. The present study tests the effect of increased IL-1β activity on intervertebral disc in mice with an IL-1Ra gene deletion.

Lateral Lumbar Interbody Fusion With rhBMP-2 can Achieve High Fusion Rates in Adult Spine Deformity Surgeries.

Study Design: An ambispective, observational study of the prospective, institutional adult spine deformity (ASD) database.

Objectives: The study investigates the clinical and radiographic fusion rates with lateral interbody approach and rhBMP-2 in multiple-level lumbar fusion in the ASD population. Previous studies have reported over 10% pseudoarthrosis rate with multiple segment fusions.

Mechanical Complications in Adult Spinal Deformity Surgery: Can Spinal Alignment Explain Everything?

Study Design: Cohort study.

Objective: Our goal was to verify the validity of the global alignment and proportion (GAP) score, SRS-Schwab, and Roussouly theoretical apex of lordosis in predicting mechanical complications in adult spinal deformity (ASD).

Summary Of Background Data: Achieving adequate sagittal alignment is critical to obtain favorable outcomes in ASD surgery.

Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network.

Study Design: Uncontrolled retrospective observational study.

Objectives: Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN).

Fractures After Removal of Spinal Instrumentation: Revisiting the Stress-Shielding Effect of Instrumentation in Spine Fusion.

Background: Many practicing spine surgeons believe that instrumentation can be removed during revision surgery in successful posterolateral or anterior spinal fusions, confirmed by computed tomography and intraoperative exploration. The stress-shielding effect of spinal instrumentation was well described in the late 1980s and 1990s but has not received recent attention. Despite the paucity of recent literature, concepts underlying the biology and biomechanics of the spinal fusion mass remain particularly salient given the increasing incidence of revision spinal fusion surgery.

The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: a comparison of transpsoas and open techniques.

Introduction: Surgical treatment improves quality of life in patients with adult degenerative scoliosis (ADS). However, open ADS surgeries are complex, large magnitude operations associated with a high rate of complications. The lateral transpsoas interbody fusion technique is a less invasive alternative to open ADS surgery, but less invasive techniques tend to be more expensive.

Hypotension in the Right Lateral Position Secondary to Inferior Vena Cava Abnormality.

Surgical positioning is accompanied by numerous anesthetic considerations, particularly its potential effects on the cardiovascular, respiratory, and nervous systems. Clinical studies have shown that lateral positioning does not affect hemodynamics; however, with the addition of trunk flexion, there is a decrease in cardiac output, which may be secondary to caval compression. In this report, we describe a unique case of hypotension that arose in a patient positioned only in the right lateral decubitus position with flexion and that was exacerbated by an abnormally narrow inferior vena cava.

Forces in spinal cannulation and breaches ex vivo.

Background: Pedicle screw insertion, to stabilize or correct the spine, relies on creating a probe path with the correct trajectory to prevent unsafe breaching of the cortical wall. Safe pedicle cannulation is aided when the surgeon can feel the difference between a safe and unsafe path. Pedicle probe forces and torques are currently unknown.

Does preoperative DVT chemoprophylaxis in spinal surgery affect the incidence of thromboembolic complications and spinal epidural hematomas?

Background: Deep venous thrombosis (DVT) and pulmonary embolus (PE) remain common surgical complications, often affecting patients without any prior warning. Postoperative spinal epidural hematomas (SEH) may have a devastating impact on a patient's recovery from a routine procedure. The effect of preoperative DVT prophylaxis administration on elective spinal patients has not previously been studied.

Acute cervical fractures in ankylosing spondylitis: an opportunity to correct preexisting deformity.

Study Design: A new technique for the management of traumatic cervical fracture in patients with chin-on-chest deformity in ankylosing spondylitis is presented. OBJECTIVE.: To present a new surgical technique for acute deformity correction through cervical fractures in the setting of kyphotic deformities.

Juvenile idiopathic scoliosis: the effectiveness of part-time bracing.

Study Design: A retrospective review of 34 patients with juvenile idiopathic scoliosis (JIS) treated with a nighttime bending brace.

Objective: To determine the effectiveness of part-time bracing in JIS.

Summary Of Background Data: Although previous bracing studies have focused on adolescent idiopathic scoliosis, no authors have dealt specifically with part-time bracing for JIS.

The selection of L5 versus S1 in long fusions for adult idiopathic scoliosis.

The treatment of adult spinal deformities often involves long thoracolumbar fusions into the lower lumbar spine, raising the debate of selecting L5 or S1 as the caudal extent of the fusion. The presence of significant deformity or degenerative pathologic findings at L5-S1 mandates fusion to the sacrum. Fusion to the sacrum is of larger magnitude than fusion to L5 and introduces a higher surgical complication rate.