Postoperative lumbar spine MRI: How well does a radiology report that raises suspicion for infection correlate with true clinical infection?

Introduction: Interpretation of a lumbar spine MRI in the immediate postoperative period is challenging, as postoperative tissue enhancement and fluid collections may be mistaken for infection. Radiology reports may use ambiguous language, creating a clinical problem for a surgeon in determining whether a patient needs treatment with antibiotics or revision surgery. Moreover, retrospective criticism of management in instances of a true infection may lead to medicolegal ramifications.

4-Point C2 Fixation for Occipitocervical Fusion: Technical Case Report.

Background: Occipitocervical fusion is an important surgical procedure to treat instability of the upper cervical and craniocervical junction. Fixation to the dense cortical bone of the occiput, contemporaneously typically accomplished with a plate and screws, is known to be strong and durable, but there are many competing methods used to secure an adequate number of fixation points of sufficient strength at the cervical end. Extension of hardware to the midcervical region to acquire additional fixation points, however, results in loss of subaxial motion segments and additional potential morbidity.

Bilateral paraspinal muscle flap closure technique for reduction of wound complications from posterior thoracolumbar spinal fusion: results of a series of 716 patients.

Objective: Wound complications such as surgical site infection (SSI) and dehiscence are among the most common complications of thoracolumbar spinal fusion surgery and are particularly prevalent in patients with risk factors such as obesity, diabetes, smoking, malignancy, and multilevel and/or revision procedures. A specialized wound closure technique with muscle flap mobilization, which reduces tension at the wound edges and increases the bulk of vascularized tissue in the midline, can be employed as a salvage procedure to manage wound complications. The authors evaluated the effectiveness of prophylactic muscle flap closure for reducing SSI in patients with risk factors for wound complications who undergo thoracolumbar fusion surgery.

Long-term fate of C3-7 arthrodesis: 4-level ACDF versus cervical laminectomy and fusion.

Background: Cervical spondylotic myelopathy (CSM) most commonly occurs at the C3-7 levels and is successfully treated by multilevel anterior cervical discectomy and fusion (ACDF) or cervical laminectomy and fusion (CLF), but no procedure has clearly demonstrated superiority. Most prior investigations comparing approaches are limited by marked heterogeneity in the composition of the study groups. This investigation compares ACDF versus CLF surgery specifically at C3-7 in terms of long-term neurological outcome and the fate of the adjacent levels.

Improved Cosmetic Outcome With Bilateral Paraspinal Muscle Flap Closure Following Cervical Laminectomy and Fusion.

Background: Poor cosmetic results following cervical laminectomy and fusion (CLF) are rarely considered in assessing surgical complications. Atrophy from muscle denervation and posterior bone loss may result in a sunken appearance; relative tension may lead to wide, unsightly scars. Paraspinal muscle flaps are routinely employed by plastic surgeons for closure of wound infection and dehiscence.

Myelopathy from Intradural Extramedullary Metastasis as an Initial Presentation of Metastatic Melanoma.

The incidence of metastatic melanoma (MM) has been steadily rising, and it is the third most common metastatic lesion to the central nervous system (CNS). Spinal intradural extramedullary (IDEM) MM is rare, and it is associated with coexisting or antecedent brain metastasis. Metastatic disease to the CNS is a complication of advanced disease, and it generally occurs months to years after initial diagnosis and treatment.

Protein kinase M zeta synthesis from a brain mRNA encoding an independent protein kinase C zeta catalytic domain. Implications for the molecular mechanism of memory.

Protein kinase M zeta (PKM zeta) is a newly described form of PKC that is necessary and sufficient for the maintenance of hippocampal long term potentiation (LTP) and the persistence of memory in Drosophila. PKM zeta is the independent catalytic domain of the atypical PKC zeta isoform and produces long term effects at synapses because it is persistently active, lacking autoinhibition from the regulatory domain of PKC zeta. PKM has been thought of as a proteolytic fragment of PKC.