Publications by authors named "John Czerwein"

Article Synopsis
  • * A 54-year-old male with a history of cancer developed rapid weakness and loss of verbal communication after undergoing a cervical foraminotomy; imaging revealed serious vascular complications.
  • * The cause of locked-in syndrome in this patient appears to be complex, likely involving previous radiation treatment and potential intraoperative damage to the blood vessels during surgery.
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Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued.

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Case: An 82-year-old man with a history of lumbar spinal stenosis and prior laminectomy presented with chronic lower back pain and was treated with placement of bilateral superior cluneal nerve stimulators. At the 2-week follow-up, the patient reported loss of efficacy and new-onset paresthesia of the left lower extremity. Fluoroscopic evaluation revealed lead breakage and distal migration of the left-sided stimulator lead to the left anteromedial thigh.

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Article Synopsis
  • Lateral decubitus positioning is commonly used in orthopaedic surgeries for better access to the surgical site.
  • This position can lead to potential complications in various areas, including eyes, muscles, nerves, and blood circulation.
  • Orthopaedic surgeons need to recognize these risks to effectively prevent and address any issues that may occur during or after surgery.*
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Case: We describe a case of a 65-year-old woman with bilateral chronically subluxated C6 to 7 facets with facet fusion, who presented for care for the first time 1 year after a motor vehicle accident. The patient was minimally symptomatic at the time of her evaluation; thus, nonoperative treatment was provided. At 3-year follow-up, our patient remained minimally symptomatic with no progression of neurologic deficits.

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Lumbar spine surgery can be complicated by perioperative cerebrospinal fluid (CSF) leak. However, development of brain herniation secondary to CSF leak following lumbar spine surgery has not been previously reported in the current literature. This case report describes a 48-year-old woman who, after a revision lumbar decompression and fusion, experienced CSF leak followed by development of brain herniation, which resulted in patient demise.

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A previously healthy 26-year-old female presented with one month of worsening low back pain radiating to the right lower extremity. Magnetic resonance imaging (MRI) without contrast of the lumbar spine demonstrated enhancement of the right sacroiliac joint. Sacroiliac joint aspiration followed by culture and microbiology revealed  as the cause of infectious sacroiliitis.

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Benign tumors in the spine include osteoid osteoma, osteoblastoma, aneurysmal bone cyst, osteochondroma, neurofibroma, giant cell tumor of bone, eosinophilic granuloma, and hemangioma. Although some are incidental findings, some cause local pain, radicular symptoms, neurologic compromise, spinal instability, and deformity. The evaluation of spinal tumors includes a thorough history and physical examination, imaging, sometimes laboratory evaluation, and biopsy when indicated.

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The incidence of anterior lumbar surgery is increasing. Although adverse events are uncommon, several have been described. Complications can be categorized based on the time of occurrence (ie, intraoperative, postoperative), patient positioning, surgical exposure, and spinal procedure.

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The orthopaedic patient on chronic anticoagulation therapy is at risk of thromboembolism and hemorrhage in the perioperative period. To establish the most effective anticoagulation regimen, patients should be stratified according to the risk of arterial or venous thromboembolism. Timing of surgery, thromboembolic risk, and bleeding risk should be considered when developing an anticoagulation protocol.

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