Ropivacaine-epinephrine-clonidine-ketorolac is an effective opioid-sparing local anesthetic for patients undergoing posterior spinal fusion.

Background Context: Ropivacaine-Epinephrine-Clonidine-Ketorolac (RECK) cocktail can improve pain control in patients undergoing lumbar decompression. Given the aging population, rising healthcare costs, the opioid epidemic, and associations of acute pain control with long-term opioid use, effective opioid-sparing analgesia following spinal fusion surgery may impart societal benefits.

Purpose: We aimed to investigate whether RECK was an effective local anesthetic for patients undergoing posterior spinal fusion.

Black disc morphology during routine lumbar discectomy with subsequent diagnosis of enterococcal discitis.

Background: is reported infrequently as an infectious cause of discitis. In the literature, the diagnosis is commonly made based on the clinical picture coupled with blood cultures, imaging, and tissue cultures.

Case Description: A 62-year-old male with chronic lower back pain underwent lumbar decompression for a lumbar disc.

Treatment of unilateral L5-S1 locked facet in a pediatric patient.

Background: Traumatic unilateral lumbosacral facet dislocations are rare injuries. The majority of cases are treated with open reduction and instrumented spinal fusions. Only less commonly can they be managed conservatively.

Obesity and calcification of the ligaments of the spine: a comprehensive CT analysis of the entire spine in a random trauma population.

Background Context: Obesity, which is currently surging to epidemic levels within the United States, has been linked to hyperostotic conditions like diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL). Excess adipose tissue and insulin-resistance may cause a systemic increase in serum levels of proinflammatory cytokines and these signals can affect bone metabolism. Spinal ligaments and discs may have receptors for these signaling molecules.

Anterior Fixation of Floating Facet Fractures in the Cervical Spine: A Prospective Case Series and Biomechanical Analysis.

Background: Unilateral fractures involving complete separation of the lateral mass from the vertebra and lamina (floating lateral mass fractures) are a unique subset of cervical spine fractures. These injuries are at significant risk for displacement without operative fixation. Posterior fixation has proven to facilitate adequate fusion.

Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity.

Study Design: Retrospective case series of surgically treated patients with adult spine deformity (ASD).

Objective: To report the incidence of proximal junctional failure (PJF), characterize PJF and evaluate the outcome of revision surgery for PJF. A modified classification is also proposed.

The use of routine thoracoabdominal CT scans in the polytrauma patient to estimate obesity.

Objective: To utilize data from routine CT scans to quantify obesity in polytrauma patients without the need to obtain a height and weight.

Design And Methods: We utilized a comprehensive database including multidetector CT thoracoabdominal images of all polytrauma patients admitted to a Level 1 trauma center. One thousand one hundred seventy-four patients were reviewed from 2006 to 2008 and of these, 162 had previous documentation of Body Mass Index (BMI) or height and weight measurements as an outpatient within 6 months of trauma activation and with a truncal girth smaller than the scanning area of the CT machine.

L5 nerve root decompression after malunion of surgically managed vertically unstable pelvic ring injuries.

We describe the outcomes of late decompression of the L5 nerve root after malunion of surgically managed pelvis injuries. Four patients underwent decompression of the L5 nerve root. Surgery included hemilaminotomy with facetectomy at L5-S1 followed by decompression of the L5 nerve root laterally from the surrounding displaced sacral ala.

The significance of facet joint cross-sectional area on magnetic resonance imaging in relationship to cervical degenerative spondylolisthesis.

Background Context: Characteristic changes of the facet joints, including synovial cysts, facet joint hypertrophy, and facet joint effusions, on magnetic resonance imaging (MRI) and computed tomography have been associated with lumbar degenerative spondylolisthesis. The cervical facets have not been examined for associations with cervical degenerative spondylolisthesis similar to those seen in the lumbar spine.

Purpose: To define abnormalities of the facet joints seen on supine MRI that correlate with cervical spondylolisthesis seen on upright radiographs.

Evaluation of an interprofessional clinician-patient communication workshop utilizing standardized patient methodology.

Objective: Communication and interpersonal skills (CIS) are one of the 6 general competencies required by the Accreditation Council for Graduate Medical Education (ACGME). The clinician-patient communication (CPC) workshop, developed by the Institute for Healthcare Communication, provides an interactive opportunity to practice and develop CIS. The objectives of this study were to (1) determine the impact of a CPC workshop on orthopedic surgery residents' CIS (2) determine the impact of physician alone or incorporation of nursing participation in the workshop, and (3) incorporate standardized patients (SPs) in resident training and assessment of CIS.

A proteomic study of protein variation between osteopenic and age-matched control bone tissue.

The focus of this study was to identify changes in protein expression within the bone tissue environment between osteopenic and control bone tissue of human femoral neck patients with osteoarthritis. Femoral necks were compared from osteopenic patients and age-matched controls. A new method of bone protein extraction was developed to provide a swift, clear view of the bone proteome.

Survival of atlanto-occipital dissociation correlates with atlanto-occipital distraction, injury severity score, and neurologic status.

Background: Case series suggest that atlanto-occipital dissociation (AOD) is a potentially survivable injury. Intuitively, a significant neurologic injury, a high degree of initial distraction, and more severe associated injuries would decrease the likelihood of survival. However, this has never been demonstrated for this injury pattern in a statistically meaningful way.

Defining and detecting missed ligamentous injuries of the occipitocervical complex.

Study Design: Retrospective radiographic and clinical review of patients in a comprehensive trauma database.

Objective: The primary aim of this study was to detect occipitocervical complex (OCC) injuries initially missed at a level 1 trauma center.

Summary Of Background Data: Recent case series demonstrate that OCC injuries are potentially survivable.

Cytokine-mediated inflammatory reaction following posterior cervical decompression and fusion associated with recombinant human bone morphogenetic protein-2: a case study.

Study Design: Case study with unique laboratory analysis.

Objective: To present a potentially serious adverse event that may occur in unique individuals when using recombinant human bone morphogenetic protein-2 (rhBMP-2) to augment fusion in posterior cervical spine surgery.

Summary Of Background Data: The use of rhBMP-2 to augment posterior cervical decompression and fusion has not been approved by the Food and Drug Administration but has been advocated as safe to use by case series studies and multiple authors.

Postoperative instrumented spine infections: a retrospective review.

Background: Postoperative infection following posterior instrumentation of the spine is not uncommon and is a potentially catastrophic complication. Removal of the instrumentation is ideal for eradicating infection. However, removal is not always possible from a structural standpoint.

Clinical and radiographic assessment of transforaminal lumbar interbody fusion using HEALOS collagen-hydroxyapatite sponge with autologous bone marrow aspirate.

Background Context: Studies have suggested that the use of bone marrow aspirate (BMA) with HEALOS (DePuy Spine, Raynham, MA), a collagen-hydroxyapatite sponge (CHS), is an effective substitute for autologous iliac crest bone graft when used in fusion procedures of the lumbar spine.

Purpose: To assess clinical and radiographic outcomes after implantation of BMA/CHS in patients undergoing transforaminal lumbar interbody fusion (TLIF) with posterolateral fusion (PLF).

Study Design/setting: Case series radiographic outcome study.

The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis.

Study Design: Retrospective radiographic review of consecutive patients with universally applied standard.

Objectives: To define MRI findings at the facet joints that may suggest abnormal sagittal plane translation seen on standing lateral flexion-extension (SLFE) radiographs.

Summary Of Background Data: MRI findings, including facet joint orientation, facet joint osteoarthritis, and the presence of synovial cysts, have all been linked with degenerative spondylolisthesis (DS).

Internal fixation without fusion of a flexion-distraction injury in the lower cervical spine of a three-year-old.

Background: Reported surgical treatment of unstable pediatric cervical spine injuries typically involves posterior fusion with internal fixation, usually with posterior wiring.

Purpose: To discuss management issues in the treatment of an unstable Salter-Harris type I pediatric cervical spine injury and surgical intervention without fusion.

Study Design: A case report.