Why you should wear your seatbelt on an airplane: Burst fracture of the atlas (jefferson fracture) due to in-flight turbulence.

The Jefferson fracture is a burst-type fracture to the atlas first described in 1919, characterized by anterior and posterior fractures of the weak C1 ring caused by a sudden axial load to the vertex of the skull. Here we report a Jefferson fracture caused by head trauma due to mid-flight turbulence in an unrestrained 56-year-old male airline passenger. Imaging revealed a comminuted burst fracture of the atlas with an avulsion fracture of the transverse atlantal ligament.

Surgical Site Infection as a Risk Factor for Long-Term Instrumentation Failure in Patients with Spinal Deformity: A Retrospective Cohort Study.

Background: Surgical site infection (SSI) remains a complication of spine deformity surgery. Although fusion/instrumentation failure in the setting of SSI has been reported, few studies have investigated the relationship between these entities. We examine the relationship between early SSI and fusion/instrumentation failure after instrumented fusion in patients with thoracolumbar scoliosis.

Isolated multiple lumbar transverse process fractures with spinal instability: an uncommon yet serious association.

Purpose: Isolated vertebral transverse process fractures of thoracolumbar spine without other vertebral injuries and neurological deficit are generally considered as minor injuries with no concern for associated spinal instability. This report describes a case of multiple lumbar transverse fractures associated with an unexpected yet clinically significant spinal instability.

Methods: A young male presented with right flank pain following being pushed and trapped against the ground by a reversing truck.

Fibromyalgia as a Predictor of Increased Postoperative Complications, Readmission Rates, and Hospital Costs in Patients Undergoing Posterior Lumbar Spine Fusion.

Study Design: Retrospective review.

Objective: The aim of this study was to identify whether a concomitant diagnosis of fibromyalgia (FM) influences postoperative complications, readmission rates or cost following primary 1 to 2 level lumbar fusions in an elective setting.

Summary Of Background Data: Patients with FM often are limited by chronic lower back pain, many of whom will seek operative treatment.

Analysis of Internet Review Site Comments for Spine Surgeons: How Office Staff, Physician Likeability, and Patient Outcome Are Associated With Online Evaluations.

Study Design: Observational study.

Objective: To evaluate how online patient comments will affect website ratings for spine surgeons.

Summary Of Background Data: With the ever-growing utilization of physician review websites, healthcare consumers are assuming more control over whom they choose for care.

How social media, training, and demographics influence online reviews across three leading review websites for spine surgeons.

Background Context: The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website.

Percutaneous and open iliac screw safety and accuracy using a tactile technique with adjunctive anteroposterior fluoroscopy.

Background Context: All currently described percutaneous iliac screw placement methods are entirely dependent on fluoroscopy.

Purpose: The purpose of this study was to determine the safety and the accuracy of percutaneous and open iliac screw placement using a primarily tactile technique with adjunctive anteroposterior (AP) fluoroscopy.

Study Design/context: All patients who underwent open and percutaneous iliac screw placement over a 5-year period were identified.

Changes in Cervical Alignment after Multilevel Schwab Grade II Thoracolumbar Osteotomies for Adult Spinal Deformity.

Study Design: A retrospective cohort.

Objective: The aim of this study was to describe changes in cervical alignment (CA) and cervical deformity (CD) after multilevel Schwab Grade II Osteotomies for adult spinal deformity (ASD).

Summary Of Background Data: Reciprocal cervical and global changes after ASD surgery have not been previously described in the setting of multilevel osteotomy.

Prophylactic vertebral cement augmentation at the uppermost instrumented vertebra and rostral adjacent vertebra for the prevention of proximal junctional kyphosis and failure following long-segment fusion for adult spinal deformity.

Background Context: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common problems after long-segment (>5 levels) thoracolumbar instrumented fusions in the treatment of adult spinal deformity (ASD). No specific surgical strategy has definitively been shown to lower the risk of PJK as the result of a multifactorial etiology.

Purpose: The study aimed to assess the incidence of PJK and PJF in patients treated with prophylactic polymethylmethacrylate (PMMA) cement augmentation at the uppermost instrumented vertebrae (UIV) and rostral adjacent vertebrae (UIV+1).

Multilevel Schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity.

Background Context: Prior reports have compared posterior column osteotomies with pedicle subtraction osteotomies in terms of utility for correcting fixed sagittal imbalance in adolescent patients with deformity. No prior reports have described the use of multilevel Smith-Petersen Osteotomies (SPOs) alone for surgical correction in the adult spinal deformity (ASD) population.

Purpose: The study aimed to determine the utility of multilevel SPOs in the management of global sagittal imbalance in ASD patients.

Is a Persistent Vacuum Phenomenon a Sign of Pseudarthrosis After Posterolateral Spinal Fusion?

The purpose of this study is to evaluate whether the vacuum phenomenon (VP) resolves after posterolateral lumbar fusion, and whether persistence of VP is indicative of failed fusion. We retrospectively reviewed patients with degenerative lumbar spinal stenosis with instability with a positive VP on preoperative computed tomography (CT) who underwent posterolateral lumbar spinal fusion. Lumbar CT and radiographs were evaluated for the presence of VP and fusion at each level.

Focal Correction of Severe Fixed Kyphosis with Single Level Posterior Ponte Osteotomy and Interbody Fusion.

Objective: To report the successful correction of a severe, fixed kyphotic deformity utilizing a combination posterior lumbar interbody fusion (PLIF) and Ponte osteotomy at the site of acute kyphosis.

Summary Of Background Data: There have been no reports on the experience and surgical strategy of combined one-level focal PLIF and Ponte osteotomy for fixed severe kyphotic deformity. Typically, these corrections would need a pedicle subtraction osteotomy or a vertebrectomy.

Minimally Invasive Versus Open Lumbar Fusion: A Comparison of Blood Loss, Surgical Complications, and Hospital Course.

Background: Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF).

The use of modest systemic hypothermia after iatrogenic spinal cord injury during surgery.

Iatrogenic spinal cord injury (SCI) is an uncommon (0%-3%), yet devastating, complication of spine surgery. Recent evidence based on small clinical studies indicates that modest hypothermia is a feasible treatment option for severe SCI. We extended this treatment modality to patients with devastating iatrogenic SCI.

Vertebral body osteolysis following the use of bone morphogenetic protein in spinal surgery: a mimicker of infection.

This report describes the imaging findings in three patients who developed lumbar spine osteolysis after posterior spinal fusion using rhBMP-2. These cases demonstrate the variable course of osteolysis, as well as the importance of recognizing its radiological appearances to prevent confusion with infection following spinal fusion.

Leiomyosarcoma metastases to the spine. Case series and review of the literature.

Leiomyosarcoma is a rare malignant smooth-muscle tumor that rarely metastasizes to bone. It is extremely uncommon for osseous metastasis to be the initial presentation of leiomyosarcoma or to be the initial manifestation of recurrence in patients with a history of leiomyosarcoma. The authors have treated four cases of metastatic leiomyosarcoma with the lesion initially presenting in the spine, and a fifth case of disseminated leiomyosarcoma that involved the spine.

Biomechanical comparison of lumbosacral fixation techniques in a calf spine model.

Study Design: biomechanical testing of the strength and stability of lumbosacral fixation constructs.

Objectives: The purpose of this study was to quantify and compare the biomechanical properties of five different lumbosacral fixation constructs and determine the benefit of adding supplementary fixation to S1 screws.

Summary Of Background Data: Extension of long fusions to the sacrum remains a difficult clinical challenge.