Antibiotic-Resistant Spondylodiscitis With Canal Invasion and Aggressive Evolution to Epidural Abscess: A Case Series of Spontaneous Occurrence in 16 Patients.

Background: The study aimed to assess the effectiveness of antibiotic treatment for spondylodiscitis, its failure rates, and the need for surgical intervention.

Methods: This is a retrospective study of patients who presented with spontaneous deep spinal infections and spondylodiscitis between 2011 and 2013. Clinical, bacteriologic, and radiographic data during hospitalization were analyzed.

Cervical spine injuries in civilian victims of explosions: Should cervical collars be used?

Background: Semirigid cervical collars (SRCCs) are routinely applied to victims of explosions as part of the prehospital trauma protocols. Previous studies have shown that the use of SRCC in penetrating injuries is not justified because of the scarcity of unstable cervical spine injuries and the risk of obscuring other neck injuries. Explosion can inflict injuries by fragments penetration, blast injury, blunt force, and burns.

Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment.

Purpose: Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP) is based on direct compression and control of both venous and arterial retroperitoneal bleeders. This study describes the safety and efficacy of emergent EPPP employment, as a stand-alone surgical treatment, that is, carried out without external pelvic fixation or emergent angiography.

Intradural Extension of a Pyogenic Epidural Abscess: A Case Report.

Case: Few cases of spinal epidural abscess involving an extradural abscess with an intradural extension have been reported. A unique complication with extension of pus from the epidural space through multiple perforations into the dura is described. Due to a proximal meningeal inflammatory reaction, which served as a proximal plug, no cerebrospinal fluid leak was encountered.

Low-back pain, lassitude and loss of appetite.

White blood cells, Erythrocyte sedimentation rate and C-reactive protein are sensitive tools to discover rare, but potentially serious pyogenic vertebral osteomyelitis, a disease whose incidence is increasing.

Efficacy of MRI for assessment of spinal trauma: correlation with intraoperative findings.

Study Design: Observational diagnostic study on consecutive patients.

Objective: To assess the efficacy of magnetic resonance imaging (MRI) for detecting spinal soft tissue injury after acute trauma using intraoperative findings as a reference standard.

Summary Of Background Data: Recognizing injuries to spinal soft tissue structures is critical for proper decision making and management for blunt trauma victims.

A cadaver study to compare vertebral augmentation with a high-viscosity cement to augmentation with conventional lower-viscosity cement.

Study Design: Comparison of extravasations in fractured cadaver vertebrae augmented with commercial low-viscosity versus high-viscosity cements.

Objective: Use of high-resolution, 3-dimensional (3D) imaging to test the hypothesis that high-viscosity cements can reduce the type and severity of extravasations after vertebral augmentation procedures.

Summary Of Background Data: Cement extravasations are one of the primary complications of vertebral augmentation procedures.

Toward the establishment of optimal computed tomographic parameters for the assessment of lumbar spinal fusion.

Background Context: The accurate detection of the extent of bony fusion after attempted lumbar arthrodesis is important given that subsequent efforts-such as decisions regarding need for continued external bracing, use of enhancing modalities (electrical stimulation and pulsed ultrasound), recommended activity levels, return to employment, early surgical intervention, and others-may be needed to reduce the risk of late failure, especially in light of the fact that late revisions for failed fusions often result in poor outcomes and significant costs. Thin-cut computed tomography (CT) has emerged as the study of choice for this purpose.

Purpose: To delineate the optimal CT parameters for determining fusion versus pseudarthosis after attempted lumbar fusion.

Reference data for interpreting widening between spinous processes in the lumbar spine.

Background Context: Traumatic injury to the lumbar spine is evaluated and treated based on the perceived stability of the spine. Recent classification schemes have established the importance of evaluating the posterior ligamentous complex (PLC) to fully comprehend stability. There are a variety of techniques to evaluate the PLC, including assessment of interspinous distance.

Motion within the unstable cervical spine during patient maneuvering: the neck pivot-shift phenomenon.

Background: Cervical extrication collars are applied to millions of blunt trauma victims despite the lack of any evidence that a collar can protect against secondary injuries to the cervical spine. Cadaver studies support that in the presence of a dissociative injury, substantial motion can occur within the occipitocervical spine with collar application or during patient transfers. Little is known about the biomechanics of cervical stabilization; hence, it is difficult to develop and test improved immobilization strategies.

The association of occipitocervical dissociation and death as a result of blunt trauma.

Background Context: Despite multiple reports of survivability, dissociative occipitocervical injury (OCI) is generally accepted to be fatal in most cases. The actual number of trauma victims where OCI may have made the difference between life and death is unknown because multiple studies have shown that these injuries can be missed with current diagnostic methods. An improved understanding of the relative importance of OCI in blunt trauma mortality may help to refine protocols for the assessment and treatment of patients who arrive alive to the emergency room after severe blunt trauma.

A pictorial classification atlas of cement extravasation with vertebral augmentation.

Background Context: Minimally invasive procedures for the treatment of vertebral compression fractures (VCFs) have been in use since the mid-1980s. A mixture of liquid monomer and powder is introduced through a needle into one or both pedicles, and it polymerizes within the vertebral body in an exothermic chemical reaction. The interaction between cement and the fractured vertebral body determines whether and how the cement stabilizes the fragments, alters morphology, and extravasates.

Occipitocervical dissociative injuries: common in blunt trauma fatalities and better detected with objective computed tomography-based measurements.

Background Context: Occipitocervical injuries (OCIs) are generally not common in blunt trauma victims, but autopsy studies of blunt trauma fatalities consistently report a high prevalence of these injuries. New computed tomography (CT)-based quantitative criteria have recently been developed for use in assessing the occipitocervical spine. The efficacy of these new criteria for detecting OCI would be supported if the high prevalence of OCI in blunt trauma fatalities can also be detected using these objective CT-based criteria.

Reference data for assessing widening between spinous processes in the cervical spine and the responsiveness of these measures to detecting abnormalities.

Background Context: Traumatic injury to the spine is evaluated and treated based on the perceived stability of the spine. Recent classification schemes have established the importance of evaluating the discoligamentous complex to fully comprehend stability. There are a variety of techniques to evaluate the discoligamentous complex, including assessment of interspinous distance.

Comprehensive computed tomography assessment of the upper cervical anatomy: what is normal?

Background Context: High-speed computed tomography (CT) exams have replaced traditional radiographs for assessment of cervical spine injuries in many emergency departments. Recent evidence demonstrates that even subtle displacements can indicate significant upper cervical spine injuries. Many different anatomical measurements have been described in the upper cervical spine to date, most of them based on X-ray.

Diagnosis of unstable cervical spine injuries: laboratory support for the use of axial traction to diagnose cervical spine instability.

Background: The ability to detect damage to the intervertebral structures is critical in the management of patients after blunt trauma. A practical and inexpensive method to identify severe structural damage not clearly seen on computed tomography would be of benefit. The objective of this study was to assess whether ligamentous injury in the subaxial cervical spine can be reliably detected by analysis of lateral radiographs taken with and without axial traction.

Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury.

Background: Cervical collars are applied to millions of trauma victims with the intent of protecting against secondary spine injuries. Adverse clinical outcomes during the management of trauma patients led to the hypothesis that extrication collars may be harmful in some cases. The literature provides indirect support for this observation.

An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery.

Background Context: The objective of the North American Spine Society (NASS) Evidence-Based Clinical Guideline on antithrombotic therapies in spine surgery was to provide evidence-based recommendations to address key clinical questions surrounding the use of antithrombotic therapies in spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of February 2008. The goal of the guideline recommendations was to assist in delivering optimum, efficacious treatment with the goal of preventing thromboembolic events.

Infectious Collet-Sicard syndrome in the differential diagnosis of cerebrovascular accident: a case of head-to-neck dissociation with skull-based osteomyelitis.

Background Context: Collet-Sicard syndrome (CSS) is a rare condition that includes palsies of cranial nerves IX, X, XI, and XII. There are multiple reported causes in the literature, although infection is particularly unusual.

Purpose: To report an unusual case of CSS as a result of infection causing head-to-neck dissociation with involvement of the upper cervical spine.

Internal decapitation: survival after head to neck dissociation injuries.

Study Design: Case series.

Objective: To describe survival and outcomes after occipitocervical dissociation injuries.

Summary Of Background Data: Historically, occipitocervical dissociation injuries have a high rate of associated neurologic deficit with a relatively high incidence of mortality.

Threshold cervical range-of-motion necessary to detect abnormal intervertebral motion in cervical spine radiographs.

Study Design: Whole human cadaver model to assess a common diagnostic test for cervical spine stability.

Objective: Determine criteria that can be used to determine if sagittal plane angular motion of the head/neck during a cervical spine flexion/extension study is adequate to reliably assess intervertebral motion (IVM).

Summary Of Background Data: Flexion/Extension radiographs of the cervical spine are commonly used to help identify specific abnormalities in IVM.

Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip.

Study Design: Prospective clinical study on the effect of total hip replacement surgery (THR) on low back pain (LBP) in patients with severe hip osteoarthritis.

Objective: To assess the affect of THR on LBP.

Summary Of Background Data: Hip osteoarthritis causes abnormal gait and spinal sagittal alignment and is associated with LBP.

Direct transoral manipulation to reduce a displaced odontoid fracture: a technical note.

Background Context: Irreducible anteriorly displaced odontoid fractures are usually treated with posterior atlantoaxial fusion.

Purpose: To present an alternative for fracture reduction and anterior stabilization for displaced odontoid fractures.

Study Design: A technique for reduction of odontoid fractures is reported.

Intrathecal migratory foreign body without neurological deficit after a gunshot wound.

Background Context: Penetrating bullets dissipate thermal and kinetic energy into surrounding tissues. Within the thecal sac, this is universally associated with neurological deficits.

Purpose: We report a case of intrathecal penetration of a bullet without neurological deficit.

The distended facet sign: an indicator of position-dependent spinal stenosis and degenerative spondylolisthesis.

Background Context: Symptoms of spinal stenosis are position-dependent. Stand up magnetic resonance imaging (MRI) and myelography can demonstrate further dynamic components of spinal stenosis that may go unrecognized on supine MRI.

Purpose: To describe a radiographic finding seen on standard supine MRI that is an indicator for dynamic spinal stenosis and degenerative spondylolisthesis.