Journal of neurosurgery. Spine
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Case Reports
Revision surgery after interbody fusion with rhBMP-2: a cautionary tale for spine surgeons.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) promotes the induction of bone growth and is widely used in spine surgery to enhance arthrodesis. Recombinant human BMP-2 has been associated with a variety of complications including ectopic bone formation, adjacent-level fusion, local bone resorption, osteolysis, and radiculitis. Some of the complications associated with rhBMP-2 may be the result of rhBMP-2 induction of the inflammatory host response. ⋯ He recovered over the next several days and was discharged at his neurological baseline. The authors propose that the rhBMP-2-induced host inflammatory response partially contributed to vessel fibrosis and scarring, resulting in the life-threatening vascular injury during the reoperation. Spine surgeons should be aware of this potential inflammatory fibrosis in addition to other reported complications related to rhBMP-2.
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The purpose of this study was to evaluate the feasibility and safety of minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty (PVP) for treating acute thoracolumbar osteoporotic vertebral compression fracture (VCF) and preventing secondary VCF after PVP. ⋯ Minimally invasive pedicle screw fixation combined with PVP is a good choice for the treatment of acute thoracolumbar osteoporotic VCF and can prevent the occurrence of new VCFs after PVP.
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Reversal of the normal cervical spine curvature, as seen in cervical kyphosis, can lead to mechanical pain, neurological dysfunction, and functional disabilities. Surgical intervention is warranted in patients with sufficiently symptomatic deformities in an attempt to correct the deformed cervical spine. In theory, improved outcomes should accompany a greater degree of correction toward lordosis, although there are few data available to test this relationship. The purpose of this study is to determine if the degree of deformity correction correlates with improvement in neurological symptoms following surgery for cervical kyphotic deformity. ⋯ The authors' results suggest that the degree of correction of focal kyphosis deformity correlates with improved neurological outcomes. The authors also saw a positive relationship between attainment of global lordosis and improved mJOA scores. With consideration for the risks involved in correction surgery, this information can be used to help guide surgical strategy decision making.
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Presurgical devascularization of hypervascular spinal metastases has been shown to be effective in preventing major blood loss during open surgery. Most often, embolization can be performed using polyvinyl alcohol (PVA) microparticles. However, in some cases, the close relationship between the feeders of the metastases and the feeders of the anterior spinal artery (ASA) poses a risk of spinal cord ischemia when PVA microparticle embolization is performed. ⋯ Satisfactory devascularization of the lesions was obtained; the ASA remained patent in both cases. The metastases were surgically removed in both cases within the 48 hours after the embolization and major blood loss did not occur. Presurgical devascularization of hypervascular spinal metastases close the ASA by direct puncture with Onyx-18 seems to be an effective technique and appears to be safe in terms of the preserving the ASA's patency.
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Recent studies have reported the incidence of superior facet joint violation using percutaneous techniques. These techniques have not been compared with the open midline approach. An increased incidence of superior facet violation may lead to adjacent-segment disease. In this paper, the authors' goal is to compare the rate of superior facet violation with the use of percutaneously placed pedicle screws versus midline approach open placement. ⋯ The use of a percutaneous method to insert pedicle screws results in a statistically significantly higher incidence of facet joint violation, even if only proximal screws are considered. Further studies are needed to determine if this leads to a higher incidence of symptomatic adjacent-level disease.