Spine
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Retrospective review of the clinical course and cervical spine plain radiographs, computed tomography, and magnetic resonance imaging of 24 consecutive patients for a 2-year period with a unilateral lateral mass/facet fracture. ⋯ Plain radiographs of the cervical spine lack sensitivity to detect the presence of lateral mass/ facet fractures. The appearance of the fracture on computed tomography does not indicate instability. The degree of ligamentous injury at the level of the fracture demonstrated on magnetic resonance imaging correlates with instability in this series. Operative stabilization may be indicated for unilateral lateral mass fractures that present with a subluxation or that have injury to at least three of the following ligaments: the facet region, the interspinous ligament, the anterior longitudinal ligament, and the posterior longitudinal ligament. However, before a definitive management plan can be formulated, results from this small series require further validation.
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A retrospective study of 16 patients who underwent the modified Robinson anterior cervical discectomy and fusion at three operative levels. ⋯ A three-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. Although not all pseudarthroses are painful, these data suggest that those with a successful fusion have a better outcome. It is recommended that these patients undergo additional or alternative measures to achieve arthrodesis consistently.
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Case Reports
Continuous electromyographic monitoring to detect nerve root injury during thoracolumbar scoliosis surgery.
The results of intraoperative monitoring during a case of nerve root injury sustained from scoliosis surgery to the thoracolumbar spine are described. ⋯ The authors of this study recommend electromyographic monitoring of appropriate lumbosacral myotomes in addition to somatosensory-evoked potentials during this type of procedure.
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Case Reports
Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases.
A retrospective analysis of eight cases of delayed spinal infection after elective posterior or combined anterior and posterior spinal instrumentation and fusion. ⋯ The diagnosis of delayed infection after elective spinal instrumentation and fusion requires a high index of suspicion. These infections may have been caused by intraoperative inoculation. All patients were successfully treated with debridement, instrumentation removal, and culture-directed postoperative antibiotics.