European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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To describe a case of late-onset deep surgical-site infection (SSI) after posterior lumbar interbody fusion in a patient treated with tocilizumab (TCZ) for rheumatoid arthritis (RA), with emphasis on the clinical symptoms and changes in inflammatory markers such as white blood cell (WBC) count and C-reactive protein (CRP) level. ⋯ As TCZ strongly suppresses inflammatory reactions, detecting deep SSI based on local and systemic findings and laboratory data is quite difficult. Care must be taken regarding SSI when patients treated with TCZ complain of long-lasting LBP after lumbar surgery.
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Case Reports
Combined traumatic atlantooccipital and atlantoaxial articulation instability: a case report with survival.
Traumatic atlantooccipital dislocation is a rare injury in survivors with 15 % share in deaths due to spinal injury. The authors present a case of a patient with concurrent atlantooccipital and atlantoaxial instability of the upper cervical spine, which he suffered after a fall from height. ⋯ We performed realignment of the dislocation and posterior occipitocervical (C0-C3) fusion. After the surgery, the patient manifested neurological improvement almost to a normal neurological outcome with persistent residual finding after subarachnoid hemorrhage.
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Galactosialidosis is an autosomal recessive lysosomal storage disease caused by deficiency of both α-neuraminidase and β-galactosidase due to a defect of the protective protein/cathepsin A. Three clinical subtypes have been described, depending on the age of onset and severity of the symptoms: the early infantile, late infantile and juvenile/adult form. We report an adult-type patient who underwent surgery for galactosialidosis-related spinal deformity, and showed a favorable course thereafter. ⋯ This is the first report on spinal surgery for adult-type galactosialidosis and histological examination of spinal LF.
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Case Reports
Analysis of a β-TCP bone graft extender explanted during revision surgery after 28 months in vivo.
Analysis of a β-tricalcium phosphate (β-TCP) bone graft soaked with bone marrow aspirate explanted during revision surgery after 28 months. ⋯ Histological analysis of bone grafts is rare after implantation in humans due to ethical and clinical limitations of sample harvest. In this study, implantation of a β-TCP bone graft did not result in bone formation after 28 months in vivo.
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Sub-axial cervical spine(C spine) distraction flexion injuries, known as cervical sprains, have been divided into either "benign" or "severe" sprains depending on the integrity of the posterior longitudinal ligament (PLL) of the spinal column. It is a very uncommon injury and rarely reported in the literature. Most of the reports in the literature discuss this injury in the adult age group and so the adolescent age group was also considered to follow the same model of progression of mechanical instability depending on the degree and extent of structures injured, including the PLL as a cutoff factor between a "stable" and an "unstable" injury. ⋯ We report three cases of adolescents with severe cervical sprains at the C2-C3 level and argue the integrity of PLL as a determinant factor in the sagittal stability of the C spine in this age group.