The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
The perioperative cost of Infuse bone graft in posterolateral lumbar spine fusion.
There is mounting evidence supporting the efficacy of bone morphogenetic protein (BMP) for both anterior interbody and posterolateral lumbar fusion. However, the relative cost of BMP remains an important concern for physicians, hospitals, and payers. ⋯ The hospital carries the cost burden associated with the utilization of rhBMP-2/ACS. In contrast, the payer in a Diagnosis-Related Group (DRG) model achieves a net savings, based primarily on the decreased payment for inpatient rehabilitation, but also on decreased hospital reimbursement, physician costs, and other outpatient services.
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Spinal injuries are common sequelae of falls from hunting tree stands. Significant neurological injury is not uncommon and can result in significant morbidity as well as enormous expenditure of health care dollars. Recent literature on the subject is limited. ⋯ Falls from hunting tree stands remain a significant cause of spinal injury and subsequent disability. The best intervention for these injuries is prevention. There is a continued need for hunter safety education to reduce the incidence of these injuries with emphasis on safety harness usage, proper installation and annual inspection of tree stands, hunting in groups with periodic contact, the use of communication devices, and abstinence from alcohol consumption while hunting.
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Case Reports
Primary erector spinae pyomyositis causing an epidural abscess: case report and literature review.
Primary pyomyositis (PM) is a rare bacterial infection of skeletal muscle usually restricted to tropical zones. Typically caused by Staphylococcus aureus, primary staphylococcal PM associated with an epidural abscess has not been reported before. ⋯ Spinal infection must always be considered when back pain and sciatica are associated with clinical signs of sepsis. We present the first case of staphylococcal PM associated with an epidural abscess.
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Spontaneous spinal epidural hematoma (SSEH) is a very rare condition, so there were few studies assessing the management criteria of SSEH. ⋯ Precise diagnosis without delay and rapid surgical treatment are essential for the management of SSEH.
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Bone morphogenetic proteins (BMPs) are potential therapeutic factors for degenerative discs, and BMP-12 does not have the osteogenic potential of BMP-2, making it better suited for intradiscal injection. However, no reports have compared the actions of BMP-2 and -12 on human annulus fibrosus (AF) and nucleus pulposus (NP) cells nor evaluated adenoviral-mediated gene therapy in human AF cells. ⋯ Both rhBMP-2 and -12 increase human NP cell matrix protein synthesis while having minimal effects on AF cells. However, Ad-BMP-12 did increase matrix protein synthesis in both NP and AF cells, making it a potential therapy for enhancing matrix production in the IVD. These responses plus the proliferative action of Ad-BMP-12 seen in the current studies, and the lack of an osteogenic action noted in other studies justifies future studies to determine if gene therapy with BMP-12 could provide protective and/or reparative actions in degenerating discs.