The spine journal : official journal of the North American Spine Society
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The incidence of osteoporotic and insufficiency fractures of the pelvic ring is increasing. Closed reduction and percutaneous fixation with cannulated sacroiliac screws is well-established in the operative treatment of osteoporotic posterior pelvic ring fractures. However, osteoporotic bone quality might lead to the risk of screw loosening. For this reason, cement augmentation of the iliosacral screws is more frequently performed and recommended. ⋯ Regarding iliosacral screw fixation in osteoporotic bone, the primary stability of techniques involving cement augmentation is significantly higher compared with screw fixation without cement augmentation. Perforated screws with the same primary stability as that of conventional screw fixation in combination with cement augmentation might be a promising alternative in reducing complications of cement leakage. These biomechanical results have to be transferred into clinical practice and prove their clinical value.
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Lumbar epidural steroid injections (LESIs) are often performed as a treatment option for lumbar stenosis and radiculopathy before lumbar decompression surgery. Several case series have reported spinal infections after LESIs. There is lack of literature on the rate of postoperative infections after lumbar decompression in patients who had prior LESIs. ⋯ Overall, the rate of postoperative infection after single-level lumbar decompression after LESI remained relatively low, ranging between 0.8% and 1.7%. The incidence of 90-day postoperative infection after lumbar decompression was significantly higher than matched controls in groups with LESI within 1 month (OR=3.2, p<.0001) and 1-3 months before surgery (OR=1.8, p<.0001). The incidence of 90-day postoperative infection was not significantly different from matched controls in groups with LESI between 3-6 months (OR=1.3, p=.15) and 6-12 months before decompression surgery (OR=1.3, p=.18) CONCLUSIONS: Single-level lumbar decompression within 3 months after LESI may be associated with an increased rate of postoperative infection. Increasing the time interval between LESI and single-level lumbar decompression surgery to at least 3 months may decrease postoperative infection rates.
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Cervical radiculopathy is a common disorder caused by compression of the cervical nerve roots and is characterized by arm pain and altered sensory-motor function. Incongruity in the locations of C6 and C7 dermatomes in competing versions of historical dermatome maps has plagued interpretation of impaired sensation associated with C6 and C7 radiculopathies. Magnetic resonance imaging (MRI) allows accurate identification of the C6 or C7 nerve root compression and therefore makes it possible to explore sensory findings that are associated with compression of specific nerve root. ⋯ The location of sensory impairments associated with symptomatic C6 and C7 nerve root compression overlap to the extent that caution should be exercised when predicting compression of either the C6 or C7 nerve roots based on locations of impaired sensation. Impaired sensation in the radial aspect of the distal forearm is more common in C6 radiculopathies.
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Pedicle screws are routinely used in contemporary spinal surgery. Screw misplacement may be asymptomatic but is also correlated with potential adverse events. Computer-assisted surgery (CAS) has been associated with improved screw placement accuracy rates. However, this technology has substantial acquisition and maintenance costs. Despite its increasing usage, no rigorous full economic evaluation comparing this technology to current standard of care has been reported. ⋯ Computer-assisted spinal surgery has the potential to reduce reoperation rates and thus to have serious cost-effectiveness and policy implications. High acquisition and maintenance costs of this technology can be offset by equally high reoperation costs. Our cost-effectiveness analysis showed that for high-volume centers with a similar case complexity to the studied population, this technology is economically justified.