The spine journal : official journal of the North American Spine Society
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There have been several reports describing the usage of subaxial cervical laminar screws. However, the anatomic feasibility of placing such screws has not been thoroughly evaluated yet. ⋯ The relatively high success rate at C7, particularly of unilateral placement, suggests that laminar screw placement can be a sound alternative method for fixation at this level. However, careful preoperative CT scan evaluation and patient selection are required, particularly for bilateral fixation in women. At C3 and C6, unilateral screw placement can be considered in approximately 30% of patients after careful selection using preoperative CT scans. At C4 and C5, neither unilateral nor bilateral screw fixation is recommended for most patients.
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Clinical Trial
Routine insertion of the lateral mass screw via the posterior arch for C1 fixation: feasibility and related complications.
To our knowledge, there is no clinical study analyzing the feasibility and complications of the routine insertion of the lateral mass screw via the posterior arch for C1 fixation in a live surgical setting. ⋯ Routine insertion of the lateral mass screw via the C1 posterior arch was feasible in even those with a small posterior arch, ponticulus posticus, or persistent first intersegmental artery. Although cortical perforation or vertical splitting of the posterior arch was often inevitable, it did not lead to significant weakening of the fixation or nonunion. Vertical split could be minimized by overdrilling the posterior arch. Vertebral artery injury was preventable by mobilization before screw insertion. Occipital neuralgia was not uncommon but thought to be unrelated to screw placement in most cases.
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Previous studies have demonstrated significant changes in red blood cell (RBC) transfusion practice over several decades. ⋯ In this retrospective review, we report a significant change in blood management strategies in pediatric patients undergoing elective scoliosis surgery. We demonstrated a shift from utilization of allogeneic RBC transfusion toward preoperative donation and intraoperative autotransfusion. Although transfusion triggers were significantly lower in the recent practice group, we were unable to demonstrate a difference in major morbidity or mortality. Utilization of autologous RBC transfusion was safe and effective in reducing allogeneic RBC transfusions in this study. The advantages of autologous blood transfusion may be in preserving a relatively scarce resource (ie, allogeneic blood), rather than mitigating transfusion-related complications.
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Spinous process fracture is a recognized complication associated with interspinous process spacer (IPS) surgery. Although occasionally identified by plain radiographs, computed tomography (CT) appears to identify a higher rate of such fractures. Although osteoporotic insufficiency fracture is considered a contraindication for IPS surgery, a formal risk factor analysis for this complication has not previously been reported. ⋯ Degenerative spondylolisthesis appears strongly associated with the occurrence of spinous process fracture after IPS surgery. There is a trend toward increased fracture risk in patients with decreased bone mineral density as measured by both DXA scan and CT-based volume averaging of Hounsfield units, but osteoporosis appears to be a relatively weaker risk factor. The association between spondylolisthesis and fracture observed in this study may account for the relatively poorer outcome of IPS surgery in patients with spondylolisthesis that has been reported in previous series.