scholarly journals Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Sinan Kahraman ◽  
Meriç Enercan ◽  
Özkan Demirhan ◽  
Türker Şengül ◽  
Levent Dalar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Postoperative Period ◽  
Spinal Canal ◽  
Posterior Instrumentation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Early Postoperative Period ◽  
Screw Length ◽  
Cord Injury ◽  
Tracheal Tear

Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period.

Neurological Improvement Associated with Late Decompression of the Thoracolumbar Spinal Cord

Neurosurgery ◽  
1984 ◽  
Vol 14 (3) ◽  
pp. 302-307
Author(s):  
J. Maiman Dennis ◽  
J. Larson Sanford ◽  
C. Benzel Edward
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Canal ◽  
Spinal Instrumentation ◽  
Spinal Fixation ◽  
Neurological Improvement ◽  
Fixation Devices ◽  
Cord Injury ◽  
Spinal Fixation Devices ◽  
Premature Removal

Abstract We reviewed the cases of 20 patients admitted to our institution with thoracolumbar spinal cord injury who had previously undergone laminectomy and/or spinal instrumentation. Thirteen patients had a mass in the spinal canal, and 7 had kyphotic deformities. The lateral extracavitary approach to the spine and posterior stabilization when indicated were done in each. Seventeen patients obtained substantial neurological improvement. All 7 patients with kyphosis regained the ability to walk, as did all but 3 of the nonambulatory patients with a mass in the spinal canal. Morbidity was limited to pneumothorax and 1 case of late kyphosis associated with premature removal of the spinal fixation devices. Elective anterior approaches for reconstruction of the spinal canal with appropriate stabilization afford the best opportunity for neurological improvement in cases of thoracolumbar spinal cord injury.

scholarly journals Management of spinal cord injury–related scoliosis using pedicle screw–only constructs

2015 ◽  
Vol 22 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Steven W. Hwang ◽  
Mina G. Safain ◽  
Joseph J. King ◽  
Jeff S. Kimball ◽  
Robert Ames ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Shoulder Balance ◽  
Radiographic Outcomes ◽  
Cord Injury ◽  
Scoliosis Correction ◽  
Almost All

OBJECT Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw–only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution. Methods Medical records and radiographs from Shriner's Hospital for Children–Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed. Results Thirty-seven patients, whose mean age at the index surgery was 14.91 ± 3.29 years, were identified. The cohort had a mean follow-up of 33.2 ± 22.8 months. The mean preoperative coronal Cobb angle was 65.5° ± 25.7°, which corrected to 20.3° ± 14.4°, translating into a 69% correction (p < 0.05). The preoperative coronal balance was 24.4 ± 22.6 mm, with a postoperative measurement of 21.6 ± 20.7 mm (p = 1.00). Preoperative pelvic obliquity was 12.7° ± 8.7°, which corrected to 4.1° ± 3.8°, translating into a 68% correction (p < 0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2° ± 8.4°, which corrected to 2.7° ± 3.1° (67% correction, p < 0.05). Preoperatively, thoracic kyphosis measured 44.2° ± 23.7° and was 33.8° ± 11.5° postoperatively. Thoracolumbar kyphosis was 18.7° ± 12.1° preoperatively, reduced to 8.1° ± 7.7° postoperatively, and measured 26.8° ± 20.2° at the last follow-up (p < 0.05). Preoperatively, lumbar lordosis was 35.3° ± 22.0°, which remained stable at 35.6° ± 15.0° postoperatively. Conclusions Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.

scholarly journals P.125 Back “pane” secondary to glass coffee table mishap: a very unusual penetrating injury to the thoracic dura without spinal cord injury

2019 ◽  
Vol 46 (s1) ◽  
pp. S46
Author(s):  
R Mercure-Cyr ◽  
D Fourney
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Canal ◽  
Motor Evoked Potential ◽  
Cerebrospinal Fluid Leak ◽  
Penetrating Injury ◽  
Glass Fragment ◽  
Rare Injury ◽  
Thoracic Spinal ◽  
Cord Injury

Background: Non-gunshot wound penetrating injury to the spinal canal have been known to have variable injury patterns with respect to trajectory and depth. Methods: We present a case of a penetrating glass fragment injury to the T11-12 level with a cerebrospinal fluid leak. Results: A T11-12 bilateral laminectomy and duraplasty with motor-evoked potential monitoring was performed to remove the foreign object and associated hematoma. The clinical presentation and surgical management are discussed with respect to other non-gunshot-related penetrating spine injuries in the literature. Conclusions: This case demonstrates a very rare injury pattern, as the vast majority of intradural penetrating injuries to the thoracic spine result in complete or incomplete spinal cord injury. This patient was neurologically intact, which is remarkable, given the 7cm glass fragment crossing the thoracic spinal canal transversely from the right to left.

scholarly journals Use of subtransverse process polyester bands in pediatric spine surgery: a case series of 4 patients with a minimum of 12 months’ follow-up

2016 ◽  
Vol 17 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Ben A. Strickland ◽  
Christina Sayama ◽  
Valentina Briceño ◽  
Sandi K. Lam ◽  
Thomas G. Luerssen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Case Series ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Lessons Learned ◽  
Minimal Risk ◽  
Instrumented Fusion ◽  
Cord Injury ◽  
Posterior Instrumented Fusion

OBJECT In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients. METHODS The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands. RESULTS Four patients, ranging in age from 11 to 22 years, underwent posterior instrumented fusion for neuromuscular scoliosis (3 patients) and thoracic hyperkyphosis (1 patient). There were 3 instances of transverse process fracture, with application and tensioning of the polyester band in 1 patient. Importantly, there was no instance of spinal cord injury with subtransverse process passage of the polyester band. The lessons learned from this technique are discussed. CONCLUSIONS This study has shown the “Eleghia” technique of passing subtransverse process bands to be a technically straightforward and neurologically safe method of spinal fixation. Pedicle screws, laminar/pedicle/transverse process hooks, and sublaminar metal wires/bands have been incorporated into posterior spinal constructs; they have been widely reported and used in the thoracic and lumbar spines and sacrum or ilium with varying success. This report demonstrates the promising results of hybrid posterior spinal constructs that include the Eleghia technique of passing subtransverse process polyester bands. This technique incorporates technical ease with minimal risk of neurological injury and biomechanical stability.

Incidence of intraoperative hypotension in acute traumatic spinal cord injury and associated factors

2020 ◽  
Vol 32 (1) ◽  
pp. 127-132 ◽  
Author(s):  
Xavier P. Gaudin ◽  
Jacob C. Wochna ◽  
Timothy W. Wolff ◽  
Sean M. Pugh ◽  
Urmil B. Pandya ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Associated Factors ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Spinal Instrumentation ◽  
Discharge Disposition ◽  
Intraoperative Hypotension ◽  
Cord Injury ◽  
Asia Score

OBJECTIVEThe importance of maintaining mean arterial pressure (MAP) > 85 mm Hg for patients with acute spinal cord injury (SCI) is well documented, because systemic hypotension greatly increases the risk of secondary SCI. Current literature focuses on the ICU setting; however, there is a paucity of data describing the changes in MAP in the operating room (OR). In the present study, the authors investigated the incidence of intraoperative hypotension for patients with acute traumatic SCI as well as any associated factors that may have impacted these findings.METHODSThis retrospective study was performed at a level 1 trauma center from 2015 to 2016. All patients with American Spinal Injury Association (ASIA) score A–D acute traumatic SCIs from C1 to L1 were identified. Those included underwent spinal instrumentation and/or laminectomy decompression. Associated factors investigated include the following: age, body mass index, trauma mechanism of injury, Injury Severity Score, level of SCI, ASIA score, hospital day of surgery, total OR time, need for laminectomy decompression, use of spinal fixation, surgical positioning, blood loss, use of blood products, length of hospital stay, length of ICU stay, and discharge disposition. Intraoperative minute-by-minute MAP recordings were used to determine time spent in various MAP ranges.RESULTSThirty-two patients underwent a total of 33 operations. Relative to the total OR time, patients spent an average of 51.9% of their cumulative time with an MAP < 85 mm Hg. Furthermore, 100% of the study population recorded at least one MAP measurement < 85 mm Hg. These hypotensive episodes lasted a mean of 103 cumulative minutes per operative case. Analysis of associated factors demonstrated that fall mechanisms of injury led to a statistically significant increase in intraoperative hypotension compared to motor vehicle collisions/motorcycle collisions (p = 0.033). There were no significant differences in MAP recordings when analyzed according to all other associated factors studied.CONCLUSIONSThis is the first study reporting the incidence of intraoperative hypotension for patients with acute traumatic SCIs, and the results demonstrated higher proportions of relative hypotension than previously reported in the ICU setting. Furthermore, the authors identified that every patient experienced at least one MAP below the target value, which was much greater than the initial hypothesis of 50%. Given the findings of this study, adherence to the MAP protocol intraoperatively needs to be improved to minimize the risk of secondary SCI and associated deleterious neurological outcomes.

scholarly journals The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ramazan Erden Erturer ◽  
Bekir Eray Kilinc ◽  
Bahadir Gokcen ◽  
Sinan Erdogan ◽  
Kursat Kara ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Sagittal Plane ◽  
Operating Time ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Early Postoperative Period ◽  
X Rays ◽  
Hemivertebra Resection ◽  
The Mean

Aim. To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. Material and Method. Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. Results. Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. Conclusion. The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

The Significance of Thoracolumbar Spinal Canal Size in Spinal Cord Injury Patients

Spine ◽  
2001 ◽  
Vol 26 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Alexander R. Vaccaro ◽  
Richard S. Nachwalter ◽  
Gregg R. Klein ◽  
J. Milo Sewards ◽  
Todd J. Albert ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Canal ◽  
Cord Injury

scholarly journals Management of cervical deformity in ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E9 ◽  
Author(s):  
Daniel J. Hoh ◽  
Paul Khoueir ◽  
Michael Y. Wang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Ankylosing Spondylitis ◽  
Spinal Instrumentation ◽  
Primary Treatment ◽  
Neurological Injury ◽  
Flexion Deformity ◽  
Cervical Kyphosis ◽  
Effective Treatment Modality ◽  
Cord Injury

✓ Ankylosing spondylitis can lead to severe cervical kyphosis, causing problems with forward vision, swallowing, hygiene, patient functionality, and social outlook. Evaluation of patients with cervical flexion deformity includes assessment of global sagittal balance and chin–brow angle. The primary treatment in extreme disabling cases is surgical correction involving a posterior cervical extension osteotomy, which is a technically demanding procedure with considerable risk of neurological injury. To address the potential complications with extension osteotomy, the authors of several reports have described modifications to the surgical technique. These developments incorporate recent advances in anesthesia, neuromonitoring, and spinal instrumentation. Complications associated with the procedure include subluxation at the osteotomy level, spinal cord injury, radiculopathy, dysphagia, and pseudarthrosis. Although the risks of spinal correction are considerable, extension osteotomy remains an effective treatment modality for patients with disabling cervical flexion deformity.

Case report of ervical myelopathy due to ossification of the posterior longitudinal ligament in association with flavum ligament ossification: MRI and CT appearance

2013 ◽  
Vol 20 (2) ◽  
pp. 79-83
Author(s):  
Monique Boukobza ◽  
Jurgita Ušinskienė ◽  
Simona Letautienė
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Double Layer ◽  
Spinal Canal ◽  
Mixed Type ◽  
Cervical Spinal Cord ◽  
Asian Population ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Cord Injury

Background. Our objective is to analyze the cervical spinal cord damage and spinal canal stenosis due to OPLL which usually affects the cervical spine and leads to progressive myelopathy in 50–60s in Asian population; to demonstrate the mixed type OPLL and to show OPLL specific dural penetration signs: “double- layer” and “C-sign” on imaging. Materials and methods. Subacute cord compression developed over a 3-month period in a 43-year-old Japanese patient. Severe spinal canal narrowing was related to the mixed type OPLL at C3–C4 through C6–C7 associated to flavum ligament ossification at T3–T4. Lateral radiograph of the cervical spine showed intraspinal ossification, CT demonstrated specific dural penetration signs, and MRI disclosed spinal cord compression. Laminectomy at C3–C7 was performed and decompression of the spinal cord was confirmed by postoperative MRI. Conclusions. Absolute cervical stenosis and association with other diseases (like calcification of flavum ligament) predispose the patient to develop more severe deficit earlier in the clinical course. Specific CT signs, “double-layer” and “C-sign”, show dural involvement. MRI is a very useful modality to identify the precise level and extent of the spinal cord injury. OPLL must be included in the differential diagnosis of subacute cervical myelopathy.

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