Charcot spinal arthropathy

Charcot spinal arthropathy (CSA) is a rare progressive disorder of vertebral joint degeneration that occurs in the setting of any condition characterized by decreased afferent innervation with loss of deep pain and proprioceptive sensation in the vertebral column. While surgical circumferential arthrodesis remains the most effective treatment modality, it is associated with multiple complications, including hardware construct failure. This manuscript represents an up-to-date narrative review of the treatment of CSA, its associated complications, and complication prevention

Revisiting cruciate paralysis: A case report and systematic review

Objective: Cruciate paralysis is a rare, poorly understood condition of the upper craniovertebral junction that allows for selective paralysis of the upper extremities while sparing the lower extremities. Reported cases are few and best treatment practices remain up for debate. The purpose of this study was to conduct a systemic literature review in an attempt to identify prognostic predictors and outcome trends associated with cases previously reported in the literature. Materials and Methods: We conducted a systematic literature review for all cases using the term "Cruciate Paralysis," reviewing a total of 37 reported cases. All outcomes were assigned a numerical value based on examination at the last follow up. These numerical values were further analyzed and tested for statistical significance. Results: Of the 37 cases, 78.4% were of traumatic causes. Of these, there were considerably worse outcomes associated with patients over the age of 65 years (P < 0.001). Those patients undergoing surgical treatment showed potentially worse outcomes, with a P value approaching significance at P = 0.08. Conclusion: Numerous cases of trauma associated cruciate paralysis have been reported in the literature; however, there remains a strong need for further study of the condition. While certain risk factors can be elicited from currently reported studies, insignificant data exist to make any sound conclusion concerning whether surgical intervention is always the best method of treatment

Risk Factors for Supplementary Posterior Instrumentation After Anterolateral Decompression and Instrumentation in Thoracolumbar Burst Fractures.

BACKGROUND: In spite of the established benefits of anterolateral decompression and instrumentation (ALDI) for thoracolumbar burst fractures (TLBF), the indications for supplementary posterior instrumentation remain unclear. METHODS: A retrospective review of clinical and radiographic data of a prospective cohort of 73 patients who underwent ALDI for TLBF from T12 to L4. RESULTS: The mean age of the cohort was 42 ± 15 years, with 49 males and 24 females. Forty-six patients had neurological deficit, and 27 were intact. Owing to symptomatic settling, supplemental posterior instrumentation was performed in 7 out of 73 patients. The age of patients requiring supplemental posterior instrumentation (59 ± 14 years) exceeded that of patients who did not (41 ± 16, p=0.004). Otherwise, the patients who required posterior instrumentation were comparable to those treated with ALDI in terms of body mass index (BMI), American Spinal Injury Association (ASIA) scores on admission and follow-up, residual spinal canal, and local kyphosis on admission and follow-up. The posterior ligamentous complex (PLC) integrity was assessed in 38 patients in whom the MRI scans were retrievable, 31 successfully treated with ALDI, and all 7 undergoing supplementary posterior instrumentation. Subgroup analysis demonstrated that there was no difference in the incidence of PLC disruption between the 2 groups (p=0.257). CONCLUSIONS: Secondary supplemental posterior instrumentation was deemed necessary in 10% of cases following ALDI. Age was the only significant risk factor predicating supplemental posterior instrumentation

Minimally invasive treatment of thoracic disc herniations.

In the past, treatment of thoracic disc herniations has not been seen as a minimally invasive procedure. This article evaluates the progression of minimally invasive techniques for the treatment of thoracic disc herniations. Discussion of the advantages and disadvantages of the approaches is noted so that surgeons may consider them while incorporating these techniques in their practice

Predictors for Airway Complications Following Single- and Multilevel Anterior Cervical Discectomy and Fusion

STUDY DESIGN: A retrospective, multivariate analyses of a prospectively collected multicenter database. OBJECTIVE: The aim of this study was to evaluate the risk factors for postoperative airway complications following single- and multilevel anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Airway compromise following ACDF may result in catastrophic outcome. However, its predictors have not been identified by a multi-institutional study. METHODS: Patients who underwent ACDF between 2011 and 2013 were selected from the American College of Surgeons National Surgical Quality Improvement Program database. Multiple logistic regression analysis was performed to identify the risk factors for airway compromise following ACDF. RESULTS: Twelve thousand one hundred eighty-five patients were analyzed in this study. Our multivariate analysis identified older age, male gender, dependent functional status, chronic obstructive pulmonary disease, bleeding disorder, American Society of Anesthesiology class \u3e2, Wound Class \u3e2, and prolonged operative durations as significant predictors of postoperative airway compromise following ACDF. Surprisingly, multilevel and corpectomy procedures were not significant risk factors for airway complication following ACDF. CONCLUSION: We identified significant risk factors for airway compromise following ACDF procedures. While ACDF is considered a safe procedure, postoperative airway complication can lead to disastrous outcome. Continued efforts to elucidate preoperative risk factors and subsequent optimization are warranted to improve outcomes in ACDF. LEVEL OF EVIDENCE: 3

Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The identification of factors that lead to the failure of nonoperative management in neurologically intact thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: The treatment of thoracolumbar burst fractures (TLBF) can be controversial, particularly in the neurologically intact. Surgery for intact burst fractures has been advocated for early mobilization and a shorter hospital stay. These goals, however, have not always been achieved, rejuvenating an interest in nonoperative treatment. METHODS: Sixty-eight neurologically intact patients with burst fractures of the thoracolumbar junction (T11-L2), and a thoracolumbar injury classification and severity score (TLICS) of 2, were treated at our institution. Based on CT scans, patients were scored based on the load-sharing classification (LSC) scale. Initial treatment consisted of bracing in clamshell thoracolumbar orthosis and gradual mobilization. RESULTS: Owing to pain limiting mobilization, 18 patients failed nonoperative management and required instrumentation. Those who failed nonsurgical management were significantly more kyphotic (8° ± 10) and stenotic (52% ± 14%) than those successfully treated nonoperatively (3° ± 7 and 63 ± 12%, respectively). The LSC score of those undergoing surgery (6.9 ± 1.1) was also greater than those successfully treated nonoperatively (5.8 ± 1.3, P = 0.006). Length of hospitalization was longer, and hospital charges higher in those requiring surgery compared to the nonoperative group. At follow-up there was no difference between groups in the visual analog score for pain (VAS) or the Oswestry disability index. CONCLUSION: Owing to pain limiting mobilization, a quarter of neurologically intact patients with thoracolumbar burst fractures and a TLICS score of 2 failed nonsurgical management. The greater the kyphosis, stenosis, and fragmentation of the fracture, the more likely patients required surgery. In addition to the TLICS classification, other radiographic and clinical parameters should be included in selecting appropriate treatment strategy. The cost savings with nonoperative treatment of intact burst fractures, when appropriate, are significant