Bilateral psoas release for long standing hip-spine syndrome: surgical technique and case report

ABSTRACT: Background: Severe positive sagittal malalignment can potentially lead to shortening and contracture of the psoas and joint capsule in a flexed spinopelvic position. The utilization of bilateral psoas release to supplement sagittal spinal deformity correction in the same hospitalization was not reported in the literature. Case presentation: A 66-year-old patient presented with a 5-year history of severe global spinal deformity (sagittal vertical axis 220 mm, 60° spinopelvic mismatch) that did not improve on supine radiographs, and a modified Thomas test with more than 30° flexion contracture of bilateral hips. A 3-stage operation utilizing posterior spinal column osteotomies, anterior lumbar interbody fusion, and bilateral psoas releases was performed. Outcome: Her postoperative alignment significantly improved and she was pleased with her new posture and the ability to stand up straight. Conclusions: This report is the first to demonstrate safe and substantial correction of severe spinal deformities associated with bilateral hip flexion contracture in 1 hospitalization

Using Conventional Analysis in Parallel with Geographical Information Systems Techniques to Examine the Distribution of Brown Shrimp in the Mississippi Sound

A geographical information systems technique for visualizing spatial data was used ill Conjunction with standard analytical procedures to examine the size-specific distribution of brown shrimp Farfantepenaeus aztecus in nearshore nursery areas and open waters of the Mississippi Sound. Brown shrimp abundance was assessed during 2000, 200 1, and 2002 by means of an otter trawl along 10 transects consisting of three stations each. The number of brown shrimp, together with the dissolved oxygen, temperature, and salinity values, were collected at each sampling station. A decreasing trend in salinity was observed from cast to west. The highest salinities were measured in 2000. No temporal patterns in dissolved oxygen or temperature were apparent. Brown shrimp showed the highest abundances in western Mississippi Sound, an area adjoining the extensive marshes of St. Tammany and St. Bernard parishes in Louisiana. The average size of the brown shrimp in the western sound was smaller than that of the brown shrimp in other areas, indicating continued recruitment in the former area

Historical Changes in Seagrass Coverage on the Mississippi Barrier Islands, Northern Gulf of Mexico, Determined From Vertical Aerial Imagery (1940-2007)

Vertical aerial image data were used with an edge-detection procedure and visual image interpretation to determine yearly to decadal changes in seagrass (predominantly Halodule wrightii Ascherson) coverage on the Mississippi barrier islands. On Horn Island, seagrass coverage declined from 77 ha in 1940 to 19 ha in 1971, but returned to its 1940 value by 2006. Coverage on Petit Bois declined from 54 ha in 1940 to 8–19 ha from 1952 through 2007. On East Ship, seagrass coverage varied at 2–19 ha from 1963 to 2007. On West Ship, coverage dropped to zero in 2003, but by 2007 it had increased to approximate its 1975 value of 1.8 ha. On Cat Island, coverage increased from 22 ha in 2003 to 71 ha in 2007. There was no apparent negative impact of Hurricane Camille or Hurricane Katrina on seagrass coverage, which could vary annually by a factor of two or more

Burst fracture treatment caudal to long posterior spinal fusion for adolescent idiopathic scoliosis utilizing temporary lumbo-pelvic fixation with restoration of lumbar mobility after instrumentation removal

ABSTRACT: Background: Thoracolumbar burst fractures are common traumatic spinal fractures. The goals of treatment include stabilization, prevention of neurologic compromise or deformity, and preservation of mobility. The aim of this case report is to describe the occurrence and treatment of an L4 burst fracture caudal to long posterior fusion for adolescent idiopathic scoliosis (AIS). Case report: A 15-year-old girl patient underwent posterior spinal fusion from T3–L3. The patient tolerated the procedure well and there were no complications. Seven years postoperatively, the patient reported to the emergency department with lumbar pain after fall from height. A burst fracture at L4 was diagnosed and temporary posterior instrumentation to the pelvis was performed. One-year postinjury, the hardware was removed with fixation replaced only into the fractured segment. Flexion/extension radiographs revealed restored motion. Conclusions: Treatment of fractures adjacent to fusion constructs may be challenging. This case demonstrates that avoiding fusion may lead to satisfactory outcomes and restoration of mobility after instrumentation removal

Acute spinal cord compression in the setting of chronic extramedullary hematopoiesis of the thoracic spine

Background: Though rare, pathologic extramedullary hematopoiesis (EMH) can occur in response to myeloproliferative disorders and may present as paravertebral masses. Case Description: We describe a 63-year-old female with unspecified thalassemia, hemochromatosis, and known asymptomatic extramedullary hematopoiesis of the thoracic spine who acutely developed severe spinal cord compression and a T9 vacuum phenomenon fracture 7 months after her initial diagnosis. Outcome: The patient was treated with urgent decompression and T9 kyphoplasty, which resulted in complete resolution of her neurological deficits. Conclusions: The timeline of symptomatology in the case suggests that asymptomatic patients with T-spine extramedullary hematopoiesis can develop progressive neurologic deterioration and atraumatic compression fractures culminating in acute spinal cord injury. While it may be appropriate to treat asymptomatic patients conservatively, surgical decompression must always remain a consideration

Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes

Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients’ bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes

Delayed cerebrospinal fluid (CSF) leak following anterior cervical discectomy and fusion surgery

Background: An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early. Case Description: This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness. Imaging revealed ACDF plate subsidence and CSF leak with inferior displacement of the cerebellar tonsils. Outcome: The patient underwent a revision procedure with removal of index screws and CSF repair using epidural blood patch, fat graft, and Tisseel. The original bicortical screws were replaced with shorter larger diameter unicortical screws. Post-operative imaging at 2 and 6 weeks confirmed resolution of CSF leak. Conclusions: Healthcare professionals and patients undergoing spinal surgery should be aware of late presentation CSF leaks which can represent gradual decline in neurological function. Surgical candidates at risk to develop CSF leaks should be counseled about possible complications in preoperative planning