Paralumbar compartment syndrome, a rare sequela of deadlifting: a case report and review of current literature.

BACKGROUND: Compartment syndrome is a well-known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting. CASE PRESENTATION: 53-year-old male who presented with progressively worsening low back pain and paresthesias one day after high-intensity deadlifting. Laboratory testing found the patient to be in rhabdomyolysis; he was admitted for intravenous fluid resuscitation and pain control. Orthopedics was consulted, and Magnetic Resonance Imaging revealed significant paravertebral edema and loss of muscle striation. Given the patient's lack of improvement with intravenous and oral pain control, clinical and radiographic findings, there was significant concern for acute paralumbar compartment syndrome. The patient subsequently underwent urgent fasciotomy of bilateral paralumbar musculature with delayed closure. CONCLUSION: Given the paucity of literature on paralumbar compartment syndrome, the authors' goal is to promote awareness of the diagnosis, as it should be included in the differential diagnosis of intractable back pain after high exertional exercise. The current literature suggests that operative cases of paralumbar compartment syndromes have a higher rate of return to pre-operative function compared to those treated non-operatively. This case report further supports this notion. The authors recommend further study into this phenomenon, given its potential to result in persistent chronic exertional pain and irreversible tissue damage.

"Bloodless" Neurosurgery Among Jehovah's Witnesses: A Comparison with Matched Concurrent Controls.

BACKGROUND: Jehovah's Witnesses (JW) are a Christian faith with >1 million members in the United States who do not accept autologous blood transfusions. The optimal management of these patients undergoing neurosurgical procedures is not well defined. Here, we examined the feasibility and safety of JW undergoing neurosurgery in a blood management program. STUDY DESIGN AND METHODS: Sixty-eight JW patients including 23 men and 45 women (mean age 53 ± 12 years) who underwent a variety of cranial (n = 19) and spinal (n = 49) neurosurgical procedures during a 5-year period were identified retrospectively and their hospital charts, anesthetic records, and operative reports reviewed. A concurrent cohort of sex-, age-, and procedure-matched non-JW controls also was identified. RESULTS: Among JW patients, a cell-saving system was used in 27 cases, with blood retransfused in 13 cases. Lactated Ringers solution was used extensively intraoperatively; albumin was given to 15 patients. The median decrease in hemoglobin was 2.1 g/dL. One patient had a postoperative hemoglobin value <7 g/dL. One patient returned to the operating room to revise a lumbar pedicle screw, and one patient had postoperative seizures. No cardiopulmonary complications, sepsis, pneumonia, or wound infection were observed. Compared with the matched control group, similar outcome results were observed. Blood loss and operative time also were similar in JW patients and controls. CONCLUSIONS: Neurosurgical procedures in Jehovah's Witnesses are feasible, safe, and have similar outcomes to patients willing to accept transfusion when managed within a multidisciplinary blood-management program.

The prevalence of indications and contraindications to cervical total disc replacement.

BACKGROUND CONTEXT: Although the prevalence of indications and contraindications to lumbar total disc replacement (TDR) has been evaluated, no study to date has quantified the potential candidacy for cervical disc replacement in practice. PURPOSE: To report the potential candidacy rate for cervical TDR from both an academic and private practice spine surgery setting. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: Patient record review of 167 consecutive patients who underwent cervical spine surgery by 1 of 2 orthopedic spine surgeons between January 1, 2003 and January 1, 2005. OUTCOME MEASURES: Evaluation of potential candidacy for cervical TDR, with emphasis on both contraindications and indications. METHODS: In this study, we used the published contraindications and indications listed in trials of four different cervical disc arthroplasty devices: ProDisc-C (Synthes Spine, West Chester, PA), PRESTIGE LP (Medtronik Sofamor Danek, Memphis, TN), Bryan Cervical Disc prosthesis (Medtronik Sofamor Danek, Memphis, TN), and Porous Coated Motion (PCM; Cervitech, Rockaway, NJ). The proportion of patients who met both inclusion and exclusion criteria was calculated. We also examined the proportion of patients who would be candidates for cervical TDR if the indications were expanded to include the treatment for adjacent segment disease (ASD). RESULTS: Of the 167 patients (mean age 50.8 years, range 20-89 years) reviewed, 91.6% (153/167) had fusion surgery and 8.4% (14/167) had nonfusion surgery. Fifty-seven percent (95/167) had absolute contraindications to cervical TDR, and within this group the average number of contraindications was 2.1 (SD=1.2, range 0-5). Forty-three percent (72/167) met the strict inclusion criteria, and had no exclusion criteria. If the indications were expanded to include treatment for ASD, an additional 4.2% (7/167) of the patients would have qualified as candidates for cervical TDR. CONCLUSIONS: Compared with lumbar TDR, total disc replacement may have a larger potential role in the treatment of cervical degenerative conditions, as 43% of patients would have met the strict criteria for TDR candidacy, or 47% if the indications were expanded to include treatment for ASD.

Posterior cervical arthrodesis for subacute odontoid fracture in a patient with osteopetrosis: case report.

STUDY DESIGN: A case of subacute odontoid fracture in a patient with osteopetrosis treated with posterior cervical arthrodesis using transarticular screws and interspinous wiring. OBJECTIVES: To report the first successful cervical arthrodesis in a patient with osteopetrosis and to highlight the potential perioperative pitfalls in this rare surgical population. SUMMARY OF BACKGROUND DATA: Osteopetrosis is a group of skeletal dysplasias characterized by osteoclast dysfunction, impaired bone resorption, and poor bone remodeling. Unique challenges associated with surgical fixation in osteopetrotic bone include a high incidence of nonunion, intraoperative fractures, intraoperative instrumentation failure, infection, and prosthesis loosening. We report the case of a patient with a subacute odontoid fracture treated successfully with posterior cervical arthrodesis using transarticular screws and interspinous wiring. METHODS: The surgical technique, intraoperative pitfalls, and 2-year follow-up data are reported. RESULTS: The patient underwent a successful posterior cervical arthrodesis using transarticular screws and interspinous wiring with autogenous iliac crest graft. At 2 years, a stable fixation was achieved with only mild postoperative limitation in neck range of motion. CONCLUSIONS: Cervical fractures and instability that require surgery in patients with osteopetrosis represent a unique challenge to the orthopedic spine surgeon. Despite the increased potential for perioperative instrumentation complications, nonunion, and infection, posterior cervical arthrodesis can be achieved and should be considered in the treatment armamentarium for this potentially catastrophic injury.

Tuberoplasty: creation of an acromiohumeral articulation-a treatment option for massive, irreparable rotator cuff tears.

This article reports the results of treatment for irreparable tears of the rotator cuff with a new procedure that we have termed a tuberoplasty. The tuberoplasty procedure involves removal of exostoses on the humerus followed by reshaping of the greater tuberosity to create a smooth, congruent acromiohumeral articulation. The coracoacromial ligament is preserved, and an acromioplasty is not performed. Twenty patients underwent this procedure with a minimum 27-month follow-up. All patients had significant disabling pain and weakness preoperatively. On the basis of the modified UCLA rating scale, the overall score increased from 9.3 to 27.7, with 12 excellent results, 6 good results, and 1 fair result (95% satisfactory). Pain relief was most dramatic, with 13 patients (68%) completely pain-free. All patients were able to perform activities of daily living, and 9 of 11 who were employed preoperatively returned to work. All patients had residual weakness in external rotation. There were no poor results and no complications.

Intramedullary injection of contrast into the cervical spinal cord during cervical myelography: a case report.

STUDY DESIGN: A case of iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography is reported. OBJECTIVE: To investigate the occurrence of iatrogenic intramedullary contrast injection during a current C1-C2 cervical myelography. SUMMARY OF BACKGROUND DATA: Intramedullary injection of contrast is a rare but serious complication of C1-C2 cervical myelography that has not been reported since the widespread use of magnetic resonance imaging and the NASCIS III study protocol. METHODS: A 39-year-old woman received an iatrogenic intramedullary contrast injection during a C1-C2 cervical myelography. RESULTS: During the procedure the patient reported right-side face, neck, and arm pain and parethesias. After the procedure, right arm weakness and diffuse hyperreflexia developed. Postmyelography imaging demonstrated intramedullary contrast and cord swelling. High-dose methylprednisolone was administered intravenously and the patient's symptoms improved. The literature and management of this rare complication are reviewed. CONCLUSIONS: Intramedullary cord injection is a rare complication of cervical myelography. The mechanism of spinal cord injury appears to involve a combination of physical compression from the injected liquid and neurotoxicity of the contrast material. Iohexol rather than metrizamide should be used when C1-C2 myelography is indicated in patients who are unable to undergo magnetic resonance imaging, or those whose pathology is inadequately demonstrated magnetic resonance imaging alone. In the event of contrast injection into the spinal cord, administration of high-dose methylprednisolone is recommended.