Complications After Percutaneous Pedicle Screw Fixation for the Treatment of Unstable Spinal Metastases.

BACKGROUND: Complications after surgical stabilization for the treatment of unstable spinal metastases are common. Less invasive surgical (LIS) procedures are potentially associated with a lower risk of complications; however, little is known regarding the complications after LIS procedures for the treatment of spinal metastases. Our primary objective was to determine the characteristics and rate of complications after percutaneous pedicle screw fixation (PPSF) for the treatment of mechanically unstable spinal metastases. The secondary objective was to identify factors associated with the occurrence of complications and survival. METHODS: A retrospective multicenter cohort study of patients who underwent PPSF between 2009 and 2014 for the treatment of unstable spinal metastases was performed. Patient data pertaining to demographics, diagnosis, treatment, neurologic function, complications, and survival were collected. RESULTS: A total of 101 patients were identified, 45 men (45 %) and 56 women (55 %) with a mean age of 60.3 ± 11.2 years. The median operating time was 122 (range 57-325) minutes with a median blood loss of 100 ml (based on 41 subjects). Eighty-eight patients (87 %) ambulated within the first 3 days after surgery. An overall median survival of 11.0 (range 0-70) months was observed, with 79 % of the patients alive at 3 months after treatment. Eighteen patients experienced a total of 30 complications; nonsurgical complications were the most commonly encountered. Prolonged operating time was independently associated with an increased risk of complications. CONCLUSIONS: A complication rate of 18 % was found after PPSF for unstable spinal metastases. Potential advantages of less invasive treatment are limited blood loss and high early ambulation rate.

Talar Fractures in Children: A Possible Injury After Go-Karting Accidents.

Go-karting is an increasingly popular high-energy sport enjoyed by both children and adults. Because of the speeds involved, accidents involving go-karts can lead to serious injury. We describe 6 talar fractures in 4 patients that resulted from go-karting accidents. Talar fractures can cause severe damage to the tibiotalar joint, talocalcaneal or subtalar joint, and the talonavicular joint. This damage can, in turn, lead to complications such as avascular necrosis, arthritis, nonunion, delayed union, and neuropraxia, which have the potential to cause long-term disability in a child.

The Subaxial Cervical Spine Injury Classification System: an external agreement validation study.

BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC treatment algorithm outcome improved agreement on treatment decisions among surgeons. STUDY DESIGN: An external classification validation study. PATIENT SAMPLE: Twelve spinal surgeons (five consultants and seven fellows) assessed 51 randomly selected cases. OUTCOME MEASURES: Raw agreement, Fleiss kappa, and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules and latent class modeling were used for accuracy analysis. METHODS: Fifty-one randomly selected cases with significant injuries of the cervical spine from a prospective consecutive series of trauma patients were assessed using the SLIC system. Neurologic details, plain radiographs, and computed tomography scans were available for all cases as well as magnetic resonance imaging in 21 cases (41%). No funds were received in support of this study. The authors have no conflict of interest in the subject of this article. RESULTS: The inter-rater agreement on the most severely affected level of injury was strong (κ=0.76). The agreement on the morphologic injury characteristics was poor (κ=0.29) and agreement on the integrity of the discoligamentous complex was average (κ=0.46). The inter-rater agreement on the treatment verdict after the total SLIC injury severity score was slightly lower than the surgeons' agreement on personal treatment preference (κ=0.55 vs. κ=0.63). Latent class analysis was not converging and did not present accurate estimations of the true classification categories. Based on these findings, no second survey for testing intrarater agreement was performed. CONCLUSIONS: We found poor agreement on the morphologic injury characteristics of the SLIC system, and its treatment algorithm showed no improved agreement on treatment decisions among surgeons. The authors discuss that the reproducibility of the SLIC system is likely to improve when unambiguous true morphologic injury characteristics are being implemented.

Traumatic complex dislocation of the atlanto-axial joint with odontoid and C2 superior articular facet fracture.

STUDY DESIGN: Case report and clinical discussion. OBJECTIVE: We intend to report a unique case of a atlantoaxial dislocation with a odontoid and C2 superior articular facet fracture. SUMMARY OF BACKGROUND DATA: Traumatic dislocation of the atlantoaxial joint in combination with a C2 fracture is a rare injury. Only 5 cases have been reported in the literature. METHODS: We present a case of a 43-year-old man with a primary atlantoaxial complex dislocation associated with an odontoid and comminuted C2 superior articular facet fracture with complete recovery of an accompanying hemiplegia after reduction. RESULTS: The patient underwent gentle traction with a halo frame until a complete reduction was achieved within 3 days, after which a vest was installed. His neurologic status improved to a slight weakness of the right shoulder in abduction (Grade 4/5) after 4 months and his C2 fracture healed in an acceptable position. CONCLUSION: To our knowledge, this is the first case of a traumatic atlantoaxial rotatory dislocation with accompanying odontoid and C2 superior articular facet fracture.

Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures.

PURPOSE: To prospectively assess short-term, midterm, and long-term pain relief in patients with painful osteoporotic vertebral compression fractures (VCFs) treated with percutaneous vertebroplasty (PV). MATERIALS AND METHODS: Visual analog scale (VAS) scores for pain at the treated vertebral level, analgesic use, and satisfaction with outcome were assessed in 112 patients after PV of 168 VCFs. Serial follow-up was performed at 24 hours and 3, 6, and 12 months and in a small number of patients at 1-3 years. Procedure-related complications were evaluated by physical examination and computed tomography of treated levels. RESULTS: After PV, VAS scores for pain at the individual vertebral levels treated and use of analgesic agents were significantly reduced compared with before treatment at every follow-up period. Within 24 hours after the procedure, the decreases in all scores were less compared with scores at later follow-up periods, but this was not significant. The preprocedural mean VAS score was 8.8 (range, 5-10). At follow-up, mean VAS scores ranged from 2.5 to 3.3 (range, 0-10). In the short term after PV, patients used significantly less analgesic drugs and 86% of patients were satisfied with the outcome. At midterm and long-term follow-up, patients used even less analgesic drugs and 95%-100% of patients were satisfied with the outcome of PV. Procedure-related complications with clinical consequences occurred in three patients (2.7%): one patient experienced a cardiovascular reaction, one patient had a pedicle chip fracture, and one had a rib fracture. CONCLUSION: PV of painful osteoporotic VCFs provides significant pain reduction in nearly all treated patients.

Intersurgeon variance in computer-assisted planning of anterior cruciate ligament reconstruction.

PURPOSE: To test the hypothesis that computer-controlled virtual planning will prohibit tunnel malpositioning and minimize variance in tunnel placement in anterior cruciate ligament (ACL) reconstruction, thereby providing us with a more accurate and reproducible procedure. TYPE OF STUDY: In vitro cadaver study. METHODS: Three orthopaedic surgeons with different levels of experience in ACL reconstruction were asked to position tunnel placement K-wires in a predefined "optimal" position using both computer-assisted surgery (CAS) and conventional techniques in 12 fresh-frozen cadaver knees. Virtual cylindrical 8-mm grafts were virtualized as the computer system outlined an impingement area and visualized graft elongation. CAS positioning and conventional techniques were compared between surgeons and correlated to experience level. RESULTS: The difference in virtual planning was 5.02 mm (SD, 2.40; range, 1.77 to 9.64 mm) between the tibial tunnels and 4.61 mm (SD, 2.13; range, 2.06 to 8.42 mm) between the femoral tunnels. The mean difference between the CAS and conventional procedures was 6.20 mm (SD, 2.49; range, 3.00 to 10.39 mm) for the femoral tunnel and 6.46 mm (SD, 2.27; range, 2.65 to 10.47 mm) for the tibia tunnel. The 2 less-experienced surgeons were responsible for 3 cases of impingement when using a conventional procedure. No elongation or impingement was seen when using CAS. CONCLUSIONS: This cadaver study shows that computer assisted planning may reduce intersurgical variance. CLINICAL RELEVANCE: Computer navigation and virtual ligament reconstruction constitute a good arthroscopic surgery teaching tool. This technique enables residents and less experienced surgeons to control positioning and limit complications caused by tunnel misplacement.

Dislocation of polyethylene liner in uncemented Harris Galante II acetabulum: report of 6 cases.

We report the dislocation of 6 liners out of the metal backing shells of Harris Galante II cementless total hip prostheses implanted between 1993 and 1996. The time between primary implantation and failure varied from 46 to 95 months. The dislocations were probably the result of suboptimal mechanical fixation of the polyethylene liner in the shell compounded by suboptimal positioning of the acetabular component. In 5 cases, both the metal backing and the liner were revised because of broken tines. In one case, only the liner was exchanged.