Delayed Adjacent Level Spondylodiscitis after Initial Surgery with Instrumented Spinal Fusion: A Report of Three Cases and Review of the Literature.

To date, 2 cases of adjacent level spondylodiscitis occurring a few months after initial spinal fusion were reported. However, the development of delayed adjacent level spondylodiscitis is very rare. The authors report 3 cases of spondylodiscitis that occurred at the proximal adjacent level of the fused spine more than 1 year after the initial surgery. Antibiotic treatment was initially chosen in all three cases. In two of the cases, progressive neurological deficit occurred at the level of the infection due to compression of neural elements and spinal instability. For these patients, additional spinal fusion was performed. In each of the three cases, the selected treatment resulted in successful bony fusion at the level of the spondylodiscitis. According to the National Nosocomial Infections Surveillance System, deep wound infection is defined as occurring within 1 year after surgery with instrumentation. The spondylodiscitis in the present cases occurred more than 1 year after the initial surgery, suggesting that these cases may be considered as adjacent segment disease rather than surgical site infection.

Anterior spinal fixation for recollapse of cemented vertebrae after percutaneous vertebroplasty.

Although recollapse after percutaneous vertebroplasty (PV) is a serious complication that needs salvage surgery, there is no consensus regarding the best operative treatment for this failure. We present cases of 3 patients, diagnosed as having thoracic osteoporotic vertebral fractures, who had undergone PV at other institutes. Within less than half a year, recollapse occurred at the cemented vertebrae in all 3 patients, and we conducted anterior spinal fixation (ASF) on them. In all cases, ASF relieved the patient's severe low back pain, and there was no recurrence of symptoms during the follow-up period of 6 years, on average. ASF is the optimal salvage procedure, since it allows for the direct decompression of nerve tissue with reconstruction of the collapsed spinal column, and preservation of the ligaments and muscles that stabilise the posterior spine. Surgeons who perform PV need to be able to assess this failure early and to perform spinal fixation.

Sagittal Cervical Alignment in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective case series of surgically treated adolescent scoliosis patients. OBJECTIVES: To assess the radiographic changes of cervical kyphosis and identify the possible factors affecting postoperative sagittal cervical kyphosis in surgically treated patients with adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Cervical kyphosis is a well-recognized phenomenon in patients with adolescent idiopathic scoliosis. Despite recent reports, the prevalence, radiographic changes, and possible factors affecting postoperative sagittal cervical kyphosis are controversial. MATERIALS AND METHODS: A retrospective review of a single-center database was performed on 133 consecutive patients with adolescent idiopathic scoliosis treated with long instrumented (more than 5 levels) spine fusion (minimum, 2 years; mean, 3.3 years; range, 2 to 5.5 years). A total of 89 patients met all of the inclusion criteria. Preoperative and postoperative radiographic measurements and patient demographics were investigated. RESULTS: Postoperative cervical kyphosis was observed in 46 patients. Cobb angle decreased from 48.1° ± 13.1° to 15.4° ± 11.1° at the final follow-up. Cervical kyphosis significantly decreased from 5.5° ± 8.9° preoperatively to -1.5° ± 8.9° at the final follow-up. No difference was observed for T2-T5, T5-T12, lumbar lordosis, sacral slope, pelvic incidence, pelvic tilt, and sagittal vertical axis during the follow-up. Notably, T2 sagittal tilt was significantly increased from preoperatively to the final follow-up. Pearson correlation coefficient test showed a strong correlation between postoperative cervical lordosis and T2 sagittal tilt (r = 0.73; p < .001). CONCLUSIONS: Despite the significant increase of cervical lordosis, 85% of patients still have a kyphotic or less lordotic cervical spine. The strong positive association between cervical lordosis and T2 sagittal tilt suggests that the sagittal cervical alignment of adolescent idiopathic scoliosis patients is closely related to the global sagittal spine balance rather than thoracic kyphosis.

Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis?

STUDY DESIGN: Retrospective, observational study. OBJECTIVE: To assess the efficacy and safety of tranexamic acid (TXA) in decreasing operative blood loss and the need for transfusion during posterior spinal fusion for the treatment of idiopathic scoliosis in adolescents. SUMMARY OF BACKGROUND DATA: Blood loss associated with spinal surgery is a common potential cause of morbidity and often requires a blood transfusion, which subjects patients to the known risks of blood transfusion including transmission of diseases. Since the 1990s, intraoperative administration of antifibrinolytics has gained popularity. This study assesses the efficacy and safety of TXA in controlling blood loss during posterior spinal fusion for the treatment of idiopathic scoliosis in adolescents at 1 institution. METHODS: A retrospective comparative analysis of 106 consecutive adolescents undergoing posterior spinal fusion procedures at 1 institution was performed. Patients were analyzed according to treatment group: controls (63) and TXA (43). There were no significant differences in demographic (age, sex, and comorbidities) or surgical traits (surgical time, number of fused vertebrae, preoperative hematocrit and hemoglobin) between the 2 groups. RESULTS: TXA group had significantly less intraoperative blood loss (613 ± 195 mL) than the control group (1079 ± 421 mL; P < 0.001) as well as postoperative blood loss (155 ± 86 mL and 263 ± 105 mL, respectively; P < 0.001). TXA group received significantly less blood during the surgical procedure than the control group (258 ± 246 mL and 377 ± 200 mL, respectively; P < 0.001). There were no major intraoperative complications for any of the treatment groups. CONCLUSION: TXA treatment group lost significantly less blood and received significantly fewer blood transfusions than the control group without significant differences in intra- and postoperative complications. A multicenter randomized prospective analysis would provide additional information of the efficacy and safety of TXA.

Surgical treatment of Charcot spine.

The authors report 4 cases of Charcot spine treated surgically. In the surgical treatment, combined anterior and posterior with extensive debridement, autogenous bone grafting, and posterior instrumentation is the main therapeutic modality. Some cases with mild bone destruction could be treated by posterior interbody fusion. For the unstable, symptomatic Charcot spine, surgical treatment can provide excellent results.

Surgical treatment of lumbar ossification of the posterior longitudinal ligament. Report of two cases and description of surgical technique.

The authors report two cases of patients with lumbar ossification of the posterior longitudinal ligament (OPLL). One patient underwent surgery via the single posterior approach, and the other patient underwent combined anterior-posterior surgery. The authors consider the anterior approach for excision of the ossified lesion to be the most reasonable for treatment of lumbar OPLL. It is extremely important, however, to select the surgical procedure according to the individual patient's condition.

Cervical laminoplasty for subaxial lesion in rheumatoid arthritis.

Expansive laminoplasty of the cervical spine was performed for 15 patients with subaxial lesion (SAL) in rheumatoid arthritis (RA) with or without symptomatic occipitocervical pathology. Clinical results were satisfactory, and radiographic evaluation revealed that the range of movement of the cervical spine decreased to 56.3%, spinal alignment was well preserved, and intervertebral slipping advanced only slightly. Therefore, expansive laminoplasty is shown to be clinically effective in decompressing the subaxial spinal cord without the need for fusion of this region, yet it avoids exacerbating or creating significant instability. We found that it can serve as a useful procedure for treating spinal cord compression caused by SAL in RA. For patients with upper cervical instability, laminoplasty with upper cervical fusion appears to be an effective option. In a case in which kyphosis was observed preoperatively, its deformity became worse after laminoplasty. Thus, it may be advisable to consider subaxial fusion in such cases.