Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop.

Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.

Use of Omnipaque Intraoperative Dye in the Surgical Treatment of Pan-Spinal Epidural Abscesses: Technical Case Report.

BACKGROUND AND IMPORTANCE: Spinal epidural abscesses are difficult to diagnose and could have high morbidity and mortality if left untreated. If patients present with acute neurological deficits and evidence of a multilevel ventral spine abscess on neuroimaging, blood cultures should be taken and the abscess emergently evacuated in patients able to tolerate surgical interventions. CLINICAL PRESENTATION: A 57-year-old man presented with lower back pain, which progressed to include urinary retention and evidence of lumbar discitis/osteomyelitis on magnetic resonance imaging. The patient was started on antibiotic therapy. After the patient developed new cervical pain, interval magnetic resonance imaging showed extension of the abscess to involve the cervical, thoracic, and lumbar spine with intraventricular extension. The decision was made to perform a C4 corpectomy and insert a flexible ventriculoperitoneal catheter to serially flush out the abscess. Omnipaque dye was then used to ensure that the entire abscess was evacuated and no septations existed in the anterior epidural space. CONCLUSION: The patient's neurological deficits completely resolved, and he is intact a year after the operation. In selected patients with pan-spinal epidural abscesses associated with acute neurological deficits, a combination of an open approach and a catheter-based procedure in addition to an intraoperative monitoring option to ensure complete evacuation of the abscess and absence of septations in the anterior epidural space is a low-morbidity option in the armamentarium of the surgeon.

Prevention and management of dysphonia during anterior cervical spine surgery.

OBJECTIVES/HYPOTHESIS: Dysphonia is a common postoperative complaint following anterior cervical spine surgery (ACSS). The purpose of this study was to analyze voice outcomes following ACSS, to identify risk factors predicting vocal cord impairment, and to develop an algorithm for postoperative management of dysphonic patients. STUDY DESIGN: Retrospective cohort study. METHODS: This was a retrospective review of 815 consecutive patients undergoing ACSS from January 2000 to January 2009. All cases were performed using a team approach with a neurosurgeon and head and neck surgeon. Factors associated with voice change and vocal cord motion impairment were analyzed. RESULTS: The mean age of the cohort was 53 years (range, 13-88 years), with a male-to-female ratio of 1.2. There were 32 of 815 available patients (3.9%) who developed dysphonia following ACSS. Fiberoptic laryngoscopy demonstrated that only nine (1.1%) of these patients had ipsilateral vocal fold motion impairment. Of these nine patients, only one (0.1%) was found to have permanent vocal fold paralysis at 1-year follow-up. Factors that correlated significantly with voice change included kyphosis, revision surgery, and level C6-C7 surgery. Kyphosis was the only independent factor correlating with voice change. CONCLUSIONS: ACSS is a safe surgical procedure with a low incidence of postoperative dysphonia when exposure is provided by a head and neck surgeon. Team performance of ACSS appears to reduce laryngeal complications and optimize the management of temporary or permanent postoperative dysphonia.

Cervical neurapraxia in elite athletes: evaluation and surgical treatment. Report of five cases.

OBJECT: Neurapraxia, transient posttraumatic paralysis of the motor and/or sensory tracts in the spinal cord, may be a career-ending event in an athlete. Management, rehabilitation, and return-to-play decisions remain controversial. METHODS: Five elite football players were evaluated after experiencing episodes of neurapraxia. All patients experienced bilateral paresthesias--three in all four extremities and two in the upper extremities--lasting a few minutes to more than 24 hours. Transient motor deficits occurred in two individuals but caused no permanent sequelae. Neuroimaging confirmed the presence of herniated discs, focal cord compression, and no parenchymal changes in all cases. All patients underwent anterior cervical microdiscectomy and fusion, and cervical plates were placed in four. After aggressive rehabilitation and confirmation of fusion ranging from 9 weeks to 8 months postoperatively, the players were allowed to return to active play. Two of the players developed recurrent career-ending disc herniations, one above and the other below the fusion level. One player required repeated spinal cord decompression. CONCLUSIONS: Neurologically intact athletes with focal cord compression due to a single-level herniated disc may safely return to football after undergoing decompressive surgery and confirmation of fusion. It appears, however, that there may be an increased chance of repeated herniation above or below a fused level.