Sweet's syndrome associated with spinal surgical intervention. A case report.

STUDY DESIGN: A patient with a medical history of Sweet's Syndrome, an acute neutrophilic dermatosis, was seen at the authors' institution for cervical pain. After undergoing a thorough history-taking and physical examination and after experiencing no relief with conservative therapy, the patient underwent cervical spine surgery. After the surgical procedure, the patient developed multiple cutaneous lesions that were consistent with the findings associated with an acute recurrence of Sweet's Syndrome. OBJECTIVES: To characterize the authors' experience with this unusual histologically documented dermatologic disorder. SUMMARY OF BACKGROUND DATA: Sweet's Syndrome is a rare form of neutrophilic dermatosis characterized by recurrent eruptions of painful, edematous, red, tender plaques that are found predominantly on the torso in middle-aged women. After an extensive literature search, it was noted that this rare and unusual disorder has not been reported previously in association with surgical intervention of any type, including spinal operations. METHODS: The patient's postoperative course was documented, and all medical records were reviewed retrospectively. RESULTS: The patient's rash resolved spontaneously. Solid fusion of C5-C6 occurred. The patient remained neurovascularly intact, and her axial cervical pain decreased significantly from its preoperative levels. CONCLUSIONS: Sweet's Syndrome remains a rare dermatologic disorder, which may complicate a routine postoperative course. Patients with Sweet's Syndrome have an exceedingly high rate of other serious medical illness. The effect of Sweet's Syndrome on physiologic bone healing is unknown. In this patient, there was nonunion of the cervical spine, with eventual solid bony union. Perioperatively, patients with this disorder are treated with oral prednisone and oral antibiotics to prevent secondary complications at the surgical wound.

Rigid internal fixation with lateral mass plates in multilevel anterior and posterior reconstruction of the cervical spine.

STUDY DESIGN: A retrospective clinical and radiographic analysis was performed on 17 patients with multilevel cervical disease who were treated with anterior and posterior reconstruction with a new rigid, segmental, internal fixation system applied to the lateral masses. OBJECTIVES: To determine the applicability, safety, and clinical efficacy of an instrumentation system used as a cervical lateral mass plate in the management of complex spinal disorders. SUMMARY OF BACKGROUND DATA: Cervical disorders involving three or more levels present a difficult reconstruction problem, especially if the posterior elements are deficient. Segmental fixation with lateral mass plating provides an alternative method to situations that would otherwise require a halo. METHODS: Seventeen patients treated by a single surgeon underwent cervical reconstruction surgery involving three or more levels. All patients had anterior decompression and reconstruction and a posterior fusion with rigid internal fixation with a device applied to the lateral masses of the cervical vertebrae. Patients were reviewed clinically and radiographically to determine the efficacy and safety of this method of fixation. RESULTS: Of the 15 patients with adequate follow-up data that were studied, the condition of 13 patients, (87%) was improved, that of one patient (6.7%) was the same, and that of another (6.7%) was worse after surgical intervention. Sagittal alignment was restored to within 5 degrees of the preoperative lordosis in active extension by the modified Cobb method and the Gore method. No patient had radiographic nonunion. One patient had a sensory radiculopathy associated with an overpenetrated lateral mass screw that partially resolved after hardware removal. One patient had asymptomatic loosening of a C7 lateral mass screw. CONCLUSIONS: Segmental posterior fixation with lateral mass plating provides more rigid immobilization than traditional techniques, allows restoration and maintenance of spinal alignment, obviates the need for halo immobilization, and is associated with a low incidence of neurovascular injury.

Reconstructive spinal surgery: assessment of outcome.

One of the foremost problems in evaluating patients who have had spinal surgery is the difficulty in reliably assessing changes in symptoms and function attributable to the operative procedure. In this study, a questionnaire was sent to patients who had had spinal surgery at least 6 months earlier. The data were entered into a data base that contained information about the surgical procedure. Correlation studies were conducted and t tests were used to find statistically significant differences. Seventy-two patients returned the completed questionnaire. The rate of return to work was significantly lower among those involved in workers' compensation or litigation and those with prolonged preoperative unemployment. Depression inversely correlated with satisfaction, the number of dissatisfied patients correlating directly with the number of patients significantly depressed. Physical deconditioning, change in attitude and perception, preinjury job dissatisfaction, secondary gain, and other medical conditions significantly decreased the probabilities of return to work and satisfaction.