SummaryThe cross-pin technique presented here was technically easy to perform, allowed latitude in pin placement, had manageable post-operative issues and allowed for facilitated pin removal. Objective patient inclusion criteria remain to be established.
A preliminary report warned that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could have neuro-invasive potential as it was observed that some patients showed neurologic symptoms such as headache, nausea, and vomiting. Following early speculation there have been reports of neurologic manifestations involving both the central nervous system and peripheral nervous system including reports that coronavirus disease 2019 (COVID-19) may increase the risk of acute ischemic stroke. Here we present a patient with recent COVID-19 infection who experienced low-pressure hydrocephalus requiring high-output cerebrospinal fluid (CSF) diversion following spontaneous angiogram-negative subarachnoid hemorrhage. We hypothesize that patients who are either currently or who have recently been infected with SARS-CoV-2 may have altered ventricular compliance and/or altered CSF hydrodynamics from mechanisms that are not yet understood but potentially related to previously described pathophysiologic mechanisms of the virus and associated inflammatory reaction.
INTRODUCTION As surgeons become more aware of deformity, some say that “you either treat deformity or you create it.” A common concern is that patients who undergo 1 or 2-level lumbar fusions for degenerative disease may need more extensive procedures due to undetected spinal misalignment. We prospectively evaluated our 1 or 2-level lumbar fusion candidates with standing scoliosis films to determine whether we needed to change our initial operative plan. METHODS All patients, offered a lumbar fusion, were recommended to undergo standing scoliosis films prior to surgery. The sagittal vertical alignment (SVA) and pelvic incidence (PI) minus lumbar lordosis (LL) were measured using free available software (Surgimap). RESULTS Between January 2015 and December 2018, 170 patients underwent a 1 or 2-level fusion at our institution, of which 127 accepted to undergo standing scoliosis films prior to surgery. The average SVA was 1.5 cm (range: −5 to 11 cm) and average PI-LL was 2.5 degrees (range: −5 to 11 degrees). The borderline patients were older and the parameters were considered acceptable for age. The original operative plan was not changed for any patient. CONCLUSION Standing scoliosis films are probably not necessary in patients who are candidates for a 1 or 2-level lumbar fusion for degenerative disease. This imaging is not available in most hospitals and incurs additional costs that should be reserved for patients needing multilevel fusions and/or clinical deformity correction
Sexual activity is unlikely to result in spinal injuries. We present the first case of a cervical fracture-subluxation and spinal cord injury following sexual activity. This 31-year-old female presented to the emergency room with neck pain and quadriparesis, following sexual activity in an extreme position. Imaging revealed a hyperflexion cervical fracture-subluxation injury, requiring reduction by traction, followed by circumferential surgical fixation. At 6 months postoperatively, she reported baseline return of function. This case demonstrates that sex-induced spinal injuries are possible and may require urgent surgical treatment.
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