Percutaneous vertebroplasty was first introduced in 1984 by Galibert et al. for the treatment of hemangiomas in the spine. The current indications for vertebroplasty also include compression fractures due to osteoporosis as well as osteolytic metastases and spinal myeloma lesions. With the numbers of percutaneous vertebroplasty performed by orthopedic and trauma surgeons, neurosurgeons, and radiologists steadily increasing, complications have also risen. Over the last 3 years an increasing number of cases with varying complications, their genesis, and their management have been reported in the literature. Complications include asymptomatic cement leakage, cardiovascular effects, embolism with lethal outcome as well as severe neurological deficits. This article presents a review of the complications reported in the literature, strategies for preventing possible complications as well as current concepts in therapy management. Several of our cases with cement leakages are presented.
Minimizing the surgical approach in treating patients with spinal infections by using local antibiotic treatment and avoiding a ventral approach reduces the anesthesia and surgical risks in patients with comorbidities. In this study we used calcium sulphate pellets (OsteoSet T and the OsteoSet Bone-void Filler kit) as a delivery system for different antibiotics. Of a group of 32 patients with histologically and microbiologically diagnosed spondylitis, a cohort of 16 patients was treated by just a dorsal surgical approach in combination with a local antibiotic delivery system. Of these 16 patients, 14 patients showed a normalization of the infection parameters, no more bone loss in the spondylitic region, and a bony fusion after 6 to 9 months postoperatively. Two patients died from septic circumstances 4 and 6 weeks postoperatively. Two patients had to have one revision surgery because of a seroma; no other complications caused by the calcium sulphate pellets were observed. The use of calcium sulphate pellets as antibiotic delivery system allows a controlled local antibiotic therapy with an osteoconductive material in combination with a minimized surgical approach. Furthermore, calcium sulphate pellets have proven their reliable capability as bone void filler.
The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.
In contrast to the present, the diagnosis and treatment of pes cavus was a major subject of research at the beginning of last century. This was due to the high incidence of certain neurological disorders (poliomyelitis, myelodysplasia) which led to the development of this foot deformity. Advances in anaesthetic technique and the establishment of antisepsis contributed largely to the development of the surgical treatment of pes cavus. Ladislaus Leo Freiherr von Lesser performed the first surgically induced ankylosis of the ankle by denuding the joint surfaces of cartilage followed by fixation with a metal nail. This procedure was then introduced as arthrodesis; a word derived from the Greek meaning "binding of the joint". Numerous methods and modifications of arthrodesis have been developed for the correction of foot deformities. With increasing knowledge of the pathogenesis of pes cavus, soft tissue and tendon transfer procedures were added to the surgical treatment. Today, the philosophy of arthrodesis in the treatment of foot deformity is the same, but the development of fixation techniques and implant materials could improve postoperative care and outcome.
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