tion, groin paresthesias, or falls. Magnetic resonance imaging revealed wedge collapse of the T5 and T6 vertebral bodies with intervertebral disk destruction and epidural abscess. Urgent thoracic decompression with debulking and posterior fusion was performed. Biopsy revealed Mycobacterium tuberculosis. He received appropriate antibiotics for 1 year. At 1-year follow-up, he regained full strength throughout the lower extremities without evidence of myelopathy. He did, however, have focal tenderness of the left rhomboid major and latissimus dorsi. Setting: Outpatient spine clinic. Results: Repeated spinal films were obtained and showed no hardware failure. The patient was referred to physical therapy for stretching and strengthening of the latissimus dorsi and rhomboids, posture education, and a home exercise program. Discussion: Roughly a third of the global population is infected with Mycobacterium tuberculosis. India had the highest incidence of the disease with 2 million cases reported by the World Health Organization in 2009. Unfortunately, early symptoms of Pott disease are often mistaken for axial low back pain, and the diagnosis is often delayed. Nonetheless, rehabilitation of patients with Pott disease requires a multidisciplinary approach to maximize motor and functional outcomes. Conclusions: A high clinical suspicion of spinal tuberculosis should be considered in foreign-born patients from endemic regions who present with mid or low back pain despite absence of constitutional symptoms or neurologic compromise. Early diagnosis and appropriate medical and/or surgical care should be combined with an early rehabilitation program to improve quality of life after spinal tuberculosis.

Setting: Outpatient chronic pain clinic. Participants: The study included 31 patients, between ages 28 and 64 years old. with chronic pain; 64.5% of subjects were women (nϭ20), and 35.5% was men (nϭ11). Interventions: Not applicable, Results: The mean pupil size for the hydrocodone group was OD 4.00 mm, OS 4.14 mm; for the oxycodone group was OD 3.00 mm, OS 3.00 mm; for the morphine sulfate group was OD 3.20, OS 3.20 mm; and for the fentanyl group was propoxyphene OD 4.80 mm, OS, 4.80 mm. We found a significant difference in pupil diameter between hydrocodone usage and fentanyl usage (PϽ.01) as well as between hydrocodone and morphine sulfate. However, there was no significant difference when comparing hydrocodone and propoxyphene or when comparing fentanyl and morphine sulfate. There was no significant difference in the measured pupil diameter when comparing groups of treatment duration. Conclusions: There is a significant difference in measured pupil diameter between schedule II and schedule III opioid usage. There was no significant association between measured pupil diameter and length of opioid usage. This is the first study that compared the effects of various opioids on pupil diameter in the chronic pain population.

erative day 11 and persisted despite temporary pain relief after trigger point injections. Setting: Acute inpatient rehabilitation unit. Results: Cervical spine radiographs demonstrated partial pull out of the C3 anterior fusion plate screws, with anterior displacement of the fibular strut graft with a slight collapse and face joint subluxation. There also was evidence of partial displacement of the C7 screws. She was transferred to orthopedic surgery for revision. Discussion: There is evidence in the medical literature of high failure rates of multilevel cervical corpectomies with instrumentation. However, we believe that this is the first reported case of failure of an ACCD in a patient with comorbidities that would impede bone healing, such as RA and T1DM; this would also be the first reported case of failure after a prior posterior laminectomy. Conclusions: This is a unique case of failure of ACCD and fusion in a patient with RA, T1DM, and a recent history of cervical laminectomy. The patient presented with a nonspecific complaint, such as postoperative cervicalgia, during rehabilitation, which supports the case for more vigilant monitoring with serial radiographs, especially in patients with comorbidities that hinder bone healing. Further studies are required to determine the role of prior posterior laminectomies and fusions, as well as medical comorbidities, in failure rates of ACCD and dynamic plate fixation.

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