We report a case of high rectal injury during Trans-1 axiaLIF L5-S1 fixation and strongly advice that patients who are candidates for this surgery and have any risk factors for intra-abdominal adhesion formation, undergo a pelvic CT with rectal contrast before the surgery to evaluate for any signs of altered rectal-sacral anatomy.
Metal wear debris can form in pediatric patients during the healing process after spinal fusions or when pseudarthrosis is present. Clinically, this manifests as back pain with a possible aseptic inflammatory abscess. Hardware removal can achieve resolution of symptoms and regression of inflammation.
BackgroundWrong site surgery is one of five surgical "Never Events," which include performing surgery on the incorrect side or incorrect site, performing the wrong procedure, performing surgery on the wrong patient, unintended retention of a foreign object in a patient, and intraoperative/immediate postoperative death in an ASA Class I patient. In the spine, wrong site surgery occurs when a procedure is performed on an unintended vertebral level. Despite the efforts of national safety protocols, literature suggests that the risk for wrong level spine surgery remains problematic.Case PresentationA 34-year-old male was referred to us to evaluate his persistent thoracic pain following right-sided microdiscectomy at T7-8 at an outside institution. Postoperative imaging showed the continued presence of a herniated disc at T7-8 and evidence of a microdiscectomy at the level immediately above. The possibility that wrong level surgery had occurred was discussed with the patient and revision surgery was planned. During surgery, the site of the previous laminectomy was clearly visualized; however, we also experienced confusion when verifying the level of the previous surgery. We ultimately used the previous laminectomy site as a landmark for identifying and treating the correct pathologic level. Postoperative consultation with Musculoskeletal Radiology revealed the patient had two abnormalities in his spinal anatomy that made intraoperative counting of levels inaccurate, including a pair of cervical ribs at C7 and the absence of a pair of thoracic ribs.ConclusionThis case highlights the importance of strict adherence to a preoperative method of vertebral labeling that focuses on the landmarks used to label a pathologic disc space, rather than simply relying on the reference to a particular level. That is, by designating the pathological level as the disc space associated with the fourth rib up from the last rib-bearing vertebrae, rather than calling it "T7-8", then the correct level can be found intraoperatively even in the case of abnormal segmentation. We recommend working closely with radiology during preoperative planning to identify unusual anatomy that may have been overlooked. We also recommend that radiology colleagues use the same system of identifying pathological levels when dictating their reports. Together, these strategies can reduce the risk of wrong level surgery and increase patient safety.
Study Design. Biomechanical study using human cadaveric lumbar spines.Objective. To evaluate effects of total disc replacement (TDR) on spine biomechanics at the treated and adjacent levels. Summary of Background Data. Previous studies on spine biomechanics after TDR were focused on facet forces and range of motion and report contradictory results. Characterization of contact pressure, peak contact pressure, force, and peak force before and after TDR may lead to a better understanding of facet joint function and may aid in prediction of long-term outcomes after TDR. Methods. Seven fresh-frozen human cadaveric lumbar spines were potted at T12 and L5 and installed in a 6 degrees of freedom displacement-controlled testing system. Displacements of 15° fl exion/ extension, 10° right/left bending, and 10° right/left axial rotation were applied. Contact pressure, peak contact pressure, force, peak force, and contact area for each facet joint were recorded at L2-L3 and L3-L4 both before and after TDR at L3-L4. The data were analyzed with analysis of variance and t tests. Results. Axial rotation had the most impact on contact pressure, peak contact pressure, force, peak force, and contact area in intact spines. During lateral bending and axial rotation, TDR resulted in a signifi cant increase in facet forces at the level of treatment and a decrease in contact pressure, peak contact pressure, and peak force at the level superior to the TDR. With fl exion/extension, there was a decrease in peak contact pressure and peak contact force at the superior level. Conclusion. Our study demonstrates that rotation is the most demanding motion for the spine. We also found an increase in facet forces at the treated level after TDR. We are the fi rst to show a decrease in several biomechanical parameters after TDR at the adjacent superior level. In general, our fi ndings suggest there is an increase in loading of the facet joints at the level of disc implantation and an overall unloading effect at the level above. C hronic low back pain is the most prevalent musculoskeletal condition that results in chronic disability and sufferance for the patient, a real challenge for the medical management team and an enormous economic burden for society. 1 Considering the anatomy of the lower back, low back pain (LBP) can have multiple origin sites, including muscles, intervertebral discs, and facet and sacroiliac joints. Of all LBP causes, degenerative disc disease (ODD) plays the leading role and it follows the ageing process with 10% and 70% incidence in 50-and 70-year-old males, respectively. 2,3One of treatment option for ODD is total disc replacement (TDR). Several studies have investigated changes in spine biomechanics after TDR to different extents and in different models. Most of these studies were focused on facet forces and range of motion (ROM) and report contradictory results. 4,6 Finite element model studies predict higher ROM and increased facet forces after TDR. 6,7 Cadaveric studies confi rm an increase in ROM up to 140% of intact s...
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