Object The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. Methods Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool. Results Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006. Conclusions During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.

Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of the subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously dormant vertebral hemangiomas. However, the occurrence is rare with only 24 cases reported in the literature. The authors present a case of vertebral hemangioma symptomatic during the third trimester of pregnancy. The patient, a 20-year-old woman in her 33rd week of pregnancy, initially presented with acute back and bilateral leg pain, and developed the cauda equina syndrome within a week of its onset. Imaging studies revealed an L2 vertebral hemangioma, and the thecal sac was severely compressed by the epidural portion of the tumor. Emergency decompression and reconstruction surgery was undertaken 3 days after an uneventful cesarean section. The combined surgical management, consisting of laminectomy, intraoperative vertebroplasty, and segmental fixation, afforded adequate decompression, instant mechanical stability of the spine, and prompt pain elimination. The long-term efficacy of this combined treatment is unclear and needs to be followed cautiously.

Femoral reaming provides an alternative source of autograft bone when other sources are unavailable.

Object Anterior lumbar interbody fusion (ALIF) is often supplemented with instrumentation to increase stability in the spine. If anterior plate fixation provided the same stability as posterior pedicle screw fixation (PSF), then a second approach and its associated morbidity could be avoided. Methods Seven human cadaveric L4–5 spinal segments were tested under three conditions: ALIF with an anterior plate, ALIF with an anterolateral plate, and ALIF supplemented by PSF. Range of motion (ROM) was calculated for flexion/extension, lateral bending, and axial torsion and compared among the three configurations. Results There were no significant differences in ROM during flexion/extension, lateral bending, or axial torsion among any of the three instrumentation configurations. Conclusions The addition of an anterior plate or posterior PS/rod instrumentation following ALIF provides substantially equivalent biomechanical stability. Additionally, the position of the plate system, either anterior or anterolateral, does not significantly affect the stability gained.