Spine Surgery and Related Research最新文献

{"title":"Secondary Osteoporosis with Normal Bone Mineral Density: A Case of Compression Fracture and Spinal Cord Injury in Cushing's Disease.","authors":"Mohamed Sarraj, Ahmed Saidahmed, Patrick Thornley, Frank Koziarz, Rami Abou Khamis, Thorsten Jentzsch, Kunal Bhanot, Colby Oitment","doi":"10.22603/ssrr.2022-0187","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0187","url":null,"abstract":"1) McMaster University, Division of Orthopedic Surgery, Department of Surgery, Hamilton General Hospital, Ontario, Canada 2) McMaster University, Department of Internal Medicine, Hamilton General Hospital, Ontario, Canada 3) Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland 4) Division of Orthopaedic Surgery, St. Michael’s Hospital, Ontario, Canada 5) Division of Orthopedic Surgery, Western University, Ontario, Canada 6) McMaster University, Department of Health Research Methods, Evidence and Impact, Ontario, Canada","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"406-409"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/42/2432-261X-7-0406.PMC10447193.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10163403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographical Results of Adolescent Idiopathic Scoliosis with Major Curve at Proximal Thoracic Spine.","authors":"Yosuke Horiuchi,&nbsp;Mitsuru Yagi,&nbsp;Satoshi Suzuki,&nbsp;Yohei Takahashi,&nbsp;Satoshi Nori,&nbsp;Osahiko Tsuji,&nbsp;Narihito Nagoshi,&nbsp;Morio Matsumoto,&nbsp;Masaya Nakamura,&nbsp;Kota Watanabe","doi":"10.22603/ssrr.2022-0088","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0088","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent idiopathic scoliosis (AIS) with a major curve at the main thoracic (MT) area is classified as Lenke type 1, 2, or 3 depending on the flexibility of the proximal thoracic (PT) curve and lumbar curve. No definite classification has been established for a major curve at the PT spine. The purpose of this study is to investigate the radiographic characteristics before and after correction surgery for AIS with a major curve at the PT area.</p><p><strong>Methods: </strong>This is a retrospective cohort study at a single academic institution. Twelve patients with a major curve at the PT spine participated in our study and followed for at least two years after surgery. We evaluated the pre- and postoperative Cobb angles of the curve, curve range, location of the apex, sagittal parameters, and shoulder balance-related parameters. All patients were treated by posterior correction and fusion surgery using pedicle screw constructs.</p><p><strong>Results: </strong>The patients were classified as having a double-curve (DC) type, in which the MT curve was structural, or a single-curve (SC) type, in which the MT curve was corrected to less than 25° on supine side-bending films. The mean correction rates for the PT curve were favorable in both groups (DC, 65.7%±9.6%; SC, 39.2%±4.9%). The mean Cobb angle of the lumbar curve improved in the DC group (preoperative, 17.1°±4.0°; postoperative, 5.0°±4.2°) but deteriorated in the SC group (preoperative, 7.1°±1.2°; postoperative, 12.4°±4.4°) after surgery.</p><p><strong>Conclusions: </strong>We illustrated the postoperative radiographical changes of 12 consecutive patients with the major curve at the PT curve. Although posterior correction and fusion surgery corrected the PT curve satisfactorily in both DC and SC patients, the Cobb angle of the lumbar curve deteriorated after surgery in all SC patients. Surgeons need to pay attention to the fusion area, especially LIV, when operating the SC curve type.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"371-376"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/94/2432-261X-7-0371.PMC10447189.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Cage Subsidence in Minimally Invasive Lateral Corpectomy for Osteoporotic Vertebral Fractures.","authors":"Shuhei Iwata,&nbsp;Toshiaki Kotani,&nbsp;Tsuyoshi Sakuma,&nbsp;Yasushi Iijima,&nbsp;Shun Okuwaki,&nbsp;Shuhei Ohyama,&nbsp;Satoshi Maki,&nbsp;Yawara Eguchi,&nbsp;Sumihisa Orita,&nbsp;Kazuhide Inage,&nbsp;Yasuhiro Shiga,&nbsp;Masahiro Inoue,&nbsp;Tsutomu Akazawa,&nbsp;Shohei Minami,&nbsp;Seiji Ohtori","doi":"10.22603/ssrr.2022-0215","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0215","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate risk factors for cage subsidence following minimally invasive lateral corpectomy for osteoporotic vertebral fractures.</p><p><strong>Methods: </strong>Eight males and 13 females (77.2±6.0 years old) with osteoporotic vertebral fractures who underwent single corpectomy using a wide-footprint expandable cage with at least a 1-year follow-up were retrospectively included. The endplate cage (EC) angle was defined as the angle between the vertebral body's endplate and the cage's base on the cranial and caudal sides. A sagittal computed tomography scan was performed immediately after surgery and at the final follow-up, with cage subsidence defined as subsidence of ≥2 mm on the cranial or caudal side. Risk factors were analyzed by dividing cases into groups with (<i>n</i>=6) and without (<i>n</i>=15) cage subsidence.</p><p><strong>Results: </strong>No significant differences were noted in age, bone mineral density, number of fixed vertebrae, sagittal parameters, preoperative and final kyphosis angle, amount of kyphosis angle correction, bone union, screw loosening, and number of other vertebral fractures preoperatively and 1-year postoperatively between the two groups. No difference was noted in cranial EC angle, but a significant difference was noted in caudal EC angle in the group with (10.7±4.1°) and without (4.7±4.2°) subsidence (<i>P</i>=0.008). Logistic regression analysis with the dependent variable as presence or absence of subsidence showed that caudal EC angle (>7.5°) was a significant factor (odds ratio: 20, 95% confidence interval: 1.655-241.7, <i>P</i>=0.018).</p><p><strong>Conclusions: </strong>In minimally invasive lateral corpectomy for osteoporotic vertebral fractures, a cage tilted more than 7.5° to the caudal vertebral endplate is a risk factor for cage subsidence. The cage should be placed as perpendicular to the endplate as possible, especially to the caudal vertebral body, to avoid cage subsidence.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"356-362"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/10/2432-261X-7-0356.PMC10447195.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Intrathecal Baclofen Dose Need to Be Changed after Spinal Fusion Surgery for Neuromuscular Scoliosis?","authors":"Kathryn M DeFoe,&nbsp;Jeremiah Atkinson,&nbsp;Jean Stansbury,&nbsp;Angela Sinner,&nbsp;Walter H Truong","doi":"10.22603/ssrr.2022-0230","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0230","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with cerebral palsy (CP) may receive intrathecal baclofen (ITB) to reduce muscle spasticity and dystonia. It can be challenging to identify the proper dose of ITB, and anecdotally these dosing needs may change after spinal fusion surgery. This study aimed to evaluate the need for changes in ITB dosing following a spinal fusion in pediatric neuromuscular scoliosis (NMS) patients and identify predisposing factors for those changes.</p><p><strong>Methods: </strong>This was a retrospective case-control study of NMS patients with an ITB pump who later received a spinal fusion surgery. Dosing changes and the indications for the changes were postoperatively noted. Demographics, preoperative factors, and surgical factors were evaluated for correlation with dosing changes.</p><p><strong>Results: </strong>A total of 49 patients were included in this study. Most had no change in ITB dose (71.4%), and others required a change that averaged about 10%. Male patients, those with larger pumps, and those that had a longer hospital stay were more likely to require a decrease in dose. Complications were similar between groups. Three catheters were revised during surgery: two continued on the same dose and one required an increase in dose after surgery.</p><p><strong>Conclusions: </strong>Spinal fusion after ITB pump placement is feasible and safe. Most patients did not require dosing changes after spine fusion; however, careful evaluation postoperatively remains prudent.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"385-389"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/d6/2432-261X-7-0385.PMC10447190.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10163402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cadaveric Simulation Study of Radiation Exposure to the Surgical Team during Fluoroscopic Spinal Surgery: How Much Are We Exposed?","authors":"Kazuta Yamashita,&nbsp;Yasuaki Tamaki,&nbsp;Daiki Nakajima,&nbsp;Yasuyuki Omichi,&nbsp;Yoshinori Takahashi,&nbsp;Michihiro Takai,&nbsp;Tomohiro Goto,&nbsp;Hiroaki Hayashi,&nbsp;Kosaku Higashino,&nbsp;Yoshihiro Tsuruo,&nbsp;Koichi Sairyo","doi":"10.22603/ssrr.2022-0184","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0184","url":null,"abstract":"Introduction The harmful effects of long-term low-dose radiation have been well known. There are few comprehensive reports evaluating concrete real exposure doses for each part of a surgeon, assistant surgeon, scrub nurse, and anesthesiologist associated with fluoroscopic spinal procedures. This research aimed to quantify the radiation exposure dose to surgical team members during C-arm fluoroscopy-guided spinal surgery. Methods Seven fresh cadavers were irradiated for 1 and 3 min with C-arm fluoroscopy. The position of the X-ray source was under the table, over the table, and laterally. The radiation exposure doses were measured at the optic lens, thyroid gland, and hand in mannequins used to simulate surgical team members. Results A significant difference was observed in the radiation exposure dose according to the position of the X-ray source and the irradiated body area. The risk of scatter radiation exposure was the biggest for the lateral position (nearly 30-fold that for the position under the table). All radiation exposure doses were positively correlated with irradiation time. Conclusions The occupational radiation exposure dose to surgical team members during C-arm fluoroscopy-guided lumbar spinal procedures varies according to the X-ray source position. Our findings would help surgical team members to know the risk of radiation exposure during various fluoroscopic procedures. Surgeons in particular need to reduce their radiation exposure by using appropriate shielding and technique.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"341-349"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/59/2432-261X-7-0341.PMC10447199.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10163404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Separation Surgery and Adjuvant Carbon Ion Radiotherapy for a Recurrent Solitary Fibrous Tumor/Hemangiopericytoma: A Case Report.","authors":"Yusuke Tomomatsu,&nbsp;Eiji Takasawa,&nbsp;Shintaro Shiba,&nbsp;Masahiko Okamoto,&nbsp;Hayato Ikota,&nbsp;Kazuhiro Inomata,&nbsp;Akira Honda,&nbsp;Sho Ishiwata,&nbsp;Tokue Mieda,&nbsp;Yoichi Iizuka,&nbsp;Tatsuya Ohno,&nbsp;Hirotaka Chikuda","doi":"10.22603/ssrr.2022-0177","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0177","url":null,"abstract":"The treatment of solitary fibrous tumor/hemangiopericytoma (SFT/HPC) remains challenging because gross total resection is difficult for vertebral lesions located near the spinal cord. Adjuvant chemotherapy and radiotherapy can be considered for cases of recurrence or malignant change. We herein report our experience of performing separation surgery and adjuvant carbon ion radiotherapy (CIRT) for a rare case of recurrent spinal SFT/HPC. Ten years ago, a 74-year-old woman visited a public hospital with a 2-month history of chest pain, muscle weakness, and hypesthesia in her lower extremities. Magnetic resonance imaging (MRI) revealed an extradural, extramedullary dumbbell-shaped tumor at the T4-T5 level (Fig. 1-A). She underwent subtotal tumor resection combined with T2-T7 fusion. Pathological examination of the resected specimen revealed SFT/HPC grade 3. Seven years after the initial surgery, she was referred to our university hospital because of unsteady gait due to progressive thoracic myelopathy. Imaging studies showed local recurrence of the tumor. We performed partial resection of the tumor surrounding the dural sac because total resection was considered to have a high risk of spinal cord injury. Postoperatively, she was able to walk without support. Two years after her second operation, she gradually became bedridden due to progressive gait disturbance with dysesthesia below the T5 level. MRI showed spinal cord compression due to the regrowth of the recurrent tumor with vertebral invasion (Fig. 1-B). We planned separation surgery and adjuvant CIRT. Following additional laminectomy, the tumor was observed as a nodular, tan to reddish-brown mass, which surrounded the dura mater. An ultrasonic scalpel was used to remove the tumor adjacent to the dural sac. Gelfoam of 1-cm thickness wrapped with Goa-Tex membrane (Fig. 2-A) was placed between the ventral dura mater and the residual tumor as a spacer (Fig. 2-B). We then applied 5.5-mm Ti-alloy rods medially to allow for the optimal trajectory of irradiation (Fig. 2-C). After separation surgery, adjuvant CIRT was performed once a day, 4 days per week, in a total of 16 fractions over 4 weeks with the respiratory-gated plan (Fig. 3-B) for a total dose of 64.0 Gy. Two years after separation surgery and adjuvant CIRT, the tumor size had decreased, and local control was maintained (Fig. 3-C, 3-D). The patient was able to walk with a cane without CIRT-related adverse events. Histopathological examination revealed spindle cells proliferating with staghorn-like shaped vessels (Fig. 4-A, 4-B). According to immunohistochemistry, the intervening blood vessels expressed biomarkers CD34, and tumor cells were positive for the nuclear marker STAT6, indicating SFT (Fig. 4-C, 4-D). The final diagnosis was SFT/HPC grade 3. The local control rates of SFT/HPC treated with gross total and subtotal resection are reported to be 84% and 30%, respectively, with a time to recurrence of approximately 5 years. Although CIRT i","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"402-405"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/00/2432-261X-7-0402.PMC10447192.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 4. Surgical Treatment.","authors":"Gen Inoue","doi":"10.22603/ssrr.2022-0209","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0209","url":null,"abstract":"・Surgical procedures should be selected with patient consent based on comprehensive evaluations, including short-term and long-term clinical outcomes, risk of complications, and cost-effectiveness. Surgical treatment is indicated when conservative treatments are less effective or severe neurological symptoms in the cauda equina, such as bladder and bowel dysfunction, are noted. ・Several reports have indicated that decompression for lumbar spinal stenosis (LSS) produces better clinical outcomes than conservative treatment. It is suggested to perform decompression for patients with LSS without spinal segmental instability diagnosed by physical findings and imaging, in whom conservative treatment is ineffective. ・While decompression with fusion is useful for patients with spinal instability and the improvement of Quality of Life (QOL)/Activities of Daily Living (ADL) is expected, the cost is higher than that of decompression alone, and the return-to-work rate is slightly poorer. The rates of complications and reoperation are also higher than those of decompression alone. So, fully considering pathological conditions and surgical procedures to examine indications is necessary, such as instability and the need for long-segment fusion. ・The bone union state may affect clinical outcomes, but a clear recommendation cannot currently be presented. ・It is suggested to use local bone and to combine the use of artificial bone, demineralized bone matrix, and allogenic bone as the bone graft material for spinal fusion. ・A clear recommendation cannot be made as to whether surgical treatment using Interspinous Process Devices (IPDs) or dynamic stabilization using pedicle screws is more useful than conservative treatment, decompression, or fusion surgery for LSS. ・For patients with LSS, minimally invasive spine surgery may be more useful for preventing the occurrence of iatrogenic instability, alleviating low back pain, and reducing the bleeding volume than conventional surgery, and it is suggested to perform it. ・Even in the very elderly aged 80 years (octagenarian and over), surgical treatment for LSS improves their clinical symptoms.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"308-313"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/06/2432-261X-7-0308.PMC10447186.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Condoliase Injection Therapy for Lateral Lumbar Disc Herniation.","authors":"Yujiro Kagami,&nbsp;Hiroaki Nakashima,&nbsp;Naoki Segi,&nbsp;Ryuichi Shinjo,&nbsp;Shiro Imagama","doi":"10.22603/ssrr.2022-0189","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0189","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the efficacy of condoliase injection therapy (CIT) for lateral lumbar disc herniation (LLDH).</p><p><strong>Methods: </strong>This retrospective study included 157 of 180 enrolled patients (70 males, 87 females; mean age: 52.6±16.9 years). These patients were divided into two groups (group L: LLDH, group M: medial LDH [subligamentous and transligamentous]). From baseline to 1 year after injection (final follow-up), leg pain was assessed using the visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) scoring for CIT's clinical efficacy of CIT. Radiography and magnetic resonance imaging conducted before and 3 months after the injection were assessed. Patients with a VAS improvement of ≥50% at the final follow-up were defined as responders. The responder and nonresponder LLDH groups were also compared.</p><p><strong>Results: </strong>Groups L and M showed comparable responder rates (75.0% and 77.4%, respectively) (<i>P</i>=0.80). VAS and JOA scores at 1 year showed no significant differences between the groups (<i>P</i>=0.82 and 0.80, respectively). VAS score at 1 month after injection reduced considerably in the responder group compared with that in the nonresponder group (19.7 vs. 66.0, <i>P</i><0.01) and continued to decrease at the last follow-up (3.5 vs. 52.0, <i>P</i><0.001). Nonresponders had significantly lower disc heights after 3 months. However, intervertebral instability, alignment, and disc degeneration did not differ between the responders and nonresponders.</p><p><strong>Conclusions: </strong>The response rate of CIT for LLDH was comparable to that for medial LDH. Therefore, CIT is an effective treatment for LLDH.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"363-370"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/24/2432-261X-7-0363.PMC10447184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Dislocation Fracture Complicated by a Serious Electric Shock Injury: A Case Report.","authors":"Ryosuke Hirota,&nbsp;Atsushi Teramoto,&nbsp;Mitsumasa Chiba,&nbsp;Masahiro Onuma,&nbsp;Hidetomo Narimatsu,&nbsp;Takatoshi Yotsuyanagi,&nbsp;Toshihiko Yamashita","doi":"10.22603/ssrr.2023-0007","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0007","url":null,"abstract":"The patient, a 14-year-old boy, was injured after he collided with a high-voltage power line, which led to his loss of consciousness and caused him to fall from a 20-meterhigh steel tower. After being taken to a nearby hospital, he was flown by helicopter to our hospital for multidisciplinary treatment, where he was administered light sedation for pain relief. His initial measurements were 112/68-mmHg blood pressure, 118-beats/min heartbeat, respiratory rate of 15 breaths/ min, SpO2 of 100%, and body temperature of 38.0°C. His posterior neck, chest, and back were all severely burned (Fig. 1), and he had lost all motor and sensory function caudally from the Th10 level. He was diagnosed with an electric shock injury, a Th 10/11 dislocation fracture (AO type classification; type C), and a complete thoracic spinal cord injury. Concomitant injuries included Th 7.8.9.12 fractures, right hemothorax, left hemothorax, and multiple rib fractures (Fig. 2A-D). MRI revealed a complete spinal cord tear at the Th10/11 level (Fig. 2E). The paraspinal muscles showed high signals on MRI T2 weighted imaging, respectively (Fig. 2F-G). After confirming partial dislocation repair by manual traction under fluoroscopic guidance, we performed percutaneous posterior stabilization (Th5-L2) with percutaneous pedicle screws (PPS) without bone fusion. Relatively good realignment was achieved by intraoperative compression of the injured area in the supine position (Fig. 3A-D). On day 20 after injury, Th7-12 anterior intervertebral body fusion was performed via the extraperitoneal approach to reconstruct the anterior column (Fig. 3E-H). Debridement of burned skin was performed on the 5th, and skin grafting on the back was performed on the 35th day after the injury, respectively. The grafted skin survived well, and the wound healed completely on day 47 (Fig. 4). Rehabilitation, including wheelchair mobility training, could be started after two-stage spine surgery. On the 70th day after the injury, the wound was well-healed, and the patient was transferred to a nearby hospital. Electric shock injuries may be accompanied by deep tissue injury to the nerves, blood vessels, muscles, and bones. To our knowledge, this is the first report of severe electroshock injury combined with spinal cord injury. Recently, the concept of spine damage control has been reported in the field of spine trauma injuries, often accompanied by complications caused by high-energy trauma, such as iliac and pelvic ring fractures. Early stabilization of the spinal column promotes hemodynamic stability, respiratory failure, and systemic management and prevents complications. Initial stabilization with PPS and two-stage anterior strut reconstruction may be helpful in cases of high spinal instability and soft tissue damage. In this case, early surgery allowed good alignment without direct visual repair of the injured area. Electroshock wounds generally result in deep tissue damage, resulting in deep tissue necros","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"410-413"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/ab/2432-261X-7-0410.PMC10447183.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10163405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 2. Diagnosis and Evaluation.","authors":"Miho Sekiguchi","doi":"10.22603/ssrr.2022-0080","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0080","url":null,"abstract":"•In the middle-aged and elderly, if pain and numbness are experienced from the buttocks to the lower limbs and the symptoms are exacerbated when walking and standing but alleviated when in the sitting and flexed positions, lumbar spinal stenosis (LSS) is very likely. Intermittent claudication is a characteristic symptom of LSS, but it is important to differentiate it from vascular intermittent claudication. •The “Diagnostic Support Tool for Lumbar Spinal Stenosis” is a convenient and useful tool for screening patients.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"300-305"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/c6/2432-261X-7-0300.PMC10447202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}