Clinton J. Devin, Anthony L. Asher, Mohammed Ali Alvi, Yagiz U. Yolcu, Panagiotis Kerezoudis, Christopher I. Shaffrey, Erica F. Bisson, John J. Knightly, Praveen V. Mummaneni, Kevin T. Foley, and Mohamad Bydon
The authors investigated the effect of predominant location of preoperative pain on patient-reported outcomes following 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. Predominant neck pain was associated with lower rates of patient satisfaction and worse Neck Disability Index scores compared with predominant arm pain and equal arm and neck pain at the 1-year follow-up. This study underlines the role of predominant pain location in predicting outcomes after ACDF and provides potential targets for improving patient management.
The objective was to determine how focal apex angle and C2–7 angle affect spinal cord decompression status and neurological recovery in patients after cervical laminoplasty. Patients with both focal apex angle > 32.1° and C2–7 angle < 12.4° may have poor spinal cord decompression status and neurological recovery after surgery. To ensure successful decompression with cervical laminoplasty, surgeons should evaluate not only the C2–7 angle but also focal apex angle.
Jinping Liu, Pingguo Duan, Praveen V. Mummaneni, Rong Xie, Bo Li, Yinhui Dong, Sigurd Berven, and Dean Chou
The objective of this paper was to evaluate with long-term follow-up whether transforaminal lumbar interbody fusion (TLIF) induces kyphosis or lordosis in the spine. The key finding was that a TLIF will induce either kyphosis or lordosis of the spine based on the preoperative disc angle and cage position. This information may help surgeons decide if TLIF is the best operation for the patient if lordosis needs to be induced with surgery.
Alaina M. Body, Zachary J. Plummer, Bryan M. Krueger, Justin Virojanapa, Rani Nasser, Joseph S. Cheng, and Charles J. Prestigiacomo
The authors review the literature on retrograde ejaculation following anterior lumbar surgery and identify limitations in the published accounts. They pool data from published literature and report an overall low incidence. They subsequently surmise how the risk of retrograde ejaculation may be inflated in the literature due to perpetuation of data unrepresentative of the current landscape of spine surgery, and they encourage surgeons not to dismiss an anterior approach as a viable option in men with child-siring potential.
Thiago S. Montenegro, Glenn A. Gonzalez, Fadi Al Saiegh, Lucas Philipp, Kevin Hines, Ellina Hattar, Daniel Franco, Aria Mahtabfar, Kavantissa M. Keppetipola, Adam Leibold, Elias Atallah, Umma Fatema, Sara Thalheimer, Chengyuan Wu, Srinivas K. Prasad, Jack Jallo, Joshua Heller, Ashwini Sharan, and James Harrop
The authors investigated the use of defined evidence-based medicine (EBM) lumbar fusion criteria on clinical outcomes of lumbar spine revision surgeries. Revision procedures that met criteria for EBM lumbar fusion guidelines were associated with greater patient-reported outcomes, with results closer to the ones achieved in the primary lumbar fusions. This study has important implications because it illustrates the importance of EBM in patient care.
Maximilian Scheer, Bruno Griesler, Elisabeth Ottlik, Christian Strauss, Christian Mawrin, Christian Kunze, Julian Prell, Stefan Rampp, Sebastian Simmermacher, Jörg Illert, Heike Kielstein, and Christian Scheller
Because of the unusual course of a spontaneous hemorrhage in the area of the conus medullaris, the authors performed histological examination of the conus medullaris in the case patient and 18 cadaveric specimens and found great individual variation in the distance from the caudal ending of the gray matter to the macroscopic end of the conus medullaris. Awareness of the gray matter to cone termination (GMCT) length and use of electrophysiological monitoring are important for operative care in the area of the conus medullaris.
The authors investigated the prevalence, postoperative pathologies, and relation with radiological parameters of early-onset adjacent-segment disease (ASD) occurring within 3 years after primary posterior lumbar interbody fusion (PLIF). Important findings were that lumbar disc herniation was significantly more common in early-onset ASD and that a major risk factor for ASD, especially early-onset ASD, is a change in segmental lordosis, which is also the only parameter that can be adjusted by the surgeon.
Austin H. Carroll, Ehsan Dowlati, Esteban Molina, David Zhao, Marcelle Altshuler, Kyle B. Mueller, Faheem A. Sandhu, and Jean-Marc Voyadzis
This study investigated the benefits and limitations of minimally invasive surgery (MIS) approaches to posterior lumbar surgery compared with open surgery in obese and nonobese patients and the effect of obesity on MIS outcomes. MIS reduced blood loss, operative time, hospital length of stay, and surgical site infections in obese patients. This study has been the largest to date investigating posterior lumbar MIS outcomes in obese patients, which will continue to be an important area of consideration as the prevalence of obesity increases.
Heiko Koller, Meric Enercan, Sebastian Decker, Hossein Mehdian, Luigi Aurelio Nasto, Wolfgang Hitzl, Juliane Koller, Axel Hempfing, and Azmi Hamzaoglu
In this study the authors sought to improve prediction accuracy for adding on and surgical outcomes in Lenke type 3, 4, and 6 curves. An analysis of 101 patients with Lenke 3, 4, and 6 curves showed that correction of thoracic and lumbar curves had significant influence on lumbosacral curve resolution and the risk for adding on. This study adds new variables to factor into the surgical strategy for correction of idiopathic double major curves.
Sinian Wang, Liang Xu, Muyi Wang, Yong Qiu, Zezhang Zhu, Bin Wang, and Xu Sun
Researchers aimed to evaluate the contribution of vertebral remodeling to reversal of vertebral wedging in patients with Scheuermann's kyphosis (SK) after posterior-only instrumented correction. For SK patients who underwent posterior correction, the biomechanical environment of the vertebral bodies around the most deformed vertebra improved significantly, and obvious reversal in wedge deformation of vertebrae was observed. This study provides important reference data for determination of timing of surgery for skeletally immature SK patients.
The aim of this study was to elucidate factors affecting patient satisfaction after thoracopelvic corrective fusion surgery for patients with adult spinal deformity (ASD). Achievement of Scoliosis Research Society–22r (SRS-22r) self-image and function minimal clinically important differences (MCIDs) was significantly associated with postoperative satisfaction in corrective fusion surgery for ASD. Given that patients with poor preoperative health-related quality of life are more likely to achieve SRS-22r MCIDs, surgeons should carefully consider whether to operate on patients with a relatively good baseline HRQOL when making surgical decisions.
Emily P. Rabinovich, Thomas J. Buell, Tony R. Wang, Christopher I. Shaffrey, and Justin S. Smith
The present study evaluated the effect of accessory supplemental rod (ASR) implantation on postoperative occurrence of primary rod fracture (RF) in 114 patients who underwent long-segment spinal instrumentation for adult spinal deformity. Patients treated with ASR were 76.9% less likely to experience RF than patients managed with dual-rod construct. The statistically significant improvement in RF rates among patients treated with ASR suggests a potential benefit to using this technique to prevent RF.
Jitendra Thakur, Christian T. Ulrich, Ralph T. Schär, Kathleen Seidel, Andreas Raabe, and C. Marvin Jesse
The authors present an illustrative case report with a technical note on microsurgical resection of a ventrolateral, completely ossified spinal meningioma (OSM) and a literature review of the surgical management of calcified or ossified spinal meningiomas. The results of this study suggest that gross-total resection of OSMs can be readily achieved using the surgical strategy of a burr hole technique and drilling away tumor mass with minimal manipulation of the spinal cord, and continuous intraoperative monitoring of motor and somatosensory evoked potentials.
Gaston Tabourel, Louis-Marie Terrier, Arnaud Dubory, Joseph Cristini, Louis-Romée Le Nail, Ann-Rose Cook, Kévin Buffenoir, Hugues Pascal-Moussellard, Alexandre Carpentier, Bertrand Mathon, and Aymeric Amelot
Survival scoring systems for spine metastasis (SPM) allow one to determine the most suitable treatment according to survival estimation. In this multicenter study of 739 patients treated and followed for SPM, the authors determined that prognosis scoring systems used to estimate survival are obsolete and underestimate survival. Surgical treatment decisions should not be based only on survival estimations.
The authors investigated functional, oncological, and quality-of-life (QOL) outcomes in a large series of patients who underwent surgery for cauda equina ependymoma (CEE) and myxopapillary ependymoma (MPE). Important findings were that larger tumors were associated with recurrences and worse outcomes, surgery should be aimed at achieving en bloc gross-total resection, and some features of MPE are associated with higher recurrence rates. Outcomes are usually favorable, but the mean QOL after treatment is inferior to that of the general population. This study may contribute to optimization of treatment and preoperative counseling of CEE patients.
Matching the surgical with the conceptual center of rotation (COR) is difficult with pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). The authors aimed to examine sagittal correction geometry and surgical COR in three-column osteotomy. In PSO and VCR, the COR was mainly in the anterior and anterior or middle column, respectively. Surgical and conceptual COR matched in 65% and 31% of cases, respectively. Matching is difficult and failed in about two-thirds of patients. To avoid sagittal translation, the use of temporary rods, tracking rods, or special instruments for correction is recommended.
The aim of this study was to assess the success rates of short-level posterior lumbar interbody fusion (PLIF) for patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment (L-DISH). The authors found that L-DISH was associated with a high rate of postoperative symptoms related to early-onset adjacent segment disease and pseudarthrosis, especially at a lower segment and one distance from the segment adjacent to L-DISH. Little evidence is available to recommend short-level PLIF as the standard surgery.
This study aimed to examine the effect of preoperative teriparatide administration on cancellous bone with bone histomorphometry and to clarify the timing of preoperative administration for osteoporotic patients with spinal fusion. Dynamic bone formation became significant after 3 months of administration and reached a peak at 4 months. The authors recommend at least 3 months of preoperative teriparatide administration to provide a more substantial anabolic effect from the early postoperative stage.
This study aimed to understand patient complaints after spine surgery and identify unique characteristics of the patients who submitted them. Patient complaints were most often related to quality of care and communication breakdown. Multiple clinical and demographic factors were found to be associated with patient complaints. This study provides a foundational understanding of patient grievances following spine surgery and can guide approaches to best care for patients at high risk for postoperative complaints.
This prospective study demonstrated the efficacy of using synthetic MRI to assess bone quality of the spine. Quantitative proton density (PD) and T1 intensity sequences generated with synthetic MRI were significantly correlated with T-score of the lumbar spine determined with dual-energy x-ray absorptiometry; in particular, PD was excellent for prediction of osteopenia and osteoporosis. This novel MRI technology has the potential to impact spine care by improving preoperative evaluations of bone density in patients with degenerative lumbar spine disorders.
In this study the authors report the accuracy of the first 205 consecutively placed pedicle screws inserted using augmented reality assistance with a unique head-mounted display navigation system at their institution. The authors describe an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B. Augmented reality depicted through a unique head-mounted display is a novel and clinically accurate technology for the navigated insertion of pedicle screws.
Researchers reported their multiinstitutional experience with management of patients with sacral arteriovenous fistulas, including clinical and radiographic characteristics and postprocedural outcomes. In this series, conus medullaris edema and enlargement of the filum terminale vein were consistent radiographic signs of sacral arteriovenous fistula. Although endovascular embolization was safe and effective, surgical obliteration had a higher rate of success. Further studies are needed to determine the best treatment modality based on case-specific characteristics.
The authors aimed to evaluate predicting factors for short- and long-term recovery outcomes following surgery for foot drop, secondary to lumbar degenerative disease. The authors found that early surgery may improve recovery rate, yet the strongest predictor for recovery was the severity of preoperative tibialis anterior muscle weakness. Maximal short-term recovery led to sustained long-term independence. The study results, together with further research, may assist in building a decision-making algorithm for this controversial topic.
Surgeons and researchers used statistical modeling to identify characteristics of patients with lumbar degenerative disc disease that may predict better outcomes after total disc replacement than the average 7-year outcomes seen in a clinical trial. Preoperative narcotics use was associated with less functional improvement than the 7-year average and reduced chance of return to unrestricted full-time work. Tailoring patient care before lumbar total disc replacement may further improve patient outcomes.
The authors showed that anterior column release (ACR) surgery is a safe and useful method to create segmental lordosis in patients with degenerative lumbar kyphosis. In this study sagittal alignment was restored to an appropriate range with ACR. The study results indicate that three-column osteotomy, which carries a higher risk of significant complications, can be avoided through the use of this ACR technique.
This study evaluates the performance of motor evoked potentials in detecting new postoperative neurological deficits following three-column osteotomy for cervical deformity. Neurological deficit typically occurs from nerve root rather than spinal cord injury. The sensitivity of monitoring to detect spinal cord–associated weakness is high, but the sensitivity is modest in identifying nerve root neurapraxia.
Researchers present the surgical results for Lenke type 1AR curve and compare anterior and posterior approaches to consider the advantages of anterior surgery. Anterior surgery for the curves could minimize the distal extent of the instrumented fusion without alignment complication. Moreover, anterior surgery for Lenke type 1AR curves would leave more mobile disc space below the fusion.
Researchers investigated risk factors for the progression of sacroiliac joint (SIJ) degeneration after S2 alar-iliac screw insertion. Preoperative SIJ degeneration and young age at surgery had a significant association with the progression of SIJ degeneration. There is a possibility that S2 alar-iliac screws may affect pre-existing degeneration and the progression of SIJ degeneration in younger patients. Further long-term observation may reveal other effects of S2 alar-iliac screw insertion on SIJ degeneration.
The authors performed a cadaveric biomechanical study to evaluate stability after sequential C1 lateral mass resection in a direct lateral approach. Stability was maintained after 25% lateral mass resection, but was lost after 50% resection. This study can guide the need for instrumentation and fusion after partial lateral mass resection through the direct lateral approach.
The objective of this study was to examine if endoscopic dissection would aid microsurgical dissection in treating extensive spinal adhesive arachnoiditis, with and without syringomyelia. A key finding was that the flexible endoscope visualized the spinal cord surface, nerve roots, vessels, and fibrotic tissue well. Advancing the endoscope and spreading its forceps cleared dorsal subarachnoid space fibrosis, opening the CSF pathway. The study is a valuable foundation for future investigators to add navigational, sharp dissection, and coagulation techniques.
The surgical strategy for symptomatic sacral perineural cysts remains controversial, and this study was conducted to evaluate the effectiveness of a novel wrapping surgery. Seven patients presenting with severe radicular pain underwent this procedure and experienced substantial long-lasting relief of the pain without any complications. This new wrapping technique proved to be effective to relieve radicular symptoms caused by sacral perineural cysts and can be recommended as a safe and simple procedure.
The authors analyzed imaging and clinical characteristics of cases of biopsy-proven peripheral neurolymphomatosis (NL) with spread to the cauda equina. Based on these findings, the authors propose a pathoanatomical mechanism of spread of NL to cauda equina and illustrate the potential benefits of using extraspinal biopsy targets. Recognition of safer extraspinal biopsy targets could allow for greater functional recovery after appropriate treatment for this disease.
The objective of the present study was to evaluate the impact of surgical overlap, either before or after the critical operative portion, on adverse postoperative outcomes following single-level, posterior-only lumbar fusion. Comparison of exact-matched patients with the least and most amounts of overlap, either before or after the critical portion, demonstrated equivalent outcomes. This finding suggests that overlapping surgery can be safely performed and does not independently affect mid-term outcomes following this common neurosurgical procedure.
This international (5 countries) longitudinal conjoined effort, based on > 2 years of follow-up of prospective multicenter high-quality (follow-up > 75%) data, shows a progressive and robust improvement in quality-of-care indicators associated with adult spinal deformity surgery. Over the last decade, postoperative complications and reinterventions have been progressively reduced by 50%, patient enrollment has increased, and postoperative improvement in disability has augmented, although baseline patient characteristics have remained the same. Quality metrics trends show that surgeons are facing the adult spinal deformity epidemic more efficiently.
The authors report a novel concept of anterior decompression through a posterior approach aimed at anterior shift of the ossification of the posterior longitudinal ligament (OPLL) during surgery rather than extirpation or size reduction of the OPLL. In surgical outcomes, the mean recovery rate of the Japanese Orthopaedic Association score was 72% and no patients showed neurological deterioration postoperatively. The surgical technique is a useful alternative for safely achieving anterior decompression through a posterior approach and improving surgical outcomes in patients with thoracic OPLL.
This study investigated the impact of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) on access to elective spine surgery. Using data from 14 states from 2011 to 2016, the authors found that Medicaid expansion was associated with economically and statistically significant increases in spine surgery volume and proportion of surgical patients with Medicaid insurance. These results indicate that Medicaid expansion under the ACA was associated with improved access to elective spine care.
Researchers analyzed the data of primary spinal cord astrocytoma (pSCA) to depict the clinicoradiological characteristics of this rare disease. The H3 K27M mutation frequently occurred in pSCA, and the majority of cases involved a histologically high-grade tumor. Additionally, the H3 K27M mutation did not impact survival outcome in histologically high-grade astrocytoma. Furthermore, a short symptom duration may indicate the presence of the H3 K27M mutation. To date, this is the first study to investigate the clinicoradiological predictors of the H3 K27M mutation in pSCA.
The authors investigated risk factors for medially migrated vertebral arteries on CT angiography and evaluated the diagnostic accuracy of MRI and nonenhanced CT for high-risk vertebral artery anatomy in the subaxial cervical spine. The incidence of medially migrated vertebral artery was associated with advanced age, left vertebral artery, and C5/6 disc level. MRI and nonenhanced CT demonstrated high specificities but only fair sensitivities. Surgeons should be aware of this for safe anterior cervical spine surgery.
The objective of this paper was to evaluate the utility of triggered EMG for the safe placement of condylar screws. The key finding of the study is that the minimum acceptable threshold is 2.7 mA; thresholds between 2.7 mA and 9.0 mA indicate safe placement, but require additional inspection by the surgeon. Thresholds above 9.0 mA correlate with safely placed screws. Although EMG has been used for condylar screw placement, this is the first report determining the minimum acceptable threshold.
This study was performed to compare rod fracture rates among three types of rod constructs following lumbar pedicle subtraction osteotomy for patients with adult spinal deformity. Use of multiple-rod constructs in the satellite rod construct and nested rod construct groups was associated with lower rates of rod fracture, pseudarthrosis, and reoperations following lumbar pedicle subtraction osteotomy. The study is the largest to investigate the use of multiple-rod constructs for the prevention of rod fracture and reoperation in patients undergoing lumbar pedicle subtraction osteotomy at a single institution.
The objective of this study was to prospectively compare outcomes of long-segment fusion performed using minimally invasive and open techniques for adult scoliosis. The key finding was that long-segment fusion performed using modern minimally invasive techniques for adult scoliosis had comparable outcomes to open surgery at 1-year follow-up. This study adds value because it shows that minimally invasive adult scoliosis surgery may be a viable alternative to open surgery as a treatment of adult scoliosis.
This study aimed to assess pelvic obliquity changes and their effects on clinical outcomes in patients with adolescent idiopathic scoliosis, Lenke types 5 and 6. Study findings revealed that postoperative coronal decompensation occurred more frequently in patients with preoperative pelvic obliquity. In addition, postoperative progression of pelvic obliquity could be related to residual lumbar curve progression. To the best of the authors' knowledge, few studies have described postoperative pelvic obliquity changes, and their relationship with alignment remains unclear.
Vertebral compression fracture (VCF) is a common and potentially morbid complication of stereotactic body radiation therapy (SBRT) for spinal metastases. Researchers developed a machine learning model to predict VCF after SBRT, using radiomic features that quantify the characteristics of the affected vertebra on pretreatment imaging. This model predicted VCF with high accuracy. If validated with multiinstitutional data, this model may help clinicians better identify the patients at highest risk of VCF when considering prophylactic interventions.
The purpose of this paper was to describe the time and rate of return to work (RTW) after lumbar spine surgery in the Canadian population. The key findings were a median time of 61 days to RTW and a RTW rate of 71%. The median RTW varied for procedure type, with simple decompressions having an earlier RTW than fusion procedures. This study provides information for surgeons when counseling patients on expectations for RTW after spine surgery.
The authors investigated the epidemiology and morbidity of venous thromboembolism (VTE) in pediatric patients following traumatic spinal injuries. Patients with more severe spinal injury were at greater risk for VTE development; VTE was associated with longer hospital stays and increased incidence of discharge to rehabilitation centers. This study highlights key risk factors and clinical predictors for VTE development and underscores the need to develop prophylaxis protocols for pediatric trauma patients nationwide.
This study analyzed the biomechanical effects of adding a titanium triangular-shaped sacroiliac implant to a long-segment lumbopelvic construct with S2 alar-iliac screws. The analysis showed that laterally placed devices did not significantly change local stability of the sacroiliac joint; however, the strain distribution at the lumbopelvic region was affected. These findings may help clinicians understand the in vitro biomechanical effects of supplementing adult deformity correction constructs with a sacroiliac fusion device.
Researchers investigated whether a reduction in Meyerding grade is associated with clinical outcomes after decompression and fusion for grade I degenerative lumbar spondylolisthesis. They found no association between reduction in Meyerding grade and 24-month disability, back pain, leg pain, quality of life, patient satisfaction, and cumulative reoperation rate. This study does not provide evidence to support the reduction of Meyerding grade for grade I degenerative lumbar spondylolisthesis.
The authors aimed to determine whether postoperative antibiotic administration prevents surgical site infection (SSI). Neither postoperative antibiotic administration ≤ 24 hours nor postoperative antibiotic administration >> 24 hours was associated with superficial SSI, compared with no antibiotic administration. The odds of deep SSI decreased by 45% with postoperative antibiotic administration ≤ 24 hours and by 40% with postoperative antibiotic administration >> 24 hours. Spine surgeons can safely consider 24 hours of antibiotic administration to be almost equally as effective as long-term antibiotic administration for prophylaxis against deep SSI.
The scope of this study was to delineate predictors of radiographic and clinical outcomes after surgery for high-grade spondylolisthesis (HGS) and to identify risk factors of postoperative foot drop. Analysis of 101 patients with HGS showed that surgical improvement of radiographic measures of deformity influences clinical outcomes. Also, the risks of major complications and foot drop were related to radiographic measures and surgical variables. The identified radiographic and clinical predictors of clinical outcomes and complications will help to improve surgical outcomes of patients with HGS.
The authors present the rationale and describe the technique for open bilateral SI joint fusion for adult deformity surgery. Image-guided open SI joint fusion with triangular titanium rods is technically feasible, and malpositioned implant detection is aided with intraoperative CT. Because the feasibility of this technique has not been widely reported, the authors hope that their institution's experience and description will facilitate learning of surgeons utilizing this technique.
The authors present their experience in the management of 25 resections of intradural extramedullary lesions using a minimally invasive surgery (MIS) approach with a novel double-tubular technique. After being stretched with sutures, the dura were angulated with a telescopically inserted second tubular retractor and the dural opening was widened. This approach could significantly increase the intraoperative visual field and maintain freedom of maneuverability through the small operative corridors during resection of such pathologies.
In a cohort of 91 patients with adult spinal deformity, investigators showed that spine flexibility, defined by the change in alignment between supine and standing radiographs, was associated with the use of an osteotomy. This sets the initial groundwork for flexibility thresholds to standardize surgical decision-making in spine deformity.
The objective of this paper was to develop and validate, retrospectively, a preoperative prediction model for postoperative urinary retention by using machine learning techniques. The authors were able to develop such a model by using a combination of regression modeling and neural network modeling to obtain a maximum accuracy of 78%. No such prediction tool has existed in the field to date.
Awake, transforaminal endoscopic 360° foraminal lumbar decompression is presented in a series of 34 patients who presented with postfusion lumbar radiculopathy. A technique for 360° foraminal endoscopic drilling is presented. Minimally invasive endoscopic surgery is presented as a reasonable awake, outpatient solution to the treatment of postfusion lumbar radiculopathy.
The authors investigated global variations in the management of subaxial cervical spine injuries according to fracture location, morphological pattern, geographic region, surgeon experience, and clinician specialty. Fractures of both the A3 and A4 subtypes, as designated by the AO Spine Subaxial Injury Classification System, were more likely to be operatively managed if they occurred at the cervicothoracic junction compared with those at the upper or middle subaxial regions. These findings should be reflected in future treatment algorithms.
The authors reviewed a consecutive series of spinopelvic fusion surgeries to identify a novel acute failure mechanism of S2-alar-iliac (S2AI) instrumentation. A 5% acute failure rate was identified. Large-magnitude surgical correction, particularly in the sagittal plane, was associated with increased failure risk. Patients with large corrections may benefit from 4 total S2AI screws at the time of the index surgery. Salvage with a minimum of 4 rods and 4 pelvic fixation points can be successful.
The authors report the development of low bladder compliance, detrusor overactivity, and high detrusor pressure within days in patients with severe traumatic spinal cord injuries, which challenges the current teaching that the detrusor muscle is initially acontractile after a spinal cord injury. The finding that at this early stage bladder function is dynamic and influenced by fluctuations in the physiology and metabolism at the injury site suggests that optimizing spinal cord perfusion is likely to improve urological outcome.