S pinal deformity surgery is often associated with a significant volume of blood loss. 2 , 7 The need for blood transfusion to compensate for these losses is associated with a wide array of complications, including infection, 11 thromboembolic events, 1 and hemolytic reactions. 17 In addition, patients requiring blood transfusion have been shown to have prolonged hospitalizations and higher surgery-related costs. 23 Because of these myriad deleterious effects, significant efforts have been made to curtail the need for blood products intraoperatively and
Jian Guan, Chad D. Cole, Meic H. Schmidt and Andrew T. Dailey
Frank S. Bishop, Andrew T. Dailey and Meic H. Schmidt
C harcot disease of the spine, also known as spinal neuropathic or neurogenic arthropathy, is a destructive degenerative process involving the vertebral bodies and surrounding discs. This condition results from repetitive microtrauma in patients who have decreased joint protective mechanisms from loss of deep pain and proprioceptive sensation, typically because of spinal cord injury or sensory neuropathies. The patient typically presents with back pain and progressive spinal instability and deformity. We report a unique case of massive Charcot spinal disease
Vijay M. Ravindra, Kaine Onwuzulike, Robert S. Heller, Robert Quigley, John Smith, Andrew T. Dailey and Douglas L. Brockmeyer
neurological deficit, a left apical curve, kyphotic deformity associated with the curve, or early onset. 16 Known risk factors for curve progression and early spinal fusion include older age at presentation, level of spinal deformity, less syrinx resolution, and greater degree of initial scoliosis. 2 , 3 , 16 , 24 , 27 Previous reports have addressed the short-term response of CRS to suboccipital decompression and duraplasty (SODD). 3 , 5 , 6 , 8 , 18 , 33 , 35 The aim of the current study was to investigate the long-term behavior of CRS in a cohort of patients who
James K. Liu, Douglas L. Brockmeyer, Andrew T. Dailey and Meic H. Schmidt
Aneurysmal bone cysts of the spine are benign, highly vascular osseous lesions of unknown origin that may present difficult diagnostic and therapeutic challenges. They are expansile lesions containing thin-walled, blood-filled cystic cavities that cause bone destruction and sometimes spinal deformity and neurological compromise. The treatment of aneurysmal bone cysts of the spine remains controversial according to the literature. In this review, the authors discuss the clinical manifestations, pathophysiological features, neuroimaging characteristics, and treatment strategies for these lesions.
Treatment options include simple curettage with bone grafting, complete excision, embolization, and radiation therapy. Reconstruction and stabilization of the spine may be warranted if deformity and instability are present. Special factors need to be considered in the management of these lesions.
Complete excision of aneurysmal bone cysts offers the best chance of cure and spinal decompression if neurological deficits are present.
Wilson Z. Ray, Vijay M. Ravindra, Meic H. Schmidt and Andrew T. Dailey
iliac fixation, S-2 alar screws can be used for high-grade spondylolisthesis, for kyphoscoliotic deformities requiring caudal fixation, in revision of L5–S1 pseudarthrosis, and for adjacent-segment disease caudal to a long-segment fusion. 10 As a result, S-2 alar iliac fixation provides a useful primary or salvage alternative. 17 The placement of screws across the 2 cortical surfaces of the sacroiliac joint and into dense bone above the sciatic notch provides superior pullout strength. 32 We describe our techniques using stereotactic navigation in the placement of
Ganesh Rao, Darrel S. Brodke, Matthew Rondina and Andrew T. Dailey
T he indications for pedicle screw fixation in the thoracic spine continue to expand the more familiar surgeons become with the anatomy and techniques for pedicle fixation. 1, 3, 7, 13, 17, 18, 21 By providing rigid fixation, pedicle screws allow for greater correction of deformity 18 and greater pullout strength than traditional hook/rod constructs. 12 Whereas the authors of initial reports suggested screw misplacement rates of up to 41%, 20 those of more recent studies indicate rates of approximately 10%, with an incidence of neural complications of less
Tobias A. Mattei and Daniel R. Fassett
-called “freehand” technique) can be safely performed during the vast majority of cases that do not involve major deformities, with rates of pedicle violation that are not significantly different from those of procedures in which intraoperative fluoroscopy is employed. 15 , 16 In relation to pelvic fixation, although several studies have demonstrated that the new technique of using sacral-alar iliac screws may present major advantages over the classic iliac wing screws, 13 , 14 the study of Ray et al. 20 is the first report in the literature of the benefits of employing
Thomas J. Buell, Davis G. Taylor, Ching-Jen Chen and Bhiken I. Naik
TO THE EDITOR: We read with great interest the outstanding article by Guan and colleagues 2 ( Guan J, Cole CD, Schmidt MH, et al: Utility of intraoperative rotational thromboelastometry in thoracolumbar deformity surgery. J Neurosurg Spine 27:528–533, November 2017 ). This timely study showed intraoperative rotational thromboelastometry (ROTEM)-guided transfusion for posterior thoracolumbar deformity surgery (≥ 7 levels) significantly reduced total blood product transfusion requirements. However, we were left with unresolved questions. We request clarification
Marcus D. Mazur, Vijay M. Ravindra, Meic H. Schmidt, Darrel S. Brodke, Brandon D. Lawrence, Jay Riva-Cambrin and Andrew T. Dailey
U nplanned reoperation after surgery for adult lumbar spine deformity is costly, in terms of both direct costs and health care resource utilization. It was recently estimated that revision fusion surgery in the lumbar spine has an estimated average cost of $28,000. 1 Frequent causes of reoperation in this patient population include wound infection/breakdown, implant failure, pseudarthrosis, and removal of instrumentation because of pain. 21 , 25 , 29 , 30 From a patient’s standpoint, the high rates of complications and reoperation associated with lumbar
Carlo Bellabarba, Sohail K. Mirza, G. Alexander West, Frederick A. Mann, Andrew T. Dailey, David W. Newell and Jens R. Chapman
postural changes, these methods were entirely provisional because external immobilizaton does not appear to effectively stabilize Stages 2 and 3 craniocervical injuries. Although we found that halo vest immobilization was the better alternative pending internal fixation, it occasionally accentuated the distractive deformity ( Fig. 6 ). More definitive stabilization options include the placement of occipitocervical bone grafts and wire-based hardware; 18 , 39 , 42 , 60 , 64 , 79 posterior fixation involving contoured structural rods with suboccipital and sublaminar wires