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Spinal instrumentation in infants, children, and adolescents: a review

JNSPG 75th Anniversary Invited Review Article

Stephen Mendenhall, Dillon Mobasser, Katherine Relyea and Andrew Jea

instrumentation on the skeletally immature spine. Fusing the skeletally immature spine may lead to far more serious issues beyond growth retardation. These issues may include restrictive lung disease, pulmonary hypertension, right heart failure, and death. This review of our experience and series of pediatric patients describes seldom-used anterior and more often used posterior approaches for the placement of spinal instrumentation in the pediatric spine. It surveys the history of spinal instrumentation in children, beginning with Paul Harrington and his revolutionary treatment

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Christina Sayama, Sudhakar Vadivelu, Andrew Livingston, Allen Ho, Shayan A. Izaddoost, Valentina Briceño, Thomas G. Luerssen and Andrew Jea

W ound dehiscence after spinal instrumentation in the pediatric age group presents a challenging problem to the spine surgeon and plastic surgeon. 3 , 11–13 , 17 , 19 , 21 , 22 , 26 Soft-tissue complications after spinal instrumentation are most commonly observed in patients with young age, poor nutritional status, severe disability from neurological deficits, multiple previous surgeries, and malignant neoplastic disease necessitating adjuvant therapy. 5 , 7 , 8 , 17 , 21 In the pediatric age group, these risk factors are found most commonly in children

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Matthew J. Tormenti, Dean B. Kostov, Paul A. Gardner, Adam S. Kanter, Richard M. Spiro and David O. Okonkwo

surgeon an intraoperative assessment of instrumentation placement. Methods Patient Population Between November 2007 and July 2008, 12 patients underwent posterior spinal instrumentation using intraoperative CT-based image-guided navigation for spinal deformity. All screws were placed under the direction of the senior surgeon (D.O.O.). A comparison group of 14 patients who underwent thoracolumbar instrumentation utilizing fluoroscopy during the same time period and who had postoperative CT scans was evaluated and included in this analysis. All patients in the

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Allan D. O. Levi, Curtis A. Dickman and Volker K. H. Sonntag

fixation must also be appreciated by spinal surgeons; these include, among others, hardware failure and neurological injury. Infections may develop after any surgical procedure, and the management of this complication in the setting of spinal instrumentation is critical in providing appropriate postoperative care to these patients. The incidence of wound infection after spinal surgery without instrumentation is relatively low. In an era in which antibiotic prophylaxis before spine surgery has become relatively routine, the incidence of infection after lumbar discectomy

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Matthew R. MacEwan, Michael R. Talcott, Daniel W. Moran and Eric C. Leuthardt

I njuries of the back and spine represent the leading cause of lost productivity and immobility in the United States. 24 Of the 279,000 surgeries conducted annually in the United States for the treatment of low-back pain, 160,000 involve such spinal fusion procedures. 1 , 24 Recent literature suggests that only 68% of patients undergoing lumbar spinal fusion experienced satisfactory outcomes, and 20%–40% of spinal fusion procedures failed. 30 Spinal instrumentation has been demonstrated to increase the rate of fusion in single-level lumbar interbody

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Allan D. O. Levi, Curtis A. Dickman and Volker K. H. Sonntag

The authors retrospectively reviewed 452 consecutively treated patients who underwent a spinal instrumentation procedure at a single institution to establish which patients and which surgical approaches might be associated with an increased risk of developing deep wound infections and to determine the efficacy with which the institution's current treatment strategy eradicates these infections. Wound infections occurred in 17 patients (10 men and seven women) with spinal instrumentation (incidence 3.8%). All infections occurred after posterior spinal instrumentation procedures (7.2%); there were no infections after anterior instrumentation procedures regardless of the level. Each patient was assigned an infection risk factor (RF) score depending on the number of RFs identified in an individual patient preoperatively. The mean RF score of patients who developed infections was 2.18, whereas the mean RF score for a procedure-matched, infection-free control group was 0.71. The mean number of days from surgery to clinical presentation was 27.6 days (range 4-120 days), and the mean increase in hospitalization time for the subset of patients who developed infections was 16.6 days. The most common organism isolated from wound cultures was Staphylococcus aureus (nine of 17 cases). Of the 17 patients, five had infections involving multiple organisms. All patients were infection free at a minimum of 8 months follow-up review. The current treatment regimen advocated at this institution consists of operative debridement of the infected wound, a course of intravenous followed by oral antibiotic medications, insertion of an antibiotic-containing irrigation-suction system for a mean of 5 days, and maintenance of the instrumentation system within the infected wound.

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Bryan W. Cunningham, Nadim J. Hallab, Nianbin Hu and Paul C. McAfee

T he effect of unintended wear particulate debris resulting from micromotion between the interconnection mechanisms in spinal instrumentation remains a clinical concern. Recently, there have been a number of retrospective clinical studies describing the histological response to wear particulate generated from spinal implants and the clinical consequence of this material in posterolateral arthrodesis procedures. 4 , 10 , 15 , 34 , 42 , 56 , 60 Dubousset et al. 15 were among the first to describe a late “infection” complication in patients in whom

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Faiz U. Ahmad, Charif Sidani, Roberto Fourzali and Michael Y. Wang

Trammell TR , Flint K , Ramsey CJ : A comparison of MRI and CT imaging clarity of titanium alloy and titanium alloy with cobalt-chromium-alloy pedicle screw and rod implants in the lumbar spine . J Bone Joint Surg Am 94 : 1479 – 1483 , 2012 22 Wang JC , Sandhu HS , Yu WD , Minchew JT , Delamarter RB : MR parameters for imaging titanium spinal instrumentation . J Spinal Disord 10 : 27 – 32 , 1997 23 Wang JC , Yu WD , Sandhu HS , Tam V , Delamarter RB : A comparison of magnetic resonance and computed tomographic image

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Sait Naderi, Feridun Acar and Tansu Mertol

As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery.

The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4–5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4–5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered.

Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable charectaristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.

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John R. Vender, Sydney Hester, Paul J. Houle, Haroon F. Choudhri, Andy Rekito and Dennis E. McDonnell

T he development and evolution of spinal instrumentation technology has enabled the spine surgeon to achieve immediate spinal stabilization during the initial operation. The immediacy of this fixation has allowed for more extensive decompressive procedures in which stability may be compromised as well as the aggressive correction of deformity and the rapid stabilization of the unstable spine. In these cases the instrumentation immediately restores alignment and stability, protects neural elements from secondary or delayed injuries, and allows rapid