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Stambough JL. Managing Expectations in Three-Column Spinal Osteotomy Surgery: Motor Deficits Are More Common: Commentary on an article by Lawrence G. Lenke, MD, et al.: "Lower Extremity Motor Function Following Complex Adult Spinal Deformity Surgery. Two-Year Follow-up in the Scoli-RISK-1 Prospective, Multicenter, International Study". J Bone Joint Surg Am 2018; 100:e55. [PMID: 29664864 DOI: 10.2106/jbjs.18.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Stambough JL. CORR Insights®: Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery. Clin Orthop Relat Res 2016; 474:1026-7. [PMID: 26769620 PMCID: PMC4773327 DOI: 10.1007/s11999-016-4693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/04/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Jeffery L. Stambough
- grid.24827.3b0000000121799593Department of Engineering, University of Cincinnati, 4030 Smith Rd., Suite 350, Cincinnati, OH 45209 USA
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Stambough JL. In the eye of the beholder: Commentary on an article by Joshua D. Auerbach, MD, et al.: "Mitigating adverse event reporting bias in spine surgery". J Bone Joint Surg Am 2013; 95:e120(1-2). [PMID: 23965713 DOI: 10.2106/jbjs.m.00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dawson E, Bae HW, Burkus JK, Stambough JL, Glassman SD. Recombinant human bone morphogenetic protein-2 on an absorbable collagen sponge with an osteoconductive bulking agent in posterolateral arthrodesis with instrumentation. A prospective randomized trial. J Bone Joint Surg Am 2009; 91:1604-13. [PMID: 19571082 DOI: 10.2106/jbjs.g.01157] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge has been shown to be a safe and effective replacement for iliac crest bone graft when used with a threaded fusion device in anterior lumbar interbody arthrodesis. Use of rhBMP-2 on an absorbable collagen sponge in posterolateral lumbar arthrodesis requires the addition of a bulking agent to provide resistance against compression and to serve as an osteoconductive scaffold for new bone formation. METHODS We performed a prospective, randomized, multicenter pilot study to investigate the use of rhBMP-2 on an absorbable collagen sponge combined with a ceramic-granule bulking agent as a replacement for autogenous iliac crest bone graft in single-level posterolateral lumbar arthrodesis with instrumentation. The investigational group (twenty-five patients) was treated with a 1.5 mg/mL solution of rhBMP-2 on two strips of absorbable collagen sponge (total dose of rhBMP-2, 12 mg) combined with 10 cm(3) of ceramic granules. The control group (twenty-one patients) received iliac crest bone graft. Clinical outcomes were assessed with use of well-established instruments. Radiographs were reviewed to assess consolidation of fusion. RESULTS Eighty-eight percent (twenty-two) of the twenty-five patients in the investigational group and 86% (eighteen) of the twenty-one patients in the control group were considered to have completed the twenty-four-month follow-up. At all follow-up intervals, there were significant improvements in the clinical outcome measures, including the Oswestry Disability Index (ODI) scores, Short Form-36 scores, and back and leg pain scores, in both groups. At twenty-four months, the improvement in the mean ODI score, as compared with the preoperative score, was 28.2 points in the investigational group and 23.0 points in the control group. By twenty-four months, 95% (eighteen) of nineteen patients in the investigational group compared with 70% (fourteen) of twenty in the control group had a radiographically documented fusion. The overall success rate was 81% (seventeen of twenty-one) in the investigational group and 55% (eleven of twenty) in the control group (p = 0.345). CONCLUSIONS Compared with an iliac crest bone graft, the combination of an absorbable collagen sponge soaked with rhBMP-2 and ceramic granules resulted in trends toward improvements in clinical outcomes and toward a higher rate of radiographic fusion. This combination of an osteoinductive agent with an osteoconductive matrix may be an effective replacement for autograft in single-level posterolateral lumbar arthrodeses with instrumentation.
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Affiliation(s)
- Edgar Dawson
- Spine Research Foundation, The Spine Institute, Santa Monica, CA 90404, USA
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Messerschmitt PJ, Stambough JL. Unusual case of secondary scoliosis in a 20-year-old man. Am J Orthop (Belle Mead NJ) 2008; 37:E173-E176. [PMID: 19081887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Brown C, Stambough JL. Focal spontaneous osteonecrosis and medial meniscus tear: two cases and a literature review. Am J Orthop (Belle Mead NJ) 2008; 37:81-87. [PMID: 18401483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Christopher Brown
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Abstract
Visual impairment and blindness associated with general anesthesia and prone positioning in spine surgery have been increasing in incidence over the past several decades. Corneal abrasion, the most common ophthalmologic injury, is usually self-limiting. However, prolonged surgical procedures (>7 hours) associated with acute blood loss anemia, hypotension, and hypoxia may lead to posterior ischemic optic neuropathies. Direct pressure to the periorbital region of the eye can cause increased intraocular pressure and blindness as the result of central retinal artery occlusion. Hypoxia and cerebral embolism are associated with occipital cortical infarct or cortical blindness. The prognosis for visual recovery from ischemic neuropathy and retinal artery occlusion is poor. Cortical blindness usually improves to varying degrees. Effective treatment of perioperative amaurosis is lacking and usually ineffective, making prevention the cornerstone of management. To best prevent permanent ophthalmologic complications associated with prone positioning during spine surgery, orthopaedic surgeons should be aware of pathophysiology and related risks associated with spine surgery in the prone position, and initiate preventive measures and predictable treatment options.
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Affiliation(s)
- Jeffery L Stambough
- Spine Service, Orthopedic Diagnostic and Treatment Center, Cincinnati, OH, USA
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Abstract
This article reviews the reactivation of the latent varicella-zoster virus infection within the sensory dorsal root ganglia resulting in shingles. Although the association between surgery and reactivation of the varicella-zoster virus is known, we feel it is important to keep the diagnosis of shingles in mind especially in a patient with sudden onset of increased pain after surgery. Our purpose is to report 2 rare clinical presentations of shingles after spinal surgery in which the patient's initial diagnosis was not clear until the classical rash was observed. Two case reports are presented in which 1 patient developed shingles 5 days after surgery with distribution of the maculopapular rash in a surgical incision, whereas the second patient did not present until 4 weeks after surgery with a disseminated picture. Early recognition of this postoperative problem is imperative for prompt and appropriate management, as misdiagnosis can lead to short-term and long-term pain control issues, postherpetic neuralgia, neuropathic pain, or other related sequelae.
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Affiliation(s)
- Elisha K Godfrey
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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Abstract
BACKGROUND CONTENT With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. PURPOSE To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. STUDY DESIGN Case report with a review of literature. METHODS Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. RESULTS A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. CONCLUSIONS Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.
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Affiliation(s)
- Christopher Brown
- University of Cincinnati, College of Medicine, 231 Albert B. Sabin Way, Cincinnati, OH 45267, USA
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Abstract
BACKGROUND CONTEXT The reported incidence of vertebral hemangioma within the spinal column is common. Most often these benign vascular tumors are incidental radiographic findings and do not cause neurological sequelae. Rarely, vertebral hemangiomas will cause compressive neurological symptoms, such as radiculopathy, myelopathy and paralysis. In these cases the clinical presentation is usually the subacute or delayed onset of progressive neurological symptoms. This report demonstrates a symptomatic vertebral hemangioma presenting with rapid onset neurologic sequelae. PURPOSE To discuss diagnostic and management issues presented by symptomatic vertebral hemangioma. STUDY DESIGN Case report and review of literature. PATIENT SAMPLE Sixty-one-year-old white woman with low back pain and rapidly progressive myelopathic symptoms. METHODS A case of vertebral hemangioma with neurological sequelae is presented followed by a discussion of the literature concerning diagnostic and therapeutic options in the management of this pathologic entity. RESULTS The results of our review reveal that the incidence of vertebral hemangioma causing compressive neurological symptoms is rare despite the overall prevalence of vertebral hemangioma. Vertebral hemangioma may present with rapid onset myelopathic symptoms and may mimic those symptoms caused by a malignancy. Radiographic imaging modalities are extremely useful and display characteristic findings in the diagnostic evaluation of these tumors. Angiographic embolization of feeding vessels has been effective in minimizing operative blood loss, and surgical decompression and stabilization is frequently indicated. Postsurgical radiotherapy has also been demonstrated to serve as a limited adjunct to surgery by reducing tumor recurrence in the event of less than complete tumor resection. CONCLUSIONS Because of the rapid presentation of myelopathic symptoms in this case, preoperative angiographic embolization was not performed, and the patient underwent emergent decompressive surgery. In this case emergent operative decompression and stabilization was effective in reversing the patient's myelopathic symptoms, while maintaining long-term stability of the spinal column. Postoperative radiation was not administered because of the extent of tumor resection. Surgical intervention has produced long-term cure of this patient's myelopathy and T10 vertebral hemangioma.
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Affiliation(s)
- Cary R Templin
- Department of Orthopaedic Surgery, Northwestern University Medical School, 645 N. Michigan Ave., Chicago, IL 60611, USA
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Stambough JL. From the infectious disease service... When a septic patient develops increasing general weakness. Spine J 2004; 4:364-5. [PMID: 15185695 DOI: 10.1016/j.spinee.2003.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
An unusual complication of epidural anesthesia performed for routine total knee arthroplasty is presented. Epidural catheter placement or removal resulted in an acute cauda equina syndrome in a patient with asymptomatic high-grade lumbar spinal stenosis at L3-4. The case is presented along with a literature review.
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Affiliation(s)
- J L Stambough
- Deaconess Hospital, and Musculoskeletal Research Center, Cincinnati, Ohio, USA
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Abstract
Treatment of thromboembolic disease in the postoperative lumbar spine patient is controversial. This case report describes an epidural hematoma with neurologic sequelae in an elderly patient who received intravenous heparin therapy over 2 weeks after lumbar decompression. Implications for treatment of thromboembolic disease in the postoperative lumbar spine is reviewed.
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Affiliation(s)
- D E Spanier
- St. Vincent Hospitals and Health Services, Indianapolis, Indiana, USA
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Abstract
Incidental dural tears are a common complication of lumbar spine surgery, but if unrecognized cerebrospinal fluid (CSF) leakage can lead to the formation of a fistula or pseudomeningocele. Traditionally, fistulae and pseudomeningoceles have been treated with open revision surgery, but acute fistulae with direct CSF leakage through the incision site have reportedly been treated by extracorporal drainage. This report presents a case in which an established or chronic pseudomeningocele was successfully managed without open surgical repair.
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Affiliation(s)
- J L Stambough
- Musculoskeletal Research Center, University of Cincinnati, College of Engineering, Ohio, USA
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Stambough JL, El Khatib F, Genaidy AM, Huston RL. Strength and fatigue resistance of thoracolumbar spine implants: an experimental study of selected clinical devices. J Spinal Disord 1999; 12:410-4. [PMID: 10549706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Results of strength and endurance tests of several screw/rod thoracolumbar spinal implants are presented. The devices tested were: AcroMed ISOLA, CD systems, Depuy systems, and Synergy systems. The AcroMed ISOLA devices had the greatest stiffness and strength. The Synergy and AcroMed systems had the greatest fatigue resistance. The predominant failure mode was screw bending, although several instances of rod fracture and screw fracture were observed. A number of design improvements are identified, including reducing the number of components, thereby reducing the number of failure mechanisms; avoiding notches and knurled surfaces to provide greater resistance to crack initiation; and strengthening attachments between components, particularly between pedicle screws and horizontal rods.
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Affiliation(s)
- J L Stambough
- Institute for Applied Interdisciplinary Research, University of Cincinnati, Ohio 45221-0072, USA
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Stambough JL. Lumbosacral instrumented fusion: analysis of 124 consecutive cases. J Spinal Disord 1999; 12:1-9. [PMID: 10078943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
One hundred twenty-four cases of lumbosacral fusion receiving transpedicular screw fixation were divided into two groups and reviewed retrospectively. The conditions treated include spondylolisthesis, scoliosis, tumor, trauma, and degenerative disc disease. There were 83 males and 41 females in this consecutive series averaging a 45.2-month follow-up. The primary or first-time arthrodesis rate was 91.9%. A learning curve effect as it relates to operative time but not pedicular screw placement was shown. Instrumentation-related and general medical and surgical complications were low. Infection rates were also low; superficial 2.4%, deep 1.6%. Nonunion or delayed union was salvaged in 10 cases, improving the overall fusion rate to 97.6%. The results of this study support the use of lumbosacral transpedicular screw fixation in select spinal conditions.
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Affiliation(s)
- J L Stambough
- Back Treatment Center, Deaconess Hospital, University of Cincinnati, College of Engineering, Ohio, USA
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Stambough JL, Sabri EH, Huston RL, Genaidy AM, Al-Khatib F, Serhan H. Effects of cross-linkage on fatigue life and failure modes of stainless steel posterior spinal constructs. J Spinal Disord 1998; 11:221-6. [PMID: 9657547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study tested the effects of cross-linkage on the fatigue performance of posterior spinal constructs (i.e., AcroMed stainless steel Isola systems). The failure modes encountered during fatigue were also examined. The results of this study confirmed earlier findings that the use of cross-linkage does not significantly affect the stability of posterior constructs during axial loading. Their influence in torsion loading is much more pronounced. During the fatigue tests, posterior stainless steel spinal implants instrumented without cross-linkage reached 1 million cycles at 500- and 750-N loads. When the load was increased to 1,000 N, the number of cycles to failure dropped by two-thirds. These findings demonstrate that the endurance limit was between 750 N and 1,000 N for spinal constructs without cross-linkage, with the limit being closer to 750 N. Devices equipped with one or two cross-linkages reached 1 million cycles at 500 N. The number of cycles to failure dropped dramatically as the load was increased to 750 and 1,000 N. It appears that the endurance limits for spinal devices using cross-linkage should be 500 and 750 N, with the limit closer to the 500-N load. All rod fractures occurred near the junction between the longitudinal and transverse rods. Stress concentration was greatly in the vicinity of that contact point. These results should provide a basis for future improvement in endurance limits of spinal implants equipped with cross-linkage. Higher endurance limits will reduce the toxic effects encountered during fracture modes. The implants will also be better able to withstand the high physiologic loads experienced by obese individuals.
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Affiliation(s)
- J L Stambough
- Mechanical Industrial and Nuclear Engineering Department, University of Cincinnati, Ohio 45221-0116, USA
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Stambough JL. Lumbar disk herniation: an analysis of 175 surgically treated cases. J Spinal Disord 1997; 10:488-492. [PMID: 9438813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This is a retrospective review of 175 consecutive open lumbar diskectomies with a minimum 1-year follow-up (average follow-up, 54 months). Results of the diskectomies were: 91.0% good-to-excellent result, 3.4% fair, and 1.1% poor. Complications were few, and the overall recurrence rate was 4.6%. By multiple linear regression analysis, no one factor could predict the relief of leg pain.
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Affiliation(s)
- J L Stambough
- Back Treatment Center, Deaconess Hospital, Associated with the University of Cincinnati, College of Engineering, Ohio, USA
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Stambough JL, Genaidy AM, Huston RL, Serhan H, El-khatib F, Sabri EH. Biomechanical assessment of titanium and stainless steel posterior spinal constructs: effects of absolute/relative loading and frequency on fatigue life and determination of failure modes. J Spinal Disord 1997; 10:473-81. [PMID: 9438811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The goal of this study was to examine the effects of absolute/relative loads and frequency on the fatigue life of titanium and stainless steel posterior spinal constructs, and to determine the failure fracture modes. The stainless steel constructs had higher stiffness and yield strength than the titanium constructs, but the ultimate static strength was almost equal for both types of constructs. Titanium constructs, however, exhibited higher variability than the stainless steel constructs. In fatigue tests, the stainless steel constructs were significantly affected by the external load and were frequency independent. It appears from fatigue curves that 500 N can be approximated as the endurance limit for the stainless steel constructs. Titanium constructs were load-frequency dependent, and their endurance limit was somewhere between the 500 and 750 N load levels. There were no differences in performance between the stainless steel and titanium constructs at 16 Hz. At 4 Hz, titanium constructs performed as well or better than stainless steel constructs. Also, the titanium constructs resulted in better performance than the stainless steel constructs in the elastic region, and with smaller differences in the plastic region. Most of the failure modes for stainless steel constructs were in screw bending at 16 Hz with a smaller percentage of rod fractures at high loads, with a higher percentage of rod fractures observed for the stainless steel constructs at 4 Hz. Most of the failure modes for titanium constructs occurred in screw bending or fracture.
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Affiliation(s)
- J L Stambough
- Mechanical Industrial and Nuclear Engineering Department, University of Cincinnati, Ohio 45221-0116, USA
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Stambough JL. Posterior instrumentation for thoracolumbar trauma. Clin Orthop Relat Res 1997:73-88. [PMID: 9020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The majority of thoracolumbar spine fractures and fracture dislocations may be considered acute sagittal plane deformities. Unstable thoracolumbar spine injuries require stabilization to (1) allow mobilization of the patient to prevent pulmonary and venous complications; (2) to relieve pain; (3) to realign the spine and spinal canal, and (4) to decompress directly or indirectly the neural elements. Posterior spinal instrumentation is a safe, available, familiar, and effective method to achieve these goals. Posterior spinal instrumentation techniques used rod hook systems or screw rod and screw plate systems. Most of these unstable injuries can be managed using these well established techniques without the need for additional combined or staged anterior spinal surgery.
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Affiliation(s)
- J L Stambough
- Back Treatment Center, University of Cincinnati, Department of Engineering, OH, USA
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Stambough JL, Nayak S. Frankel A paraplegia: a comparison of two spinal instrumentation systems. South Med J 1996; 89:597-602. [PMID: 8638199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Seventeen patients with unstable thoracolumbar fracture dislocations and Frankel A (complete) paraplegia had posterior spinal fusion and instrumentation--nine with Cotrel-Dubousset instrumentation and eight with Luque rod instrumentation (LRI). Both systems maintained fracture reduction, and fusion occurred in all cases within a mean of 42 months (range, 30 to 66 months). Operative time and associated blood loss was less in the LRI group. One patient with LRI had fracture of the sublaminar wires that did not lead to loss of reduction or nonunion. Both instrumentation systems provided long-term posterior spinal stabilization in these patients.
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Affiliation(s)
- J L Stambough
- Department of Orthapaedics, University of Cincinnati, OH 45219, USA
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Hamilton W, Stambough JL. Diskitis associated with transpedicular screw fixation. J Spinal Disord 1996; 9:68-71. [PMID: 8727459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- W Hamilton
- Back Treatment Center, Deaconess Hospital, Cincinnati, Ohio, USA
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Stambough JL. Cotrel-Dubousset instrumentation and thoracolumbar spine trauma: a review of 55 cases. J Spinal Disord 1994; 7:461-9. [PMID: 7873842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A series of 55 patients treated with posterior Cotrel-Dubousset instrumentation and osteosynthesis for unstable thoracolumbar spine fractures were reviewed. Follow-up averaged 48.3 months. The fractures were all unstable, with 27 classified as fracture-dislocations (FD) and 28 classified as flexion compression injuries or unstable burst fractures (FC/B). The study population was composed of 29 men and 26 women with an average age of 31 (range 20-45) years. Mechanisms of injuries included 35 motor vehicle accidents, 19 falls, and one blunt trauma. No case worsened as a result of surgery, and 31% of the cases improved an average of 0.5 Frankel grade (range 0-2). Sixty percent of patients were braced with a custom molded thoracolumbosacral orthosis (TLSO) fitted after surgical stabilization. Minor complications occurred in 45% of the cases (urinary tract infection most common). There was a singular deep wound infection and another iliac crest donor site infection. There were no instrument failures or pseudarthroses. Radiographic analysis showed the following improvements in fracture angle, vertebral body compression, and fracture displacement. The pattern of radiographic improvement in the FD and FC/B subgroups showed significant improvement in each parameter when comparing preoperative to immediate postoperative values. Of importance, the radiographic findings comparing 1 month to the final follow-up showed little to no deterioration. Cotrel-Dubousset instrumentation proved to be a highly effective device for immediate restabilization of unstable thoracolumbar injuries.
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Stambough JL. Recurrent same-level, ipsilateral lumbar disc herniation. Orthop Rev 1994; 23:810-6. [PMID: 7824292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An operative technique for the surgical management of the recurrent lumbar disc herniation is illustrated and presented. Five cases of ipsilateral, same-level, recurrent disc herniations are reviewed and discussed in light of the available literature. All patients presented with severe recurrent sciatica at variable times from the incident surgery. The treatment and possible factors favoring recurrence are discussed.
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Affiliation(s)
- B E Lazio
- Department of Orthopedic Surgery, University of Cincinnati College of Medicine, Ohio 45267-0212
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Meding JB, Stambough JL. Critical analysis of strut grafts in anterior spinal fusions. J Spinal Disord 1993; 6:166-74. [PMID: 8504230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fifty patients undergoing anterior spinal decompression with partial or complete corpectomy and fusion with strut grafting were reviewed. The etiology of the spinal lesions included pathologic fracture (9 patients), trauma (22 patients), congenital/developmental lesions (6 patients), failed fusion (6 patients), and degenerative lesions (7 patients). Vertebral body reconstruction of the cervical, thoracic, or lumbar spine used iliac crest (20 cases), rib (12 cases), and fibular autografts (9 cases). Additionally, in 10 cases fibular allografts were used. There were four deaths, all secondary to systemic disease. Of the remaining 46 patients, 2 required revisions and all subsequently progressed to a solid anterior arthrodesis with an average follow-up of 30.4 months (range 12-62 months). Posterior spinal fusion was staged in 38 patients. Twenty of 29 patients with neurologic lesions improved after corpectomy. Eleven cases treated for a progressive, painful kyphosis averaged correction of 11.4 degrees (26%), which was maintained on long-term follow-up. Complications were primarily pulmonary and/or genitourinary. Others included a pseudarthrosis, an early fractured strut, and a late allograft infection. On the basis of this review, it appears that spinal arthrodesis with anterior decompression and strut grafting is an effective method of treating anterior compressive syndromes of the spine and painful progressive kyphoses.
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Affiliation(s)
- J B Meding
- Department of Orthopaedic Surgery, University of Cincinnati, Ohio
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Lazio BE, Staab M, Stambough JL, Hurst JM. Latissimus dorsi rupture: an unusual complication of anterior spine surgery. J Spinal Disord 1993; 6:83-6. [PMID: 8439723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Anterior spinal surgery is a common part of the treatment for spinal trauma and deformity. Two cases of an unusual postoperative complication of the surgical exposure for anterior spinal fusion with rib strut grafts are herein reviewed. In each case, the patient presented 3-6 months postoperatively with a large, painful mass along the posterior axillary line near the surgical incision. The mass was diagnosed as a rupture of the latissimus dorsi. The cause of this disruption is unclear, but it appears to be a complication of the surgical approach; therefore, surgeons performing transthoracic and thoracoabdominal approaches should be aware of it.
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Affiliation(s)
- B E Lazio
- University of Cincinnati College of Medicine, Ohio
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Abstract
A rare complication of the knee-chest position used for lumbar disk surgery is reported. Central retinal artery occlusion resulted in permanent loss of vision secondary to direct ocular pressure. Prevention is the only rational treatment for this unfortunate condition.
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Affiliation(s)
- J L Stambough
- Department of Orthopaedic Surgery, University of Cincinnati School of Medicine, Ohio
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33
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Abstract
A review of 19 consecutive patients treated for deep wound infections after spinal surgery was performed. Patients were analyzed for preoperative risk factors, original diagnosis requiring surgery, onset of infection, presentation, treatment, and outcome. These patients (10 men, nine women), with a mean age of 44 years (range 18-74) were treated for 13 deep and six subcutaneous infections: 16 spine infections and nine graft site infections (six with both). All 19 presented with draining wounds on an average of 17 days after surgery (range 4-86). Staphylococcus aureus was cultured in 14. Patients were treated with i.v. antibiotics for an average of 3 weeks (range 0-14) followed by oral antibiotics for an average of 6 weeks (range 2-12). Surgical treatment included an average of 1.8 debridements (range 0-5), primary closure in two, delayed primary closure in seven, and healing by secondary intent in 10. All but three patients were noted to be malnourished at the onset of their infection, with a total lymphocyte count of less than 2,000. Three patients required removal of their hardware. Eighteen of 19 healed or their infections were stabilized, 17 of 18 arthrodeses fused, and no patient had neurological deterioration secondary to the infection. The treatment outlined produced satisfactory results in all but one patient. We conclude that postoperative spine infections are frequently associated with poor nutrition. Although definitive diagnosis is determined by the culture, clinical exam is helpful in establishing a presumptive diagnosis and, thus, earlier institution of surgical and antibiotic treatment.
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Affiliation(s)
- J L Stambough
- Giannestras Adult Spine Service, University of Cincinnati School of Medicine, Ohio
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34
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Rahim KA, Stambough JL. Radiographic evaluation of the degenerative cervical spine. Orthop Clin North Am 1992; 23:395-403. [PMID: 1620534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite some claims to the contrary, the use of plain film radiography can be an inexpensive initial means of evaluating the degenerative cervical spine if viewed in the context of the patient's clinical history and physical examination and may serve as a guide for further imaging techniques. This article presents a systematic approach for evaluating cervical spine radiographs for the spectrum of degenerative changes, followed by a brief discussion of differential diagnoses.
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Affiliation(s)
- K A Rahim
- Department of Radiology, University of Cincinnati School of Medicine, Ohio
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35
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Abstract
Compression of the spinal cord secondary to disc disorders in Scheuermann's kyphosis is rare. This review reports an unusual case emphasizing mechanisms of compression of the spinal cord from this disc disorder. Contrasts and comparisons with previously published cases are included.
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Affiliation(s)
- J L Stambough
- Spine Service, University of Cincinnati School of Medicine, Ohio
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36
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Stambough JL, Hopson CN, Cheeks ML. Stable and unstable fractures of the femoral shaft. Orthop Rev 1991; 20:855-61. [PMID: 1749650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A retrospective review of 99 cases of stable and unstable femoral shaft fractures treated with Grosse-Kempf intramedullary fixation is presented. Despite minor complications and technical problems, the procedures resulted in union with acceptable alignment in 98% of cases. Details of the complications and technical problems are reviewed. There was no incidence of deep infection despite 16 open fractures. The two cases of nonunion were salvaged with revision internal fixation and bone grafting. Grosse-Kempf interlocking intramedullary fixation is a technically demanding procedure, but offers excellent results in the management of stable and unstable, open and closed fractures of the femoral shaft.
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Affiliation(s)
- J L Stambough
- Department of Orthopaedic Surgery, University of Cincinnati School of Medicine, Ohio
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37
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Affiliation(s)
- J Meding
- Department of Orthopedic Surgery, University of Cincinnati, Ohio
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38
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39
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Stambough JL, Balderston RA, Grey S. Technique for occipito-cervical fusion in osteopenic patients. J Spinal Disord 1990; 3:404-7. [PMID: 2134457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A technique for occipito-cervical fusion in patients with upper cervical spine abnormalities and osteopenia is described and illustrated. This technique combines the use of autogenous bone graft and a polymethylmethacrylate (PMMA)-wire construct.
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Affiliation(s)
- J L Stambough
- Department of Orthopaedic Surgery, University of Cincinnati School of Medicine, Ohio 45267-0212
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40
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Keith RW, Stambough JL, Awender SH. Somatosensory cortical evoked potentials: a review of 100 cases of intraoperative spinal surgery monitoring. J Spinal Disord 1990; 3:220-6. [PMID: 2134432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A review of our experience with evoked potential monitoring of over 100 spinal procedures is summarized here. Typical results of somatosensory cortical evoked potential (SCEP) testing found that latency of responses increased slightly and amplitude decreased substantially from preanesthesia to predistraction with no further changes. SCEP results are effected by many factors, but when they are understood and recognized, evoked potential monitoring can play a significant role in recognizing potential problems and preventing postoperative neurological problems in patients undergoing spinal surgery.
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Affiliation(s)
- R W Keith
- Department of Otolaryngology, University of Cincinnati Medical Center, OH 45267-0528
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41
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Anderson DJ, Stambough JL, Rothman RH. A rare intradural tumor simulating spondylolisthetic radiculopathy. Clin Orthop Relat Res 1990:136-8. [PMID: 2302877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Intradural tumors can produce nerve root symptoms similar to those caused by extradural compressive processes. In a 48-year-old man, the preoperative evaluation was spondylolisthetic radiculopathy; however, a lumbar myelogram prior to surgery revealed an unsuspected intradural tumor. The patient's symptoms resolved after removal of the tumor without treatment of the spondylolisthesis. When planning surgical treatment for any extradural process, intradural abnormalities must be ruled out by appropriate preoperative studies. Myelography and magnetic resonance imaging are now standard methods of evaluating the dural contents.
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Affiliation(s)
- D J Anderson
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Ohio
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42
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Affiliation(s)
- J L Stambough
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Ohio
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43
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Abstract
Patients with thoracolumbar fractures and fracture-dislocations of the spine often have associated injuries. One rare and potentially life-threatening concomitant injury is aortic trauma. In cases of fracture-dislocation at the thoracolumbar junction, injuries to the thoracic aorta must be diagnosed early and treated appropriately in conjunction with posterior fixation of the unstable spine.
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Affiliation(s)
- J L Stambough
- Department of Orthopaedic Surgery, University of Cincinnati School of Medicine, Ohio 45267-0212
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44
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Stambough JL, Cheeks ML, Keiper GL. Nonglucocorticoid-induced lumbar epidural lipomatosis: a case report and review of literature. J Spinal Disord 1989; 2:201-7. [PMID: 2520077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A case of nonglucocorticoid-induced lumbar epidural lipomatosis in a middle-aged black woman with neurogenic claudication is presented. The etiology, diagnosis, management, and outcome are discussed in detail.
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45
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Abstract
Unintended incidental durotomy is not an infrequent complication of spinal surgery (incidence, 0.3-13% reported). Although prompt repair is advocated, little has been written regarding any consequences of primarily repaired durotomies on long-term patient outcome. A retrospective review of 450 patients undergoing lumbar spine surgery revealed 17 cases (4%) of incidental durotomy, recognized intraoperatively and repaired primarily. These patients were evaluated at long-term follow-up (mean, 25.1 months); and their results were compared with controls matched for age, diagnosis, procedure, and length of follow-up. No differences of statistical significance could be identified in comparing the outcomes of the two groups. Incidental durotomy, when recognized and repaired intraoperatively, does not increase perioperative morbidity or compromise final result.
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Affiliation(s)
- A A Jones
- Department of Orthopaedic Surgery, Naval Hospital, Oakland, California
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46
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Ferree BA, Stambough JL, Greiner AL. Spinal epidural abscess. A case report and literature review. Orthop Rev 1989; 18:75-80. [PMID: 2644615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Spinal epidural abscess is a rare infectious disorder often subject to a delayed diagnosis. This delay can be disastrous, resulting in permanent neurologic dysfunction or death. Surgeons treating patients with spinal disorders must be aware of this condition to avoid confusing it with more frequent spinal problems, eg, herniated lumbar disk. This case report is presented to acquaint or refresh the occasional spinal surgeon with this condition.
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Affiliation(s)
- B A Ferree
- University of Cincinnati Medical Center, Department of Orthopaedic Surgery, Ohio
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47
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Petrik ME, Stambough JL, Rothman RH. Posttraumatic gluteal compartment syndrome. A case report. Clin Orthop Relat Res 1988:127-9. [PMID: 3370867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Posttraumatic sciatic nerve palsy associated with severe pain, swelling in the gluteal region, elevated tissue pressures, and diffuse edema of the gluteal musculature documented by computed tomography (CT) occurred in a 22-year-old man. Diffuse muscle swelling was observed intraoperatively, and sciatic nerve function returned within days following surgical decompression. This case represents an acute gluteal compartment syndrome, and this entity should be included in the differential diagnosis of posttraumatic sciatic nerve palsy.
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Affiliation(s)
- M E Petrik
- University of Pennsylvania School of Medicine, Philadelphia
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48
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Abstract
A major concern with the use of sublaminar wires for segmental spinal instrumentation is the risk of neurologic compromise associated with repeated passage of wires through the epidural space. Because of the inability to visualize the wire tip during its sublaminar passage, the surgeon is unable to appreciate the depth of wire penetration (DOWP). The purpose of this investigation was to determine, through direct measurement, the depth of intraspinal penetration during the passage of sublaminar wires. Using their model, the authors have been able to define the optimal parameters for safe wire passage. Careful attention to maintaining contact between the wire tip and the under-surface of the lamina, using a wire of optimal configuration, will result in minimal DOWP and reduce the possibility of neurologic compromise.
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Affiliation(s)
- S R Goll
- Department of Orthopaedic Surgery, Wright-Patterson USAF Medical Center, Dayton, Ohio
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49
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Stambough JL, Balderston RA, Booth RE, Rothman RH. Surgical management of sciatica involving anomalous lumbar nerve roots. J Spinal Disord 1988; 1:111-4; discussion 114-5. [PMID: 2485156 DOI: 10.1097/00002517-198801020-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Twenty patients with sciatica associated with anomalous lumbar nerve roots were reviewed with an average follow-up of 26.3 months. All patients had predominantly leg pain and their nerve root anomaly was known preoperatively. Overall success rate was 65% but was increased to 80% in patients with concurrent disk herniation. Improved results of surgical decompression were most consistently associated with concurrent disk herniation whereas other factors such as more extensive decompression were less strongly correlated. Surgery should only be offered with these results in mind.
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Affiliation(s)
- J L Stambough
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Ohio
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50
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Prusick VR, Herkowitz HN, Davidson DD, Stambough JL, Rothman RH. Sciatica from a sciatic neurilemoma. A case report and review of the literature. J Bone Joint Surg Am 1986; 68:1456-7. [PMID: 3536936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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