The results of the surgical treatment of osteomyelitis with expandable titanium cages and either allograft or autograft are presented.
Thirty-six patients with vertebral osteomyelitis are presented. There were 7 cervical, 17 thoracic, 4 thoracolumbar (involving T12-L1), 5 lumbar, and 3 lumbosacral (involving L5-S1) lesions. The most frequently identified organisms were Staphylococcus aureus, Mycobacterium tuberculosis, and Coccidioides immitis. Imaging studies included x-rays, computed tomographic scans, and magnetic resonance imaging scans. All patients were treated with corpectomies and expandable cage reconstruction. Fusion was performed with rib autograft, iliac crest autograft, or allograft. Most patients who had an anterior approach also underwent posterior instrumentation, whereas a few had anterior instrumentation only. Four patients underwent a posterior approach (transpedicular corpectomy) only.
The median follow-up period was 21 months. There were no implant failures. Two recurrences of infection were noted: 1 case involved allograft, and the other involved autograft. At follow-up, neurological deficits improved in all patients, and 81% of patients were pain-free.
This study suggests that the treatment of vertebral column osteomyelitis can be performed with expandable titanium cages, and allograft does not appear to increase the rate of recurrence, as compared with autograft.
"The pedicles are then taken down, exposing the vertebral body for corpectomy and adjacent level discectomy. Multiple techniques have been described for placement of an expandable cages in the transpedicular approach: including thecal sac mobilization, rib head osteotomy, rib head disarticulation, and trap-door rib head osteotomy, with thinning of the rib to allow greenstick fracture and displacement with subsequent displacement [47, 52, 53]. "
[Show abstract][Hide abstract] ABSTRACT: The rapid expansion of minimally invasive techniques for corpectomy in the thoracic spine provides promise to redefine treatment options in this region. Techniques have evolved permitting anterior, lateral, posterolateral, and midline posterior corpectomy in a minimally invasive fashion. We review the numerous techniques that have been described, including thoracoscopy, tubular retraction, and various instrumentation techniques. Minimally invasive techniques are compared to their open predecessors from a technical and complication standpoint. Advantages and disadvantages of different approaches are also considered, with an emphasis on surgical strategies and nuance.
Minimally Invasive Surgery 07/2012; 2012(7):213791. DOI:10.1155/2012/213791
"The diagnosis of PBL relies on both radiological and pathological studies, and it can be easily missed on plain radiographs.89 In our patient, the lesions appeared osteoblastic in the pelvic and iliac bones, which can lead to a misdiagnosis of metastatic disease in the first impression. "
[Show abstract][Hide abstract] ABSTRACT: Primary bone lymphoma (PBL) comprises less than 5% of all malignant bone tumors and almost 7% of all extranodal lymphomas. Only 1.7% of all PBLs have been reported to involve the vertebrae. In our case, osteomyelitis was accidentally found during surgery, which might have resulted in the rapid collapse of vertebral body. This is the first report on primary lymphoma of the vertebrae with superimposed osteomyelitis in the English literature to the best of our knowledge. The patient reported here received anterior vertebrectomy and posterior interbody fusion with instrumentation for spinal instability. Tumor mass and the necrotic debris were removed. After the procedure, the patient received treatment with antibiotics and six cycles of chemotherapy. This case reminds us the possibility of hematologic seeding of bacteria in the tissue, especially with tumor necrosis. We suggest percutaneous needle aspiration for pathology and culture before making a decision whether or not to proceed with surgical decompression for fear of missing the occult bacterial infection.
Indian Journal of Orthopaedics 07/2012; 46(4):479-82. DOI:10.4103/0019-5413.98835 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Demonstrates the application of a simplified version of the
GENOCOP (GEnetic algorithm for Numerical Optimisation for COnstrained
Problems) system to calibrate gravity and logit models of road traffic
simultaneously for the road network in the Gascoyne, Pilbara and
Kimberley regions in Western Australia, as well as other regions in
Australia. From the census population data by locality and a set of data
on traffic flows by link, it is possible to estimate the entire set of
origin-destination travel volumes and the full set of link loadings.
Calculation of the objective function involves a complex process in
which the parameters for an individual in a genetic algorithm are
applied to two sequential models of road traffic. This application of a
genetic algorithm indicates that it is possible to calibrate the two
traffic models simultaneously
Evolutionary Computation, 1995., IEEE International Conference on; 01/1995
Virginia Mumford, Rebecca Reeve, David Greenfield, Kevin Forde, Johanna Westbrook, Jeffrey Braithwaite
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