Joshua M. Ammerman

The role of Osteocel Plus as a fusion substrate in minimally invasive instrumented transforaminal lumbar interbody fusion

BACKGROUND Instrumented lumbar fusion has become an accepted and effective surgical technique used to address a wide variety of conditions of the lumbar spine. Iliac crest autograft remains the gold standard with regards to bony fusion substrate. Unfortunately there are significant potential disadvantages associated with autograft harvest, including pain, infection, iatrogenic fracture and bleeding. Osteocel Plus (OC+) is an allograft cellular bone matrix containing mesenchymal stem cells (MSCs) and osteoprogenitor cells combined with DBM and cancellous bone. OC+ is designed to mimic the osteobiologic profile of human autograft bone, thereby eliminating the risks of autograft harvest. METHODS A retrospective chart review was conducted to identify all patients who had undergone a MITLIF with OC+ for degenerative lumbar conditions. Patient demographics including age, sex, history of risk factors for nonunion including: osteoporosis documented on DEXA scanning, diabetes mellitus, smoking or steroid use were examined and recorded. Successful arthrodesis was judged based on post-operative X-ray imaging. RESULTS 23 patients at 26 spinal levels underwent a MITLIF with OC+. Twenty-one patients (91.3%) and 24 levels (92.3%) went on to achieve radiographic evidence of solid bony arthrodesis by 12 months post-op. Six patients (26%) demonstrated clear evidence of early interbody bone growth within 6 months of surgery. CONCLUSION OC+ results in robust and reproducible lumbar interbody fusion, in both young and older patients.

Cruciate paralysis secondary to traumatic atlantooccipital dislocation: Case report

Cruciate paralysis is a clinical phenomenon thought to result from injury to decussating pyramidal tract fibers at the cervicomedullary junction, producing clinical findings of upper-extremity weakness out of proportion to the lower extremities. The authors present, to their knowledge, the first reported case of cruciate paralysis resulting from atlantooccipital dislocation.

Acute tetraplegia and cardiac arrest following high cervical leptomeningeal metastasis of giant cell glioblastoma

Giant cell glioblastoma multiforme (gcGBM) is an unusual subtype of high-grade glioma (grade IV, World Health Organization classification). We report a patient with a rare acute tetraplegia, followed by lethal cardiac arrest, who had undergone a prior resection of a supratentorial gcGBM. Neuroradiological workup revealed a large, high cervical compressive leptomeningeal mass consistent with a drop metastasis. Due to the possibility of a rapid clinical deterioration in patients with high cervical cord compression, the diagnosis of drop metastasis to the spine should be considered in patients with a previous history of supratentorial GBM who present with acute diffuse motor weakness.

Intraoperative Pathologic Evaluation of Central Nervous System Hemangioblastoma

Hemangioblastoma, a benign central nervous system (CNS) tumor occurring sporadically or as part of the von Hippel-Lindau (VHL) syndrome, can challenge pathologists at intraoperative consultation. Cytologic preparations are more useful than conventional cryostat sections for demonstrating the diagnostic features of hemangioblastoma during intraoperative consultation.