Sakthivel Rajan Rajaram Manoharan

Type III odontoid fractures: A subgroup analysis of complex, high-energy fractures treated with external immobilization

Study Design: Retrospective cohort study. Objective: Type III odontoid fractures are classically treated nonoperatively, yet, the current literature on Type III odontoid fractures includes fractures of multiple etiologies and fracture morphologies. We hypothesize that a subgroup of complex, Type III fractures caused by high-energy mechanisms are more likely to fail nonoperative treatment. Materials and Methods: Acute Type III odontoid fractures were identified at a single institution from 2008 to 2015. Fractures were categorized as high- or low-energy fracture with high-energy fractures defined as those with lateral mass comminution (>50%) or secondary fracture lines into the pars interarticularis or vertebral body. Patients were treated in either a hard collar orthosis or halo vest and were followed for fracture union and stability. Results: One hundred and twenty-five Type III odontoid fractures were identified with 51% classified as complex fractures. Thirty-three patients met the inclusion and exclusion criteria including 15 patients treated in a halo vest and 18 in a hard collar orthosis. Mean follow-up was 32 (±44) weeks. Seven patients demonstrated progressive displacement of either 2 mm of translation or 5° of angulation and underwent delayed surgical stabilization. Two additional patients required delayed surgery for nonunion and myelopathy. Initial fracture displacement and angulation were not correlative with final outcome. No statistical advantage of halo vest versus hard collar orthosis was observed. Conclusions: Complex Type III odontoid fractures are distinctly different from low-energy injuries. In the current study, 21% of patients were unsuccessfully treated nonoperatively with external immobilization and required surgery. For complex Type III fractures, we recommend initial conservative treatment, while maintaining close monitoring throughout patient recovery and fracture union.

Nanotechnology in orthopedics: a clinically oriented review

The utility of nanotechnology in medicine, specifically within the field of orthopedics, is a topic of extensive research. Our review provides a unique comprehensive overview of the current and potential future uses of nanotechnology with respect to orthopedic sub-specialties. Nanotechnology offers an immense assortment of novel applications, most notably the use of nanomaterials as scaffolds to induce a more favorable interaction between orthopedic implants and native bone. Nanotechnology has the capability to revolutionize the diagnostics and treatment of orthopedic surgery, however the long-term health effects of nanomaterials are poorly understood and extensive research is needed regarding clinical safety.

Endoscopic Spine Surgery: Current State of Art and the Future Perspective

Copyright C 2018 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Asian Spine Journal • pISSN 1976-1902 eISSN 1976-7846 • www.asianspinejournal.org Received Nov 8, 2017 Corresponding author: Sakthivel Rajan Rajaram Manoharan University of Alabama, 510, 20th St S Birmingham, AL 35233, USA Tel: +1-205-934-8718, E-mail: srajaram@uabmc.edu

Posttraumatic Spinal Cord Injury without Radiographic Abnormality

“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.

Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management

Traumatic lumbosacral dislocation is a rare, high-energy mechanism injury characterized by displacement of the fifth lumbar vertebra in relation to the sacrum. Due to the violent trauma typically associated with this lesion, there are often severe, coexisting injuries. High-quality radiographic studies, in addition to appropriate utilization of CT scan and MRI, are essential for proper evaluation and diagnosis. Although reports in the literature include nonoperative and operative management, most authors advocate for surgical treatment with open reduction and decompression with instrumentation and fusion. Despite advances in early diagnosis and management, this injury type is associated with significant morbidity and mortality, and long-term patient outcomes remain unclear.

Spinopelvic Dissociation: Comparison of Outcomes of Percutaneous versus Open Fixation Strategies

Introduction Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. Recent technological advances have allowed for percutaneous fixation with indirect reduction. Herein, we evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Methods Retrospective review of patients undergoing spinopelvic fixation from a single, level one trauma center from 2012 to 2017. Patient information regarding demographics, associated injuries, and treatment outcome measures was recorded and analyzed. All fractures were classified via the AO Spine classification system. Results Thirty-one spinopelvic dissociations were identified: 15 treated with open and 16 with percutaneous techniques. The two treatment groups had similar preoperative characteristics including spinopelvic parameters (pelvic incidence and lumbar lordosis). Compared to open reduction internal fixation, percutaneous fixation of spinopelvic dissociation resulted in statistically significantly lower blood loss (171u2009cc versus 538u2009cc; p = 0.0013). There were no significant differences in surgical site infections (p = 0.48) or operating room time (p = 0.66). Conclusion Percutaneous fixation of spinopelvic dissociation is associated with significantly less blood loss. Treatment outcomes in terms of infection, length of stay, operative cost, and final alignment between the open and percutaneous group were similar.

To Plate or Not to Plate after a Single- or Two-Level Anterior Cervical Discectomy: Fusion with Cage-Plate Construct or Stand-Alone Cage

Copyright C 2017 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Asian Spine Journal • pISSN 1976-1902 eISSN 1976-7846 • www.asianspinejournal.org Received Jan 11, 2017; Accepted Jan 11, 2017 Corresponding author: S.R. Manoharan University of Alabama, Birmingham Medical Center, FOT 960, 20th St S Birmingham, AL, USA 35294. Tel: +205-934-8718, E-mail: srajaram@uabmc.edu

Concomitant Lumbar Stenosis and Aortic Pseudoaneurysm: A Case Report

Aortic pseudoaneurysm can create a constellation of symptoms that can mimic lumbar back pain. There are rare but well-documented reports of aortic pathology (aneurysms, pseudoaneurysms, and chronic contained aneurysm ruptures) eroding into the vertebral column causing neural compression. We report a case of a rapidly progressive aortic pseudoaneurysm in a patient with pre-existing lumbar spine pathology which had the potential for catastrophic intraoperative bleeding during a minimally invasive surgery (MIS) using the transforaminal lumbar interbody fusion (TLIF) technique. Postoperatively, the patient’s radicular pain resolved but her back pain remained. Further workup identified the pseudoaneurysm and the patient subsequently underwent open vascular repair. In this report, we highlight a lesser known mimicker of lumbar back pain.