Delayed iliac crest autograft fractures following plated single-level anterior cervical corpectomy with fusion

Recurrent cervical pain following single-level plated anterior corpectomy with fusion signaled delayed mid-iliac crest autograft fractures in four of 56 patients. Single-level anterior corpectomy with fusion used 15 fixed plates (Sofamor Danek) and 41 dynamic ABC plates (Aesculap). Patients in the fixed-plate and dynamic-plate groups averaged 46 and 48 years of age, respectively. Fusion was confirmed on both dynamic radiograph and two-dimensional CT studies an average of 4.5 months postoperatively. Two (13%) fixed-plated patients developed mid-iliac crest strut fractures 1 and 2 years postoperatively, whereas two (5%) dynamic-plated patients showed similar fractures 6 and 9 months following surgery. Immobilization in CTO orthoses resulted in fusion in one case, whereas three patients required secondary posterior wiring/fusion. Recurrent pain signaled delayed autograft strut fractures in four of 56 patients undergoing plated single-level anterior corpectomy with fusion.     

Multilevel anterior cervical fusion using skull bone grafts. Case report.

The successful use of autogenous skull bone grafts for a C3-7 anterior cervical fusion is reported and compared with results using other bone grafts. A 51-year-old man with C4-7 anterior cord compression due to spurs and ossified posterior longitudinal ligaments developed progressive tetraparesis following a minor head injury. He underwent anterior decompression and fusion. On two occasions an iliac graft had failed; however, a graft of autogenous skull bone was successful. The skull bone was found superior to bone from other sites, such as the iliac crest, rib, tibia, and fibula, showing sufficient strength and less morbidity. The skull may be a better source of graft material for multilevel anterior cervical fusion, which requires long and strong grafts.     

Reduction of donor site morbidity of the iliac crest free flap by preservation of the anterior superior iliac spine

To reduce donor site morbidity in the iliac crest free flap, we suggest leaving the anterior superior iliac spine in situ. The advantages are: less tension on the wound, less pain, faster rehabilitation, preservation of the ability to wear pants without braces, and a better cosmetic result through preservation of contour. Received: 1 December 1999 / Accepted: 1 February 2000     

Iliac crest fracture after removal of two bone plugs for anterior cervical fusion. Case report.

A case is reported in which the iliac crest fractured following removal of two bone plugs. The plugs had been removed for use in a double cervical vertebral body fusion operation by the method of Cloward.     

双侧髂前上棘撕脱骨折1例

患者，男，18岁，学生，以“双侧髂前上棘肿痛1周，加重1d”就诊。1周前患者上体育课跑步后感双髂前上棘处疼痛，当时未予重视，休息后稍缓角，1d前再次参加田径比赛后出现双侧髂前上棘处疼痛加重，拒按，肿胀明显，双正肢伸直时疼痛加剧，行走困难，以肌肉拉伤外搽消肿止痛酊治疗，体息后症状不缓解，遂来我院求治。     

Tracheostomy following anterior cervical spine fusion in trauma patients

Purpose

Traumatic injuries to the cervical spine are frequently accompanied by cervical spinal cord injuries—often necessitating tracheostomy. The purpose of this study was to evaluate patient characteristics and outcomes after undergoing anterior cervical spine fusion (ACSF) with tracheostomy.

Methods

All patients with cervical spine injury (CSI) who underwent ACSF and tracheostomy between December 1992 and June 2014 were included in this retrospective data analysis. The study group consisted of 32 men (84 %) and six women (16 %), with an average age of 47?±?20 years. Blunt trauma to the cervical spine was the cause of CSI in all 38 patients.

Results

The mean Injury Severity Score (ISS) was 30.50?±?6.25. Eighteen patients sustained severe concomitant injuries related to the spinal injury. In 15 patients (39.5 %), traumatic brain injury (TBI) with fractures of the cranium and/or intracranial lesions were observed. The mean Glasgow Coma Scale (GCS) score was 11?±?4.5 (range 3–15). Two tracheostomies (5.3 %) were performed simultaneously with ACSF. The remaining 36 were performed with an average “delay” of 15?±?ten days. We observed no difference in time to tracheostomy among patients initially presenting with an American Spinal Injury Association (ASIA) score of either A, B, C or D. Only two patients (5.3 %) were identified as having an infection at the site of ACSF after placement of a tracheostomy. There were no deaths directly related to airway difficulties in our cohort.

Conclusions

Our data show that tracheostomy is safely performed after an average of 15 days post-ACSF, thereby being associated with a very low rate of complications. However, future prospective randomised studies are needed to identify the optimal timing of tracheostomy placement after ACSF. Level of evidence: IV; retrospective case series.

     

The anatomical variation of the lateral femoral cutaneous nerve in relation to the anterior superior iliac spine and the iliac crest

The location of lateral femoral cutaneous nerve (LFCN) in relation to the anterior superior iliac spine (ASIS) and the iliac crest was investigated in 96 embalmed cadaveric specimens. Fifty-six nerves (58.3%) passed medial to the ASIS. Twenty-two nerves (22.9%) passed at the ASIS. Eighteen nerves (18.8%) passed lateral to the ASIS. The LFCN is usually located at 2.1 ± 0.8 to 3.9 ± 1.0 cm below the crest in the range of 2–5 cm lateral to the ASIS, respectively. When the anterior iliac crest bone graft harvesting is planned, the anatomical variation in this area should be concerned to reduce the risk of LFCN injury.     

脊柱前路手术髂前嵴取骨并发症相关分析

目的:探讨脊柱前路手术髂前嵴取骨的并发症发生情况。方法:回顾性分析2001年1月-2005年9月取髂骨行脊柱植骨融合术的154例患者,取骨部位均为髂前嵴,统计供骨区并发症,分析其相关因素。结果:术后随访时间均超过1年。28例(18.2%)患者发生不同程度的并发症,其中14例(9.1%)出现轻度并发症,12例(7.8%)出现中度并发症,2例(1.3%)出现重度并发症。127例(82.5%)患者接受了问卷调查,其中17例(13.4%)患者诉取骨处疼痛,疼痛自我感觉评分为1-6分(平均2分),其中3例(2.4%)患者需服用非甾体类抗炎药以减轻疼痛;7例(5.5%)患者诉取骨处有麻木感;无患者诉取骨处的疼痛及麻木感影响其日常活动;122例(96.1%)患者对供骨区切口外观满意。结论:髂前嵴取骨并发症中供骨区疼痛及麻木发生率较高,尤其是疼痛,应引起足够的重视。     

Avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica: a case report

We present a rare case of avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica in a 16-year-old male basketball player. He had sensory disturbance affecting his left lateral thigh 10 days after the injury. Tinel's sign was elicited on percussing the avulsed bony fragment of the anterior superior iliac spine. He underwent open reduction and internal fixation. The lateral femoral cutaneous nerve was noted to be entrapped by one third of the avulsed bony fragment. That fragment was removed, and the remaining portion was reduced and fixed with 2 screws. At week 6, the patient had returned to basketball playing without pain. At week 8, sensory distribution in the left lateral thigh had returned to normal.     

双侧髂前上棘骨骺撕脱1例

1病例资料患者,男,14岁。因双髋部疼痛、活动受限5 d入院。主诉5 d前上体育课医结合七年制2000级,四川成都6100752成都中医药大学附属医院骨科,四川成都610072参加50 m短跑,跑至终点时即感双髋部疼痛,行走受限,当时未摔倒。外院就诊行骨盆正位X线片及骨盆CT检查,诊断为双侧髂前上棘骨骺撕脱,未予处理。因双髋疼痛症状未缓解而来我院就诊。查体:双侧髂前上棘处轻度肿胀,明显压痛,触诊时有骨擦感,可扪及裂缝及骨折块;无放射痛,无明显的血管、神经损伤症状,双侧阔筋膜张肌、缝匠肌肌张力降低。仰卧位时双髋关节可屈曲40°,双髋关节其余各方向…     

颈前路减压自体髂骨植骨术供区晚期并发症的临床观察

目的:观察颈前路减压自体髂骨植骨术供区的晚期并发症并分析相关因素.方法:16例颈椎伤病患者行颈前路减压自体髂骨植骨术.髂前上棘后2～3cm处沿髂嵴向后作切口,取全层髂骨.切口置半管引流,加压包扎2～3d,24～48h拔除引流管.术后24h可在颈托保护下坐起或下地活动.结果:全部病例随访6～84个月,平均15.4个月.供区严重并发症3例,占18.8%.结论:颈前路减压自体髂骨植骨术供区并发症将对患者工作生活造成明显影响,不容忽视.临床上应重视取骨手术技巧及颈椎伤病新术式新材料的应用以减少或杜绝供区并发症的发生.     

髂前上棘骨折15例

髂前上棘骨折一些学者以保守治疗为主，也有一些专家认为应保守与手术疗法相结合，少数主张手术内固定。自1998年6月—2003年1月共诊治该类骨折15例，通过保守治疗与手术治疗，收效较好，特报告如下。     

可吸收螺钉治疗髂前上棘骨折

我科1995年以来采用可吸收螺钉治疗髂前上棘骨折30例,临床上取得满意效果,现报道如下.     

The fractured cervical spine rendered unstable by anterior cervical fusion.

Anterior interbody grafts are prone to displacement if there is posterior instability or gross deformity of the vertebral body. Twenty-one patients treated with anterior interbody fusion for cervical vertebral fractures and dislocations were studied. Twelve of the fractures were considered unstable preoperatively, and 50% of this group treated with anterior stabilization had graft migration postoperatively. If anterior fusion is used in unstable cervical fractures then posterior stabilization or complete bed rest with effective external stabilization (i.e., tongs or Halo-thoracic brace) for 4 weeks is mandatory. The other alternative is posterior stabilization before anterior decompression. In the presence of posterior instability, anterior interbody fusion alone cannot be recommended as the treatment of choice for cervical fractures.