1/11. Adjacent fracture-dislocations of the lumbosacral spine: case report.OBJECTIVE AND IMPORTANCE: Traumatic fracture-dislocations of the lumbosacral junction are rare, with all previously reported cases involving fracture-dislocations at a single level. No cases of multiple fracture-dislocations of contiguous spinal segments in the lumbosacral spine have been reported. A case of traumatic adjacent fracture-dislocations of the fifth lumbar segment is presented. CLINICAL PRESENTATION: An 18-year-old male patient sustained open lumbar spinal trauma after a motor vehicle accident. A neurological examination revealed an L4 level. Radiographic evaluation of the spine revealed a three-column injury at L5 with spondyloptosis of the L5 vertebral body. Aorto-ilio-femoral angiography revealed no evidence of vascular injury. INTERVENTION: The patient was treated with a combined anterior and posterior approach in a two-stage operation. Six months postoperatively, he was neurologically unchanged; however, he was able to walk with the aid of a cane. Plain films revealed normal alignment of the lumbosacral spine. CONCLUSION: The management of traumatic lumbosacral fracture-dislocations requires careful consideration of retroperitoneal structures and possible exploration of the iliac vessels in addition to spinal reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Delayed aortic rupture caused by an implanted anterior spinal device. Case report.The authors describe a case of delayed aortic rupture following the application of a smooth-rod Kaneda (SRK) instrument. This is a rare but critical complication of anterior spinal fusion in which instrumentation is placed, and the authors wish to draw attention to the possible complications arising from such surgery. A few cases of this complication were reported in 1986. No reports have been published since then; perhaps because techniques and implant design have improved. In this case, a 53-year-old man suffered a T-11 fracture and related paraparesis, and he underwent decompression and anterior fusion in which an iliac bone graft was placed using an SRK device. Although his neurological deficit resolved postoperatively, nonunion of the grafted bone caused progressive kyphosis of the thoracolumbar spine. Twenty months after surgery, he complained of progressive gastrointestinal symptoms, and a delayed aortic rupture with a pseudoaneurysm was found surrounding the implant. The aortic pseudoaneurysm was replaced with an artificial vessel, and the SRK device was removed immediately. Delayed aortic rupture associated with anterior instrumentation is extremely rare but can occur. Even if the design of the implants can be improved, the placement of implants near the aorta and subsequent changes in the close anatomical relationship between the aorta and the implant eventually may result in this life-threatening complication. Careful follow-up examination and early removal of the implant, if necessary, are important.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Asymptomatic vertebral artery injury after acute cervical spine trauma.Two recent cases of vertebral artery injury from cervical fracture-dislocation prompted us to review the literature of these wrongly thought uncommon lesions. Extracranial vertebral artery injury during cervical trauma needs to be suspected not only in the case of vertebrobasilar ischemia, but also in asymptomatic patients presenting serious flexion-distraction deformities. Fracture of a transverse foramen or facet joint dislocation should alert the clinician. Magnetic resonance evaluates blood flow and vessel injury, usually unilateral, localized to the traumatized unstable vertebral segment. A four-stage classification is useful to understand and treat vertebral artery injury, also a standardized therapeutic protocol is not documented. Anterior cervical fusion seems indicated to decompress the injured vessel, and to avoid further damage to both vertebral arteries. Unstable spine conditions may also promote clot mobilization at the traumatized vessel leading to vertebrobasilar embolization. The benefit of antithrombotic therapy in reducing neurological morbidity and improving outcome is not yet established and needs long-term follow-up.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/11. Intrapelvic intrusion of the lumbosacral spine.A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. Neglected major vessel injury after anterior spinal surgery: a case report.STUDY DESIGN: This is a case report. OBJECTIVES: To present a case of neglected major vessel injury after anterior spinal surgery. SUMMARY OF BACKGROUND DATA: Vascular complications during spinal surgery are fortunately few in number. The incidence and management of vascular complications during anterior approaches to the thoracolumbar spine are not well known, and it is likely that most acute or delayed vascular injuries and complications are not reported. methods: A case that underwent anterior spinal surgery for T12 burst fracture with an iatrogenic injury to the aorta was presented. RESULTS: paraparesis (Frankel B) was present before last operation and disappeared completely at 30 months of follow-up. CONCLUSIONS: As with any complication, the best treatment is prevention. Careful and meticulous exposure of the involved anatomic area is very important for prevention. Early recognition with rapid treatment of vascular complications can reduce potential morbidity and mortality.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
6/11. Vascularized iliac bone graft based on a pedicle of upper lumbar vessels for anterior fusion of the thoraco-lumbar spine.A new option for the use of a vascularized iliac bone graft, based on the upper (first or second) lumbar vessels, has been developed. As a pedicled graft, this supero-posteriorly-based vascularized iliac bone graft can reach the vertebrae from T8 to the sacrum, and the lower sternum and thoracic cage. In this report, the vascular anatomy of the flap and clinical experience using it for anterior spinal fusion are described.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
7/11. color-coded Duplex sonography of vertebral arteries. 11 cases of blunt cervical spine injury.In 11 patients with locked cervical spine facets after blunt injury, the patency of the vertebral arteries was evaluated by color-coded Duplex sonography (CCDS) up to 11 years after the accident. In 7 patients the dislocations had been reduced, 2 had been treated conservatively, and 9 had been fused. In 9 patients (3 of them with persistent locking) the mean systolic peak flow velocity was 55 cm/sec and the vessel diameter was 0.35 cm. Only 2 patients had an abnormal CCDS. In 1 with persistent locking the ipsilateral vertebral artery was occluded, and in the other flow signals were abnormal and the vessel diameter was smaller than on the contralateral side. The high coincidence of vertebral artery occlusions and locked dislocations, as well as fracture dislocations reported by others, was not confirmed in our series.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/11. Potential large vessel injury during thoracolumbar pedicle screw removal. A case report.STUDY DESIGN: A case study of a previously unreported complication of unsuccessful broken pedicle screw removal in the thoracolumbar spine is presented. OBJECTIVES: To emphasize an increased awareness of the potential for large vessel injury during difficult broken pedicle screw removal in the thoracolumbar spine and to encourage the thorough evaluation of indications for the removal of any broken distal fragment in a vertebral body. SUMMARY OF BACKGROUND DATA: Reported complications of pedicle screw removal include the inability to remove the distal screw fragment, nerve root injury, and dural sheath violation. Damage to anterior vascular structures, including the vena cava, iliac arterial and venous systems, and aorta, has not yet been reported in association with difficult broken pedicle screw removal. methods: An instrument designed to capture the distal end of a screw fragment through an interference fit resulted in inadvertent screw migration into the retroperitoneal space. Plain roentgenograms and computed tomography were used to document this complication, revealing the close proximity of the screw fragment to the aorta. RESULTS: Expedient recognition of the anteriorly migrated screw fragment with its subsequent removal resulted in a satisfactory outcome. CONCLUSION: Great care must be taken during the removal of broken pedicle screws to prevent injury to surrounding structures. Additionally, indications for the removal of distal screw fragments must be carefully established. Instruments designed to capture the end of the distal screw fragment through an interference fit may allow anterior screw migration to occur, particularly in osteoporotic bone.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
9/11. Pathogenesis and neuroprotective treatment in Purtscher's retinopathy.Purtscher's retinopathy is characterized by sudden visual loss in severely traumatized patients and is associated with multiple areas of superficial retinal whitening located primarily in the posterior pole. Visual outcome in Purtscher's retinopathy is variable, and there is no well-defined treatment. We report on a patient with immediate blurred vision in the right eye after a traffic accident. ophthalmoscopy revealed multiple whitish patches scattered over the macular and peripapillary areas in the right eye. fluorescein angiography showed multifocal retinal arteriolar occlusion in the early phase and staining of the involved retinal vessels and optic nerve head in the late phase. indocyanine green angiography (ICG) showed rarefaction of choroidal vessels in the peripapillary area of the right eye at early phase. The late phase ICG study revealed multifocal hypofluorescent patches in the macular and peripapillary areas. Megadose steroid therapy was given with good visual response in the first 2 weeks, and the patient's vision had recovered completely when followed-up 10 months later.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/11. Delayed cortical blindness and recurrent quadriplegia after cervical trauma.In a retrospective, single-patient case report, we report on a 56-year-old woman with delayed cortical blindness and recurrent quadriplegia after a comminuted C1 burst fracture and a type II odontoid fracture. The vertebral artery is susceptible to injury during trauma to the cervical spine. The resulting vascular compromise may be responsible for a variety of neurologic outcomes. The patient was followed up through personal examination and chart review from initial presentation to 6 months after the injury. Three months after cervical fusion and anticoagulation therapy, the patient was noted to have marked improvement of her visual acuity with almost complete return of strength, as well as normalization of vertebral vessel size. Because of the proximity of the vertebral artery to the atlantoaxial complex, it is susceptible to injury during trauma to the cervical spine. Injury to the vasculature supplying the brain may result in both immediate and delayed neurologic consequences.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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