POVL 

Background  Unclear etiology  Associated with prone position, facial pressure and venous congestion  RF  Patient factors  Obesity  Old age  Preop anemia  PVD  Perioperative factors  Prone  Prolonged OR time >6h  ++ blood loss  Perioperative transfusion  HD – intaroperative hypottension  Management  Emergent opthalmology consult  Vasopressor as salvage 

Dural Tear  

Dural Tear Intraop  Incidence 1-17%  RF  Revision  Decompression for stenosis  Age  Ossified LF  High BMI  Challenging tear  Nerve root  Anterior spine (from posterior approach)  Management  Expose tear  Proximal and distal extension oof decompression  Protect neural elements  Watch sucker  Remove sticker on sucker  Patties to push in roots  Nerve hooks to lift edge of dura  Closure  Primary Continue reading “Dural Tear  “

Complications and Management  

Infected AIS or Deformity  Management  Preop Imaging  Screw Halo (loosoe)  Broken Hardwar  Graft subsidence  Soft Tissue Collectiono  BW  Operative  5 cultures including soft tissue  9L NS low flow  Remove loose HW  replace if any instability (ie: osteotomy)  Alternative fixation methods (ie: hooks, wires)  Remove graft, replace with osteocet with Abx  Vancomycin powder  Drain  Primary closure or Plastics  IVContinue reading “Complications and Management  “

Background 

Charcot Spine looks like infection  2-4% of osteomyleitis infections  Mortality is 1-20%  Delay in diagnosis = 3 months  Average duration of treatment = 12 months  Costly treatment  Hibbs and Albee = fusion for treatment of tuberculosis  Biology  Intervertebral disc  3 zones of endplate (marrow cavities)  Central – numerous small homes  Good nutrient flow centrally  Peripheral – fewContinue reading “Background “

Imaging – Infection vs Modic vs Tumour  

MRI  Infection  T1  Body – dec  Disc – dec  Destruction of margin between body and disc space  T1 fat suppressed with Gad  Abscess is dark with rim enhancement (due to hypervascularity)  Gadolinium – ring enhancement  Contrast, fat suppression and evaluating appearance of disk, endplates, epidrual space and paraspinal tissues will differentiate infection from degenerative and tumour  T2 Continue reading “Imaging – Infection vs Modic vs Tumour  “

Granulomatous Infection  

Background  TB (Pott’s disease)  Osteo, kyphosis, mechanical instability  Other  Brucellosis, actinomyces, nocardia, fungal, parrasitic  Location: thoracic  Caseating granuloma  3 Patterns  Peridiscal (most common)   Central – VB collapse and deformity  Anterior – anterior to VB, posterior to ALL  Pyogenic vs TB  Paraspinal abscess formations (50%)  Anterior and large (more common in TB than pyogenic)  Initially not involve discContinue reading “Granulomatous Infection  “

Infection 

Background  Risk facors  IVDU  DM  HIV  Malignancy  Stroid  Renal failue  Sppinal sugey  Malnutirion  Age  Most common organism: Staph Aureus  Lumbar spine  Vertebrarl osteeo  Epidrual, parabetebral or psoas abscess  Cervical  Mediastinum, supraclavicular fossa, retrophayneal space  Pediatric  Vessels go into the disc space (adults they don’t)  Isolated disc space infection  Happens more often than in adults  Lumbar, Staaph auerus (salmonella is sickle cell)  Age <5  Symptoms  Pain, refusalContinue reading “Infection “

NOMS Framework  

Background  NOMS Framework – A tool/ framework used to determine the optimal therapy for patients with spinal metastases (20% of Ca pt have mets, 10% have compression)  Goals of Care:  Pain relief  Maintain vs recover neurologic function  Local durable tumour control  Spinal stability  QoL  Considers 4 sentinel decision points  Neurologic – degree of ESCC (myelopathy/ radiculopathy)  Oncologic –Continue reading “NOMS Framework  “

Primary Malignant Lesions  

Enneking  Low grade  High grade  Mets  Intracompartmental  Extracompartmental  Lesions  Osteosarcoma  Location: Anterior Column  Presentation: pain, neurologic symptoms (70%)  Ix:  Lytic/ blastic/ mixed anterior column  SUNBURST pattern  Bone scan – very hot  Mx:  Tumour workup  Neoadjuvant Chemo + Rads  Wide Resection  Sacral – total Sacrectomy with Recon with PMMA, plate/ screw devices, custom prosthesis  Ewing Sarcoma  Location: Anterior ColumnContinue reading “Primary Malignant Lesions  “