Study Design: Broad narrative review of current literature and adverse event databases. Objective: The aim of this review is to report the current state of wrong-site spine surgery (WSSS), whether the Universal Protocol has affected the rate, and the current trends regarding WSSS. Methods: An updated review of the current literature on WSSS, the Joint Commission sentinel event statistics database, and other state adverse event statistics database were performed. Results: WSSS is an adverse event that remains a potentially devastating problem, and although the incidence is difficult to determine, the rate is low. However, given the potential consequences for the patient as well as the surgeon, WSSS remains an event that continues to be reported alarmingly as often as before the implementation of the Universal Protocol. Conclusions: A systems-based approach like the Universal Protocol should be effective in preventing wrong-patient, wrong-procedure, and wrong-sided surgeries if the established protocol is implemented and followed consistently within a given institution. However, wrong-level surgery can still occur after successful completion of the Universal Protocol. The surgeon is the sole provider who can establish the correct vertebral level during the operation, and therefore, it is imperative that the surgeon design and implement a patient-specific protocol to ensure that the appropriate level is identified during the operation.
A utograft bone graft harvest is an important surgical technique in the armamentarium of the orthopaedic surgeon. The iliac crest can provide a robust amount of bone graft, but using it carries a risk of complications including neurologic injury, gait disturbance, sensory dysesthesia, and ilium fracture. We present a surgical technical involving harvest of cancellous bone graft from the anterior iliac crest that minimizes the complication profile associated with tricortical bone graft harvest. It should be noted that there are differences between the outcomes of anterior and posterior crest harvests. Anterior autograft harvest is associated with a higher complication rate, with more iliac wing fractures, postoperative hematomas, and sensory disturbances. The posterior approach, however, is associated with more postoperative pain than the anterior approach, with the patient often experiencing more pain from the harvest than from the procedure itself. The allcancellous iliac crest bone graft harvest provides the benefit of a large quantity of autogenous bone for various procedures, ranging from spinal fusion to osseous reconstruction. The major steps of this procedure are (1) offset of the surgical incision, (2) exposure of the iliac crest while avoiding neurologic structures, (3) identifying the location of and performing a corticotomy of the iliac crest, (4) harvesting the cancellous bone graft using curets, (5) obtaining hemostasis, and (6) performing a layered closure. The postoperative course entails immediate weight-bearing as tolerated. There is a potential for complications, which are discussed at the individual points of concern during this video.
Background: Unilateral fractures involving complete separation of the lateral mass from the vertebra and lamina (floating lateral mass fractures) are a unique subset of cervical spine fractures. These injuries are at significant risk for displacement without operative fixation. Posterior fixation has proven to facilitate adequate fusion. However, there are few data supporting the clinical success of single-level anterior fixation.Methods: Biomechanical evaluation of floating lateral mass fractures and a consecutive case series of patients with rotationally unstable floating lateral mass fractures treated with anterior fixation using an integrated cage-screw device with anterior plating (ICSD) was performed. The study comprised 7 fresh human cadaver cervical spines (C2-C7), and 11 patients with floating lateral mass fractures. Segmental flexibility testing evaluating axial rotation, flexion/extension, and lateral bending was performed in a cadaveric model after 2 types of single-level anterior fixation and 1 type of 2-level posterior fixation. Eleven patients with a floating lateral mass fracture of the cervical spine underwent anterior fixation with an ICSD. Radiographs and clinical outcomes were retrospectively reviewed.Results: Compared with the intact condition, posterior instrumentation significantly (P , .05) reduced range of motion (ROM) in all 3 planes; anterior fixation with cervical plate and interbody spacer significantly reduced ROM in lateral bending only; and the ICSD significantly reduced ROM in flexion/extension and lateral bending. In the clinical arm, there were no long-term complications, subsidence .2 mm, failure of fixation, reoperation, pseudoarthrosis, or listhesis at final follow-up.Conclusions: The addition of 2 screws placed through a cervical cage can improve anterior fixation in a human cadaveric model of floating lateral mass fractures. Early clinical results demonstrate a low complication rate and a high rate of healing with single-level anterior fixation using this technique.
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