Outcomes in posterior cervical spine surgery are highly dependent on proper operative head and neck positioning. As with any spinal procedure, posterior cervical surgery can be associated with significant morbidity; known complications directly related to positioning include postoperative vision loss, neurological injury, and poor surgical outcome. Unsurprisingly, a variety of techniques have been developed that aim to mitigate these complications while improving overall outcomes. The aim of this article is to present a standardized technique for application of the Mayfield skull clamp focusing on a team-based approach for patient positioning to minimize complications. The existing literature is also reviewed for complications associated with head positioning devices. Our method of clamp application and patient positioning minimizes complications (0.36% over a 14-y period), optimizes surgical exposure with anatomic position of the bony elements, and maximizes intraoperative spinal stability. This protocol is ideal for all the posterior cervical procedures.
Benign bone tumors are commonly treated with intralesional curettage and bone graft, with autogenous bone graft being the gold standard. However, autogenous bone graft has its limitation, and artificial bone graft substitutes were developed as an alternative. PRO-DENSE™ (Wright Medical Technology, Arlington, Tennessee) is a calcium sulfate and calcium phosphate mixed bone graft substitute that is biodegradable and osteoconductive, which has made them a popular choice among surgeons. However, long-term studies of this treatment method for benign tumors are still limited.In this report, we present a case of progressive femoral neck osteolysis caused by an inflammatory reaction to PRO-DENSE™ two years after intralesional curettage and bone grafting of a benign bone tumor.A twenty-one-year-old female with fibrous dysplasia underwent intralesional curettage with the use of PRO-DENSE™ bone substitute to fill the cavitary defect. She developed an inflammatory reaction to the bone graft substitute leading to increasing pain and osteolysis requiring a reoperation.Bone graft substitute has many advantages; however, they should be used with discretion due to many unknown regarding their safety and long-term outcomes.
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