Multiple anterior and posterior approaches to the thoracic disc space have been reported. However, we are not aware of any previous reports describing a transforaminal approach for thoracic disc release and interbody cage placement. In this case report, we describe a method to perform transforaminal thoracic interbody fusion (TTIF), which is an adaptation of an established lumbar fusion technique (transforaminal lumbar interbody fusion). Key differences between the two procedures are discussed. A 24-year-old woman presented after sustaining a T11-12 Chance fracture that had been treated in a brace. She had severe, debilitating pain and a rigid segmental kyphotic deformity of 38°. The patient was treated 3 months post-injury with T10-L1 fusion with anterior release and interbody fusion with cage placement at T11-12. Anterior column release and fusion were performed via a transforaminal approach. The patient had anatomic reduction of deformity, solid arthrodesis, and relief of pain at 1-year follow-up. The TTIF approach permits access to the anterior column of the thoracic spine for the purpose of reduction of deformity and interbody fusion with reduced morbidity compared to anterior-posterior surgery.

INTRODUCTION:Prior authorizations (PAs) are intended to control prescription drug expenditures.METHODS:One hundred fifty-six physician and advanced practice provider members of the American College of Gastroenterology completed a national survey to assess PA burden and impact.RESULTS:One-half of PA requests relate to prescription refills. Greater than 50% of the respondents choose inferior treatments at least weekly because of perceived PA burden for preferred agents. One-half of the respondents reported a patient who experienced serious adverse events due to PA-related care delays.DISCUSSION:PA is an administrative burden that exhausts practice resources and may have a negative impact on patient care.

We emphasize the natural history of the ISF so that its recognition will lead to earlier medical management of the originating ileitis. Furthermore, it adds evidence of the recognition that the causative agent of Crohn's disease is carried by the fecal stream.

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Most ISFs and IRFs are now found preoperatively by imaging and some are incidental surgical findings. The segmental sigmoid polyps that we describe should help the gastroenterologist to be suspicious of ISF. The polyps are a surrogate marker for the progression of the fistula and the underlying ileitis as they tend to appear after the fistula has matured and lead to increased intensity of medical therapy well before surgical intervention is required.