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Treatment of adjacent segment disease after total disc replacement (TDR)
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Postoperative care of these patients is essentially no different from the typical care for the index procedure. Prophylactic antibiotics are continued only for 24 hours. No collar is used except for rare circumstances in which a soft collar is provided for comfort. A drain is used at the surgeon's discretion; in obese patients or patients with difficult dissections, drainage is probably necessary. Our criteria for doing these cases as an outpatient include minimal bleeding with the dissection, age ≤ 60 years, body mass index (BMI) ≤ 30. ASA ≤ 2, and a nonsmoker. We observe the patient for 4 hours to ensure that there are no swallowing issues. If the patient meets these criteria, then he or she is fine for discharge. Any other concerns warrant an overnight observation stay. We prescribe a 3-week course of nonsteroidal anti-inflammatory drugs (NSAIDs) to diminish the risk of heterotopic ossification (HO) after TDR implantation. However, it has been observed in our patients that heterotopic ossification may progress for up to 4 years postprocedure. Keeled implants have a higher rate of HO, so this factor needs to be considered in the preoperative planning. Lastly, no restrictions are recommended to postoperative activity. The patient may resume his or her lifestyle, as tolerated.
Injuries of the spine
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
If flexion contractures have been allowed to develop, tenotomies may be necessary. Painful flexor spasms are rare unless skin or bladder infection occurs. They can sometimes be relieved by tenotomies, neurectomies, rhizotomies or the intrathecal injection of alcohol. Heterotopic ossification is a common and disturbing complication. It is more likely to occur with high lesions and complete lesions. It may restrict or abolish movement, especially at the hip. Once the new bone is mature, it should be considered for excision if it interferes with function.
Lower limb symptoms and signs
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
There may be other associated fractures of the femoral head, neck and shaft, and these must not be missed if a an attempt is to be made to reduce the dislocation. Sciatic nerve injury (see Chapter 3) complicates over 10 per cent of dislocations, although fortunately most recover. Avascular necrosis of the femoral head is common, appearing within 12 months of the injury in 10 per cent of cases. Heterotopic ossification can also occur.
Total hip arthroplasty in the setting of tuberculosis infection of the hip: a systematic analysis of the current evidence
Published in Expert Review of Medical Devices, 2019
Assem A. Sultan, Sarah E. Dalton, Erica Umpierrez, Linsen T. Samuel, Emily Rose, Pierre Tamer, Jacob M. Rabin, Michael A. Mont
Yoon et al. [5] evaluated stability of femoral prostheses in patients treated with immediate cementless THA for active intraarticular tuberculosis with three patients having systemic manifestations as well (two pulmonary, one spine tuberculosis) using the Engh and Bobyn system [21]. All seven patients had stability with radiographic evidence of bone ingrowth into both the socket and femoral stem. They also did not detect heterotopic ossification greater than Grade I according to the Brooker system [22]. Öztürkmen et al. [10] also used the Engh and Bobyn [21] system to confirm the stability of the femoral component in nine patients with active disease who underwent cementless THA. One patient did have grade II heterotopic ossification according to Brooker et al. [22]. Similarly, Sidhu et al. [9] reported one instance of Brooker grade II heterotopic ossification among 23 patients following cemented THA for active disease; this reportedly did not affect joint function. They found no other evidence of implant failure or component loosening. Kim et al. [7] found radiolucent lines less than 1 mm in length in six of 38 patients, as well as un-united osteotomies of the greater trochanter in two patients. One patient had heterotopic ossification that restricted movement, requiring surgery. One patient also required revision arthroplasty for aseptic loosening of femoral and acetabular components.
Longitudinal study of the activities of daily living and quality of life in Japanese patients with fibrodysplasia ossificans progressiva
Published in Disability and Rehabilitation, 2019
Yasuo Nakahara, Hiroshi Kitoh, Yasuharu Nakashima, Junya Toguchida, Nobuhiko Haga
Although FOP is a progressive disease, it is not continuous. It originates as a painful inflammatory swelling brought about by flare-ups, and worsens in stages that are accompanied by decreases in ADL function. Heterotopic ossification typically appears during infancy, usually presenting as a painful soft tissue mass in the posterior regions of the neck and spine (areas that subsequently become foci of ossification). During early childhood, loss in mobility gradually spreads from the trunk to the joints of the upper and lower extremities. The initial site of ossification is frequently the neck, spine, or shoulder girdle. Ossification generally spreads from proximal to distal locations (i.e., from the trunk to the limbs, and from cranial to caudal locations). At least 95% of FOP patients experience functional upper extremity impairment by 15 years of age [15].
Review of long-term outcomes of disc arthroplasty for symptomatic single level cervical degenerative disc disease
Published in Expert Review of Medical Devices, 2018
Siddharth A. Badve, Pierce D. Nunley, Swamy Kurra, William F. Lavelle
Based on the mid- to long-term evidence, the following summarizes some inferences that can be made. CDA appears to offer better overall success rates and statistically significant superior functional outcomes (NDI, VAS neck and arm, SF-36, neurological success) in comparison to ACDF. CDA performs better than ACDF concerning the need for additional surgical interventions and these differences have been statistically significant. Pertaining to implant-related adverse events, CDA offers a better safety profile in comparison to ACDF. There appears to be some evidence suggesting a lesser incidence of radiological adjacent segment degeneration in the CDA group. This was more evident at the superior level, but it has yet to be shown if there is an obvious variance in the rate of symptomatic adjacent segment disease between CDA and ACDF. Heterotopic ossification is a concern with the incidence and severity being quite variable. The predisposing factors and the precise mechanisms are unknown; however, certain studies quote male gender and/or the device type may play an important role. A majority of patients continue to demonstrate functionality in the form of preservation of range of motion at the CDA level. CDA appears to be a more commercially viable alternative in the management of symptomatic cervical DDD with some advantage over ACDF procedure; however, CDA has to remain functional for a longer time period to offer this advantage.