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Wrong-site Spine Surgery

Wrong-site spine surgery is an adverse event that has potentially devastating consequences for the patient as well as the surgeon. Despite substantial efforts to prevent wrong-site spine surgery, this complication continues to occur and has the potential for serious medical, personal, and legal repercussions. Although systems-based prevention methods are effective in identifying the proper patient, procedure, and region of the spinal column, they cannot be relied on to establish the correct vertebral level during the operation. The surgeon must design and implement a patient-specific protocol to ensure that the appropriate operation is performed on the correct side and level or levels of the spinal column.

Complications of Anterior Lumbar Surgery

The incidence of anterior lumbar surgery is increasing. Although adverse events are uncommon, several have been described. Complications can be categorized based on the time of occurrence (ie, intraoperative, postoperative), patient positioning, surgical exposure, and spinal procedure. Notable approach-related complications involve vascular, visceral, and neural structures. Abdominal complications have been reported. Clinically significant complications related to spinal decompression and reconstruction consist primarily of neurologic injuries and graft- and device-related problems. The rate of complications is higher in the setting of revision anterior surgery than with initial anterior lumbar surgery. A thorough understanding of the complications associated with anterior lumbar surgery will aid in prevention, recognition, and management of these rare problems. The assistance of a vascular, neurologic, or general surgeon may be helpful in avoiding or effectively managing complications.

Spine Surgery Outcomes in Workers’ Compensation Patients

Occupational spine injuries place a substantial burden on employees, employers, and the workers’ compensation system. Both temporary and permanent spinal conditions contribute substantially to disability and lost wages. Numerous investigations have revealed that workers’ compensation status is a negative risk factor for outcomes after spine injuries and spine surgery. However, positive patient outcomes and return to work are possible in spine-related workers’ compensation cases with proper patient selection, appropriate surgical indications, and realistic postoperative expectations. Quality improvement measures aimed at optimizing outcomes and minimizing permanent disability are crucial to mitigating the burden of disability claims.

Congratulations to the 2018 Senior Achievement Award and Achievement Award Winners

Volunteer involvement is at the heart of all AAOS activities. The Academy’s meetings, courses, educational materials, clinical practice guidelines, and advocacy efforts are just a few of the many activities that depend on volunteer participation. Not only are volunteers vital to the AAOS, they also play a significant role in local, state, and national orthopaedic societies; specialty societies; and the broader medical community.

 

Spinal Epidural Abscess

A spinal epidural abscess is a collection of pus or inflammatory granulation tissue that is localized to the epidural space of the spinal cord. The abscess causes swelling in the area and threatens the spinal cord by compression and vascular disruption. The presence of a spinal epidural abscess is typically associated with a disk space infection or vertebral osteomyelitis. Common presenting symptoms include back pain, neurologic deficit, fever/chill, local tenderness, and paresthesias. Weakness or paralysis may not develop for many months or may occur suddenly and unpredictably in a matter of hours. Treatment goals for patients with spinal epidural abscess are eradication of infection, pain relief, preservation or improvement of neurologic status, and preservation of spinal stability. Laminectomy generally is the treatment of choice because the abscess is posterior in most patients. With surgery, most patients will recover fully or with minimal weakness.