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Biomedical subjects

G R Rechtine

Publications and source records attributed to G R Rechtine.

At least 19 recordsLinked to original sources
PubMed2001

Postoperative wound infection after instrumentation of thoracic and lumbar fractures.

OBJECTIVE: To assess the risk of infection in trauma patients undergoing surgical intervention with instrumentation for thoracic and lumbar fractures. DATA SOURCES: A case series of 235 consecutive patients who sustained thoracic and lumbar fractures seen at Tampa General Hospital in Tampa, Florida between 1986 and 1997. STUDY SELECTION: 117 patients of the 235 consecutive patients included in the case series underwent surgical intervention; of these patients, twelve were identified as having acute postoperative wound infections. DATA EXTRACTION: Of those patients treated with operative decompression and internal fixation, the authors identified and studied those with an acute wound infection. These patients were analyzed for risk factors and infection management. DATA SYNTHESIS: Twelve (10 percent) patients with acute postoperative wound infections were identified. These included nine deep and three superficial infections. This provides an overall infection rate of 10 percent (12 of 117). Of these, there were three infections in twenty-one patients undergoing anterior spinal procedures. Only two of the twelve patients had pure cultures of gram-positive organisms (2 Staphylococcus aureus). Cultures from eight (67 percent) patients showed multiple organisms. There was a significantly (P < 0.05) higher risk of infection in the patients with a complete neurologic injury 41 percent (7/17) as compared with those with no deficit or incomplete injuries 5.0 percent (5/100). CONCLUSIONS: The overall risk of infection is higher in the trauma patient than in the elective surgery population. Those patients with a complete neurologic deficit are at a greater risk. Aggressive and early intervention can help contribute to a favorable outcome.

Adolescent↗
PubMed2000

Effect of the spine practitioner on patient smoking status.

STUDY DESIGN: A prospective evaluation of the smoking habits of new spine patients was performed during a 4-year interval. OBJECTIVE: To assess what effect the spine health care provider has on a patient's ongoing nicotine addiction. SUMMARY OF BACKGROUND DATA: The negative effects of smoking and nicotine for the spine patient are well defined. METHODS: Spine patients (N = 10,901) were queried as to their smoking habits during their new patient consultation; 3041 current smokers were identified. Data were obtained during 20,835 follow-up visits. Some of the smokers (n = 1632) were seen in follow-up visits and evaluated for their cigarette usage. Two different approaches were applied to assist the patient to stop smoking: 1) chart identification, reinforcement at each visit, continued education, written handout, practitioner assigning high priority, and 2) occasional mentioning, lower priority. RESULTS: The number of smokers who quit smoking was 35.6% in the high priority group versus 19.5% in the lower priority group. There was also a difference in the number of patients who decreased their smoking (67% vs. 38%). The fear that confronting a patient who smoked would cause the patient to leave the practice was not realized. Other factors that predicted successful cessation were fewer packs per day, fewer years smoking, and older age. The effect of the practitioner was independent of these other variables as determined by a logistic regression analysis. CONCLUSION: Patients will respond better if the practitioner assigns a priority and works with the patient to educate them about ways to address this particular substance abuse. Just asking about the patient's smoking status had a dramatic effect on smoking status. All spine practitioners should do all in their power to help their patients overcome their nicotine addiction.

Humans↗
PubMed2000

Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study.

STUDY DESIGN: A prospective study of 15 patients who underwent modified Smith-Robinson anterior cervical discectomy and fusion at three or four operative levels stabilized with an unicortical anterior plate. OBJECTIVES: To provide medium-term follow-up data on the surgical success and patient outcome of three- and four-level anterior cervical discectomies and fusions and to determine the effect that plate fixation has on the results. SUMMARY OF BACKGROUND DATA: The success of arthrodesis for anterior cervical fusion depends on several factors, including the number of surgical levels. The arthrodesis rate and outcome for patients having three- and four-level discectomy and fusion procedures is disappointing. Internal fixation putatively improves these parameters. METHODS: Fifteen patients (average age, 51 years; range, 35-77), were observed for an average of 42 months (range, 25-73) All had an anterior discectomy, burring of the endplates, placement of an autogenous tricortical iliac crest graft at three (12 patients) or four (3 patients) levels, and application of a Cervical Spine Locking Plate. All patients had follow-up office visits with examinations and radiographs. Radiographic union, postoperative pain relief, and neurologic recovery were evaluated. RESULTS: Solid arthrodesis was achieved at all levels in only 7 (47%) of the 15 patients after a single procedure. Of the 8 patients with pseudarthrosis, 3 had sufficient pain to necessitate revision surgery (with pain relief in two), 1 had pain without further surgery, and 4 no pain. Of the 7 with solid fusion, 3 had persistent pain, and 4 had none. Two in this group had a second procedure. All 4 patients with preoperative myelopathy improved, and 10 of the 11 with radiculopathy had resolution of arm symptoms. CONCLUSIONS: Three- and four-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. The Cervical Spine Locking Plate alone does not appear to improve the arthrodesis rate.

Adult↗
PubMed1999

Nonsurgical treatment of thoracic and lumbar fractures.

The treatment of thoracolumbar trauma remains controversial. As more and more data are collected, there appears to be information that substantiates both surgical and nonsurgical treatment. Orthopaedic surgeons must all be cognizant of the fact that we draw our conclusions from data and not subjective prejudicial opinions. Nonsurgical treatment is still a viable and effective treatment for thoracic and lumbar fractures and should be part of the armamentarium available to all practitioners involved in the treatment of these patients.

Adult↗
PubMed1999

Nonsurgical treatment of cervical degenerative disease.

A regular exercise program, even something as simple as a daily walk, can help to keep the ongoing degenerative process at bay. Such efforts at prevention can help with the patient's general health and should be encouraged by the spine physician. The vast majority of patients with degenerative cervical disease that is manifesting itself as neck and arm pain will respond to nonsurgical treatment. However, a very small percentage of patients who have cervical radiculopathy will require surgical treatment. Each practitioner must develop his or her own protocol based on personal experience, using a combination of the methods we have just discussed. An accurate diagnosis is necessary to avoid treating the wrong problem (i.e., lung cancer, shoulder impingement, etc). Patients should be knowledgeable about their disease. They should be empowered to participate in their care and encouraged to work with the physician and/or therapist to accomplish the goal of returning to a reasonable lifestyle at work as well as at home. An ongoing exercise program and an ergonomic evaluation at home and work can be helpful in reducing recurrences.

Cervical Vertebrae↗
PubMed1999

Treatment of thoracolumbar trauma: comparison of complications of operative versus nonoperative treatment.

The complications from the acute hospital stays of 235 patients with unstable thoracolumbar fractures were reviewed and compared based on patients who underwent surgical stabilization and those treated with an aggressive nonoperative course of 6 weeks on a kinetic bed. Complications such as deep venous thromboses, pulmonary emboli, and decubitus occur in patients with spine trauma. The perception is that surgical intervention decreases such complications and allows for earlier mobilization. The authors sought to determine the actual rate of occurrence and compare the groups for surgical and nonoperative complications. Two hundred thirty-five charts were reviewed. One hundred seventeen patients were treated with surgical stabilization, and 118 patients were treated with a nonoperative course of 6 weeks on a kinetic bed. Complications were assessed from the medical record. There was no significant difference in the occurrence of decubitus, deep venous thromboses, pulmonary emboli, or mortality between the two groups. Deep wound infections occurred in 8% of the operative cases. The length of stay was 24 days longer in the nonoperative group. Both operative and nonoperative treatments of thoracolumbar fractures are viable alternatives. The complication rates are similar, with the exception of wound infection. The length of hospital stay is longer in the nonoperative group. The selection of treatment method remains a matter of controversy.

Adult↗
PubMed1999

Smoking cessation in the spine surgeon's office: a review.

Tobacco abuse is a major health and economic problem in the world today. The spine practitioner has direct experience with the negative effects of the addiction. This review will provide an outline to assist all involved in spine care to help the patient overcome his or her dependence on nicotine. Every practitioner should participate. Even minimal intervention, if carried out at each office visit, can have surprisingly positive effects.

Guidelines as Topic↗
PubMed1996

The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis.

A total of 18 patients with grade I or II degenerative spondylolisthesis fused three levels or fewer with autogenous bone graft were entered at three clinical sites. After 2 years, these patients were found to have a fusion rate of 89%. A statistical analysis of these results compared with those in the literature showed that patients with spondylolisthesis who underwent fusion with pedicle screw instrumentation were > 3 times more likely to fuse than comparable patients implanted without a pedicle screw/plate system. The pedicle screw/plate system used in this study was shown to be an effective method of facilitating lumbar or lumbosacral fusion with autogenous bone graft for adult patients with a primary indication of grade I or II degenerative spondylolisthesis.

Adult↗
PubMed1995

The effect of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusions in patients with degenerative disc disease.

STUDY DESIGN: A prospective, multi-center Investigational Device Exemption Study was carried out in the United States using a pedicle screw and plate system to perform a fusion in patients with degenerative disc disease or spondylolisthesis. The patients' pain function, complications, and fusion status were evaluated and compared with literature controls. OBJECTIVES: To study the safety and efficacy of the ISF pedicle screw/plate system. This article focuses only on those study patients with degenerative disc disease treated with autogenous bone grafts and compares the results to those of similar patients treated without instrumentation, as reported in the literature. SUMMARY OF BACKGROUND DATA: Twenty-eight patients were in the subgroup studied--patients with degenerative disc disease who had fusions with autogenous bone graft. This study was conducted at four clinical sites with a 2-year follow-up. Patient follow-up was greater than 95% at all time points. METHODS: To be considered a patient with degenerative disc disease, radiographs had to demonstrate a collapse of the disc, the presence of bone erosion, or the compression of the vertebrae as the primary spinal abnormality. Spinal fusion must have been the recommended surgical treatment for discogenic pain. The fusion status was evaluated by the operating surgeon and an independent reviewer. RESULTS: After 2 years, this subset of patients (n = 28) with degenerative disc disease who had lumbar/lumbosacral fusion with autogenous bone graft was found to have a pseudarthrosis rate of 0%. Eight articles in the literature were found to be valid noninstrumented literature controls with which this subgroup could be compared. The average pseudarthrosis rate in the control group was 32%. CONCLUSIONS: A statistical analysis showed that patients with degenerative disc disease who underwent fusion without pedicle screw instrumentation were over 24 times more likely to have a pseudarthrosis than comparable patients implanted with a pedicle screw/plate system. Regarding the most important goal in performing a spinal fusion--fusion of the spine--the pedicle screw/plate system used in this study was shown to be a safe and efficacious method of facilitating fusion with autogenous bone graft for this patient population.

Adult↗
PubMed1995

Non-operative treatment of thoracolumbar fractures.

Between 1986 and 1992, 32 thoracolumbar fractures in 32 patients were treated nonoperatively with 4-6 weeks on a rotorest bed followed by bracing with a thoracolumbosacral orthosis for a total of 3-6 months. The fractures were classified as 20 burst, six fracture dislocations, five severe compression fractures, and one gunshot wound. There were 12 multilevel fractures. Nine patients had incomplete neurological injuries and three had complete neurological injuries. The average age was 36.8 years (range 17-63) and the average follow-up was 22.3 months (range 12-60). Fifty three percent (17/32) of these had multisystem injuries including visceral trauma and long extremity fractures. There were only two complications; a deep vein thrombosis and a heel ulcer. Neither of these complications extended the patients' hospital stay. All nine of those with incomplete neurological injuries improved at least one Frankel grade. Fifteen of 24 patients who were employed returned to their previous jobs, and only nine patients had persistent back pain requiring medication. Surgical treatment of thoracolumbar fractures is often favored over conservative treatment in the multitrauma and neurologically injured patient because of complications related to bedrest. However, by using a rotorest bed and aggressive physical therapy, conservative treatment may actually result in lower morbidity.

Adolescent↗
PubMed1993

Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery.

We analyzed the cases of seventy-three patients who were managed over a twenty-year period for rheumatoid involvement of the cervical spine and were followed for a minimum of two years, with an average follow-up of seven years. A neurological deficit did not develop in thirty-one patients (Ranawat et al. Class I) and paralysis developed in the remaining forty-two patients: Class II in eleven and Class III in thirty-one. Of the forty-two patients in whom paralysis developed, thirty-five had operative stabilization. Seven patients were managed with a soft cervical collar because they refused or were medically unable to have the operation; all of the had an increase in the severity of the paralysis. The posterior atlanto-odontoid interval and the diameter of the subaxial sagittal canal measured on the cervical radiographs demonstrated statistically significant correlations with the presence and severity of paralysis. All of the patients who had a Class-III neurological deficit had a posterior atlanto-odontoid interval or diameter of the subaxial canal that was less than fourteen millimeters. In contrast, the anterior atlanto-odontoid interval, which has traditionally been reported, did not correlate with paralysis. The prognosis for neurological recovery following the operation was not affected by the duration of the paralysis but was influenced by the severity of the paralysis at the time of the operation. The most important predictor of the potential for neurological recovery after the operation was the preoperative posterior atlanto-odontoid interval. In patients who had paralysis due to atlanto-axial subluxation, no recovery occurred if the posterior atlanto-odontoid interval was less than ten millimeters, whereas recovery of at least one neurological class always occurred when the posterior atlanto-odontoid interval was at least ten millimeters. If basilar invagination was superimposed, clinically important neurological recovery occurred only when the posterior atlanto-odontoid interval was at least thirteen millimeters. All patients who had paralysis and a posterior atlanto-odontoid interval or diameter of the subaxial canal of fourteen millimeters had complete motor recovery after the operation. In this series, although only patients who had a neurological deficit were operated on, we observed the range of the posterior atlanto-odontoid interval that was associated with poor or no recovery after the operation, and we identified the safe range on the basis of the patients in whom paralysis did not develop.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Pyogenic osteomyelitis of the spine in the elderly.

The authors report 10 cases of spontaneous pyogenic spinal osteomyelitis encountered within a 3-year period. There were six women and four men, ranging in age from 60 to 84 years. Six cases occurred at the thoracic level, three at the lumbar level, and one in the cervical spine. No patient was diabetic, immunocompromised, or receiving steroid therapy, and none had a history of endocarditis or intravenous drug abuse. No patient had undergone previous spinal surgery. There were no instances of coexisting tuberculosis or malignancy. Contemporaneous cases with known predisposing factors have been excluded from this report; however, three patients did have a recent history of somatic infection, one with known sepsis. All 10 patients had been previously misdiagnosed, frequently by neurosurgeons and orthopedists as well as by internists and family practitioners. Three had undergone inappropriate or unnecessary surgical procedures, and two had received inappropriate radiation therapy. Seven cases were caused by Staphylococcus species. Gram-negative bacteria, or anaerobic infections. In the other three, no bacteriological diagnosis was made, secondary to prolonged antibiotic therapy before surgery. Each patient had developed symptomatic neural element compression, spinal instability, or both by the time of their referral. The patients with subcervical pyogenic spinal osteomyelitis underwent transthoracic or retroperitoneal decompression and corpectomy with simultaneous autologous bone grafting, followed by 6 weeks of bed rest and 6 weeks of intravenous broad-spectrum or organism-specific antibiotic therapy. They were then mobilized in orthoses for an additional 6 weeks. In no case were foreign implants employed or further stabilization procedures necessitated. One patient required an additional 6 weeks of antibiotics for recalcitrant Pseudomonas colonization. Despite the patients' advanced age and the extensive surgical procedures, there was no mortality and no neurological morbidity. All patients were asymptomatic or demonstrated objective improvement upon discharge from the hospital. In this subset of patients with spontaneous pyogenic vertebral osteomyelitis, the only predisposing factor was advanced age.

Aged↗
PubMed1991

The role and incidence of facet tropism in lumbar spine degenerative disc disease.

The correlation of posterior intervertebral (facet) joint tropism (asymmetry), degenerative facet disease, and intervertebral disc disease was reviewed in a retrospective study of magnetic resonance images of the lumbar spine from 100 patients with complaints of low back pain and sciatica. Of the 27 of 100 (27%) of patients discovered to have disc disease (either herniation of nuclear material or bulge) at the L4-5 level, an approximately equal number had facet tropism (14 of 27) as did not (13 of 27). Of the 27 of 100 (27%) patients noted to have disc disease at the L5-S1 level, slightly more (16 of 21) had facet tropism than did not (11 of 27). Of the 65 of 100 (65%) of patients who had facet degenerative disease at the L4-5 level, an approximately equal number had facet tropism (33 of 65) as did not (32 of 100). At the L5-S1 level there was slightly more of a difference, with 25 of 41 having facet degenerative joint disease and tropism and 16 of 41 without it. This study raises questions as to the significance of facet joint tropism in intervertebral disc disease and degenerative facet joint disease but did show that asymmetry of the posterior intervertebral joint is far more common than previously thought: 50% of patients were found to have asymmetric facets at the L5-S1 level and 42% at the L4-5 level.

Back Pain↗
PubMed1989

False-positive diagnosis of an odontoid fracture by CT scan.

Although computed tomography (CT) is a valuable tool for evaluating spine trauma, it's usefulness is limited. Horizontally oriented fractures of the cervical spine, particularly type 2 fractures at the base of the odontoid process, may be difficult to detect with CT. Our case report illustrates a false-positive diagnosis of this fracture and suggests that conventional polytomography is superior to CT for demonstrating this particular lesion when minimal displacement is present.

Adolescent↗
PubMed1988

Fractures of the scapula. A review of the literature.

Scapular fractures, a relatively uncommon injury, most often result from major trauma. This paper categorizes the different types of scapular fractures; outlining clinical presentation, diagnosis, treatment, and complications. The importance of a good physical examination is stressed; as overlooking a soft tissue injury (i.e., pneumothorax, neurovascular tear, cerebral contusion) commonly associated with scapular fractures may be life-threatening. Scapular fractures are commonly treated nonoperatively. However, when glenohumeral joint function is impaired, surgery may be indicated after patient age, occupation, and clinical status are evaluated.

Acromion↗
PubMed1988

Using the Heffington frame in elective lumbar spinal surgery.

Numerous techniques and frames are available to position the patient on an operating table for elective lumbar spine surgery. We utilized the Heffington frame to position 27 patients with hips and knees flexed and abdomen free. This group was compared with those patients positioned prone during surgery. Our data indicate that average intraoperative blood loss is reduced by the use of such a frame, a finding that is attributable to maximal decompression of the abdomen. Complications related to the Heffington frame were not observed in our series of patients.

Adult↗