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S R Garfin

Publications and source records attributed to S R Garfin.

At least 37 records · Page 2Linked to original sources
PubMed1999

Anterior C1-C2 screw fixation and bony fusion through an anterior retropharyngeal approach.

We present a case that demonstrates an occasion where an alternative method of C1-C2 fusion may be used when a posterior approach limited to the atlantoaxial level is not desirable. A 22-year-old man presented with a symptomatic nonunited Brooks posterior atlantoaxial fusion following a chronically displaced type II odontoid fracture with a two-part fracture of the posterior arch of C1. An anterior retropharyngeal approach was used to perform an anterior C1-C2 fusion with screw fixation. The surgical technique, as well as the merits and indications of this infrequently used procedure, are discussed.

Adult↗
PubMed1998

Cervical trauma: rationale for selecting the appropriate fusion technique.

The selection of the appropriate surgical approach in the management of an unstable cervical spine injury is predicated on the biomechanic deficiencies of the bony and ligamentous structures, the age of the patient, the level of experience of the surgeon, and the concomitant medical comorbidities. The optimal approach ideally is the least invasive, provides the greatest benefit-to-risk ratio in terms of potential injury to contiguous neurovascular structures, and provides adequate stabilization to avoid cumbersome external immobilization and allows early rehabilitation. This article discusses anterior, posterior, and combined stabilization techniques in patients who have sustained trauma to the upper and lower cervical spine.

Atlanto-Occipital Joint↗
PubMed1998

Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technnique.

Despite recent advances in surgical techniques and instrumentation, two issues in the treatment of thoracic and lumbar remain contested: (1) the indications for surgical intervention; and (2) the optimal approach to obtain decompression, realignment, and fusion of the disrupted segment (anterior, posterior, or combined). Choosing among the options requires the ability to define accurately the extent of the injury to both the structural and the neurologic elements of the spine as well as an appreciation of the historic rationale of individual treatment methods.

Animals↗
PubMed1998

Early failure of long segment anterior cervical plate fixation.

A retrospective, multicenter study was undertaken to evaluate the early postoperative failure rate of long segment anterior cervical fusion and plating to stabilize the cervical spine after a two- or three-level corpectomy for degenerative, traumatic, and neoplastic diseases of the cervical spine. Patient demographic factors as well as technical factors such as bone graft placement, plate and screw position, and postoperative brace immobilization were analyzed. During the early postoperative period, the graft/plate construct dislodged in 3 of 33 patients with a two-level corpectomy and fusion (9%) compared with 6 of 12 patients with a three-level corpectomy and fusion (50%). The difference in failure rates after a three- versus two-level corpectomy and fusion was statistically significant (p < 0.05). A higher early failure rate was also seen with failure to correctly lock the screws to the plate and the use of a peg-in-hole type bone grafting technique, although these differences were not statistically significant. Although several technical and patient-specific factors may contribute to this, anterior cervical plating and bone grafting alone after a three-level cervical corpectomy for various spinal disorders appears to afford inadequate stability in the early postoperative period, regardless of immobilization methods.

Adolescent↗
PubMed1997

Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with chronic back pain and previously asymptomatic low-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: The role of previously asymptomatic low-grade isthmic spondylolisthesis in chronic adult low back pain is unclear. Operative intervention in this setting is controversial. METHODS: Twenty-four consecutive adult patients with chronic low back pain and low-grade isthmic spondylolisthesis first detected during routine work-up of new onset low back pain underwent spinal fusion with or without decompression. The influence of active worker's compensation or litigation claims, radicular pain, concomitant laminectomy, age, gender, fusion to L4, intervertebral disc bulge, and pseudarthrosis were investigated. RESULTS: All 13 patients involved in worker's compensation claims or pending litigation had fair or poor results. Nine of 11 patients without such issues had good or excellent results. Although the strong association of worker's compensation with poor results made it difficult to assess the importance of other risk factors, the data suggest that good results may be more likely in patients with radiculopathy who undergo laminectomy. CONCLUSIONS: This investigation, although limited by a number of factors including small sample size and retrospective, unblinded review, suggests that active worker's compensation and litigation issues are associated strongly with poor results of operative management for chronic low back pain in adult patients with low-grade spondylolisthesis.

Adult↗
PubMed1997

An association between the flat back and postpolio syndromes: a report of three cases.

The cases of three patients with a history of paralytic poliomyelitis in childhood who developed the flat back syndrome before or after spinal fusion for degenerative disease as adults were reviewed. The flat back syndrome, a combination of an inability to stand erect because of forward flexion of the trunk and pain in the low back and/or legs, typically occurs in the setting of decreased lumbar lordosis as a result of distraction instrumentation of the spine for scoliosis, vertebral fracture, or degenerative disease. Focus was placed on determining the factors responsible for the development and/or persistence of the flat back syndrome in these patients despite maintenance of, or partial operative restoration of, lumbar lordosis. Considering the essential role that the trunk extensor musculature plays in maintaining upright posture, it may be that a new onset of weakness (postpolio syndrome) in this musculature represents a major contributing factor to the flat back syndrome in these patients. Spine surgeons considering operative procedures in patients with a remote history of paralytic poliomyelitis should be aware of the possible increased risk of the flat back syndrome in this population of patients.

Back Pain↗
PubMed1997

Pseudarthrosis: US evaluation after posterolateral spinal fusion: work in progress.

PURPOSE: To determine the value of ultrasound (US) in evaluation of pseudarthrosis after posterolateral spinal fusion. MATERIALS AND METHODS: In 10 patients who had undergone bilateral posterolateral thoracic or lumbar fusion with autologous bone graft and instrumentation more than 9 months previously, US was performed within 1 week before second-look surgery. A total of 20 sites each side of midline were evaluated for the presence of bone graft, solid fusion, clefts, fluid collections, and hardware visibility. US findings were compared with those at surgery. In three patients, standard radiographs were reviewed before US; blinded US evaluation was performed in the remaining seven patients. RESULTS: At US, all 10 sites of pseudarthrosis seen at surgery were identified correctly. Of 10 sites with solid fusion at surgery, US depicted six. At four sites (two patients), fusion was mistaken for or obscured by hardware. Overall, sensitivity was 100%, specificity was 60%, and accuracy was 80%. CONCLUSION: US can play a valuable role in the detection of posterolateral bone graft pseudarthrosis, especially when hardware is present.

Adult↗
PubMed1997

Food and Drug Administration regulation of spinal implant fixation devices.

The role of the Food and Drug Administration in regulating medical devices generally is not well understood by physicians. The practice of medicine does not fall under Food and Drug Administrations's regulatory purview. Nevertheless, the Food and Drug Administration and its regulation of medical devices can influence physicians' activities. This article provides an overview of the scope of the Food and Drug Administration's authority and the agency's regulatory framework, with particular focus on orthopaedic medical devices as related to spinal implant devices. During the past 10 years, a regulatory dilemma has arisen surrounding the use of bone screws in the pedicles of the spine. Except for recent clearances for a limited treatment indication, the Food and Drug Administration has not cleared these devices to be labeled for pedicle screw fixation and, therefore, has restricted industry supported educational activities pertaining to this type of treatment. In spite of the Food and Drug Administration's regulatory position, physicians have chosen to use pedicle screw fixation in treating patients who have a variety of spinal disorders. This use is now considered an accepted (state of the art) medical practice by many physicians for certain spinal conditions. This article explores this specific Food and Drug Administration regulatory issue, its impact on physicians and manufacturers (especially as it pertains to medical education), and recent actions taken to resolve it.

Bone Screws↗
PubMed1997

Salvage anterior C1-C2 screw fixation and arthrodesis through the lateral approach in a patient with a symptomatic pseudoarthrosis.

On occasions when the posterior approach to the upper cervical spine is not feasible, the options provided by a lateral exposure can be invaluable. A case of a nonunited posterior fusion between C1 and C2, with a free-floating posterior C1 arch due to nonhealing of a previous intraoperative C1 ring fracture, is presented to illustrate this point. This 28-year-old man underwent screw fixation between the first and second cervical vertebrae, supplemented with autogenous iliac crest cancellous bone graft, via the lateral approach of Whitesides. The patient's symptoms subsequently resolved, and radiographic evaluation 3 months after the procedure revealed a solid fusion.

Adult↗
PubMed1997

Pseudarthrosis after postoperative wound infection in the lumbar spine.

This retrospective investigation attempts to define the incidence of fusion success after postoperative infection after a posterior lumbar fusion, as well as which risk factors may adversely affect arthrodesis after successful debridement. At an average follow-up of 37 months, 18 of 29 patients (62.1%) had a successful arthrodesis. Eighty-seven percent of patients whose fusion excluded the sacrum had a solid arthrodesis, compared with only 36% of those fusions including the sacrum. The fusion rate in female patients was 33.3%, compared with 82.4% in male patients. The rate of fusion with allograft bone was 17.2 versus 83.3% with autograft bone. Female sex, the use of allograft bone, and extension of the fusion mass to the sacrum significantly increase the incidence of nonunion after a postoperative deep spinal wound infection.

Adolescent↗
PubMed1996

Perioperative nutrition and postoperative complications in patients undergoing spinal surgery.

STUDY DESIGN: The authors undertook a three-part study to better understand the impact of perioperative nutritional status on postoperative complications in patients undergoing spinal surgery. In preliminary Parts I and II, the authors targeted two groups of patients who are particularly nutritionally challenged. In Part III, they studied a large group of consecutive patients undergoing routine lumbar spinal fusion. OBJECTIVES: To determine whether preoperative nutritional status was a significant predictor of postoperative complications in patients undergoing elective lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: In Part I, 27 patients treated surgically for vertebral osteomyelitis were divided into two groups based on their preoperative nutritional status. Twenty-four of the 26 postoperative complications were in the malnourished group (P < 0.001). In Part II, 15 (75%) of 20 patients treated surgically for spinal cord injury were found to become malnourished in the postoperative period. Seventeen complications were noted, all in the malnourished group (P = 0.001). METHODS: One hundred fourteen consecutive patients undergoing selective lumbar decompression and fusion were identified and their records reviewed. In addition to preoperative nutritional status, data gathered included age, sex, height, weight, past medical history, steroid use, alcohol use, tobacco use, type of bone graft (allograft vs. autograft), history of previous lumbar surgery, number of levels fused, and use of spinal instrumentation. RESULTS: Eleven of 13 postoperative infectious complications (10 deep wound infections) were noted in the malnourished group (P < 0.001). By stepwise logistic regression analysis, preoperative nutritional status was an extremely significant independent predictor of postoperative complications in patients undergoing elective lumbar spinal fusion (P = 0.0018). CONCLUSIONS: The prevalence data in our study population suggest that a large number (25%) of patients undergoing elective lumbar spine surgery are nourished inadequately at surgery. This number is higher (42%) in older patients. The authors recommend that close attention be paid to the perioperative nutritional status of patients undergoing lumbar spinal surgery. Patients with suboptimal nutritional parameters should be supplemented and replenished before elective surgery.

Adult↗
PubMed1996

Myogenic motor-evoked potential monitoring using partial neuromuscular blockade in surgery of the spine.

STUDY DESIGN: The authors analyzed motor-evoked potentials using transcranial electrical cortical stimulation during spinal surgery in 40 patients under conditions of partial neuromuscular blockade. OBJECTIVES: The results were used to investigate the utility of motor-evoked potential monitoring to prevent neurologic injury in spinal surgery. SUMMARY OF BACKGROUND DATA: Noninvasive transcranial electrical motor-evoked potentials are reportedly effective in predicting postoperative spinal cord deficits caused by intraoperative occurrences. However, the sensitivity and specificity of these predictions have not been assessed under conditions of partial neuromuscular blockade during a wide variety of surgical procedures. METHODS: Compound muscle action potentials were recorded at the tibialis anterior muscle while general anesthesia was maintained with nitrous oxide, etomidate, and sufentanil. Surgery was performed at all spinal levels for a variety of diagnoses. RESULTS: Reference motor-evoked potential amplitudes, measured after induction of partial neuromuscular blockade, ranged from 25 to 7562 microV (median, 600 microV). Variation in intraoperative motor-evoked potential amplitude ranged from signal loss to a 3440% increase. A decrease to less than 20% of the individual reference value for motor-evoked potential amplitude occurred at least once in nine patients (22.5%) but as not associated with postoperative motor deficits. Two patients who had loss of motor-evoked potential signal without recovery did have postoperative motor deficits. Motor-evoked potentials predicted postoperative motor improvement in six patients. An improvement threshold of 160% of the reference amplitude predicted postoperative motor improvement with 100% sensitivity and 81% specificity. CONCLUSIONS: The authors support the utility of recording transcranial electrical motor-evoked potentials in spinal surgery under partial neuromuscular blockade. Recovery of lost motor-evoked potentials was not associated with postoperative motor deficits, whereas non-recovery of lost motor-evoked potentials was.

Adolescent↗
PubMed1996

External fixation in patients with panvertebral osteomyelitis and paraplegia.

Vertebral osteomyelitis is a difficult problem in the spinal cord injured patient. We present three such cases treated with extensive debridement followed by grafting and stabilization with external fixation. In all three patients the infection resolved. We feel this is a viable option for treating this condition.

Abscess↗