Biomedical subjects

Steven D Glassman

Publications and source records attributed to Steven D Glassman.

24 records · Page 2Linked to original sources

PubMed2003

Adult spinal deformity in the osteoporotic spine: options and pitfalls.

Osteoporosis has received heightened attention over the past 2 decades because of its overwhelming cost to society. It is one of the most common diseases affecting both men and women. The key to treatment is early prevention accompanied by modification of risk factors and impact-oriented exercise, optimal medical management with antiresorptive medications, and addressing the complications of this disease such as compression fractures and spinal deformities. Most osteoporotic vertebral compression fractures can be treated nonsurgically, but new techniques such as vertebroplasty and kyphoplasty are producing good early clinical results with low complication profiles. The surgical treatment of deformities such as kyphosis and scoliosis can be very challenging given the poor bone quality and propensity for instrumentation cutout. The surgical treatment of spinal stenosis in the face of deformity in these patients requires keen surgical planning and a clear identification of the source of the patient's complaints--be it the deformity, the stenosis, or both. Several advances in instrumentation, such as the use of laminar fixation (if available), multisegment fixation, limited correction of the deformity, and augmentation of pedicle screw purchase through biologic and nonbiologic fillers have been developed.

Humans↗

PubMed2002

Vertebral osteonecrosis associated with the use of intradiscal electrothermal therapy: a case report.

STUDY DESIGN: This report describes a case of vertebral body osteonecrosis associated with the use of intradiscal electrothermal therapy. OBJECTIVES: To alert clinicians to a previously unreported complication, vertebral body osteonecrosis, after an intradiscal electrothermal therapy procedure. SUMMARY OF BACKGROUND DATA: The intradiscal electrothermal therapy procedure is a new treatment that has been advocated in the management of chronic low back pain of discogenic origin. The intradiscal electrothermal therapy procedure uses a fluoroscopically guided thermal catheter to heat the intervertebral disc. A review of the literature regarding this procedure has not revealed osteonecrosis as a complication. METHODS: The patient's work-up and postoperative course are documented, and all medical records were reviewed retrospectively. RESULTS: The patient's pain had improved only minimally at initial follow-up after L5-S1 combined anterior and posterior spinal fusion, undertaken after intradiscal electrothermal therapy failure. CONCLUSIONS: Intradiscal electrothermal therapy has gained increasing popularity in the treatment of discogenic low back pain, in large part because of its minimally invasive nature and perceived low risk for major complications. Previous reports in the literature have not noted any major complications associated with the proper use of this device. Clinicians should be advised that intradiscal electrothermal therapy can be associated with complications, which in the current case, led to osteonecrosis of the vertebral body.

Adult↗

PubMed2002

Evaluation of the fixation and strength of a "rescue" revision pedicle screw.

One potential complication of pedicle screw instrumentation is long-term nerve root irritation, most commonly resulting from medial or inferior screw malpositioning. This study evaluated the pullout strength and fatigue strength properties of a novel "rescue" revision screw designed to reduce the sequelae of medial screw malpositioning by eliminating threads along the section of the screw corresponding to the pedicular region. The results of this study revealed that a rescue screw with threads eliminated from one half of its circumference provided comparable pullout strength to fully threaded pedicle screws in cadaveric specimens. In addition, mechanical testing of the rescue screw did not show a decrease in fatigue strength characteristics compared with controls. These results suggest that the rescue screw may offer a way to decrease nerve root irritation caused by canal impingement without jeopardizing the overall strength of the spinal construct.

Aged↗

PubMed2002

Surgical management of adjacent level degeneration following lumbar spine fusion.

Thirty-eight patients who underwent extension of a prior lumbar fusion for treatment of adjacent level degeneration were retrospectively evaluated. Patient age, pain relief with the initial surgical procedure, and distal level of fusion significantly affected outcome. Overall, this study suggests that adjacent level fusion yields results that are not optimal but provides sigificant clinical improvement for patients with symptomatic adjacent level degeneration.

Adult↗

PubMed2002

Acute calcific discitis in adults.

Acute calcific discitis in the pediatric population is a well-described entity and may rarely involve the adult population. Acute calcific discitis does occur in adults, presenting clinically with the abrupt onset of severe back pain with a classic radiographic calcification of the disc similar to that of a discogram; it resolves with nonsurgical symptomatic treatment. To our knowledge, no cases of "idiopathic" adult calcific discitis have been reported in the orthopedic literature. We report 2 adult patients with symptomatic thoracic disc calcifications that closely resemble those observed in children and briefly discuss the relevant clinical and radiographic features, along with a review of the literature.

Adult↗

PubMedDate not supplied

Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus.

BACKGROUND CONTEXT: Prior studies have documented an increased complication rate in diabetics treated by lumbar decompression. Despite the assumption that this risk would be exacerbated in larger fusion procedures, a recent study found no such increased risk. PURPOSE: To clarify the perioperative risk for patients with diabetes mellitus undergoing instrumented lumbar fusion as compared with controls. To identify differences, if any exist, between patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes (NIDDM). STUDY DESIGN/SETTING: This is a retrospective case-control study designed to examine the risk of perioperative complications in patients with diabetes mellitus treated by lumbar instrumentation and fusion. This study analyzed 94 diabetic patients and 43 controls treated by posterior lumbar instrumentation and fusion. Outcome was assessed based on the occurrence of perioperative complications. Complications were classified as major or minor. METHODS: Hospital and office records were reviewed for 94 diabetics (51 NIDDM, 43 IDDM) and 43 controls matched for age, sex and procedure with the IDDM group. The groups were compared for demographic characteristics, surgical data, perioperative complications and fusion rate. RESULTS: The NIDDM, IDDM and control groups were equivalent with regard to age, gender, nicotine use, fusion levels, operative time and estimated blood loss. There was a significant difference in complication rate between the NIDDM (53%) and IDDM (56%) groups versus controls (21%). There was a significant increase in complications with multilevel fusion in all groups and with increased operative time in the IDDM group. There was a significantly greater nonunion rate in the NIDDM (22%) and IDDM (26%) groups as compared with controls (5%). CONCLUSIONS: Patients with both IDDM and NIDDM have a significantly increased risk of perioperative complications as compared with controls when treated by lumbar instrumentation and fusion.

Adolescent↗