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Biomedical subjects

Charles A Reitman

Publications and source records attributed to Charles A Reitman.

16 recordsLinked to original sources
PubMed2007

Oral step-down therapy is comparable to intravenous therapy for Staphylococcus aureus osteomyelitis.

BACKGROUND: We hypothesized that regimens with an early switch to oral antibiotics are as effective as prolonged parenteral regimens for staphylococcal osteomyelitis. METHODS: We retrospectively reviewed records of adult patients with osteomyelitis caused by Staphylococcus aureus as determined by sterile site cultures, who had at least 6 months of follow-up post-therapy. The population was divided into two treatment groups: (1) an intravenous group (i.v.) that received > or = 4 weeks of parenteral therapy, and (2) a switch group that received < 4 weeks of intravenous followed by oral therapy. RESULTS: A total of 72 patients (36 in each group) were identified with groups evenly matched for demographic and clinical characteristics. The overall apparent cure rate was 74%; 69% for the i.v. group and 78% for the switch group (P=0.59). Apparent cure rates were similar regardless of duration of intravenous therapy: 83% < 2 weeks, 72% 2-4 weeks, 75% 4-6 weeks and 66% > or = 6 weeks (P=0.68). Among the 39 patients who received rifampin-based combinations, those treated simultaneously with vancomycin and rifampin did significantly worse than those who received other rifampin combinations (P<0.02). Overall, MRSA infections responded poorly compared to MSSA (65% apparently cured versus 83%). However, 11/14 (79%) MRSA patients who received rifampin combinations, other than vancomycin and rifampin simultaneously, were apparently cured. CONCLUSIONS: Overall outcomes did not differ significantly between i.v. and switch groups. Given the markedly lower costs and ease of administration, prolonged oral regimens after initial intravenous therapy may be a preferred regimen for staphylococcal osteomyelitis.

Administration, Oral↗
PubMed2007

Reduction in head and intervertebral motion provided by 7 contemporary cervical orthoses in 45 individuals.

STUDY DESIGN: Biomechanical evaluation of cervical orthoses. OBJECTIVE: To provide data to help clinicians select an orthosis for immobilization of the adult cervical spine. SUMMARY OF BACKGROUND DATA: There are limited data on the effectiveness of cervical orthoses at restricting intervertebral motion, and many of the commonly used, contemporary braces have not been evaluated. Additionally, no data exist comparing the effectiveness of braces in the supine versus the upright position. New technology is available to measure intervertebral motion with greater accuracy. METHODS: Overall range of motion of the head in 3 planes as well as intervertebral motion in the sagittal plane were measured in 45 healthy adult volunteers while wearing 7 cervical orthoses. Subject-reported comfort of each brace was also recorded. RESULTS: All braces significantly reduced intervertebral motion. Effectiveness and comfort varied between braces. In general, orthoses could be grouped as cervical braces or cervicothoracic braces. The latter was consistently better at limiting motion, with some differences within these groups as well. CONCLUSION: These data will help to guide the clinician in selecting the appropriate cervical orthosis for their adult patient based on comfort, morphologic considerations, and degree of immobilization required.

Adult↗
PubMed2006

Diskography in the evaluation of low back pain.

Diskography is evolving to play a crucial role in the evaluation of axial low back pain, especially in regard to surgical decision making. Despite advances in other forms of imaging, diskography remains unique in that it is the only test that seeks to provoke a pain response during the study. It has been suggested that patients with axial low back pain who experience a concordant pain response during diskography are more likely to respond favorably to surgical intervention. However, the efficacy of using this potential correlation is dependent on the technical application and interpretation. The validity of diskography remains controversial, in part because postdiskography surgical outcomes have been inconsistent. Therefore, in select patients with recalcitrant back pain, diskography remains a second-line diagnostic modality that is used to clarify surgical indications. Despite well-defined guidelines, the technical aspects of diskography and its interpretation are still evolving.

Contrast Media↗
PubMed2005

Intervertebral motion after incremental damage to the posterior structures of the cervical spine.

STUDY DESIGN: Compare intervertebral motion after incremental damage to posterior cervical structures in whole cadavers to motion in asymptomatic subjects. OBJECTIVE: Determine if damage to the posterior structures of the cervical spine can be detected by quantitative analysis of flexion-extension radiographs. SUMMARY OF BACKGROUND DATA: Simulated damage to the posterior structures of the cervical spine can change intervertebral motion, if intervertebral motion before damage is known. It is not known if intervertebral motion measured from flexion-extension radiographs can be used to detect damage to the posterior structures if motion before damage is not known. METHODS: Incremental injury to posterior ligaments and facet joints was simulated in 12 whole cadavers. Intervertebral motion was measured from flexion-extension images using validated and clinically applicable software. Measurements were compared to previously published measurements for asymptomatic subjects. RESULTS: Extensive damage could be simulated in all the cervical spines without intervertebral motion exceeding the 95% confidence limits for asymptomatic subjects. After sectioning all posterior ligaments, destroying both facet joints, and then sectioning the posterior longitudinal ligaments, intervertebral motion exceeded the 95% confidence intervals in 69% of the cadavers. Intervertebral shear decreased with incremental damage to posterior structures. CONCLUSIONS: Radiographic assessment of the cervical spine may not be sufficient to exclude even extensive damage to the posterior structures of the cervical spine.

Arthrography↗
PubMed2005

Defining pseudoarthrosis in the cervical spine with differing motion thresholds.

STUDY DESIGN: Calculate the apparent pseudarthrosis rate for anteriorly plated cervical spine fusions using different threshold levels of intervertebral rotation. OBJECTIVES: Determine whether the apparent pseudarthrosis rate depends on the amount of intervertebral rotation used to characterize a fusion as a pseudarthrosis. SUMMARY OF BACKGROUND DATA: Intervertebral motion at a spine fusion site is an important outcome measure in most spine fusion research studies. Intervertebral motion measures are used to determine if a device can be sold for use in spine fusion surgery. There is no consensus on how much motion is too much motion at a spine fusion site, and the intervertebral motion threshold that is used to define a pseudarthrosis is arbitrary. There are only limited data on the dependence of the pseudarthrosis rate on the threshold used to define a pseudarthrosis. METHODS: Intervertebral motion at the fusion site was measured from flexion extension radiographs taken 1 year after cervical spine fusion using anterior plates and allograft in 200 patients. The number of cases where intervertebral motion at the fusion site exceeded thresholds between 1 degrees and 4 degrees were calculated. RESULTS.: The apparent pseudarthrosis rate varied from 6% when the intervertebral motion threshold was 4 degrees to 44% when the intervertebral motion threshold was 1 degrees . CONCLUSIONS: The apparent pseudarthrosis rate was highly dependent on the threshold of motion used to define a pseudarthrosis.

Bone Plates↗
PubMed2004

Intervertebral motion between flexion and extension in asymptomatic individuals.

STUDY DESIGN: Measure and analyze variation in intervertebral motion in asymptomatic subjects. OBJECTIVES: Gain further insight into intervertebral motion during flexion and extension in asymptomatic individuals, identify factors that contribute to variation in motion, and establish a quantitative database using a clinically practical imaging tool. SUMMARY OF BACKGROUND DATA: Several authors have reported on normal values for intervertebral motion during flexion and extension of the cervical spine. However, the sources of the wide variations in intervertebral motion are poorly understood. METHODS: Fluoroscopic images of the cervical spine in maximum flexion and extension were analyzed for 140 asymptomatic volunteers using a validated and clinically applicable image analysis system. Several independent variables were analyzed for their contribution to variation in motion. The dependent variables studied included sagittal plane rotation and translation, and displacements between vertebrae measured at the anterior and posterior aspects of each motion segment. RESULTS: There was considerable variation in measured intervertebral motion. Intervertebral level and total gross rotation between C2 and C6 significantly affected all measures of intervertebral motion. The intervertebral motion measures were all interrelated. After adjusting for differences in gross motion between C2 and C6, intervertebral levels and the three displacement measures could be used to explain almost 90% of the variation in sagittal plane intervertebral rotations. In addition, the data suggest that currently accepted clinical guidelines for shear should be raised at all levels except C6-C7. CONCLUSIONS: A database describing intervertebral motion in asymptomatic subjects representing both sexes and a wide age range was established that should aid in interpreting intervertebral motion in patients. Evaluating various aspects of intervertebral motion may improve the clinical efficacy of radiographic flexion-extension studies of the cervical spine.

Adolescent↗
PubMed2004

The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study.

STUDY DESIGN: Review of efficacy of Cell Saver in a nonrandomized group of patients undergoing lumbar fusion. OBJECTIVES: Determine the necessity and cost-effectiveness of the use of Cell Saver for adult lumbar spine fusions. SUMMARY OF BACKGROUND DATA: Specific indications for the use of Cell Saver in adult lumbar fusion surgery have not been clearly determined. In addition to effectiveness in blood replacement, the economic benefits of the Cell Saver have not been evaluated. METHODS: A total of 102 consecutive cases of posterolateral fusion with internal fixation were reviewed retrospectively. There were 56 patients in the Cell Saver group and 46 patients in the control group. Recorded hospital medical and financial data were analyzed for each patient. RESULTS: There was a 38% recovery rate of blood using the Cell Saver. This resulted in a decreased need for postoperative transfusion in the study group (1 U to 36% of patients) relative to the control group (1 U to 50% of patients). Significant predictors for surgery time were the number of levels fused (P < 0.0001), patient's weight (P = 0.0030), and use of Cell Saver (P = 0.0472). Significant indicators of blood loss were the number of levels fused (P < 0.0001) and surgical time (P = 0.0304). The average cost for blood-related charges in the Cell Saver group was 512 dollars versus 270 dollars per patient in the control group. CONCLUSIONS.: While the Cell Saver group did require fewer postoperative transfusions, the difference was not as much as expected. In elective fusions for degenerative conditions of the lumbar spine, blood requirements can usually be satisfied with predonation of autologous blood. With contemporary practices of predonation, the use of the Cell Saver appears to be neither necessary nor cost-effective during most elective lumbar fusions.

Adult↗
PubMed2004

Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study.

STUDY DESIGN: Prospective, observational. OBJECTIVES: Quantify the changes in intervertebral motion adjacent to cervical arthrodesis over time. SUMMARY OF BACKGROUND DATA: One of the frequently acknowledged sequelae following anterior cervical fusion is the development of adjacent segment disease. It has been argued that a spine fusion transfers stress to adjacent levels and results in increased compensatory motion. However, there are conflicting reports as to whether this actually occurs, and most of these are in vitro or retrospective clinical studies. METHODS: Patients undergoing anterior cervical discectomy and fusion underwent a preoperative dynamic fluoroscopic study, followed by imaging at regular intervals after surgery. Imaging data were analyzed by a validated software system. Relative motion between adjacent vertebrae was then calculated, and changes in motion cephalad to the fusion followed over time. RESULTS: Twenty-one patients were analyzed. Mean follow-up was 13 months (10-22 months). Intervertebral motion adjacent to the fusion changed by more than 4 degrees in 4 of the 21 patients. However, on average, there was no difference between preoperative and postoperative motion for shear, flexion-extension, or vertical displacement at the anterior or posterior disc space. CONCLUSIONS: Although there was some individual variation, at a mean of 13 months following surgery, there was no significant change in the average junctional intervertebral motion. If fusion is going to affect adjacent motion, it appears that this does not consistently occur in the first 1 to 2 years following surgery. Additionally, there was no observable relationship between motion and development of degenerative changes during this time.

Cervical Vertebrae↗
PubMed2003

Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure.

STUDY DESIGN: Pedicle screw strength or load to failure was biomechanically evaluated, and the geometric characteristics of pedicle screw instrumentation systems were compared. OBJECTIVES: To compare the features of pedicle screw systems, and to demonstrate the failure point of the polyaxial pedicle screw head. SUMMARY OF BACKGROUND DATA: Many pedicle screw instrumentation systems are currently available to the spine surgeon. Each system has its unique characteristics. It is important for the surgeon to understand the differences in these pedicle screw systems. Pedicle screw load to failure has not been subjected to a comparison study. METHODS: The physical characteristics of each pedicle screw instrumentation system were determined. Features of rods, instruments, and pedicle screws were cataloged. Biomechanical testing of the pedicle screw construct was performed to determine the site and force of the load to failure. Nine pedicle screw systems were evaluated. Testing was performed with a pneumatic testing system under load control. Three polyaxial screws were used for each test at a load rate of 100 N/second. The load failure value was the force at which the pedicle screw or polyaxial head-screw interface initially deflected. RESULTS: Biomechanical testing demonstrated in all instances that the polyaxial head coupling to the screw was the first failure point. Although there have been subtle design differences in the instruments over time, the features of the pedicle screw instrument sets have become remarkably similar. CONCLUSIONS: Biomechanical pedicle screw load-to-failure data demonstrated that the polyaxial head coupling to the screw is the first to fail and may be a protective feature of the pedicle screw, preventing pedicle screw breakage. Knowing the physical characteristics of the available pedicle screw instrumentation systems may allow the choice of pedicle screw best suited for a given clinical situation.

Biomechanical Phenomena↗
PubMed2002

Spinal brucellosis: case report in the United States.

STUDY DESIGN: Case report. OBJECTIVE: To increase awareness of spinal brucellosis and discuss demographics, diagnosis, and treatment. SUMMARY OF BACKGROUND DATA: Brucellosis is a rare cause of spinal infections in the United States, although there have been regional increases in its prevalence. METHODS: Retrospective review of a patient with spinal brucellosis. She underwent a protracted course of treatment, with a long delay in diagnosis. History ultimately revealed regular consumption of unpasteurized goat cheese. Appropriate testing subsequently led to the diagnosis. RESULTS: After multiple surgeries and medications, the condition responded well to definitive antibiotic therapy. CONCLUSION: Brucellosis is rare in the United States and thus often overlooked in the differential diagnosis of back pain. The changing risk pattern for this disease requires a high index of suspicion, which can result in early diagnosis and predictably favorable results to treatment.

Anti-Infective Agents↗
PubMed2002

Subdural hematoma after cervical epidural steroid injection.

STUDY DESIGN: A case report is presented involving a subdural hematoma after cervical epidural steroid injection. OBJECTIVE: To demonstrate a previously unreported complication of cervical epidural steroid injection. SUMMARY OF BACKGROUND DATA: Cervical epidural steroid injection is a common procedure performed in the care of patients with spine-related complaints. Reports of complications are rare, and most of these are fairly benign. To the authors' knowledge, subdural hematoma has never been described as a complication of a cervical epidural steroid injection. METHODS: A patient underwent an uncomplicated cervical epidural steroid injection by an experienced anesthesiologist. She developed acute onset of axial pain followed by progressive quadriparesis within a matter of 8 hours. She was transferred from a local emergency room after a CT scan suggested posterior cord displacement consistent with an anterior spinal hematoma from C3 to C5. She was taken to the operating room for urgent decompression. Exploration revealed an anterior subdural hematoma that was evacuated followed by dural closure with a patch. RESULTS: After surgery the patient was initially quadriplegic but rapidly gained full function in the left upper and lower extremities. She was making steady progress with motor recovery on the right side when she developed acute meningitis about 8 days after surgery, and then she subsequently went into cardiopulmonary arrest. She was successfully resuscitated but remained critically ill with no evidence of encouraging neurologic function. Six days later she had a second cardiac arrest and could not be resuscitated. CONCLUSIONS: It is important to acknowledge that spinal hematomas can occur after cervical epidural steroid injection, as prompt recognition and treatment could improve the prognosis for recovery. The sequelae of a cervical subdural hematoma after epidural steroid injection remain potentially devastating.

Cross Infection↗
PubMedDate not supplied

Direct repair of spondylolytic defects in young competitive athletes.

BACKGROUND CONTEXT: Operative treatment of symptomatic spondylolysis is rare. A variety of surgeries have been described. In general, reported operative success rates are high, although in most studies the successful return to sport of the competitive athlete is not detailed. PURPOSE: To review outcome, specifically return to sport, in a group of competitive athletes after direct pars repair for symptomatic spondylolysis. STUDY DESIGN/SETTING: This was a retrospective case series of a single surgeon. PATIENT SAMPLE: Series of four athletes who underwent direct pars repair over an 18-month period. OUTCOME MEASURES: Return to their sport. METHODS: Chart review of all patients who had undergone a single-level pars repair over an 18-month period. All patients had normal discs above the level of the repair. Postoperative clinical course was determined for all patients. RESULTS: The patients participated in different sports. All were able to return to their presymptomatic level of activity with no restriction. One had periodic low back pain that required nonsteroidal anti-inflammatory medicine as needed. The others were entirely asymptomatic. CONCLUSIONS: This small series suggests that with specific inclusion criteria, a select group of motivated athletes can expect to return to their sport after direct pars repairs for symptomatic spondylolysis that has failed conservative treatment.

Adolescent↗
PubMedDate not supplied

Lumbar isthmic defects in teenagers resulting from stress fractures.

BACKGROUND CONTEXT: An accepted classification of spondylolysis exists. However, etiology remains controversial. There are several reports supporting acquired stress fractures in the etiology of this condition, although radiographic evidence of an acquired fracture in a given individual is very rare. PURPOSE: To present evidence of development of pars defects during the teenage years. STUDY DESIGN/SETTING: Retrospective review of charts. PATIENT SAMPLE: Two case studies. METHODS: Charts and X-rays were reviewed to look for radiographic evidence of development of pars defects in patients who were ultimately found to have spondylolisthesis or spondylolysis. RESULTS: Two cases were found that demonstrated development of a pars fracture. Both patients had radiographic evidence that these fractures developed during their teenage years. Both were active individuals with a consistent level of participation in athletics. CONCLUSIONS: Although development of pars defects may be multifactorial, these two cases support the concept that these fractures can be acquired lesions resulting from repetitive stress injury. They also demonstrate that isthmic defects can arise in teenagers, in these cases in an athletic population.

Adolescent↗
PubMedDate not supplied

Cervical plates: comparison of physical characteristics and in vitro pushout strength.

BACKGROUND CONTEXT: There are many cervical plates available to the spine surgeon today. A single plate design may not be appropriate for every clinical situation. It is important for the surgeon to understand the differences of these plating systems. Plate systems are known to fail by screw pullout from the bone, screw and plate breakage and a less frequent but clinically observed screw pushout from the plate. Pushout testing of the screws from the plate have not previously been subjected to study. PURPOSE: This compares the features of cervical plating systems and the strength of the locking mechanisms to allow the surgeon to make a knowledgeable choice of plating system. STUDY DESIGN: This is a review of descriptive geometric characteristics of cervical plate systems and a biomechanical evaluation of locking mechanism screw pushout strength. METHODS: Physical characteristics of each plate were determined. Features of plates and screws were cataloged. Each of the test plate systems had a different locking mechanism. Biomechanical testing of the locking mechanism-screw-plate constructs was performed to determine the pushout strength of the fixation screw from the plate-locking mechanism. RESULTS: Physical characteristics of the plating systems, including lengths, widths, shortest screw lengths and distance from edge of plate to nearest screw, were determined. Biomechanical testing showed significant differences in pushout strength, in part explained by the type of locking mechanism. CONCLUSIONS: Biomechanical screw pushout data demonstrate that a significant range of pushout strengths exist across the available cervical plate systems today. Knowing the physical characteristics of the cervical plating systems available may allow the selection of a plate best suited for a given clinical situation.

Biomechanical Phenomena↗