PubMed Health⌕ Search

Biomedical subjects

J Fischgrund

Publications and source records attributed to J Fischgrund.

5 recordsLinked to original sources
PubMed2002

Risk factors for spinal epidural hematoma after spinal surgery.

STUDY DESIGN: A case-control retrospective analysis comparing patients who developed a postoperative spinal epidural hematoma with patients who did not develop this complication. OBJECTIVES: To identify risk factors for the development of an epidural hematoma following spinal surgery. SUMMARY OF BACKGROUND DATA: Neurologic deterioration following spinal surgery is a rare but devastating complication. Epidural hematomas should be suspected in the patient who demonstrates a new postoperative neurologic deficit. The risk factors that predispose a patient to a postoperative spinal epidural hematoma have not been identified. METHODS: Patients who underwent spinal surgery at a single institution over a 10-year period were retrospectively reviewed. Twelve patients who demonstrated neurologic deterioration after surgery and required surgical decompression because of an epidural hematoma were identified. All cases involved lumber laminectomies. A total of 404 consecutive patients that underwent lumbar decompression and did not develop an epidural hematoma formed the control group. Factors postulated to increase the risk of postoperative spinal epidural hematoma were compared between the two groups using logistic regression. RESULTS: Multilevel procedures (P = 0.037) and the presence of a preoperative coagulopathy (P < 0.001) were significant risk factors. Age, body mass index, perioperative durotomies, and postoperative drains were not statistically significant risk factors. CONCLUSIONS: Patients who require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk for developing a postoperative epidural hematoma.

Blood Coagulation Disorders↗
PubMed1994

Variables affecting time to bone healing during limb lengthening.

Radiographs and charts of 114 consecutive patients who underwent 140 lower-extremity bone-segment lengthening procedures using the Ilizarov external fixator were reviewed. Patient age, bone segment (femur, tibia), corticotomy level (metaphyseal, diaphyseal, double level), and distraction gap (DG) were recorded. Distraction-consolidation time (DCT) was defined as the interval in months from the date of the corticotomy until the DG was healed according to radiographic and manual testing criteria. Distraction-consolidation time had a direct linear relationship with the magnitude of the DG. Distraction--consolidation time versus DG was significantly less for femoral than tibial lengthening. Patients 20 years and older healed slower than patients younger than the age of 20 years. Patients 20 to 29 years old healed faster than patients older than 30 years and slower than patients younger than 20 years. Diaphyseal lengthening healed more slowly than metaphyseal lengthening. Double-level lengthening reduced the DCT when the DG was greater than 4 cm. Distraction--consolidation index--DCT divided by DG--was not a constant. Distraction--consolidation index decreased with increasing DG. To facilitate prediction of bone-healing time, graphs were developed demonstrating the average treatment time +/- 2 SD expected for a specific amount of lengthening, considering the bone segment, the level of osteotomy, and the age of the patient.

Adolescent↗
PubMed1993

Open reduction and circular external fixation of intraarticular calcaneal fractures.

Open reduction and internal fixation techniques do not allow early weight bearing. In an effort to develop a better method to obtain calcaneal fracture reduction and maintain it in the face of early weight bearing, a circular external fixator was applied to seven patients in combination with a limited lateral approach and open reduction and internal fixation of the depressed subtalar joint fragments. The operative technique uses the Ilizarov circular external fixator to obtain a ligamentotaxis reduction, following which the depressed subtalar joint fragments are elevated open; then, the fixator is used to reduce the lateral translation. All displacements of the fracture fragments are corrected. This method proved successful in six patients, all of whom achieved a satisfactory result with anatomic restoration of the subtalar joint and heel. One patient went on to late partial collapse of the posterior facet. Subtalar motion was greater than 50% in four of seven patients. None of the patients complained of heel pad pain, which was attributed to the desensitization of the heel by early weight bearing. This technique has produced encouraging preliminary results in two- to four-year follow-up evaluation.

Calcaneus↗
PubMedDate not supplied

Anterior cervical interbody fusion with rhBMP-2 and tantalum in a goat model.

BACKGROUND CONTEXT: Tricortical autogenous iliac crest has long served as the gold standard for arthrodesis after cervical discectomy. The added morbidity resulting from bone graft harvest may be eliminated by the use of a biocompatible synthetic bone graft substitute with osteoconductive abilities, and when used with an osteoinductive agent, such as recombinant bone morphogenic protein (rhBMP)-2, it may facilitate arthrodesis similar to autograft. PURPOSE: To determine by radiographic and histologic analysis whether tantalum with and without rhBMP-2 can facilitate bony ingrowth and arthrodesis in an animal model. STUDY DESIGN/SETTING: Single-level anterior cervical discectomy and fusion was performed using a tantalum bone graft substitute with and without rhBMP-2 in a previously established goat model for anterior cervical fusion. METHODS: Eight goats underwent single-level anterior cervical discectomy and stabilization with a porous tantalum implant. There were four goats in each experimental group. Group A underwent anterior cervical stabilization with tantalum alone, whereas in Group B rhBMP-2 was added to the tantalum implant. The goats were sacrificed at 12 weeks, and their cervical spines were removed for histologic and radiological analysis. RESULTS: Only one of four goats in Group A had any bony ingrowth into the tantalum. Three of four goats in Group B demonstrated bony ingrowth. The average extent of bony ingrowth at the perimeter of the tantalum in Group A was 2.5% compared with 12.5% in Group B. Similarly, the volume of bony ingrowth within the tantalum was 2.5% in Group A and 10% in Group B. The difference was not statistically significant. CONCLUSIONS: The data in this pilot study suggest that tantalum may function as a synthetic osteoconductive bone graft substitute. The addition of rhBMP-2 may facilitate osteoinduction within a synthetic osteoconductive implant. The sample size in this study was too small for statistical significance. The present animal model as used in this study was inadequate for cervical arthrodesis where rigid implant fixation is desired.

Animals↗