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John J Carbone

Publications and source records attributed to John J Carbone.

5 recordsLinked to original sources
PubMed2005

Cervical spine trauma.

Traumatic injuries to the cervical spine are often difficult to detect and are associated with substantial morbidity and mortality. Along with standard trauma radiographs, a thorough physical examination and meticulous documentation are of the utmost importance because many neurologic injuries evolve over time. Although many injuries to the cervical spine can be treated nonoperatively, any injuries with neurologic deficits, instability, or ligamentous injury require instrumentation and fusion. It is crucial to recognize injuries to the cervical spine and the different treatment options. Computed tomography can be very helpful in defining the bony injury and evaluating the spinal canal, whereas magnetic resonance imaging can better evaluate the spinal cord and assess ligamentous injury.

Arthrodesis↗
PubMed2003

Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: technique and short-term complications.

STUDY DESIGN: Retrospective review of charts and fluoroscopic, radiographic, and computed tomography images for 252 screws (41 patients). OBJECTIVES: To describe a fluoroscopically assisted technique of thoracic pedicle screw insertion and to determine the technique's safety, short-term complications, and accuracy. SUMMARY OF BACKGROUND DATA: Pedicle screw instrumentation is safe and effective for lumbar spine stabilization, but evidence of its accuracy and complications in the thoracic spine is lacking. METHODS: Between 1997 and 2000, 41 consecutive patients with unstable cervicothoracic, thoracic, and thoracolumbar spine injuries were admitted to a regional, level 1 trauma center. These patients underwent posterior spine arthrodesis and pedicle screw instrumentation placed intraoperative multiplanar fluoroscopic imaging. Pedicle screw placement accuracy was determined by review of postoperative computed tomography scans. Instrumentation failure prevalence was determined by review of fluoroscopic images, postoperative radiographs, and computed tomography scans. Neurologic, infectious, vascular, and gastrointestinal complications were determined by review of operative reports, hospital records, and clinic notes. RESULTS: Of the 126 (50%) thoracic screws (22 patients) with postoperative computed tomography scans, 16 (12.7%) penetrated the pedicle cortex (4 [2.4%] medially and 13 [10.3%] laterally) and 7 (5.6%) penetrated the vertebral body. There were four surgical complications: one instrumentation failure (broken rod, no loss of correction), one deep infection, and two superficial infections. The infections resolved with irrigation, debridement, and intravenous antibiotics. During the 6- to 24-month follow-up period, there were no neurologic, vascular, or gastrointestinal complications. CONCLUSIONS: Cervicothoracic, thoracic, and thoracolumbar spine injuries can be managed safely and effectively with thoracic pedicle screws inserted under multiplanar fluoroscopic imaging.

Adolescent↗
PubMedDate not supplied

Lateral mass screw fixation for cervical spine trauma: associated complications and efficacy in maintaining alignment.

BACKGROUND CONTEXT: Many studies have documented the efficacy of lateral mass screws, but there are no studies examining the alignment maintenance capability and few large studies examining the complications associated with the use of these devices in cervical spine trauma. PURPOSE: To evaluate complications and alignment maintenance capability associated with lateral mass screw placement for cervical spine trauma by one surgeon at one institution. STUDY DESIGN: A retrospective chart and radiograph review of adult patients who underwent lateral mass screw fixation after traumatic injuries to the cervical spine. PATIENT SAMPLE: Of 34 consecutive patients with cervical spine injuries who were treated surgically at a level-I regional trauma center, 29 met the inclusion criteria and formed the study group. OUTCOME MEASURES: Sagittal alignment, screw placement, and fusion were assessed on postoperative radiographs. METHODS: Inclusion criteria included an unstable cervical vertebral fracture or a fracture-dislocation treated with posterior spine fusion and lateral mass instrumentation and a minimum follow-up of 24 months. A review of hospital charts, operative reports, clinic notes, and plain radiographs for the 29 patients was performed, with an emphasis on operative and postoperative complications and alignment maintenance. RESULTS: For 28 of the 29 patients, the mean change in sagittal alignment from the immediate postoperative to the most recent follow-up radiographic examination was 2 degrees (range, 0 degrees to 6 degrees ). Radiographically, there was one case of instrumentation/fixation failure and loss of sagittal alignment 3 months postoperatively. Other complications included one case of C5 nerve root injury and four wound infections. CONCLUSIONS: The use of lateral mass screws for traumatic injuries of the cervical spine is associated with excellent maintenance of alignment and minimal complications.

Adolescent↗
PubMedDate not supplied

Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists.

BACKGROUND CONTEXT: Greater trochanteric pain syndrome (GTPS) is a regional syndrome characterized by pain and reproducible tenderness in the region of the greater trochanter, buttock or lateral thigh that may mimic the symptoms of lumbar nerve root compression. Despite these known features, the diagnosis of GTPS is often missed, and documentation of its prevalence in an orthopedic spine specialty practice is lacking. PURPOSE: To determine the prevalence of the GTPS in patients referred to a tertiary care orthopedic spine referral center for the evaluation of low back pain, and to describe the demographic and clinical characteristics of patients with this syndrome. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: A total of 247 consecutive patients referred for low back pain from August 1998 through December 2000. OUTCOME MEASURES: Clinical response to injection, demographic characteristics, physical examination findings, prevalence of GTPS and preexisting diagnostic evaluations. METHODS: The diagnosis of GTPS was made based on history and physical examination and was confirmed by response to anesthetic corticosteroid injection. Demographic and clinical characteristics of the study group were evaluated. Follow-up data were available at a mean of 8 weeks postinjection (range, 2 to 48 weeks). RESULTS: The prevalence of GTPS was 20.2% (51 of 252). Mean age (54 years) was the same for patients with (range, 25 to 85 years) and without (range, 17 to 85 years) GTPS. Significantly more women than men had GTPS (p<.03). Of the 51 patients diagnosed with GTPS at initial presentation, 54.9% (28 of 51) had already obtained a magnetic resonance imaging examination (although only 15.7%, ie, 8 of 51, demonstrated objective neurologic findings) and 62.7% (32 of 51) had previously been evaluated by an orthopedist or neurosurgeon; one patient had undergone two lumbar decompressions without clinical improvement before our evaluation. CONCLUSIONS: GTPS accounts for a substantial proportion of patients referred to our center for evaluation of low back pain. Both primary care physicians and specialty surgeons may miss this diagnosis, most common in middle-aged women. Accurate recognition of this problem earlier in the evaluation of patients with low back, buttock or lateral thigh symptoms may dramatically reduce costly patient referrals and diagnostic tests and may prevent unwarranted surgery.

Adult↗