BMC Musculoskeletal Disorders最新文献

Background: Delayed neurological deterioration caused by a postoperative high-pressure cerebrospinal fluid (CSF) collection is an uncommon but clinically recognized complication after thoracic decompression complicated by incidental durotomy. We report a case of delayed thoracic myelopathy due to a tension subfascial CSF collection and summarize relevant literature.

Case presentation: A 55-year-old woman with thoracic myelopathy due to ossification of the posterior longitudinal ligament at T2-4 and ossification of the ligamentum flavum at T5-6 underwent posterior decompression and instrumented fusion (T2-6 laminectomy with T1-6 instrumentation). An incidental dural tear occurred at T5-6 and was managed with an onlay artificial dural patch reinforced with fibrin glue and gelatin sponge. The wound drain was removed on postoperative day 7. On postoperative day 9, she developed acute left lower-extremity weakness. MRI demonstrated a large subfascial CSF collection causing significant spinal cord compression, consistent with a tension pseudomeningocele. Bedside subfascial incision and continuous closed low-level drainage (with the drainage bag kept at bed level) resulted in rapid neurological improvement. After recurrence following drain removal, ultrasound-guided drainage was performed, leading to sustained symptom relief. At 3-month follow-up, she had full motor recovery and follow-up MRI confirmed resolution of the collection with adequate decompression.

Conclusions: A tension subfascial CSF collection after incidental durotomy can mimic recurrent stenosis and cause delayed thoracic myelopathy. When imaging confirms a compressive CSF collection, continuous closed low-level subfascial drainage may be considered before revision surgery.

Background: This study aimed to evaluate the clinical efficacy of a modified application of Ilizarov external mini-fixation (IEP) in comparison with conventional surgical.

Methods: A retrospective analysis was conducted on 45 patients with boxer's fractures who underwent surgical intervention between January 2018 and December 2023. Thirteen patients were treated with the modified IEF. Baseline characteristics, intraoperative parameters, and postoperative outcomes-including fracture healing time, residual angulation, metacarpophalangeal (MP) joint range of motion (ROM), return-to-work time, and complication rates-were assessed and compared among the IEF, KW, and LP groups.

Results: Complete fracture healing was achieved in all cases, with no significant differences in mean healing time among the three groups. However, residual angulation was significantly greater in the KW group than in the IEF and LP groups. At 4 weeks postoperatively, the IEF group demonstrated excellent MP joint ROM compared to the KW and LP groups. At the final follow-up, the ROM in the IEF group was comparable to the KW group and slightly better than that observed in the LP group. Patients in the IEF group returned to work significantly earlier than those in the KW. No significant differences in the overall complication rates were observed among the groups.

Conclusions: The modified IEF technique demonstrated early functional advantages, including improved early ROM and expedited return to work, while maintaining long-term efficacy and complication rates comparable to established fixation methods. Despite its inherent limitations, this method may be particularly beneficial for patients with high functional demands or those prioritizing early rehabilitation.