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Background Instrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed. Certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, are known to negatively affect these procedures. An advanced cellular bone allograft (CBA) with viable osteogenic cells (V-CBA) has demonstrated high fusion rates, but the rates for patients with severe and/or multiple comorbidities remain understudied. The purpose of this study was to assess fusion outcomes in patients undergoing IPLF/TLIF using V-CBA with baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion. Methods This was a retrospective study of de-identified data from consecutive patients at an academic medical center who underwent IPLF procedures with or without TLIF, and with V-CBA. Baseline patient and procedure characteristics were assessed. Radiological outcomes included fusion rates per the Lenke scale. Patient-reported clinical outcomes were evaluated via the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain. Operating room (OR) times and intraoperative blood loss rates were also assessed. Results Data from 96 patients were assessed with a total of 222 levels treated overall (mean: 2.3 levels) and a median follow-up time of 16 months (range: 6 to 45 months). Successful fusion (Lenke A or B) was reported for 88 of 96 patients (91.7%) overall, including in all IPLF-only patients. Of 22 patients with diabetes in the IPLF+TLIF group, fusion was reported in 20 patients (90.9%). In IPLF+TLIF patients currently using tobacco (n = 19), fusion was reported in 16 patients (84.3%), while in those with a history of tobacco use (n = 53), fusion was observed in 48 patients (90.6%). Successful fusion was reported in all 6 patients overall with previous pseudarthrosis at the same level. Mean postoperative ODI and VAS scores were significantly reduced versus preoperative ratings. Conclusion The results of this study suggest that V-CBA consistently yields successful fusion and significant decreases in patient-reported ODI and VAS, despite patient comorbidities and lifestyle risk factors that are known to negatively affect such bony healing.

BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion (TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over previous surgical methods, instrumentation and bone graft-related complications such as spacer misplacement or migration, screw fracture or misplacement, or rod breakage continue to be reported. The objective of this manuscript is to report on a fractured allograft interbody spacer that displaced into the neural foramen and resulted in impingement on the exiting nerve root that required revision. CASE SUMMARY A 50-year-old male had two-level TLIF with immediate post-operative right L5 radiculopathy. Computed tomography scan demonstrated a fractured allograft interbody spacer that displaced into the right neural foramen and impinged on the exiting L5 nerve root. Revision surgery was performed to remove the broken allograft fragments from the right L5 foramen and the intact portion of the spacer was left in place. The right leg L5 radicular pain resolved. At the last follow up 12 mo after the index procedure, computed tomography scan confirmed sound interbody and posterolateral fusion. CONCLUSION Displacement of broken allograft interbody spacer following TLIF procedures can result in neurological sequelae that require revision. To avoid such an occurrence, the authors recommend allowing sufficient time for the reconstitution of the graft in saline prior to use to decrease brittleness, to use an impactor size that is as close as possible to the spacer size and meticulous inspection of the cortical allograft spacer for any visible imperfection prior to insertion.

This case reports on a knee locked in flexion due to incarceration of the semitendinosus tendon around an osteochondroma in a patient with a history of multiple hereditary exostoses (MHE). An 18-year-old female with history of MHE presented with acute right medial knee pain and inability to extend her knee. Radiographs confirmed multiple lower extremity osteochondromas, notably a large, 3-cm pedunculated osteochondroma about her right medial proximal tibia. This was assessed as a locked knee secondary to incarcerated hamstring tendons around an osteochondroma. Excision of the osteochondroma restored normal flexion and extension of her knee. At the 3-month follow-up visit, she had returned to all activities with no recurrent medial knee pain or locking. The differential diagnosis for a locked knee joint can be broad, but tendon incarceration should be considered in appropriate patients with significant symptoms. In patients with a history of MHE, osteochondromas may be the cause of tendon entrapment.

Cubital tunnel syndrome is the second most common peripheral nerve compression seen by hand surgeons. A thorough understanding of the ulnar nerve anatomy and common sites of compression are required to determine the cause of the neuropathy and proper treatment. Recognizing the various clinical presentations of ulnar nerve compression can guide the surgeon to choose examination tests that aid in localizing the site of compression. Diagnostic studies such as radiographs and electromyography can aid in diagnosis. Conservative management with bracing is typically trialed first. Surgical decompression with or without ulnar nerve transposition is the mainstay of surgical treatment. This article provides a review of the ulnar nerve anatomy, clinical presentation, diagnostic studies, and treatment options for management of cubital tunnel syndrome.