Faculty Bibliography

Considering their proximity to abdominal viscera, transverse process lesions may pose a diagnostic challenge. We present a case of fibrous dysplasia of the transverse process, causing urinary retention, frequent urinary tract infections, and thigh numbness. This is the first reported case of a transverse process fibrous dysplasia lesion, causing simultaneous urinary retention and neurologic symptoms. Clinicians may consider lesions of the lumbar transverse processes in patients presenting to orthopedic surgeons with urinary symptoms, especially when combined with neurologic symptoms. In these lesions, fibrous dysplasia should be within the differential diagnosis. We discuss the diagnosis and present a brief review of fibrous dysplasia.

Occiput-C1 and C1-C2 dissociations and dislocations have been well documented in the literature. However, after thorough review of the literature, we found very little in the literature regarding combined occiput-C1 and C1-C2 dissociations in adults who survived. We present 2 case reports describing the clinical presentation, initial management, operative treatment, and postoperative course of 2 patients who sustained traumatic combined occiput-C1 and C1-C2 dissociations. After initial stabilization, both patients underwent open reduction and posterior occipital-cervical fusion with segmental fixation. At recent follow-up, both patients maintain good sagittal alignment without loss of reduction, and they have radiographic progression to fusion, minimal pain, and improved neurologic function. Combined occiput-C1 and C1-C2 dissociations are rare but serious injuries. Incomplete dissociations may not be evident on initial radiographs. Computed tomography or magnetic resonance imaging is recommended for formal diagnosis. A traumatic dural tear may be present. We recommend open reduction and posterior occipital-cervical fusion with segmental fixation for these patients.

Cauda equina syndrome (CES) is a rare syndrome that has been described as a complex of symptoms and signs--low back pain, unilateral or bilateral sciatica, motor weakness of lower extremities, sensory disturbance in saddle area, and loss of visceral function--resulting from compression of the cauda equina. CES occurs in approximately 2% of cases of herniated lumbar discs and is one of the few spinal surgical emergencies. In this article, we review information that is critical in understanding, diagnosing, and treating CES.

Priapism is defined as a prolonged engorgement or erection of the penis or clitoris that is unrelated to sexual arousal. Recent studies have determined the incidence of priapism to be between 1.5 and 2.9 per 100,000 person years. The incidence of priapism following elective orthopedic surgery is rare. Defining the etiology of a case of postoperative priapism following orthopedic surgery can be difficult, and many times cannot be determined. This case represents the first report of priapism following an elective total hip arthroplasty (THA) performed under spinal anesthesia, and focuses on a review of the literature and potential etiologies of this rare complication. A 44-year-old man with a history of right hip osteoarthritis underwent elective minimally invasive cementless right THA under spinal anesthesia (1 mg of Intrathecal Morphine and 100 mg of intravenous Fentanyl) without initial complication. A preoperative Foley catheter was placed without incident and the patient was placed into the left lateral decubitus position. Surgical time was recorded at 60 minutes. Nine hours after the Foley catheter was removed, the patient developed a persistent painless erection. Successful emergent treatment included a penile Winter shunt, to irrigate blood from the corpora. A computed tomography scan of the pelvis ruled out pelvic deep vein thrombosis as an etiology. This case represents the first report of priapism after an elective THA. The incidence of priapism as a complication is well described and has been associated with numerous medical conditions discussed in this article.