OKOJ, Volume 3, No. 6

Most subcutaneous masses are benign lipomas, inflammatory nodules, sebaceous cysts, ganglion cysts or benign fibrous lesions. These lesions are typically smaller than 3 cm in size. Sarcomas are usually firm, nontender masses that will grow much larger than 3 cm, if ignored.

Subcutaneous sarcomas have a much lower incidence than the benign and inflammatory subcutaneous masses. Of all soft-tissue sarcomas, a third occur subcutaneously. Between 2,000 and 3,000 subcutaneous sarcoma cases occur in the United States annually.

This topic provides an overview of the distinguishing characteristics for subcutaneous masses, including sarcomas, and an overview of the diagnosis and management of this subcutaneous lesions.

This topic reviews three anterior approaches to the thoracolumbar spine: thoracotomy, retroperitoneal flank approach, and the pararectus retroperitoneal approach.

Thoracotomy is used to expose vertebral bodies from T3-T12; debride vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; for corpectomy for thoracic burst fractures; for thoracic diskectomies or fusion; and for anterior release with or without instrumentation in surgery to correct deformity.

The retroperitoneal flank approach is used for fusions from L1-4 with placement of lateral interbody implants; for debridement of vertebral osteomyelitis or diskitis; for vertebral body tumor excision; for decompression and stabilization in fractures from T12 to L4; and for anterior release and stabilization for scoliosis.

The pararectus retorperitoneal approach is used to expose the anterior aspect of vertebral bodies from L4 to S1; for interbody fusion of L4-5 and L5-S1; for débridement of vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; and for anterior release for deformity. It is not considered to be appropriate if there is prior inflammatory or infectious disease in the anatomic region; if there is prior surgery with consequent adhesions or endometriosis, or if exposure of vertebral bodies is difficult, even hazardous.

This topic reviews the anterior approach to the cervical spine and the anterior approach to the cervicothoracic spine.

The anterior approach to the cervical spine is used to expose the spinal column from C2 to T1 in thin individuals; for anterior cervical diskectomy/corpectomy; for artificial disk replacement; for debridement of vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; and for decompression and stabilization in cervical spine trauma.

The anterior approach to the cervicothoracic spine is used for anterior exposure of the vertebral bodies from C7 through T4; for débridement of vertebral osteomyelitis or diskitis; for anterior vertebral body tumor excision; and for decompression with fusion for upper thoracic fractures.

Over 750,000 meniscal tears are treated annually in the United States. The actual incidence of tears is much higher, but many patients either do not want surgical treatment or are asymptomatic. Approximately 60% of people over 60 years of age have meniscal tears.

This OKO topic provides a thorough discussion of meniscal allograft transplantation. Surgical techniques described in detail include the use of double bone plugs and bone bridges, including the keyhole, trough, and dovetail approaches. The dovetail approach is illustrated step-by-step on video.

Short-term results have been encouraging in terms of pain relief and improved knee function, although studies with midterm follow up indicate that graft durability is a concern. It has not been determined whether meniscal allograft transplantation can prevent or delay the progress of arthrosis.