Abstract: Spinal tuberculosis (TB), or Pott disease, has classically been recognized as a source of spinal deformities in unindustrialized countries. However, in industrialized countries with more access to sensitive imaging studies, Pott disease may be identified earlier as vertebral osteomyelitis with local complications, such as psoas abscess. In industrialized countries, persons at risk for Pott disease include the immunosuppressed, African Americans and those with a history of prior exposure to TB (Maron et al. Spine 31(16):E561-E564, 2006). This report describes an unusual case with a very interesting radiological appearance of spinal TB. A 30-year-old man presented with dull, progressive back pain. Radiological control showed complete destruction of the L4 vertebral body and partial destruction of the L3, as well as extensive bilateral paraspinal soft tissue infection. The patient underwent open biopsy, complete abscess drainage, lumbar spine stabilization and antituberculous chemotherapy.
Abstract: The management of thoracolumbar burst fractures remains challenging Ideally, it should effectively correct the deformity induce neurological recovery, allow early mobilization and return to work and be associated with minimal risk of complication. This article reviews the related studies reporting their clinical data for the management of thoracolumbar burst fractures, discusses the most suitable approach in cases such as these, highlights specific treatment recommendations, and proposes a treatment algorithm. Using PubMed and Scopus databases to search the term thoracolumbar burst fractures, abstracts and original articles in English investigating the treatment of thoracolumbar burst fractures were searched and analyzed.
Abstract: Calcification of the ligamentum flavum secondary to calcium pyrophosphate dihydrate (CPPD) deposition may be a rare cause of cervical myelopathy. We present a 56-year-old man with spinal stenosis secondary to CPPD disease and subacute cervical myelopathy following minor trauma. The patient had no history of CPPD disease. Posterior C4-C6 decompression and instrumented fusion were performed. Intraoperative findings were densely thickened ligamentum flavum and distortion of the cervical dura mater due to impingement. Histological sections of discs and ligamentum flavum specimens showed CPPD crystals. Postoperatively, neck pain and paresthesias improved immediately. At 2 weeks after spinal surgery, the patient experienced acute right knee swelling. Standard radiographs showed chondrocalcinosis of the knee menisci.
Abstract: Medical science is as old as human history and the need for disease treatment Archivists, researchers and historians are collaborating in the project to preserve the documentary inheritance and make the medical science useful to the public This research aims to identify and analyze the first registered sport injuries in the history of medicine. After a review of the literature, the Homeric epics, the texts of the first historical period of ancient Greece, were identified and analyzed as the texts which contain the first sport injuries in world history
Abstract: WC, present the technique of combined posterior decompression and spinal instrumentation. and Surgical (open) vertebroplasty using it novel system called vertebral body stenting (VBS) during a single session in it patient with metastatic vertebral and epidural cauda equina compression. J, surg. oncol. 2010;101.-253-258. (C) 2010 Wiley-Liss, Inc.
Abstract: Pancreatic cancer may cause osteolytic metastases, but the osteoblastic ones are extremely rare. In addition, it almost always presents with symptoms related to the invasion of the structures in the abdomen. Symptoms from bone metastases are rare and, if seen, are in the late phase of the course. We present a case of cancer of the body of the pancreas, which presented with severe back pain due to an osteoblastic lesion to L3 vertebra. Biopsy of the vertebra led to the diagnosis. Radiographs, computed tomography, magnetic resonance and scintigraphic images as well as pathology slices are shown. The present case raises the issue that pancreatic cancer, as a cause of an osteolytic bone lesion, should not be overlooked in an unknown primary investigation.
Abstract: Background: Traumatic or trophic defects of the soft tissue of the lower leg are quite often very difficult to manage, especially in the distal third of the leg. Fasciocutaneous flaps are a relatively simple option for covering small- and medium-sized defects of the lower leg. The aim of this study is to investigate the distribution of septocutaneous perforators of the anterior tibial artery and their possible clinical applications. Methods: An anatomical study was performed on 50 fresh adult cadaveric lower extremities. Using coloured contrast materials, the location of septocutaneous perforators, originating from the anterior tibial artery, were mapped. These findings were then compared with colour Doppler imaging (CDI) data in 20 living volunteers. Results: The septocutaneous perforators of the anterior tibial artery follow a reproducible pattern all over the lower leg (septa I, II and III). In the distal segment, we found relatively few perforators. There was a marginal difference between cadaveric and CDI data for perforators with diameter >= 1 mm. The average number of anterior tibial artery septocutaneous perforators in anatomical dissections was 6.6 +/- 2.4, while CDI revealed 8.2 +/- 3.2 perforators in living volunteers (P = 0.053). In five areas of the lower leg, there is a >50% chance that a septocutaneous perforator with diameter >= 1 mm is coming off the anterior tibial artery. Anatomical dissections for a cutaneous territory 5 cm above the lateral maleollus, and 10 cm in width, revealed 6.1 +/- 2.2 septocutaneous perforators (range 4 to 12). Conclusions: CDI, paired with knowledge of anatomical details, is a reliable tool for preoperative identification of septocutaneous perforators of 1 mm or larger outer diameter, thus providing critical information for planning and harvesting safe fasciocutaneous flaps of the lower leg. Additionally, according to our anatomical study, a new transverse fasciocutaneous flap (Type B according to the Nahai-Mathes classification), located over the distal anterolateral third of the lower leg and based on perforators of the anterior tibial artery, may be successfully used for covering selected defects of the distal third of the lower leg. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Abstract: The purpose of this study was to present the effectiveness of 2 cyclooxygenase-2 inhibitors, meloxicam. and parecoxib, in the prevention of heterotopic ossification. Eighteen white mature male rabbits were divided into 3 groups of 6 animals. One was the control group; 1 group was administered meloxicam subcutaneously, and I group was administered parecoxib subcutaneously. For the induction of heterotopic new bone, the Michelsson model was used. The extent of heterotopic new bone development was assessed according to Scott's classification. The meloxicam and parecoxib groups developed significantly less heterotopic bone when compared to the control group. There was no significant difference between the meloxicam. and parecoxib group. We concluded that meloxicam and parecoxib are capable of preventing the development of heterotopic new bone in rabbits. The clinical relevance of this study is that meloxicam and parecoxib may be helpful in reducing heterotopic ossification in humans. (C) 2009 Elsevier Inc. All rights reserved.
Abstract: A clinical study was performed to evaluate a new classification for odontoid process fractures. The external and internal anatomy of the axis has been studied. The files of 97 patients with a fracture of the odontoid process admitted to our institution were reviewed and classified according to the proposed new classification. The method was tested for reliability and validity. The patients were followed for a mean period of 14 years, in order to evaluate the outcome of these fractures and to correlate it to the fracture type. Intraobserver and interobserver agreement was excellent with intraclass correlation coefficients at levels of 0.98 and 0.85, respectively. Four types of odontoid process fractures are distinguished. Type B fractures are associated with high risk of pseudarthrosis. Existing classifications are inadequate and misleading since they do not include all types of odontoid process fractures, nor they consider the internal anatomy of the odontoid process. Classification of the odontoid process fractures has to be reconsidered as novel-imaging technology has shown new patterns of fractures. The analysis of the imaging data in the present study justifies the new classification.
Abstract: Chordomas are rare bony tumors, usually involving the skull base and sacrococcygeal spine, while least presented in cervical and thoracic spine. Chordomas of the cervical spine may cause variable neurological symptoms. Adult patients presenting with neck pain, paresthesias or limb paresis are further investigated. The history of progressive tetraparesis, however, implies a long-standing disease. Clinical presentation and imaging investigation of the cervical spine chordoma aims to alert the physicians for its early detection. Herein is reported the clinical presentation of two chordomas with progressive tetraparesis in two patients involving in both cases the third cervical vertebra. Plain radiographs, bone scintigraphy, CT and MR scanning were the imaging modalities depicting the mass, its prevertebral and intraspinal extension.
Abstract: Brucellosis is a common zoonosis, which still remains as a major health problem in certain parts of the world. Spondylodiscitis is the most frequent osteoarticular complication of brucellosis. Herein is reported an uncommon case of a middle-aged male treated for brucellosis who developed 2 years after the treatment brucellar spondylo-discitis complicated by a psoas muscle abscess, an infected abdominal aorta aneurysm and deep venous thrombosis of IVC, common iliac, external iliac and common femoral veins. CT and CT angiography were the imaging modalities depicting the findings. After an endovascular stent graft placement in abdominal aorta aneurysm, a CT guided drainage of retroperitoneal abscess revealed Brucella melitensis as the pathogen microorganism. Diagnosis of spondylodiscitis and contiguous psoas abscess is usually simple but aortic involvement is difficult to identify and can be easily overlooked. A high degree of suspicion is essential to reduce the delay for the treatment.
Abstract: Tear-drop fractures, as described by Schneider and Kahn, are by definition unstable injuries, since both bony and ligamentous elements are involved in such lesions. Fifty-four patients having sustained the above-mentioned injury were treated in our Orthopaedic Department during the last 36 years, representing the 8.1% of all cervical spine injuries. Those patients, 45 men and 9 women, of a mean age of 34.3 years, were injured following a RTA (63%), or a fall from the height (22.2%). Fifty-five percent of those patients suffered spinal cord injury. These injuries were classified in four types (I, II, III, IV) according to the severity of the lesions and were treated accordingly. The whole spectrum of the medical records were analysed and discussed in relation to the available bibliography. Attention was paid to the presence of neurological lesions and the severity of the injury. It was shown that Type I lesions respond satisfactory to conservative treatment, while Types III and IV have an absolute indication for surgical treatment.
Abstract: We describe the case of a 60-year-old patient who presented a pre-patellar mass for a period of 2 months, which did not respond to NSAIDs and antibiotic treatment. At physical history, the patient mentioned a recent direct hit at the pre-patellar region. Moreover, he stated that the lesion was painful and fast progressing. Clinical examination revealed the presence of the pre-patellar mass. At palpation, the pre-patellar area was found solid, warm and swollen. No other signs of systemic inflammation were detected. Aspiration of the pre-patellar area with fine needle did not revealed the nature of the lesion. Therefore, we proceeded to a surgical resection of the mass, at healthy margins. Pathologoanatomic examination set the diagnosis of gout. Such an early manifestation of gout is extremely rare and should always be taken into account when one is dealing with painful syndromes of the pre-patellar region.
Abstract: Only localized cases of Mycobacterium chelonae osteomyelitis have been reported. In this article, a 55-year-old immunosuppressed man with M. chelonae osteomyelitis and multiple spinal and extra-spinal involvement is presented. The patient had nodulo-pustular skin lesions, spondylodiscitis at multiple levels, and osteolytic lesions at extra-spinal locations. Biopsy and cultures of the osseous lesions showed M. chelonae osteomyelitis. The patient started antimycobacterial chemotherapy with ciprofloxacin and clarithromycin. Progressive cervical kyphosis associated with anterior wedged deformity of the C5 vertebra and posterior C5-C6 spondylolisthesis resulted in compression of the spinal cord and neurological impairment. The patient underwent anterior decompression and C4-C6 arthrodesis using a titanium mesh cage and cervical plate. About 15 months after the initiation of chemotherapy and 5 months after surgery, the patient was pain free, with significant improvement of his neurological function. In the presence of immunosuppression, the physician should be alert for unusual or opportunistic pathogens of osteomyelitis. Long-term antimicrobial chemotherapy and surgical intervention is the cornerstone of successful treatment of multifocal bone M. chelonae infection.
Abstract: OBJECTIVES: The social and economic burden of osteoporosis is important since it concerns a continuously aging population, while the disease is silent until the emergence of fractures. Aim of the study was to assess female population knowledge about osteoporosis risk factors and to identify the risk factors of the studied population. METHODS: A sample of 99 (aged: 61.59+/-9.61 years) women under treatment for osteoporosis or osteopenia answered the questionnaire provided by their pharmacists and were included in the study's analysis. Various parameters on osteoporosis awareness and risk factor knowledge of the population sample studied were analyzed. RESULTS: It was revealed that 96% of the participants knew osteoporosis definition and sources of this knowledge were one or more of the following: doctors (86.3%), mass media (20%) and friends or relatives (13.7%). It was found that the older age was associated with less knowledge (OR=0.93, CI: 0.88-0.97, p=0.004), and higher education with increased knowledge (OR=1.68, CI: 1.10-2.55, p=0.014) about osteoporosis. 56.4% of the participants were aware of at least one osteoporosis risk factor. In multivariate analysis, it was revealed that the participants who referred increased milk products consumption in childhood (OR=3.72, CI: 1.34-10.36, p=0.012) and current performance of physical activity (OR=13.06, CI: 3.22-53.05, p<0.001) were more likely to be informed about osteoporosis risk factors; age >61 years was associated with decreased knowledge of risk factors (OR=0.27, CI: 0.09-0.82, p=0.018). CONCLUSIONS: This study implies that a higher degree of participant's health education may result in the avoidance of osteoporosis risk factors. Increasing knowledge of osteoporosis should be a priority for future intervention programs in order to promote specific behavioural strategies for osteoporosis prevention.
Abstract: High-energy tibial. plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients. (C) 2005 Elsevier Ltd. All rights reserved.
Abstract: Proximal humeral fractures, especially in elderly patients, remain a challenging problem for the surgeon because the complication rate for these fractures still remains high. The internal locked system (PHILOS) plate is a new device used for proximal humerus fracture fixation is designed to decrease the high complication rate. We prospectively evaluated our early experience using this system. Twenty patients with fractures of the proximal humerus were treated with a PHILOS plate from September 2001 to January 2004 at Princess Alexandra Hospital in Harlow, UK. Functional assessment was done using the Constant shoulder score. Two patients who had brachial plexus injury were evaluated only with the visual analogue score because we thought that the Constant objective assessment would be unreliable. Complications were monitored. The mean Constant score was found to be 76.1% (range, 30-100%). The preliminary results seem to be satisfactory. According to our experience, the plate design provides stable fixation with a good functional outcome and eliminates most hardware problems such as failure and impingement syndrome. The PHILOS plate is suitable for the majority of fractures providing that the correct surgical technique is used.
Abstract: Isolated dislocation of the carpal scaphoid is an extremely rare injury. The authors report herein a case of a 28-year-old man managed with open reduction and Kirschner wire fixation. The aim of this study is to comprehensively present this unusual injury along with its treatment and to attempt to merge the available experience in the literature in a suggested algorithm that will guide the surgeon confronted with this rare problem to treat it promptly and effectively.
Abstract: Background. Infections of the musculoskeletal system are tuberculous in nature in 1-5% of cases. The sacroiliac joint is involved in 3-9.7%. We describe the case of a 32-year-old man with tuberculous sacroiliitis presented as a growing mass on the lateral aspect of his right proximal and mid-thigh. Open biopsy, histology, cultures and PCR established the diagnosis of tuberculosis. Results: After surgical drainage of the abscess, the patient was administrated a triple antibiotic regimen for 12 months. Seven years postoperatively, the patient is disease-free with no functional limitation. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.
Abstract: Distal interlocking in intramedullary nailing of long bone fractures accounts for a significant proportion of the total fluoroscopy and operative time. We describe a modification of the "perfect circles" freehand technique employing a metallic grid temporarily attached to the skin of the lateral surface of the femur or to the medial surface of the tibia that acts as a fixed "navigational" aid. The position of the distal nail holes in relation to the grid is fluoroscopically ascertained. Subsequently, under fluoroscopic control, a modified Steinmann pin with a metallic handle attached to its blunt end ("flag") is used to accomplish targeting and to create the screw holes, affording improved visualization. This technique was compared with the traditional freehand technique in 2 groups of patients. Use of the modified technique led to reduction of radiation exposure and total distal interlocking time, and there were no significant complications related to the technique.
Abstract: Primary anterior cruciate ligament (ACL) reconstruction is considered a successful surgical procedure, but the results reported for revision ACL surgery are less satisfactory. The most common cause of technical failure in primary reconstruction is tunnel misplacement, particularly on the femoral side, although an anterior placement of the tibial tunnel may lead to graft impingement and failure. Several technical problems are encountered during revision procedures. We describe a technique for revision ACL surgery using a special. Jig for preparing the tibial tunnel that references the apex and roof of the intercondylar notch and an over-the-top routing for proximal femoral placement. This combination avoids graft impingement at the tibial tunnel exit and circumvents the problems associated with further femoral tunnel preparation.
Abstract: Study Design. A retrospective study was performed to identify horizontal fractures of the body of the axis, with special attention to their pattern, prevalence, and clinical outcome. Objective. The prevalence of this type of injury and the long - term clinical behavior are examined. Summary of Background Data. Although isolated cases have been reported, horizontal Chance-type fractures of the body of the axis are not common cervical spine injuries. Methods. The medical records of 674 consecutive patients with fractures of the cervical spine admitted to the authors' institute from 1970 to 2002 were reviewed. Of them, 2 (0.3%) had a horizontal Chance-type fracture of the body of the axis. Neurologic deficits were not diagnosed at admission. Mechanism of injury, treatment, and long-term follow-up were evaluated. Results. Both patients were treated nonoperatively. At the latest follow-up, 3 and 12 years, respectively, both patients had a satisfactory clinical outcome. Conclusion. Horizontal fractures of the Chance-type of the body of the axis are rare. Conservative treatment proved to be effective.
Abstract: Introduction We used an experimental hip model to assess the mechanical stability of a hip prosthesis, and compared the femoral medullary canal preparation techniques of reaming and broaching. Methods 15 pairs of cadaveric femora had a simulated replacement, the right femur with a reaming technique and the left with a broaching technique. Both femurs were radiographed to assess component positioning and cement mantle. The femurs were osteotomized 30 days after the procedure. The shear strength of the interface was studied at 4 different levels along an aluminum rod during push-out tests. Results The overall mean value of the interface failure load was 15% lower with the reaming technique (6.5 kN for the reaming technique versus 7.7 kN for the broaching technique; p = 0.02). Interpretation Broaching was superior to reaming for the preparation of the femoral canal, and should be used in order to increase primary stability. Further in vivo studies are required to account for factors such as intramedullary pressure, bleeding and surgical variations, which could not be accounted for in our study.
Abstract: Multiple fractures of the axis are not common lesions. A retrospective study was performed to identify the different fracture patterns and to analyze the incidence of these injuries and their long-term behavior. The medical records of 674 consecutive patients with fractures of the cervical spine were reviewed. Nine (1%) of 674 patients (6 men and 3 women) had multiple fractures of the axis. Mean patient age was 48 years. The most common lesion was a combination of traumatic spondylolisthesis with either an odontoid process or a teardrop fracture of the axis body. All patients were treated conservatively with an excellent or good outcome at mean 12-year follow-up (range: 2-18 years). Computed tomography was the imaging modality of choice for the correct diagnosis of these rare lesions.
Abstract: Peripheral quantitative computed tomography scans of the axis in 20 fresh cadaveric specimens obtained at autopsy were studied to investigate the internal structural properties of the axis. In all specimens, serial scans were done in three planes. The area of the dens consisted of dense cortical and trabecular bone (Region 1, above the base of the dens) and showed statistically significantly greater peripheral quantitative computed tomography values when compared with the anterior part of the body of the axis (Region 2, below the base of the dens). An age-related progressive decrease of peripheral quantitative computed tomography values was observed, with specimens from subjects younger than 40 years showing statistically significantly greater peripheral quantitative computed tomography values when compared with those from subjects older than 40 years. A small area of trabecular bone with decreased density was found close to the anteroinferior edge of the body of the axis in the specimens from younger subjects. In contrast, a large area of trabecular bone with decreased density extending anteroinferiorly to superoposteriorly to the base of the dens was found in the specimens from older subjects. Based on these findings, we think that dens fracture classification systems and fixation techniques-should be reconsidered.
Abstract: From 1970 to 2000, 81 patients with noncontiguous fractures of the spine were evaluated. Of these 81 patients, 36 had a neurologic deficit. Sixty-six patients with stable injuries were treated conservatively, whereas 15 patients with unstable injuries required surgical stabilization. There was no neurologic deterioration either in the patients who had surgical stabilization or in the patients who were treated conservatively. Thirteen patients with an A score on the American Spinal Injury Association neurologic impairment scale did not improve and had a high mortality rate (61.5%). Although multiple level noncontiguous fractures of the spine are uncommon, they constitute a threat to neurologic function, and therefore warrant radiographic evaluation of the entire spine with multiple injuries.
Abstract: The authors present a 45-year-old man with bone marrow edema syndrome (BMES) of the medial condyle of the knee. Early diagnosis of BMES was based upon clinical, bone scintigraphy and magnetic resonance (MRI) findings. After failure of the conservative treatment, core decompression was performed. Histological examination showed no evidence of osteoporosis or osteonecrosis. Within 2 months after the operation, the patient was pain-free and he resumed his previous activities. At 1-year follow-up examination, MRI showed complete resolution of all signal abnormalities; at 3-year follow-up the patient remained symptom-free and with no functional limitations. (C) 2002 Elsevier Science B.V. All rights reserved.
Abstract: This prospective study analyzed the long-term effects of horse riding on the cervical and lumbar spine of jockeys. Thirty-two jockeys were observed for 13 years. All jockeys had clinical and radiographic evaluation of the spine; three consecutive age groups were studied. Results were compared to age-matched, normal population control groups. The incidence of degenerative changes of the spine was higher in the jockeys compared with the control groups and was more prominent in the older age group for both the lumbar and cervical spine. These findings suggest that equestrian sports, particularly professional horse riding, apart from the increased risk of direct spinal injury caused by a fall from the horse, can lead to progressive spine degeneration as a result of repetitive trauma and increased physical stress on the spine.
Abstract: Fifty patients with an average age of 47 years received epidural steroid injections for lumbosacral radicular pain due to disk herniation or spinal stenosis. All patients had failed previous conservative treatment. Mean follow-up was 24 months (range: 12-36 months). Immediately after injection, all 50 patients reported various degrees of relief from leg and back pain. At the last follow-up examination, 68% of patients were asymptomatic, 20% had no change in preinjection radicular symptoms, and 12% had various degrees of relief. No significant correlation was found between pain relief, age, or number of injections. Early pain relief may be anticipated after epidural steroid injections in 80% of patients with radicular symptoms due to disk herniation or spinal stenosis.
Abstract: This experimental study compared the long-term (12 months) mechanical stability of the morselized graft-cement interface with the conventional bone-cement interface in both femoral bones of 10 adult dogs. For mechanical testing, three-point bending and push-out loading tests of composite bone-cement beams were used, while the incorporation of the graft was assessed by serial radiographs. Although the parameters fracture load and interface failure load showed inferior values in the specimens with a morselized graft-cement interface compared to those in specimens with a conventional bone-cement interface, no statistically significant differences were found between groups. Radiographic reconstitution of the lateral femoral cortex was observed in all animals at 3 months while signs of advanced remodeling were apparent at 6 months. These results indicate the long-term mechanical stability of the impacted morselized graft-cement interface is comparable to that of the conventional bone-cement interface created in primary total hip replacements provided the grafted area is protected from early heavy loading.
Abstract: Hemangioma of the bone is a benign tumor usually involving the spine and the bones of the skull and pelvis. It may be either a single lesion or part of a generalized multifocal disease. Multiple lesions involving non-adjacent vertebrae are rare. Two cases of multiple vertebral hemangiomas at non-adjacent levels with different pain patterns are presented at various stages of follow-up in order to emphasize the fact that multiple vertebral hemangiomas may present with different clinical characteristics over a long period of time. The change in the location and pattern of the initially presented pain in both patients suggested the passibility of multiple level involvement. Investigation revealed multiple hemangiomas involving three non-adjacent vertebrae in the first patient and four in the second. We stress the Fact that the existence of multiple non-adjacent lesions may remain undiagnosed for a considerable period of time and may be responsible fur even longer-term recurrent episodes of pain. Multifocal location of back pain in patients with a known vertebral hemangioma may be considered a relative indication for the presence of multiple non-adjacent level lesions.
Abstract: To evaluate the rationale of spontaneous spine fusion after a spinal injury, the authors conducted an experimental study that consisted of three types of controlled injuries to a rabbit spine model. The first was injury to the intervertebral disk (type I injury). The second was injury of the intervertebral disk along with injury to one of the adjacent vertebral end plates (type II). In type III injury, both the opposing end plates were injured along with the intervertebral disk. In 38 rabbits, a total of 82 injuries of these three types were inflicted. Twenty-six injuries were of type I (n = 22 rabbits), 26 were type II (n = 24 rabbits), and 30 were type III (n = 26 rabbits). Spontaneous fusion occurred only in type III injuries. From the 30 type III injuries, fusion occurred in 20 (66.6%). For an autofusion to occur, both epiphyseal plates may be injured. In the clinical situation, this observation suggests that a radiographically obscure lesion of both neighboring vertebrae may proceed to autofusion of that spinal segment observed later.
Abstract: This study reviewed operative treatment of Maisonneuve fracture of the fibula in 26 patients. Operative treatment consisted of restoration of the fibular length, repair of the lateral and medial ankle ligamentous structures, and placement of one or two suprasyndesmotic screws. After average follow-up of 6.4 years, the clinical results were satisfactory in 23 (88.4%) patients. Operative treatment is the treatment of choice for Maisonneuve fractures, and a satisfactory outcome nay be anticipated after appropriate management of any associated bony and syndesmotic injuries.
Abstract: Study Design. A retrospective, follow-up study. Objectives. To assess the effects of conventional surgery for lumbar disc herniation over an extended period of time and to examine factors that might correlate with unsatisfactory results. Summary of Background Data. Although the short; term results of lumbar discectomy are excellent When there is a proper patient selection, the reported success; rates in the long-term follow-up studies vary, and few factors have been implicated for an unsatisfactory outcome. Methods. One hundred-nine patients with surgically documented herniated lumbar disc were analyzed, retrospectively, by an independent observer. Long-term follow-up (mean 12.2 years) was done by a mailed, self-report questionnaire that included items about pain relief in the back and leg, satisfaction with the results, need for analgesics, level of activity, working capacity, and reoperations. Subjective disability was measured by the Oswestry questionnaire. Radiographic review was carried out in 66% of patients. End results were assessed using the modified Stauffer-Coventry's evaluating criteria. Several variables were examined to assess their influence to the outcome. Results. The late results were satisfactory in 64% of patients. The mean Oswestry disability score was 18.9. Of the 101 patients who had primary procedures, 28% still complained of significant back or leg pain. Sixty-five percent of patients were very satisfied with their results, 29% satisfied, and 6% dissatisfied. The reoperation rate was 7.3% (8 patients), about one-third of which was due to recurrent disc herniation. Sociodemographic factors pre disposing to unsatisfactory outcome, including female gender, low vocational education, and jobs requiring significant physical strenuousness. Disc space narrowing was common at the level of discectomy, but was without prognostic significance. Conclusions. The long-term results of standard lumbar discectomy are not very satisfying. More than one-third of the patients had unsatisfactory results and more than one quarter complained of significant residual pain. Heavy manual work, particularly agricultural work, and low educational level were negative predictors of a good out come. These indicators should be used preoperatively to identify patients who are at high risk for an unfavorable long-term result.
Abstract: 35 patients with volar Barton fractures were treated operatively from 1985-1994. The injury was due to a high velocity motor vehicle accident in 20 patients. All fractures were closed without major carpal injuries. 11 fractures were type B3.1, 21 type B3.2 and 3 type B3.3, according to the AO classification. All fractures were openly reduced and internally fixated by small buttress plates and screws. In 31 cases, the median nerve was unaffected by the injury and was not explored or decompressed during surgery. The patients were assessed clinically and radiographically after mean 6 (2-10) years. According to the criteria of Pattee and Thompson (1988), 23 patients had excellent results, 10 good and 2 fair. Posttraumatic arthrosis was found in 12 patients and was related to the congruency of the articular surface achieved at surgery. We conclude that the median nerve, when not damaged or compressed, should not be explored or decompressed during surgery.
Abstract: We report 13 fracture-separations of an articular pillar at the lower cervical spine in 12 patients. There were 9 men and 3 women with a mean age at injury of 32 years, with involvement of C4, C5 and C6 vertebrae. Neurological symptoms were present in 9 patients, 2 were classified as ASIA A and 7 as ASIA D. The average magnitude of rotation of the articular pillar was 24 degrees (10 degrees-36 degrees). 4 patients with neurologic deficit and a rotated articular pillar of more than 25 degrees were operated on, while 8 patients, 3 of which had a rotation of more than 25 degrees, had closed treatment. Patients were followed from 8 months to 15 years (mean 9 years). Patients who had closed treatment and/or with a rotated fractured articular pillar of more than 25 degrees had less satisfactory results. This observation was affirmed by cadaveric studies which showed that rotation of more than 25 degrees is an additional factor of instability in a fractured articular pillar.
Abstract: The present study involves 16 surgically treated patients who had sustained an old injury of their lower cervical spine. This group represents the 29% of the 55 patients that were admitted in our Department with an old injury of the cervical spine. The aim of the present study is to see the effect of surgery on these old injuries in relation to clinical and radiological parameters. Operative treatment was indicated in the presence of instability and the resulting deformity or pain or, more important, in case of further deterioration (or development) of the neurological status, The patients were followed up for 1-14.4 years (mean 5.5 years), At follow-up, fusion was sound in all but 1 patient and the deformity was improved in 12 cases. As for the clinical evaluation, pain was still present in two patients and the neurological status was improved in all but one patient with complete tetraplegia. Surgical treatment is of value irrespective of time delay to avoid fixed deformities and/or permanent neurological lesions.
Abstract: We present a case of an extradural thoracic spinal angiolipoma in a 27-year-old woman. The epidural tumor was evaluated with computerized tomographic scans and magnetic resonance imaging scans. The tumor was removed, and the clinical symptoms improved remarkably.
