Fissures in the anulus fibrosus are common in disc degeneration, and are associated with discogenic pain. We hypothesise that anulus fissures are conducive to the ingrowth of blood vessels and nerves. To investigate the mechanical and chemical micro-environment of anulus fissures.Background
Purpose
The incidence of degenerative scoliosis in the lumbar spine is not known. In the ageing population deformity may coexist or cause stenosis. MRI gives limited information on this important parameter in the treatment of stenosis. The aim of this study was to highlight the incidence of coronal abnormalities of the lumbar spine dependent on age in a large population of patients. We reviewed all abdominal radiographs performed in our hospital over ten months. 2276 radiographs were analysed for degenerative lumbar scoliosis and lateral vertebral slips in patients who are over 20 years. Evidence of osteoarthritis of the spine was also documented. Radiographs were included if the inferior border of T12 to the superior border of S1 was visualised and no previous spinal surgery was evident (metal work). 2233 (98%) radiographs were included. 48% of patients were female. The incidence of degenerative lumbar scoliosis, lateral listhesis and osteoarthritis increased with age. Degenerative scoliosis was present in 1.6% of 30–39 year olds increasing every decade to 29.7% of patients 90 years or older. In all age groups curves were more frequent and had greater average Cobb angles in female patients. Degenerative lumbar scoliosis starts to appear in the third decade of life increasing in frequency every decade thereafter, affecting almost a third of patients in the ninth decade. It is more common in female patients and has a greater magnitude. Deformity may be even greater on standing views and is important to recognise in all patients that are undergoing lumbar spinal decompressive surgery. A failure to do so may lead to inferior results or the need for further surgery.
67% of open subluxations occurred at L3/4. In closed subluxations the most frequent level involved was LI/2 (53% of cases). Open dislocations are located closest to the apex of the curve, with closed dislocations being more peripheral. The curve was noted to rotate towards the apex.
56% of open subluxations occurred at L3/4. In closed subluxations the most frequent level involved was LI/2 (36% of cases). Where both subluxations coexisted, the open subluxation was more proximal.
Pedicle screw fixation has become the norm for the surgical correction of adolescent idiopathic scoliosis (AIS), with much biomechanical research into different types of rod screw constructs. The senior authors have experience using a monoaxial screw only construct in the correction of AIS since 2003 and the polyaxial screw only construct since 2005. We retrospectively reviewed our experience in the first ten patients with AIS using the polyaxial system and compared this against 18 patients who had been corrected using the monoaxial system. Table I shows our results, expressed as mean and ranges or means ± SD for the main thoracic and lumbar curves. Our early results show that the polyaxial system produces similar correction of both the thoracic and lumbar curves as compared to the monoaxial system in the immediate post-operative period. Though the absolute values for the lumbar curves differ between the two groups the percentage correction shows no statistical difference.
The Copeland Shoulder Arthroplasty is a cementless, pegged humeral head surface replacement. The design is based on the principle of minimal bone resection and has been in clinical use since 1986. The only published series to date, that of Levy and Copeland, reported results for 103 patients which were comparable to those obtained with stemmed implants. We report the outcome at our institution using the same prosthesis with a hydroxyapatite coating. 81 shoulders (74 patients) underwent resurfacing hemiarthroplasty through an anterior deltopectoral approach. Preoperative diagnoses were: osteoarthritis (39), rheumatoid arthritis (29), rotator cuff arthropathy (1), post-traumatic arthrosis (2). They were followed for an average 28 months. 10 were lost to follow-up (8 deaths). Constant scores improved from a mean preoperative figure of 15.7 to 54.0 (p<
0.01) at last follow-up. For rheumatoid arthritis and osteoarthritis the scores improved from 15.2 to 50.4 (p<
0.01) and 16.0 to 55.4 (p,<
0.01) respectively. There was a 13% complication rate with one case requiring revision for loosening to a stemmed implant. Most were cases requiring subsequent acromioplasty. In one case the glenoid rim was fractured during head dislocation. There was a low rate of perioprosthetic radiolucency (4.2%) which may relate to the hydroxyappatite coating within the shell of the prosthesis. Ipsilateral stemmed elbow replacement was performed in some cases without a double stress riser effect. Periprosthetic humeral neck fracture as managed non-operatively with uneventful union.
The purpose of this study was to look at the results of using the Copeland surface replacement in the treatment of arthritis of the shoulder. We report the results of 61 Type 3 Copeland surface replacements in 57 patients. Operations were performed in 33 cases of Rheumatoid Arthritis, 27 cases of Osteoarthritis and 1 case of posttraumatic arthritis. Hemiar-throplasty was performed via a Deltopectoral approach by the senior author in all cases. There were 38 females and 19 males with a minimum follow up of 1 year and a mean follow up of 26 months (range 12–65). Patients were scored pre and post operatively using the Constant score. Average pre-op score was 15.6 and post-operatively was 52.5. There was one case of loosening ( ? secondary to infection) requiring revision to a stemmed implant. Two patients required Sub-Acromial decompression for postoperative impingement. All patients considered their shoulder improved following this procedure. There was no evidence of radiolucency in any postoperative radiograph. Cementless surface replacement arthroplasty in our series show similar results to previously reported series of stemmed implants and to the published results available for this implant.
The purpose of this study was to identify aetiological factors that may determine prognosis in ulnar nerve lesions at the elbow and to evaluate the role of non-operative treatment. One hundred and thirty consecutive patients (92 male) with 152 electrophysiologically proven (by nerve conduction and electromyography) ulnar nerve lesions at the elbow were identified from the departmental records. Patient details, symptoms, known aetiology and treatment profile were recorded. Each patient was then contacted by telephone and / or questionnaire between one and six years after electrodiagnosis to determine clinical progress and outcome. In patients with sensory symptoms alone or non-progressive painless motor symptoms, non-operative treatment was commenced. This involved advice on activity modification and protection with a tubipad bandage or night splint with continued clinical and electrophysiological surveillance. Sixty-one percent of lesions were idiopathic with no clinical aetiological factor. Defined causes included deformity and/or synovitis from arthritis of the elbow (11.2%), injudicious intra-operative pressure (9.2%), injury/trauma (8.5%) repeated pressure (4.1%), medial epicondylitis (2.9%) and benign space occupying lesions (2.9%). Twenty-two patients had expected bilateral lesions whereas 15 had contralateral lesions that were not symptomatic. Eighty-three percent of patients received non-operative first line treatment. Twenty-one percent of these required operative intervention (simple decompression) following further clinical and electrophysiological assessment. Partial or complete recovery occurred in 88%, 80%, 67% and 52% of the arthritis, intra-operative, idiopathic and injury cases respectively (P<
0.05). We conclude lesions of the ulnar nerve at the elbow predominate in males and the majority can be treated non-operatively providing clinical and electrophysiological monitoring is possible. Bilaterality is not uncommon and should be excluded. Lesions due to injury have a worse prognosis than those caused by arthritis of the elbow, direct continuous or repeated pressure or where no aetiological factor exists.