Aims

Hydroxyapatite (HA)-coated collars have been shown to reduce aseptic loosening of massive endoprostheses following primary surgery. Limited information exists about their effectiveness in revision surgery. The aim of this study was to radiologically assess osteointegration to HA-coated collars of cemented massive endoprostheses following revision surgery.

Objectives

We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis.

Introduction

This biomechanics investigation evaluated commercially available studded and bladed football boots to determine whether boot type influences potential non-contact ACL injury when football players sidestep cut.

Background: There is conflicting evidence of correlation between clinical outcome and severity of thoracolumbar spine fractures in neurologically intact patients1. Kalyan et al2 presented the results of their prospective study of thoracolumbar spinal fractures and concluded that the clinical outcome was consistently better predicted by the severity of disc injury than that of the bony fracture. They suggested that if severe disc injury was present, treatment of the disc injury may result in a better short term clinical outcome. The aim of this study was to detail the incidence and type of disc injury in patients with thoracolumbar spinal fractures with intact neurology.

Methods: Retrospective analysis of a prospectively collected spinal injury database at a regional spinal injuries unit. Only patients with a thoracolumbar spinal fracture and intact neurology were included. Retrospective analysis of magnetic resonance imaging (MRI) findings. One hundred and thirty nine neurologically intact patients (89M:50F, mean age 36 years, range 15 – 77yrs) with a thoracolumbar (T11 –L5) spinal fracture were admitted to our spinal unit over the last 11 years (1994 – 2004). Patient data was collected prospectively onto a spinal injuries database. All of these patients had an MRI scan on admission. All types of thoracolumbar fracture were included in this study and the presence or absence of an associated disc injury was recorded retrospectively from the MRI study. The type of disc injury was also recorded.

Results: The incidence of severe disc injury adjacent to a thoracolumbar spinal fracture in our cohort of patients was 43% (60 patients). Disc prolapse or extradural herniation was seen in 16 patients (11%). Intraosseous disc herniation into an adjacent vertebral body was seen in 20 patients (14%). Internal disc disruption was seen in 24 patients (17%). Disc injury was found at more than one level in 21 patients (15%).

Conclusion: The incidence of severe disc injury in our study of neurologically intact patients with a thoracolumbar fracture was considerable (43%). Kalyan et al² suggested that treatment directed at addressing the disc injury in these patients may promote earlier pain relief and also earlier return to pre-morbid activities. If this is the case, then the decision making regarding operative versus non-operative management, in a patient with a thoracolumbar fracture and intact neurology, should be based on the severity of the disc injury as well as the bony injury.

Background: It is very difficult to ascertain how much of the degeneration seen in a post-traumatic spine was due to pre-existing disease and how much was due to the trauma. The aim of the current study was to determine the prevalence of pre-existing disc degeneration on MRI in a region of the spine injured by spinal trauma.

Methods: Prospective whole spine MRI study in 118 patients with spinal trauma. One hundred and eighteen consecutive patients (79M:39F, mean age 36years, range 13 – 90 yrs) admitted to our spinal unit for treatment of their acute spinal trauma were investigated with whole spine magnetic resonance imaging (MRI). Whole spine MRI was already the standard protocol for all patients admitted with spinal trauma to rule out co-existing pathology and multiple spinal fractures¹. Patient data, including age, sex, and mechanism of injury was recorded prospectively onto a spinal injury database. We divided the spine into cervical (C1–C7), thoracic (T1–T12), and lumbosacral (L1–S1) regions. For the purpose of this study we documented the presence or absence of pre-existing degenerative disc disease in all regions of the spine. Of particular interest was any pre-existing degenerative disc disease in the region affected by the spinal trauma. The number of spinal levels affected by pre-existing disc disease within each region was also detailed.

Results: The two most common mechanisms of injury were flexion-compression (68 patients) and flexion-distraction (24 patients). Seventy-one of the patients sustained burst fractures and the vast majority of these were in the thoracolumbar region. Thirty-seven patients (31%) had degenerative disc disease in the same region of the spine that was injured in the spinal trauma. Seven patients had pre-existing cervical degeneration in the presence of cervical spine trauma and thirty had pre-existing lumbosacral degeneration in patients that had lumbosacral trauma. Twenty four patients (20%) had more than one level of degenerative change within the same region as their spinal trauma. Eighteen patients (15%) had degeneration in a different region of the spine to the one that was injured.

Conclusion: Thirty one percent of the patients in our study had pre-existing degenerative disc disease in the same region as their spinal trauma despite the average age of our patients being only 36yrs. This has important medicolegal implications because it means that a large % of patients who sustain spinal trauma have pre-existing degenerative changes which are not the result of their injury.