Background

Wallis implant was developed in 1986 to stiffen unstable operated degenerate lumbar segments while preserving some intervertebral mobility. The long-term results of first-generation Wallis implant from developers were promising. However, documentation pertaining to safety and efficacy of second generation Wallis implant is sparse in literature.

Background: Non-rigid fixation clearly appears to be a useful technique in the management of degenerative intervertebral lumbar disc disease. A mobile, dynamic stabilization restricting segmental motion is possible to be advantageous in various indications, allowing greater physiological function and reducing the inherent disadvantages of rigid instrumentation and fusion.

Aim: This study is a prospective analysis of the early results of second generation Wallis implant for degenerative disc disease.

Methods and Materials: Twenty-five patients with leg and back pain that was not responsive to conservative treatment underwent discectomy and implantation of second generation device. There were 22 one-level and 3 two-level cases. The preoperative radiological work-up included conventional X-rays, computed tomography and magnetic resonance imaging (MRI). All patients underwent neurological examination, assessment of pain on a visual analog scale, and a functional evaluation using the Revised Oswestry disability index before surgery, 3 months after surgery and at follow- up.

Results: A total of 25 patients (13 men, 12 women) with a mean age of 51.9 years (range, 34 to 69 years) were evaluated with a mean follow-up of 1.4 year after the intervention. Mean pain and function scores improved significantly from baseline to follow up as follows: – back pain scale from 7.2 to 2.9, leg pain scale from 6.8 to 2.5 and Oswestry Disability Index from 59.1% to 22.6%. No cases of infection or worsening of neurological deficit occurred. One patient had revision surgery for persistent pain as a result of granulation tissue underneath the implant. No mechanical failure of the implants or loosening was observed and the process retained motion.

Conclusion: Clinical results are satisfactory and compare well with those obtained by conventional procedures in addition to which mobile stabilisation are less invasive then fusion. Wallis neutralisation proves to be a safe and effective in the treatment of unstable lumbar condition.

Aim: To determine the effectiveness of therapeutic lumbar facet joint injections in patients with chronic low back pain.

Methods: Eighty-six patients with refractory chronic low back pain were randomly assigned to receive facet joint injection using local anaesthetic and corticosteroid suspension under fluoroscopic guidance after clinical and radiological assessment. The main parameter for the success or failure of this treatment was the relief of the pain. Pain intensity was assessed with a visual analog scale (VAS) and changes in function and quality of life were assessed by the revised Oswestry Disability Questionnaire (ODQ) at baseline and during follow-up after injection.

Results: Patients reported lasting pain relief, better function, and improved quality of life following injection. Cumulative significant relief following injection was 91.9% up to 1 to 3 months, 81% for 4 to 6 months, 34% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/− 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. No complications were noted following injection.

Conclusion: The results of this study demonstrate that intra-articular facet joint injection appear to have a beneficial medium-term effect in patients with chronic lower back pain and may therefore be a reasonable adjunct to non-operative treatment.

Proximal tibial epiphyseal injuries are rare. Reported incidence varies from 0.5 – 3% of epiphyseal injuries. Proximal tibial epiphysis is well protected unlike distal femoral epiphysis. Thus, the distal femoral injuries are 7 times more frequent than proximal tibial epiphyseal injuries.

Case Report: 12-year old boy, hit a pole at the bottom of a dry ski slope and presented to A& E within 20 minutes. He had a swollen, deformed knee and leg that was immobilised in a temporary splint. He had absent posterior tibial and dorsalis pedis pulses. Emergency manipulation under GA and further stabilised with K-wires, A/K Back Slab in 450 flexion. Distal pulses returned on table. K-wires were removed after 4 weeks and physiotherapy started. At 3 months, he was back to normal activities except sports. At 2 years, he was longer by 1 cm in left tibia, valgus of 120 at the knee, full ROM, no ligament laxity and reports occasional anterior knee pain.

Discussion: Posteriorly displaced proximal tibial Salter Harris II injuries are very rare. Emergency reduction and stabilisation, absence of popliteal artery tear had prevented the immediate complications. The late complications did not warrant a surgical intervention.