Purpose: The aim of this study is to analyze objectively pathoanatomical changes of clubfoot treated with Ponseti method. Introduction: In the treatment of clubfoot, regardless of the grade and severity of the disease, first conservative treatment and serial casting should be chosen. The follow up period for surgery performed group ranges usually from 2 to 8 years (not longer than 10–15 years). Thirty years results of Ponseti’s idiopathic clubfoot treatment is with 78% success. In some recent series 95% success rate was reported. Standard conservative treatment (Kite’s) success rates are only 11% to 58% for idiopathic group. Material and Methods: Seventy patients, 115 feet (45 Bilateral, F/M 15/55) were included in the study. 28 of these patients were
Purpose and background. To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with
Purpose: Claudication is a common complaint of elderly patients. Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are the two main etiologies, producing
Introduction: Patients with cerebral palsy or other neurological diseases have a high incidence of foot deformities, limiting the mobility and quality of life for these patients. We analyzed the results of surgical correction and determined the optimal treatment for the main deformities. Material and Methods: We analysed retrospectively the results of surgical correction of foot deformities. 87 Patients were treated between 1995 and 2003. We have actual data from 51 Patients (59%) with 68 feet treated. Mean follow up time is 4,25 years. We had 23 Patients with
Purpose: Few studies have been devoted to
Hypothesis: For Neer, humeral head ascension is caused by anterior impingement. The anatomic or ischemic factors favoring anterior impingement are well known, but have not been shown to have a determining effect. Our work on the comparative action of the rotator cuff muscles to lower the humeral head (1992), led to the conclusion that the infraspinatus muscle plays a highly dominant role. The frequent association of anterior impingement and a history of cervical pain might suggest that
The
We carried out the Bernese periacetabular osteotomy for the treatment of 13 dysplastic hips in 11 skeletally mature patients with an underlying neurological diagnosis. Seven hips had flaccid paralysis and six were spastic. The mean age at the time of surgery was 23 years and the mean length of follow-up was 6.4 years. Preoperatively, 11 hips had pain and two had progressive subluxation. Before operation the mean Tönnis angle was 33°, the mean centre-edge angle was −10°, and the mean extrusion index was 53%. Postoperatively, they were 8°, 25° and 15%, respectively. Pain was eliminated in 7 patients and reduced in four in those who had preoperative pain. One patient developed pain secondary to anterior impingement from excessive retroversion of the acetabulum. Four required a varus proximal femoral osteotomy at the time of the pelvic procedure and one a late varus proximal femoral osteotomy for progressive subluxation. Before operation no patient had arthritis. At the most recent follow-up one had early arthritis of the hip (Tönnis grade I) and one had advanced arthritis (Tönnis grade III). Our results suggest that the Bernese periacetabular osteotomy can be used successfully to treat
Purpose: Lumbar spinal stenosis is the most common indication for spine surgery in the elderly. XStop IPD is an attractive alternative to traditional laminectomy or laminectomy with fusion as it avoids a longer procedure and anaesthesia with significantly less blood loss. The purpose of this study is to prospectively evaluate clinical outcomes, complications and functional evaluation of symptom severity, physical function and patient satisfaction following XStop IPD procedure. Method: Preoperative and postoperative clinical data as well as SF 36, visual analog scale and Roland Morris questionnaire data collected on 16 consecutive patients over 60 years undergoing XStop IPD at L3-4 and L4-5 levels or both levels. All patients had symptomatic lumbar spine stenosis with intermittent
Purpose of the study: The rate of intra and postoperative complications is generally high after surgery for
Introduction: Lumbar spinal stenosis (LSS) is a condition involving the narrowing of either the spinal canal or neural foramina and may lead to intermittent
Purpose. To observe the safety and efficacy of a minimally destructive decompressive technique without fusion in patients with lumbar stenosis secondary to degenerative spondylolisthesis. Methods. 30 patients with degenerative spondylolisthesis (DS) were consecutively managed by a single consultant spinal surgeon. All patients presented with
We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD). We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m. 2. Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative leg-length discrepancy (LLD) was −16.3 mm (−50 to 2). At a mean time of 81 months of follow-up, survival rate was 97% taking revision of the stem for any reason and 100% for aseptic loosening as endpoints. No additional femoral osteotomy was required in any case. Average surgical time was 66 minutes (45 to 100). There was a significant improvement in the mHHS score when comparing preoperative and postoperative values (47.3±10.6 vs. 92.3±3.7, p=0.0001). Postoperative LLD was in average 1 mm (−9 to 18) (p=0.0001). According to Engh's criteria, all stems were classified as stable without signs of loosening. Postoperative complications included 1 pulmonary embolism, 1
In spite of preventive treatment, particularly in young paraplegics with transverse lesions above T9, a high rate of
In this paper we propose a new classification
of
Perioperative pain involves both
Objective: The purpose of this study was to determine the safety and efficacy and evaluate several radiographic parameters after implantation of coflex™ for the primary diagnosis of spinal stenosis (1 or 2 levels) in patients with
Background.
Simultaneous bilateral total hip arthroplasties (THAs) present unique and unwarranted dangers to the patient and surgeon alike. These include a significantly increased risk of blood transfusion (up to 50% in contemporary series even with the use of tranexamic acid), longer operative times, longer length of stays, and higher mortality rates in patients with minimal risk factors (age > 75 years, rheumatoid arthritis, higher ASA class, and/or male sex). This is even in light of the fact that the vast majority of literature has a substantial selection bias in which only the healthiest, youngest, non-obese, and most motivated patients are included. Traditionally, simultaneous bilateral THAs were completed in the lateral decubitus position. This required the surgeon and surgical team to reposition the patient onto a fresh wound, as well as additional prepping and draping. To mitigate these additional limitations of simultaneous bilateral THAs, there has been a recent trend towards utilizing the direct anterior approach. However, this particular approach presents its own unique set of complications such as an increased risk of periprosthetic femoral fracture and early femoral failure, an increased risk of impaired wound healing (particularly in obese patients), potential injury to the lateral femoral cutaneous nerve with subsequent
Heterotopic ossification (HO) is perhaps the
single most significant obstacle to independence, functional mobility, and
return to duty for combat-injured veterans of Operation Enduring
Freedom and Operation Iraqi Freedom. Recent research into the cause(s)
of HO has been driven by a markedly higher prevalence seen in these
wounded warriors than encountered in previous wars or following
civilian trauma. To that end, research in both civilian and military
laboratories continues to shed light onto the complex mechanisms
behind HO formation, including systemic and wound specific factors,
cell lineage, and
Patients with
Radiological diagnosis is not the only tool in detection, monitoring of progress and making easy to undertake a decision about the surgical scoliosis correction. The below presented algorithm of scoliosis monitoring with complex and repetitive (comparative) neurophysiological examinations facilitates the doctor’s decision about method of the conservative treatment or just the moment of surgical intervention [3, 14].
In talipes equino-varus the diminished bulk of the calf muscle suggests a neuromuscular defect. Accordingly, biopsies were taken from the postero-medial and peroneal muscle groups, and occasionally from abductor hallucis, in sixty patients mostly under the age of five years; 111 were studied histochemically and histologically, and a further fifty-three by electron-microscopy. Histochemical anomalies were revealed in ninety-two specimens; the muscle fibres in the other nineteen varied in size but were abnormal at the ultramicroscopic level, as were all specimens examined with the electron microscope. Evidence of
Introduction &
Aims: The X-stop interspinous process decompression system is being used as an alternative to laminectomy in the treatment of
Objectives.
Surgery for spondylolisthesis is controversial. It is debatable whether a spondylolisthesis should be fused in situ or reduced and fused in the corrected position. In an attempt to address this issue 68 patients who had undergone surgery between 2000 and 2005 for back and leg pain related to a spondylolisthesis with associated spinal stenosis were retrospectively reviewed. The average age was 53 years. There were 24 male and 44 female patients. A degenerative spondylolisthesis was present in 38 patients while 30 had an isthmic spondylolisthesis. All patients presented with
There are increasing opportunity of operative treatment for advanced aged patients with degenerative spinal disease aiming for better quality of life. We have studied such patients concerning operative result, complication and problem in pre- and peri- operative management, and achievement of their aims. Patients and Results: 1) 26 patients were analyzed; 16 males and 10 females, av. aged 82.3, pts of 19 lumbar canal stenosis with marked intermittent claudication and 7 disc herniation. 2) Low back pain and
Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient’s prognosis. Categories of CES attempt to group patients for management and prognostication purposes. We aimed in this study to assess the inter-rater reliability of dividing patients with CES into categories to assess whether they can be reliably applied in clinical practice and in research. A literature review was undertaken to identify published descriptions of categories of CES. A total of 100 real anonymized clinical vignettes of patients diagnosed with CES from the Understanding Cauda Equina Syndrome (UCES) study were reviewed by consultant spinal surgeons, neurosurgical registrars, and medical students. All were provided with published category definitions and asked to decide whether each patient had ‘suspected CES’; ‘early CES’; ‘incomplete CES’; or ‘CES with urinary retention’. Inter-rater agreement was assessed for all categories, for all raters, and for each group of raters using Fleiss’s kappa.Aims
Methods
This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. However, with an ever-advancing technology and deeper understanding of the damaged spinal cord, this appears increasingly conceivable. A brief synopsis of the most prominent challenges facing both clinicians and research scientists in developing functional treatments for a progressively complex injury are presented. Moreover, the multiple mechanisms by which damage propagates many months after the original injury requires a multifaceted approach to ameliorate the human spinal cord. We discuss potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair. Although acute and chronic SCI share common final pathways resulting in cell death and neurological deficits, the underlying putative mechanisms of chronic SCI and the treatments are not covered in this review.
Tumours of the sacrum are difficult to manage. The sacrum provides the structural connection between the torso and lower half of the body and is subject to both axial and rotational forces. Thus, tumours or their treatment can compromise the stability of the spinopelvic junction. Additionally, nerves responsible for lower limb motor groups as well as bowel, bladder, and sexual function traverse or abut the sacrum. Preservation or sacrifice of these nerves in the treatment of sacral tumours has profound implications on the function and quality of life of the patient. This annotation will discuss current treatment protocols for sacral tumours. Cite this article:
Introduction: The existence of peripheral blood (PB) derived mesenchymal stem cells (PB-MSCs) have been documented in different mammalian species including young and adult human. However, the number of PB-MSCs is low in normal adult human blood. We have demonstrated previously that there was an increase in the number of PB-MSCs following long bone fracture and in the patients suffering from fracture non-union. The present study was to compare the biological characteristics of the PB-MSCs from fracture non-union patients, with human bone marrow derived MSCs (BM-MSCs). Methods: 200 mls PB was collected from 9 patients suffering from fracture non-union. The mononuclear cells (MNCs) were isolated by density gradients centrifugation and cultured in á-MEM containing 15% FBS. The PB-MNCs from normal donors (n=8) and BM-MSCs from patients underwent total hip replacement were used as controls. The colony forming efficiency (CFE) of the PB-MSCs was calculated, and the phenotypes of PB-MSCs and BM-MSCs were compared using immunocytochemistry and flow cytometry methods. Their multipotent differentiation potentials into osteoblasts, chondrocytes, adipocytes,
Nerve growth factor (NGF) is involved in several joint diseases. It participates in pain initiation, inadequate nociception and
Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs. A PROSPERO-registered systematic literature review was performed following PRISMA guidelines. All relevant studies published until January 2023 were identified. Individual outcomes and outcome measurement tools were extracted verbatim. The measurement tools were assessed for reliability and validity, and all outcomes were grouped according to the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT) filters.Aims
Methods
Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age. Patients aged ≥ 18 years with a traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and data about injury, management, and outcome were collected. Statistical analysis was performed to assess mortality and between-group differences.Aims
Methods
Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents. Cite this article:
The August 2023 Spine Roundup360 looks at: Changes in paraspinal muscles correspond to the severity of degeneration in patients with lumbar stenosis; Steroid injections are not effective in the prevention of surgery for degenerative cervical myelopathy; A higher screw density is associated with fewer mechanical complications after surgery for adult spinal deformity; Methylprednisolone following minimally invasive lumbar decompression: a large prospective single-institution study; Occupancy rate of pedicle screw below 80% is a risk factor for upper instrumented vertebral fracture following adult spinal deformity surgery; Deterioration after surgery for degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network.
Study design. Prospective randomized study. Objective. Primary aim of this study was to compare clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) with posterolateral (interlaminar) instrumented lumbar fusion (PLF) in adult low grade (Meyerding 1 & 2) spondylolisthesis patients. Background data. Theoretically, TLIF has better radiological result than PLF in spondylolisthesis in most of the studies. Method. 24 patients of low grade adult spondylolisthesis were randomly allocated to one of the two groups: group 1- PLF and group 2-TLIF. Study period was between August 2010 to March 2013. All patients were operated by a single surgeon (CN). Posterior decompression was performed in all patients. Average follow up period was 18.4 months. Quality of life was accessed with Visual analogue scale and Oswestry Low Back Pain Disability Index. Fusion was assessed radiologically by CT scan and X-ray. Result. Though fusion was significantly better in TLIF group, clinical outcome including relief of back pain and
The August 2023 Wrist & Hand Roundup360 looks at: Complications and patient-reported outcomes after trapeziectomy with a Weilby sling: a cohort study; Swelling, stiffness, and dysfunction following proximal interphalangeal joint sprains; Utility of preoperative MRI for assessing proximal fragment vascularity in scaphoid nonunion; Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review; The position of the median nerve in relation to the palmaris longus tendon at the wrist: a study of 784 MR images; Basal fractures of the ulnar styloid? A randomized controlled trial; Proximal row carpectomy versus four-corner arthrodesis in SLAC and SNAC wrist; Managing cold intolerance after hand injury: a systematic review.
The diagnostic sub-categorization of cauda equina syndrome (CES) is used to aid communication between doctors and other healthcare professionals. It is also used to determine the need for, and urgency of, MRI and surgery in these patients. A recent paper by Hoeritzauer et al (2023) in this journal examined the interobserver reliability of the widely accepted subcategories in 100 patients with cauda equina syndrome. They found that there is no useful interobserver agreement for the subcategories, even for experienced spinal surgeons. This observation is supported by the largest prospective study of the treatment of cauda equina syndrome in the UK by Woodfield et al (2023). If the accepted subcategories are unreliable, they cannot be used in the way that they are currently, and they should be revised or abandoned. This paper presents a reassessment of the diagnostic and prognostic subcategories of cauda equina syndrome in the light of this evidence, with a suggested cure based on a more inclusive synthesis of symptoms, signs, bladder ultrasound scan results, and pre-intervention urinary catheterization. Cite this article:
Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes.Aims
Methods
To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre’s MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).Aims
Methods
The aim of this meta-analysis was to determine the pooled incidence of postoperative urinary retention (POUR) following total hip and knee arthroplasty (total joint replacement (TJR)) and to evaluate the risk factors and complications associated with POUR. Two authors conducted searches in PubMed, Embase, Web of Science, and Scopus on TJR and urinary retention. Eligible studies that reported the rate of POUR and associated risk factors for patients undergoing TJR were included in the analysis. Patient demographic details, medical comorbidities, and postoperative outcomes and complications were separately analyzed. The effect estimates for continuous and categorical data were reported as standardized mean differences (SMDs) and odds ratios (ORs) with 95% CIs, respectively.Aims
Methods
Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires. Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires.Aims
Methods
A three-month-old girl presented with a massive abdominal tumour arising from the right lumbar region. Microscopic examination of a biopsy specimen showed a typical neuroblastoma. No treatment was given except that necessary symptomatically for paralysis caused by compression of the cauda equina. Spontaneous regression was accompanied by maturation to a small ganglioneuroma, found at necropsy examination at the age of ten years. Death was from urinary infection due to a persistent
The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of medical comorbidities that increase the risk for severe intraoperative or postoperative complications. A multidisciplinary approach is mandatory at every stage to ensure that all nonoperative measures have been applied, and that the treatment goals have been clearly defined and agreed with the family. This will involve input from multiple specialities, including allied healthcare professionals, such as physiotherapists and wheelchair services. Surgery should be considered when there is significant impact on the patients’ quality of life, which is usually due to poor sitting balance, back or costo-pelvic pain, respiratory complications, or problems with self-care and feeding. Meticulous preoperative assessment is required, along with careful consideration of the nature of the deformity and the problems that it is causing. Surgery can achieve good curve correction and results in high levels of satisfaction from the patients and their caregivers. Modern modular posterior instrumentation systems allow an effective deformity correction. However, the risks of surgery remain high, and involvement of the family at all stages of decision-making is required in order to balance the risks and anticipated gains of the procedure, and to select those patients who can mostly benefit from spinal correction.
Introduction: We carried out a revision of Necrotizing Fasciitis diagnosed in our Hospital from January 2000 to July 2008. Necrotizing Fasciitis is an infection of soft tissues, caused in most of cases by Streptococcus pyogenes. It is a dangerous infection, because it progresses quickly, and it can lead to death due to systemic toxicity. Materials and Methods: The study includes 18 patients afected by Necrotizing fasciitis treated in our Hospital from January 2000 until July 2008. In order to identify risk factors and clinical emergency signs, clinical detailed information was obtained for each patient. Results: In 70% of the cases, Streptococcus pyogenes was found as the main germ involved in Necrotizing Fasciitis. In inicial stages, the patients complained of pain, heat, swelling, reddening and crepitation of the affected subcutaneous tissues. In advanced stages, patients went in a state of
To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele. We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire.Aims
Methods
Aim. To evaluate morbidity and outcome associated with lumbar spine decompression for central spinal stenosis in the elderly compared with younger age groups. Patients & methods. Case notes review of patients with symptomatic and MRI proven central lumber canal stenosis, under the care of a single surgeon. The study population was 3 age groups: patients < 60 year of age (Group 1, n=21), patients between 60 and 79 years (Group 2, n=54), and > age of 80 years (Group 3, n=15). Data with regard to intra- and post-operative complications and subjective outcome variables were collected. These included pain (VAS), walking distance, Oswestry Disability score (ODI) and patient satisfaction scores. Results. There was a statistically significant improvement in VAS score for leg pain (p<0.05) and back pain (p<0.05) after surgery for each group. All three groups reported improvement in their walking distance. The average walking distance improved by factor 5 in groups 1 and 2 and by factor 2.5 in group 3 (p< 0.05). However the improvement in group 3 was not statistically significant. There was a statistically significant improvement in ODI for all three groups (mean ODI improvement in Group 1, 16 points, Group 2, 23 points and Group 3, 15 points). Overall 96% of patients were satisfied and would consider the same treatment again under similar circumstances. The overall complication was 19% in group 1, 18% in group 2, and 33% in group 3. Conclusions. Surgery for
1. A controlled trial of ninety-nine patients with myelomeningocele has shown that immediate closure did not result in any significant (at P<0.05) reduction in mortality or alteration in muscle power. 2. If required, closure of the back may be delayed for forty-eight hours after birth or longer to allow a detailed clinical assessment of the infant. 3. The muscle power in the lower limbs is a useful guide to prognosis both in relation to mortality and the incidence of hydrocephalus. 4. Mortality is greatest in the first year of life. 5. In the urinary tract the commonest anomaly is
Our purpose was to study the functional outcome and electrophysiologically to assess the axially nerve function in patients who have undergone surgery using a deltoid-splitting approach to treat complex proximal humeral fractures. This was a prospective observational study and was carried out in the Shoulder injury clinic at a university teaching hospital. Over a one-year period we treated fourteen locally-resident patients (median age 59 years) who presented with a three- or four-part proximal humeral fracture. All patients were treated using the extended deltoid-splitting approach, with open reduction, bone grafting and plate osteosynthesis. All patients were prospectively reviewed and underwent functional testing using the DASH, Constant and SF-36 scores as well as spring balance testing of deltoid power, and dynamic muscle function testing. At one year after surgery, all patients underwent EMG and nerve latency studies to assess axillary nerve function. Thirteen of the fourteen patients united their fractures without complications, and had DASH and Constant score that were good, with comparatively minor residual deficits on assessment of muscle power. Of these thirteen patients, only one had evidence of slight
Persistent post-surgical pain (PPSP) remains a problem after knee replacement with some studies reporting up to 20% incidence. At its most basic level, pain can be divided into two categories, mechanical and non-mechanical. Mechanical pain is like the pain of a fresh fracture. If the patient does not move, the pain is less. This type of pain is relieved by opiates. Mechanical pain is seen following knee replacement, but is fortunately becoming less frequent. It is caused by a combination of malrotations and maltranslations, often minor, which on their own would not produce problems. The combination of them, however, may produce a knee in which there is overload of the extensor mechanism or of the medial stabilizing structures. If these minor mechanical problems can be identified, then corrective surgery will help. Non-mechanical pain is present on a constant basis. It is not significantly worsened by activities. Opiates may make the patient feel better, but they do not change the essential nature of the pain. Non-mechanical pain falls into three broad groups, infection, neuropathic and perceived pain. Infection pain is usually relieved by opiates. Since some of this pain is probably due to pressure, its inclusion in the non-mechanical pain group is questionable, but it is better left there so that the surgeon always considers it. Low grade chronic infection can be extremely difficult to diagnose. Loosening of noncemented knee components is so rare that when it is noted radiologically, infection should be very high on the list of suspicions. The name
Purpose: Isolated paralysis of the great toe long extensor is a rare complication of leg fractures. In certain patients, an erroneous diagnosis of compartment syndrome or muscle incarceration may be made. Material and methods: We dissected ten fresh cadavers. Results: The great toe long extensor was innervated by a branch of the deep fibular nerve which arose 15 cm from the talocrural joint space and directly in contact with the periosteum of the tibial shaft. In this localisation, the branch can be directly sectioned during trauma, reduction, or reaming. Discussion: We had one patient aged 30 years with a fracture of the mid third of the leg who was treated by centromedullar nailing. Postoperatively, this patient developed isolated paralysis of the great toe long extensor. The isolated
Segmental spinal reflexes (stretch reflexes) were studied in patients with scoliosis. The proprioceptive responses to the phasic stretch of the paraspinal muscles were asymmetric in all patients, and were increased on the convex side. The asymmetry was more pronounced when the patients were standing. The observed asymmetry of the reflex responses was taken to indicate asymmetry in the tone and postural activity of the superficial layer of the paraspinal muscles. A reciprocal relationship was found in the segmental reflex organisation between the superficial and deep layers of the paraspinal muscles. The increase in reflex response of the superficial muscles on the convex side can be due to diminished reciprocal inhibition from weak, deep muscles. Thus a segmental
Introduction: The term dorsal bunion describes a condition characterised by a swelling in the region of the 1st MTPJ with an elevated first metatarsal and a flexed toe. The literature available concentrates on the forefoot aetiology- no author has yet documented the role of the hindfoot in its pathogenesis. Methods: We have conducted a review of 28 consecutive patients, excluding those with hallux rigidus collected prospectively in the course of a full-time foot and ankle practice between 1996 and 2005. All of the patients have been examined with respect to their primary pathology leading to the dorsal bunion and had the mobility and position of the hindfoot assessed. Results: In the series of 28 patients, the average age was 31.6 and there were 18 male and 10 females. Every patient examined had either a rigid hindfoot or stiffness contributing to a failure to correct for abnormal forefoot position. Conclusion: The causes of dorsal bunion may be considered to be Primary (Hallux Rigidus) or Secondary (CTEV,
Introduction: The purpose of the study was to evaluate the outcome of multiple spinal operations by an expert spinal surgeon HV Crock. Materials and Methods: A retrospective review of 169 patients who had multiple spinal surgery including spinal Fusion and spinal decompression was undertaken. A special Questionnaire form was designed and sent to each patient to answer with an appointment for the patient to be seen and assessed in the spinal assessment clinic where data from the questionnaire, clinical notes and thorough clinical examinations were recorded in a spinal data base which covered the following sections:. Patients Symptoms. Treatment received. Spinal Operations. Body Diagram for shading the site of pain. Final outcome. Patient Satisfaction. Results:. – 76 patients 66% of the patients who replied “were satisfied” with the surgery. – 38 patients 33% of the patients who replied were not satisfied. – 58 patients did not reply as they were not interviewed. There were no significant post-operative
Aim: Lumbar spinal stenosis is a common disease in spine surgery, especially for older patients. Internal laminoplasty technique is minimal invasive and can offer relieve from symptoms and early recovery to the patient. This method is our choice for surgical treatment in lateral spinal stenosis. Material and Method: From 1996–2002, 48 patients (28 male-28 female) operated for lumbar spinal stenosis (central or lateral).Eighteen(18) of them in level L3-L4, twenty two(22) in level L4-L5 and eight(8) in level L5-S1 with mane age of 62 years. Their clinical condition was
Aims: 1 To assess the histological changes in patients with Achilles tendinopathy. 2 To map the distribution of nerves and nerve endings within the Achilles tendon. Methods: Tendon biopsy specimens were taken from patients with spontaneous (ie previously painless) Achilles rupture patients and chronic painful tendinopathy patients. ‘Normal’ cadaveric /lacerated tendon biopsies were used for comparison. Sections were stained with H&
E for basic histology. Immunolocalisation of nerve tissue was performed with 2 anti-neurofilament antibodies. Non-specific immunoglobulin was used as a negative control. Results: The number of nerves and nerve endings found within the normal tendons and both groups of degenerate tendons was very low. Only 30% of the normal tendon sections showed any positive staining at all. Compared to 36% of ruptured tendon and 43% of the painful tendinopathy sections. Conclusions: Tendon rupture and chronic painful tendinopathy biopsies ALL show widespread degenerative changes. There is a paucity of nerve tissue within these tendons, which may have implications for the
Aim: To evaluate morbidity and outcome associated with lumbar spine decompression for central spinal stenosis in the elderly compared with younger age groups. Patients &
Methods: Case notes review of patients with symptomatic and MRI proven central lumber canal stenosis, under the care of a single surgeon. The study population was 3 age groups: patients <
60 year of age (Group 1, n=19), patients between 61 and 79 years(Group 2, n=54), and >
age of 80 years (Group 3, n=15). The number of levels decompressed &
grade of surgeon were noted. Outcome data: Length of operation &
hospital stay, blood loss, and intra and post operative complications. Subjective variables: Pain (VAS), walking distance, Oswestry Disability score (ODI) and patient satisfaction scores. Results: The duration of operation (p<
0.05), and intra-operative complication rate (p<
0.025) was dependent on the seniority of the surgeon. There was a statistically significant improvement in VAS score for leg pain (p<
0.05) and back pain (p<
0.05) after surgery for each group. The average walking distance improved by factor 5 in group 1 and 2 and by factor 2.5 in group 3 (p<
0.05). Conclusions: Surgery for
Purpose: Despite advances in surgical technique, neurological injury remains a potentially devastating complication of spinal deformity correction surgery. The purpose of the study is to describe surgical and patient factors associated with “electrophysiologic (EP) events” and
Curative treatment of malignancies in the sacrum and lower lumbar spine frequently requires en bloc spinopelvic resection. There is no standard classification of these procedures. We present outcomes and a classification scheme with oncologic and reconstructive guidelines for spinopelvic tumors based on an analysis of 30 cases of en bloc resection and reconstruction performed with curative intent. Mean follow-up of surviving patients was 38 months. Tumors included osteosarcoma (n=9), chondrosarcoma (n=6), chordoma (n=5), other sarcomas (n=5),
Purpose of the study: Although the iliac autograft is the gold standard for single-level intervertebral fusion, complications and morbidity related to autologous graft harvesting from the iliac crest remain a point of concern. Bone morphogenic protein (BMP) has proven advantages for fusion of the intersomatic and posterolateral graft. This study compared the efficacy and tolerance of OP-1 compared with an autologous graft in patients with symptomatic spondylolisthesis. This study reports the preliminary results of a prospective randomised controlled trial comparing OP-1 with an iliac autologous graft for instrumented single-level posterolateral fusion for arthrodesis of grade 1 spondylolisthesis. Material and methods: Lamino-arthrectomy associated with a posteriolateral instrumented arthrodesis with an iliac autologous graft or a mixture of OP-1 and local autologous graft material was performed in 27 patients with spondylolisthesis leading to lumboradiculalgia or
Introduction Symptoms of
Over 5 years we gave 84 patients epidural cortisone (80 mg depomedrol and local anaesthesia) for back and/or leg pain due to degenerative disease of the spine. The mean age of the 35 men and 49 women was 65.2 years (37 to 86). All patients had back pain and 77% had
We performed positron emission tomography (PET) with . 18. fluorine-fluoro-2-deoxy-D-glucose (FDG) on 55 patients with tumours involving the musculoskeletal system in order to evaluate its role in operative planning. The standardised uptake value (SUV) of FDG was calculated and, to distinguish malignancies from benign lesions, the cases were divided into high (≥ 1.9) and low (<
1.9) SUV groups. The sensitivity of PET for correctly diagnosing malignancy was 100% with a specificity of 76.9% and an overall accuracy of 83.0%. The mean SUV for metastatic lesions was twice that for primary sarcomas (p <
0.0015). Our results suggest that the SUV may be useful in differentiating malignant tumours from benign lesions. However, some of the latter, such as schwannomas, had high SUVs so that biopsy or wide resection was selected as the first operation. Thus, some other quantitative analysis may be required for preoperative planning in cases of high-SUV
INTRODUCTION: Chronic back ache is a common disorder which rarely indicates surgery. There are accepted indications for surgical intervention; namely that of
Objective: To determine if there was any difference in standard spine outcome measures for single level degenerative lumbar spondylolisthesis treated by decompression and intertransverse fusion alone or with pedicle screw instrumentation. Methods: A prospective longitudinal cohort study was undertaken looking at 23 patients undergoing surgery for L4/5 degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome was assessed through specific outcome measures of walking distance(yards), Oswestry disability index (ODI), Back Functional Assessment (BFA) and Visual analogue score for pain(VAS). Results: Follow up was achieved in 21 patients (91%) and the mean length of follow up was 29 months (range 12–60 months). The mean age at operation was 66 years. In the uninstrumented group (n=12), the mean pre and post operative outcome scores were: walking distance (pre-122, post-950), ODI (pre-45, post-29), BFA (pre-23, post-31) and VAS (pre-83, post 49). In the instrumented group (n=11), the mean pre- and post operative outcome scores were: walking distance (pre-143, post-763), ODI (pre-54, post-33), BFA (pre-14, post 33) and VAS (pre-77, post-49). There was no statistically significant difference in improvement in each outcome measure between the two groups. Conclusion: Surgical decompression in degenerative spondylolisthesis aims to relieve symptoms of radicular pain and
We performed electrophysiological studies on both legs of 52 children, aged from 3 months to 15 years, with idiopathic club foot. In only nine (17%) was no abnormality found. Isolated peroneal nerve damage was seen in 14 (27%). Abnormality of both peroneal and posterior tibial nerves was found in five (10%). Four patients (8%) had evidence of isolated spinal-cord dysfunction, whereas combined spinal-cord and peripheral-nerve lesions were seen in 14 (27%). Six patients (11%) had variable
Introduction: It is likely that the incidence of spinal stenosis will increase with ageing populations. The outcome after surgery in central spinal stenosis has been satisfying in quite many studies. The appropriateness of the indications for surgery has been found to be only around 60% however. Recently we reported that the degree of cauda equina constriction at the most constricted level in the lumbar spine directly was related to typical preoperative symptoms like walking distance, radiating pain but also quality of life. The aim of this study was to relate the degree of preoperative constriction to the results one year postoperatively. MATERIAL AND Methods: 35 men and 47 women, mean age 64 years with preoperative imaging of the lumbar spine, completed preoperative questionnaires and operated for central stenosis between June 2002 and May 2004 were followed up one year postop. The self administered pre- and postoperative questionnaires asked for pain intensity in the back or leg(s) (VAS), walking distance before
Purpose: To assess the effectiveness of nasal salmon cal-citonin in the treatment of lumbar spinal stenosis. Methods: Forty patients with symptoms of
The purpose of this study was to evaluate the results of the surgical treatment of the thoracic outlet syndrome. Between 1990–2002, 46 patients, 15 male and 31 female aged ranging from 23 to 49 years old (mean age 34 years) underwent decompressive surgery of the thoracic outlet syndrome. Some 9 patients required bilateral operations. Symptoms due to compression of neural elements were present in 23 patients, of vascular elements in 12 patients and of both elements in 11 patients. The duration of symptoms was less than 2 years in 25 patients and 2 to 6 years in 21 patients. Operations consisted of scalenectomy in 47 cases with brachial plexus neurolysis for
Purpose: To measure outcome in patients undergoing decompression for lumbar canal stenosis (LCS) by lami-nectomy. Methods: 100 patients (57 men, 43 women) under one consultant surgeon presenting with
Introduction: The effect of the X-STOP on sagittal kinematics and spinal canal and neural foraminal area are reported when this interspinous device is used for the treatment of
Arthroplasty has become increasingly popular to treat end-stage ankle arthritis. Iatrogenic posterior neurovascular and tendinous injury have been described from saw cuts. However, it is hypothesized that posterior ankle structures could be damaged by inserting tibial guide pins too deeply and be a potential cause of residual hindfoot pain. The preparation steps for ankle arthroplasty were performed using the Infinity total ankle system in five right-sided cadaveric ankles. All tibial guide pins were intentionally inserted past the posterior tibial cortex for assessment. All posterior ankles were subsequently dissected, with the primary endpoint being the presence of direct contact between the structure and pin.Aims
Methods
We evaluate the patients with lumbar spinal stenosis in multiple levels that were treated with posterior decompression and posterolateral fusion, using transpedicular screw fixation system. Twenty-six patients, mean age 65.7 years (range 49 to 77years), with lumbar spinal stenosis, in more than three levels, were treated surgically between 1994 and 2002. Indications for surgical treatment included low back pain and
Purpose: To give the review of the foot deformities in the patients with myelomeningocele (MMC), their relationship to the level of the neurological lesion and therapeutic possibilities. Material &
Methods: Since 1998 till 2004 there were 20 patients with myelomeningocele treated in our clinic, in 19 patients was noted the foot deformity (total 34 feet). The deformity was unilateral in 4 patients, asymmetric in 2 patients (equinovarus + calcaneovalgus or planovalgus). The most frequent was equinovarus deformity (16 feet, 47%), next planovalgus deformity (9 feet, 26,5%), calcaneovalgus (7 feet, 20,6%) and equinovalgus (2 feet, 5,9%). In 28 feet the surgery was done. For the correction of the various deformities of the feet were used soft tissue releases or tendons transfer, in the older patient or after failed soft tissue release the bony operation was done (tarsal osteotomy, talo-calcaneal stabilisation, artrodesis). Results: The aim of every type of surgery was to achieve the acceptable foot shape, with plantigrade step and possibility of weigh bearing, with minimal risk of the pressure necrosis. In the most patients the purpose was achieved, although some of them passed several surgeries. In 18 deformities only one surgery obtained the correction of the deformity, the but for the 10 feet subsequent surgery was required because of the residual or relapsing deformity. In 3 patients was noted the pressure necrosis, in 1 patient appeared the fracture of the distal tibia (epiphyseolysis) after the removal the postoperative plaster. Conclusion: The orthopaedic care about the patients with MMC is only a part of the interdisciplinary approach of several specialists. The procedures for the correction of the
Purpose: The quality of the functional result for surgical treatment of lumbar stenosis has been the subject of much debate. The objectives of this retrospective review were to assess functional outcome ten years after surgical treatment of lumbar stenosis and determine the rate of revision in order to identify factors influencing outcome at last follow-up. Material and methods: One hundred forty-one patients underwent surgery for lumbar stenosis between January 1990 and December 1992. Mean follow-up was ten years. Functional outcome at last follow-up was assessed with a specific questionnaire with items for lumbar and radicular pain and signs of radicular ischemia and with a self-administered satisfaction questionnaire as well as two visual analogue scales (VAS) for lumbar and radicular pain. Other data noted were: epidemiological and morphological features, comorbidity, presence or not of objective signs of neurological involvement, the SF-36, and a self-assessed anxiety-depression score (GHQ28). Two types of analysis were performed. A descriptive analysis to determine the severity of functional signs observed at last follow-up, patient satisfaction and incidence and reasons for surgical revision. Multivariate analysis was designed to search for factors affecting the self-administered senosis score. Results: During the study period, fifteen patients underwent a revision procedure involving the lumbar spine. At last follow-up the overall satisfaction index was 71%. The best results were obtained for radiculalgia and intermittent
The degenerative processes of the glenohumeral joint can be derived from primitive glenohumeral arethrosis, post traumatic arthrosis,
Background: The incidence of neurological symptoms due to spinal stenosis in patients with achondroplasia is reported to be as great as 38%. 1. These symptoms most commonly occur in the 4. th. decade and myelography and CT myelography are most commonly described in evaluation of the stenosis. Difficulty arises in localisation of stenosis in patients presenting with neurological deficit. 2. The value of MRI of the cervicomedullary junction has been reported in achondroplasia but it has not yet been evaluated in the investigation of spinal stenotic symptoms. The aim of this study was to review our experience of whole spine imaging in patients with achondroplasia that presented with symptoms and signs of neurological deficit. Methods: We retrospectively reviewed the clinical notes and radiological imaging of 10 consecutive achondroplastic patients (3F:7M, mean age 31.7 years, range 13 to 60yrs) that presented to our unit with neurological compromise between 1998 and 2003. All patients had whole spine MRI at the time of presentation. Recorded from the notes were age and sex, and whether symptom pattern was radiculopathy, claudication or paresis. All radiological levels of stenosis on MRI were documented. Results: Four patients presented with spinal paresis, four with
Aim: To assess the clinical effectiveness of X stop interspinous decompression device in patients with
Aim: Spinal stenosis is a known entity in achondroplasia and a need for screening for the symptomatic children was identified in a tertiary limb reconstruction service. The aim of this study was to evaluate whether clinical and radiological imaging would identify the at risk group. Materials and methods: 205 achondroplastic children were treated at our service in the last 20 years. A prospective clinical screening programme for spinal stenosis which also included the MRI imaging of entire spine was however introduced only in 1996. 26 patients were available for this study. Case notes were reviewed for clinical symptoms and neurological signs. MR images were assessed for stenosis especially at Cervico medullary junction and lumbar level. Canal diameters were measured at all spinal levels from CMJ to lumbo-sacral junction. Neurosurgical interventions were recorded. An attempt was made to identify high risk factors that required surgical intervention. Results: Delayed milestones were observed in 7 patients. Positive history of back pain or radicular pain was obtained in 10 whereas 10 patients had symptoms of
Objective: Retrospective analysis of consecutive paediatric patients treated surgically for high-grade spondylolisthesis by one of three circumferential surgical procedures with emphasis on complications and patient outcome measurements. Methods: Between 1980 and 1998 fourty patients underwent anterior-posterior correction for Meyerding Grade 3 or 4 isthmic dysplastic spondylolisthesis. Ten patients were treated with an anterior reduction according to Louis and anterior interbody fusion followed by posterior decompression and instrumented fusion (group A). Fourteen patients underwent posterior decompression followed by anterior reposition and fusion with tricortical iliac bone crest and posterior instrumented fusion (group B). Sixteen patients underwent progressive reduction by halopelvic traction followed by anterior and posterior fusion (group C). All patients completed the North American Spine Society (NASS) outcome questionnaire and the SF-36. The cosmetic assessment was performed by means of a VAS. The mean follow-up period for group A was 13,5 years, for group B 5,5 years and for group C 15,4 years, respectively. Results: The three groups were comparable with respect to age at operation, radiographic measurement of the slip, lumbosacral kyphosis and lumbar lordosis. The incidence of postoperative extensor hallucis longus weakness was 33% in group A, 50% in group C and 0% in group B (p<
0.001). Pearson correlation coefficient revealed a positive correlation between extensor hallucis longus weakness and the degree of correction of the lumbosacral kyphosis (P=0.56, p=0.024). Postoperative reduction of the sagittal slip (A: 64%, B: 44%, C: 50%) and lumbosacral kyphosis (A: 27°, B: 16°, C: 27°) was significant in all three groups. The incidence of pseudarthrosis was 10% in group A, 7% in group B and 6% in group C. SF-36 and NASS outcome questionnaire results have not been found statistically significant among the groups. Conclusion: Outcomes of function, satisfaction and cosmesis are satisfactory in all three surgical groups. Posterior decompression followed by anterior reduction and fusion using tricortical iliac crest bone graft and posterior instrumented fusion lack
Background: Autologous mesenchymal stem cells (MSC) have been shown to improve the functional outcome after severe skeletal muscle trauma. The reasons for this improvement have yet not been revealed. Up to now insufficient techniques of cell labelling, which could only be used for histologic analysis ex vivo, have been a problem. The development of iron oxide nanoparticles, which are taken up and endosomally stored by stem cells, allows the evaluation of cellular behaviour in the muscle with the use of magnetic resonance imaging (MRI). Previous work has shown that labelling does not affect the proliferation and
Introduction Symptoms of
During the last 2 decades it has been recognized that scoliosis may start de novo during adult life as a result of advanced degenerative disc disease, osteoporosis or both. In some the degenerative process is superimposed on a previous adolescent curve. Aside from the disfigurement caused by the spinal deformity, pain and disability are usually the major clinical problem. The prevalence of adult scoliosis rises with age: from 4% before age 45, 6% at age 59 to 15% in-patients older than 60 years. More than two thirds of the patients are females and the prevalence of right lumber curves is higher than in comparable series of patients with adolescent scoliosis. Adult scoliosis is characterized by vertebral structural changes with translatory shifts i.e. lateral olisthesis accompanied by degenerative disc and facet joint arthrosis. Although the magnitude of these curves is usually mild (20–30 degrees) lateral spondylolisthesis is observed frequently. It is also common to observe degenerative spondylolisthesis in patients with degenerative lumbar scoliosis. The annual rate of curve progression ranges from 0.3 to 3%. Patients present with a history of a spinal deformity accompanied by loss of lumbar lordosis, trunk imbalance and significant mechanical back pain. Pain may arise not only from degenerative disc disease and facet arthritis leading to symptoms of spinal stenosis, but also from muscle fatigue due to the altered biomechanics secondary to a deformity in the coronal and sagittal planes. Root entrapment is common and occurs more often on the concavity of the curve. Symptoms of
Introduction: The surgical correction of idiopathic scoliosis is a technically complex procedure that requires significant surgical expertise and highly specialized support. The current study examines practice patterns for the surgical treatment of scoliosis over a 5-year period in the State of California, with particular attention to the effect of payer status on surgical outcomes. Given the significant disparity in reimbursement for scoliosis surgery between patients with different payment sources (i.e. Medicaid versus private insurance), the potential exists for different management of disease and patient outcomes. Methods: Using the California Office of Statewide Health Planning and Development (OSHPD) hospital discharge database, data for all surgical discharges between 1993 and 1997 for children ages 10–18 years old with a primary diagnosis of idiopathic scoliosis were reviewed. 1614 children were discharged from 99 hospitals over this period, and form the basis for this report. Outcomes of interest included length of stay (LOS), readmission, death, and need for surgical reoperation. Results: The mean age at admission of patients was 13.97 years (SD=1.89). The mean LOS was 7.38 days (SD=5.63) and mean readmission rate was 4.5%. Death (n=2) and reoperation (n=4) were extremely uncommon, making it impossible to use these as primary endpoints. Patients insured by Medi-Cal did not have significantly higher readmission rates, but did have a significantly longer length of hospital stay than patients with other payment sources (p<
0.001) and had a greater proportion of cases of extreme severity (p<
0.05), according to DRG severity code. Patients insured by Medi-Cal also incurred significantly higher hospital charges than patients with other sources of payment (p<
0.001). Discussion and conclusions: The current study highlights the significant disparity in reimbursement rates for scoliosis surgery for patient insured by Medicaid versus private insurance in California. While this study does not address the issue of “unmet need” among the underinsured segment of the population, review of administrative data suggests that patients with Medicaid are more likely to have a higher severity of illness when presenting for surgery, and perhaps as a result, a longer length of stay. Future investigations will seek to reanalyze this dataset in patients with
Introduction: Thickened ligamentum flavum (LF) is a major contributor to the clinical syndrome of lumbar canal stenosis (LCS). The patho-mechanisms responsible for this phenomenon remain unclear. Cysts adjacent to facet joints (FJ) in the spine are regarded as rare entities that may uncommonly contribute to LCS. Inaccurate pathological interpretation and unawareness of a key anatomical feature has generated erratic terminology and confusion about their origin. Methods: Twenty-seven consecutive patients with radiologically confirmed central canal or lateral recess stenosis underwent lumbar laminectomy for
Introduction: Preliminary studies suggest that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischaemic damage. We describe the continuous measurement of intramuscular pressures (IMP) during decompressive lumbar laminectomy and the relationship to back pain and disability. Methods: In this prospective interventional study, 28 patients undergoing surgery for lumbar canal stenosis were recruited. Back pain and function were assessed using the Visual Analogue Score (VAS), Oswestry Disability Index (ODI) and Short Form 36 (SF36) health survey. During surgery, IMP was continuously recorded from the multifidus muscle using a pressure transducer. The intramuscular perfusion pressure (IPP) was derived as the difference between the patient’s mean arterial pressure (MAP) and IMP (IPP = MAP − IMP). The data was analysed using repeated measures ANOVA (SPSS package). Results: The mean age was 60.4 ± 3 years and the mean duration of symptoms of 31.0 ± 6 months. The predominant symptoms were
Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining.Aims
Materials and Methods
This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.Aims
Methods
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article:
Introduction: Spinal fusions have been shown to be useful in correcting spinal deformities resulting from degenerative disc disease. We sought to produce a prospective analysis of functional outcomes following lumbar spinal fusion surgery for degenerative spondylolisthesis or degenerative scoliosis secondary to degenerative disc disease. We present the interim results from our case cohort of 74 patients. Methods: Over a period of 3 years (2005–2007), all patients who presented to this private practice with symptoms of canal stenosis or radicular pain secondary to degenerative spondylolisthesis or degenerative scoliosis were offered decompressive laminectomy and posterior lumbar interbody fusion (PLIF) surgery with interbody cages, pedicle screw instrumentation, bone morphogenic protein (BMP) and bicalcium phosphate (BCP). Patients who presented only with low back pain and did not have radicular pain or
This study aimed to explore whether intraoperative nerve monitoring can identify risk factors and reduce the incidence of nerve injury in patients with high-riding developmental dysplasia. We conducted a historical controlled study of patients with unilateral Crowe IV developmental dysplasia of the hip (DDH). Between October 2016 and October 2017, intraoperative nerve monitoring of the femoral and sciatic nerves was applied in total hip arthroplasty (THA). A neuromonitoring technician was employed to monitor nerve function and inform the surgeon of ongoing changes in a timely manner. Patients who did not have intraoperative nerve monitoring between September 2015 and October 2016 were selected as the control group. All the surgeries were performed by one surgeon. Demographics and clinical data were analyzed. A total of 35 patients in the monitoring group (ten male, 25 female; mean age 37.1 years (20 to 46)) and 56 patients in the control group (13 male, 43 female; mean age 37.9 years (23 to 52)) were enrolled. The mean follow-up of all patients was 13.1 months (10 to 15).Aims
Patients and Methods