The aim of the prospective study was to examine advantages and disadvantages of less invasive spine fusion in comparison with traditional fusion technique. In the literature there exists no comparison study of less invasive fusion technique with traditional fusion technique. In the prospective comparison study 2 groups were compared: Group I, percutaneous fusion, and group II a traditional medial approach to the lumbar spine. In all two groups monosegmental or bisegmental fusions in the lumbar spine were performed. From january 2005 to september 2007 147 patients with oste-chondrosis, spondylolisthesis and failed back surgery syndrom were operated. In all cases fusion with autogenic or allogenic bone graft was perfomed. In group I the mean age at operation was 48 years (range from 35 to 63), 72 patients (39 women, 33 men); and in group II the mean age at operation was 39 (35–73), 75 patients (43 women, 32 female). For the clinical examination VAS, a patient satisfaction score and a SF 36 were used. A monosegmental fusion was performed in group I in 60 cases and in group II in 45 cases. A bisegmental fusion was done in group I in 12 cases and in group II in 30 cases in the lumbar spine. The mean follow up was 18 months (range from 3 months to 34 months). The mean time of operation was in group I 65 minutes (55 to 125); blood loss was in mean 25 ml (10 to 150), skin incision 4.5 cm (4 to 8cm). In group II mean time of operation 75 minutes (50 –120), blood loos 600 ml (350–600), and skin incision 12 cm (9–15). There was no statistical significant difference between the both groups in VAS, SF 36, and patient satisfaction score after 1 year follow-up. There was none infection, none neurological complication. In group I in two cases a revision surgery was necessary in cause of medial misplacement of the pedicle screw. No broken rod or broken screw was seen. The fusion rate was 85% in both groups. The prelimanary results have shown that percutaneous pedicle screw instrumentation is a reliable technique and has advantages comparing traditional open procedure. However more prospective comparison study of a open and minimal percutaneous procedure with long time follow up are necessary.
Instruments used in surgery which rotate or vibrate at a high frequency can produce potentially contaminated aerosols. Such tools are in use in cemented hip revision arthroplasties. We aimed to measure the extent of the environmental and body contamination caused by an ultrasound device and a high-speed cutter. On a human cadaver we carried out a complete surgical procedure including draping and simulated blood flow contaminated with Environmental contamination was present in an area of 6 x 8 m for both devices. The concentration of contamination was lower for the ultrasound device. Both the ultrasound and the high-speed cutter contaminated all members of the surgical team. The devices tested produced aerosols which covered the whole operating theatre and all personnel present during the procedure. In contaminated and infected patients, infectious agents may be present in these aerosols. We therefore recommend the introduction of effective measures to control infection and thorough disinfection of the operating theatre after such procedures.
We carried out 71 primary total hip arthroplasties using porous-coated, hemispherical press-fit Duraloc ‘100 Series’ cups in 68 consecutive patients; 61 were combined with the cementless Spotorno stem and ten with the cemented Lubinus SP II stem. Under-reaming of 2 mm achieved a press-fit. Of the 71 hips, 69 (97.1%) were followed up after a mean of 2.4 years. Migration analysis was performed by the Ein Bild Röntgen Analyse method, with an accuracy of 1 mm. The mean total migration after 24 months was 1.13 mm. Using the definition of loosening as a total migration of 1 mm, it follows that 30 out of 63 cups (48%) were loose at 24 months.
