Subluxation of the hip is common in patients with intermediate spinal
The majority of patients with chronic infantile and juvenile forms of spinal
Background: The long term survival of patients with type II and III spinal
Introduction Musculoskeletal injuries, especially fractures, cause reduced limb mobilization. The diminished limb activity promotes
The gluteus minimus (GMin) and gluteus medius (GMed) have unique structural and functional segments that may be affected to varying degrees, by end-stage osteoarthritis (OA) and normal ageing. We used data from patients with end-stage OA and matched healthy controls to 1) quantify the atrophy of the GMin and GMed in the two groups and 2) describe the distinct patterns of the fatty infiltration in the different segments of the GMin and GMed in the two groups. A total of 39 patients with end-stage OA and 12 age- and sex frequency-matched healthy controls were prospectively enrolled in the study. Fatty infiltration within the different segments of the GMin and the GMed was assessed on MRI according to the semiquantitative classification system of Goutallier and normalized cross-sectional areas were measured.Aims
Methods
The June 2024 Children’s orthopaedics Roundup. 360. looks at: Proximal femoral unicameral bone cysts: is ESIN the answer?; Hybrid-mesh casts in the conservative management of paediatric supracondylar humeral fractures: a randomized controlled trial; Rate and risk factors for contralateral slippage in adolescents treated for slipped capital femoral epiphysis; CRP predicts the need to escalate care after initial debridement for musculoskeletal infection; Genu valgum in paediatric patients presenting with patellofemoral instability; Nusinersen therapy changed the natural course of spinal
Aims. To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). Methods. We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. Results. A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal
Disturbed muscular architecture, fatty infiltration and
The practice of rotator cuff repair rapidly moves towards arthroscopic techniques especially for single tendon tears. Although the clinical results are relatively well established, the structural results of open rotator cuff repair and their correlation with the clinical outcome are poorly known. In order to provide a baseline for future studies using other repair techniques, this study was carried out to assess the structural changes in the repaired musculotendinous unit and to correlate these findings with the clinical outcome after rupture and repair of an isolated full thickness single tendon tear of the rotator cuff. To prospectively assess the quality of an open rotator cuff tendon repair technique, to determine how structural changes of rotator cuff muscles are affected by tendon repair, and to correlate the structural results of MRI studies with the clinical outcome. Direct open repair of a complete, isolated single tendon tear of the rotator cuff resulted in significant improvement in function and objective evidence of tendon healing on MRI. Successful direct repair was not associated with recovery of preoperative
Objectives. Our objectives were to describe the therapeutic aspects and assess the prognosis of chronic osteomyelitis in children. Materials and methods. We made a retrospective study from January 2007 to December 2016. The study concerned children from 0 to15 years, treated for chronic osteomyelitis and monitored in the pediatric surgery department of the teaching hospital Gabriel Toure, Bamako (Mali). The other types of bone infections, osteitis and bone tumors were not included in the study. In 10 years we received and treated 215 children with chronic osteomyelitis. This represented 3.56% of all the hospitalizations. The mean age was 8.8 (± 6.67) years with extremes of 28 days and 15 years. The patients were first seen by the traditional healer in 165 (76.7%) cases. The sex ratio was 1.26. The major clinical feature was local swelling associated with pain in 110 cases (51.2%). In 135 cases (62.8%) the staphylococcus aureus was found in direct examination or culture. After a year we performed a functional and morphological assessment according to the method of DIMEGLIO. Results. Surgical treatment was performed in all patients. The average delay of stay in hospital was 4.95 ± 4.57 weeks, with extremes of 2 and 12 weeks. The means follow-up was 13 months with extremes of 3 and 20 months. Good results were found in 115 patients, fair in 60 (40 in keloid knee valgus to 11 ° in 10,
Subscapularis tenotomy (SST) has been the preferred approach for shoulder arthroplasty for decades but recent controversy has propelled lesser tuberosity osteotomy (LTO) as a potential alternative. Early work by Gerber suggested improved healing and better outcomes with LTO although subscapularis
We have treated 101 patients with scoliosis secondary to muscular dystrophy over a 13-year period; 64 had Duchenne’s muscular dystrophy, 33 spinal
Objective: This study evaluates the use of the Isola Growing Rod System for scoliosis in a group of skeletally immature patients with predominantly neuromuscular disorders. Our series of patients was unsuitable for definitive anterior and posterior fusion due to poor respiratory function. Design: We reviewed the case notes and x-rays of eighteen patients who had undergone instrumentation with the Isola Growing Rod System. The Cobb angles on the pre-operative and subsequent post-operative X-rays were measured. Complications were noted. Subjects: Eighteen children with scoliosis. Outcome measures: Curve correction and complications. Results: Two patients had idiopathic scoliosis, four patients had spinal
Aims: To find a long-term effect of posterolateral fusion for isthmic spondylolysis and spondylolisthesis on lumbar spine. Methods: A posterolateral fusion was performed on 56 patients (30 females, 26 males) with an average age of 16 (range 11 to 20) years. A clinical and MRI examination was performed on these patients on average 18 years later (range 11 to 25 years). The size of the spinal canal were assessed. Disc space, degeneration and protrusions were evaluated. Bone marrow changes (Modic I &
II), facet joint degeneration and the state of the spinal muscles were assessed. Results: In MR images, none of the patients had lumbar spinal stenosis. In contrast, the spinal canal was wide in the level spondylolysis and spondylolisthesis. Narrowing of the neural foramina was noted in 13 (23%) patients. This was associated usually in severe slip (>
50%) and was noted always at the L5-S1 level. Of the studied 332 intervertebral discs 56 (17%) were speckled and 57 (17%) were black and 76 (23%) narrowed. Most commonly speckled/black and narrowed disc was found in the two lowest lumbar levels. Only one patient, 41-year-old female, had prolapse. Modic I and II changes were noted in 7 (2%) and 9 (3%) intervertebral disc levels, respectively. Degenerative-like facet joint hypertrophy was noted in 47 (48%) of the studied levels. Of the patients, seven (12%) had
Objective: To evaluate per-operative and postoperative complications following surgical correction of neuromuscular scoliosis and assess the amount of radiological correction of Cobb’s angle and pelvic obliquity angle. Design: Retrospective study of 25 consecutive patients with neuromuscular scoliosis (10 Duchenne Muscular Dystrophy, 8 Cerebral palsy, 2 Neurofibromatosis, and 1 each of Spinal
Aims: Muscle fat degeneration and fibrosis following long time denervation is today the main cause of poor functional recovery after peripheral nerve surgery especially for reconstruction of proximally located lesions of median and ulnar nerves such as those at brachial plexus level. External electro-stimulation is actually one possible way to avoid
Purpose of the study: We noted that four postoperative compartment syndromes observed in our department occurred in short stature patients with micromely secondary to chondrodysplasia. This complication occurred in young subjects with significant muscular development (two with intensive sports practice) whose muscle hypertrophy appeared exaggerated by the short length of the limbs. Material and methods: The first case concerned a young man with pycnodysostosis who developed a tibial compartment syndrome after prolonged ventral decubitus subsequent to spinal surgery. No surgical procedure had been performed on the lower limb. The complication was probably triggered by simple compression of the proximal portion of the limb leading to elevated venous pressure and rapid self-aggravating
Aim: The aim of the study is to evaluate the results of the use of the Rotating Knee Endo Model not only as a revision implant, but as a primary choice too. Method: It is a retrospective study of 73 patients who underwent primary total knee replacement (TKR) in 96 knees, during 1990–2001. The mean follow up is 5.6 years. The average age of the patients was 70.6 years (38 – 87 years), and 79.6 % were female. The indications for surgery were osteoarthritis in 66 knees, rheumatoid arthritis (R.A.) in 10 knees and aseptic osteonecrosis of femoral condyles in 3 knees. Seventy-nine prosthesis were examined both clinically and with plain films. Fifteen patients died in the mean time and 2 others could not participate in the follow up. The pre- and post-operative evaluation based on the «The Hospital for Special Surgery (HSS) knee rating scale». Results: Fifty-eight knees were rated as excellent, 13 knees were rated as good and 8 knees were rated as fair. Deep venous thrombosis occured in 3 patients, non-fatal pulmonary embolism in 2, and 3 patients demonstrated superficial wound infection cured with oral antibiotic administration. One patient suffered dislocation of the apparatus, which required revision of the femoral component. The tibial insertion of the patellar tendon of one patient detached, which was reattached. Ectopic ossification was present in another patient 4 months after surgery and excised in a second stage, deep infection in 1 patient with history of osteomyelitis silent for 10 years, who eventually underwent an above-knee amputation. Conclusions: The Rotating Knee Endo Model allows axial correction of the extremity, stabilization of the joint, useful range of motion and pain relief while the infection rate is considered low. So the prosthesis could be a good alternative not only in revision procedures but in primary TKA in cases of serious axial deformity and in rheumatoid knees with instability and
Introduction: Pathological conditions, which determine human atrophy, are numerouses and heterogeneous. Experimental studies prove that these different pathological conditions use common enzymatic pathways leading muscle atrophy. In every catabolic conditions where there is proteolyses’s increase, this one happens in association with up-regulation of two specific genes of skeletal muscle atrophy. These genes, MuRf1 (muscle ring finger-1) and MAFbx (muscle atrophy F-box), encode ubiquitin ligases. These ligases bind and mediate ubiquitination of myofibrillar proteins for subsequent degradation during muscle atrophy. The aim of our study is to obtain a better understanding of human muscle physiopathology in atrophy by use of histochemistry and immunolocalisation of MuRF-1 and MAFbx. Patients and Methods: 15 patients, amputated at third distal or proximal leg because of different acute or chronic pathology, were divided in two group. Group A: 12 elderly patients (mean age 72 years) amputated for vascular diseases (8) and complication of a diabetic foot (4). Group B: 3 young patients involved in car accident (mean age 25) amputated for limb’s acute arterial insufficiency. Gastrocnemius muscle biopsy specimens were obtained for all the patients, after that the informed consent was obtain, for histochemical (haematossilineosin), and immunohistochemical (anti- MuRf1, anti- MAFbx) analysis. Results: Histochemistry: Group A: skeletal muscle showed a decrease in fiber size in cross-sectional area and fiber length with adipose tissue. Group B: light skeletal muscle structural alteration. Immuno-histochemistry: in group A, in muscular drawings, polyclonal antibodies direct against MuRf1 and MAFbx had stained muscle biopsy specimens. Muscle fiber cells showed MuRf1 and MAFbx subsarcolemmatic immunoreactivity and weakly immunoreactivity of the extracellular matrix. We noticed no positivity to anti- MuRf1 and anti- MAFbx less in sections from group B muscle biopsy specimens and in sections in which were present tissue muscle degeneration with replacement of adipose tissue. Conclusion: The pathological results supported the concept that MuRf1 and MAFbx appeared to be regulatory peptide in cellular pathology that conduce to
Rotator cuff (RC) injuries are characterized by tendon rupture, muscle atrophy, retraction, and fatty infiltration, which increase injury severity and jeopardize adequate tendon repair. Epigenetic drugs, such as histone deacetylase inhibitors (HDACis), possess the capacity to redefine the molecular signature of cells, and they may have the potential to inhibit the transformation of the fibro-adipogenic progenitors (FAPs) within the skeletal muscle into adipocyte-like cells, concurrently enhancing the myogenic potential of the satellite cells. HDACis were added to FAPs and satellite cell cultures isolated from mice. The HDACi vorinostat was additionally administered into a RC injury animal model. Histological analysis was carried out on the isolated supra- and infraspinatus muscles to assess vorinostat anti-muscle degeneration potential.Aims
Methods
Introduction and Aims: Surgical correction of pelvic obliquity is an important component of spinal instrumentation for neuromuscular scoliosis, though instrumentation to the pelvis has high reported complication rates. This study evaluates the results of pelvic fixation during surgical correction of neuromuscular scoliosis in a consecutive series of 62 children and adolescents. Method: A retrospective chart and radiographic review of 62 consecutive patients treated with spinal fusions to the pelvis as treatment for neuromuscular scoliosis was performed. Follow-up ranged from two to seven years. Diagnoses included cerebral palsy (36 patients), muscular dystrophy (16 patients), myelomeningocele (three patients), spinal
Previous studies in animal models of limb lengthening have shown a wide spectrum of histopathological changes during distraction phase. Much less is known about the structural response of muscle during the consolidation phase. This study aimed to observe and score changes in morphology, weight, length and maximal perimeter of gastrocnemius during the distraction and consolidation phases. Thirty two immature New Zealand white rabbits were divided into two equal groups: lengthening and sham. In each group, half of the rabbits were killed at the end of lengthening and half 5 weeks later. A bilateral external fixator was applied to tibia and a mid-diaphysis osteotomy performed. The lengthening rate was 0.4 mm twice daily with an initial delay of 7 days. 30% lengthening was achieved in 4 to 5 weeks. After sacrifice, the whole gastrocnemius was taken from its attachments. Its weight, length and maximal perimeter were measured. At the middle of belly, a specimen 0.5cm in length was taken from the medial gastrocnemius for H&
E and Masson trichrome staining. A scoring system was used to achieve a semi-quantitative analysis of the histopathological changes in gastrocnemius. No abnormal changes were observed in the sham side. Degeneration, atrophy and endomysial fibrosis were all found in the lengthened side. The scores of histopathological changes between the end of lengthening and 5 weeks later showed a decreasing trend, but no significant difference. The weight and perimeter decreased and length increased in the lengthening side. The weight, perimeter and length of gastrocnemius in both lengthening and control sides increased at 5 weeks after the end of lengthening.
The first aim of this study was to evaluate whether preoperative renal function is associated with postoperative changes in whole blood levels of metal ions in patients who have undergone a Birmingham Hip Resurfacing (BHR) arthroplasty with a metal-on-metal bearing. The second aim was to evaluate whether exposure to increased cobalt (Co) and chromium (Cr) levels for ten years adversely affected renal function. As part of a multicentre, prospective post-approval study, whole blood samples were sent to a single specialized laboratory to determine Co and Cr levels, and the estimated glomerular filtration rate (eGFR). The study included patients with 117 unrevised unilateral BHRs. There were 36 females (31%). The mean age of the patients at the time of surgery of 51.3 years (SD 6.5), and they all had preoperative one-, four-, five-, and ten-year laboratory data. The mean follow-up was 10.1 years (SD 0.2).Aims
Methods
The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation.Aims
Methods
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.
The aim of this study was to describe a quantitative 3D CT method to measure rotator cuff muscle volume, atrophy, and balance in healthy controls and in three pathological shoulder cohorts. In all, 102 CT scans were included in the analysis: 46 healthy, 21 cuff tear arthropathy (CTA), 18 irreparable rotator cuff tear (IRCT), and 17 primary osteoarthritis (OA). The four rotator cuff muscles were manually segmented and their volume, including intramuscular fat, was calculated. The normalized volume (NV) of each muscle was calculated by dividing muscle volume to the patient’s scapular bone volume. Muscle volume and percentage of muscle atrophy were compared between muscles and between cohorts.Aims
Methods
Severe spinal deformity in growing patients often requires surgical management. We describe the incidence of spinal deformity surgery in a National Health Service. Descriptive study of prospectively collected data. Clinical data of all patients undergoing surgery for spinal deformity between 2005 and 2018 was collected, compared to the demographics of the national population, and analyzed by underlying aetiology.Aims
Methods
Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates.Aims
Patients and Methods
The aim of this study was to compare the outcomes of surgery
using growing rods in patients with severe A review of a multicentre EOS database identified 107 children
with severe EOS (major curve ≥ 90°) treated with growing rods before
the age of ten years with a minimum follow-up of two years and three
or more lengthening procedures. From the same database, 107 matched
controls with moderate EOS were identified.Aims
Patients and Methods
Osteoporosis is a chronic disease. The aim of this study was to identify key genes in osteoporosis. Microarray data sets GSE56815 and GSE56814, comprising 67 osteoporosis blood samples and 62 control blood samples, were obtained from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified in osteoporosis using Limma package (3.2.1) and Meta-MA packages. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to identify biological functions. Furthermore, the transcriptional regulatory network was established between the top 20 DEGs and transcriptional factors using the UCSC ENCODE Genome Browser. Receiver operating characteristic (ROC) analysis was applied to investigate the diagnostic value of several DEGs.Objectives
Methods
Our aim was to review the efficacy of the wound vacuum-assisted closure (VAC) system in the treatment of deep infection after extensive instrumentation and fusion for spinal deformity in children and adolescents. A total of 14 patients with early deep spinal infection were treated using this technique. Of these, 12 had neuromuscular or syndromic problems. Clinical and laboratory data were reviewed. The mean follow-up was 44 months (24 to 72). All wounds healed. Two patients required plastic surgery to speed up the process. In no patient was the hardware removed and there was no loss of correction or recurrent infection. We believe that the wound VAC system is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for the retention of the instrumentation and the maintenance of spinal correction. It is reliable and easy to use.
In this case study, we describe the clinical
presentation and treatment of 36 patients with periosteal chondrosarcoma
collected over a 59-year period by the archive of the Netherlands
Committee on Bone Tumours. The demographics, clinical presentation,
radiological features, treatment and follow-up are presented with
the size, location, the histological grading of the tumour and the
survival. We found a slight predominance of men (61%), and a predilection
for the distal femur (33%) and proximal humerus (33%). The metaphysis
was the most common site (47%) and the most common presentation
was with pain (44%). Half the tumours were classified histologically
as grade 1. Pulmonary metastases were reported in one patient after
an intra-lesional resection. A second patient died from local recurrence
and possible pulmonary and skin metastases after an incomplete resection. It is clearly important to make the diagnosis appropriately because
an incomplete resection may result in local recurrence and metastatic
spread. Staging for metastatic disease is recommended in grade II
or III lesions. These patients should be managed with a contrast-enhanced MRI
of the tumour and histological confirmation by biopsy, followed
by Cite this article:
We determined the frequency, rate and extent
of development of scoliosis (coronal plane deformity) in wheelchair-dependent
patients with Duchenne muscular dystrophy (DMD) who were not receiving
steroid treatment. We also assessed kyphosis and lordosis (sagittal
plane deformity). The extent of scoliosis was assessed on sitting anteroposterior
(AP) spinal radiographs in 88 consecutive non-ambulatory patients
with DMD. Radiographs were studied from the time the patients became
wheelchair-dependent until the time of spinal fusion, or the latest assessment
if surgery was not undertaken. Progression was estimated using a
longitudinal mixed-model regression analysis to handle repeated
measurements. Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in
78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted
longitudinal model revealed that time in a wheelchair was a highly
significant predictor of the magnitude of the curve, independent
of the age of the patient (p <
0.001). Scoliosis developed in
virtually all DMD patients not receiving steroids once they became
wheelchair-dependent, and the degree of deformity deteriorated over
time. In general, scoliosis increased at a constant rate, beginning
at the time of wheelchair-dependency (p <
0.001). In some there
was no scoliosis for as long as three years after dependency, but
scoliosis then developed and increased at a constant rate. Some
patients showed a rapid increase in the rate of progression of the
curve after a few years – the clinical phenomenon of a rapidly collapsing
curve over a few months. A sagittal plane kyphotic deformity was seen in 37 of 60 patients
(62%) with appropriate radiographs, with 23 (38%) showing lumbar
lordosis (16 (27%) abnormal and seven (11%) normal). This study provides a baseline to assess the effects of steroids
and other forms of treatment on the natural history of scoliosis
in patients with DMD, and an approach to assessing spinal deformity
in the coronal and sagittal planes in wheelchair-dependent patients
with other neuromuscular disorders. Cite this article:
Haematogenous osteomyelitis in newborns and infants usually occurs in the long bones and is rare in the short or flat bones. We present two neonates with osteomyelitis of the upper cervical spine affecting the second to fourth cervical vertebrae and the first and second cervical vertebrae, respectively. Despite some delay in diagnosis, both responded successfully to conservative treatment with antibiotics, a cervical collar and needle puncture. The latest follow-up at six and seven years, respectively, showed no persistent neurological deficit and a normal diameter of the cervical spinal canal on MRI.
Scapulothoracic fusion (STF) for painful winging
of the scapula in neuromuscular disorders can provide effective pain
relief and functional improvement, but there is little information
comparing outcomes between patients with dystrophic and non-dystrophic
conditions. We performed a retrospective review of 42 STFs in 34
patients with dystrophic and non-dystrophic conditions using a multifilament
trans-scapular, subcostal cable technique supported by a dorsal
one-third semi-tubular plate. There were 16 males and 18 females
with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0
years (2.0 to 10.6). The mean Oxford shoulder score improved from
20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions
had lower overall functional scores but achieved greater improvements
following STF. The mean active forward elevation increased from
59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10°
to 90°) to 83° (30° to 130°) with a greater range of movement achieved
in the dystrophic group. Revision fusion for nonunion was undertaken
in five patients at a mean time of 17 months (7 to 31) and two required
revision for fracture. There were three pneumothoraces, two rib
fractures, three pleural effusions and six nonunions. The main risk
factors for nonunion were smoking, age and previous shoulder girdle surgery. STF is a salvage procedure that can provide good patient satisfaction
in 82% of patients with both dystrophic and non-dystrophic pathologies,
but there was a relatively high failure rate (26%) when poor outcomes
were analysed. Overall function was better in patients with dystrophic
conditions which correlated with better range of movement; however,
patients with non-dystrophic conditions achieved greater functional
improvement.
We retrospectively examined the prevalence and
natural history of asymptomatic lumbar canal stenosis in patients treated
surgically for cervical compressive myelopathy in order to assess
the influence of latent lumbar canal stenosis on the recovery after
surgery. Of 214 patients who had undergone cervical laminoplasty
for cervical myelopathy, we identified 69 (32%) with myelographically
documented lumbar canal stenosis. Of these, 28 (13%) patients with
symptomatic lumbar canal stenosis underwent simultaneous cervical
and lumbar decompression. Of the remaining 41 (19%) patients with
asymptomatic lumbar canal stenosis who underwent only cervical surgery,
39 were followed up for ≥ 1 year (mean 4.9 years (1 to 12)) and
were included in the analysis (study group). Patients without myelographic
evidence of lumbar canal stenosis, who had been followed up for ≥ 1
year after the cervical surgery, served as controls (135 patients;
mean follow-up period 6.5 years (1 to 17)). Among the 39 patients
with asymptomatic lumbar canal stenosis, seven had lumbar-related
leg symptoms after the cervical surgery. Kaplan–Meier analysis showed that 89.6% (95% confidence interval
(CI) 75.3 to 96.0) and 76.7% (95% CI 53.7 to 90.3) of the patients
with asymptomatic lumbar canal stenosis were free from leg symptoms
for three and five years, respectively. There were no significant
differences between the study and control groups in the recovery
rate measured by the Japanese Orthopaedic Association score or improvement
in the Nurick score at one year after surgery or at the final follow-up. These results suggest that latent lumbar canal stenosis does
not influence recovery following surgery for cervical myelopathy;
moreover, prophylactic lumbar decompression does not appear to be
warranted as a routine procedure for coexistent asymptomatic lumbar
canal stenosis in patients with cervical myelopathy, when planning
cervical surgery.