Aims. The presence of
Cervical spine
Objectives. Understanding lumbar facet joint involvement and biomechanical changes post spinal fusion is limited. This study aimed to establish an in vitro model assessing mechanical effects of fusion on human lumbar facet joints, employing synchronized motion, pressure, and stiffness analysis. Methods and Results. Seven human lumbar spinal units (age 54 to 92, ethics 15/YH/0096) underwent fusion via a partial nucleotomy model mimicking a lateral cage approach with PMMA cement injection. Mechanical testing pre and post-fusion included measuring compressive displacement and load, local motion capture, and pressure mapping at the facet joints. pQCT imaging (82 microns isotropic) was carried out at each stage to assess the integrity of the vertebral endplates and quantify the amount of cement injected. Before fusion, relative facet joint displacement (6.5 ± 4.1 mm) at maximum load (1.1 kN) exceeded crosshead displacement (3.9 ± 1.5 mm), with loads transferred across both facet joints. After fusion,
Abstract. Objectives. While spinal fusion is known to be associated with adjacent disc degeneration, little is known on the role of the facet joints in the process, and whether their altered biomechanics following fusion plays a role in further spinal degeneration. This work aimed to develop a model and method to sequentially measure the effects of spinal fusion on lumbar facet joints through synchronisation of both motion analysis, pressure mapping and mechanical analysis. Methods. Parallel measurements of mature ovine lumbar facet joints (∼8yr old, n=3) were carried out using synchronised load and displacement measurements, motion capture during loading and pressure mapping of the joint spaces during loading. Functional units were prepared and cemented in PMMA endcaps. Displacement-controlled compression measurements were carried out using a materials testing machine (3365, Instron, USA) at 1 mm/min up to 950 N with the samples in a neutral position, while motion capture of the facet joints during compression was carried out using orthogonal HD webcams (Logitech, Switzerland) to measure the displacement of key facet joint features. The pressure mapping of load transfer during displacement was carried out using a flexible pressure sensor (6900 series, Tekscan, USA). Each sample was imaged at an isotropic resolution of 82 microns using a μCT scanner (XtremeCT, Scanco, Switzerland) to quantify the curvature within the facet joints. Results. Relative facet joint displacement under load, in a neutral position, showed more displacement (2.36 ±1.68 mm) compared to the cross-head when under compression (2.06 ±1.19 mm). Motion capture indicated the relative displacement of the facet joints was more posterior with some lateral motion. For five of the six facet joints, pressure measurement was possible only on 24±7 % of the surface due to the large change in curvature. Partially measured loads through the
We carried out a study to determine the effect of
Traumatic unilateral
Summary. Nucleotomy almost doubles the transmitted forces on the facet joints in human lumbar spine, regardless of the amount of removed nucleus pulposus. Introduction. Low back pain involves the lumbar facet joints in 15% to 45% of the cases. The surgical intervention, nucleotomy, might also lead to painful
Introduction. Mechanical integrity of patella can be weakened by the technique of removing the articulating surface. The senior author developed the technique of maintaining subchondral bone of the lateral patellar
Introduction and Aims: The aim of this paper is to review C1-C2
Purpose: Facet joint arthrosis is an entity that can have a key role in the etiology of low back pain, especially with hyperextension, and is a key component of surgical planning, especially when considering disc arthroplasty. Plain films and MRI are most commonly utilized as the initial imaging of choice for low back pain, but these methods may not truly allow an accurate assessment of
The supraspinatus tendon (SP) often ruptures. Gray established that the tendinous insertion always attaches to the highest
Abstract. Objective. Flexible stabilisation has been utilised to maintain spinal mobility in patients with early-stage lumbar spinal stenosis (LSS). Previous literature has not yet established any non-fusion solution as a viable treatment option for patients with severe posterior degeneration of the lumbar spine. This feasibility study evaluates the mean five-year outcomes of patients treated with the TOPS (Total Posterior Spine System)
Introduction: The effect of
Aim: To investigate the efficacy of the Insall tube realignment procedure when used to treat osteoarthrosis of the lateral
Background. Surgical resection of middle
Hypertrophy of lumbar articular
Introduction. Anteromedial gonarthrosis is a common well described pattern of knee osteoarthritis with cartilage wear beginning in the anteromedial quadrant of the medial tibial plateau in the presence of an intact and functioning ACL. It is well known that mechanical factors such as limb alignment and meniscal integrity affect the progression of arthritis and there is some evidence that the morphology of the tibial plateau may be a risk factor in the development of this disease. The extension
Introduction: Anteromedial gonarthrosis is a common well described pattern of knee osteoarthritis with cartilage wear beginning in the anteromedial quadrant of the medial tibial plateau in the presence of an intact and functioning ACL. It is well known that mechanical factors such as limb alignment and meniscal integrity affect the progression of arthritis and there is some evidence that the morphology of the tibial plateau may be a risk factor in the development of this disease. The extension
We treated 36 patients with unilateral
Fractures of the anteromedial
Peroneal spastic flatfeet without coalition or other known etiologies in adolescence remain a challenge to manage. We present eight such cases with radiological and surgical evidence of bony abnormalities in the subtalar region just anterior to the posterior
We describe a lumbar
Painful peroneal spastic flatfeet without coalition or other known etiologies in adolescence, remains a difficult condition to treat. We present eight such cases with radiological and surgical evidence of bony abnormalities in the lateral subtalar region just anterior to the posterior
Introduction. Historically, surgeons have focused on isolated simple coalition resection in symptomatic tarsal coalition with concomitant rigid flat foot. However, a review of literature suggests that coalitions with severe preoperative planovalgus malposition treated with resection alone are associated with continued disability and deformity. We believe that concomittant severe flatfoot should be considered as much as a pathological component and pain generator as the coalition itself. Our primary hypothesis is that simple resection of middle
The requirements for a motion segment fusion for degenerative disc disease are relief from symptoms from a solid union with minimal damage to surrounding tissue. This is possible with the ‘Mini PLIF’ using the B Twin cages and
Aim. Historically, surgeons have focused on isolated simple coalition resection in symptomatic tarsal coalition with concomitant rigid flat foot. However, recent evidence suggests that coalitions with severe preoperative planovalgus malposition treated with resection alone are associated with continued disability and deformity. We believe that concomitant severe flatfoot should be considered as much as a pathological component and pain generator as the coalition itself. Our primary hypothesis is that simple resection of middle
The aim of this study was to assess the benefit and durability of isolated lateral release for advanced osteoarthritis of the lateral
Bilateral interlocking of the articular
We report 13 patients with missed bilateral
Awake Rapid Heavy-Weight Closed Reduction (ARHWCR) with weights from 18 to 72 kg was used to reduce six unilateral and nine bilateral cervical
The cervical spine is the most vulnerable segment in high velocity injuries. Bifacet dislocations are associated with significant soft tissue damage and neurological deficit. Management of delayed presentation of cervical
Objective. To identify any difference in clinical outcome between Intra-Capsular
Cervical total disc replacement has been in practice for years now as a viable alternative to cervical fusion in suitable cases, aspiring to preserve spinal motion and prevent adjacent segment disease. Reports are rife that neck pain emerges as an annoying feature in the early postoperative period. The facet joint appears to be the most likely source of pain. 50 patients were prospectively followed up through 5 years after having received disc replacement surgery, indicated for symptomatic soft disc herniation of the cervical spine presenting with radiculopathy.
We excluded those with degenerative trophic changes of the cervical spine, focal instability, trauma, osteoporosis, previous cervical spine surgery, previous infection, ossifying axial skeletal disease and inflammatory spondyloarthritides. The device used was an unconstrained implant with stabilizing teeth. Over the 5 years, we studied their postoperative comfort level via the Neck Disability Index (NDI) and Visual Analogue Score (VAS). Pre-operative and post-operative analysis of the sagittal axis and of involved facet joints were done. 22 patients suffered postoperative neck pain as reflected by the NDI and VAS scores. Of these, 10 reported of neck pain even 24 months after surgery. However, none were neurologically worse and all patients returned to their pre-morbid functions and were relieved of pain by 28 months. All 22 patients reported of rapid dissolution of neckache after peri-facetal injections of steroids were done under image guidance. We draw attention to the facet joint as the pain generator, triggered by inappropriate implant height, eccentric stresses via hybrid constructs, eccentric loading due to unconstrained devices and unaddressed Luschka joint degeneration. Such factors require careful selection of patients for surgery, necessitate proper pre-operative templating and call for appropriate technical solutions during surgery.
• All were skeletally mature and aged between 22 to 50.
• Single surgeon (first author)
Facet joint osteoarthritis (FJOA) is a prominent clinical hallmark of degenerative spine disorders. During disease progression, cartilage and subchondral bone tissues undergo increased turnover and remodeling. The structural changes to the subchondral tissue of FJOA have not been studied thus far. In this study, we performed a micro computed tomography (µCT) study of the subchondral cortical plate (SCP) and trabecular bone (STB) in FJOA and determined osteoarthritis-specific alterations. Twenty-four patients (11 male, 13 female, median age 65) scheduled for decompression and stabilization surgery for degenerative spinal stenosis were included in this study. FJOA specimens were harvested during surgery and analyzed by µCT. Bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N) were evaluated using CT Analyser. Lumbar facet joints without chondropathy from cadaveric specimens (9 male, 6 female, median age 57) served as healthy controls. Age-, gender- and disease-specific effects were identified by ANOVA (Introduction
Methods
A case of a ganglion arising from a distal lumbar articular facet joint associated with low back pain and sciatica is reported and the pertinent literature reviewed.
To determine whether spinal
Aims. The purpose of this retrospective study was to investigate the
clinical relevance of increased facet joint distraction as a result
of anterior cervical decompression and fusion (ACDF) for trauma. Patients and Methods. A total of 155 patients (130 men, 25 women. Mean age 42.7 years;
16 to 87) who had undergone ACDF between 1 January 2001 and 1 January
2016 were included in the study. Outcome measures included the Neck
Disability Index (NDI) and visual analogue scale (VAS) for pain.
Lateral cervical spine radiographs taken in the immediate postoperative
period were reviewed to compare the interfacet distance of the operated
segment with those of the facet joints above and below. Results. There was a statistically significant relationship between greater
facet distraction and increased NDI and VAS pain scores. This was
further confirmed by Spearman correlation, which showed evidence
of a moderate correlation between both NDI score and
Ulnocarpal impaction (UCI) is a common cause of ulnar-sided wrist pain. UCI typically occurs in wrists with positive ulnar variance, which causes altered loading mechanics between the ulnar head, lunate and triquetrum. However, many individuals with positive ulnar variance never develop UCI, and some with neutral or negative ulnar variance do experience UCI. This suggests that other variables contribute to the development of UCI. Suspected culprits include lunate morphology, and dynamic changes with loaded (grip) pronation. If these anatomic variations are contributing to UCI, we expect them to influence functional impairment scores. Therefore, the objective of this study was to evaluate the relationship between radiographic parameters and pre-surgical upper extremity patient-rated outcomes scores (PROS) in patients with a diagnosis of UCI. Retrospective cohort study of patients undergoing ulnar shortening osteotomy or arthroscopic wafer procedure for UCI. Data derived from prospectively collected departmental database that captured demographic, clinical, functional and radiographic information. Radiographic parameters evaluated were: lunate morphology [presence vs. absence of hamate
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective cohort study and followed over a 12-month period. Post-operative computed tomography (CT) imaging of bilateral feet was obtained to assess surgical reduction using a combination of pre-determined parameters: Böhler's angle, calcaneal height, congruence and articular step-off of the posterior
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective cohort study and followed over a 12-month period. Post-operative computed tomography (CT) imaging of bilateral feet was obtained to assess surgical reduction using a combination of pre-determined parameters: Böhler's angle, calcaneal height, congruence and articular step-off of the posterior
Displaced intraarticular calcaneal fractures are debilitating injuries with significant socioeconomic and psychological effects primarily affecting patients in active age between 30 and 50 years. Recently, minimally and less invasive screw fixation techniques have become popular as alternative to locked plating. The aim of this study was to analyze biomechanically in direct comparison the primary stability of 3 different cannulated screw configurations for fixation of Sanders type II-B intraarticular calcaneal fractures. Fifteen fresh-frozen human cadaveric lower limbs were amputated mid-calf and through the Chopart joint. Following, soft tissues at the lateral foot side were removed, whereas the medial side and Achilles tendon were preserved. Reproducible Sanders type II-B intraarticular fracture patterns were created by means of osteotomies. The proximal tibia end and the anterior-inferior aspect of the calcaneus were then embedded in polymethylmethacrylate. Based on bone mineral density measurements, the specimens were randomized to 3 groups for fixation with 3 different screw configurations using two 6.5 mm and two 4.5 mm cannulated screws. In Group 1, two parallel longitudinal screws entered the tuber calcanei above the Achilles tendon insertion and proceeded to the anterior process, and two transverse screws fixed the posterior
We scanned 25 left knees in healthy human subjects
using MRI. Multiplanar reconstruction software was used to take
measurements of the inferior and posterior
From a search of MRI reports on knees, 20 patients were identified with evidence of early anteromedial osteoarthritis without any erosion of bone and a control group of patients had an acute rupture of the anterior cruciate ligament. The angle formed between the extension and flexion
We examined the reliability of radiological findings in predicting segmental instability in 112 patients (56 men, 56 women) with a mean age of 66.5 years (27 to 84) who had degenerative disease of the lumbar spine. They underwent intra-operative biomechanical evaluation using a new measurement system. Biomechanical instability was defined as a segment with a neutral zone >
2 mm/N. Risk factor analysis to predict instability was performed on radiographs (range of segmental movement, disc height), MRI (Thompson grade, Modic type), and on the axial CT appearance of the