Subjects

A prospective study of 127 patients who underwent posterior spinal arthrodesis and segmental spinal instrumentation with iliac crest bone graft for correction of adolescent idiopathic scoliosis. Patients were divided according to their Cobb angle into two groups. Group 1 (n= 78) with a Cobb angle > 70° who underwent an additional concave rib osteotomy (CRO) and group 2 (n= 49) with a Cobb angle < 70° who did not (NCRO). All patients received a pulmonary rehabilitation programme post-operatively. Vital capacity (VC) and peak expiratory flow rate (PEF) were measured pre-operatively, at 3 months and 12 months post-operatively.

To provide short- term follow-up data on the surgical success and patient outcome following early anterior cervical fusion in this particular type of injury. A prospective study of 10 consecutive patients.

Stage I compressive extension injury of the cervical spine, as described by Allen and Ferguson, is not always a stable injury. The combined unilateral failure of the posterior structures under compression together with failure of the anterior structure under tension will lead to a rotationally unstable segment. Various treatment options are available including halo vest immobilization, posterior stabilization with plating and anterior fusion and plating.

10 consecutive patients diagnosed with stage I compressive extension injury (fracture subluxation of the cervical spine). All subjects presented with a neurological deficit and vertebral subluxation. All patients were investigated with CT scan of the involved segment; in addition 2 patients had MRI scans.

The surgical protocol consisted of early reduction followed by anterior cervical fusion using a tricortical iliac graft, and stabilization, using locking plate fixation. Follow-up was by radiographs and clinical examination.

Intraoperative assessment revealed disc injury in all patients. Anatomical realignment was achieved together with a solid fusion in all of the patients. All patients showed improvement in the neurological deficit. One patient remains with some residual weakness in his triceps and another patient required removal of a prominent screw.

Early anterior fusion and plating for this type of injury is a safe procedure

Introduction and Aims: To evaluate the long-term results of an operation which does not involve instrumentation or fusion and which leaves the midline structures intact.

Method: A retrospective clinical and radiological review of consecutive patients.

Results: One hundred and sixty patients (87 females and 73 males) with a mean age at operation of 68 (range 40–90); the majority of patients (79%) had either a one or two level bilateral decompression. The most common level decompressed was the L4/5 level (91%). The mean post-operative follow-up was 22 months.

Summary of background data: spondylosis, commonly involving a degenerative listhesis, is the most common cause of stenosis in the lumbar spine. The symptoms arise from root compromise of the stenotic level and surgery offers the only permanent cure. To date, the standard procedure remains a laminectomy with fixation and fusion in the presence of possible instability. A laminectomy, however, destabilises the spine and the instrumented fusion makes it a much bigger operation in patients often not best placed to cope with it. There has been, therefore, a need for an effective operation that does not compromise spinal stability.

Conclusion: At six weeks post-operation, 141 patients (85%) reported relief of leg pain and this rose to 90% at six months. One hundred and fifty-three patients (96%) reported an increase in their walking distance. Of those patients who also presented with back pain pre-operatively, 79% reported an improvement. There were no significant post-operative complications. The results were sustained at follow-up.

The operation of limited segmental decompression for degenerative lumbar spinal stenosis has been found to be effective, safe, and providing good long-term results, without compromising the existing spinal stability. Appropriate patient selection and attention to operative technique are of paramount importance.

Introduction: Spondylolytic spondylolisthesis is a not uncommon cause of back pain in adults. The initial management, especially for the low grade slips, is usually conservative. When this fails or is deemed inadequate surgical options are considered. The principles of surgical treatment involve a fusion of the painful segment or segments (usually with instrumentation), with an associated decompression if there is radicular leg pain. Some authors also propose a simultaneous reduction of the slip. Most reports in the literature on adults have a short follow-up.

Materials and method: This paper reports the results of surgery from two centres carried out between 1993 and 1998 on 75 adult patients using the same indication for surgery and the same surgical technique. The indication for surgery was a significant reduction in the quality of life with persistent low back and/or leg pain after conservative treatment for a minimum of six months. The surgery involved an in situ posterolateral fusion with pedicular fixation (Oswestry system) with a simultaneous decompression for radicular involvement. The average operating time was 2.5 hours (range 2–4) and the average blood loss 850 mls (range 300–2300). The mean follow-up was 61 months (range 24 to 95).

Results and conclusion: A solid fusion was considered to be present in 71 of the 75 cases (95%) using the Lenke and Bridwell (1997) criteria for radiological union. Seventy-two of the 75 cases (96%) had a very satisfactory clinical outcome (Ricciardi et al 1995). The complications were limited – two superficial wound infections and one deep wound infection which resolved after debridement of the wound. There were no neurological complications.

The authors believe that with careful patient selection an instrumented in-situ posterolateral fusion is a safe and effective operation for symptomatic low grade slips providing good long term results.