Purpose of the Study. At our Department, we prefer surgical treatment of all patients with Type II and III fractures of the dens, regardless of the age, with the exception of non-displaced fractures or perfectly reduced fractures in young patients. Material and Methods. We treated surgically 28 patients 65 years old and older with dens fractures. The group consisted of 13 men and 15 women with a mean age of 77.4 years (range, 65–90 years). According to the type of treatment, anterior srew fixation or posterior C1–C2 fixation, the whole cohort was divided into 2 groups that were subdivided into two age groups of patients 65–74 years old and 75 years old and older. The age group of patients 65–74 years old included 8 patients with a mean age of 68.5 years and the mean age of the age group of patients 75 and more years old was 81 years. The injury was caused in 22 cases by a fall, in 5 by a car accident. Only in 1 case the injury was caused differently. Neurological deficits were found in three patients, all of them Frankel D type. All patients with injury to the dens underwent radiograph examination in the lateral and transoral projections and CT scan including the sagittal and frontal reconstructions of the atlantoaxial complex and in most cases also MRI examination to eliminate injury to the transverse ligament of the atlas. Based on these examinations, the type of injury was determined and method of treatment indicated. Final retrospective evaluation of the patients was carried out at the interval of 12 to 78 months after the primary surgery (mean 31.3 months) taking into account aetiology of the injury, type of injury, neurological finding, method of treatment, union of the dens fracture line or, where appropriate, C1–C2 fusion, stability of the spine and the final outcome. Statistical analysis was based on X2-test. Results. Comparison of the two age groups showed a statistically significant difference in the mortality (p<0.05), with 0% in the younger group and 40% in the older group. In total, mortality within 6 weeks after the injury accounted for 28.6%. Comparison of surgical techniques revealed 21.4% mortality after anterior screw fixation of the dens and 35.7% mortality after
Introduction. Correction and arthrodesis for cervical kyphosis associated with atetoid cerebral palsy has been considered to be difficult because of their involuntary neck movements and severe deformity. The aim of this study is to evaluate the surgical outcome of midline T-saw laminoplasty and posterior arthrodesis using pedicle screws. Methods. 15 patients were retrospectively reviewed. There were 6 women and 9 men, with a mean age 52.9 years (range 31–71 years). Mean follow-up period was 43 months (range 24–84 months). For clinical evaluation, the Japanese Orthopaedic Association (JOA) score and Barthel index (BI) which shows independence in ADL were used. For radiographic evaluation, change of C2–C7 Cobb angle of sagittal alignment, adjacent segment instability after the surgery were evaluated. Results. The average JOA score improved significantly from 6.2 preoperatively to 10.5 postoperatively. The average BI improved from 44.2 before surgery to 72.5 after surgery. C2–C7 Cobb angle of sagittal alignment measured 12.3 degrees of kyphosis preoperatively and 1.2 degrees of lordosis postoperatively. Solid
Background Context. Different minimally invasive approaches to the lumbar spine have been proposed but they can be associated with increased risk of complications, steep learning curve and longer operative time. Purpose. To report the complications associated with a minimally invasive technique of retroperitoneal anterolateral approach to the lumbar spine. Study design. Retrospective study of 179 patients who underwent anterior oblique lumbar interbody fusion (OLIF). Methods. A total of 179 patients with previous
The optimal method for the management of neglected traumatic bifacetal dislocation of the subaxial cervical spine has not been established. We treated four patients in whom the mean delay between injury and presentation was four months (1 to 5). There were two dislocations at the C5-6 level and one each at C4-5 and C3-4. The mean age of the patients was 48.2 years (27 to 60). Each patient presented with neck pain and restricted movement of the cervical spine. Three of the four had a myelopathy. We carried out a two-stage procedure under the same anaesthetic. First, a posterior soft-tissue release and partial facetectomy were undertaken. This allowed partial reduction of the dislocation which was then supplemented by interspinous wiring and corticocancellous graft. Next, through an anterior approach, discectomy, tricortical bone grafting and anterior cervical plating were carried out. All the patients achieved a nearly anatomical reduction and sagittal alignment. The mean follow-up was 2.6 years (1 to 4). The myelopathy settled completely in the three patients who had a pre-operative neurological deficit. There was no graft dislodgement or graft-related problems. Bony fusion occurred in all patients and a satisfactory reduction was maintained. The posteroanterior procedure for neglected traumatic bifacetal dislocation of the subaxial cervical spine is a good method of achieving sagittal alignment with less risk of iatrogenic neurological injury, a reduced operating time, decreased blood loss, and a shorter hospital stay compared with other procedures.
Heterotopic ossification occurring after the use of commercially available bone morphogenetic proteins has not been widely reported. We describe four cases of heterotopic ossification in patients treated with either recombinant bone morphogenetic protein 2 or recombinant bone morphogenetic protein 7. We found that while some patients were asymptomatic, heterotopic ossification which had occurred around a joint often required operative excision with good results.
