Both posterior and anterior surgery have potential for complete scoliosis correction. Significant difference in judging the procedures still persists. Aim. To establish objective advantages and risks of the procedures, basing upon long term results. Method. From 1982–2007, 859 anterior(A) and 388 posterior(P) instrumentations were performed by the same surgeon. Single level thoracotomy used even in double curves. Spinal canal was never opened, rib heads left intact, ribs were fractured at the top of rib hump. Zielke rod was used for correction, and another rod added for aditional correction and stabilisation. Various posterior instrumentations were used. Results. CORRECTION (A)frontal 67-45-16(76%), sagital +6, (P)frontal 66-44-29(56%), sag+3; OP. TIME (A)140(50–300), (P)155(110–350); BLOOD REPL. (A)18%, (P)92%; HOSP STAY (A)10, (P)13; VC (A)-10%, (P)0%; SPORT ACT. (A)3mths, (P)12mths; MAJOR COMPLICATIONS: no deaths, (A)1 aorta rupture, 1 bronchus penetration, 0,7% haematothorax, 0,6% reinstrumentation, 0,7% infections demanding op, (P)2 paraplegia (0,5%), 3.9% infections, 4.9% reinstrumentation. Discussion. (A)required no neuromonitoring, no intensive care unit. Blood replacement was occasionally used only for double curves (11 segm), and in preop. anemia. Most of the complications were preventable. Hospitalisation was longer in (P) group due to wound problems. Pulmonary decrease was found only in curves greater than 100 °. Halo traction improved VC, but both instr. had no influence on further improv. In (A)VC recovered in 6 months. Conclusions. (A) can be performed in less radical and agressive way. Anterior release significantly mobilizes the spine and decreases necessary corrective forces. Infection was more frequent in (P) but consequences were more dramatic in (A). All major complications in (A) were preventable. There is temporary decrease in pulmonary function after (A). We could not find objectives for (A) to have more morbidity than (P). Due to superior results we still prefer (A) in surgery of AIS. Our indications for (P) is VC<40%, age, poor bone quality, surgery in upper thoracic spine

Lowest instrumented vertebra (LIV) selection is critical to preventing complications following posterior spinal arthrodesis (PSA) for thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L AIS), but evidence guiding LIV selection is limited. This study aimed to investigate the efficacy of PSA using novel unilateral convex segmental pedicle screw instrumentation (UCS) in correcting TL/L AIS, to identify radiographic parameters correlating with distal extension of PSA, and to develop a predictive equation for distal fusion extension using these parameters. We reviewed data (demographic, clinical, radiographic, and SRS-22 questionnaires) preoperatively to 2-years' follow-up for TL/L AIS patients treated by PSA using UCS between 2006 to 2011. 53 patients were included and divided into 2 groups: Group-1 (n=36) patients had PSA between Cobb-to-Cobb levels; Group-2 (n=17) patients required distal fusion extension. A mean curve correction of 80% was achieved. Mean postoperative LIV angle, TL/L apical vertebra translation (AVT), and trunk shift were lower than previous studies. Six preoperative radiographic parameters significantly differed between groups and correlated with distal fusion extension: thoracic curve size, thoracolumbar curve size, LIVA, AVT, lumbar flexibility index, and Cobb angle on lumbar convex bending. Regression analysis optimised an equation (incorporating the first five parameters) which is 81% accurate in predicting Cobb-to-Cobb fusion or distal extension. SRS-22 scores were similar between groups. We conclude that TL/L AIS is effectively treated by PSA using UCS, six radiographic parameters correlate with distal fusion extension, and a predictive equation incorporating these parameters reliably informs LIV selection and the need for fusion extension beyond the caudal Cobb level

A new anterior intrapelvic approach for the surgical management of displaced acetabular fractures involving predominantly the anterior column and the quadrilateral plate is described. In order to establish five ‘windows’ for instrumentation, the extraperitoneal space is entered along the lateral border of the rectus abdominis muscle. This is the so-called ‘Pararectus’ approach. The feasibility of safe dissection and optimal instrumentation of the pelvis was assessed in five cadavers (ten hemipelves) before implementation in a series of 20 patients with a mean age of 59 years (17 to 90), of whom 17 were male. The clinical evaluation was undertaken between December 2009 and December 2010. The quality of reduction was assessed with post-operative CT scans and the occurrence of intra-operative complications was noted. In cadavers, sufficient extraperitoneal access and safe instrumentation of the pelvis were accomplished. In the patients, there was a statistically significant improvement in the reduction of the fracture (pre- versus post-operative: mean step-off 3.3 mm (. sd. 2.6) vs 0.1 mm (. sd. 0.3), p < 0.001; and mean gap 11.5 mm (. sd. 6.5) vs 0.8 mm (. sd. 1.3), p < 0.001). Lesions to the peritoneum were noted in two patients and minor vascular damage was noted in a further two patients. Multi-directional screw placement and various plate configurations were feasible in cadavers without significant retraction of soft tissues. In the treatment of acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach allowed anatomical restoration with minimal morbidity related to the surgical access

Aims

This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days.

We report on the 5 year results of a randomized study comparing TKR performed using conventional instrumentation versus electromagnetic computer-assisted surgery. This study analysed patient reported outcome measures (PROMs) at 5 years utilising the American Knee Society Score (AKSS), Oxford Knee Score (OKS), the Short Form 36 score and range of motion (ROM). Of the 200 patients enrolled 125 completed 5 year follow up, 62 in the navigated group and 63 in the conventional group. There were 28 deceased patients, 29 withdrawals and 16 lost to follow-up. There was improvement in clinical function in most PROMs from 1-5 year follow up across both groups. OKS improved from a mean of 26.6 (12–55) to 35.1 (5–48). AKSS increased from 75.3 (0–100) to 78.4 (−10–100), SF36 from 58.9 (2.5–100) to 53.2 (0–100). ROM improved by an average 7 degrees from 110 degrees to 117 degrees (80–135). There was no statistically significant difference in PROMs between the groups at 5 years. Patients undergoing revision surgery were identified from the dataset and global PACS. There were no revisions within 5 years in the navigated group and 3 revisions in the conventional group, two for infection and one for mid-flexion instability, giving an all cause revision rate of 3.06% at 5 years for this group. There appears to be no significant advantage in clinical function for patients undergoing TKR for OA of the knee with electromagnetic navigation when compared to conventional techniques. There may be an advantage in reducing early revision rates using this technology

Scheuermann's kyphosis is a structural deformity of the thoracic or thoracolumbar spine, which can result in severe pain, neurological compromise and cosmetic dissatisfaction. Modern surgical techniques have improved correction through a posterior-only or antero-posterior approach but can result in significant morbidity. We present our results of the surgical management of severe Scheuermann's kyphosis by a single surgeon with respect to deformity correction, global balance parameters, functional outcomes and complications at latest follow-up. We included 49 patients, of which 46 had thoracic and 3 had thoracolumbar kyphosis. Surgical indications included persistent back pain, progressive deformity, neurological compromise and poor self-image. Fourty-seven patients underwent posterior-only and 2 antero-posterior spinal arthrodesis utilising Chevron-type osteotomies and hybrid instrumentation. Mean age at surgery was 16.0 years with mean postoperative follow-up of 4.5 years. Mean kyphosis corrected from 92.1o to 46.9o (p<0.001). Concomitant scoliosis was eliminated in all of the 28 affected patients. Coronal and sagittal balance was corrected in all patients. Mean blood loss was 24% total blood volume. Mean operation time was 4.3 hours with mean inpatient stay of 9 days. SRS-22 questionnaire improved from a mean preoperative score of 3.4 to 4.6 at 2 years, with high treatment satisfaction rates. Complications included one toxic septicaemia episode but otherwise no wound infections, no junctional deformity, no loss of correction and no requirement for re-operation. Posterior spinal arthrodesis with the use of hybrid instrumentation can safely achieve excellent correction of severe Scheuermann's kyphosis helping to relieve back pain, improve functional outcomes and enhance self-image

Aims

The study objective was to prospectively assess clinical outcomes for a pilot cohort of tibial shaft fractures treated with a new tibial nailing system that produces controlled axial interfragmentary micromotion. The hypothesis was that axial micromotion enhances fracture healing compared to static interlocking.

Background. Exeter Trauma Stem (ETS) is a polished tapered collarless monopolar prosthesis used for cemented hemiarthroplasty for fracture neck of femur. Two modular rasps are available on the instrumentation set. The larger rasp, in practice, rarely fits into the femur making trial reduction impossible. Our hypothesis was that the absence of a trial reduction could affect leg length and stability of the prosthesis. Aim. To evaluate the leg length discrepancy following use of Exeter Trauma Stem for intracapsular fracture neck of femur. Methods. All patients who underwent ETS hemiarthroplasty between June 2009 to March 2010 (n = 100) were included in the study. Radiographic assessment of leg length was performed by two independent assessors based on measurements by Woolson et al. Results. Upto half of the patients had equal leg length measurements. Forty four patients had lengthening of the operated leg with a mean of 10mm (5–25). Further complications included four dislocations. There was no statistical significance between leg lengths and dislocations. Conclusion. Care is needed with regards to correct positioning of the ETS prosthesis to achieve equal leg lengths. Following this study a new intermediate sized modular rasp has been introduced to the instrumentation set

Purpose. Assessment of effectiveness of spinal fixation in conditions of general osteoporosis. Material and methods of studies. 112 patients with multiple osteoporotic pathological vertebral body fractures were surgically treated. Multilevel laminar or transpedicular instrumentation with or without ventral stabilization (group A) was used on 64 of them. The cemented polyaxial screws were used in 48 cases (group B). The patients treated with multilevel transpedicular fixation with cemented screws were included in B-I subgroup. The patients treated with monosegmental fixation (around fractures) with same screws were included in B-II subgroup. The parameters of stability (bone resorption around screws and cement, dislocation of implants, clinical symptoms) were studied in both groups. Outcome results and discussion: In group “A” the parameters of stability were the purest. The displacement of instrumentation with lost of correction has been revealed in 21% of cases. The reoperations were done in 17% of them. In groups B-I and B-II the parameters of stability were the same. There were no clinical signs of instability up to2 years of supervision. In 75% of cases the bone resorption around bone cement has been revealed after 3–6 months. But there were no cases of instrumental displacement. Spinal fixation in treatment of multiple pathological vertebral body fractures in conditions of general osteoporosis using the vertebroplasty with cemented screws provide good stability of the spine for long outcome. This method allows to achieve the clinical result with less invasive approach by shortening of extent of fixation

PURPOSE OF THE STUDY. Occipitocervical fixation and spondylodesis is indicated in various cases of occipitocervical instability. The aim of this retrospective study was to evaluate the results of occipitocervical fixation at our institutions. MATERIAL + METHODS. Between 1997 and 2007, a total of 57 patients underwent occipitocervical fixation (OC) there were 25 men and 32 women, from 4 to 77 years of age. 2 groups, group one - tying wires or cables and group two - screw-rod or screw-plate systems. Indications included trauma in 15, rheumatoid arthritis (RA) in 28, destruction due to psoriasis in one, tumour in eight, and congenital anomalies in five patients. The patients were evaluated at a final follow-up ranging between 12 and 132 months after the primary surgery (average, 42.7 months). Indications for surgery and the method and extent of instrumentation were recorded. The evaluation included pain and neurological deficit assessment, radiographic evidence of the stability of fixation and bone union and intra-operative and early and late post-operative complications. RESULTS. Of the 57 patients, bone fusion was the aim of surgery in 52. Five patients died of associated injuries or serious medical complications shortly after the operation. Of the remaining 47, bone union was achieved in 44 patients (93.6%). Pseudoarthrosis developed in three patients who. In terms of bone union, there was no difference between a short (C0–C2) and a long (C0-CX or C-T) fixation. No differences among fixation materials were found. The differences in percent bone union after spondylodesis between the tying-wire and screw-rod fixation systems were not statistically significant (p>0.05). In the patients treated for RA, psoriasis or congenital anomaly, the Nurick scale score significantly improved at 2 years after surgery (p<0.05). In comparison with the others, the RA patients had a significantly higher number of complications (p<0.05). The patients treated for tumour showed a significant difference between the pre- and post-operative VAS values (p<0.05). DISCUSSION. Of the patients with RA, psoriasis or congenital anomaly, 57.6% showed post-operative improvement in the Nurick scale score by 1–2 but never more than by 2. A decrease in pain intensity and neurological findings was recorded in 88.2% of the patients. This is in agreement with the results published in the international literature. In the patients treated for trauma, a high proportion (53.3%) had neurological deficit, which is unusually high for craniocervical injuries. This can be explained by the fact that OC fixation is used only in the most serious injuries. Of five patients with neurological deficit of Frankel grade A or B, three died and two required mechanical ventilation. Less serious neurological findings of Frankel grade C or D in three patients improved to a normal condition. CONCLUSIONS. Rigid OC fixation is a very effective method for the treatment of craniocervical junction instability. The currently used implants allow us to achieve high stability and efficiency of bone union. Regardless of the instrumentation used, fusion is achieved in more than 90%, and clinical improvement in more than 80% of the patients

Introduction. Short-segment posterior instrumentation for spine fractures is threatened by unacceptable failure rates. Two important design objectives of pedicle screws, bending and pullout strength, may conflict with each other. Hypothesis. Multiobjective optimization study with artificial neural network (ANN) algorithm and genetic algorithm (GA). Materials & Methods. Three-dimensional finite element (FE) methods were applied to investigate the optimal designs of pedicle screws with an outer diameter of 7 mm using a multiobjective approach for these two objectives. Based on the FE results on an L25 orthogonal array, two objective functions were developed by an ANN algorithm. Then, the trade-off solutions known as Pareto optima were explored by a GA. The optimal design was validated by mechanical tests. Results. The knee solutions of the Pareto fronts had simultaneous high bending and pullout strength ranging from 92 to 94 percent of their maxima. The corresponding range of the design parameters was 3.8 to 4.06 mm for inner diameter and 3.21 to 3.3 mm for pitch; 0 mm for beginning position of conical angle, 0.4 mm for proximal root radius, 5 degrees for proximal half angle, and 0.1 mm for thread width. The optimal design was well validated by mechanical tests, comparing with commercially available pedicle screws. Discussion & Conclusions. The optimal design of pedicle screws obtained could achieve an ideal with high mechanical performance in both bending and pullout tests

Introduction. Metal-on-metal hip resurfacing (MOMHR) is a good surgical indication for young active patients. However, it cannot be used in patients with an excessively short femoral head/neck. To address these cases, a new surgical technique has been developed comprising femoral head augmentation using impacted morcellized bone grafts. Methods. 32 osteoarthritis patients who had severe congenital insufficiency of the femoral head/neck were treated with MOMHR combined with femoral head augmentation. Mean patient age was 49 ± 9 years (18–66). The required amount of augmentation was calculated on preoperative X-rays and confirmed during surgery. Using specially designed instrumentation, bone chips produced while reaming the socket and trimming the head were impacted onto the head to achieve the desired reconstruction and lengthening. Finally, the femoral component was cemented. Results. Mean head lengthening was 12 ± 2mm. Mean follow-up was 4.2 years (3–6). Mean preoperative Harris hip score was 58, increasing to 95 at follow-up (p<0.05). Mean leg lengthening was 2.2cm (p=0.001). In all Gruen zones, bone mineral density (BMD) decreased during the first 3 months. At 2 years, in zone 1, mean BMD increased to 96.8% (p=0.009) and to 102.1% in zone 7 (p=0.05). A correlation was found between valgus positioning of the femoral components and increased BMD (p=0.005). To date, only 1 patient has been revised due to socket loosening. Discussion and conclusions. This bone grafting technique expands the use of MOMHR to patients with severe deficiencies of the femoral head, thereby leading to a more anatomical reconstruction with a full recovery of function and BMD of the proximal femur

Study Design. Retrospective review. Objective. To report the technique and results of vertebral column decancellation (VCD) for the management of sharp angular spinal deformity. Summary of Background Data. The goal of management of sharp angular spinal deformity is to realign the spinal deformity and safely decompress the neurological elements. However, some shortcomings related to current osteotomy treatment for these deformities are still evident. Methods. From January 2004 to March 2007, 45 patients (27 males/18 females) with severe sharp angular spinal deformities at our institution underwent VCD. The diagnoses included 29 congenital kyphoscoliosis and 16 Pott's deformity. The operative technique included multilevel VCD, disc removal, osteoclasis of the concave cortex, compression of the convex cortex accompanied by posterior instrumentation with pedicle screws. Preoperative and postoperative radiographic evaluation was performed. Intraoperative, postoperative and general complications were noted. Results. For a kyphosis type deformity, an average of 2.2 vertebrae was decancellated (range, 2to 4 vertebrae). The mean preoperative kyphosis was +98.6° (range, 82° to 138°), and the meankyphosis in the immediate postoperative period was +16.4° (range, 4° to 30°) with an averagepostoperative correction of +82.2° (range, 61° to 124°). For a kyphoscoliosis type deformity, thecorrection rate was 64% in the coronal plane (from 83.4° to 30.0°) postoperatively and 32.5°(61% correction) at 2 years follow-up. In the sagittal plane, the average preoperative curve of88.5° corrected to 28.6° immediately after surgery and to 31.0° at 2 years follow-up. All patientshad solid fusion at latest follow-up. Complications were encountered in 8 patients (17.8%) andincluded transient neurological deficit and complete paralysis (n = 1). Conclusion. Single stage posterior vertebral column decancellation (VCD) is an effective option to manage severe sharp angular spinal deformities

Introduction. To introduce a new classification method and analyze related risk factor about lateral wall perforation associated with lower cervical pedicle screw and free-hand insertion technique. Methods. A Retrospective study was made to analyze 214 patients (1024 screws) with various cervical spine disorders, involved in pedicle screw instrumentation at C3-7 from July 2004 to July 2009. Researchers assessed the position of the screws in the pedicle by carefully probing intraoperatively and studying postoperative thin-slice computed tomography scan. Perforation of lateral wall was classified into two phases. Phase I refers to the burst of the pedicle by screw, which means that the length of screw threads penetrating the external cortex of pedicles on CT scan is 2 mm, whereas in Phase, the length is >2 mm. The Penetrated screws and related factors were analyzed though Backward Stepwise (Wald) Logistic regression. Results. During the follow-up, 2 screws were reported to be broken and 1 screw loosened. Of the screws inserted, total of 129 screws 12.60% have shown violated of lateral pedicle walls, included 101 screws (9.86%) causative of Phase I and 28 screws (2.73%) of Phase II. Two variance were deduced in the regression analysis, which concerned to ratio variance between inner and lateral walls, PRC 0.695, OR value = 2.003and angle difference variance between screws implanted and measurements preoperativePRC −1.542, OR value = 0.214). Conclusions. Free-hand lower cervical pedicle screw insertion in this series was comparatively safety. Phase I Penetration was believed to be safe of vertebral artery and Phase II faced to higher risk of artery damage. The main risk factor of lateral wall perforation was the ratio variance between inner and lateral wall, while the main protection factor was the angle difference variance between screws implanted and CT measurements

INTRODUCTION. Short femoral nail is the most popular instrumentation for femoral trochanteric fractures. PFNA is in widely use and good results are reported. In these papers, fracture classification and evaluation of surgical results were based on plain X-ray. However, some cases of delayed union, non-union, and blade cut out showed no critical problems in immediate postoperative X-ray. Cause of these complications was not able to solve in X-ray analysis. CT scan provides more information about fracture pattern and position of nail and blade. CT analysis is likely to solve the cause of these complications. MATERIALS & METHODS. 20 cases of 36 femoral trochanteric fractures treated with PFNA-II were evaluated by CT scan (pre and post surgery). Four males and 16 females, and average age at surgery was 80.5 (65–100). Eleven cases were A1 fracture and 9 cases were A2 fracture in AO classification. Nail insertion hole was made by custom made Hollow Reamer. Fracture classification with 3D-CT (Nakano's classification), position of nail insertion hole (relationship between neck or head), and postoperative evaluation with 3D-CT insertion part of nail and blade were investigated. RESULTS. Nakano classified femoral trochanteric fracture into 7 types in 3D-CT. Two subtype in 2 part fracture, 4 subtype in 3 part fracture and 4part fracture. Seven cases were two part fracture, 11 were three part, and 2 were four part in our series. Five cases of 11 in 3 part fracture was considered unstable type. Nail insertion hole of six cases was made posteriory to the connecting line between neck center and head center. Fracture line of greater trochnater in lateral wall opened in 4 cases because of nail insertion. DISCUSSION. Femoral trochanteric fracture was classified by Evans classification or AO classification. However, it is very difficult to classify the fracture by plain X-P. Classification with 3D-CT is very usefull to distinguish which the fracture is stable or unstable. CT analysis will solve the postoperative complications in stable type in X-P classification

Background. The aim of the study was to assess the outcome of internal fixation using two ordinary plates with autogenous bone grafting in the management of non-union of femoral shaft fractures over a period of eleven years. Method. A retrospective study of double plating and autogenous bone grafting for un-united femoral shaft fractures performed by the two Senior Authors between 1996 and 2007. During this period, twenty-one cases were carried out. Details of preoperative, intra-operative, and postoperative findings were assessed. Postoperative follow up was recorded over a period of minimum two years. The procedure was performed using two ordinary plates; a broad lateral and narrow anterior plates. Autogenous cancellous grafts from iliac crest were used in all of the cases, and in some, half fibulas were inserted through the medullary canal of the femur. Results. A total of twenty-one patients were included in the study. All of them received previous treatment. The primary treatment was by intramedullary nailing in thirteen patients, uni-plating in four, external fixator in three, and traction in one. The average age was 32 (range from 16 to 52). The average interval between the initial fracture and the treatment of the non-unions was 13 months (range from 6 to 28 months). All wounds, both at fracture site and the graft donor site, healed primarily except one. That was at an iliac crest graft donor site, where superficial infection occurred, and was treated with antibiotics and healed 6 weeks later. All patients achieved union on an average of 16 weeks (range from 12 to 28 weeks). There has been no failure in implants. The average lower limb shortening was 0.75 cm (range from 0.5 to 1.0 cm). No one requested shoe raise. All the patients regained the preoperative range of motion at the hip and knee joints except four, who had limited flexion to 100 degrees. Conclusion. We conclude that double plating with autogenous bone grafting is not only a convenient method to treat non-union of femoral shaft fractures as it requires minimal instrumentation and equipment, but it should also be considered as a safe and accepted treatment method as postoperatively patients can be discharged early on crutches, with a high success rate. It is less expensive, an important consideration in developing countries

Introduction. The degeneration of the adjacent segment in lumbar spine with spondylodesis is well known, though the exact incidence and the mechanism is not clear. Several implants with semi rigid or dynamic behavior are available to reduce the biomechanical loads and to prevent an adjacent segment disease (ASD). Randomized controlled trials are not published. We investigated the biomechanical influence of dynamic and semi rigid implants on the adjacent segment in cadaver lumbar spine with monosegmental fusion (MF). Materials and Methods. 14 fresh cadaver lumbar spines were prepared; capsules and ligaments were kept intact. Pure rotanional moments of ±7.5 Nm were applied with a Zwick 1456 universal testing machine without preload in lateral bending and flexion/extension. The intradiscal pressure (IDP) and the range of motion (ROM) were measured in the segments L2/3 and L3/4 in following situations: in the native spine, monosegmental fusion L4/5 (MF), MF with dynamic rod to L3/4 (Dynabolt), MF with interspinous implant L3/4 (Coflex), and semi rigid fusion with PEEK rod (CD Horizon Legacy) L3-L5. Results. Under flexion load all implants reduced the IDP of segment L2/L3, whereas the IDP in the segment L3/4 was increased using interspinous implants in comparison to the other groups. The IDP was reduced in extension in both segments for all semi rigid or dynamic implants. Compared under extension to the native spine the MF had no influence on the IDP of the adjacent disc. The rod instrumentation (Dynabolt, PEEK rod) lead to a decreased IDP in lateral bending tests. The ROM in L3 was reduced in all groups compared to the native spine. The dynamic and semi rigid stabilization in the segment L3/4 limited the ROM more than the MF. Discussion. The MF reduced the ROM in all directions, whereas the IDP of the adjacent segment remained unaffected. The support of the adjacent segment by semi rigid and dynamic implants decreased the IDP of both segments in extension mainly. This fact is an agreement with other studies. Compared to our data, no significant effect on the adjacent levels was observed. Interestingly, in our study, the IDP of the adjacent segment is unaffected by MF. The biomechanical influence in the view of an ASD could be comprehended, but is not completely clear. The fact of persistent IDP in the adjacent segment suggests that MF has a lower effect on the adjacent segment degeneration as presumed. Biomechanical studies with human cadaver lumbar spines are limited and depend on age and degenerative situation. The effect on supporting implants on adjacent segment disease in lumbar spine surgery has to be investigated in clinical long term studies

Introduction. Surgical treatment of spinal metastasis belongs to the standards of oncology. The risk of spinal cord compression represents an operative indication. Intraoperative bleeding may vary, depending on the extent of the surgical technique. Some primary tumors, such as the renal cell carcinoma, present a major risk for hemorrhage and preoperative embolisation is mandatory. The purpose of this study is to evaluate the possible benefit of embolisation in different types of primary tumors. Material and Methods. The charts of 93 patients (42 women, 51 men, mean age 60.5 years) who were operated for spinal metastasis, 30 cases with multiple levels, were reviewed. Surgical procedures were classified as: (1) thoracolumbar laminectomy and instrumentation, (2) thoracolumbar corpectomy or vertebrectomy, (3) cervical corpectomy. A preoperative microsphere embolisation was performed in 35 patients. The following parameters, describing blood loss, were evaluated: hemoglobin variation from beginning to end of surgery, blood volume in suction during the intervention, number transfused packed red blood cells units until day 5 after surgery. A Poisson model was used for statistical evaluation. Results. The origins of spinal metastasis were: 28 breast cancer (30.1%), 19 pulmonary carcinoma (20.4%), 16 renal cell carcinoma (17.2%), 30 other cancers (32.3%). An embolisation was always performed in metastasis of renal cell carcinoma. An embolisation was performed in 8 cases in breast, 3 in pulmonary and 9 in other cancers. In the breast cancer group, there was no difference between embolisation versus non-embolisation concerning intraoperative blood loss and transfusion (P=0.404). In the pulmonary group, no difference was found either, but the number of embolisation cases was limited. For other metastasis types, the embolisation had no significant influence (P=0.697). The type of surgical intervention (2) increased intraoperative bleeding significantly in all groups: breast (P=0.002), pulmonary (P=0007), others (P=0.001). The average intraoperative hemoglobin decrease was: 2.3 in renal, 2.5 in breast, 3.0 in pulmonary, 1.9 in other metastasis (P=0.692). Conclusion. Several studies have clearly shown that the preoperative embolisation of renal cell carcinoma is recommended because of their risk of hemorrhage. However, the benefits of this procedure have been less described for other metastatic vertebral lesions. For breast cancer and other carcinoma (mainly digestive and prostate), the results of this study do not indicate a clear benefit for patients who received an embolisation. The same tendency was observed for pulmonary metastasis. The extent of the operation (corpectomy or vertebrectomy) represents the main factor that influences intraoperative bleeding

Aims

The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality.

Aims

Outcome measures quantifying aspects of health in a precise, efficient, and user-friendly manner are in demand. Computer adaptive tests (CATs) may overcome the limitations of established fixed scales and be more adept at measuring outcomes in trauma. The primary objective of this review was to gain a comprehensive understanding of the psychometric properties of CATs compared with fixed-length scales in the assessment of outcome in patients who have suffered trauma of the upper limb. Study designs, outcome measures and methodological quality are defined, along with trends in investigation.