Identifying cervical spine injuries in confused or comatose patients
with multiple injuries provides a diagnostic challenge. Our aim
was to investigate the protocols which are used for the clearance
of the cervical spine in these patients in English hospitals. All hospitals in England with an Emergency Department were asked
about the protocols which they use for assessing the cervical spine.
All 22 Major Trauma Centres (MTCs) and 141 of 156 non-MTCs responded
(response rate 91.5%).Aim
Patients and Methods
Recently published results suggest insertion of shorter screws in L5/S1 stand-alone anterior interbody fusion, fearing S1 nerve root violation. However, insertion of shorter screws led to screw fixation failure and new onset of S1 body fractures. Retrospective review of patients with L5/S1 stand-alone anterior interbody fusion, focussing on screw length, radiological outcomes (especially metal work failure, screw fixation and S1 body fractures) and new onset of S1 nerve root irritation.Introduction
Material and Methods
Lumbar spondylolysis is a fatigue fracture of the pars interarticularis and correlates with Spina Bifida Oculta (SBO) in 67%. Load is normally transferred across the arch in axial rotation. Bifid arch results in increased strain across the isthmus of the loaded inferior articular process.Introduction
Hpothesis
Due to co-morbidities in elderly like atherosclerosis and approach-related risks, anterior lumbar surgery is mainly recommended for younger patients. We reviewed approach-related complications in anterior lumbar surgery in senior patients for complex reconstructions. Retrospective review of 12 patients (8 female and 4 male), mean age 65.5±4.9 years, treated with anterior fusion mainly for degenerative scoliosis and lumbar kyphosis in between 2007-10. 9(75%) patients had multilevel procedures. Most common co-morbidities were atherosclerosis (CT-proven in 7 patients), coronary heart disease and COPD. Renal impairment was present preoperatively in 3 patients.Introduction
Materials and Methods
Iatrogenic spondylolisthesis occurs infrequently after posterior decompression. Posterior surgery is challenging due to altered anatomy and scarring. Anterior lumbar interbody fusion (ALIF) allows indirect decompression, restoration of lordosis and fusion. Retrospective review of 6 patients (5 female, 1 male, mean age 64±5.8 years) with iatrogenic spondylolisthesis (5 L4/L5; 1 L4/L5) treated with stand-alone ALIF (Synfix, BMP2). Assessment of pelvic incidence, listhesis, pre- and post-operative ODI, VAS, global lumbar lordosis and segmental lordosis as outcome measurements.Introduction
Material and Methods
Isolated U-shaped sacral fractures are rare entities, mostly seen in polytraumatized patients, and hence, they are difficult to diagnose. While the pelvic ring remains intact across S2/S3, the U-shaped fracture around S1 leads to marked instability between the base of the spine and the pelvis. As severe neurological deficits can occur, timely treatment of these fractures is crucial. We present a novel technique of percutaneous reduction and trans-sacral screw fixation in U-shaped fractures. 3 multiply injured patients with u-shaped sacral fractures (female, age 21.7±7.23). Two underwent immediate fracture fixation. In the third case delayed reduction and fixation was performed after referral 6 weeks following open decompression. In prone position, a pair of Schanz pins was inserted into pelvis at the PSIS. A second pair of Schanz pins was inserted into S1 or L5. All pins were inserted percutaneously. The fracture was reduced indirectly, using the Schanz pins as levers. After image intensifier control of the reduction result, two trans-sacral screws were inserted for finite fixation.Introduction
Material and Methods
