Cement pressurisation in the distal humerus is technically difficult due to the anatomy of the humeral intramedullary (IM) cavity. Conventional cement restrictors often migrate proximally or leak, reducing the effect of pressurisation during implantation. Theoretically with a better cement bone interdigitation, the longevity of the elbow replacement can be improved. The aim of this cadaveric study was to evaluate the usefulness of a novel technique for cementation. Eight paired fresh frozen cadaveric elbows were randomly allocated to conventional cementing techniques or cementing using a paediatric foley catheter as a temporary restrictor. The traditional cementing technique consisted of canal preparation using irrigation, brushing and drying prior to cementation, with no use of a cement restrictor. The new technique involved same canal preparation but prior to cementation a size 8 foley catheter was introduced and the balloon inflated to act as a temporary cement restrictor. The humeri were cut into 10mm sections. Each slice was photographed and radiographed. This dual imaging technique was used to establish the best methodology for evaluation of cement penetration. Cement penetration was calculated as a ratio of the area of intra-medullary cavity occupied by the cement.Introduction
Method
The management of discogenic pain continues to be controversial. The results for operative and non-operative management are variable. This study aims to look at the results of interbody fusion versus dynamic stabilisation in patients with discogenic pain. Diagnosis was made by use of MRI and provocative discography. All patients had pre-operative Visual Analogue Scores and Oswestry Disability Index scores. Patients were then assessed in the post-operative period at 6 months, 1 year and 2 years. Case matched series with 19 patients in each group with a mean follow-up of 24 months. In comparison of both techniques there were no statistically significant differences but the dynamic stabilisation group had improved outcomes with both measures. The results did raise some further issues, as several patients in each group were either worse or had no significant improvement following surgery. In conclusion this paper raises concerns regarding the use of surgery for patients with discogenic pain. If surgery is however considered, dynamic stabilisation is a valid alternative to interbody fusion.
