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: 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.

Introduction: The Charite Mark 3 disc prosthesis has been used by the senior author for ten years. There has always been a question mark over the wear properties of the high density polyethylene spacer used in this prosthesis.

Methods: Ten patients who have received Charite implants, eight, nine and ten years ago were subjected to helical CT scanning. Slices at 3 mm. intervals were taken across the prosthetic levels. Fifteen prostheses were studied. Four clinicians, two of whom were radiologists and one a spinal fellow, assessed the CT scans against a standard protocol. Since the original heights of the prostheses were known, it was possible to measure prosthetic height and therefore get an estimate of wear. In addition, areas of osteolysis around the prostheses were estimated, again as a sign of wear.

Results: Remarkably little wear or wear debris was noted around the 15 prostheses.

Conclusions: Although this is a small series, it confirms that the medium-term performance of this prosthesis as far as wear is concerned is good.