This study aims to 1) determine reported cannabis use among patients waiting for thoracolumbar surgery and to 2) identify demographics and health differences between cannabis-users and non-cannabis users.

This observational cohort study is a retrospective national multicenter review data from the Canadian Spine Outcomes and Research Network registry. Patients were dichotomized as cannabis users and non-cannabis users. Variables of interest: age, sex, BMI, smoking status, education, work status, exercise, modified Oswestry Disability Index (mODI), the Numerical Rating Scales (NRS) for leg and back pain, tingling/numbness scale, SF-12 Quality of Life Questionnaire - Mental Health Component (MCS), use of prescription cannabis, recreational cannabis, and narcotic pain medication. Continuous variables were compared using an independent t-test and categorical variables were compared using chi-square analyses.

Cannabis-use was reported by 28.4% of pre-operative patients (N=704), 47% of whom used prescription cannabis. Cannabis-use was reported most often by patients in Alberta (43.55%), British Colombia (38.09%) and New Brunswick (33.73%). Patients who reported using cannabis were significantly younger (mean=52.9 versus mean=61.21,). There was a higher percentage of concurrent narcotic-use (51.54 %) and smoking (21.5%) reported in cannabis-users in comparison to non-cannabis users (41.09%,p=0.001; 9.51%, p=0.001, respectively). There were significant differences in cannabis-use based on pathology (p=0.01). Patients who report using cannabis had significantly worse MCS scores (difference=3.93, p=0.001), and PHQ-8 scores (difference=2.51, p=0.001). There was a significant difference in work status (p=0.002) with cannabis-users reporting higher rates (20%) of being employed, but not working compared to non-cannabis users (11.13%). Non-cannabis users were more likely to be retired (45.92%) compared to cannabis-users (31.31%). There were no significant differences based on cannabis use for sex, education, exercise, NRS-back, NRS-Leg, tingling-leg, mODI, or health state.

Thoracolumbar spine surgery patients are utilizing cannabis prior to surgery both through recreational use and prescription. Patients who are using cannabis pre-operatively did not differ in regards to reported pain or disability from non-users, though they did in demographic and mental health variables.

This study aims to 1) determine reported cannabis use among patients waiting for thoracolumbar surgery and to 2) identify demographics and health differences between cannabis-users and non-cannabis users.

This observational cohort study is a retrospective national multicenter review data from the Canadian Spine Outcomes and Research Network registry. Patients were dichotomized as cannabis users and non-cannabis users. Variables of interest: age, sex, BMI, smoking status, education, work status, exercise, modified Oswestry Disability Index (mODI), the Numerical Rating Scales (NRS) for leg and back pain, tingling/numbness scale, SF-12 Quality of Life Questionnaire - Mental Health Component (MCS), use of prescription cannabis, recreational cannabis, and narcotic pain medication. Continuous variables were compared using an independent t-test and categorical variables were compared using chi-square analyses.

Cannabis-use was reported by 28.4% of pre-operative patients (N=704), 47% of whom used prescription cannabis. Cannabis-use was reported most often by patients in Alberta (43.55%), British Colombia (38.09%) and New Brunswick (33.73%). Patients who reported using cannabis were significantly younger (mean=52.9 versus mean=61.21,). There was a higher percentage of concurrent narcotic-use (51.54 %) and smoking (21.5%) reported in cannabis-users in comparison to non-cannabis users (41.09%,p=0.001; 9.51%, p=0.001, respectively). There were significant differences in cannabis-use based on pathology (p=0.01). Patients who report using cannabis had significantly worse MCS scores (difference=3.93, p=0.001), and PHQ-8 scores (difference=2.51, p=0.001). There was a significant difference in work status (p=0.002) with cannabis-users reporting higher rates (20%) of being employed, but not working compared to non-cannabis users (11.13%). Non-cannabis users were more likely to be retired (45.92%) compared to cannabis-users (31.31%). There were no significant differences based on cannabis use for sex, education, exercise, NRS-back, NRS-Leg, tingling-leg, mODI, or health state.

Thoracolumbar spine surgery patients are utilizing cannabis prior to surgery both through recreational use and prescription. Patients who are using cannabis pre-operatively did not differ in regards to reported pain or disability from non-users, though they did in demographic and mental health variables.

Pain management in spine surgery can be challenging. Cannabis might be an interesting choice for analgesia while avoiding some side effects of opioids. Recent work has reported on the potential benefits of cannabinoids for multimodal pain control, but very few studies focus on spinal surgery patients. This study aims to examine demographic and health status differences between patients who report the use of (1) cannabis, (2) narcotics, (3) cannabis and narcotics or (4) no cannabis/narcotic use.

Retrospective cohort study of thoracolumbar patients enrolled in the CSORN registry after legalization of cannabis in Canada. Variables included: age, sex, modified Oswestry Disability Index (mODI), Numerical Rating Scales (NRS) for leg and back pain, tingling/numbness leg sensation, SF-12 Quality of Life- Mental Health Component (MCS), Patient Health Questionnaire (PHQ-9), and general health state. An ANCOVA with pathology as the covariate and post-hoc analysis was run.

The majority of the 704 patients enrolled (mean age: 59; female: 46.9%) were non-users (41.8%). More patients reported narcotic-use than cannabis-use (29.7% vs 12.9%) with 13.4% stating concurrent-use. MCS scores were significantly lower for patients with concurrent-use compared to no-use (mean of 39.95 vs 47.98, p=0.001) or cannabis-use (mean=45.66, p=0.043). The narcotic-use cohort had significantly worse MCS scores (mean=41.37, p=0.001) than no-use. Patients reporting no-use and cannabis-use (mean 41.39 vs 42.94) had significantly lower ODI scores than narcotic-use (mean=54.91, p=0.001) and concurrent-use (mean=50.80, p=0.001). Lower NRS-Leg pain was reported in cannabis-use (mean=5.72) compared to narcotic-use (mean=7.19) and concurrent-use (mean=7.03, p=0.001). No-use (mean=6.31) had significantly lower NRS-Leg pain than narcotic-use (p=0.011), and significantly lower NRS-back pain (mean=6.17) than narcotic-use (mean=7.16, p=0.001) and concurrent-use (mean=7.15, p=0.012). Cannabis-use reported significantly lower tingling/numbness leg scores (mean=4.85) than no-use (mean=6.14, p=0.022), narcotic-use (mean=6.67, p=0.001) and concurrent-use (mean=6.50, p=0.01). PHQ-9 scores were significantly lower for the no-use (mean=6.99) and cannabis-use (mean=8.10) than narcotic-use (mean=10.65) and concurrent-use (mean=11.93) cohorts. Narcotic-use reported a significantly lower rating of their overall health state (mean=50.03) than cannabis-use (mean=60.50, p=0.011) and no-use (mean=61.89, p=0.001).

Patients with pre-operative narcotic-use or concurrent use of narcotics and cannabis experienced higher levels of disability, pain and depressive symptoms and worse mental health functioning compared to patients with no cannabis/narcotic use and cannabis only use. To the best of our knowledge, this is the first and largest study to examine the use of cannabis amongst Canadian patients with spinal pathology. This observational study lays the groundwork to better understand the potential benefits of adding cannabinoids to control pain in patients waiting for spine surgery. This will allow to refine recommendations about cannabis use for these patients.

Anatomical variations in the attachment between the tendon of the flexor hallucis longus (FHL) and of the flexor digitorum longus (FDL) are not clearly detailled in the medical literature. Twenty-four cadaver specimens were dissected and the distal anatomical relationship between the FHL and the FDL were analyzed and measured. There are three configurations of the attachment between the tendon of the FHL and of the FDL. The absence of a tendon link seems to be more common than has been published to date in the medical literature. We have also shown that the same patient may have a different configuration on each foot.

Anatomical variations in the links between the tendon of the flexor hallucis longus (FHL) and of the flexor digitorum longus (FDL) are not clearly detailled in the medical literature.

There are three configurations of links between the tendon of the FHL and of the FDL. The absence of a tendon link seems to be more common than has been published to date in the medical literature.

A surgeon who wants to preserve the distal function of the FDL after transferring the proximal portion of the latter should perform surgical tenodesis initially or explore the FHL-FDL attachment and perform tenodesis when a type-3 configuration is discovered.

We distinguish three different configurations of the distal link between the FHL and the FDL. In type 1, a tendinous band from the FHL is attached to the FDL (42%, 10/24). In type 2, a tendinous band from the FHL is attached to the FDL and another one from the FDL is attached to the FHL (42%, 10/24). In type 3, there is no attachment (17%, 4/24). In no case is there only an attachment from the FDL to the FHL. In four cadavers a different configuration was present on each foot. The diameter of the attachment compared with the “donor” tendon varied between 37 and 53%.

Twenty-four intact cadaver specimens were dissected and the distal anatomical relationship between the FHL and the FDL were analyzed. The width of the tendons and their attachments were measured to the nearest half-millimetre.

Entre Janvier 1998 et Février 2001, 39 patients avec une fracture du 5e distal du tibia furent traités primaire-ment à l’aide d’un enclouage centromédullaire vérouillé statique. La population étudiée est composée de 24 hommes et 15 femmes, âgés de 40 ans en moyenne. Le suivi moyen est de 12,9 mois.

Une union osseuse a été obtenue pour toutes les fractures. Le temps moyen de consolidation fut de 21,5 semaines (incluant un cas à 68 semaines). Quatre patients on présenté un retard d’union, et une chirurgie additionnelle fut requise chez trois d’entre eux. Deux patient ont présenté une malunion. Ces deux cas étaient associés à une fracture du péroné distal qui n’avait pas été ostéosynthésée.

Les fractures du tibia distal demeurent un défi thérapeutique pour le chirurgien orthopédique. L’enclouage centromédullaire alésé verrouillé statique est une méthode d’ostéosynthèse sécuritaire et efficace pour ces fractures, tel que démontré dans notre série.

L’enclouage centromédullaire est désormais considéré comme la méthode d’ostéosynthèse la plus appropriée dans le traitement des fractures déplacées de la diaphyse tibiale. Son usage s’est étendu aux fractures des tiers proximaux et distaux du tibia. Par contre, beaucoup moins de preuves sur l’efficacité d’un tel traitement existent.

Les fractures du tibia distal demeurent un défi thérapeutique pour le chirurgien orthopédique. L’enclouage centromédullaire alésé verrouillé statique est une méthode d’ostéosynthèse sécuritaire et efficace pour ces fractures, tel que démontré dans notre série. Le montage offre une stabilité suffisante pour la mobilisation et la mise en charge précoce. L’adhérence à une technique minutieuse est requise et permet d’éviter une malunion.

Notre série confirme la place de l’enclouage centromédullaire comme méthode d’ostéosynthèse primaire des fractures du 1/5 distal du tibia.

Entre Janvier 1998 et Février 2001, 39 patients avec une fracture du 5e distal du tibia furent traités primaire-ment à l’aide d’un enclouage centromédullaire vérouillé statique.

La population étudiée est composée de 24 hommes et 15 femmes, âgés de 40 ans en moyenne (16 à 79 ans). Le suivi moyen est de 12,9 mois (7 à 24 mois)

Une union osseuse a été obtenue pour toutes les fractures. Le temps moyen de consolidation fut de 21,5 semaines (incluant un cas à 68 semaines). Quatre patients on présenté un retard d’union, et une chirurgie additionnelle fut requise (dynamisation du clou) chez trois d’entre eux.

Deux patient ont présenté une malunion, soit 5o de varus dans un cas et 7o de valgus dans un cas. Ces deux cas étaient associés à une fracture du péroné distal qui n’avait pas été ostéosynthésée.

Aucune perte de réduction n’a été notée en postopératoire.

Cinq complications furent notées, soit un bris de matériel (vis de verrouillage n’entrainant pas de séquelle foinctionnelle et ne requérant pas de réopération), deux syndromes du compartiment et deux atteintes neurologiques (sciatique poplité externe). Aucune infection ni problème cutané ne sont survenus.

En moyenne, la mise en charge fut autorisée à 5,8 semaines postopératoire.

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