To study the preliminary clinical results of patients submitted to kyphoplasty with an expandable titanium cage (OsseoFix).

Between 09-2008 and 02-2009 16 patients (6 men, 10 women, total 36 vertebrae) with a mean age of 67 (23 to 81) were submitted to kyphoplasty using a system involving the implantation of an expandable titanium cage (OsseoFix) for the treatment of fractures in the lower thoracic and lumbar spine. Five patients were submitted to kyphoplasty at one level, 4 at two levels, 5 at three levels, and 2 at four levels. Two patients additionally needed a posterior spinal fusion. The underlying causes for the spinal fractures were: secondary osteoporosis (7), recent acute trauma (5), and malignancy (4: 1 Hodgkin lymphoma, 1 Non-Hodgkin lymhoma, 1 metastatic breast cancer, 1 metastatic prostate cancer). In 8 patients biopsy specimens were harvested at the same procedure.

Mean follow-up time was 4 months (2 to 6). No intra-operative complication occurred. No bone cement leakage or pulmonary embolism was observed. The mean pain improvement, as measured with the VAS scale, was 5,12 (7,81 preop – 2,69 postop). The mean vertebral body height restoration was 19,5%, and the kyphotic angle was corrected by a mean of 2,24°.

The main advantage of using an expandable metal cage in kyphoplasty is the improved reduction of the vertebral body compression and the minimal risk of bone cement leakage. Especially in young patients, the maintenance of the reduction could potentially be achieved even without cementation, by the mere support provided by the cage. A longer follow-up time is needed for the safe validation of these preliminary encouraging results

Aims: To evaluate the value of 99mTc-labeled mono-clonal Fab antibodies (Leukoscan) in the diagnosis of septic loosening of total hip arthroplasty (THA). Methods: 16 patients (mean age 63.2 years) with hip arthroplasty (5 hemi,9 cementless,2 cemented THAs) were investigated for deep infection with the use of Leukoscan. Patient selection was based on a “high-risk protocol”. All patients were clinically evaluated using modified HHS and each patient’s workout included x-rays, WBC, ESR, CRP, dynamic bone scan 99mTc-MDP and Leukoscan. Two (2) patients were treated by wide debridement and continuous lavage,6 with revision surgery and 8 with Girdlestone. Histologic samples and cultures were received and their results were compared with Leukoscan’s findings. Results: Preoperative evaluation of the patients revealed as major risk factors:pathologic blood tests (16), previous surgical interventions (13), implant loosening (8), wound infection (7). Mean mHHS was 58 (28–80), mean ESR 51 (23–87 mm/h), mean CRP 4,1 (0,9–18 mg/dl). Bone scans were evaluated as 15 positive and 1 negative and they were matched with 15 positive and 1 negative Leukoscan respectively. Twelve (12) positive histopathologic results and 2 positive tissue cultures were matched with 14 positive Leukoscans, while 1 positive Leukoscan was not verified by positive histopathologic findings of chronic infection. Bacteriae identified were: S.epidermidis 5x, S.aureus 2x, Escherichia Coli 1x, S.saprophyticus 1x, Klebsiella pneumoniae 1x. Conclusions: Leukoscan seems to offer a reliable diagnostic tool for investigation of septic bone infection in presence of hip arthroplasty, presenting a senstitivity of 100% and spesitivity of 93,75%. Proper patient selection, based on diagnostic criteria and risk factors is essential.

Aim: To investigate the potential of biological fixation of cementless total hip arthroplasty (THA) in patients over 75 years old, with diagnosed osteoporosis.

Material-Methods: Between 1994–2000, 30 patients (mean age 77.3 years) underwent cementless THA.25 patients were found at the last follow-up, which ranged from 3–7 years (mean follow-up,4 years).THA was performed due to primary osteoarthritis (n=18), subcapital fracture (n=5), or dysplastic hip (n=2).7 Spotorno,9 Synergy and 9 Perfecta prostheses were implanted.Singh index was used for the evaluation of osteoporosis and Harris Hip Score (HHS) was used for the clinical evaluation of each patient.Modified Wixon score was used for the evaluation of stability probability of the tapered stem.Engh score was calculated for the evaluation of osseointegration of the porous coated implants.

Results: Pre and post-operative mean Singh index was grade 4.Mean HHS at the last follow-up was 88.6.For the Spotorno stem a stable fixation probability was calculated at 74.8%.Porous coated stems provided +13.45 mean Engh score,implying satisfactory fixation of the implant.Postoperative systematic complications are not reported.

Conclusions: In patients over 75 years old, with possible cardiopulmonary disease, cementless total hip arthroplasty offers a reliable treatment,regardless the presence of osteoporosis.Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.

Aim:Evaluate the results of primary cemented/cementless THA for the treatment of displaced femoral neck fractures.

Material-Method:121 pts with femoral neck fractures underwent THA 2.1 days on average after their admission.The mean follow up period 4.1 y.112 pts had Garden III-IV fractures,9 pts had Garden II fractures.A cementless THA was applied in 75 pts (Group A,average age 61.4 y),46 pts were treated with cemented THA (Group B,72.4 y).Last follow up evaluation with Harris Hip Score (HHS) and radiological assessment with the Engh/Wixon scores was available in 92 pts.In 25 elderly pts a cementless THA was applied due to established impairment of their cardiopulmonary status.

Results:The mean HHS was 82,3.Radiological score for the cementless THA:+5,8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the prosthesis Perfecta,Synergy) and a 74,8% liability of integration according to Wixon scale (Spotorno).Complications:Early dislocation 3,loosening 5,heterotopic ossification 8,periprosthetic fracture 1,femoral nerve paresis 1,wound infection 1.No systematic complications were noted in the elderly patients with cardiopulmonary disorders,possible due to selection of a cementless THA.

Conclusions:THA (cemented/cementless) for the treatment of displaced femoral neck fractures give very good midterm results.Cementless THA is probably the choice of treatment in elderly pts with cardiopulmonary disorders.

We evaluate the patients with lumbar spinal stenosis in multiple levels that were treated with posterior decompression and posterolateral fusion, using transpedicular screw fixation system. Twenty-six patients, mean age 65.7 years (range 49 to 77years), with lumbar spinal stenosis, in more than three levels, were treated surgically between 1994 and 2002. Indications for surgical treatment included low back pain and neurogenic claudication for more than 6 months. The diagnostic approach consisted of x-rays, MRI, myelography and myelo-CT. Oswestry disability score and VAS (visual analog scale), were used for the clinical evaluation of the patients. Surgical procedure consisted of wide posterior decompression, regarding laminectomy, complete or incomplete facetectomy and foraminotomy, combined with posterolateral fusion, using transpedicular screw systems and bone graft. Fusion in three levels was performed at seven patients, in four levels at ten, in five levels at seven, in six and seven levels at one patient respectively.

Mean follow-up was 26.8 months (range 12 to 38 months). Oswestry score and VAS revealed improvement 40.75% and 5.4 levels respectively. The better results were concerned to pain (2.88 levels improvement) and the less good to lifting (1.58 levels improvement). Two cases with superficial infections were observed and treated with surgical debridement. Screw breakage was observed in 1 patient and treated conservatively. Loosening of two sacral screws, which were removed, was observed in one patient.

We conclude that myelography and myelo-CT revealed with satisfactory accuracy intra and outer foraminal lumbar spinal stenosis. Posterior decompression and instrumented fusion, offer satisfactory clinical results in patients with lumbar spinal stenosis in multiple levels when performed by experienced surgical team.

Purpose: We present the midterm results of conservative treatment of upper (atlas and axis) cervical spine injuries and we propose a CT-based radiological follow-up study.

Material and Methods: In a 12 year period (1990–2001), 45 patients (33 male and 12 female) with a mean age 37.2 years (range 15–75) were presented with an acute injury of the upper cervical spine. There were 19 fractures of the atlas (8 Jefferson’s fractures, 6 isolated lateral mass fractures and 5 posterior arch fractures) and 26 axial fractures (12 odontoid fractures, types I–III according to Anderson’s classification and 14 traumatic spondylolisthesis, types I–II according to Effendi classification). Twenty (20) patients were immobilized using halo-vest and 25 Minerva orthosis. Two (2) patients presented with Brown-Sequard syndrome. All patients were retrospectively reviewed and had clinical and radiological follow-up study (plain films and CT spiral reconstruction films).

Mean follow-up was 6.2 years. Mean immobilization time was 3.8 months range.

Results: Patients with incomplete neurological lesion did not recover. One patient with an isolated atlas lateral mass fracture, developed a hemiparesis during his hospitalization, which was partially resolved. In the final follow-up study, all patients presented a stable upper cervical spine, on the dynamic flexion/extension plain films. In the final CT spiral reconstruction films, fracture line was evident in 12 patients (27%), while atlantoaxial joint incongruity was obvious in 5 patients. Seven (7) patients (16%) complained for residual neck pain and stiffness and presented reduced range of motion.

Conclusion: Conservative treatment of atlantoaxial injuries is effective and offers a stable upper cervical spine. Solid fracture union is not always present. CT spiral reconstruction is very helpful in detecting transverse ligament efficacy and atlantoaxial joint incongruity.

To investigate the potential of biological fixation of cementless total hip prosthesis in patients over 75 years old, with diagnosed osteoporosis.

Between 1994–2000, 30 patients (mean age 77.3 years) underwent total hip arthroplasty (THA). Twenty-two (22) patients, 10 male and 12 female, were found at the last follow-up, which ranged from 1, 5–7 years (mean follow-up, 3 years). THA was performed due to primary osteoarthritis (n=16), subcapital fracture (n=4), or dysplastic hip (n=2). Eight (8) smooth, tapered design (CLS) and 14 proximally porous coated prostheses were implanted. Smgh index was used for the evaluation of osteoporosis and modified Harris Hip Score was used for the clinical evaluation of each patient. Modified Wixon score was used for the evaluation of stability probability of the tapered stem. Engh score was calculated for the evaluation of osseointegration of the porous coated implants.

Pre and post-operative mean Singh index was grade 4. Mean modified Harris Hip Score at the last follow-up was 88.6. For the CLS-Spotomo stem a stable fixation probability was calculated at 74.8%, while possible instability was calculated at 48.17%. Porous coated stems provided +13.45 mean. Engh score, implying satisfactory fixation of the implant. Post-operative systematic complications are not reported, in contrast to 3 dislocations in the first post-operative period, which were treated by closed reduction.

In patients over 75 years old, with possible cardiopulmonary disease, cementless total bip arthroplasty offers a reliable treatment, regardless the presence of osteoporosis. Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.