Lumbar fusion is known to reduce the variation in pelvic tilt
between standing and sitting. A flexible lumbo-pelvic unit increases
the stability of total hip arthroplasty (THA) when seated by increasing
anterior clearance and acetabular anteversion, thereby preventing
impingement of the prosthesis. Lumbar fusion may eliminate this protective
pelvic movement. The effect of lumbar fusion on the stability of
total hip arthroplasty has not previously been investigated. The Medicare database was searched for patients who had undergone
THA and spinal fusion between 2005 and 2012. PearlDiver software
was used to query the database by the International Classification
of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural
code for primary THA and lumbar spinal fusion. Patients who had
undergone both lumbar fusion and THA were then divided into three
groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The
rate of dislocation in each group was established using ICD-9-CM codes.
Patients who underwent THA without spinal fusion were used as a
control group. Statistical significant difference between groups
was tested using the chi-squared test, and significance set at p
<
0.05.Aims
Patients and Methods
There are many causes of paraspinal muscle weakness which give rise to the dropped-head syndrome. In the upper cervical spine the central portion of the spinal cord innervates the cervical paraspinal muscles. Dropped-head syndrome resulting from injury to the central spinal cord at this level has not previously been described. We report two patients who were treated acutely for this condition. Both presented with weakness in the upper limbs and paraspinal cervical musculature after a fracture of C2. Despite improvement in the strength of the upper limbs, the paraspinal muscle weakness persisted in both patients. One ultimately underwent cervicothoracic fusion to treat her dropped-head syndrome. While the cause of the dropped-head syndrome cannot be definitively ascribed to the injuries to the spinal cord, this pattern is consistent with the known patho-anatomical mechanisms of both injury to the central spinal cord and dropped-head syndrome.
Thoracic back pain caused by osteoarthritis of a single costovertebral joint is a poorly recognised condition. We report a series of five patients who were successfully treated by resection arthroplasty of this joint. Each had received a preliminary image-guided injection of local anaesthetic and steroid into the joint to confirm it as the source of pain. The surgical technique is described. There were no complications. The pain improved from a mean of 7.0 (6 to 8) on a visual analogue scale to 2.0 (0 to 4) post-operatively. The final post-operative Oswestry disability index was a mean of 19.4 (9 to 38). Isolated osteoarthritis of a costovertebral joint is a rare but treatable cause of thoracic back pain. It is possible to obtain excellent short- and intermediate-term relief from pain with resection arthroplasty in appropriately selected patients.
