Posterior lumbar interbody fusion (PLIF) is indicated for many patients with pain and/or instability of the lumbar spine. We performed 36 PLIF procedures using the patient’s lumbar spinous process and laminae, which were inserted as a bone graft between two vertebral bodies without using a cage. The mean lumbar lordosis and mean disc height to vertebral body ratio were restored and preserved after surgery. There were no serious complications. These results suggest that this procedure is safe and effective

We describe a patient with traumatic right-sided invagination of two consecutive laminae into the spinal canal. The injury resembled a greenstick fracture and resulted in an acute Brown-Séquard syndrome. There was also an undisplaced hangman’s fracture of the axis vertebra. These injuries were caused by an acute hyperextension and axial compression of the cervical spine. Open reduction and internal fixation of the laminar fractures without fusion was followed by full neurological recovery within six weeks

We treated 12 patients with multilevel stenosis of the cervical canal after spondylosis or ossification of the posterior longitudinal ligament by an expansive open-door laminoplasty, stabilised by using an anchor system.

The preoperative sagittal diameter of the canal was 9.8 mm(±2.2) which was increased to 16.1 mm (±2.9) after surgery. The mean expansion ratio of the canal was 64% (42 to 100). The anchoring systems did not fail during the follow-up period (mean 29.5 months), and the decompression was maintained. The use of anchor systems to stabilise the posterior elements after laminoplasty is a simple and effective technique for maintaining the increased sagittal diameter of the canal.

Aims

The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF.

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The optimal procedure for the treatment of ossification of the posterior longitudinal ligament (OPLL) remains controversial. The aim of this study was to compare the outcome of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) with posterior laminectomy and fusion with bone graft and internal fixation (PTLF) for the surgical management of patients with this condition.

Ultrasound can be used to outline the spinous processes and the laminae, and thus to measure axial rotation. Using our own technique, we measured vertebral rotation in 47 patients with idiopathic scoliosis. There was a strong linear relationship between the Cobb angle and the rotation of the apical vertebra in untreated patients, but this relationship was lost in patients who had had brace treatment. Vertebral rotation can easily be measured by ultrasound. This is a harmless and fairly rapid investigation which can be used at routine follow-up examination of patients with idiopathic scoliosis

1. This paper presents the neurological findings in forty-one patients with rheumatoid arthritis complicated by atlanto-axial subluxation. 2. A method of radiological measurement of the subluxation is described. The extent of neurological involvement was found not to correspond with the degree of subluxation. 3. Fusion of the atlanto-axial complex or of the occipito-atlanto-axial complex is indicated only in patients with progressive neurological signs and in those suffering from acute neurological episodes. 4. Difficulty in obtaining fusion with cancellous bone grafts alone was encountered and we recommend wiring of the laminae C.1 to C.2 in addition

In 17 patients (eleven males, six females) with Morquio-Brailsford syndrome (mucopolysaccharidosis IV) we have used onlay femoral and tibial autografts placed posteriorly and secured to the laminae of C1 and C2 to obtain satisfactory occipito-C1/C2 posterior fusion. They were immobilised postoperatively in a halo-plaster body jacket for four months. The age at operation varied between three and 28 years. Those with myelopathic symptoms of recent onset made some recovery, but severely myelopathic patients showed little or no recovery. We advise prophylactic occipitocervical fusion in these patients since the cartilaginous dens is not strong enough to ensure atlanto-axial mechanical stability

Of 232 patients with evidence of lumbar spinal stenosis, 13 had symptoms of meralgia paraesthetica. Myelography demonstrated that in all but one of these 13 cases the L3-4 level was involved by stenosis; in 12 matched control patients with spinal stenosis, none had involvement at this level. We found that both the ligamentum flavum and the laminae at L3-4 level were thicker than in a control group. Decompressive laminectomy at the L3-4 level significantly reduced the area of hypo-aesthesia in the thigh, effecting complete cure in seven of the 11 cases. Meralgia paraesthetica is not uncommon in patients with spinal stenosis and is referable to changes at the L3-4 level. It seems that many cases of meralgia may have a spinal origin

1. The management of severe kyphosis of the lumbar spine in association with myelomeningocele is discussed. 2. Neonatal spinal osteotomy-resection has been performed in six patients with partial correction of the deformity and a greatly improved ease of closure and healing of the skin defect. The severity of lower limb paralysis has been diminished compared with the complete paraplegia that almost always results from conservative management of closure of the defect without osteotomy. 3. In an older child who has not had the benefit of neonatal osteotomy and who has complete lower limb paralysis, transverse spinal osteotomy or excision of the prominent laminae and pedicles on each side of the midline makes possible the fitting of apparatus for walking and diminishes the liability to recurrent ulceration of the skin

An electrophysiological system for monitoring the spinal cord during operations for scoliosis is described. During the development of the technique the recording of cortical somatosensory evoked potentials from the scalp and spinal somatosensory evoked potentials from the laminae or spines was superseded by the positioning of recording electrodes in the epidural space cephalad to the area to be fused. All recordings were made in response to stimulation of the posterior tibial nerve at the knee. Results in 138 patients are presented and the findings in three patients who exhibited neurological deficits after operation are described. It is concluded that spinal somatosensory evoked potentials are sensitive to minor spinal cord impairment, possible due to ischaemia, and that these changes may be reversed when the cause is quickly remedied. The monitoring system interferes minimally with anaesthetic and surgical procedures and is now performed as a routine

The fine structure of palmar fascia from patients with Dupuytren's contracture (DC) was compared with that from patients with carpal tunnel syndrome (CTS). In contrast to previous assumptions, the ultrastructure of fibroblasts both in vivo and in vitro from DC and CTS appeared identical, indicating that myofibroblasts are not specific to DC. The major differences between DC and CTS were: 1) a sixfold and fortyfold increase in fibroblast density in cord and nodular areas of DC compared with CTS; 2) a more disorganised pattern of collagen fibrils in DC; and 3) markedly narrowed microvessels surrounded by thickened, laminated basal laminae and proliferating fibroblasts in DC compared with CTS. To account for these morphological changes a hypothesis is presented which proposes that oxygen-free radicals cause pericytic necrosis and fibroblastic proliferation. This hypothesis provides a potential avenue for therapy of DC and other fibrotic conditions

1. In this investigation one was impressed by the close relationship that exists between the constituent parts of the intervertebral discs and the surrounding supporting structures. The part that is responsible for the maintenance of a co-ordinated balance between these structures, and hence for the effective mechanism of the spine, is the nucleus pulposus. 2. The cruciate arrangement of the annulus fibrosus is related to spinal function, and the angle of intersection of consecutive laminae of the annulus fibrosus is more or less constant. 3. In the Bantu it was found that the interspinous and supraspinous ligaments differ from the classical descriptions given in anatomical text-books. 4. The movements taking place between two vertebrae are comparable to those of a rocking-horse. 5. Narrowing of a disc is a progressive process which is the result of the disturbances in the balance between the components of the force to which a disc is subjected. The process is initiated by the loss of nucleus pulposus content. 6. With the approximation of two adjacent vertebrae a disturbance of the relations of the structures in the intervertebral foramen was noted. On anatomical grounds, when a disc is narrowed it appears that the most likely structures to cause pressure on the nerve root are not the disc itself, but the superior articular processes with their overlying ligamentum flavum

1. A relatively simple method of spinal fusion with internal splinting by screw fixation has been described. Complications have been few. 2. Emphasis is placed upon thorough removal of soft tissue, correct placement of screws of good length, the exposure of bleeding bone wherever possible in the fusion area, and the use of well packed cancellous bone. 3. There is enough spongy bone in one posterior superior iliac spine for an ordinary spinal fusion, and, if more is needed, the other is readily available through the same skin incision. Not only is cancellous bone more desirable than a massive cortical graft, but the leg is spared, allowing early walking and freedom from complications in the limb. 4. The lateral articulations are left intact. 5. Screw fixation has eliminated the use of external support except in spondylolisthesis, or when so much bone has been removed during laminectomy that good fixation cannot be obtained. 6. Early, sometimes immediate, relief of symptoms is usual after operation, and early walking with moderate activity is desirable. 7. When the operation was done for degenerative changes with no apparent defect in the laminae there was no radiological evidence of failure of fusion after operations at one level, but two failures were found after attempted fusions at multiple levels. 8. Root irritation from screw contact in two patients was due to faulty technique. A method of screw placement to avoid this complication is described and illustrated by radiographs and photographs of a cadaver specimen. 9. There has been no known instance of an adverse psychological effect from the use of screws. Rather, there has commonly been a lively and healthy interest shown in the factor which has allowed early activity

Aims

The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort.

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Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.

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We aimed to evaluate the temperature around the nerve root during drilling of the lamina and to determine whether irrigation during drilling can reduce the chance of nerve root injury.

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The aim of this study was to determine whether chilled irrigation saline decreases the incidence of clinical upper limb palsy (ULP; a reduction of one grade or more on manual muscle testing; MMT), based on the idea that ULP results from thermal damage to the nerve roots by heat generated by friction during bone drilling.

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Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients.

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We aimed to identify the pattern of nerve injury associated with paediatric supracondylar fractures of the humerus.