We have examined the outcome in 19 professional rugby
Lumbar spondylolysis can heal with conservative treatment, but few attempts have been made to identify factors which may affect
Transarticular screw fixation with autograft
is an established procedure for the surgical treatment of atlantoaxial instability.
Removal of the posterior arch of C1 may affect the rate of fusion.
This study assessed the rate of atlantoaxial fusion using transarticular
screws with or without removal of the posterior arch of C1. We reviewed
30 consecutive patients who underwent atlantoaxial fusion with a
minimum follow-up of two years. In 25 patients (group A) the posterior
arch of C1 was not excised (group A) and in five it was (group B).
Fusion was assessed on static and dynamic radiographs. In selected
patients CT imaging was also used to assess fusion and the position
of the screws. There were 15 men and 15 women with a mean age of
51.2 years (23 to 77) and a mean follow-up of 7.7 years (2 to 11.6).
Stable
Methods. In this study of patients who underwent internal fixation without
fusion for a burst thoracolumbar or lumbar fracture, we compared
the serial changes in the injured disc height (DH), and the fractured
vertebral body height (VBH) and kyphotic angle between patients
in whom the implants were removed and those in whom they were not. Radiological
parameters such as injured DH, fractured VBH and kyphotic angle
were measured. Functional outcomes were evaluated using the Greenough
low back outcome scale and a VAS scale for pain. Results. Between June 1996 and May 2012, 69 patients were analysed retrospectively;
47 were included in the implant removal group and 22 in the implant
retention group. After a mean follow-up of 66 months (48 to 107),
eight patients (36.3%) in the implant retention group had screw
breakage. There was no screw breakage in the implant removal group.
All radiological and functional outcomes were similar between these
two groups. Although solid
We evaluated the efficacy of Escherichia
coli-derived recombinant human bone morphogenetic protein-2
(E-BMP-2) in a mini-pig model of spinal anterior interbody fusion.
A total of 14 male mini-pigs underwent three-level anterior lumbar
interbody fusion using polyether etherketone (PEEK) cages containing
porous hydroxyapatite (HA). Four groups of cages were prepared:
1) control (n = 10 segments); 2) 50 μg E-BMP-2 (n = 9); 3) 200 μg
E-BMP-2 (n = 10); and 4) 800 μg E-BMP-2 (n = 9). At eight weeks
after surgery the mini-pigs were killed and the specimens were evaluated
by gross inspection and manual palpation, radiological evaluation
including plain radiographs and micro-CT scans, and histological
analysis. Rates of fusion within PEEK cages and overall
We treated 183 patients with fractures of the odontoid process (109 type II, 74 type III) non-operatively.
We describe the results of a prospective case series of patients with spondylolysis, evaluating a technique of direct stabilisation of the pars interarticularis with a construct that consists of a pair of pedicle screws connected by a U-shaped modular link passing beneath the spinous process. Tightening the link to the screws compresses bone graft in the defect in the pars, providing rigid intrasegmental fixation. We have carried out this procedure on 20 patients aged between nine and 21 years with a defect of the pars at L5, confirmed on CT. The mean age of the patients was 13.9 years (9 to 21). They had a grade I or less spondylolisthesis and no evidence of intervertebral degeneration on MRI. The mean follow-up was four years (2.3 to 7.3). The patients were assessed by the Oswestry Disability Index (ODI) and a visual analogue scale (VAS). At the latest follow-up, 18 patients had an excellent clinical outcome, with a significant (p <
0.001) improvement in their ODI and VAS scores. The mean ODI score at final follow-up was 8%. Assessment of the defect by CT showed a rate of
There have been few reports regarding the efficacy
of posterior instrumentation alone as surgical treatment for patients
with pyogenic spondylitis, thus avoiding the morbidity of anterior
surgery. We report the clinical outcomes of six patients with pyogenic
spondylitis treated effectively with a single-stage posterior fusion
without anterior debridement at a mean follow-up of 2.8 years (2
to 5). Haematological data, including white cell count and level
of C-reactive protein, returned to normal in all patients at a mean
of 8.2 weeks (7 to 9) after the posterior fusion. Rigid bony fusion
between the infected vertebrae was observed in five patients at
a mean of 6.3 months (4.5 to 8) post-operatively, with the remaining
patient having partial
This study assessed the frequency of acute injury to the spinal cord in Irish Rugby over a period of ten years, between 1995 and 2004. There were 12 such injuries; 11 were cervical and one was thoracic. Ten occurred in adults and two in schoolboys. All were males playing Rugby
We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody
A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18). Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to
The purpose of this retrospective study was to investigate the
clinical relevance of increased facet joint distraction as a result
of anterior cervical decompression and fusion (ACDF) for trauma. A total of 155 patients (130 men, 25 women. Mean age 42.7 years;
16 to 87) who had undergone ACDF between 1 January 2001 and 1 January
2016 were included in the study. Outcome measures included the Neck
Disability Index (NDI) and visual analogue scale (VAS) for pain.
Lateral cervical spine radiographs taken in the immediate postoperative
period were reviewed to compare the interfacet distance of the operated
segment with those of the facet joints above and below.Aims
Patients and Methods
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. Between 2001 and 2010, 51 patients with a mean age of 62.5 years
(39 to 86) underwent long posterior instrumentation and short posterior
or posterolateral fusion for TB of the thoracic and lumbar spines,
followed by anti-TB chemotherapy for 12 months. No anterior debridement
of the necrotic tissue was undertaken. Posterior decompression with
laminectomy was carried out for the 30 patients with a neurological
deficit.Aim
Patients and Methods
The aims of this study were to evaluate the clinical and radiological
outcomes of instrumented posterolateral fusion (PLF) performed in
patients with rheumatoid arthritis (RA). A total of 40 patients with RA and 134 patients without RA underwent
instrumented PLF for spinal stenosis between January 2003 and December
2011. The two groups were matched for age, gender, bone mineral
density, the history of smoking and diabetes, and number of fusion
segments. The clinical outcomes measures included the visual analogue scale
(VAS) and the Korean Oswestry Disability Index (KODI), scored before
surgery, one year and two years after surgery. Radiological outcomes
were evaluated for problems of fixation, nonunion, and adjacent
segment disease (ASD). The mean follow-up was 36.4 months in the RA
group and 39.1 months in the non-RA group.Aims
Methods
Rates of mortality as high as 25% to 30% have been described
following fractures of the odontoid in the elderly population. The
aim of this study was to examine whether easily identifiable variables
present on admission are associated with mortality. A consecutive series of 83 elderly patients with a fracture of
the odontoid following a low-impact injury was identified retrospectively.
Data that were collected included demographics, past medical history
and the results of blood tests on admission. Radiological investigations
were used to assess the Anderson and D’Alonzo classification and
displacement of the fracture. The mean age was 82.9 years (65 to
101). Most patients (66; 79.5%) had a type 2 fracture. An associated
neurological deficit was present in 11 (13.3%). All were treated
conservatively; 80 (96.4%) with a hard collar and three (3.6%) with
halo vest immobilisation.Aims
Patients and Methods
We performed a retrospective, comparative study of elderly patients
with an increased risk from anaesthesia who had undergone either
anterior screw fixation (ASF) or halo vest immobilisation (HVI)
for a type II odontoid fracture. A total of 80 patients aged 65 years or more who had undergone
either ASF or HVI for a type II odontoid fracture between 1988 and
2013 were reviewed. There were 47 women and 33 men with a mean age
of 73 (65 to 96; standard deviation 7). All had an American Society
of Anesthesiologists score of 2 or more.Aims
Patients and Methods
In this prospective observational study, we investigated the
time-dependent changes and correlations of upper arm performance
tests (ten-second test and Simple Test for Evaluating Hand Function
(STEF), the Japanese Orthopaedic Association (JOA) score, and the
JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) in 31
patients with cervical myelopathy who had undergone surgery. We hypothesised that all the indices correlate with each other,
but show slightly different recovery patterns, and that the newly
described JOACMEQ is a sensitive outcome measure.Aims
Patients and Methods
We evaluated the impact of lumbar instrumented
circumferential fusion on the development of adjacent level vertebral
compression fractures (VCFs). Instrumented posterior lumbar interbody
fusion (PLIF) has become a popular procedure for degenerative lumbar
spine disease. The immediate rigidity produced by PLIF may cause
more stress and lead to greater risk of adjacent VCFs. However,
few studies have investigated the relationship between PLIF and
the development of subsequent adjacent level VCFs. Between January 2005 and December 2009, a total of 1936 patients
were enrolled. Of these 224 patients had a new VCF and the incidence
was statistically analysed with other covariants. In total 150 (11.1%)
of 1348 patients developed new VCFs with PLIF, with 108 (72%) cases
at adjacent segment. Of 588 patients, 74 (12.5%) developed new subsequent
VCFs with conventional posterolateral fusion (PLF), with 37 (50%)
patients at an adjacent level. Short-segment fusion, female and
age older than 65 years also increased the development of new adjacent
VCFs in patients undergoing PLIF. In the osteoporotic patient, more
rigid fusion and a higher stress gradient after PLIF will cause
a higher adjacent VCF rate. Cite this article:
Fractures of the odontoid peg are common spinal
injuries in the elderly. This study compares the survivorship of
a cohort of elderly patients with an isolated fracture of the odontoid
peg A total of 32 patients with an isolated odontoid fracture were
identified. The rate of mortality was 37.5% (n = 12) at one year.
The period of greatest mortality was within the first 12 weeks.
Time made a lesser contribution from then to one year, and there
was no impact of time on the rate of mortality thereafter. The rate
of mortality at one year was 41.2% for male patients (7 of 17) compared
with 33.3% for females (5 of 15). The rate of mortality at one year was 32% (225 of 702) for patients
with a fracture of the hip and 4% (9 of 221) for those with a fracture
of the wrist. There was no statistically significant difference
in the rate of mortality following a hip fracture and an odontoid
peg fracture (p = 0.95). However, the survivorship of the wrist
fracture group was much better than that of the odontoid peg fracture
group (p <
0.001). Thus, a fracture of the odontoid peg in the
elderly is not a benign injury and is associated with a high rate
of mortality, especially in the first three months after the injury. Cite this article:
We reviewed the outcome of a retrospective case series of eight patients with atlantoaxial instability who had been treated by percutaneous anterior transarticular screw fixation and grafting under image-intensifier guidance between December 2005 and June 2008. The mean follow-up was 19 months (8 to 27). All eight patients had a solid C1–2 fusion. There were no breakages or displacement of screws. All the patients with pre-operative neck pain had immediate relief from their symptoms or considerable improvement. There were no major complications. Our preliminary clinical results suggest that percutaneous anterior transarticulation screw fixation is technically feasible, safe, useful and minimally invasive when using the appropriate instruments allied to intra-operative image intensification, and by selecting the correct puncture point, angle and depth of insertion.