A series of 246 patients with scoliosis and attempted fusion had exploration performed six months later in order to detect and treat any pseudarthrosis at an early stage and so prevent subsequent loss of correction. Bilateral or unilateral pseudarthroses occurred in 25 per cent and were of three types--definite, hairline and doubtful. Single unilateral pseudarthroses accounted for 6 per cent and were of little if any clinical significance. The hairline pseudarthroses could not be seen radiologically and were easily missed at exploration. In general the pseudarthroses were least common in the more rigid parts of the
The efficacy of modern drugs in the treatment of tuberculosis of the
1. Forty patients with solitary eosinophilic granuloma of bone from the Hospital for Sick Children, Toronto, have been reviewed. They had clinical and laboratory findings similar to those reported by others except for the erythrocyte sedimentation rate, which was raised in nearly half the patients tested. 2. Radiographs in all cases showed the lesion to be osteolytic. In the skull and cervical spine there was no bony reaction ; in the thoracic and lumbar
The aim of this study was to compare the peak pull-out force
(PPF) of pedicle-lengthening screws (PLS) and traditional pedicle
screws (TPS) using instant and cyclic fatigue testing. A total of 60 lumbar vertebrae were divided into six groups:
PLS submitted to instant pull-out and fatigue-resistance testing
(groups A1 and A2, respectively), TPS submitted to instant pull-out
and fatigue-resistance testing (groups B1 and B2, respectively)
and PLS augmented with 2 ml polymethylmethacrylate, submitted to
instant pull-out and fatigue-resistance testing (groups C1 and C2,
respectively). The PPF and normalized PPF (PPFn) for bone mineral density
(BMD) were compared within and between all groups.Aims
Materials and Methods
We present the results of correcting a double or triple curve
adolescent idiopathic scoliosis using a convex segmental pedicle
screw technique. We reviewed 191 patients with a mean age at surgery of 15 years
(11 to 23.3). Pedicle screws were placed at the convexity of each
curve. Concave screws were inserted at one or two cephalad levels
and two caudal levels. The mean operating time was 183 minutes (132
to 276) and the mean blood loss 0.22% of the total blood volume
(0.08% to 0.4%). Multimodal monitoring remained stable throughout
the operation. The mean hospital stay was 6.8 days (5 to 15).Aims
Patients and Methods
We performed a case-control study on the influence of oophorectomy on the development of degenerative spondylolisthesis, including a clinical review and determination of serum oestradiol levels. We also compared the radiological appearance of the lumbar
We carried out a cadaver study of 16 iliolumbar veins in order to define the surgical anatomy. Two variants were found; a single vein at a mean distance of 3.74 cm from the inferior vena cava (11 of 16) and two separate draining veins at a mean distance from the vena cava of 2.98 cm for the proximal and 6.24 cm for the distal stem (5 of 16). Consistently, the proximal vein tore on attempted medial retraction of the great vessels. The mean length of the vein was 1.6 cm and its mean width 1.07 cm. Three stems were shorter than 0.5 cm. Two or more tributaries usually drained the iliacus and psoas muscles, and the fifth lumbar vertebral body. The obturator nerve crossed all veins superficially at a mean of 2.76 cm lateral to the mouth. In four of these, this distance was less than 1.5 cm. Usually, the lumbosacral trunk crossed deep, at a mean distance of 2.5 cm lateral to the mouth, but in three veins, this distance was 1 cm or less. Our findings emphasise the need for proper dissection of the iliolumbar vein before ligature during exposure of the anterior lumbar
Vertebroplasty, which is the percutaneous injection of bone cement into vertebral bodies has recently been used to treat painful osteoporotic compression fractures. Early clinical results have been encouraging, but very little is known about the consequences of augmentation with cement for the adjacent, non-augmented level. We therefore measured the overall failure, strength and structural stiffness of paired osteoporotic two-vertebra functional
The aim of this study was to investigate the clinical and radiographic
outcomes of microendoscopic laminotomy in patients with lumbar stenosis
and concurrent degenerative spondylolisthesis (DS), and to determine
the effect of this procedure on spinal stability. A total of 304 consecutive patients with single-level lumbar
DS with concomitant stenosis underwent microendoscopic laminotomy
without fusion between January 2004 and December 2010. Patients
were divided into two groups, those with and without advanced DS
based on the degree of spondylolisthesis and dynamic instability. A
total of 242 patients met the inclusion criteria. There were 101
men and 141 women. Their mean age was 68.1 years (46 to 85). Outcome
was assessed using the Japanese Orthopaedic Association and Roland
Morris Disability Questionnaire scores, a visual analogue score
for pain and the Short Form Health-36 score. The radiographic outcome
was assessed by measuring the slip and the disc height. The clinical
and radiographic parameters were evaluated at a mean follow-up of
4.6 years (3 to 7.5).Aims
Patients and Methods
Degenerative disc disease (DDD) and osteoarthritis (OA) are relatively frequent causes of disability amongst the elderly; they constitute serious socioeconomic costs and significantly impair quality of life. Previous studies to date have found that aggrecan variable number of tandem repeats (VNTR) contributes both to DDD and OA. However, current data are not consistent across studies. The purpose of this study was to evaluate systematically the relationship between aggrecan VNTR, and DDD and/or OA. This study used a highly sensitive search strategy to identify all published studies related to the relationship between aggrecan VNTR and both DDD and OA in multiple databases from January 1996 to December 2016. All identified studies were systematically evaluated using specific inclusion and exclusion criteria. Cochrane methodology was also applied to the results of this study.Objectives
Methods
A radiological study of 50 patients with thoracic Scheuermann's disease revealed two types of lateral spinal curvature. A total of 43 lateral curves was present in 35 of the patients. Thirteen were apical at the same level as the Scheuermann's kyphosis and were due to vertebral-body wedging in the coronal plane; these curves had a mean Cobb angle of 15 degrees, occurred with equal prevalence in boys and girls and were directed equally to right and left. Thirty curves occurred in regions of compensatory lordosis (mean 5.6 degrees) situated above or, more commonly, below the Scheuermann's kyphosis. These scolioses had a mean Cobb angle of 16 degrees, were more often convex to the right than to the left and were significantly more prevalent in girls than in boys. The presence of these kyphoses and scolioses in the same
Biopsies of lumbar multifidus muscles were obtained at operation on seventeen patients aged from fifteen to fifty-eight with lumbar spinal derangement, and further material was taken from the cadavers of three subjects aged from nineteen to fifty-one. Sections were prepared to show the presence of ATPase activity, so distinguishing Fast from Slow types of muscle fibre. The normal mosaic pattern arising from the intermingling of fibres from Fast and Slow motor units was seen in sections from cadaveric material and from many of the biopsies. With age and limited lumbar flexibility, the Fast fibres became relatively smaller but with increasing variation in size, suggesting a reduced capacity for phasic activity. The presence of positive root signs was associated with a greater proportion of Slow fibres, and in some patients with the occurrence of atrophied Fast fibres, giving rise to differences in the populations of the two fibres in neighbouring fascicles. The results suggest that multifidus adopts an increasingly postural role with advancing age and with disabling lesions of the lumbar
1 . Standard lumbar laminectomy was performed at multiple levels in thirty dogs, and manipulations were carried out in the spinal canal to observe their effects on periradicular adhesion formation. The canal was scarified, packed with Gelfoam, or treated with three varieties of Silastic membranes. The results were serially assessed from three days to twelve weeks by gross observation, nerve conduction studies, histological examination of transverse sections of the
There is no consensus about the best method of achieving equal
leg lengths at total hip arthroplasty (THA) in patients with Crowe
type-IV developmental dysplasia of the hip (DDH). We reviewed our
experience of a consecutive series of patients who underwent THA
for this indication. We retrospectively reviewed 78 patients (86 THAs) with Crowe
type-IV DDH, including 64 women and 14 men, with a minimum follow-up
of two years. The mean age at the time of surgery was 52.2 years
(34 to 82). We subdivided Crowe type-IV DDH into two major types
according to the number of dislocated hips, and further categorised
them into three groups according to the occurrence of pelvic obliquity
or spinal curvature. Leg length discrepancy (LLD) and functional
scores were analysed.Aims
Patients and Methods
The loss of cervical lordosis in radiographs of patients presenting with neck pain is sometimes ascribed to muscle spasm. We performed a cross-sectional study of the prevalence of 'straight' cervical spines in three populations: 83 patients presenting to an accident department with acute neck pain, 83 referred to a radiology department with chronic neck problems, and 80 radiographs from a normal population survey carried out in 1958. Curvature was assessed on lateral radiographs both subjectively and by measurement. The prevalence of 'straight' cervical spines was 19% in the acute cases and 26% in the chronic cases. The 95% confidence interval for the difference was -6.4% to +19.3%. In the normal population 42% showed a straight
We undertook a comparative study of magnetic resonance imaging (MRI) vertebral morphometry of thoracic vertebrae of girls with adolescent idiopathic thoracic scoliosis (AIS) and age and gender-matched normal subjects, in order to investigate abnormal differential growth of the anterior and posterior elements of the thoracic vertebrae in patients with scoliosis. Previous studies have suggested that disproportionate growth of the anterior and posterior columns may contribute to the development of AIS. Whole spine MRI was undertaken on 83 girls with AIS between the age of 12 and 14 years, and Cobb’s angles of between 20° and 90°, and 22 age-matched controls. Multiple measurements of each thoracic vertebra were obtained from the best sagittal and axial MRI cuts. Compared with the controls, the scoliotic
Between 1978 and 1988 a total of 27 operations were performed on 26 patients for cervical myelopathy due to rheumatoid disease in the subaxial
We compared the clinical and radiological outcomes of using a
polyetheretherketone cage with (TiPEEK) and without a titanium coating
(PEEK) for instrumented transforaminal lumbar interbody fusion (TLIF). We conducted a randomised clinical pilot trial of 40 patients
who were scheduled to undergo a TLIF procedure at one or two levels
between L2 and L5. The Oswestry disability index (ODI), EuroQoL-5D,
and back and leg pain were determined pre-operatively, and at three,
six, and 12 months post-operatively. Fusion rates were assessed
by thin slice CT at three months and by functional radiography at
12 months.Aims
Materials and Methods
1. A twenty-six-year-old woman was paraplegic because of a benign giant-cell tumour which had destroyed the body of the twelfth thoracic vertebra completely and the bodies of the eleventh thoracic and first lumbar vertebrae partially. The tumour had expanded into both pleural cavities and displaced the aorta forward and to the left. The extent and topography of the tumour were evaluated before operation by angiography. The function of the spinal cord had not been improved significantly by laminectomy. It was therefore decided to attempt extirpation of the tumour by removing all remaining parts of the three vertebrae involved. 2. After the removal of the tumour, only the spinal cord with the thecal sac bridged the gap between the tenth thoracic and second lumbar vertebrae. The gap was bridged with struts of cortical bone from both tibiae and with two strong plates, all secured with steel wire. The metal was removed five months later because it had become loose. Gradual shortening and angulation of the