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
1. The intervertebral disc is an organic viscous elastic structure capable of maintaining very great loads without disintegration. 2. Recovery of the disc after deformation depends upon: a) the imbibition of tissue fluid by the disc, b) the removal of the deforming force. Complete recovery is modified by the duration of the force. 3. Factors that interfere with the elasticity of the disc are: extreme youth (immaturity of the disc), chronic wasting diseases (general nutritional disturbance), and local pathological changes in the bodies of the vertebrae which interrupt or damage its blood supply. The intervertebral disc reaches its greatest state of efficiency in adult life—that is, when the nucleus pulposus has disappeared as an entity. The function of the disc appears not to depend upon the presence of the nucleus : rather does the presence of the nucleus indicate immaturity of the disc. 4. The highly resilient elastic nature of the
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
The long-term results of 17 patients who had had fusion in situ for severe lumbosacral spondylolisthesis are reported. The average follow-up was 14 years with a range of 7 to 20 years. The average age at operation was 16 years. At follow-up seven patients had occasional backache but only one patient had changed his job and no patient had lost any time off work in the previous year. Nine patients felt that their deformity had been improved and all but one patient still rated the results as excellent up to 20 years after the operation. Although all the patients had persistent foreshortening of the trunk only two patients were aware of any cosmetic deformity. There had been no significant increase in forward slip since the previous follow-up examination five years after the operation. There were no late complications nor significant degenerative changes in the lumbar
One hundred and sixty-seven patients with adolescent idiopathic scoliosis were allocated prospectively to one of three different groups for correction before undergoing posterior spinal fusion and Harrington instrumentation, In group 1 single curves were corrected by a Risser turnbuckle plaster jacket and double curves by halo-pelvic traction. In Group 2 patients performed Cotrel dynamic traction for three weeks and this was followed by correction in a plaster cast. In Group 3 patients were given Cotrel dynamic traction for one week only and the operation was performed without a plaster cast. There was no significant difference in the overall correction achieved among the patients in the three groups except that double curves corrected slightly better in Group 2. The correction achieved by Cotrel dynamic traction after three weeks was not significantly different from that obtained at 48 hours. An anteroposterior radiograph of the
Accurate placement of the acetabular component is essential in
total hip arthroplasty (THA). The purpose of this study was to determine
if the ability to achieve inclination of the acetabular component
within the ‘safe-zone’ of 30° to 50° could be improved with the
use of an inclinometer. We reviewed 167 primary THAs performed by a single surgeon over
a period of 14 months. Procedures were performed at two institutions:
an inpatient hospital, where an inclinometer was used (inclinometer
group); and an ambulatory centre, where an inclinometer was not
used as it could not be adequately sterilized (control group). We excluded
47 patients with a body mass index (BMI) of >Â 40Â kg/m2,
age of >Â 68 years, or a surgical indication other than osteoarthritis
whose treatment could not be undertaken in the ambulatory centre.
There were thus 120 patients in the study, 68 in the inclinometer
group and 52 in the control group. The inclination angles of the acetabular
component were measured from de-identified plain radiographs by
two blinded investigators who were not involved in the surgery.
The effect of the use of the inclinometer on the inclination angle
was determined using multivariate regression analysis.Aims
Patients and Methods
1. The incidence of osteogenic sarcoma, chondrosarcoma and Ewing's sarcoma in relation to age, sex and site is analysed in a study of 832 malignant primary bone tumours diagnosed in Sweden in 1958-68. The results are compared with those in other series. 2. The adolescent incidence peak for osteogenic sarcoma is caused by tumours localised to the long bones of the lower limb. The peak incidence occurs at a mean age of twelve years for girls and sixteen years for boys and is associated with the maximum growth velocity for the adolescent growth spurt. 3. Ewing's sarcoma, showing no sex difference with regard to its incidence peak, seems not to be associated with bone growth. 4. In the adult, the incidence of osteogenic sarcoma parallels that of chondrosarcoma, thus showing a successive increase with increasing age. In Sweden, where Paget's disease is uncommon, the incidence of osteogenic sarcoma over the age of thirty is only one-third of that during adolescence. 5. In osteogenic sarcoma and chondrosarcoma but not in Ewing's sarcoma, the characteristic predominance of males over females is valid only for localisations to the long bones of the lower limb, the pelvis and the
1. The production of scoliosis in young animals by resection of the posterior ends of the ribs is described and the etiological mechanisms discussed. It is suggested that retardation of posterior rib growth, removal of mechanical support from one side of the
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
The aims of this study were to describe the prevalence of previous
lumbar surgery in patients who undergo total hip arthroplasty (THA)
and to investigate their patient-reported outcomes (PROMs) one year
post-operatively. Data from the Swedish Hip Arthroplasty Register and the Swedish
Spine Register gathered from 2002 to 2013 were merged to identify
a group of patients who had undergone lumbar surgery before THA
(n = 997) and a carefully matched one-to-one control group. We investigated
differences in the one-year post-operative PROMs between the groups.
Linear regression analyses were used to explore the associations
between previous lumbar surgery and these PROMs following THA. The
prevalence of prior lumbar surgery was calculated as the ratio of
patients identified with previous lumbar surgery between 2002 and
2012, and divided by the total number of patients who underwent
a THA in 2012.Aims
Patients and Methods
Of the 4172 patients in a survey of all cases of tuberculosis notified in a six-month period in England and Wales in 1978-79, 198 had a bone or joint lesion; 79 were white and 108 were of Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin. The estimated annual notification rates for orthopaedic tuberculosis were 29 per 100 000 for the Indian subcontinent group and 0.34 per 100 000 in the white group, a ratio of 85 to 1. Rates increased with age in both groups. The
To evaluate the incidence of primary venous thromboembolism (VTE),
epidural haematoma, surgical site infection (SSI), and 90-day mortality
after elective spinal surgery, and the effect of two protocols for
prophylaxis. A total of 2181 adults underwent 2366 elective spinal procedures
between January 2007 and January 2012. All patients wore anti-embolic
stockings, mobilised early and were kept adequately hydrated. In
addition, 29% (689) of these were given low molecular weight heparin
(LMWH) while in hospital. SSI surveillance was undertaken using the
Centers for Disease Control and Prevention criteria.Aims
Patients and Methods
The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors. A total of 15 nails were retrieved from 13 patients following lower-limb lengthening. Macroscopical and microscopical surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analyzed with scanning electron microscopy and energy dispersive x-ray spectroscopy to identify corrosion.Objectives
Methods
Aternatives to autogenous bone graft for spinal fusion have been investigated for many years. It has been shown that osteoconductive materials alone do not give a rate of fusion which is comparable to that of autogenous bone graft. We analysed the effectiveness of porous ceramic loaded with cultured mesenchymal stem cells as a new graft material for spinal fusion in an animal model. Posterolateral fusion was carried out at the L4/L5 level in 40 White New Zealand rabbits using one of the following graft materials: porous ceramic granules plus cultured mesenchymal stem cells (group I); ceramic granules plus fresh autogenous bone marrow (group II); ceramic granules alone (group III); and autogenous bone graft (group IV). The animals were killed eight weeks after surgery and the
1. In this series of posterior onlay grafting with fresh autogenous bone and without internal fixation, in the treatment of non-infective structural lesions in the lumbo-sacral area, 71 per cent of the patients were relieved of their symptoms, but bony fusion was obtained in only 60 per cent. 2. It is probable that with this technique twelve weeks' immobilisation in a plaster bed is required. 3. Some failures are ascribed to the use of an insufficient quantity of bone or to poor apposition of the graft to its bed. 4. It is evident that the more vertebrae one attempts to fuse the more difficult it is to succeed. When the diseased area is successfully fused but an unnecessarily long graft has been used, a pseudarthrosis above the level of the pre-operative pathology may be the cause of persisting backache. For these reasons we believe that one should not attempt to graft more vertebrae than is necessary to stabilise the local lesion. 5. The complication rate, particularly from deep vein thrombosis, was high. This major complication could perhaps be overcome by using banked bone. 6. The indications for the operation are assessed as follows. It should be done for low back pain only when there is a definite diagnosis and a limited extent of structural pathology; one can then expect excellent results when successful fusion is achieved and also an appreciably high proportion of satisfied patients even when bony fusion has not been obtained, presumably because there is a fibrous union strong enough to stabilise the affected
The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups.Objectives
Methods