Study Design A prospective cohort study was carried out looking at the functional outcome and post procedure translational segmental instability after multi-level lumbar decompression using a hinge osteotomy technique. Objective The hinge osteotomy technique involves unilateral subperiosteal muscle dissection with osteotomy of the base of the spinous processes, thereby preserving the integrity of the posterior elements. The objective of this study was to show the results of this technique clinically and radiologically. Methods Between February 2005 and February 2007, 120 patients (51 male and 69 female) diagnosed with degenerative and/or congenital lumbar stenosis with a mean age of 64 years, underwent central and bilateral canal decompression using the hinge osteotomy technique. A mean of 2 segments (range 2 to 4) was decompressed. All patients were followed for a minimum of 3 years. Five outcome measures were used—visual analog scale for leg pain, Likert scale for functional status, symptom specific well-being score, general well-being score, and oswestry disability index score. The outcomes measures were recorded preoperatively, and at 6 months and 3 years postoperatively. Successful surgical outcome was defined as an improvement in at least 4 of 5 outcome measures. Results One hundred and eight patients (90%) had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (P<0.001), when measured at the 6-month postoperative mark as compared with preoperatively, with further marginal significant improvement (P<0.05) at 3 years post surgery. There was no evidence of progressive lumbar segmental instability at 3 years postoperatively. Conclusions Decompression of multi-level lumbar spine stenosis using the unilateral approach with the hinge osteotomy technique is a safe approach for multi-level stenosis, with good outcome and no evidence of significant segmental translational spinal instability.
Study Design A prospective cohort study was carried out looking at the functional outcome and post-procedure translational segmental instability after multi-level lumbar decompression using a Hinge osteotomy technique. Objective The Hinge osteotomy technique involves unilateral subperiosteal muscle dissection with osteotomy of the base of the spinous processes thereby preserving the integrity of the posterior elements. The objective of this study was to demonstrate the results of this technique clinically and radiologically. Methods Between February 2005 and February 2007, 120 patients (51 male and 69 female) diagnosed with degenerative and/or congenital lumbar stenosis with a mean age of 64 years, underwent central and bilateral canal decompression using the hinge osteotomy technique. A mean of 2 segments (range 2-4) was decompressed. All patients were followed up for a minimum of three years. Five outcome measures were used: visual analogue scale for leg pain, Likert scale for functional status, symptom specific well-being score, general well-being score, and ODI score. The outcome measures were recorded pre-operatively and at 6 months and 3 years post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures. Results 108 patients (90%) had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p Conclusion Decompression of multi-level lumbar spine stenosis using the unilateral approach with the Hinge osteotomy technique is a safe approach for multi-level stenosis, with good outcome and no evidence of significant segmental translational spinal instability.
Retrospective case cohort study done between 2002 and 2012.To assess the mid-term clinical and radiological outcomes of 1-level and 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone trabecular metal cages.ACDF is the gold standard surgical treatment for cervical degenerative disease. The usual surgical practice is to use an anteriorly placed fusion plate with or without interdiscal cages.Patients between 36 and 64 years of age diagnosed with cervical radiculopathy who underwent ACDF using stand-alone trabecular metal cages with at least 3 years follow-up were included in this study. Recorded clinical outcomes included residual axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity altered sensation. Visual Analogue scores were also recorded. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device at the latest follow-up.Ninety patients were included in the study. Fifty-one patients underwent 2-level surgery and 39 patients underwent 1-level surgery. Mean age was 44±10.4 years and mean follow-up time was 4.5±2.6 years. Patients reported excellent or good outcomes (90%), as well as improvements in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity altered sensation (90%). Most patients (90%) progressed to fusion at the 1-year follow-up. The reoperation rate was 3.6%. There was no reported persistent dysphagia, voice complaints, dural tear, or tracheal or oesophageal perforation in any of the patients. One patient developed a deep methicillin-resistant Staphylococcus aureus infectious infarction of the spinal cord, which was treated with antibiotics. Recovery was complete at the 1-year follow up.Mid-term results show that surgical treatment with ACDF with trabecular metal cages is a safe and effective treatment of single and 2-level cervical disc radiculopathy and neck pain.
Introduction Posterolateral Fusion (PLF) and Posterior Lumbar Interbody Fusion (PLIF) are procedures that can be undertaken for the surgical management of degenerative low grade spondylolisthesis. Although there is tentative evidence in the literature that PLIF provides an increased fusion rate and therefore an improvement in symptomology, PLIF surgery does carry an increased peri- and post-operative complication rate. The aim of this study was to establish which surgical intervention has the better outcomes. Materials and Method A prospective cohort study was undertaken of patients who underwent a single level instrumented fusion for low grade degenerative lumbosacral spondylolisthesis between 2008 and 2010. There were 56 patients in total, with 36 patients in the PLF group (group1), and 20 patients in the PLIF group (group 2). Follow-up was at 3 month, 1 year and 3 year post operatively. Visual analogue leg pain score (VAS), Oswestry Disability Index (ODI) for back pain, and SF 12 Health Survey were measured pre and 3 year post operatively. All patients were assessed by MRI scans preoperatively. Standardized lumbosacral radiographs were taken preoperatively, and at 3 month, 1 year and 3 year postoperatively, to assess radiological union. Results In the PLF group, the VAS score improved from 8 to 2, the SF 12 score from 25 to 76, and the ODI score from 36 to 8. In the PLIF group, the VAS score improved from 8 to 4, the SF 12 score from 27 to 72, and the ODI score from 38 to 12. All improvements were statistically significant. There was a statistically larger improvement margin in all scores in the PLF group than in the PLIF group. Radiological union was demonstrated in 91% of all patients, with 95% of patients in each group demonstrating at least, unilateral lateral mass bone graft incorporation. Conclusion We conclude that PLF surgery is superior to PLIF surgery for the surgical management of low grade single level degenerative spondylolisthesis
We report an unusual case in which an unabsorbed bio-absorbable screw in the tibial tunnel of anterior cruciate ligament reconstruction (ACLR) performed 11 years ago caused massive osteolysis and subsequent failure of total knee arthroplasty (TKA). ACLR was performed using suspensory fixation on the femoral side and a bio-absorbable interference screw on the tibial side. Fragmentation of the bio-absorbable screw at the time of tibial component implantation is thought to have evoked an accelerated inflammatory response, causing osteolysis, which finally resulted in early failure of the TKA.
Study Design: Prospective Cohort Study. Summary of Background Data: It has previously been suggested that fulcrum bending radiographs (Cheung et al Luk 1997) and traction radiography under anaesthetic (Davis et al 2003) predict the flexibility and correction obtained following surgery better than conventional supine bending radiographs. Objective: To compare fulcrum bending radiographs and traction radiographs for the prediction of surgical correction of idiopathic scoliosis. Subjects: The study was based on 16 patients with a diagnosis of idiopathic scoliosis who underwent corrective surgery. Outcome measures: The Cobb angle of the major curve was compared on the standing AP and fulcrum bending radiograph taken in the pre-op assessment clinic, the traction film undertaken under anaesthetic immediately prior to surgery and the first post operative standing radiograph taken. The post operative correction of the major curve was analysed using regression techniques and adjusted for the base line curve angle of the major curve. Results: The results were presented as an estimate of the parameter coefficient in the model associated with 95% confidence intervals. The median pre-operative Cobb angle of the major curve was 69 degrees, on the fulcrum bending film was 47 degrees, on the traction film was 30 degrees, and on the first post operative film was 30 degrees. There was no evidence to suggest that the fulcrum Cobb had an effect on the post operative correction of the major curve. There was however evidence to suggest that the traction Cobb angle had an effect on the post operative correction of the major curve (parameter estimate 0.87) 95% CI (0.174, 1.399), T value = 2.83, P = 0.016. Conclusion: Traction radiographs under anaesthetic better predict the surgical correction obtained in adolescent idiopathic scoliosis compared to fulcrum bending radiographs. These two techniques have not been directly compared before.
Case: We present case of a 37-year old male who sustained Patella dislocation with an unusual osteochondral fracture (OCF) involving the posterolateral femoral condyle, whilst playing a virtual game, wearing virtual game headset with goggles. He was treated conservatively for patella dislocation and had the OCF treated surgically. At 18 months follow up, his patella was stable and the OCF had healed. Conclusion: OCF of posterolateral femur following patella dislocation is unusual. It must be suspected in patients who sustain patella dislocation whilst doing deep flexion maneuvers. Patella dislocation can conceal an unusual OCF.
Infection post anterior cervical decompression and fusion (ACDF) is not a frequent complication, the infection rate is around 0.6%. Occlusive vascular lesions secondary to infection, affecting the spinal cord, are diagnostic challenges. Spinal cord infarction due to deep infectious cause, particularly MRSA (Methicillin Resistant Staphycoccus aureus) is rare. We present here a rare case of post C6–C7 ACDF infection with MRSA that leading to cord ischemia with radiological changes and rapidly evolving neurological deterioration. Rapid evaluation with MRI scanning and initiation of antibiotic produced dramatic response with our patient and satisfactory recovery at one year follow up. We assume that is the first reported case of MRSA cord infection with ischemic mylopathic changes.
Introduction This study is a prospective cohort observational trial, to evaluate the ROI-A (Radiolucent Open Implant-ALIF) and VerteBRIDGE plate construct, in the treatment of symptomatic lumbar degenerative disc disease. The principal advantage of anterior approach is that the risks associated with exploration of the spinal canal through a posterior approach can be avoided and damage to the muscles of the back is eliminated. The anterior approach offers superior visualization of the disc space itself, and can be done without disruption of the otherwise healthy posterior elements. The Mini ALIF retroperitoneal approach facilitates rapid patient recovery. Materials and Methods The ROI-A (Radiolucent Open Implant-ALIF) is made from PEEK (Polyetheretherketone), a medical grade plastic, and two metallic anchoring plates, marketed as VerteBridge, which provide both stability at the site of desired bony fusion and fixation of the implant to the vertebrae adjacent to the interbody device. Inclusion Criteria: 18 patients between the ages 31 and 65 years of age; Disc disease between L2-S1; Patients may have up to grade I spondylolisthesis or retrolesthesis at the involved site; Maximum two diseased vertebral motion segments to be instrumented; Has had no more than two previous non-fusion surgeries to the lumbar soine at the same level(s); Has failed to respond to an appropriate attempt at conservative treatment. Exclusion Criteria: More than two vertebral motion segments involved; Prior anterior, retroperitoneal approach; Has had previous anterior instrumented fusion at the proposed operative level; Higher than grade I spondylolisthesis or retrolisthesis at the involved level(s); Has reported active malignancy, localized or systemic infection; Morbid obesity, as defined by NIH Clinical Guidelines Body Mass Index (BMI > 40); Patients with a diagnosis of osteoporosis, osteopenia, Paget's or other metabolic bone disease; Patients who smoke more than 1 pack per day; Has an active workers compensation claim relative to the involved part. Outcome Measures: Subjects are evaluated clinically pre-operatively, 6 weeks and 12 months post op by the pain questionnaire (VAS), and function questionnaire (ODI); The radiological measures included the segmental lordosis, integrity of the construct, and presence of bridging bone; Fusion success is defined as presence of bridging bone, and postoperative intervertebral motion at 12 months which is less than 5 degrees, via manual radiographic angular measurements (Cobb Method) of the implanted level(s) on flexion and extension radiographs at the 12 month follow up visit. Results The VAS has improved from an average of 9 preop to an average of 2 postop. ODI score has reduced an average 30 points from preop measurement. 83% (15 patients) went on bony fusion at the radiological assessment 12 month post op. None of the patients underwent revision, removal of implant, supplemented fixation, or re-operation. One patient developed mechanical ileus for 48 hours postop, resolved with NG tube. Conclusion Mini anterior inter-body fusion is a valid option when treating degenerative/discogenic back pain, the ROI-A implant is a safe and simple, with satisfactory results up to 12 month, according to our pilot study.
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