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Biomedical subjects

M Di Silvestre

Publications and source records attributed to M Di Silvestre.

At least 19 recordsLinked to original sources
PubMed2006

An innovative diagnostic procedure of vertebral deformities without exposure to X-rays.

The objective of the study was to compare standard manual X-ray measurements of vertebral deformities and values obtained from the Ortelius 800. 52 Patients (41 females and 11 males: mean age 20.35 years) with adolescent vertebral deformities, was studied. The patients were evaluated with standard radiographic views and the Ortelius 800. The parameters considered for the comparison were the angles of scoliosis and kyphosis and the values of global axial deformity, shoulder asymmetry and pelvic tilt. We also evaluated the modification of pelvic/shoulder angle after surgery (this parameter allows to evaluate vertebral rotation and can be derived only from the Ortelius 800). This study allowed us to conclude that there is a perfect agreement between measurements with the Ortelius 800 and those resulting from standard x-rays. The system has also proved to have the capability of quantifying changes in vertebral rotation.

Adult↗
PubMed2001

Lumbar disc excision in children and adolescents.

STUDY DESIGN: The authors examined a case series of patients under the age of 18 years treated for lumbar intervertebral disc herniation. OBJECTIVES: To evaluate postoperative and long-term results of surgery in patients younger than 18 years. SUMMARY OF BACKGROUND DATA: There are only a few series, with controversial results, available on the surgical treatment of disc herniation in growing patients. METHODS: Between 1975 and 1991, a consecutive series of 129 patients 9-18 years of age (average age, 16.2 years) underwent surgery for lumbar intervertebral disc herniation. Low back pain associated with leg pain was the main clinical symptom in 106 subjects (82%), back pain in 17 (13%), and leg pain in 6 (5%). RESULTS: Short-term results were excellent or good for 123 cases (95%), with complete pain relief in 97 (75%) and moderate but incomplete relief in 26 (20%). A total of 98 (76%) long-term responses obtained at a mean follow-up of 12.4 years revealed excellent outcomes in 40% of the cases, good in 47%, and poor in 13%. Ten patients (10%) underwent reintervention after 9 years on average (2 fusions and 8 re-explorations for herniated disc). CONCLUSIONS: Results have confirmed a tendency for outcomes to deteriorate between the short-term and long-term follow-up in young patients treated by discectomy: this tendency and the rate of reintervention (10%) confirmed the need for long-term follow-up of children and adolescents treated for disc herniation.

Adolescent↗
PubMed1999

Surgical correction of dystrophic spinal curves in neurofibromatosis. A review of 56 patients.

STUDY DESIGN: A presentation of the results from 56 patients with dystrophic spinal deformities caused by neurofibromatosis surgically managed from 1971 to 1992. OBJECTIVES: To focus on the need for combined anterior and posterior fusion in the presence of severe spinal dystrophic changes. SUMMARY OF BACKGROUND DATA: It has been stated that the most effective management for dystrophic curves is early and aggressive surgery. METHODS: The patients were divided into two groups: Type I scoliosis (kyphosis < 50 degrees) and Type II kyphoscoliosis (kyphosis > 50 degrees). Results were evaluated in relation to the type of surgery performed: single posterior instrumented fusion or preplanned combined anterior and posterior fusion. RESULTS: At a mean follow-up period of 15 years (range, 5-22 years), all patients appeared to be stabilized, after a total of 120 surgical interventions. In Group I, the posterior instrumented fusion failed in nine patients (47%), and in Group II it failed in seven patients (63%). The preplanned combined anterior and posterior fusion failed in two patients (33%) in Group I and in four patients (20%) in Group II. The failure incidence of the posterior instrumented fusion alone and of the planned anterior and posterior fusion was 53% (16 patients) and 23% (6 patients), respectively. CONCLUSIONS: The severe dystrophic curve with anterior vertebral scalloping always requires combined anterior and posterior stabilization, particularly in younger patients, even if the sagittal curves have not become pathologic by the time of presentation.

Adolescent↗
PubMed1994

Pulsed electromagnetic field stimulation on posterior spinal fusions: a histological study in rats.

This study reports the histological data relative to the effect of pulsed electromagnetic fields (PEMFs) on the evolution of posterior arthrodesis induced in the lumbar vertebrae of 12 adult male Sprague-Dawley rats. After the operation, one group of six rats was stimulated with PEMFs for 18 h per day, by means of a pair of coils fixed to the outside of the cage. A control group of six rats was given no stimulation after surgery. In the groups stimulated with PEMFs an acceleration of the process of bone callus organization was already observed after 4 weeks, and even more so after 8: An early replacement was in fact observed of the newly formed cartilage tissue with primary bone (at 4 weeks) and subsequently with secondary bone (after 8 weeks).

Animals↗
PubMed1992

Implants of heterologous demineralized bone matrix for induction of posterior spinal fusion in rats.

The authors tested the osteoinductive capacity of powdered heterologous (bovine) demineralized bone matrix in rats. The first part of the study concerned a monolateral posterior spinal implant after decortication of three vertebrae, using as a control area the animal's contralateral side, in which neither bone graft nor any other material were placed. In another group of rats, a comparative evaluation was made of powdered heterologous demineralized bone matrix and fresh autologous bone. In the same animal, autologous bone was implanted to realize a thoracic posterior fusion and demineralized bone matrix, to induce a posterior fusion in the lumbar area. All data obtained suggested a good osteoinductive activity of heterologous powdered demineralized bone matrix. The two posterior spinal fusions done in the same animal with heterologous demineralized bone matrix or autologous bone, respectively, had similar callus development and required the same time for formation.

Animals↗
PubMed1991

Posterior lumbar apophyseal fractures.

From 1984 to 1987, nine patients with posterior lumbar apophyseal fracture underwent surgery. The clinical pattern was characterized by vertebral rigidity and leg pain in all cases, with associated nerve root deficit in three cases, neurogenic claudication in one, and paraparesis in one. In all patients, treatment consisted of removal of a bony and/or cartilaginous fragment. In eight patients, it was done through a posterior approach (unilateral laminotomy with partial facetectomy in six cases and bilateral laminectomy in two) and in one with paraparesis by means of hemicorporectomy followed by anterior fusion. At follow-up (minimum, 2 years), all patients showed complete regression of the painful symptoms, with a total recovery in cases with neurologic problems. The only complication was an incomplete cauda syndrome; this appeared immediately after the operation and regressed completely with conservative treatment after 6 months.

Adult↗
PubMed1991

Achondroplasia and lumbar spinal stenosis.

Achondroplasia is the most common type of rhizomelic dwarfism. The abnormal spinal development of the achondroplastic dwarf can result in neurologic damage due primarily to the following two syndromes: lumbar spinal canal stenosis and thoracolumbar kyphosis. The authors report the cases observed at their institution, discussing the diagnosis and operative treatment.

Achondroplasia↗
PubMed1990

Late paraparesis due to pseudarthrosis after posterior spinal fusion.

The authors report three cases in which paraparesis related to a pseudarthrosis occurred several years after a posterior spinal fusion, but with a different mechanism (stretching of the spinal cord for progression of the deformity in kyphosis in two cases, and spinal cord compression for bone overgrowth within the canal in the site of pseudarthrosis in the third patient). Treatment was different. Partial correction of the deformity and stabilization of the spine by combined fusion (anterior and posterior) was sufficient in the first two cases for a complete neurological recovery. Posterior spinal cord decompression and stabilization of the spine by combined fusion was necessary for complete recovery in the third.

Adult↗
PubMed1990

[Effects of pulsing electromagnetic fields (PEMF) on the course of vertebral fusion callus. A histological study].

In this paper the findings concerning the effectiveness of PEMF on the evolution of the vertebral fusion callus are reported. The study has been carried on by preparing postero-lateral arthrodesis in the lumbar spinal tract in rats. In this tract the laminae have been decorticated, the articular processes prepared by decortication and removal of the articular cartilage, and the spinal processes removed and employed as osteoinductive material. The rats sacrificed after 4 and 8 weeks, show how the decorticated areas are clearly influenced from PEMF, an early appearance of the bony fusion callus is already evident in the treated group just after 4 weeks. Also the articular areas are influenced from PEMF but less markedly than the decorticated one; in these areas after 8 weeks the fusion callus is prevalently cartilaginous even if areas of calcification are detectable inside. This different behaviour can be explained with the absence of any form of spinal fusion by means of surgical tools.

Animals↗
PubMed1989

[Our experience in the treatment of idiopathic osteonecrosis of the femur head by évidement and filling with bone grafts].

UNLABELLED: The authors relate their experience in treating idiopathic osteonecrosis of the femoral head with bone grafting. CASES: 18 hips under control for a period varying from 8 to 3 years. Radiographic and clinical assessment before and after surgery according to Ficat, Arlet and Merle D'Aubigné. Four patients were affected with idiopathic osteonecrosis of the femoral head. Results were very good in 4 cases and quite good in 2 cases. Only one third of the results could be regarded as positive. This modest achievement is partly due to the method employed. In order to obtain better results, however, an early diagnosis is required and patients who are operated on should have quite a good bone mineralization.

Adult↗
PubMed1988

Osteoid osteoma of the spine.

After reviewing the international literature the authors present three new cases of osteoid osteoma with vertebral body localisation, two in the lumbar region, and one in the cervical region. This rare localisation necessitates the use of accurate instrumental techniques, based on radiography, scintigraphy, and in particular, CT scanning, in order to arrive at a correct diagnosis as a prelude to the correct surgical treatment.

Adolescent↗
PubMed1988

Cervical osteotomy by the Simmons method in the treatment of cervical kyphosis due to ankylosing spondylitis. Case report.

Ankylosing spondylitis can produce severe kyphosis in the spine. This is rarer in the cervical spine than in the thoracolumbar region, but it is also more invalidating as it may make it impossible for the patient to look forward as well as causing difficulty in mastication, swallowing and speaking. To correct cervical kyphosis, vertebral osteotomy is performed at the apex of the deformity. The authors present a case of cervical kyphosis due to ankylosing spondylitis successfully treated by the Simmons method.

Adult↗
PubMed1986

Natural history of untreated idiopathic scoliosis after skeletal maturity.

A total of 187 random cases of untreated idiopathic scoliosis, seen from a minimum of 15 to a maximum of 47 years after the end of growth, were reviewed. All curves increased after skeletal maturity (average progression: 0.4 degrees per year). Thoracic curves tend to progress more than lumbar, lumbar more than thoracolumbar, and thoracolumbar more than double major curves. Pain was present in 114 cases (61%) and appeared more frequently in women, after pregnancies, and with fatigue. Cardiopulmonary symptoms were present in 42 patients (22%), especially those with thoracic and thoracolumbar curves greater than 40 degrees. Psychologic disturbances were found in 35 cases (19%), mostly female patients with thoracic curves greater than 40 degrees. The cosmetic appearance of these patients at long-term follow-up was better compared with that at the end of growth, even though the curves progressed. Patients with decompensation of the trunk at the end of growth seemed to improve with time. In an unselected group of patients with severe curves a mortality rate of 17% was found, twice as much as in the Italian general population.

Adolescent↗
PubMedDate not supplied

Circumferential fusion by posterior approach in lumbosacral instability with or without pedicle screw fixation: a comparison of methods.

Lumbosacral circumferential fusion, a method which is widely adopted for the treatment of the different causes of lumbar pain, may be carried out in a single stage by posterior approach, associating interbody fusion with cages with posterolateral fusion. During the same operation, pedicle screw fixation may also be performed. In order to evaluate the need for this final surgical stage represented by pedicle screws, a comparison was conducted in 2 groups of patients affected with lumbosacral instability, treated at the Division of Vertebral Surgery at the Rizzoli Orthopaedic Institute between May 1995 and May 1997. The best clinical results were obtained in the first group (where pedicle fixation was associated). Because of the persistance of pain symptoms, successive pedicle fixation was instead required in a high percentage of patients (45%) in the second group (without pedicle fixation).

Adolescent↗
PubMedDate not supplied

Lumbar disc herniation in the elderly patient.

It was the purpose of this study to clinically follow-up 78 patients affected with lumbar disc herniation, aged from 60 to 81 years (mean 66 years), hospitalized in several wards at the Rizzoli Orthopaedic Hospital between 1987 and 1996, for surgical treatment. A minimum of 24 months after surgery (maximum 61 months), sciatic pain (present in all of the patients prior to surgery) had regressed in 90% of the patients and was reported to occur only occasionally in 10%. Low back lumbar pain was still present in 21%. Results concerning recovery of motor deficit (30%), deficit in reflexes (31%), and sensory deficit (24%) were good. Better results were obtained when the surgical findings were sequestered hernia and expulsed hernia, with excellent results observed in 70% and 60%, respectively (based on the Smiley-Webster scale), as compared to contained hernia, the results for which were excellent in 54% of patients. Complications were observed in 9 cases (11%); 5 of the cases (6%) after a period of time ranging from 20 to 45 days postsurgery required further surgery because of an error in level in 3 and a residual nerve root compression in 2.

Age Factors↗
PubMedDate not supplied

Pulsing electromagnetic fields (PEMFs) in spinal fusion: preliminary clinical results.

Pulsing electromagnetic fields (PEMFs) were used during the postoperative management of 31 patients submitted to lumbosacral posterolateral fusion (PLF). The fusions were stimulated with PEMFs during the first 2 of the 4 months of postoperative immobilization. Consolidation of PLF was obtained in 20 of the 31 patients after 2 months of stimulation, thus, healing time was cut in half. After 4 months, fusion was observed in 30 out of the 31 cases submitted to stimulation (96%).

Adult↗
PubMedDate not supplied

Powdered alumina implants in the experimental animal: a histological study conducted in the rat.

The authors present a histological study conducted in the rat after powdered alumina implantation in the subcutis, the muscle and the peritoneum. After two weeks the same intense acute inflammatory reaction was observed in all of the implantation sites. After eight weeks the inflammatory reaction had regressed: there was a thin layer of connective tissue around the implant, completely isolating it from the surrounding tissues.

Aluminum Oxide↗