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Biomedical subjects

M W Fidler

Publications and source records attributed to M W Fidler.

At least 19 recordsLinked to original sources
PubMed2001

Surgical treatment of giant cell tumours of the thoracic and lumbar spine: report of nine patients.

Giant cell tumours involving vertebral bodies are still difficult to treat, though results are gradually improving. The object of this study was to assess the results of "complete excision", both of previously untreated giant cell tumours and of recurrences, and to consider the possible effects of any tumour contamination during operation. Nine consecutive patients with giant cell tumours of the thoracic and lumbar spine were treated surgically between 1986 and 1995. Four of these patients were referred with recurrent tumours. All operations aimed at complete resection of the tumour, where possible an en-bloc approach was used. The spines were reconstructed with autografts and instrumentation. All patients were regularly reviewed as part of an on-going study. Following the five operations for previously untreated tumours ("primary" operations), there were no local recurrences, but one patient died of pulmonary metastases. One of the four patients operated upon for a recurrence developed a further recurrence, which was excised 2 1/2 years ago. It would seem that giant cell tumours of the thoracic and lumbar spine, including recurrences, should be treated by complete excision. The en-bloc approach is the safest technique. Where an intralesional component is unavoidable, total removal of the (pseudo)capsule should be ensured by preliminary extralesional dissection. Any tumour spill should be meticulously removed. The use of frozen sections to check resection margins is advisable.

Adult↗
PubMed1999

Severe progressive osteoporotic spine deformity with cardiopulmonary impairment in a young patient. A case report.

STUDY DESIGN: This report describes a young patient with a rapidly progressive kyphosis caused by collapse of a severely osteoporotic thoracolumbar spine, which led to impairment of cardiopulmonary function. OBJECTIVES: To highlight the treatment strategy, difficulty of diagnosis, operative stabilization, and outcome. SUMMARY OF BACKGROUND DATA: Little is known about natural history, treatment options, and results of this condition. METHODS: The magnitude of bone loss was measured by dual-energy x-ray absorptiometry, and the deformity was visualized by computed tomography and magnetic resonance imaging. Laboratory investigations also were performed before and during halotraction in an attempt to establish a diagnosis. These data constituted the preoperation information required to assess later results of medical and surgical intervention. RESULTS: An extensive evaluation of possible underlying etiologies failed to identify a specific etiology. Before and during halotraction, bone mineral substitutes were given, partially correcting the bone mineral content as measured on repeated dual-energy x-ray absorptiometry scans. In addition, the thoracic kyphosis was partially corrected, from 100 degrees to 70 degrees Cobb's angle. Subsequently, a combined anterior and posterior stabilization was performed from C7 to S1 using a vascularized fibula graft, a double Isola rod system (AcroMed, Cleveland, OH), and a carbonate apatite cancellous bone cement to reinforce the pedicle screws. At follow-up assessment 40 months surgery, the patient was asymptomatic and fully mobilized, with radiographs showing complete incorporation of the grafts and no loosening of the fixation device. CONCLUSIONS: The diagnostic and therapeutic difficulties of progressive spine deformity caused by severe osteoporosis in young patients emphasizes the importance of a thoroughly planned treatment strategy. Halotraction is recommended to stop progression of the deformity, or even partially correct it, and to allow time to search for the diagnosis and bone mineral substitution. Surgical treatment using vascularized fibular strut grafts and a strong fixation device was successful. Biocompatible carbonated apatite cancellous bone cement was successfully used to reinforce pedicle screw fixation.

Absorptiometry, Photon↗
PubMed1997

Multifocal giant cell tumors in the spine. A case report.

STUDY DESIGN: This is a case report of a patient with two giant cell tumors, the first in thoracic spine and the second, two years later, in the sacrum. OBJECTIVES: To report the first patient in whom multifocal primary giant cell tumors have been found in the spine. SUMMARY OF BACKGROUND DATA: There have been no similar previous reports. METHODS: The diagnoses were made by biopsy. RESULTS: Curative removal of both tumors was achieved. CONCLUSIONS: More than one primary giant cell tumor in the spine can develop.

Adult↗
PubMed1997

Spinal fusion: a combined anterior and supplementary interspinous technique.

"Standard", noninstrumented, techniques of anterior interbody fusion are frequently followed by nonunion and collapse of the intervertebral space, probably because of persistent rocking movements, particularly in the sagittal plane. Elimination of these theoretical movements by supplementing an anterior interbody fusion with a posterior interspinous H-graft and a cerclage wire was considered to be biomechanically attractive without having the disadvantages associated with posterior instrumentation. In a prospective study a solid fusion was obtained at 16 of 17 operated levels, with a mediocre (+/- 50%) fusion as the exception. The height of the intervertebral space was increased at the majority of the fused levels. The technique is only applicable where neural arches are intact. The technique proved to be safe, simple, effective and inexpensive.

Bone Transplantation↗
PubMed1997

Visual analog scale for the assessment of total hip arthroplasty.

The use of a visual analog scale (VAS) for the assessment of total hip prostheses was evaluated in 54 patients (58 hips), on average 3.4 years following operation. The Harris hip scores were determined in each case and the patients were also asked to record their overall assessment of their new hips on a VAS. Five patients (6 hips) were unable to understand and use the VAS. For the remaining 49 patients (52 hips), the Harris hip score averaged 84 (41-100) and the VAS score 75 (2-100). There was a high correlation between the Harris hip scores and the VAS scores (+0.84). Use of a VAS provides a simple and reliable basis for the assessment of a total hip arthroplasty.

Adult↗
PubMed1996

The Harris-Galante cementless femoral component: poor results in 57 hips followed for 3 years.

Between 1986 and 1991, 68 Harris-Galante femoral prostheses were implanted in 63 patients. 53 patients (57 hips) attended for follow-up after a mean of 3.4 (2-6) years. The average Harris Hip Score (HHS) was 39 preoperatively and 81 postoperatively. Only 34 hips were excellent (27) or good (7). Mid-thigh pain occurred in 30 cases. 10 femoral components were radiographically loose because of osteolysis. Although 7 cups seemed to be radiographically loose, they probably played only a minor role in the poor overall early clinical results.

Adult↗
PubMed1994

Posterior atlantoaxial fusion. A new internal fixation device.

STUDY DESIGN: Biomechanical and clinical testing of an atlantoaxial posterior fixation device. OBJECTIVES: The authors tested an internal fixation device to maintain the atlas and axis in an anatomic relationship while fusion occurs. The device should also facilitate intraoperative reduction of any residual anterior atlantoaxial subluxation. The device should allow the use of cancellous rather than cortical bone graft. SUMMARY OF BACKGROUND DATA: Previous techniques of atlantoaxial fusion were not universally successful, and the quality of reduction was assessed infrequently. METHODS: Biomechanical testing of the fixator and clinical use in two "problem" patients requiring atlantoaxial fusion. RESULTS: Biomechanical testing indicated the device should be successful. Clinical testing was successful. CONCLUSION: The new fixator facilitates posterior atlantoaxial fusion in an anatomical position.

Atlanto-Axial Joint↗
PubMed1994

Cellular hemangioma and angioblastoma of the spine, originally classified as hemangioendothelioma. A confusing diagnosis.

STUDY DESIGN: The authors report two cases of vascular tumors of the spine, classified originally as benign and malignant hemangioendothelioma, and after revision, as cellular hemangioma and angioblastomatosis, respectively. OBJECTIVES: Problems in interpretation of the confusing term hemangioendothelioma and treatment modalities for vascular tumors of the spine are discussed. SUMMARY OF BACKGROUND DATA: Hemangioendothelioma is a confusing term and is often used to cover bewilderment at the biological behavior of a vascular tumor. Its spectrum ranges, depending the references used, from benign to malignant and can mistakenly include benign lesions like cellular hemangioma and angioblastoma (solitary and multicentric). METHODS: Of two patients with a cellular tumor of the spine, the clinicopathologic data and modes of treatment are reviewed. The relevant literature is discussed. RESULTS: In the first case, the diagnosis of benign cellular hemangioendothelioma was changed to cellular hemangioma. In the second case, the original diagnosis of malignant hemangioendothelioma with metastasis to liver and lungs was changed to angioblastomatosis, most probably benign. In both cases, a correct interpretation of the initial diagnosis or proper diagnosis would have influenced the mode of treatment. CONCLUSION: Avoid the confusing term hemangioendothelioma. If a vascular lesion is benign, it should be classified as a variant of hemangioma. If malignant as angiosarcoma, use a separate category, in which lesions like angioblastoma and angioblastomatosis can be put until their nature has been clarified.

Adult↗
PubMed1994

Radical resection of vertebral body tumours. A surgical technique used in ten cases.

An operation for radical resection of a tumour of the vertebral body and part of the neural arch is described. The approach is posterior and from both sides of the spine. The posterior approach is used to remove the healthy part of the neural arch, mobilise the dura, divide involved nerve roots and carry out the posterolateral parts of the spinal osteotomies or disc divisions. On one side, usually the right, the sides of the vertebral body or bodies are freed and the osteotomies or disc divisions are extended. Then from the other side, a posterolateral thoracotomy or lumbotomy allows completion of the dissection with radical resection by rolling the specimen away from the dura. Ten operations are reported in which up to three and a half vertebrae were resected. Spinal reconstruction was by internal fixation and grafting preferably with vascularised bone. The results were satisfactory after follow-up for as long as eight years.

Adolescent↗
PubMed1987

Poor results of double osteotomy for the rheumatoid knee.

A series of 27 patients (30 knees) with rheumatoid arthritis was studied 3 to 8 years after double osteotomy of the knee. Long-term results were poor. Double osteotomy should be abandoned in the management of the rheumatoid knee.

Adult↗
PubMed1986

Anterior and posterior stabilization of the spine following vertebral body resection. A postmortem investigation.

Postmortem examination of a spine, which had been instrumented anteriorly at one level and posteriorly at another following vertebral body resections, showed that the posterior instrumentation was more effective in resisting torsion. Postmortem examination of a second case, where the anterior fixation had been strengthened by the addition of cement studs in the vertebral end-plates and a paravertebral modified and strengthened Zielke screw/rod system, showed this second anterior system to be an improvement for resisting torsion following the resection of one vertebral body. Anterior interbody devices become enveloped in a firm smooth fibrous capsule. A preliminary experiment on a cadaver spine had shown that anterior interbody fixation was better than posterior instrumentation for resisting flexion-compression forces.

Aged↗
PubMed1986

Posterior instrumentation of the spine. An experimental comparison of various possible techniques.

Fourteen variations of posterior instrumentation were tested experimentally, using models based on polyester imitation vertebrae, to determine the most effective method for stabilization of a section of the spine following fracture and, in particular, pathologic fracture. The most rigid construction was a well-fitting steel rectangle fastened to the vertebrae with laminar wires. The addition of bone cement significantly improved rigidity.

Biomechanical Phenomena↗
PubMed1986

Anterior decompression and stabilisation of metastatic spinal fractures.

Seventeen patients with pathological fractures of the thoracolumbar spine which had not responded to conservative treatment are reported. All had compression of the spinal cord and/or severe pain. All (except one treated by lateral rhachotomy) were treated by anterior decompression followed by stabilisation; when the lesion was below T2 the spine was stabilised anteriorly, and when it was higher posterior instrumentation was used. Sixteen of the 17 patients benefited from the procedure.

Adult↗