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Biomedical subjects

Panagiotis Korovessis

Publications and source records attributed to Panagiotis Korovessis.

At least 19 recordsLinked to original sources
PubMed2006

Comparative multifactorial analysis of the effects of idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived health status of adolescents treated with brace.

Bracing is the most effective non-operative treatment for mild progressive spinal deformities in adolescence but it has shown a considerable impact on several aspects of adolescents' functioning. This cross-sectional study investigated the self-perceived health status of adolescents with the two most common deformities, treated with body orthosis. Seventy-nine adolescents with spinal deformities (idiopathic adolescent scoliosis, thoracic Scheuermann kyphosis) and 62 adolescents without spinal deformities were asked to complete the Quality of Life profile for Spine Deformities Instrument. This study showed that adolescents with deformities are significantly less likely to have back pain in training than controls, but more likely to have difficulty in forward bending, and in the most common daily activities while in brace. These individuals claim they wake up because of back pain and feel quite nervous with the external appearance of their body. These patients face often problems with their relations with friends, while they reported difficulties in getting up from bed and sleep at night more often than their counterparts without deformities. As they grow older, patients feel increasing ashamed of their body, as they are more concerned about the future effect of the deformity on their body. As the bracing time increases, patients have much more probability than controls to get low back pain. Girls with deformity have a higher probability than boys to get low back pain while working in the house and while training. Individuals with larger spinal curvatures have more difficulties in bending and increased incidence of back pain than their counterparts with smaller curvatures. Psychological reasons associated mainly with relations at school and back pain are the main causes for low compliance in adolescents with spinal deformities treated with body orthosis. Careful instructions for all individuals who will undergo brace therapy, psychological support for all patients who develop psychological reactions and physical training particularly for older girls should be recommended to increase bracing compliance.

Adolescent↗
PubMed2006

Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe?

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the outcome on patients with pyogenic spondylitis of the thoracolumbar spine following combined anterior and posterior surgery. SUMMARY AND BACKGROUND DATA: Several methods of surgical treatment of pyogenic spondylitis have been reported. These include anterior approach, staged and simultaneous anterior decompression, and posterior stabilization. The use of anterior implants in the presence of an infection presents a challenge for spine surgeons. This study analyzes the clinical and radiologic outcome of surgical intervention on patients with pyogenic spondylitis of the thoracolumbar spine who were treated surgically for intractable pain, instability, and neurologic impairment. METHODS: Fourteen patients (6 women, 8 men) with thoracolumbar spondylitis were treated with anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia. The age (average, SD) of the patients at the time of surgery was 55 +/- 16 years (range, 29-83 years). Most patients had also systemic diseases as lung tuberculosis, hepatic cirrhosis, diabetes mellitus, or chronic renal failure. Patients were evaluated before and after surgery in terms of pain, neurologic level, sagittal spinal balance, and radiologic fusion. RESULTS: The average duration of the combined surgery was 4.5 hours. All patients were observed up for an average of 45 months (range, 37-116 months). The Visual Analog Scale score (average, range) improved from 7 (range, 4-10) before surgery to 2 (range, 0-5) after surgery. Correction (average, range) of segmental kyphotic deformity was 6 degrees (range, 0 degrees-11 degrees) without loss of correction at the final observation. Neither a postoperative change of the position of mesh cage nor any posterior instrumentation failure was recorded. Patients with incomplete neurologic impairment showed improvement after surgery at an average 1.4 Frankel's grade. There was one complication, an anterior wound abscess culminating in an abdominal hernia. CONCLUSIONS: This clinical study showed that patients with thoracolumbar osteomyelitis can successfully undergo anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia. The presence of the mesh cage anteriorly at the site of spondylitis had no negative influence on the course of infection healing, and additionally it stabilized the affected segment maintaining sufficient sagittal profile.

Adult↗
PubMed2006

Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures.

STUDY DESIGN: Prospective randomized study. OBJECTIVES.: To compare the results of the combined anterior-posterior surgery (Group A) with posterior "short-segment" transpedicular fixation (SSTF) (Group B) in mid-lumbar burst fractures. SUMMARY OF BACKGROUND DATA: There are no comparative randomized clinical studies on the outcome following operative treatment of mid-lumbar fractures. METHODS: Forty consecutive patients with L2-L4 fresh single A3-type/AO burst fractures and load sharing score up to 6 were randomly selected to underwent either combined one-stage anterior stabilization with mesh cage and SSTF (Group A) or solely SSTF with intermediate screws in the fractured vertebra (Group B). Kyphotic Gardner angle, anterior and posterior vertebral body height (PVBHr, AVBHr), spinal canal encroachment (SCE), SF-36, VAS, and Frankel classification were used. RESULTS: The follow-up observation averaged 46 and 48 months for Group A and B, respectively. Operative time, blood loss, and hospital stay were significant more in Group A. More surgical complications were observed in the Group A. After surgery, VAS was reduced to 4.3 and 3.6 for Group A and Group B, respectively. The SF-36 domains Role physical and Bodily pain improved significantly only in Group B (P = 0.05) and (P = 0.06), respectively. Correction of AVBHr, PVBHr, and spinal canal clearance was similar in both groups. Spinal canal clearance did not differ between the two groups, but it was continuous until the last evaluation in Group B. The final Gardner angle loss of correction averaged 2 degrees and 5 degrees for Group A and Group B, respectively. The posttraumatic Gardner deformity did not significantly improve by SSTF at the final evaluation in the spines of Group B. Gardner angle correlated significantly with SCE in Group B and Group A in all three periods and in the last evaluation, respectively. Frankel grade did not correlate with loss of correction of AVBHr and PVBHr in Group A, while it significantly correlated with loss of PVBHr correction and SCE in the patients of Group B. There was no neurologic deterioration after surgery in any patient. VAS and SF-36 scores did not significantly correlate with the loss of kyphotic angle correction and AVBHr, PVBHr at the final observation in any patient of both groups. CONCLUSIONS: SSTF offered similar significant short-term correction of posttraumatic deformities associated with mid-lumbar A3-burst fractures, but better clinical results as compared to combined surgery. However, SSTF did not significantly maintain the after surgery achieved correction of local posttraumatic kyphosis at the final evaluation. Thus, SSTF is not recommended for operative stabilization of fractures with this severity.

Adult↗
PubMed2006

One-stage combined surgery with mesh cages for treatment of septic spondylitis.

UNLABELLED: There is a controversy regarding most effective operative method for treatment of pyogenic spondylitis and whether to use metallic implants on the site of infection. This retrospective study reports on the outcome of 17 patients with persistent cervical and lumbar pyogenic spondylitis who had one-stage combined surgery and fusion with use of a titanium mesh cage for intractable pain, kyphosis, and neurologic impairment. All patients tolerated the combined operation and were followed up on for 45 months. Incomplete neurologic lesions improved postoperatively an average 1.4 Frankel grades. Visual analog pain score (mean) improved from 7 preoperatively to 2 postoperatively. Average correction of local kyphotic deformity was 6 degrees without loss of correction at final observation. There was no expulsion or migration of any titanium mesh cage or loosening of the posterior instrumentation. There was an approach-related abdominal hernia after wound infection. At the final followup, the combined operation in combination with the use of the mesh cage improved sagittal alignment and resulted in eradication of the infection and attainment of solid fusion. The presence of the titanium mesh cage anteriorly at the site of infection had no adverse effect on the course of infection. Patients with cervical and lumbar osteomyelitis can successfully have instrumented-combined, one-stage surgery. LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study). Please see the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2006

Experimental usage of hydroxyapatite preadsorption with fibronectin to increase permanent stability and longevity of spinal implants.

UNLABELLED: Hydroxyapatite has been used in orthopaedic and particularly in spinal surgery by precoating implants to indirectly increase osteoblasts' adhesion and subsequently their stability and longevity. Fibronectin preadsorption synergistically with appropriately constructed hydroxyapatite's surface texture to enhance osteoblasts' adhesion has not been, to the authors' knowledge, previously investigated. In osteoporotic spines, methods to increase implant stability (pedicle screws and cages) are of major value. OBJECTIVE: This experimental study investigated the contribution of fibronectin preadsorption to enhance osteoblasts' adhesion and strength on hydroxyapatite. METHODS: Hydroxyapatite substrata with two different surface roughnesses (rough HA180 and the smooth HA1200) were produced and human osteoblasts were seeded on them after culture. Prior to osteoblasts seeding, the hydroxyapatite substrata were immersed in fibronectin solution. Osteoblast attachment on each of the two hydroxyapatite substrata was evaluated by recording the number of cells, while the osteoblast's adhesion strength was determined by measuring the shear stress required to detach the cells from the hydroxyapatite substrates. RESULTS: Fibronectin preadsorption increased the number of attached osteoblasts on smooth and rough hydroxyapatite substratum at 40% and 62% respectively, while it increased osteoblast attachment strength on the smooth and rough substratum at 165% and 73% respectively. CONCLUSIONS: Fibronectin preadsorption and smooth hydroxyapatite surface texture synergistically increased the adhesion's strength of human osteoblasts "in vitro", while preadsorption and rough hydroxyapatite surface increased the number of attached osteoblasts. Further studies in primates and human beings should be carried out to disclose the clinical relevance of the above mentioned observations in spine surgery.

Coated Materials, Biocompatible↗
PubMed2005

Posterior transcanal lumbar interbody fusion for septic vertebral fracture pseudarthrosis and sitting imbalance.

STUDY DESIGN: Case report. OBJECTIVE: To describe a new method to treat septic pseudarthrosis of the lumbar spine via a transcanal approach. SUMMARY OF BACKGROUND DATA: Septic pseudarthrosis of the spine after multiple unsuccessful anterior and posterior surgeries for vertebral fracture represents a challenge for spine surgeons. METHODS: Septic pseudarthrosis associated with dorsal fistula developed in a 40-year-old paraplegic man after unsuccessful combined anterior and posterior instrumentation for L3-burst fracture and sagittal sitting imbalance caused by collapsing spine. RESULTS: The instrumentation was removed together with meticulous pseudarthrosis debridement, fistula excision, and intravenous antibiotics plus continuous irrigation. Three months later, the pseudarthrosis area was approached via a posterior transcanal route because of the preceding multiple anterior transperitoneal and retroperitoneal surgeries. Posterior interbody instrumentation and fusion were performed with titanium mesh cages filled with autologous iliac bone graft. Pedicle screw-rod instrumentation was additionally applied to reinforce the interbody fusion and restore lumbar lordosis. Following this operation, the patient was ambulated with a custom made plastic jacket in his wheelchair. The postoperative course was uneventful, and the patient regained his sitting ability progressively. Four months later, the blood count analysis was within normal limits. Radiologically, there was a complete fusion at the level of instrumentation, while the preoperative lost lumbar lordosis was sufficiently restored. The patient was reemployed 6 months after surgery in his previous work in a sitting position, and, during the last observation 4 years later, he had normal labor analysis and lumbar lordosis. CONCLUSION: This extremely rare case focuses on the use of the transcanal approach to treat adequately lumbar septic pseudarthrosis and restore lumbar lordosis in definitively paraplegic patients in whom no anterior approach can be used.

Adult↗
PubMed2005

Correlative radiological, self-assessment and clinical analysis of evolution in instrumented dorsal and lateral fusion for degenerative lumbar spine disease. Autograft versus coralline hydroxyapatite.

This prospective longitudinal randomized clinical and radiological study compared the evolution of instrumented posterolateral lumbar and lumbosacral fusion using either coralline hydroxyapatite (CH), or iliac bone graft (IBG) or both in three comparable groups, A, B and C, which included 19, 18 and 20 patients, respectively, who suffered from symptomatic degenerative lumbar spinal stenosis and underwent decompression and fusion. The patients were divided randomly according to the graft used and the side that it was applied. The spines of group A received autologous IBG bilaterally; group B, IBG on the left side and hydroxyapatite mixed with local bone and bone marrow on the right side; group C, hydroxyapatite mixed with local bone and bone marrow bilaterally. The age of the patients in the groups A, B and C was 61+/-11 years, 64+/-8 years and 58+/-8 years, respectively. The SF-36, Oswestry Disability Index (ODI), and Roland-Morris (R-M) surveys were used for subjective evaluation of the result of the surgery and the Visual Analogue Scale (VAS) for pain severity. Plain roentgenograms including anteroposterior, lateral and oblique views, and lateral plus frontal bending views of the instrumented spine and CT scan were used to evaluate the evolution of the posterolateral fusion in all groups and sides. Two independent senior orthopaedic radiologists were asked to evaluate first the evolution of the dorsolateral bony fusion 3-48 months postoperatively with the Christiansen's radiologic method, and secondly the hydroxyapatite resorption course in the spines of groups B and C. The diagnosis of solid spinal fusion was definitively confirmed with the addition of the bending views, CT scans and self-assessment scores. The intraobserver and interobserver agreement (r) for radiological fusion was 0.71 and 0.69, respectively, and 0.83 and 0.76 for evaluation of CH resorption. T(12)-S(1) lordosis and segmental angulation did not change postoperatively. There was no radiological evidence for non-union on the plain roentgenograms and CT scans. Radiological fusion was achieved 1 year postoperatively and was observed in all groups and vertebral segments. Six months postoperatively there was an obvious resorption of hydroxyapatite granules at the intertransverse intersegmental spaces in the right side of the spines of group B and both sides of group C. The resorption of hydroxyapatite was completed 1 year postoperatively. Bone bridging started in the third month postoperatively in all instrumented spines and all levels posteriorly as well as between the transverse processes in the spines of the group A and on the left side of the spines of group B where IBG was applied. SF-36, ODI, and R-M score improved postoperatively in a similar way in all groups. There was one pedicle screw breakage at the lowermost instrumented level in group A and two in group C without radiologically visible pseudarthrosis, which were considered as having non-union. Operative time and blood loss were less in the patients of group C, while donor site complaints were observed in the patients of the groups A and B only. This study showed that autologous IBG remains the "gold standard" for achieving solid posterior instrumented lumbar fusion, to which each new graft should be compared. The incorporation of coralline hydroxyapatite mixed with local bone and bone marrow needs adequate bleeding bone surface. Subsequently, hydroxyapatite was proven in this series to not be appropriate for intertransverse posterolateral fusion, because the host bone in this area is little. However, the use of hydroxyapatite over the decorticated laminae that represents a wide host area was followed by solid dorsal fusion within the expected time.

Aged↗
PubMed2005

Backpacks, back pain, sagittal spinal curves and trunk alignment in adolescents: a logistic and multinomial logistic analysis.

STUDY DESIGN: Cross-sectional study using logistic and multinomial logistic analysis. OBJECTIVES: To investigate the influence of backpack carrying on spinal profile shoulder and trunk. SUMMARY OF BACKGROUND DATA: No similar investigations. METHODS: A randomly selected sample of 1263 students aged 12-18 years were asked for dorsal (DP) and low back pain (LBP) during the school period and holidays. Debrunner's Kyphometer and Scoliometer were used to measure craniocervical angle (CCA), thoracic kyphosis, lumbar lordosis, and shoulder shift (BL). Upper trunk shift from plumbline were recorded. RESULTS: Girls suffer from DP more often and of much more intensity pain than boys in school period and in holidays. Backpack carrying decreased CCA and changed shoulder and upper trunk shift. Asymmetrically backpack carrying increased DP and LBP. BL-shift increased DP. DP and LBP increased with coronal trunk shift. Sagittal trunk shift increased LBP. Asymmetrically carrying of backpacks increased back pain and shoulder shift in holidays. Coronal trunk shift while carrying backpacks asymmetrically increased back pain in holidays. Asymmetric backpack carrying is associated with high intensity pain. Frontal trunk shift is associated with high intensity pain. CONCLUSION: Backpack carrying, particularly asymmetrically, results in shift of upper trunk and shoulder and cervical lordosis, which furthermore seem to increase back pain in school period and holidays. Symmetric backpack carrying is recommended.

Adolescent↗
PubMed2005

Fibronectin preadsorbed on hydroxyapatite together with rough surface structure increases osteoblasts' adhesion "in vitro": the theoretical usefulness of fibronectin preadsorption on hydroxyapatite to increase permanent stability and longevity in spine implants.

OBJECTIVE: The aim of this study was to investigate the contribution of fibronectin (FN) preadsorption to enhance osteoblast adhesion and strength on hydroxyapatite (HA) used either as osteoconductive bone substitute or precoating of pedicle screws and cages in spine surgery. METHODS: HA substrata with two different surface roughness values (rough HA180 and smooth HA1200) were produced, and human osteoblasts were seeded after culturing on them. Prior to osteoblast seeding, the HA substrata were immersed in FN solution. Osteoblast attachment on each of the two HA substrata was evaluated by recording the number of cells, whereas osteoblast adhesion strength was determined by measuring the shear stress required to detach the cells from the HA substrates. RESULTS: FN preadsorption increased the number of attached osteoblasts on smooth and rough HA substratum at 40% and 62%, respectively, whereas it increased osteoblast attachment strength on the smooth and rough substratum at 165% and 73%, respectively. CONCLUSIONS: This study showed that FN preadsorption and rough HA surface texture synergistically increased "in vitro" both the number and the adhesion strength of human osteoblasts. Further studies in primates and humans should be carried out to disclose the clinical relevance (increase implant's stability and longevity) of the above-mentioned observations.

Adsorption↗
PubMed2004

Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results.

STUDY DESIGN: Prospective comparative randomized clinical and radiologic study. OBJECTIVE: This study was conducted to compare the short-term effects of rigid versus semirigid and dynamic instrumentation on the global and segmental lumbar spine profile, subjective evaluation of the result, and the associated complications. BACKGROUND DATA: Lumbar spine fusion with rigid instrumentation for degenerative spinal disorders seems to increase the fusion rate. However, rigid instrumentation may be associated with some undesirable effects, such as increased low back pain following decrease of lumbar lordosis, fracture of the vertebral body and pedicle, pedicle screw loosening, and adjacent segment degeneration. The use of semirigid and dynamic devices has been advocated to reduce such adverse effects of the rigid instrumentation and thus to achieve a more physiologic bony fusion. MATERIALS AND METHODS: This study compared 3 equal groups of 45 adult patients, who underwent primary decompression and stabilization for symptomatic degenerative lumbar spinal stenosis. The patients of each group were randomly selected and received either the rigid (Group A), or semirigid (Group B), or dynamic (Group C) spinal instrumentation with formal decompression and fusion. The mean ages of the patients who received rigid, semirigid, and dynamic instrumentation were 65 +/- 9, 59 +/- 16, and 62 +/- 10 years, respectively. All patients had detailed roentgenographic study including computed tomography scan and magnetic resonance imaging before surgery to the latest follow-up observation. The following roentgenographic parameters were measured and compared in all spines: lumbar lordosis (L1-S1), total lumbar lordosis (T12-S1), sacral tilt, distal lordosis (L4-S1), segmental lordosis, vertebral inclination, and disc index. The SF-36 health survey and Visual Analogue Scale was used before surgery to the latest evaluation. RESULTS: All patients were evaluated after a mean follow-up of 47 +/- 14 months. Both lumbar and total lordosis correction did not correlate with the number of the levels instrumented in any group. Total lordosis was slightly decreased after surgery (3%, P < 0.05) in Group C. The segmentallordosis L2-L3 was increased after surgery by 8.5% (P < 0.05) in Group C, whereas the segmentallordosis L4-L5 was significantly decreased in Group Aand C by 9.8% (P = 0.01) and 16.2% (P < 0.01), respectively. The disc index L2-L3 was decreased after surgery in Group A and C by 17% (P < 0.05) and 23.5% (P < 0.05), respectively. The disc index L3-L4 was increased in Group C by 18.74% (P < 0.01). The disc index L4-L5 was after surgery decreased in all 3 groups: Group A by 21% (P = 0.01), Group B by 13% (P < 0.05), and Group C by 13.23% (P < 0.05). The disc index L5-S1 was significantly decreased in Group B by 13% (P < 0.05). The mean preoperative scores of the SF-36 before surgery were 11, 14, and 13 for Groups C, B, and A, respectively. In the first year after surgery, there was a significant increase of the preoperative SF-36 scores to 65, 61, and 61 for Groups C, B, and A, respectively, that represents an improvement of 83%, 77%, and 79%, respectively. In the second year after surgery and thereafter, there was a further increase of SF-36 scores of 19%, 23%, and 21% for Groups C, B, and A, respectively. The mean preoperative scores of Visual Analogue Scale for low back pain for Groups C, B, and A were 5, 4.5, and 4.3, respectively, and decreased after surgery to 1.9, 1.5, and 1.6, respectively. The mean preoperative scores of the Visual Analogue Scale for leg pain for Groups C, B, and A were 7.6, 7.1, and 6.9, respectively, and decreased after surgery to 2.5, 2.5, and 2.7, respectively. All fusions healed radiologically within the expected time in all three groups without pseudarthrosis or malunion. Delayed hardware failure (1 screw and 2 rod breakages) 1 year and 18 months after surgery without radiologic pseudarthrosis was observed in 2 patients in Group C. Asymptomatic radiolucent areas were shown around pedicle screws in the pedd pedicle screws in the pedicles L5 and S1 in 2, 3, and 4 cases in Group C, A, and B, respectively. There was no adjacent segment degeneration in any spine until the last evaluation. DISCUSSION AND CONCLUSION: This comparative study showed that all three instrumentations applied over a short area for symptomatic degenerative spinal stenosis almost equally after surgery maintained the preoperative global and segmental sagittal profile of the lumbosacral spine and was followed by similarly significant improvement of both self-assessment and pain scores. Hardware failure occurred at a low rate following dynamic instrumentation solely without radiologically visible pseudarthrosis or loss of correction. Because of the similar clinical and radiologic data in all three groups and the relative small number of patients that were included in each group, it is difficult for the authors to make any recommendation in favor of any instrumentation.

Aged↗
PubMed2004

Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents.

This cross-sectional study was carried out to investigate any correlation between backpack carrying, spinal curvatures, and athletic activities on schoolchildren's dorsal (DP) and low back pain (LBP). Three thousand four hundred forty-one students aged from 9 to 15 years who carried backpacks to school were included in this study and asked for DP and LBP experiences in the school period while carrying the backpack. Nonradiating methods (surface back contour analysis) were used to indirectly measure frontal spinal curve (scoliosis) with the scoliometer and lateral curves (thoracic kyphosis and lumbar lordosis) with the kyphometer. All data analyses were undertaken regarding school year level, age, gender, sports participation, backpack weight, and way of carrying (one versus both shoulder) in relation to magnitude of scoliosis, thoracic kyphosis, lumbar lordosis, and DP and LBP while carrying the backpack. DP increased with increasing backpack weight (P < 0.05). The way (one versus both shoulder) of backpack carrying did not correlate either with DP or with LBP. Girls experienced much more LBP and DP than boys (P < 0.001). There was no difference in the prevalence of LBP and DP between adolescents and children. Students' age, height, and body weight as well as magnitude of kyphosis, lordosis, and scoliosis did not correlate with either LBP or DP. At the age of 11 years, girls and boys showed the highest prevalence for DP (72% and 38.5%, respectively), while at the age of 14 years, girls reported significantly (P < 0.05) more DP than boys. Girls showed the highest prevalence of LBP (71%) at the age of 11 years, while for the boys, it was at the age of 15 years (21%). Girls showed at the age of 11 years significantly more LBP (P < 0.05) than boys. Sports exposure seemed to increase LBP in girls (P < 0.001). The results of this study suggest a differential DP and LBP prevalence in schoolchildren and adolescents carrying backpacks with regard to gender and age. The peak in pain prevalence was immediately before puberty as well as immediately after its onset. Girls who participated in sports activities seem to experience more often DP and LBP than boys. Short children who carry backpacks as heavy as do tall children at the same age are more prone to LBP.

Adolescent↗
PubMed2004

Correlative analysis of the results of surgical treatment of thoracolumbar injuries with long Texas Scottish rite hospital construct: is the use of pedicle screws versus hooks advantageous in the lumbar spine?

This is a prospective, randomized study to compare the efficacy of two similar "long-segment" Texas Scottish Rite Hospital instrumentations with the use of hooks in the thoracic spine and pedicle screws versus laminar hook claw in the lumbar spine for thoracolumbar A3, B, and C injuries. Forty consecutive patients with such thoracolumbar fractures (T11-L1) associated with spinal canal encroachment underwent early operative postural reduction and stabilization. The patients were randomly sampled into two groups: Twenty patients received hooks in "claw configuration" in both the thoracic and the lumbar spine (group A), and 20 patients received hooks in the thoracic vertebrae and pedicle screws in the lumbar vertebrae (group B). Pre- and postoperative plain roentgenograms and computed tomography scans were used to evaluate any changes in Gardner post-traumatic kyphotic deformity, anterior and posterior vertebral body height at the fracture level, and spinal canal clearance (SCC). All patients were followed for an average period of 52 months (range 42-71 months). The correction of anterior vertebral body height was significantly more (P < 0.01) in the spines of group B (33%) than in group A (16%), with a subsequent 11% loss of correction at the latest evaluation in group A and no loss of correction in group B. There were no significant differences in the changes of posterior vertebral body height and Gardner angle between the two groups. The SCC was significantly more (P < 0.05) immediately postoperatively in the spine of group B (32%) than in group A (19%). In the latest evaluation, there was a 9% loss of the immediately postoperatively achieved SCC in group A, while SCC was furthermore increased at 10.5% in group B. All patients with incomplete neurologic lesions in groups A and B were postoperatively improved at 1.1 and 1.7 levels, respectively. There were two hook dislodgements in the thoracic spine, one in each group, while there was no screw failure in group B. There was neither pseudarthrosis nor neurologic deterioration following surgery. Visual Analog Pain Scale and Short Form-36 scores were equally improved and did not differ between the two groups. The use of pedicle screws in the lumbar spine to stabilize the lowermost end of a long rigid construct applied for A3, B, and C thoracolumbar injuries was advantageous when compared with that using hook claws in the lumbar spine because the constructs with screws restored and maintained the fractured anterior vertebral body height better than the hooks without subsequent loss of correction and safeguarded postoperatively a continuous SCC at the injury level.

Adolescent↗
PubMed2003

Colour Doppler ultrasonography for evaluation of anterior chest blood supply: the possible role of arterial blood supply to the costosternal junction in the aetiology of idiopathic scoliosis in female adolescents.

This prospective comparative study was carried out to investigate the blood supply to the anterior chest wall by measurement of several anatomical and haemodynamic flow parameters of the internal mammary artery, with the use of colour Doppler ultrasonography, in female scoliotics with idiopathic right convex scoliosis in adolescence. Previous investigations have postulated that asymmetry of the breasts in female adolescents may be linked with the development of right convex thoracic scoliosis. This breast asymmetry is supposed to be linked with anatomical and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomical and haemodynamic parameters of the internal mammary artery have been made to justify or reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Twenty female adolescents with right convex thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with roentgenograms (scoliotics only) to measure scoliosis curve, vertebral rotation and concave and convex rib-vertebra angle at three vertebrae (the apical, one level above and one below the apical vertebra). Doppler ultrasonography was used to measure, at the origin of the internal mammary artery, its lumen diameter, cross-sectional area, time average mean flow and flow volume per minute in scoliotics and controls, which were compared with each other. The roentgenographic parameters were compared with the ultrasonographic parameters in the scoliotics to disclose any relationship. The reliability of colour Doppler ultrasonography was high and the intra-observer variability low (ANOVA, P=0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. In scoliotics the right mammary artery time average mean velocity increases with the convex ( P<0.05) and concave ( P<0.01) rib-vertebra angle one level above the apical vertebrae and with the apical convex rib-vertebra angle ( P<0.05). The right internal mammary artery flow volume per minute increases with convex ( P<0.01) and concave ( P<0.01) rib-vertebra angle one level above the apical vertebrae and with the apical convex rib-vertebra angle ( P<0.05). Left internal mammary artery cross-sectional area increases with convex apical rib-vertebra angle ( P<0.01) and concave rib-vertebra angle one level above the apical vertebra ( P<0.01). Conclusively, this investigation showed that haemodynamic flow parameters of the right internal mammary artery and anatomical parameters of the left internal mammary artery are significantly correlated with the magnitude of rib-vertebra angles close to the apex of right thoracic scoliosis in female adolescents. This study did not find any evidence for side-difference in vascularity of the anterior thorax wall and, thus, it could not clearly justify previous theories for development of right thoracic scoliosis in female adolescents.

Adolescent↗
PubMed2003

Color Doppler ultrasonography for evaluation of internal mammary artery application in adolescent female patients with right-convex thoracic idiopathic scoliosis.

STUDY DESIGN: Prospective comparative study. OBJECTIVE: To establish the use of Color Doppler Ultrasonography to investigate internal mammary artery. SUMMARY OF BACKGROUND DATA: Breast asymmetry in female adolescents with right convex idiopathic scoliosis was supposed to be linked with anatomic and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomic and hemodynamic parameters of internal mammary artery have been made to justify or to reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Color Doppler Ultrasonography is a well established noninvasive method to assess vessel anatomy and hemodynamics. METHODS: Twenty female adolescents with right thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with Color Doppler Ultrasonography to measure at the origin of internal mammary artery lumen diameter, cross sectional area, time average mean flow and flow volume per minute and were compared each other. RESULTS: The reliability of Color Doppler Ultrasonography was high and the intraobserver variability low (ANOVA, P = 0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. CONCLUSIONS: Color Doppler Ultrasonography applied to assess anatomic or hemodynamic blood flow parameters at the origin of internal mammary artery was proven a highly reliable method. Color Doppler Ultrasonography disclosed no side-differences, while there were no differences between scoliotics and controls. Thus, it seems that this study cannot justify previous theories for development of right thoracic scoliosis in female adolescents.

Adolescent↗
PubMed2002

Zweymueller with metal-on-metal articulation: clinical, radiological and histological analysis of short-term results.

BACKGROUND: This is a prospective study. METHOD: . A total of 266 consecutive patients, who received 350 third-generation Zweymueller-SL total hip arthroplasties with metal-on-metal articulation for primary or secondary osteoarthritis, was followed and evaluated clinically, radiologically and histologically. The age of the patients at the time of surgery was 55+/-9 years, (range 25-70 years). Seven ( 3%) patients did not return for their last follow-up evaluation for reasons unrelated to their hip operation. RESULTS: The mean follow-up was 52 months (range 37-92 months). The preoperative Harris hip score was 45+/-19 and increased to 96+/-4 postoperatively. The invalidity of the patients was significantly improved postoperatively ( p<0.001). In all, 97% of the patients were satisfied or very satisfied with the result of the operation. There was no aseptic loosening noted in this series. Revision was done in 6 (1.8%) hips because of septic loosening ( n=5, 1.5%) or technical error ( n=1, 0.3%) during implantation. Dislocation of the prosthesis occurred in the early postoperative period in 2 (0.6%) hips. Periarticular ossification was observed in 30% of the hips (5% Brooker grades III and IV), but without associated disability. During revision surgery, no macroscopic metalosis could be identified in the newly formed hip joint membrane; however microscopic evidence for metalosis (Mirra grades 1 and 2) was seen in all revised hips. The survival for Zweymueller screw socket and stem 7.6 years after implantation was 99.4% and 96.8%, respectively. CONCLUSIONS: This study showed that the short-term results of Zweymueller total hip arthroplasty with metal-on-metal articulation were just as satisfactory as those of a conventional polyethylene on ceramic articulation, while the metal-on-metal articulation does not seem to give rise to new problems or complications.

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