Intra-articular osteocartilaginous obstruction to reduction of congenital dislocation of the hip. Report of three cases.
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Acetabulum↗
Biomedical subjects
T J Flatley
Publications and source records attributed to T J Flatley.
Painful pseudarthrosis following lumbar spinal fusion: detection by combined SPECT and planar bone scintigraphy.
Twenty-six adult patients more than 6-months post-lumbar spinal fusion were studied. Flexion and extension radiographs showing motion or bone scintigrams showing focal areas of increased activity within the fusion mass were considered positive for pseudarthrosis. Patients were classified as either symptomatic or asymptomatic. Among the 15 symptomatic patients, scintigraphy had a sensitivity of 0.78 and a specificity of 0.83 which was superior to the 0.43 sensitivity and 0.50 specificity of radiography. Six of the 11 asymptomatic patients had focal areas of increased activity in the bony fusion mass, possibly reflecting painless pseudarthrosis. Planar imaging was substantially enhanced by SPECT in 14 of the 26 cases. It is concluded that for the patient who remains symptomatic after lumbar spinal fusion, bone scintigraphy with SPECT is of significant value in detecting painful pseudarthrosis.
Adult↗
Postoperative spondylolisthesis.
The conditions and clinical significance of postlaminectomy spondylolisthesis were investigated in eight cases of lumbar spondylolisthesis, including five with slips not present at the time of decompression and three with progression of previously observed degenerative slips. All were women with an average age of 62 years. The major instability occurred at the L4-L5 level in seven of the eight cases. Either bilateral facetectomy or transection of the pars interarticularis had been part of the laminectomy. The L4-L5 level seems predisposed to spondylolisthesis in women whose facets have been destabilized by either bilateral removal or pars transection. Extra effort should be made to preserve facet stability during decompression, or add fusion after excision of posterior elements of spondylolisthesis.
Aged↗
Painful spondylolysis or spondylolisthesis studied by radiography and single-photon emission computed tomography.
Planar bone scintigraphy (PBS) and single-photon emission computed tomography (SPECT) were compared in 19 adults with radiographic evidence of spondylolysis and/or spondylolisthesis. SPECT was more sensitive than PBS when used to identify symptomatic patients and sites of "painful" defects in the pars interarticularis. In addition, SPECT allowed more accurate localization than PBS. In 6 patients, spondylolysis or spondylolisthesis was unrelated to low back pain, and SPECT images of the posterior neural arch were normal. The authors conclude that when spondylolysis or spondylolisthesis is the cause of low back pain, pars defects are frequently heralded by increased scintigraphic activity which is best detected and localized by SPECT.
Adolescent↗
Comparison of the failure biomechanics of spinal fixation devices.
The failure biomechanics of Harrington distraction rods, modified Weiss springs, and Luque rods were studied in intact cadavers and isolated spinal columns using flexion-compression loading. Most spines fractured at T-11 or T-12 at applied loads ranging between 556 and 4220 newtons (mean = 1833 N). After Harrington distraction rod placement, the same spines failed at a mean load of 859 N (42% of control), always as a result of hook extrusion and often including lamina fracture (seven cases). When modified Weiss springs were used, the spines failed at a mean load of 1128 N (54% of control) by allowing the spine to bend to the initial failure angle; in most instances, deformities resolved when the load was reduced. Luque rods were tested in four specimens; these provided the most rigid stabilization and failed at 83% of control values. Modified Weiss springs often maintain spinal stability better than Harrington distraction rods.
Aged↗
Closed loop instrumentation of the lumbar spine.
A review of 40 consecutive nonreported multilevel lumbar fusions revealed an unacceptable pseudarthrosis rate of 32.5%. In an attempt to reduce this complication, a modification of segmental spinal instrumentation with use of a closed loop was performed on 50 consecutive patients treated by multilevel lumbar stabilizations. The primary diagnoses were degenerative disc and/or facet disease in 32, spondylolisthesis in 14, and pseudarthrosis in four. Thirty-eight percent had three or more levels to be fused. Thirty-two percent had had previous spinal surgery. Follow-up study was a minimum of one year. Seventy-three percent had posterior facet fusions. Twenty-seven percent had bilateral transverse process fusions. A pseudarthrosis occurred early in six patients, an incidence of 12%; three of the six occurred in patients with spondylolisthesis. Four of the six pseudarthroses occurred following posterior fusions. Subjective symptoms were improved in 80%. Working capacity was the same or better in 56%. Closed loop instrumentation (CLI) decreased the overall incidence of pseudarthrosis. When combined with transverse process fusion, CLI produced a slightly higher rate of success (90%) than did posterior fusion alone (87%) but did not reduce the incidence of pseudarthrosis in patients with spondylolisthesis.
Adolescent↗
Spinal instability due to malignant disease. Treatment by segmental spinal stabilization.
Seven patients with a malignant tumor were treated for spinal instability with Luque-rod fixation either with or without bone-grafting. The stabilization was successful in all patients, including five who died as a result of the tumor between six and eighteen months postoperatively. Two patients were still alive at an average of twenty-two months after operation. The only complication that was directly related to the procedure was cutting through the lamina of a fixation wire.
Adolescent↗
Tissue response to implants of calcium phosphate ceramic in the rabbit spine.
Recent studies have shown that porous calcium phosphates provide a scaffold for bony ingrowth in various anatomic sites. In this preliminary investigation a type of porous calcium phosphate ceramic was implanted in the vertebral columns of 21 rabbits; the ceramic was studied as a possible bone graft substitute for use in spinal fusions. Animals were killed at three, six, eight, 12, and 24 weeks. Roentgenograms and histologic sections of the implant site were then obtained. Bony tissue ingrowth was progressing during the study period. Woven bone was found by six weeks after implantation, and lamellar bone was evident at 12 weeks. By 12 weeks the bony ingrowth had reached the central portion of the ceramic block. There was no fibrous tissue barrier to normal ossification. This type of calcium phosphate ceramic is compatible with bony ingrowth when implanted in the vertebral column of rabbits.
Animals↗
Segmental spinal instrumentation.
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Fractures, Bone↗
Case report. Posterior splint for leg fractures in spinal cord injured patients.
Traumatic fracture of the long bones of the lower extremities may frequently occur in spinal cord injured patients. In the past, conservative treatment with pillow or sand bag splinting was advocated by many clinicans. This paper presents two cases in which posterior splinting was used on the affected leg for stabilization of the fracture with good result and well accepted by patients. Also, the use of Mud bed for prevention of pressure sores was illustrated.
Adult↗
Lumbar fusion using facet inlay grafts.
A long-term analysis of 106 patients who had lumbar fusions between 1959 and 1969 is reported. The method used in this series was an inlay bone graft pointed at each end and beveled at its cephalic portion to permit easier insertion. The sacroiliac ligaments are not disturbed while obtaining the bone graft and no sacroiliac complications have occurred. The necessity for determining whether any psychophysiologic symptoms exist before a spinal fusion is emphasized. This study found the inlay facet technic of spinal fusion to be a worthwhile procedure in properly selected cases of low back and leg pain.
Adolescent↗