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PubMed1994

Pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis. A new technique for stabilization.

Controversy exists about which method is most appropriate for treating moderate- to high-grade spondylolisthesis and symptomatic pseudarthrosis. The authors report preliminary results of pedicular transvertebral screw fixation, a new technique for stabilizing the lumbosacral junction in moderate- to high-grade spondylolisthesis. Using this technique, fusion was successful in three patients, two with an established pseudarthrosis. Pedicular transvertebral screw fixation provides immediate three-column stabilization of the lumbosacral junction. The technique is safe, effective, and employs instrumentation common to spine surgery. Its use in high-grade slips makes the technique more simple to perform than other methods of lumbosacral stabilization.

Adult↗

PubMed1997

Atlantoaxial dislocation. A follow-up study of surgical results.

STUDY DESIGN: The cases of 47 patients with atlantoaxial dislocation exclusive of rheumatoid arthritis, cerebral palsy, and tumors as causative pathologies were reviewed after surgical treatment, which was performed between 1979 and 1993. OBJECTIVES: To investigate the surgical results of atlantoaxial dislocation itself without any systemic factors affected by rheumatoid arthritis, cerebral palsy, and tumors. METHODS: Neck pain (or occipitalgia) and extent of myelopathy at follow-up evaluation were compared with that present before surgery. The results were classified into four groups: excellent (no pain or recovery rate in myelopathy of more than 50%), good (decreased pain or recovery rate of 25% to 50%), fair (no improvement of pain or recovery rate of zero to 25%), and poor (aggravation of pain or recovery rate less than zero). The average follow-up period was 4 years and 2 months. RESULTS: Of the patients evaluated, 51% were assessed as excellent, 23% as good, 7% as fair, and 19% as poor. Pain relief was achieved in 95% of patients with non myelopathy. Extent of myelopathy, pathology of atlantoaxial dislocation (ligamentous or osseous instability), loss of reduction after surgery, and surgical procedures were recognized as the major factors affecting surgical results. Better surgical results were obtained in mild myelopathy cases (> 10 points in Japan Orthopaedic Association scoring), ligamentous instability, and cases without loss of reduction. The incidence of pseudarthrosis and loss of reduction was low in Brooks' method for atlantoaxial fusion and in Luque's segmental sublaminal wiring method for occipitocervical fusion. CONCLUSION: The best results occurred in patients with no myelopathy, and the worst results occurred in patients with severe myelopathy; therefore, surgery is best indicated for atlantoaxial dislocation with intractable pain or with mild myelopathy. To avoid pseudarthrosis and loss of reduction, a strong fixation method, such as Brooks' or Luque's segmental sublaminal wiring method, should be selected.

Adult↗

PubMed1998

Use of ultrasound in spinal arthrodesis. A rabbit model.

STUDY DESIGN: The biomechanical and histologic characteristics of posterolateral spinal fusion in a rabbit model with and without the application of low-intensity ultrasound were analyzed. OBJECTIVES: To evaluate the use of ultrasound to improve the spinal fusion rate and biomechanical characteristics of the fusion mass in a rabbit model. SUMMARY OF BACKGROUND DATA: This is the first study in which the benefits of ultrasound in spinal fusion have been assessed. Posterolateral intertransverse process fusion in the rabbit has a pseudarthrosis rate similar to that recorded in humans (5-40%). METHODS: Fourteen New Zealand White rabbits were randomly assigned to each of two groups to undergo spinal fusion using autologous bone with ultrasound or autologous bone without ultrasound. A specially designed plastic constraint was used to focus the ultrasound over the rabbits' lumbar spine 20 minutes per day. Animals were killed at 6 weeks for biomechanical and histologic testing. RESULTS: The rate of pseudarthrosis, evaluated radiographically and manually in a blinded fashion, decreased at a statistically significant rate (from 35% to 7%) with ultrasound. Biomechanical analysis of the fusion mass showed that ultrasound resulted in statistically significant increases in stiffness (33%; P = 0.03), area under the load displacement curve (25%; P = 0.05), and load to failure of the fusion mass (24%; P = 0.04). Qualitative histologic assessment showed increased bone formation in those fusions exposed to ultrasound. CONCLUSIONS: Lumbar spinal fusion is a complex biologic process. The results of the current study demonstrate the reproducibility of a rabbit fusion model and the ability of ultrasound to induce a statistically significant increase in fusion rate, stiffness, area under the load displacement curve, and load to failure of the fusion mass. These results provide a basis for continued evaluation of biologic improvement of spinal arthrodesis with the use of ultrasound.

Animals↗

PubMed1999

Metal debris from titanium spinal implants.

STUDY DESIGN: A prospective study of tissue surrounding spinal instrumentation was performed using histologic and chemical analysis. OBJECTIVES: To identify and quantify the amount of metal debris generated by titanium pedicle screw instrumentation and to evaluate the histologic response in the spinal tissues. SUMMARY OF BACKGROUND DATA: Microscopic metal particles from the soft tissue surrounding joint arthroplasties have been shown to activate a macrophage response that leads to bone resorption and increased inflammation. The use of titanium spinal implants for spine surgery projects the possibility of generating wear debris in the spine. METHODS: Nine patients with titanium instrumentation from a prior lumbar decompression and fusion procedure who were undergoing reoperation were entered into this study. Tissue samples were collected from areas near the pedicle screw-rod junction, the scar tissue overlying the dura, and the pedicle screw holes. Metal levels for titanium were determined by electrothermal atomic absorption spectroscopy, and histologic analysis was performed by light and electron microscopy. RESULTS: Tissue concentrations of titanium were highest in patients with a pseudarthrosis (30.36 micrograms/g of dry tissue). Patients with a solid fusion had low concentrations of titanium (0.586 microgram/g of dry tissue). Standard light microscopy identified metal particles in the soft tissues. Transmission electron microscopy demonstrated macrophages with numerous secondary lysosomes containing electron-dense bodies and collagenous stroma with electron-dense rod-like profiles consistent with metal debris. CONCLUSIONS: Wear debris is generated by the use of titanium spinal instrumentation in patients with a pseudarthrosis. These particles activate a macrophage cellular response in the spinal tissues similar to that seen in surrounding joint prostheses. Patients with a solid spinal fusion have negligible levels of particulate matter.

Biocompatible Materials↗

PubMed2001

Long-term complications in adult spinal deformity patients having combined surgery a comparison of primary to revision patients.

STUDY DESIGN: This is a comparison of primary (N = 18) to revision (N = 26) combined (anterior and posterior surgery) adult spinal deformity patients with regard to late (>6 months) complications and radiographic/functional outcomes at a minimum 2-year follow-up. OBJECTIVES: To determine whether revision status increases the risk of late complications or offers a poor prognosis for functional outcome in adult deformity patients. SUMMARY OF BACKGROUND DATA: It is known that patients who have combined surgery for adult deformity have a high incidence of perioperative complications. Long-term complications and the effect of revision status have not been clarified in the literature. The functional outcomes for these patients are unclear as to whether or not there is a difference between primary and revision patients. Outside the arena of adult spinal deformity the functional outcomes for revision cases have been disappointing. METHODS: A consecutive series of 44 patients who underwent combined procedures for adult spinal deformity were followed for a minimum of 2 years (average follow-up 42 months). Clinical data were obtained by chart and radiographic review. Major complications were considered to be deep wound infection, pseudarthrosis, transition syndrome, neurologic deficit, and death. Minor complications considered were asymptomatic instrumentation failure (without loss of correction), instrumentation prominence requiring removal, and proximal or distal junctional segmental kyphosis (5-10 degrees ) or subsequent disc space narrowing of 2-5 mm without clinical symptoms. The patients also completed the AAOS Lumbar/Scoliosis MODEMS questionnaires aimed at assessing pain, function, and satisfaction. RESULTS: Minor complications were comparable in both groups: 4 of 18 (22%) in the primary group and 6 of 26 (23%) in the revision group. Major complications were slightly more frequent in the primary group with five complications in 4 patients (4 of 18 patients) (22%) compared with 3 of 26 patients (12%) in the revision group. The incidence of pseudarthrosis was 22% (4 of 18) for the primary group and 4% (1 of 26) for the revision group (P< 0.14). Forty of 44 patients completed the questionnaires. The primary patients functioned at a slightly higher level after surgery than the revision group. The level of pain was also slightly lower at final follow-up in the primary group. Despite these differences, the revision group had a higher level of patient satisfaction. CONCLUSION: At a minimum 2-year follow-up the late complications were not higher in the revision patients than in the primary group. The rate of major long-term complications, specifically pseudarthroses, was higher in the primary group. Patient satisfaction was higher in the revision patients, probably because they were experiencing a greater level of perceived pain and dysfunction at the time of their reconstruction.

Adult↗

PubMed2002

Isolated congenital pseudoarthrosis of the fibula.

Congenital pseudarthrosis of the limb most commonly involves the tibia, although various combinations of bones including fibula, radius, ulna, clavicle and humerus have all been described. Isolated congenital pseudarthrosis of the fibula is a very rare entity with only 12 cases reported in the English literature. We report three cases of this condition treated in our institution. The first child had a varus ankle deformity at the age of 4 months. The other two children presented with valgus ankle deformity after they started to walk. Two patients were treated conservatively while the third had a distal tibio-fibular fusion in view of severe valgus deformity. All three patients showed good early results after 1 to 2 years. We advocate early distal tibio-fibular fusion to prevent valgus deformity in these children.

Arthrodesis↗

PubMed2004

The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries.

STUDY DESIGN: A radiographic review of 87 patients with either unilateral or bilateral facet dislocations or fracture/dislocations treated with anterior cervical discectomy, fusion, and plating. OBJECTIVE: The primary objective of this study was to report the incidence of radiographic failure and factors that would predispose to this loss of alignment. The secondary objective was to report the rate of pseudarthrosis. SUMMARY OF BACKGROUND DATA: Biomechanical and clinical data conflict regarding the appropriate approach and method of fixation of distractive flexion cervical injuries. Unilateral and bilateral facet fracture subluxations may be surgically stabilized by anterior cervical discectomy, fusion, and plating, posterior instrumentation, or both. There are no documented reports of the rate of radiographic failure of this procedure when limited to a single level injury from a distractive flexion mechanism. METHODS: Inclusion criteria were all single-level unilateral and bilateral facet fracture dislocations or subluxations treated with a single-level anterior cervical discectomy, fusion, and plating. Retrospectively, 107 cases were identified (87 with complete radiographs) from January 1994 to December 2001. Radiographic failure was defined as a change in translation of greater than 4 mm and/or change in angulation of greater than 11 degrees between the immediate postoperative films and the most recent follow-up. Fusion was assessed radiographically. RESULTS: A 13% incidence of radiographic loss of alignment is reported in 87 unilateral and bilateral facet fracture subluxations stabilized with anterior cervical discectomy, fusion, and plating. Radiographic failure correlated with the presence of endplate compression fracture and facet fractures on injury radiographs. There was no correlation between radiographic failure and age, gender, surgeon, unilateral or bilateral injury, plate type, level of injury, degree of translation, or sagittal alignment at the time of injury. CONCLUSION: Loss of postoperative alignment occurred in 13% of facet fracture subluxations treated with anterior cervical discectomy, fusion, and plating. Concern regarding mechanical failure of flexion/distraction injuries should be high when they are associated with fractures of either the facets or of the endplate. Endplate fracture was associated with both mechanical failure and pseudarthrosis.

Adolescent↗

PubMed2005

Complications in spondylolisthesis surgery.

STUDY DESIGN: Selected references are cited to illustrate the current status of approaches to surgical complications in isthmic spondylolisthesis surgery. OBJECTIVE: To minimize untoward events and outcomes in the surgical treatment of spondylolisthesis, an awareness of complications and pitfalls specific to spondylolisthesis surgery is necessary. SUMMARY OF BACKGROUND DATA: Pseudarthrosis is the most common complication, and factors that contribute are vertebral geometry, bone grafting options and technique, and immobilization with instrumentation constructs or an orthosis. There has been an increase in neurologic deficits associated with spondylolisthesis surgery during the period of 1996 to 2002. Neurologic sequelae can include cauda equina syndrome, root lesions, autonomic dysfunction, and chronic pain. These can result from reduction maneuvers, instrumentation, and after surgery, although neurologic deficit can occur without identifiable causes. Restoring or maintaining the physiologic sagittal contour of the lumbar spine is a necessary component of surgical planning. METHODS: Literature review. RESULTS: Problems and complications associated with the surgical treatment of spondylolisthesis are well documented in the medical literature. CONCLUSIONS: The occurrence of pseudarthrosis, neurologic deficits, and transition syndromes such as spondylolisthesis acquisita, S1-S2 deformity, and adjacent segment syndrome can be minimized with proper planning and attention to surgical technique.

Humans↗

PubMed2006

Graft resorption with the use of bone morphogenetic protein: lessons from anterior lumbar interbody fusion using femoral ring allografts and recombinant human bone morphogenetic protein-2.

STUDY DESIGN: This is a prospective cohort study examining the results and radiographic characteristics of anterior lumbar interbody fusion (ALIF) using femoral ring allografts (FRAs) and recombinant human bone morphogenetic protein-2 (rhBMP-2). This was compared to a historical control ALIF using FRAs with autologous iliac crest bone graft (ICBG). OBJECTIVE: To determine whether the use of rhBMP-2 can enhance fusion ALIF with stand-alone FRAs. SUMMARY OF BACKGROUND DATA: ALIF is a well-accepted procedure in reconstructive spine surgery. Advances in spinal surgery have produced a multitude of anterior interbody implants. The rhBMP-2 has promoted fusion in patients undergoing ALIF with cages and threaded allograft dowels. The FRA still remains a traditional alternative for anterior support. However, as a stand-alone device, the FRA has fallen into disfavor because of high rates of pseudarthrosis. With the advent of rhBMP-2, the FRA may be more attractive because of its simplicity and remodeling potential. It is important to understand the implications when rhBMP-2 is used with such structural allografts. METHODS: A total of 36 consecutive patients who underwent ALIF with stand-alone FRAs by a single surgeon (E.G.D.) at 1 institute were included. A cohort of 9 consecutive patients who received FRAs filled with rhBMP-2 was followed prospectively. After noticing suboptimal results, the senior author terminated this method of lumbar fusion. A total of 27 prior consecutive patients who received FRAs filled with autogenous ICBG were used for comparison. Analyzing sequential radiographs, flexion-extension radiographs, and computerized tomography with multiplanar reconstructions determined nonunions. Minimum follow-up was 24 months. RESULTS: Pseudarthrosis was identified in 10 of 27 (36%) patients who underwent stand-alone ALIF with FRAs and ICBG. Nonunion rate was higher among patients who received FRAs with rhBMP-2 (i.e., 5 of 9 [56%]). Statistical significance was not established because of the early termination of the treatment group (P > 0.3). Of interest, radiographs and computerized tomography revealed early and aggressive resorption of the FRAs when used with rhBMP-2. This preceded graft fracture and even disintegration, resulting in instability and eventual nonunion. CONCLUSION: The use of rhBMP-2 did not enhance the fusion rate in stand-alone ALIF with FRAs. In fact, the trend was toward a higher nonunion rate with rhBMP-2, although this was not significant with the numbers available. This result appears to be caused by the aggressive resorptive phase of allograft incorporation, which occurs before the osteoinduction phase.

Adult↗

PubMed2006

Spinal fusion with Cotrel-Dubousset instrumentation for neuropathic scoliosis in patients with cerebral palsy.

STUDY DESIGN: Retrospective. OBJECTIVE: To report on the treatment of patients with cerebral palsy and neuropathic scoliosis with third-generation instrumented spinal fusion by Cotrel-Dubousset instrumentation. SUMMARY OF BACKGROUND DATA: Second-generation instrumented spinal fusion is considered the standard for progressive neuropathic scoliosis in cerebral palsy, despite high complication rates. Evidence is needed to evaluate the increasing use of third-generation instrumented spinal fusion in similar patients. METHODS: Patients with cerebral palsy and spinal deformity treated consecutively by 1 surgeon with Cotrel-Dubousset instrumentation and minimum 2-year follow-up were reviewed. An outcome questionnaire was administered at final follow-up. RESULTS: A total of 60 patients were included. Mean age was 15 years at surgery. Mean follow-up was 79 months. There were 26 anteroposterior and 34 posterior-only procedures. Correction of coronal deformity and pelvic obliquity averaged 60% and 40%, respectively. Major complications affected 13.5% of patients, and included implant loosening, deep infection, and pseudarthrosis. Minor complications affected 10% of patients. Outcome questionnaires showed marked improvements in the areas of satisfaction, function, and quality of life after surgery. CONCLUSIONS: Segmental, third-generation instrumented spinal fusion provides lasting correction of spinal deformity and improved quality of life in patients with cerebral palsy and neuropathic scoliosis, with a lower pseudarthrosis rate compared to reports on second-generation instrumented spinal fusion.

Adolescent↗

PubMed2006

Treatment of intravertebral pseudarthroses by balloon kyphoplasty.

OBJECTIVE: This paper presents an open prospective investigation of the efficacy of balloon kyphoplasty in the treatment of intravertebral pseudarthrosis. Several described intravertebral radiolucent lines-the so-called vacuum phenomenon-originated from degenerative diseases. Pain arose from intravertebral dynamic mobility and local kyphosis. METHODS: We reduced and stabilized 24 intravertebral pseudarthroses with the balloon kyphoplasty. Pain and disability showed a rapid and distinct decrease. Radiologic features and life quality were compared with respect to the different shapes of fractures type A1, A3.1, and A3.3. The follow up was 2 years. RESULTS: The patients with fractures type A3.3 were older than those of type A1 and A3.1. In pseudarthrosis of type A3.1 fractures, the kyphotic wedge could be reduced to 13 degrees and the height could be increased to 85% with balloon kyphoplasty. In the A3.3 group, the wedge could be reduced to 8 degrees but the height could be increased only to 75%. No restoration of deformity was achieved in fractures type A1. A long-lasting effect on pain and disability was seen only after balloon kyphoplasty of fractures type A3.1. CONCLUSIONS: The treatment of intravertebral dynamic mobility with balloon kyphoplasty is useful in fractures type A3.1. In pseudarthroses type A1, the negligible reduction and only short-lasting reduction of pain stands against the costs. In pseudarthroses type A3.3, the lack of a long-lasting benefit could be the consequence of the disadvantageous shape of the vertebral body, the higher age of patients or the primary diseases.

Aged↗

PubMed1976

Periosteal pedicle grafting in dogs.

An experimental model was designed to find a theoretical solution to the clinical problem of congenital tibial pseudarthrosis in children. The osteogenic properties of periosteum having been accepted, paired pedicled flaps of periosteum were raised from the subcutaneous surface of the tibia, tubed and anastomosed in a series of young dogs. In the last twenty-four consecutive cases the rate of complete ossification in these tubes rose to one in three. In the later stages of the work, in addition to the construction of periosteal tube grafts, pseudarthroses were induced in the middle third of each canine tibia in order to see if hypertrophy would occur under the stress of weight-bearing. It was found that in each of twenty-four specimens some hypertrophy occurred in the ossified periosteal tube grafts, and in three of the specimens this hypertrophy was associated with complete ossification of the graft that by-passed the pseudarthrosis.

Animals↗

PubMed1976

Pseudoarthrosis after spinal fusion for scoliosis.

A series of 246 patients with scoliosis and attempted fusion had exploration performed six months later in order to detect and treat any pseudarthrosis at an early stage and so prevent subsequent loss of correction. Bilateral or unilateral pseudarthroses occurred in 25 per cent and were of three types--definite, hairline and doubtful. Single unilateral pseudarthroses accounted for 6 per cent and were of little if any clinical significance. The hairline pseudarthroses could not be seen radiologically and were easily missed at exploration. In general the pseudarthroses were least common in the more rigid parts of the spine and in curves which by nature of their aetiology or long duration had become most rigid. Neither the initial severity of the curve nor the degree of correction obtained before the initial attempted fusion had any apparent effect on the incidence. Follow-up for an average of four years has shown that a pseudarthrosis is of little significance with regard to the ultimate result provided it is recognised early and repaired.

Adolescent↗

PubMed2000

Vascularised fibular grafts. An experience of 102 patients.

The results and complications of 104 vascularised fibular grafts in 102 patients are presented. Bony union was ultimately achieved in 97 patients, with primary union in 84 (84%). The mean time to union was 15.5 weeks (8 to 40). In 13 patients, primary union was achieved at one end of the fibula and secondary union at the other end. In these patients, the mean time to union was 31.1 weeks (24 to 40). Five patients failed to achieve union, with a resultant pseudarthrosis (3 patients) or amputation (2 patients). There were various complications. Immediate thrombosis occurred in 14 cases. In two of 23 patients with osteomyelitis, infection recurred at two and six months after surgery, respectively. Both patients had active osteomyelitis less than one month before the operation. Bony infection occurred in a patient with a synovial sarcoma of the forearm one year after surgery. In 15 patients, 19 fractures of the fibular graft occurred after bony union, all except one within one year after union. In patients in whom an external fixator had been used, fracture occurred soon after its removal. Union was difficult to achieve in cases of congenital pseudarthrosis of the tibia. Appropriate alignment of the fibular graft is an important factor in preventing stress fracture. The vascularised fibula should be protected during the first year after union. Postoperative complications at the donor site included transient palsy of the superficial peroneal nerve in three patients, contracture of flexor hallucis longus in two and valgus deformity of the ankle in three. Vascularised fibular grafts are useful in the reconstruction of massive bony defects. We believe that meticulous preoperative planning, including choosing which vessels to select in the recipient and the type of fixation devices to use, and care in the introduction of the vascularised fibula, can improve the results and prevent complications.

Adolescent↗

PubMed1994

Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years.

Fifty-six patients who had had a fracture of the scaphoid from January 1950 through December 1959 were interviewed, re-examined, and had radiographs made of both hands an average of thirty-six years (range, thirty-one to forty years) later. The average age at the time of the treatment was twenty-eight years (range, fifteen to forty-five years). Fifty-two of the fifty-six patients were treated at the time of the fracture; the other four had a non-union when first seen. The rate of non-union for the fresh fractures at the most recent follow-up examination was 10 per cent (five of fifty-two). Dorsal intercalated-segment instability was found in three of the fifty-six patients; all three had a pseudarthrosis and manifest radiocarpal osteoarthrosis. Marked radiocarpal osteoarthrosis developed in only one (2 per cent) of the forty-seven patients who had a healed fracture; it was far more common in the group that had a pseudarthrosis, in which the prevalence was five of nine patients. Manifest osteoarthrosis also seemed to be associated with pain or weakness: it had developed in only three (6 per cent) of the forty-nine patients who did not have any symptoms at the re-examination, compared with three of the seven who had symptoms.

Adolescent↗

PubMed2005

Ossification of the posterior longitudinal ligament. Results of anterior cervical decompression and arthrodesis in sixty-one North American patients.

BACKGROUND: Ossification of the posterior longitudinal ligament is commonly associated with cervical myelopathy. Surgical treatment is a matter of controversy. We report on a series of patients who were managed with anterior cervical decompression and arthrodesis for the treatment of cervical myelopathy associated with ossification of the posterior longitudinal ligament. METHODS: We retrospectively reviewed the records for all sixty-five patients who had been managed with anterior decompression and arthrodesis for the treatment of cervical ossification of the posterior longitudinal ligament and associated neurologic compression from 1982 to 2001. Sixty-one patients (thirty-nine men and twenty-two women) were followed for at least two years (or until the time of death). The average number of vertebrae resected was 2.2. The average duration of follow-up for the sixty surviving patients was four years (range, two years to fifteen years and four months). The preoperative, six-week postoperative, and final follow-up clinical status (including neurological function as assessed with the Nurick grading system) was recorded for each patient. RESULTS: Fifty-six of the sixty-one patients had neurological improvement, with an average improvement of 1.5 Nurick grades at the time of the final follow-up. Eight patients had absent dura at the time of surgery and, of these, five had development of a cerebrospinal fluid fistula. Eight patients had development of new neurological signs and/or symptoms in the upper extremity postoperatively. Eight patients required reoperation because of a painful pseudarthrosis (one patient), strut-graft dislodgment (three), cerebrospinal fluid leakage (three), or compression of a nerve root caudad to the area of the original procedure (one). One patient died as the result of cardiac arrest on the third postoperative day. Fifty-eight patients had an osseous fusion, one had an asymptomatic nonunion, and one had a symptomatic pseudarthrosis that was treated with revision surgery. CONCLUSIONS: Anterior decompression and arthrodesis is an effective way to achieve pain relief and neurological improvement in North American patients of non-Asian descent who have cervical myelopathy associated with ossification of the posterior longitudinal ligament. The risk of durocutaneous fistula, graft dislodgment, and postoperative neurological symptoms appears to be high in patients with cervical myelopathy associated with this condition.

Arthrodesis↗

PubMed1975

Fractures of the scaphoid.

Fracture of the scaphoid is the most common injury of the carpus. Inadequate treatment frequently leads to non-union, which causes pain and serious disability. In the present study 134 scaphoid fractures treated during the period 1961-70 are reviewed. In fresh fractures less than 4 weeks old, bony union occurred in 95% with proper conservative treatment. The vexed question of whether a high or low circular cast should be used may not really be so important. In the present study, both methods of external splintage have given favourable results. It is indisputable, however, that other factors, such as the age of the fracture, its type and location are of great importance for the final result. It was also found that fracture dislocation greater than 1 mm regularly led to pseudarthrosis. Operative treatment is suggested in these cases, and the Matti-Russe technique has proved to be an excellent method for treatment of pseudarthrosis of the scaphoid. The study further confirmed that fractures of the scaphoid in children are more common than is usually supposed. They were all located in the distal two-thirds of the bone and it is suggested that this pattern of distribution is typical of childhood.

Adolescent↗

PubMed2005

Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy.

OBJECT: The authors conducted a study to investigate the long-term results and postoperative complications of a new surgical technique, fibular strut graft-assisted anterior corpectomy and fusion for multilevel (> four) cervical myelopathy. Multilevel anterior corpectomy and subsequent strut graft placement is considered a challenging procedure because of complications relating to graft dislodgment, pseudarthrosis, greater operative duration, and increased blood loss. METHODS: The study comprised 100 patients with cervical myelopathy who underwent anterior corpectomy and fusion and fibular strut graft placement at more than four disc space levels between 1989 and 1998. Single-screw fixation was used in conjunction with the autologous strut graft. Preoperative and postoperative plain radiographs, computerized tomography myelograms, and magnetic resonance images were obtained for assessment of fusion status. All complications and outcomes were analyzed based on clinical records to evaluate the results of the technique. There were no cases of graft dislodgment. The graft union rate was 85%. Analysis of clinical data showed that pseudarthrosis had no adverse effect on the clinical results. Adjacent-level disc degeneration occurred in 12% of patients, but in all cases the patients were asymptomatic. In 9% of cases C-5 palsy was observed but it recovered spontaneously. There were no infections and no case of neurological deterioration. CONCLUSIONS: With this new graft technique, graft dislodgment, the major complication associated with strut graft surgery, was resolved completely. This simple technique involving single-screw fixation provided good results when used in conjunction with anterior decompression and strut graft fixation with a very low incidence of complications.

Aged↗