Limited Laminectomy and Restorative Spinoplasty in Spinal Canal Stenosis

STUDY DESIGN: Prospective cohort study. PURPOSE: Evaluation of the clinico-radiological outcome and complications of limited laminectomy and restorative spinoplasty in spinal canal stenosis. OVERVIEW OF LITERATURE: It is critical to achieve adequate spinal decompression, while maintaining spinal stability. METHODS: Forty-four patients with degenerative lumbar canal stenosis underwent limited laminectomy and restorative spinoplasty at our centre from July 2008 to December 2010. Four patients were lost to follow-up leaving a total of 40 patients at an average final follow-up of 32 months (range, 24-41 months). There were 26 females and 14 males. The mean+/-standard deviation (SD) of the age was 64.7+/-7.6 years (range, 55-88 years). The final outcome was assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: At the time of the final follow-up, all patients recorded marked improvement in their symptoms, with only 2 patients complaining of occasional mild back pain and 1 patient complaining of occasional mild leg pain. The mean+/-SD for the preoperative claudication distance was 95.2+/-62.5 m, which improved to 582+/-147.7 m after the operation, and the preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 8.3+/-2.1 mm, which improved to 13.2+/-1.8 mm postoperatively. The JOA score improved from a mean+/-SD of 13.3+/-4.1 to 22.9+/-4.1 at the time of the final follow-up. As for complications, dural tears occurred in 2 patients, for which repair was performed with no additional treatment needed. CONCLUSIONS: Limited laminectomy and restorative spinoplasty is an efficient surgical procedure which relieves neurogenic claudication by achieving sufficient decompression of the cord with maintenance of spinal stability.

Partial-limb salvage after persistent infection in the distal femoral prosthesis: straight-plasty - a novel technique

A 35 years old female had giant cell tumour [GCT] of the distal femur for which wide resection and distal femoral endoprosthetic replacement was performed. Massive infection of prosthesis required removal and replacement of the prosthesis with nail antibiotic cement spacer, which also proved to be futile. Ultimately the whole of the infected thigh had to be excised. The limb could be preserved partially using straight-plasty instead of amputation. Patient is well rehabilitated and doing well at a follow-up of 3 years

Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients

Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity. Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion [ROM], number of spasms, gait, and hygiene were evaluated at 1[st] hour, 24[th] hour, end of the 1[st] week, and in the 1[st], 2[nd], and 3[rd] months following the intervention. The success rate was 100% with mean time to accurate nerve location 4.9 +/- 2.06 min. Average depth of needle insertion was 2.91 +/- 0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2[nd] and 3[rd] months, but they did not reach their initial values. The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene, with an efficacy lasting for about 3 months

Simultaneous bilateral trochanteric fractures---a report of four cases / 中华创伤杂志(英文版)

Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the long term rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities.

Obturator neurolysis using 65% alcohol for adductor muscle spasticity

Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. It is an important complication of spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis. If uncorrected, fibrosis and eventually bony deformity lock the joint into a fixed contracture. Chemical neurolysis using various agents is one of the therapeutic possibilities to alleviate spasticity. We are, hereby, reporting 3 patients in whom 65% alcohol was used as neurolytic agent for the treatment of hip adductor spasticity, and the effect lasted for a variable period

Intra-operative migration of dynamic hip screw into the pelvis

The authors report a rare per-operative compilation of intra-pelvic migration of dynamic hip screw, during osteosynthesis of an inter-trochanteric fracture. Possible reasons of migration are analyzed along with the importance of careful execution of the surgical technique to avoid such iatrogenic and medico-legal implications