Effect of sacral buttress technique in Ramathibodi spinal system fixation on L5-S1 motion.

This is a retrospective study which reviewed the effects of the sacral buttress technique of Ramathibodi Spinal System (RSS) instrumentation for degenerative conditions of the spine on L5-S1 motion. The inclusion criteria included patients who were treated by wide decompression and fusion of the lumbar spine. Two treatment groups of a different fusion technique were identified; the first group was treated by conventional fixation and the second group was treated by the sacral buttress technique. The objective of this study was to evaluate the effect on L5-S1 motion and translation between the conventional group and sacral buttress group. The material consisted of 66 patients who were operated from 1996 to 1999 for degenerative conditions of the lumbosacral spine. The conventional group included 25 patients in whom instrumentation was stopped at the fifth lumbar spine and the buttress group consisted of 41 patients who underwent the sacral buttress technique with RSS fixation. Dynamic lateral radiographs were measured to determine the motion and translation before and after surgery. In the group with sacral buttress technique, post operation decrease in motion of the lumbosacral joint was statistically significant. Reduced motion was also associated with the level of fusion. The use of the sacral buttress technique with RSS led to significant control in lumbosacral motion without the need for screw fixation to the sacral spine. The usefullness of this technique is a valuable adjunct to spinal fusion in patients who undergo decompressed spinal surgery and may prevent the junctional problem of fusion at this segment and also the upper end of the above fusion level.

Transient osteoporosis with bilateral fracture of the neck of the femur during pregnancy: a case report.

A case of bilateral non-nion of femoral neck fracture during the last trimester of pregnancy was reported. Bilateral hemiarthroplasty with bipolar prosthesis was performed in May, 2000. The result after one year follow-up was excellent.

Early recovery after retropleural approach in a paraparesis thoracic disc patient.

A 56 years old Thai male developed acute paraparesis 2 days before admission. The investigation showed T6-7 thoracic disc herniation on the left side with thoracic cord compression. A lateral retropleural (extracavity) approach from the left side without penetrating the pleural cavity was performed. He was able to sit up and start the rehabilitation program within the first day after the operation on the bed and neurological status was gradually recovered within 2 months after continue home program for rehabilitation. Finally he can walk with gait aids. The motor power of his legs were grade IV according to Frankel classification and he can well control the uro-genital function.