One stage combined posterior and anterior operative reduction and stabilization of old lower cervical spine dislocation

In this study, combined posterior and anterior operative realignment and stabilization was carried out at one stage for ten patients with symptomatic old lower cervical spine dislocation. The time elapsed between injury and the proper diagnosis ranged from 2-8 months. Surgery was indicated when there was instability resulting in deformity or pain and in case of further deterioration [or development] of the neurological status. Postoperatively, the patients were evaluated both clinically and radiologically to assess the value of such delayed surgery in these old injuries. At the final follow up, which averaged 20 months, the neurological status was improved in all patients, solid fusion and correction of deformity occurred in all patients and pain relief occurred in eight patients

effect of cervical plating on multiple - level anterior cervical discectomy and fusion

The study was conducted on 20 patients who had cervical plates and 20 had fusion without plates. There were no significant differences preoperatively among patients treated with or without plates. At the final follow-up ranged from 18 to 48 months [average 22 months], the pseudo-arthrosis rates were 5% in patients with plating and 15% in patients without plating. There was no correlation between pseudo- arthrosis and age, sex or level of surgery. The average loss of the gained intraoperative correction of cervical lordosis was 0.5 in the instrumented group compared with 1.3 in the patients without plates. The amount of graft collapse in the patients with plates was 0.8 mm compared with 1.6 mm in the patients without plates, the difference was significant. Accelerated degenerative changes at levels adjacent to fusion were seen in 20% of patients with plating compared with 15% in patients without plating. The overall result was excellent to good in 90% of the patients with plating compared with 80% in the group without plating based on Odom's criteria

Late follow-up of 190 patients with dorso-lumbar spinal fractures treated by transpedicular screw and plates

Between 1989 and 1995, at the Department of Orthopaedic Surgery, Assiut University Hospital, 190 patients with thoracolumbar frctures underwent surgical treatment. There were 115 males and 75 females; the average age was 27.7 years [range, 17 to 65 years]. The affected level was D-10 in 16 patients [8.4%]; D-11 in 13 [6.8%]; D-12 in 60 [31.5%]; L1 in 50 [26.3%]; L2 in 28 [14.7] L3 in 23 [12.1%]. According to the Magert and Harms classification [1988], 70 patients [36.8%] had flexion compression fractures, 89 [46.8%] had flexion distraction fractures and 31 [16.4%] had torsional injury. On admission and according to Frankel classification 55 patients [28.9%] were grade A, 30 [15.9%] grade B, 45 [23.7%] grade C, 40 [2 1%] grade D and 20 patients [10.5%] grade E. The mean operative time totaled 2 hours. Spinal plates were used in 45 patients [23.8%] and NDCP in 145 patients [76.2%]. Decompression was carried out in 125 patients [65.8%] with neurological compromise. In the earlier cases, 22 [11.6%] patients underwent fusion in combination with instrumentation. 86 patients had their implants removed for different indications. The metal was removed in 34 patients after screw failure, 6 with severe back pain without loosening of the implant and in 46 patients according to their demand. At the final follow-up which ranged from 3 to 7 years [average 4.5 years], fifty patients [26.3%] with incomplete paraplegia returned to normal; no improvement occured in patients with complete paraplegia. No neurological deterioration was reported. Compared to the preoperative status, our follow-up examinations demonstrated improvement in the neurology and function. 50 patients [26.3%] with incomplete paraplegia showed neurological improvement by one or two grades at least. The back pain was excellent and good in 79%; the range of motion was excellent and good in 85%. The radiographic assessment in the lateral plan [Cobb technique] demonstrated a significant [P < 0.001] mean restoration from an initial angle of 23.5° to 7° with gradual loss of reduction of about 2° after metal removal. There was a mean gain of regional kyphotic angle 16.3°. The mean gain of the vertebral height was 46% and the mean loss was 9%. The mean gain of the retropulsion was 8mm and the mean loss was one mm only. The preoperative wedge angle of the verebral body correlated significantly with the postoprative loss of reduction. The implant removal did not lead to increase in the range of back motion. It did not change the neurological state or lead to improvement in the back pain except in those with pain due to implant failure. The complications related to the instrumentation were screw malposition in 15 patients [7.8%], screw loosening or breakage in 34 patients [17.9%], with no metal breakage

Treatment of gap non-union of fore-arm bones

This study was carried out on 19 patients with gap nonunion of the radius and/or ulna. The average time passed since the original trauma and the treatment of gap nonunion was 4.5 months. All patients were suffering from pain, instability, limitation of elbow and wrist movements, partial loss of pronation supination, hand stiffness and three of them had discharging sinuses. All cases with diaphyseal gap nonunion were treated by dynamic compression plates together with tricortical strut iliac bone grafts 1 to 5 cm in length. After an average of 16 months follow up, 17 cases showed bony healing, a remarkable improvement of elbow and wrist motion, an improvement of pronation supination and a noticeable improvement of hand function. Excellent results were obtained in three cases, good in seven, fair in four and poor in three

Treatment of ipsilateral fractures of the arm and forearm bones [floating elbow]

Between August 1994 and June 1997, the results of management of 16 patients with ipsilateral fractures of the humerus and forearm bones were prospectively studied. They were 13 males and 3 females with an average age of 24.5 years [ranged 14-40 years]. The right upper limb was involved in six, while the left upper limb was involved in ten patients. These injuries encompass a spectrum of bone and soft tissue injuries and thus the treatment was individualized in each patient. Various combinations of internal fixation and/or external fixation were carried out in addition to an appropriate management of neurovascular and soft-tissue injuries. The follow up period ranged from 6 to 30 months [average 16 months]. The results were assessed according to the clinical scoring system of steel and Graham 1992 in addition to neurovascular assessment and cosmesis; they were acceptable in 14 and poor in 2 patients

Occipitocervical fusion for post-traumatic upper cervical spine instability

This study included fourteen patients presented with acute post- traumatic upper cervical spine instability. Out of the fourteen patients, eleven had atlantoaxial instability, two had fracture odontoid and one had craniocervical instability. They underwent occipitocervical fusion using iliac bone graft from occiput to second cervical vertebra. The iliac bone graft was augmented by wiring in nine patients. At follow up [average 12 months], 13 patients had a solid fusion and relief of neck pain. Out of the four patients who were unable to walk preoperatively because of severe motor involvement, only one was considered to be able to walk. Out of the fourteen patients, eleven had a satisfactory result. Occipitocervical fusion using iliac bone graft and the wiring technique provides immediate stable fixation allowing early mobilization. It is recommended in patients who had instability of the upper cervical spine. The operation may optimize the patient's chances of neurological recovery