Repair of spondylolysis using a rod-screw construct

To assess the results of a technique of internal fixation consisting of pedicle screws and a V-shaped rod resting against the inferior aspect on the spinous process and the posterior aspects of the laminas and post operative bracing and rehabilitation programs. Twelve Patients with painful pars defect not responding to conservative treatment were considered to be eligible for direct repair of their spondylolysis. The surgical technique involved placement of screws on the pedicles of the involved vertebra and the fixation of the loose posterior arch with a solid rod bent in a V shape, taking purchase on the spinous process and laminae. A bone graft was placed under compression in the pars defect and postoperative bracing and rehabilitation programs were carried out. Nine patients had an excellent result, returned to normal every day life and work. The outcome in one patient was rated good and in one, fair. The procedure in one was considered a failure, although bone fusion seemed to have been obtained. No complications were encountered because of the specific design of the construct. This technique offers the advantage of being easy and fast, it can be performed using available spinal instrumentations using rods and pedicle screws. It avoids penetration of the spinal canal. This technique seems safe and effective but needs careful selection of patients. Post operative bracing and rehabilitation programs have very important role in follow up and improvement of our patients with good results

Renal biopsy in systemic lupus patients with low level proteinuria, and its relation to urinary adhesive molecules

To assess whether systemic lupus [SLE] patients with levels of proteinuria <1000 mg/24h should be routinely biopsied, or we can depend on urinary adhesion molecules [ICAM-1 and VCAM-1] as markers for the severity of lupus nephritis [LN]. This study included 30 SLE patients with proteinuria <1000 mg/24h, and 20 SLE patients without proteinuria. Twenty healthy control subjects were also included. Basic laboratory parameter, RF, ANA, Anti-dsDNA, Complement C3 and C4, Urinary ICAM-1 and VCAM-1 and estimation urinary total proteins/24 hours were performed for each subject. Renal biopsy was also done in the indicated cases. Twenty three of thirty biopsies were diagnostic of lupus nephritis: 3 mild nephrosclerosis, 6 mesangial proliferation, 8 focal proliferative, 5 diffuse proliferative, and 1 membranous lupus nephritis. The levels of proteinuria were 94.5 +/- 22 mg/24h, 119 +/- 33 mg/24h and 725 +/- 180 mg/24h for control, patients without proteinuria and patients with proteinuria respectively. No statistical differences could be detected as regards to C3, C4, urinary ICAM-1 and urinary VCAM-1. Patients were reclassified according to the severity of renal histopathological changes into mildly and severely affected groups. We found no statistical differences between both groups as regards C3 and C4, but there were high statistical differences in urinary ICAM-1 and urinary VCAM-1 [P value <0.0005]. Our findings suggest that renal biopsy should be performed in these patients in the presence of new onset or rising proteinuria to enable prompt diagnosis of LN and initiation of treatment earlier in the course of the disease

electromyographic assessment of F-wave in carpal tunnel syndrome: correlation study with MRI carpus and cervical spine

In this study we have analyzed the effect C.T.S. of focal median nerve injury carpal tunnel syndrome [CT] on F wave. We have determined the F wave parameters in C.T.S. patients and evaluate the relationship between F wave and severity of injury of CT and MRI finding of the wrist and cervical spine finding. The study was conducted on all patients[104] referred from out-patients clinic in the same hospital to electrophysiologic examination in Rheumatology, Physical Medicine and Rehabilitation Dep. and Radiology department, Al Hussein University Hospital as clinical assessed as a carpal tunnel syndrome, Standard electro diagnostic study was made on all of them bilaterally. MRI of carpal tunnel and cervical spine done for selected patients with C.T. S. According to F wave parameters, patients were divided into three groups, absent F-wave, abnormally prolonged F-wave and normal F-wave. According to electrophysiological testing results, the patients were grouped into mild, moderate or severe C.T.S. Absent F wave was presented in 8 hands [7.7%], prolonged latency in 9 hands [8.6%] and normal F wave in 87 of 104 hands [83.7%]. the mean F wave latency were statistically different between the C.T.S. patients and the normal values [CI 95%, p<0.0001]. Also, the entire F wave latencies were significantly prolonged in the severely injured group [p=0.0001]. F wave determination could show injury to proximal and also severe injury to distal parts of median nerve and especially axonal injury. According to abnormalities of this test the surgical release of nerve for prevention of irreversible changes must be considered. Results of our study supported the adding of F wave parameters study to standardize electrophysiological evaluation of C.T.S