Interspinous bursa and spinal instability.

STUDY DESIGN: This is a prospective study. Interspinous tissue was taken intraoperatively for pathological examination for the presence of bursa. The pathologist was unaware of the X-ray findings in each specimen. The presence of bursa was then correlated with X-ray evidence of hypermobility in each segment. OBJECTIVE: To verify the pathogenesis of interspinous bursal formation. SUMMARY OF BACKGROUND DATA: Interspinous bursa is common in the older population. It has been associated with degenerative lumbar diseases, aging and anatomical distance between the spinous process. However, no detailed exploration of the segmental instability as a cause of bursal formation has been done. METHOD: The insterspinous tissue was taken intraoperatively from patients diagnosed as multilevelled spinal stenosis who underwent extensive decompression, fusion and instrumentation. The specimens were examined by the same pathologist for the existence of bursa. The presence of bursa was correlated with X-ray motion study of each spinal segment by student t-test. RESULTS: The existence of bursal was significantly correlated with angular mobility of more than 10 degrees. CONCLUSION: Angular mobility is a possible cause of interspinous bursa. On the contrary, the presence of insterspinous bursa may be evidence of segmental hypermobility.

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.

Degenerative disk disease at lumbosacral junction: plain film findings and related MRI abnormalities.

Due to a wide range of normal disk space heights at lumbosacral (LS) junction, we conducted this study to evaluate how to diagnose degenerative disk disease (DDD) of LS junction and how much information we can obtain from plain radiography regarding this condition. We retrospectively reviewed lateral LS spine films and magnetic resonance (MR) imaging in 100 patients presented with low back pain. Anterior disk height (ADH) and posterior disk height (PDH) were directly measured from plain radiographs. Signs of DDD were recorded from both plain radiographs and MR imaging. We found that ADH < 11.3 mm or PDH < 5.5 mm indicate DDD at LS junction with 95 per cent confidence interval. When spondylolisthesis presented, disks were all degenerated. Endplate sclerosis had significant relative risk (p < 0.05) for lateral neural canal stenosis and disk herniation. No radiographic finding showed significant relative risk for nerve root compression.

Treatment of adolescent idiopathic scoliosis using Cotrel-Dubousset spinal instrumentation.

Eighteen patients with idiopathic scoliosis who underwent posterior spinal correction and fusion using Cotrel-Dubousset instrumentation between 1991 and 1996, were evaluated for curve correction and complications. Age at surgery averaged 14.7 years. Follow-up averaged 3.7 years. Thoracic curve correction averaged 65 per cent in those with King type III/IV curves and 51 per cent in those with King type II curves. At the recent follow-up, correction loss averaged 12 per cent and 8 per cent, respectively. Lumbar curve correction averaged 31 per cent after instrumentation in type II curves, with a loss of approximately 3 per cent correction at follow-up. Thoracic sagittal contour improved 14 degrees for hypokyphotic patients. Apical vertebral rotation improved an average of 37 per cent after derotation maneuver of the left side rod. No neurologic complications or deep infection occurred. In conclusion, frontal and sagittal thoracic curve correction can be satisfactorily achieved using Cotrel-Dubousset instrumentation.

Slipped capital femoral epiphysis in Ramathibodi Hospital.

Slipped capital femoral epiphysis is rare in Asiatic Indonesian-Malays. Seven cases (9 hips) of this condition in Ramathibodi Hospital including five boys (average age, 12.5 years) and two girls (average age, 13 years) were reviewed. Most of the cases (4 out of 7) were acute on chronic and mild slips. No endocrine disorder was observed in all cases. All of the patients had a body weight above the mean of the normal population, four of which were obese. For the treatment, a single screw fixation including one case with cancellous and six cases with cannulated type were used. In the follow-up of average 2.5 years, six cases had satisfactory results. Avascular necrosis occurred in one case with mild and chronic slips in which a cancellous screw was used. It is concluded that obesity is the important factor related to the etiology in this study and probably is the same in other developing countries. The effect of a cancellous screw causing avascular necrosis is still questionable.

Treatment of giant-cell tumor of the spine: report of four cases.

Four patients who had a giant-cell tumor of the spine were managed in Ramathibodi Hospital from 1986 to 1993. All of the patients are female and the age onset was between 14-36 years. The location of the lesions was distributed in the sacrum (2 cases), lumbar spine (1 case) and cervical spine (1 case). Surgical approach was determined by the location, extent of involvement and feasibility of marginal resection. Anterior approach was performed in cases of tumor mass confined to the vertebral body and posterior approach was done in cases of posterior neural arch involvement. Adjuvant therapy and preoperative internal iliac artery ligation contributed to successful treatment in cases of sacral involvement. After follow-up of fifteen to fifty months (average, 30 months), the pain subsided and neural symptoms improved. Roentgenograms showed no evidence of local recurrence.

Risk factors for neural deficit in spinal tuberculosis.

From 1975 through 1989, retrospective study of 155 patients with spinal tuberculosis was carried out at Ramathibodi Hospital to study predisposing factors to neural deficit and results of treatment. Two groups of patients who had no neural deficit and had neural deficit were compared. Clinical characteristics of the patients between the two study groups were similar with regard to sex, duration of symptoms, number of vertebrae involved, angle of gibbus deformity and erythrocyte sedimentation rate. There were statistical differences in age, cephalad level of infection, loss of vertebral body and clinical evidence of cold abscess. For patients with neural deficit, the results generally are good with anterior decompression and stabilization.