Surgical repair of pars defects in spondylolysis.

Direct repair of the pars interarticularis defect was carried out in 16 spondylolysis patients. There were 8 male and 8 female patients. The site of pars defects involved L5 in 10 cases and L4 in 6 cases. Chronic low back pain was the main symptom, only one patient presented with acute severe back pain. Pars defects were confirmed by oblique views of the lumbosacral spine. The height of the spinous process of the involved vertebra was measured and compared to the above adjacent vertebra. Radiographic fusion of the defects was confirmed by bridging of bone across the pars on oblique views. All the patients except one were treated conservatively prior to surgery. Clinical outcomes were assessed by pre- and post-operative pain, union of the pars defects, functional status and patient verbal rating scales. The mean follow-up was 36 months, the longest was 7 years. At 2 years follow-up, the overall satisfaction and improvement were reported in most of the patients. There was no functional failure. Hypoplasia of the neural arch was found in 3 patients. There were two non unions, both of them had maldevelopment of neural arches. One symptomatic non union needed resurgery for stabilization.

A biomechanic study of the surgical repair technique of pars defect in spondylolysis.

To find out which wiring technique of direct repair of the pars defect is the strongest in resisting anteroposterior translation displacement, fifteen fresh human cadaveric L4-L5 spines were biomechanically tested by a universal testing machine. Two millimeters wide pars defect was created on both sides of L4 vertebrae. Each of the five specimens was wired using Nicol's technique (A), modified Nicol's technique (B) and modified pedicular screw technique respectively (C). At each test, motion was observed to occur initially at the pars defect. The mean minimum tensile strength (increment of the pars defect) for technique A, B and C was 87.64, 82.04 and 110.08 Kg Force respectively. By statistical analysis, technique C was the strongest in resisting anteroposterior displacement of the spinal column. There was no statistically significant difference between technique A and B.

Comparison of ketoprofen and morphine for post-operative analgesia in orthopaedic patients.

A prospective, open label, randomized study to compare efficacy of intramuscular administration of ketoprofen and morphine for post operative analgesia in elective orthopaedic surgery was performed in 50 patients. The procedures were open reduction and internal fixation of long bone fractures (26 cases), hip replacement (9 cases) and spinal surgery (15 cases). Pain intensity and pain relief in both groups were evaluated at 1, 3 and 6 hours post-injection. There was no significant differences in pain relief of both groups (P = 0.05). The side effects of intramuscular ketoprofen were encountered in only 8 per cent. Ketoprofen injection is an alternative for post operative pain relief.

Repair of nonunion lateral humeral condyle: a case report.

Epiphyseal injury of the lateral condyle of distal humerus is found commonly in children. Complications following such an injury can result in nonunion with late development of angular deformity and ulnar nerve neuritis. Nonunion at this area is extremely troublesome and difficult to treat. Controversy exists as whether late open reduction and fixation can restore the anatomy of the elbow joint and improve the function. We describe a technique of corrective osteotomy to correct the cubitus valgus deformity and repair the nonunion. The patient was treated successfully with 4 years follow-up.

The size of the vertebral canal and the significance of epidural fat in lumbar spinal stenosis.

Measurements of mid sagittal diameter (MSD) and interpedicular diameter (IPD) in patients operated on for central lumbar spinal stenosis were compared to the control group. Both groups can be matched in terms of gender and age. We found that in the stenotic patients the MSD and the IPD were smaller than in the control group, all of the measurements except the IPD in male stenotic patients was statistically different. Sagittal and axial MR images of the stenotic patients were used to evaluate the status of the posterior epidural fat which was graded as normal, small, very small and absent. All the patients were surgically treated for lumbar stenosis, imaging studies and intraoperative finding were correlated. Reduction or absence of the posterior epidural fat (PEF) by the imaging studies were found to be related to the intraoperative findings and the duration of symptoms. PEF may be used as an intraoperative indicator for optimal surgical decompression.