Unilateral transforaminal lumbar interbody fusion (TLIF) using a single cage for treatment of low grade lytic spondylolisthesis.

The authors conducted a prospective study on 30 patients with low grade lytic spondylolisthesis, who underwent unilateral transforaminal lumbar interbody fusion (TLIF) using a single cage with adjunctive pedicular fixation. There were 17 males and 13 females with a mean age of 39.5 years. The mean follow-up period was 32 months. The overall clinical results were excellent or good in 90% of the patients. Fusion was solid or probable in 91%. Three patients presented initially with a motor deficit; one of them did not recover. According to the literature this technique yields a shorter operative time, less blood loss, less need for intensive care, shorter hospital stay, lower hospital cost and less complications than other techniques for interbody fusion. It is safe and reliable in patients with low grade lytic spondylolisthesis.

Two methods of atlantoaxial stabilisation for atlantoaxial instability.

Thirty-seven patients, 19 males and 18 females, with a mean age of 37.6 years (range 9-62), underwent atlantoaxial fusion for atlantoaxial instability associated with pseudarthrosis of the odontoid, fixed rotary subluxation, rheumatoid arthritis, and mongolism. Two operative techniques were used: transarticular C1-C2 screws and posterior bone grafts according to Magerl, but without posterior wiring, in 24 patients (group 1), and C1 lateral mass screws/C2 pedicle screws, plates and posterior bone grafts, according to Goel, in 13 patients (group 2). The mean follow-up period was 27.6 months. In both groups 92% of the patients were free of neck pain. In group 1, 4 out of 9 patients with neurological involvement improved one Frankel grade and in group 2, 3 out of 5. The fusion rates were 96% and 100%, respectively; they were superior to the rates mainly seen after a Gallie fusion: 67 to 86%. One vertebral artery injury without sequelae occurred in group 1, and one wound infection, that healed with debridement, in group 2. In conclusion, the results were excellent in both groups, but slightly better in group 2.

Anterior lumbar interbody fusion using a hybrid graft.

This prospective study evaluates the clinical and radiological results of anterior lumbar interbody fusion using a femoral cortical ring allograft (FCA) packed with cancellous autologous bone (hybrid graft), combined with posterior pedicular fixation but without posterior fusion, for symptomatic degenerative disease of the lumbar spine. Twenty-eight out of 30 consecutive adult patients were followed up for a minimum period of 2 years. Intra- and postoperative complications were seen in 2 out of 28 patients (7%); no complications resulted from the allografts. Clinically, 24 out of 28 patients (85%) had a good to excellent result, one patient (4%) a fair result, and 3 patients (11%) a poor result. Radiologically, the overall fusion rate by the level was 98% in 28 patients.

Stage I compression-extension injury of the cervical spine. A rotationally unstable injury.

Stage I compression-extension injury of the cervical spine, as described by Allen et al, is not always a stable injury. The combined unilateral failure of the posterior structures under compression together with failure of the anterior structures under tension will lead to rotational instability around the intact lateral mass. We report on 10 consecutive patients who presented with this type of injury. The surgical protocol consisted of early reduction followed by anterior cervical fusion using a tricortical iliac graft and a locking plate. Mean follow-up was 38.5 months. Intra-operative assessment revealed disc injury in all patients. Anatomical realignment and solid fusion were achieved in all cases. All 10 patients showed improvement of their neurological deficit. One patient remained with some residual weakness in his triceps, and another required removal of a prominent screw.