A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results.

Patients suffering from neurogenic intermittent claudication secondary to lumbar spinal stenosis have historically been limited to a choice between a decompressive laminectomy with or without fusion or a regimen of non-operative therapies. The X STOP Interspinous Process Distraction System (St. Francis Medical Technologies, Concord, Calif.), a new interspinous implant for patients whose symptoms are exacerbated in extension and relieved in flexion, has been available in Europe since June 2002. This study reports the results from a prospective, randomized trial of the X STOP conducted at nine centers in the U.S. Two hundred patients were enrolled in the study and 191 were treated; 100 received the X STOP and 91 received non-operative therapy (NON OP) as a control. The Zurich Claudication Questionnaire (ZCQ) was the primary outcomes measurement. Validated for lumbar spinal stenosis patients, the ZCQ measures physical function, symptom severity, and patient satisfaction. Patients completed the ZCQ upon enrollment and at follow-up periods of 6 weeks, 6 months, and 1 year. Using the ZCQ criteria, at 6 weeks the success rate was 52% for X STOP patients and 10% for NON OP patients. At 6 months, the success rates were 52 and 9%, respectively, and at 1 year, 59 and 12%. The results of this prospective study indicate that the X STOP offers a significant improvement over non-operative therapies at 1 year with a success rate comparable to published reports for decompressive laminectomy, but with considerably lower morbidity.

The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial.

In a prospective, nonrandomized, multicenter study, 109 patients with bone defects were treated with a surgical grade calcium sulfate preparation as a bone graft substitute. The calcium sulfate pellets were used in place of morselized cancellous bone graft for the treatment of patients with bone defects who usually would require grafting secondary to trauma, periprosthetic bone loss, tumor, or fusion. The calcium sulfate was used alone or mixed with other materials such as bone marrow aspirate, demineralized bone matrix, or autograft. The defects that were treated were contained and were not necessary for the stability of the bony structure. Radiographic and clinical data were collected at predetermined intervals for 12 months. At 6 months postoperatively, radiographic results for all patients showed that 99% of the calcium sulfate had been resorbed and 88% of the defect was filled with trabeculated bone. There were 13 complications; however, only four (3.6%) were attributable to the product. The results of a subgroup of 46 patients with benign bone lesions treated in the same manner are identical to the results of the overall study population. Surgical grade calcium sulfate pellets are considered a convenient, safe, and readily available bone graft substitute that yield consistent successful results.

Treatment of slipped capital femoral epiphysis resulting from juvenile renal osteodystrophy.

Severe bilateral slipped capital femoral epiphysis (SCFE) secondary to renal osteodystrophy is infrequent at any age. Management was a significant dilemma in the 3-year-old child we report because of the degree of slippage and our concern over the sequelae of premature capital physeal closure. Fixation without physeal closure was obtained by inserting a specially fabricated screw without threads across the physis after the slippage had been reduced with traction.

Intraspinal pathways taken by sublaminar wires during removal. An experimental study.

The neurological complications of segmental sublaminar stabilization that have been reported by other authors led us to perform a cineradiographic study of the pathways in the spinal canal that were taken by wires as they were being removed. The single wires were removed by pulling on the wire while keeping the wire perpendicular to the lamina; by winding the wire on the wire-extractor, with the wire being kept as nearly parallel with the lamina as possible (the roll-up technique); or by pulling on the wire while keeping the wire parallel with the lamina. During removal, thirty-four single wires conformed to the lamina and forty-one single wires compressed the dura. The roll-up technique caused the most erratic pathways. Double wires, although they were removed together, assumed independent pathways unless a wire-extractor guide was used. These findings suggest that the removal of sublaminar wires may cause dural compression in the clinical situation.

Legal control and alcohol in the United States and India.

Arrest data provide an index of public concern regarding alcohol-related activities of certain groups within a society. Any differences in these data may reflect the differences in the extent to which their conduct is viewed and reacted to as problematic behavior requiring legal control. In this paper we compare the official statistics regarding alcohol arrest data of adults and juveniles in the United States, India in general, and a "dry" Indian state, Tamil Nadu. The United States, India, and Tamil Nadu are similar in that the proportion of juveniles arrested for alcohol-related convictions compared to juveniles arrested for all offenses is about the same (i.e., 8%). But proportionately more of the young people, compared with adults, in the United States are subjected to arrest for liquor law violations, although a greater proportion of adults, compared to juveniles, are arrested for public drunkenness. In India generally, and Tamil Nadu in particular, juvenile vis-à-vis adult arrests for liquor law offenses are equal to their proportions in the population. That is, in contrast to India, alcohol law enforcement in the United States is specifically directed at regulating the drinking behavior of young people.