ABSTRACT
The DIAM (Device for Interspinous Assisted Motion) interspinous device offers the possibility of a viscoelastic supplementation of the lumbar motion segment with a small, reversible operation. It is intended as a restabilisation procedure after a discectomy to avoid facet joint overload and as a topping of procedure for the segment adjacent to a fusion. The device has been on the German market since 2004. There are several biomechanical studies available showing an effect mainly in extension and flexion, but hardly any in rotation and lateral inclination. Despite frequent clinical use, there have only been a few, mainly retrospective clinical studies indicating the success of the implant; however, sound scientific data are missing. Several prospective, randomised, controlled studies are now underway to fill that gap. Only then will it be possible to assess whether this implant is of true value to improve clinical results and to slow down the degenerative cascade or not.
Subject(s)
Decompression, Surgical/methods , Intervertebral Disc Displacement/etiology , Intervertebral Disc Displacement/surgery , Joint Prosthesis , Spinal Stenosis/etiology , Spinal Stenosis/surgery , Decompression, Surgical/instrumentation , Equipment Failure Analysis , Humans , Longitudinal Studies , Prosthesis Design , Spinal Stenosis/diagnosis , Treatment OutcomeABSTRACT
Traditionally, radiographic assessment of the hip with anteroposterior and lateral views is the gold standard of diagnosis in SCFE. This paper evaluates the possible contributions of other methods of modern imaging to the early diagnosis and treatment. There is scientific evidence that ultrasound can diagnose the disease earlier than conventional radiography and also has the possibility to differentiate the classification between stable and unstable. MRI depicts marrow changes earlier than any other imaging method available and has a role in cases where the diagnosis is difficult to make as well as in assessing the risk of chondrolysis and avascular necrosis. To show the anatomic deformity, anteroposterior and lateral radiographs remain the mainstay of preoperative planning.
Subject(s)
Epiphyses, Slipped/diagnosis , Femur Head , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Ultrasonography , Child , Female , Femur Head/pathology , Femur Neck/pathology , Humans , Joint Instability/diagnosis , Male , Reference Values , Sensitivity and SpecificityABSTRACT
AIM: To examine the quality and usefulness of time-of-flight MR-angiography and duplex-doppler sonography, respectively, in assessment of the extracranial arteries before cervical spine operations. METHODS: Patients scheduled for operations of the cervical spine had an MRI plus TOF as well as a duplex and Doppler scan. At the time of the examination the radiologist and the neurologist in charge were blinded for the study. Endpoints were not only the accuracy of the procedures but more so which method improved the preoperative process most. RESULTS: Twenty patients were examined so far. Only in one case did the result differ when a complete occlusion diagnosed sonographically was judged as a severe stenosis on MRA. One patient did not tolerate the MRA for the extra 5 minutes necessary, therefore a contrast-enhanced MRA was performed. MRA eased the preoperative process as imaging of the pathology and the carotids were realised in one step. The costs were slightly higher for MRA than for duplex-doppler sonography. CONCLUSION: TOF-MRA can replace the duplex-doppler examination in the preoperative assessment of the carotids and has the potential to streamline the preoperative time schedule. Similar to duplex and doppler, in order to be accurate enough the method requires a high degree of expertise from the radiologist.
Subject(s)
Carotid Arteries/pathology , Carotid Stenosis/diagnosis , Cervical Vertebrae/surgery , Intervertebral Disc Displacement/surgery , Preoperative Care , Spinal Cord Compression/surgery , Spinal Fusion , Spinal Stenosis/surgery , Ultrasonography, Doppler, Duplex , Aged , Carotid Arteries/surgery , Cervical Vertebrae/pathology , Female , Humans , Intervertebral Disc Displacement/diagnosis , Male , Middle Aged , Sensitivity and Specificity , Spinal Cord Compression/diagnosis , Spinal Stenosis/diagnosisABSTRACT
Magnetic resonance imaging (MRI) is the leading diagnostic procedure for disk pathology and has overtaken other imaging modalities in frequency of use. However, one must be cautious not to overinterpret small abnormalities that are also frequent in asymptomatic subjects. There is conflicting evidence about the correlation of high-intensity zones with clinical symptoms. Bulging disks and protrusions are a common finding in asymptomatic individuals, whilst extrusions are almost always accompanied by back pain and sciatica. In patients with back pain or sciatica, MRI is indicated after failure of conservative management or neurological deterioration. Contrast-enhanced MRI is well suited to differentiate a recurrent disk extrusion from epidural fibrosis. In all cases suspicious of tumor or infection, MRI is indicated as a first-line investigation. The indications and pitfalls of the state of the art of MRI are delineated in this article.
Subject(s)
Intervertebral Disc/pathology , Magnetic Resonance Imaging , Spinal Diseases/diagnosis , Adolescent , Age Factors , Back Pain/etiology , Diagnosis, Differential , Discitis/diagnosis , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement , Magnetic Resonance Imaging/methods , Male , Middle Aged , Myelography/methods , Osteochondritis/diagnosis , Prospective Studies , Randomized Controlled Trials as Topic , Sciatica/etiology , Spinal Diseases/diagnostic imaging , Spinal Diseases/surgery , Time Factors , Tomography, X-Ray ComputedABSTRACT
AIM: To prospectively investigate the outcome efficacy of whole spine MRI for diagnosis and treatment in patients with suspected metastases of the spine. METHODS: All patients older than 50 years with newly diagnosed back pain and/or newly diagnosed spine-related neurological symptoms without a diagnosis by other imaging modalities were accepted in this study. A whole spine MRI and a detailed MRI per spine region with suspicious lesions were performed using a Siemens Magnetom Expert 1.0 Tesla machine. Outcome efficacy was determined by assessing further therapy and result for the patient. RESULTS: In all 15 patients of the year 1999 whole spine MRI allowed us to determine the definite diagnosis and treatment. Plain X-ray and 99mTc bone scanning gave a diagnostic suspicion but no definite diagnosis or therapeutic consequence. CONCLUSIONS: MRI of the spine including whole spine images allows clear cut decision making in diagnosis and treatment of cases suspicious for metastatic disease of the spine. Careful history taking and clinical examination provide enough information to opt for whole spine MRI as the first choice investigation. This will provide maximum benefit to the patient and avoid examination cascades.
Subject(s)
Magnetic Resonance Imaging , Spinal Neoplasms/secondary , Spine/pathology , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Spinal Neoplasms/diagnosisABSTRACT
We report a patient with a subtrochanteric fracture, for whom internal fixation failed and a prosthetic joint replacement was complicated by a local reactivation of a Mycobacterium tuberculosis infection. After hip replacement with revision and adequate medical therapy, a full recovery was attained without the necessity of removing the artificial joint.
