A controlled prospective outcome study of implantable electrical stimulation with spinal instrumentation in a high-risk spinal fusion population.

STUDY DESIGN: A series of 65 instrumented patients without stimulation were compared with a later series of 65 patients with instrumentation and implantable electrical stimulation. The groups were evaluated for risk factors, age, diagnostic groups, levels fused, and radiographic and clinical success. OBJECTIVES: To test the efficacy of electrical stimulation in instrumented high-risk lumbar fusions. SUMMARY OF BACKGROUND DATA: Spinal instrumentation and implantable electrical stimulation have been shown to improve fusion success rates. METHODS: All patients were instrumented via pedicle screws and autologous bone graft. Diagnostic groups were evaluated, and the risk factors in each group were identified and compared. Postoperation management and follow-up regimen were similar in each group. Radiographs were evaluated via Dawson's criteria and confirmed by an independent radiologist. Clinical success was evaluated via the Modified Smiley-Webster Scale and confirmed by a second orthopedic surgeon. RESULTS: Fusion success was 95.6% in the stimulated group compared with 87% in the nonstimulated group (P = 0.05). Clinical success was 91% in the stimulated group and 79% in the nonstimulated group (P = 0.02). In a workers' compensation subset, fusion success was 93% in the stimulated group and 81% in the nonstimulated group. Clinical success was 57% in the stimulated group and 46% in the nonstimulated group. CONCLUSIONS: The results from using both instrumentation and electrical stimulation in a high-risk pool of patients show a statistically significant difference, with higher rates of fusion and clinical success than in a similar pool that did not receive stimulation.

Diskitis in children.

Thirty-six patients diagnosed with diskitis from 1978 to 1988 and followed for an average of 29.2 months were reviewed. The study included 23 boys and 13 girls with an average age of 5.3 years. The initial symptoms varied, but distinct clinical patterns emerged and were identifiable in different age groups. Both the leukocyte count and sedimentation rate were elevated. Routine roentgenograms were positive for intervertebral disk space narrowing in 82% of cases, technetium bone scans positive in 72%, and magnetic resonance imaging positive in all recent cases. Treatment consisted of bed rest for all patients, plaster casts for 50%, antibiotics for 40%, and traction for 23%. Regardless of the treatment combination, the course of the disease in most children is benign. At the completion of the study, all patients were asymptomatic including three children who had recurrences. In spite of being asymptomatic, 74% had persistent roentgenographic changes. The administration of antibiotics appears to be appropriate when indicated, i.e., failure to respond to immobilization. Disk space aspiration or biopsy should be reserved for those cases that are refractory to immobilization and antibiotics.

Digital schwannoma in a skeletally immature child.

Soft tissue neoplasms of the hand are rare in general and even more uncommon in children. The most commonly considered diagnoses include ganglion, inclusion cyst, lipoma, subcutaneous foreign body granuloma, and tendon sheath xanthoma. Aside from pressure sensitivity, masses on the palmar aspect of the hand are often asymptomatic. The case reported here identifies a primary neural neoplasm (neurilemmoma) that involves a small peripheral nerve in the hand of a twelve-year-old child. The patient had no neurologic symptoms and illustrates the need to include neurilemmomas in the differential diagnosis of hand masses in children.