Pridie's marrow stimulation technique combined with collagen matrix for cartilage repair. a study in a still growing sheep model.

The study assessed the spontaneous repair of large critical full-thickness defects (FTD) in not mature and still growing sheep model and compared repaired tissue after Pridie's technique to the same technique combined with type I collagen matrix. Thirty-six FTD were divided into group 1 (untreated), group 2 (treated according to Pridie's technique with 10.2 as value ratio of marrow stimulation), and group 3 (treated using Pridie's marrow stimulation technique, and covered by a type I collagen matrix) . The histological exam at 12 months showed fibrous repair of the untreated defects. In group 2 the reparative tissue showed a prevalence of fibrocartilaginous tissue. The mean ICRS visual assessment scale score was 8.9. In group 3 the reparative tissue was similar to the normal surrounding cartilage. The mean ICRS visual assessment scale score was 14.7. Subchondral drilling with defined ratio between the stimulated marrow area and the lesion area could improve the quality of FTD repair in articular cartilage in not mature and still growing stifle sheep model if combined with type I collagen matrix.

Segond fracture with anterior cruciate ligament tear in an adolescent.

The authors report a case of acute knee injury in a 14-year-old teenager. The X-ray showed a so-called Segond's fracture: a small avulsed bone fragment, elliptical in shape, lying immediately below the external tibial plateau, a few millimeters from the lateral tibial cortex. The fracture site was in the portion of the tibial condyle which is linked to the middle third of the lateral capsule by meniscal tibial fibers. Clinical examination under anesthesia and subsequent arthroscopy revealed a total intrasubstance ACL (anterior cruciate ligament) tear close to the proximal insertion. The authors confirm Segond's report of a possible association of this avulsion fracture with ACL injuries, even in adolescence.

Quality of life of patients operated on for lumbar stenosis: a long-term follow-up.

BACKGROUND: We evaluated a sample of 28 patients surgically treated for lumbar stenosis (LS) four years after the first evaluation (length of the first follow-up mean 44.6 months, range 15-88) in order to evaluate the long-term follow-up of Quality of Life (QoL) after surgical treatment as LS may greatly impair the patients' QoL. We previously assessed QoL in 30 patients operated on for LS four years before, by performing a retrospective follow-up through the Short-Form 36 Health Survey (SF-36). METHODS: In this current study we performed a phone call evaluation administering the SF-36 and the official Italian version of the North American Spine Society (NASS) lumbar spine outcome assessment instrument. FINDINGS: With regard to the SF-36 results at long term follow-up we observed a significant improvement of Physical Function, Bodily Pain, Mental Health and the Physical Composite Score with respect to the first follow-up. Conversely, Vitality worsened. Regarding the results of NASS an improvement of neurological symptoms was observed. Comparison of SF-36 mean scores in the current LS sample vs. the Italian normal population at the same age, showed similar QoL pattern. CONCLUSIONS: The long-term follow-up showed that patients operated on for LS continue to improve their QoL pattern even between the 4th and the 8th year after surgery.

Quality of life, clinical and neurophysiological picture in patients operated on for lumbar stenosis.

BACKGROUND: In lumbar stenosis (LS) patients, clinical, neuroradiological and neurophysiological findings were not related to validated measurements of the outcomes that are more relevant to patients such as functional status and symptoms. METHOD: We have retrospectively studied 30 patients surgically treated for LS. We have evaluated the patients by means of self-administered questionnaires (SF-36), clinical examination, and neuroradiological and neurophysiological measurements and we have registered preoperative and follow-up clinical and neurophysiological findings. Finally we evaluated the relations between patient-oriented data and validated conventional clinical and neurophysiological measurements. FINDINGS: The comparison between pre- and post-operative clinical picture showed an improvement of most parameters tested. The comparison between pre- and post-operative neurophysiological picture revealed worsening of most tested parameters. The comparison between the current sample and the Italian normative data for the SF-36 showed a worsening of physical aspects of health related quality of life; conversely there was an improvement of some mental domains. CONCLUSIONS: In our sample of LS patients the most compromised SF-36 domain was Role-Physical that measures the difficulty in every-day activities due to physical problems. Conversely, the clinical findings showed a significant improvement after surgery: patients reported in particular lower sciatica after surgical treatment, but the neurophysiological evaluation did not show any improvement.

Lumbar nerve root "walled" by a calcified herniated mass in a young patient.

INTRODUCTION: Discal calcification in childhood is rare. Calcifications are occasionally discovered during routine examinations, especially in the cervical spine. Generally, the calcification process is confined to the nucleus pulposus of the intervertebral disc. CASE REPORT: In this report, we describe the case of a 16-year-old girl who presented with acute low back pain, right S1 radiculopathy and a history of increasing paresthesia. The patient underwent a CT scan, which demonstrated a postero-lateral calcified disc hernia at the L5-S1 level. The surgical decompression of the lumbar nerve root was carried out; at the operation it was observed that the nerve root was "walled" into the calcified hernia. DISCUSSION: Only a few cases with evidence of calcification of the herniated portion of the disc have been previously described. In none of them was the phenomenon was so pronounced that it sealed the nerve root completely.

Study of vertebral morphology in Scheuermann's kyphosis before and after treatment.

Variation of vertebral morphology in Scheuermann's Kyphosis before and after orthopedic treatment is usually measured by the entity of the curve, using Cobb's method, and by vertebral wedging. But the lack of correlation between these parameters and the clinical evolution of the deformity, lead to the possibility of other alterations that can explain part of the kyphosis deformities before and after the treatment. In this group of alterations the inclination of anterior and posterior walls, that express the trapezoid deformity of vertebras, seem to be more reliable indicators of curve response to ortopedic treatment.

Biomechanics of the conservative treatment in idiopathic scoliotic curves in surgical "grey-area".

The biomechanical behaviour of the spine significantly varies in relation to the age of the spine. Particularly, the elastic behaviour of the intervertebral discs has been proved to change during the spine growth, which changes the disc reaction to externally imparted forces. The biomechanical analysis of the G modulus of torsion rigidity of the intervertebral disc shows that the G values progressively increase through growth, which favours the progression of early scoliotic curves. At the same time, however, early structural scoliosis is more amenable to conservative treatment owing to the residual growth potential of the spine. Whereas indications to surgical treatment of scoliotic curves has been based upon the magnitude of the curves as measured according to the Cobb method, two additional factors affect the chance of correcting a scoliotic curve, The first is the residual growth potential of the vertebrae. In fact, a longer residual growth allows for external forces to be applied so as to change the growth model of the scoliotic spine, which ensures a stable correction of the deformity when these external forces are removed. The second is the magnitude of the elastic deformation of the intervertebral discs. It has been suggested that a deformation beyond the disc elastic behaviour, by producing hysteresis of the disc, renders the disc less susceptible to transferring the load to the neighbouring vertebral bodies, thus impairing remodelling. It ensues that both the age and the magnitude of rotation affects the success of conservative treatment and not only the magnitude in Cobb degrees. The curve localization adds to these two parameters, thoracic curves being stiffer than thoracolumbar and lumbar curves.

[Pott disease: current diagnostic and therapeutic approaches]. / Il Morbo di Pott: attuali orientamenti diagnostici e terapeutici.

Spinal tuberculosis, or Pott's disease, has been known since ancient times; it was a common orthopaedic illness until 1950, but the progress of specific therapies confined it to third word countries; its resurgency in recent years in developed countries is due to drug resistance, immigration from endemic areas, and an increase in immunodeficient patients. Spinal disease is found in about 1% of all tuberculosis cases. Modern treatment consists of a diagnostic phase, based on clinical findings and imaging exams, and of a medical and surgical therapy. Our patients have been treated with a three antibiotic drugs scheme, and underwent early surgical treatment, in order to assure the curettage of the lesion and obtain spine stabilization, so as to avoid spinal deformity.