ABSTRACT
We report the use of posterior cervical locking plate fixation after apical vertebral excision for congenital lumbar kyphosis in a 3-year-old male myelomeningocoele patient. At 4-year follow-up the fixation was secure and the correction was well preserved.
Subject(s)
Bone Plates , Bone Wires , Cervical Vertebrae/surgery , Kyphosis/surgery , Laminectomy/instrumentation , Meningomyelocele/surgery , Spinal Fusion/instrumentation , Cervical Vertebrae/diagnostic imaging , Child, Preschool , Humans , Internal Fixators , Kyphosis/diagnostic imaging , Kyphosis/etiology , Laminectomy/methods , Male , Meningomyelocele/complications , Meningomyelocele/diagnostic imaging , Radiography , Spinal Fusion/methods , Treatment OutcomeABSTRACT
BACKGROUND: Tendon repair and subsequent immobilization is frequently complicated by postoperative stiffness secondary to inflammation and peritendinous adhesions. Thermal preconditioning is known to reduce inflammation by inducing formation of cytoprotective heat shock proteins. This study evaluates the role of thermal preconditioning following complete division and repair of the Achilles tendon, with subsequent immobilization, mimicking the typical clinical scenario. MATERIALS AND METHODS: Twenty-four New Zealand White rabbits were used in the study. The treatment group underwent thermal preconditioning, by elevating their core temperature to 41.5 degrees C for 20 minutes. The Achilles tendon of the hindlimb was divided and repaired 18 hours following thermal preconditioning. The animals were sacrificed following 3 weeks of immobilization. Range of movement of the ankle, tendon gliding, quantity of adhesions, and weight of repaired tendons were assessed. RESULTS: Loss of range of movement at the ankle was significantly less in the treatment group versus controls (P = 0.02). The quantity of adhesions and weight of the repaired tendons were significantly reduced in the treatment group (P = <0.001 and P = 0.005, respectively). Tendon gliding relative to the surrounding soft tissue was also significantly improved in the treatment group (P = 0.002). CONCLUSION: Preconditioned animals demonstrated a significantly better range of ankle movement, decreases in adhesion formation and in the gliding, and dimensions of tendons. Thermal preconditioning therefore has the potential to improve clinical results in tendon surgery following repair and immobilization.
