Posterior tension band wiring and instrumentation for thoracolumbar flexion-distraction injuries.

PURPOSE: To evaluate treatment outcome of tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar flexiondistraction injury (FDI). METHODS: 36 men and 12 women aged 21 to 56 (mean, 36) years underwent tension band wiring followed by posterior spinal fusion and instrumentation using pedicular screws for FDI of the thoracolumbar spine. The injured vertebral levels were T11 (n=2), T12 (n=12), T11-T12 (n=1), T12-L1 (n=1), L1 (n=28), and L2 (n=4). Anterior vertebral body height and kyphosis were measured before and after surgery. Neurologic status was assessed using the American Spinal Injury Association (ASIA) scale. The Oswestry Disability Index questionnaire and visual analogue scale for pain were also used. RESULTS: The mean follow-up was 38 (range, 26-72) months. At final follow-up, the mean visual analogue scale for pain was 1.7, and the median Oswestry Disability Index was 4% (range, 0-32%). The mean anterior vertebral body height improved from 20.5 to 38.8 mm (p<0.001). The mean kyphosis improved from 20.4º to 1.5º (p<0.001). Four patients had persistent neurologic deficit: ASIA scale C (n=2) and D (n=2); their ASIA scales improved by one grade. All patients returned to their original work at 6 months. There were no intra-operative complications or implant failures. CONCLUSION: Posterior tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar FDIs achieved good outcome.

Influencing factors on the functional level of haemophilic patients assessed by FISH.

Joint destruction in early adulthood brings the patients to the orthopaedic clinics. If a haemophilic patient becomes disabled, it shows a number of factors such as timely diagnosis, availability of appropriate treatment depending on the country, access and affordability to treatments and equally importantly the responsibility of the patient in managing self care by remaining compliant by prescribed treatment regimen. We assessed the functional level by functional independence score in haemophilia (FISH). Overall, 104 patients with haemophilia A and 29 with haemophilia B were evaluated. We assessed the function of the patients by FISH. We divided the sum scores into weak (FISH score 8-16), moderate (17-24), and good (25-32). For evaluating the level of functional deficit in a 2 × 2 table, we categorized the weak and moderate levels into Disordered Group and the good level into Not-Disordered Group. The average age was 26.9 ± 14.24. Each 1 year increase in age can increase 1.07 fold the possibility of being placed in Disordered Function Group. Severe haemophilia can increase 7.34 fold, presence of inhibitor can increase 9.75 fold and home self-care increases 3.89 fold the possibility of being placed in Disordered Function Group. To decrease the burden of the cost on patient, family and the government, education plays the most important role. We suggest that we send a trained team of physician and nurses to the deprived villages and cities instead of waiting for the patient to refer to our Care Center.

Does percutaneous kyphoplasty have better functional outcome than vertebroplasty in single level osteoporotic compression fractures? A comparative prospective study.

Purpose. To evaluate the relative differences in surgical outcome of kyphoplasty (KP) versus vertebroplasty (VP) in the patients with single level refractory osteoporotic compression fractures (OCFs). Method. From August 2008 to May 2012, we intermittently treated 57 patients with single level OCF by PV and KP (Groups A and B, resp.). We used visual analogue scale (VAS) and short form 36 (SF36) questionnaire to measure functional recovery and followed them for six months. Independent samples t- and Kendall's tau-b tests were for statistics. Results. In terms of age, number, and bone mineral density of the patients, there were no significant differences between the two groups. In both groups, VAS and SF-36 scores improved significantly and remained relatively stable throughout the follow-up period. We had 9 and 6 asymptomatic cement extravasations and 5 and 8 new vertebral fractures in Group A and B, respectively. In comparing the two groups, the results indicated that KP almost failed to show any significant higher effect relative to VP during this period. Conclusions. In considering the high cost of KP relative to VP in the developing countries like Iran, there is no logical reason to use KP in a single level refractory OCF in these regions.

Functional Outcomes of Surgery in Cervical Spondylotic Radiculopathy versus Myelopathy: A Comparative Study.

Background. Cervical spondylosis can cause three different categories of symptoms and signs with possible overlap in the affected patients. Aim. We aim to compare functional outcome of surgery in the patients with cervical spondylotic radiculopathy and myelopathy, regardless of their surgical type and approach. Materials and Methods. We retrospectively reviewed 140 patients with cervical spondylotic radiculopathy and myelopathy who had been operated from August 2006 to January 2011, as Group A (68 cases) and Group B (72 cases), respectively. The mean age was 48.2 and 55.7 years, while the mean followup was 38.9 and 37.3 months, respectively. Functional outcome of the patients was assessed by neck disability index (NDI) and patient satisfaction with surgery. Results. Only in Group A, the longer delay caused a worse surgical outcome (NDI). In addition, in Group B, there was no significant relationship between imaging signal change of the spinal cord and our surgical outcomes. Improvement in NDI and final satisfaction rate in both groups are comparable. Conclusions. Surgery was associated with an improvement in NDI in both groups (P < 0.001). The functional results in both groups were similar and comparable, regarding this index and patient's satisfaction score.

Magnetic Resonance Imaging versus Electrophysiologic Tests in Clinical Diagnosis of Lower Extremity Radicular Pain.

Introduction. Radicular low back pain is one of the most common medical problems. The aim of this study was to evaluate the diagnostic accuracy of MRI and electrodiagnosis in lower extremity radicular pain in relation to history and clinical findings. Methods. In this cross-sectional study, we studied 165 sciatalgic subjects. A comprehensive history and physical examinations were taken from the subjects and recorded, and then MRI scanning and electrodiagnostic (nerve conduction velocity and electromyography) tests were performed. Results. From 152 subjects who remained in the study, 67 cases (44.1%) had radicular pain in left lower limb, 46 (30.3%) in right, and 39 (25.6%) in both lower limbs. 104 cases (68.4%) had shown some type of abnormalities in both MRI and electrodiagnosis, 30 (19.7%) had shown this abnormality only in MRI, and 21 (13.8%) only in electrodiagnosis, while 10 cases (6.5%) had both normal MRI and electrodiagnostic studies. Coordination rates of MRI and electrodiagnosis with clinical findings were 58.6% and 89.5%, respectively. Conclusion. In many MRI negative but symptomatic subjects, electrodiagnosis has an important diagnostic value.

Painful and tender toe, osteoid osteoma of the distal phalanx of toe, a diagnostic dilemma.

Osteoid osteoma rarely involves the phalanges of the toes. Basically osteoid osteoma is often a diagnostic dilemma in musculoskeletal practice especially in the foot and ankle. Its presentation is confusing and this may result in delayed diagnosis. We have reported a case of osteoid osteoma of the distal phalanx of the second toe which was treated successfully with surgical excision and reviewed the literature.