Spinal cord injury without radiographic abnormality (SCIWORA).

Spinal cord injury without radiographic abnormality (SCIWORA) is associated with self-reducing transient subluxation or distraction of the juvenile spine. It accounts for about 40% of spinal injuries in children under sixteen. Children's anatomical features increase their susceptibility to hyperflexion, hyperextension and distraction mechanisms. Nursing management includes an awareness of two of its greatest dangers: a delay in onset of symptoms and a possible recurrence. If these dangers are identified early, the child's potential for recovery is maximized.

HIV precautions for prevention in the workplace.

The concern over transmission of blood-borne disease from health care workers to patients has become a topic of increasing concern. The Human Immunodeficiency Virus (HIV) is one of these diseases. Mandatory HIV antibody testing of all patients and health care workers is currently under consideration with no solution immediately on the horizon. Orthopaedic health care workers are often involved in emergent care of trauma victims without the benefit of knowing the HIV status of these patients. Therefore, the only solution is to employ meticulous barrier techniques to prevent transmission of diseases such as HIV infection. Precautions for orthopaedic nurses are discussed in an effort to provide guidelines for prevention of transmission of disease.

Zielke instrumentation.

Zielke modified Dwyer's anterior spinal instrumentation to produce the Ventral Derotational Spondylodesis (VDS) System. The primary indication for VDS instrumentation is the treatment of progressive, single, major lumbar or thoracolumbar curves in idiopathic scoliosis. The surgical technique, including selection of appropriate curvatures and levels of instrumentation, is described. A group of 25 consecutive patients undergoing VDS instrumentation for lumbar or thoracolumbar curvatures was reviewed. The average correction of the major curve was 76%. The minor curvature was corrected with an average of 47%. A significant complication was a 20% incidence of pseudarthrosis and rod breakage. The implications of these problems are discussed. Zielke instrumentation is a powerful technique for the correction of selected curves. The system provides greater correction of the major curve, improved frontal and sagittal alignment, and preservation of distal motion segments.

Reconstructive spinal surgery as palliation for metastatic malignancies of the spine.

Metastatic tumors of the spine often cause severe pain and paralysis because of deformity and neural encroachment. As oncology now extends the life expectancies of these patients, spinal decompression and stabilization is necessary. We consider that prophylactic stabilization of the spine is analogous to prophylactic nailing of a femur with a pathologic lesion. Both the femur and spine are weight-bearing structures. The advent of segmental instrumentation makes this a feasible accomplishment with minimal morbidity. Seventeen patients with metastatic disease of the spine at Rush-Presbyterian-St. Luke's Medical Center, Chicago, were reviewed. All maintained spinal stability postoperatively. Eleven of the 17 had significant pain relief for 3 months or more. Five of 11 paralyzed patients had significant neural recovery. A classification for treatment purposes regardless of tissue type was developed. Once classified, the surgical goals for these patients were to decrease pain, to preserve or to improve neurologic function and to mobilize the patient without external orthosis.