Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery.

PURPOSE: The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. METHODS: In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic spondylolisthesis (n = 28) and recurrent radiculopathy after herniated disc surgery (n = 28). Clinical outcome was assessed using the visual analogue score (VAS) and Oswestry Disability Index (ODI). Quality of life was assessed with the Euroqol-5d (EQ5D), the EQ5D VAS and the WHOQOL-BREF. RESULTS: The follow-up was 5.1 (SD 2.3) years. The decrease in VAS scores was significant and comparable in both groups. We found significantly better ODI and quality of life scores for the patients with lytic spondylolisthesis. The radiological outcome showed only one non-union, and subsidence occurred in both groups at an equal amount. CONCLUSION: The MI-PLIF technique is a safe procedure with only few complications and a high fusion rate. It was successful in both groups, but the quality of life and ODI are better in primary cases.

Midterm clinical results of the Autocentric II patellofemoral prosthesis.

We studied the outcome of patellofemoral arthroplasties using the Autocentric prosthesis implanted in our clinic between 1994 and 2004. New insight on indications and contraindications motivated us to find risk factors in the failure of this prosthesis. Twenty-four patients had surgery for patellofemoral arthritis not responding to exhaustive nonoperative measures. The mean age at the time of patellofemoral arthroplasty (PFA) was 63.4 (SD 11.3, range 38-81) years with a mean follow-up of 4.8 (SD 2.9, range 2-11) years. Additional interventions were necessary in 21 knees during follow-up in our population, and seven knees required total knee arthroplasty (TKA) mainly due to progressive tibiofemoral osteoarthritis and maltracking of the patella. The patient outcomes and quality of life scores showed disappointing results, even after revision to TKA. This retrospective analysis underlines the importance of strict indications for patellofemoral arthroplasty and, in particular, of contraindications.

Anterior opening wedge osteotomy of the proximal tibia for anterior knee pain in idiopathic hyperextension knees.

We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5-99.5), and the mean Knee Society score score was 94.6 (70-100) for function and 87.7 (47-100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42-100), for stiffness 82.8 (25-100) and for pain 87.3 (55-100). Radiographs showed a significant increase in posterior tibial slope of 9.4 deg and a significant decrease of patellar height according to the Blackburne-Peel method of 0.16 postoperatively. No cases of non-union, deep infection or compartment syndrome were seen. No osteoarthritic changes in the lateral or medial knee compartment were found with more than 5 years' follow-up in 16 patients with 19 affected knees. Three out of the four dissatisfied patients had a patella infera which led to patellofemoral complaints. One patient in the study underwent a secondary superior displacement of the patella with excellent results. We conclude that in a selected group of patients with idiopathic genu recurvatum and anterior knee pain an opening wedge osteotomy of the proximal tibia can be beneficial.

Long-term results and arthropathy following the modified Bristow-Latarjet procedure.

The incidence of early osteoarthritis after the modified Bristow procedure has been the subject of several articles during the last decade. Recurrent dislocation, recurrent subluxation after surgery or the procedure itself have been suggested as the main causes of degenerative changes. We assessed 19 patients who underwent the Bristow procedure for recurrent anterior dislocations of the shoulder retrospectively. Only one redislocation occurred in 20 shoulders (six women and 13 men) with an average follow-up of 7.7 years. All patients were satisfied and experienced improved stability. Three patients showed arthritic changes (two mild and one moderate), which, surprisingly, were also seen in the opposite shoulder. We therefore conclude that the occurrence of arthropathic changes after surgical stabilisation is based on multiple factors, with the initial dislocation playing a major role.

[Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: first short term results]. / Percutane vertebroplastiek bij osteoporotische wervelinzakkingsfracturen: eerste kortetermijnresultaten.

OBJECTIVE: To describe the technique of percutaneous vertebroplasty and the short-term results in patients with symptomatic, osteoporotic vertebral compression fractures. DESIGN: Prospective follow-up study. METHOD: In a pilot-study to evaluate the short-term safety and effectiveness of percutaneous vertebroplasty, 18 consecutive patients with a total of 33 osteoporotic thoracic or lumbar vertebral compression fractures were treated from October 2001 to June 2002 with a follow-up of 3-6 months. The indication for treatment was a symptomatic, therapy-resistant osteoporotic vertebral compression fracture. Percutaneous vertebroplasty was performed under radiographic control, after previous intraossal venography, using bone cement mixed with barium sulphate. Post-procedural follow-up consisted of radiological evaluation with conventional thoracolumbar X-rays and MRI scans, and interviews of the patients. RESULTS: Percutaneous vertebroplasty was technically successful in 31 of 33 vertebral fractures (94%), and in 16 of 18 patients (89%). One patient with extreme venous contrast leakage could not be treated. Sixteen patients had less or no pain after treatment. One patient retained thoracolumbar back pain after inadequate cementations and refused further treatment. None of the patients reported aggravation of symptoms following the procedure. Contrast leakage was absent in 18 vertebrae. In 8 vertebrae there was contrast leakage to paravertebral veins. In three of these cases the leakage was so severe that embolisation was performed, with success in one case. In 13 vertebrae, cement leakage to intervertebral and paravertebral spaces and pedicular cement spurs were seen, without clinical consequences. Immediately after the procedure and during follow-up there were no clinically relevant complications. CONCLUSION: Percutaneous vertebroplasty was a technically feasible treatment in these patients with symptomatic, therapy-resistant, osteoporotic vertebral fractures. The first short-term results were comparable with results in the literature. A prospective randomised intervention study will be needed to compare percutaneous vertebroplasty with optimal conservative treatment.

Vascular changes following hip arthroplasty. The femur in goats studied with and without cementation.

We studied two groups of 6 adult female African pygmy goats, which received cemented or uncemented femoral endoprostheses in their right hip. One additional goat was used for in vivo angiography preoperatively and postoperatively. The blood supply to the proximal femur at a macroscopic level was not severed by the operation. Until the 6th postoperative week, the animals were killed at weekly intervals. Microangiography and fluorescence microscopy revealed that rapid revascularization of the metaphyseal trabecular bone in the vicinity of the implants occurred as early as the first postoperative week in both groups. However, in general, the revascularization of the bone around the uncemented prostheses occurred more rapidly, resulting in earlier bone remodeling when compared with the cemented group. Surprisingly, the apposition of periosteal bone was longer lasting and more intensive in the uncemented group, particularly at the metaphyseal level. We suggest that this phenomenon may be enhanced by mechanical stimuli; the restoration of function was delayed in the noncemented goats.

Radiographic evaluation of the modified Bristow procedure for recurrent anterior dislocation of the shoulder.

Concerning the radiological evaluation of the modified Bristow procedure in the operative treatment of recurrent anterior dislocation of the shoulder, several aspects are of importance. In the first place, the position of the coracoid transplant and the screw used to fix it with should be underneath the equator of the humeral head and within 1 cm of the glenoid rim. Secondly, bony union appears to take place in most instances in which the screw has enough length to reach the posterior cortex of the scapular neck. However, when the screw is too short, in most cases a fibrous union develops. These features can be demonstrated on three routine radiological examinations: the anatomical anterior-posterior view, the axial projection with internally rotated humerus and the axial view with the arm in external rotation.