The NuVasive MAGEC Rod Urgent Field Safety Notice Concerning Locking Pin Fracture: How Does Data From an Independent Explant Center Compare?

STUDY DESIGN: Analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods. OBJECTIVE: The aim of this study was to quantify the rate of locking pin breakage in explanted MAGEC rods and compare with the manufacturer's data. SUMMARY OF BACKGROUND DATA: On June 25, 2019, NuVasive released an Urgent Field Safety Notice stating that MAGEC rods manufactured before March 26, 2015 had a higher than expected locking pin breakage rate of 5%. For rods made on or after that date, no pin breakages had occurred. METHODS: From our independent explant database of 139 explanted MAGEC rods supplied from 10 UK spinal centers (Belfast, Bristol, Birmingham, Edinburgh, Exeter, Leeds, Newcastle, Nottingham, Oxford, and Sheffield) and one Danish center (Aarhus), we divided the rods into those manufactured before March 26, 2015, and those manufactured on or after that date. MAGEC rods were cut open to fully assess internal components including locking pins. From each of the two cohorts, 10 locking pins were selected at random and their diameters were measured using a micrometer. RESULTS: One hundred and five explanted MAGEC rods were made before March 26, 2015 and could be disassembled to allow the locking pin to be examined. Fifty-nine percent (62/105) of these locking pins had fractured. For the MAGEC rods manufactured on or after March 26, 2015, 21% (6/29) were found to have fractured locking pins. Locking pins in MAGEC rods made on or after March 26, 2015 were of a stronger material and a larger diameter. CONCLUSION: Fifty-nine percent of the locking pins in MAGEC rods manufactured before March 26, 2015 had fractured, far greater than the 5% stated in the Urgent Field Safety Notice. Locking pin fracture still occurred in MAGEC rods manufactured on or after that date, in 21% of cases. This contrasted with the 0% reported by the manufacturer. LEVEL OF EVIDENCE: 4.

Identifying risk factors for suboptimal pelvic binder placement in major trauma.

AIMS: This study aimed to identify the frequency of sub-optimal pelvic binder placement at a tertiary-level trauma centre, produce a reproducible, quantitative measure of pelvic binder fit, and identify risk factors for sub-optimal placement. PATIENTS AND METHODS: We identified all consecutive patients who had a pelvic binder in place on arrival to the Royal Brisbane and Women's Hospital in Queensland, Australia from 2012-2016. The X-Rays were reviewed by two senior clinicians for position and measured for degree of displacement if not optimally placed between the greater and lesser trochanters. Risk factors for sub-optimal position of the binder were assessed using multiple logistic regression with inclusion of all variables that had a statistical association (to p<0.05) at the univariate analysis stage. Secondary assessment was conducted of patients who had undergone CT imaging for subcutaneous body fat distribution. RESULTS: In total, 496 X-Rays were assessed for pelvic binder fit, finding 43.5% sub-optimally placed. 39.7% binders were superior to the greater trochanter line and 3.8% inferiorly placed below the lesser trochanter line. The majority of the sub-optimally placed binders were within 60 mm of the ideal position. Female patients had a greater risk of sub-optimal binder placement compared to males (62.5% vs 37%). Increasing intertrochanteric height was found to be protective for ideal binder placement with an aOR 0.62 for each cm in increased height. There was no association with sub-optimal placement and age, sex, mechanism of trauma, injury severity score, number of body regions injured or Glasgow Coma Scale. There was strong kappa agreement between the X-Ray assessors for binder position assessment on the plain radiological imaging. CONCLUSION: Sub-optimal positioning of pelvic binders is common in our trauma population. This study has described the risk factors associated with higher rates of sub-optimal fit and provides a description of rapid radiological assessment for optimal fit for the bedside clinician caring for injured patients in the resuscitation room.

Early mobilization versus plaster immobilization of simple elbow dislocations: a cost analysis of the FuncSiE multicenter randomized clinical trial.

INTRODUCTION: The primary aim was to assess and compare the total costs (direct health care costs and indirect costs due to loss of production) after early mobilization versus plaster immobilization in patients with a simple elbow dislocation. It was hypothesized that early mobilization would not lead to higher direct and indirect costs. MATERIALS AND METHODS: This study used data of a multicenter randomized clinical trial (FuncSiE trial). From August 25, 2009 until September 18, 2012, 100 adult patients with a simple elbow dislocation were recruited and randomized to early mobilization (immediate motion exercises; n = 48) or 3 weeks plaster immobilization (n = 52). Patients completed questionnaires on health-related quality of life [EuroQoL-5D (EQ-5D) and Short Form-36 (SF-36 PCS and SF-36 MCS)], health care use, and work absence. Follow-up was 1 year. Primary outcome were the total costs at 1 year. Analysis was by intention to treat. RESULTS: There were no significant differences in EQ-5D, SF-36 PCS, and SF-36 MCS between the two groups. Mean total costs per patient were €3624 in the early mobilization group versus €7072 in the plaster group (p = 0.094). Shorter work absenteeism in the early mobilization group (10 versus 18 days; p = 0.027) did not lead to significantly lower costs for loss of productivity (€1719 in the early mobilization group versus €4589; p = 0.120). CONCLUSION: From a clinical and a socio-economic point of view, early mobilization should be the treatment of choice for a simple elbow dislocation. Plaster immobilization has inferior results at almost double the cost.

Comparison of Clinical and Radiologic Outcomes Between Self-Locking Stand-Alone Cage and Cage with Anterior Plate for Multilevel Anterior Cervical Discectomy and Fusion: A Meta-Analysis.

OBJECTIVE: This meta-analysis was conducted to evaluate the therapeutic effects in clinical and radiologic outcomes of a self-locking stand-alone cage (SSC) and cage-with-plate (CP) for multilevel anterior cervical discectomy and fusion (ACDF). METHODS: A systematic search was performed for all comparative studies reported up to August 2018. Operative time, hospital stay, intraoperative blood loss, Japanese Orthopedic Association score, Neck Disability Index (NDI), cervical and segmental Cobb angle, intervertebral height, fusion rate, incidence of subsidence, dysphagia, and adjacent segment degeneration were analyzed with the RevMan 5.3.3 software. RESULTS: A total of 15 studies were included. There was no difference regarding preoperative or postoperative Japanese Orthopedic Association score, Neck Disability Index, segmental Cobb angle and intervertebral height, preoperative cervical Cobb angle, fusion rate, incidence of subsidence, and adjacent segment degeneration between the SSC and CP group (P > 0.05). However, the SSC group had shorter operative time (mean difference [MD], -11.35; 95% confidence interval [CI], -16.24 to -3.66) and hospital stay (MD, -0.64; 95% CI, -1.21 to -0.06), less intraoperative blood loss (MD, -13.22; 95% CI, -19.03 to -7.41) and postoperative cervical Cobb angle (MD, -0.70; 95% CI, -1.35 to -0.06), and lower incidence of dysphagia significantly (odds ratio, -0.57; 95% CI, 0.40-0.82) (P < 0.05). CONCLUSIONS: ACDF with SSC and CP in multilevel cervical spondylosis achieved similar clinical relief. Although CP maintained better cervical lordosis, SSC contributed to less surgical pain and fewer complications. ACDF with SSC is safe and efficient in treating multilevel cervical spondylosis.

The value of 'binder-off' imaging to identify occult and unexpected pelvic ring injuries.

AIMS: To determine the effectiveness of 'binder-off' plain pelvic radiographs in the assessment of pelvic ring injuries. PATIENTS AND METHODS: All patients requiring operative intervention at our tertiary referral pelvic unit/major trauma centre for high-energy pelvic injuries between April 2012 and December 2014 were retrospectively identified. Pre-operative pelvic imaging with and without pelvic binder was reviewed with respect to fracture pattern and pelvic stability. The frequency with which the imaging without pelvic binder changed the opinion of the pelvic stability and need for operative intervention, when compared with the computed tomography (CT) scans and anteroposterior (AP) radiographs with the binder on, was assessed. RESULTS: Seventy-three percent (71 of 97) of patients had initial imaging with a pelvic binder in situ. Of these, 76% (54 of 71) went on to have 'binder-off' imaging. Seven percent (4 of 54) of patients had unexpected unstable pelvic ring injuries identified on 'binder-off' imaging that were not identified on CT imaging in binder. CONCLUSIONS: Trauma CT imaging of the pelvis with a pelvic binder in place is inadequate at excluding unstable pelvic ring injuries, and, based on the original findings in this paper, we recommend additional plain film 'binder-off' radiographs, when there is any clinical concern.

Surgical considerations with the operative fixation of unstable paediatric pelvic ring injuries.

INTRODUCTION: The operative treatment of unstable pelvic injuries in paediatrics is not frequently indicated. The detailed modes of pelvic ring failure, surgical techniques, fixation choices, and peri-operative difficulties are not well reported. METHODS: From September 2010 to March 2016, 62 paediatric patients were admitted to an academic level I trauma center with the diagnosis of pelvic ring injury. Of them, 29 (17 males and 12 females) had operative fixation of unstable pelvic injuries. Their average age was 11.7 ± 4.4 years. RESULTS: There were six Tile's B injuries and 23 type C injuries. The commonest modes of pelvic ring failure were pubic rami fractures anteriorly and ligamentous sacroiliac joint injuries posteriorly. The iliac apophysis was avulsed in nine patients. Supra-acetabular external fixators were frequently used for anterior fixation while iliosacral IS screws and lateral compression LC screws were commonly used posteriorly. Difficulties were encountered with open reduction and repair of avulsed iliac apophyses in two patients. The IS screws pierced the soft iliac wing in three patients. In two patients with open triradiate cartilage, the purchase of retrograde LC screws was weak due the small sized crescent fragment. CONCLUSION: The iliac apophysis needs to be repaired following reduction of the displaced hemipelvis. Anterior supra-acetabular external fixation is a good choice in paediatrics even with pubic symphysis diatasis as the pathology is commonly a pubic apophysis avulsion. IS screws might be inserted through plates to prevent piercing the soft iliac wing. Retrograde LC screws should be avoided in young children.

Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty: A meta-analysis.

BACKGROUND: Both the mini-plate fixation and suture suspensory fixation techniques are extensively applied in cervical laminoplasty, but which technique is superior has not been ascertained. The purpose of this meta-analysis is to compare the results between mini-plate fixation and suture suspensory fixation in cervical laminoplasty for the patients with multilevel cervical compressive myelopathy. METHODS: PubMed, Embase, the Cochrane library, CNKI, and WANFANG were searched for studies that compared mini-plate fixation and suture suspensory fixation in cervical laminoplasty up to November 1, 2016. We calculated odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes. Review Manager 5.3 was used for the statistical analyses. RESULTS: A total of 25 studies, involving 1603 participants, were included in this review. The results of this meta-analysis indicated that there were statistically significant differences in postoperative Japanese Orthopedic Association (JOA) scores (MD = 0.67, 95% CI: 0.34-0.99, P < 0.001), JOA scores improvement rate (MD = 4.00, 95% CI: 2.51-5.50, P < 0.001), postoperative Visual Analogue Score (VAS) (MD = -0.81, 95% CI: -1.36 to -0.26, P = 0.004), postoperative range of motion (ROM) (MD = 4.15, 95% CI: 2.06-6.23, P < 0.001), postoperative cervical lordosis (MD = 3.1, 95% CI: 2.02-4.18, P < 0.001), postoperative anteroposterior diameter of the spinal canal (MD = 1.53, 95% CI: 0.11-2.95, P = 0.03), postoperative open angle (MD = 1.93, 95% CI: 0.14-3.71, P = 0.03), postoperative cross-sectional area of the spinal canal (MD = 37.10, 95% CI: 26.92-47.29, P < 0.001), axial symptoms (OR = 0.28, 95% CI: 0.20-0.37, P < 0.001), operation time (MD = 4.46, 95% CI: 0.74-8.19, P = 0.02), and blood loss (MD = 9.24, 95% CI: 6.86-11.62, P < 0.001). However, there was no statistically significant difference in C5 palsy (OR = 0.82, 95% CI: 0.37-1.84, P = 0.63). CONCLUSIONS: As compared with suture suspensory fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, mini-plate fixation is associated with bigger surgical trauma. This conclusion should be interpreted cautiously and more high-quality, randomized controlled trials are needed in the future.

Reverdin-Isham osteotomy versus Endolog system for correction of moderate hallux valgus deformity: a Randomized Controlled Trial.

OBJECTIVES: Several procedures have been described for the management of hallux valgus deformity. In this paper we would like to compare our experiences with two techniques (Endolog system and Reverdin-Isham osteotomy) with a randomized study. To our knowledge, this is the first study to be reported in the literature, that provides a detailed comparison of these two techniques to treat moderate hallux valgus. MATERIALS AND METHODS: A total of 40 consecutive patients (40 feet) with moderate symptomatic hallux valgus were randomly assigned into two groups, to compare the results of Reverdin-Isham osteotomy (group A,20 feet) and Endolog system (group B, 20 feet). RESULTS: The average follow-up was of 23.7 ±7.7months . The average correction of HVA and IMA achieved in group A was 17.1° ±6.2° and 5.2° ±2.6° respectively, while in group B, it was 14°±6.2° and 7.7°±2.6° respectively. The mean AOFAS score improved from a pre-operative of 40.5 ±15.5 points to 90.3 ±5.3 points in group A, and from 32.4 ±16.8 points to 89.2 ±10.5 in group B. CONCLUSIONS: No statistically significant differences were detected between the two groups with respect to the AOFAS score, HVA, and IMA. Both groups showed good to excellent results.

Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis.

OBJECTIVES: Pediatric forearm torus fracture, a frequent reason for emergency department visits, can be immobilized by both rigid cast and nonrigid methods. However, controversy still exists regarding the optimal treatment of the disease. The aim of this study was to compare, in a systematic review, clinical efficacy of rigid cast with nonrigid methods for immobilization of the pediatric forearm torus fractures. METHODS: Literature search was performed of PubMed and Cochrane Library by 2 independent reviewers to identify randomized controlled trials comparing rigid cast with nonrigid methods for pediatric forearm torus fractures from inception to December 31, 2013, without limitation of publication language. Trial quality was assessed using the modified Jadad scale. RESULTS: Eight randomized controlled trials with a total of 781 participants met all inclusion criteria. The nonrigid methods for immobilization included soft cast, splint, bandage, and slab. Results showed that nonrigid immobilizations had better clinical efficacy than rigid cast regarding functional recovery, treatment cost, and complication rate (relative risk, 3.02; 95% confidence interval, 1.70-5.37; P = 0.0002). Compared with rigid cast, more patients would like to choose the nonrigid methods of immobilization for future use. However, discrepant results sill surrounds the pain levels of the patients. CONCLUSIONS: The current study suggests that the nonrigid immobilization methods have more advantages than rigid cast for immobilization of pediatric forearm torus fracture. The former strategies are also safe enough for clinical therapy.

The use of circular external fixators in the management of lower limb trauma in Dublin: a single surgeon's 20-year experience.

INTRODUCTION: It has been estimated that approximately 520,000 injury presentations are made to Irish accident and emergency departments each year. Fractures account for 20 % of these injuries. Circular external fixators (frames) have been shown to be a safe and effective method of treatment for long bone fractures where internal fixation is impossible or in-advisable. We present the outcomes of all frames applied at our institution for stabilisation of acute fractures over a 20-year period. METHODS AND METHODS: We retrospectively reviewed a prospectively compiled database of all frames applied in our institution and identified all frames which were applied for acute lower limb trauma. RESULTS: We identified 68 fractures in 63 patients. There were 11 femoral fractures and 57 tibial fractures. All fractures were classified using the AO Classification system, and most fractures were Type C fractures. We used an Ilizarov frame for 53 fractures and a Taylor Spatial Frame for 15 fractures. The mean time in frame was 365 days for a femoral fracture and 230 days for a tibial fracture. There were five tibial non-unions giving an overall union rate of 93 %. Factors associated with non-union included high-energy trauma and cigarette smoking. CONCLUSION: The vast majority of lower limb fractures can be treated using 'conventional' methods. Complex fractures which are not amenable to open reduction and internal fixation or cast immobilisation can be treated in a frame with excellent results. The paucity of published reports regarding the use of frames for complex trauma reflects the under-utilisation of the technique.

Treatment and Management Outcomes of Tibial Eminence Fractures in Pediatric Patients: A Systematic Review.

BACKGROUND: Tibial eminence fractures are rare but occur more frequently in children and adolescents. There are a variety of methods to surgically treat these fractures, but surgeons disagree about the optimal method of reduction and fixation. HYPOTHESES: Regarding clinical results and complications after treatment in children and adolescent patients with tibial eminence fractures, the authors hypothesize that (1) there is no difference between reduction and fixation with screws versus sutures, (2) there is no difference in arthroscopic versus open reduction and fixation, and (3) outcomes are better in patients with minimally displaced (types I and II) versus completely displaced (types III and IV) fractures. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature was performed studying the treatment of tibial eminence fractures in children and adolescents to determine clinical results, functional outcomes, and complications. A meta-analytic technique on observational studies was used to compare outcomes when sufficient data were available. RESULTS: The review identified 26 articles with extractable clinical results and data on complications: 1 level 3 article and 25 level 4 articles. Ten of 580 tibial eminence fractures identified in the literature had nonunion, with 60% of nonunions occurring in type III fractures treated by nonoperative modalities. Appreciable healing was noted for both open and arthroscopic fixation techniques as well as patients treated by screw or suture fixation. Laxity (P < .001) and loss of range of motion (P = .009) occurred significantly less after the treatment of minimally displaced fractures (types I and II). CONCLUSION: The level of evidence supporting various treatments of tibial eminence fractures in children and adolescents is low. There is insufficient evidence to conclude the superiority of open versus arthroscopic fixation or screw versus suture fixation techniques. Nonoperative treatment of completely displaced tibial eminence fractures results in higher rates of nonunion. Type III and IV fractures heal with greater laxity and greater loss of range of motion after treatment. Higher level studies are necessary to determine the optimal method of fixation for tibial eminence fractures.

Twelve-month results of a clinical pilot study utilizing pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis.

OBJECT: Lumbar spinal stenosis (LSS) is a common condition that leads to significant disability, particularly in the elderly. Current therapeutic modalities for LSS have certain drawbacks when applied to this patient population. The object of this study was to define the 12-month postoperative outcomes and complications of pedicle-lengthening osteotomies for symptomatic LSS. METHODS: A prospective, single-treatment clinical pilot study was conducted. A cohort of 19 patients (mean age 60.9 years) with symptomatic LSS was treated by pedicle-lengthening osteotomy procedures at 1 or 2 levels. All patients had symptoms of neurogenic claudication or radiculopathy secondary to LSS and had not improved after a minimum 6-month course of nonoperative treatment. Eleven patients had a Meyerding Grade I degenerative spondylolisthesis in addition to LSS. Clinical outcomes were measured using the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), 12-Item Short-Form Health Survey (SF-12), and a visual analog scale (VAS). Procedural variables, neurological outcomes, adverse events, and radiological imaging (plain radiographs and CT scans) were collected at the 1.5-, 3-, 6-, 9-, and 12-month time points. RESULTS: The pedicle-lengthening osteotomies were performed through percutaneous approaches with minimal blood loss in all cases. There were no operative complications. Four adverse events occurred during the follow-up period. Clinically, significant improvement was observed in the mean values of each of the outcome scales (comparing preoperative and 12-month values): ODI scores improved from 52.3 to 28.1 (p < 0.0001); the ZCQ physical function domain improved from 2.7 to 1.8 (p = 0.0021); the SF-12 physical component scale improved from 27.0 to 37.9 (p = 0.0024); and the VAS score for leg pain while standing improved from 7.2 to 2.7 (p < 0.0001). Imaging studies, reviewed by an independent radiologist, showed no evidence of device subsidence, migration, breakage, or heterotopic ossification. Thin-slice CT documented healing of the osteotomy site in all patients at the 6-month time point and an increase in the mean cross-sectional area of the spinal canal of 115%. CONCLUSIONS: Treatment of patients with symptomatic LSS with a pedicle-lengthening osteotomy procedure provided substantial enlargement of the area of the spinal canal and favorable clinical results for both disease-specific and non-disease-specific outcome measures at the 12-month time point. Future studies are needed to compare this technique to alternative therapies for lumbar stenosis.

Performance of modified anatomic plates is comparable to proximal femoral nail, dynamic hip screw and anatomic plates: finite element and biomechanical testing.

AIM: To establish whether the modified anatomic plate (MAP) performs as well as the anatomic plate (AP), dynamic hip screw (DHS) and proximal femoral nail (PFN) from a biomechanical perspective. MATERIALS AND METHODS: The, AP, MAP, DHS and PFN were assessed using finite element (FE) methods and biomechanical tests. A solid model was created based on the fracture lines and results were assessed using analyses of variance. MAIN OUTCOME MEASUREMENTS: Independent variables were the implants (n=4) and axial loads: 0-1000 Newton (N) in 100 N increments. Dependent variables were loads at the intertrochanteric fracture line as measured by load cells. RESULTS: Axial loads ≤400 N generated significantly (p<0.05) greater stress at the fracture line in both the FE model and biomechanical settings: the PFN generated the highest forces at the fracture line followed by the AP, MAP and DHS. For axial loads ≥400 N, the AP and DHS generated nonsignificant (p>0.5) lower forces (almost 50% less) compared with the MAP and PFN. At 1000 N, the DHS generated the highest (p<0.05) load at the fracture line. CONCLUSION: The biomechanical features of the MAP were similar to those of the PFN. The MAP generated optimal loads at both the fracture site and the proximal femur. FE methods and biomechanical tests revealed that the MAP is associated with both intra- and extra-medullary fixation features, even though the load was applied as an extramedullary stimulus.

Usefulness of taping in lower limb osteoarthritis. French clinical practice guidelines.

OBJECTIVES: To develop clinical practice guidelines about the use of taping in the management of lower limb osteoarthritis. METHOD: We used the methodology advocated by the SOFMER (French Society for Physical and Rehabilitation Medicine), which combines a literature review, collection of data on current practice patterns, and validation of the recommendations by a multidisciplinary panel of experts. Our evaluation focused on the effectiveness of taping in relieving symptoms of lower limb osteoarthritis. RESULTS: Ankle taping for osteoarthritis is not recommended, given the absence of published data and very low level of use in France. Few studies are available on knee taping for osteoarthritis. CONCLUSIONS: Published studies exhibit a number of methodological weaknesses. There is no strong evidence that taping is effective in knee osteoarthritis, and this treatment modality is rarely used in France. Therefore, there is no strong basis at present for recommending taping as part of the management of knee osteoarthritis. Well-designed studies of patellar taping to modify the relationships between the patellar and the trochlea are desirable to determine whether this treatment modality benefits patients with knee osteoarthritis, most notably those with involvement of the femoropatellar compartment.

[Current approaches to the treatment of developmental dysplasia of the hip]. / Gelisimsel kalça displazisi tedavisinde güncel yaklasimlar.

Treatment modalities for developmental dysplasia of the hip are variable. Many authors advocate conservative treatment for infants. However, controversy arises as to the type and timing of osteotomies for older age groups. Besides classic treatment methods, different experimental and clinical studies have been performed. This article aims to summarize new treatment methods in the light of our classical knowledge.

Estudo a Longo Prazo Pós Fixação in situ Na Epifisiodese Proximal do Fêmur Para o Tratamento da Epifisiólise com Escorregamento Moderado e Grave / Long Term Follow Up Of proximal Femur Epiphysiodesis With Fixation in situ As Treatment For Moderate And Severe Femoral Head Slipping

Foram avaliados retrospectivamente 24 quadris, de 24 pacientes submetidos à epifisiodese proximal do fêmur com parafuso canelado único, no període de 1997 a 2003, que apresentavam Escorregamento Epifisário Proximal do Fêmur (EEPF)

[Follow-up study after dynamic and static stabilisation of the lumbar spine]. / Follow-up-Studie nach dynamischer und statischer Stabilisierung der lumbalen Wirbelsäule.

INTRODUCTION: The clinical indication for graf's ligamentoplasty and dorsoventral fusion may be described as the "lumbar instability syndrome". A follow-up comparison between Graf's ligamentoplasty and instrumental dorsoventral fusion in a consecutive series of 52 patients was performed. METHODS: 52 patients operated on for low back pain were recalled for a clinical and radiological review (at mean 79 months postoperatively). 26 patients underwent Graf' ligamentoplasty and 26 patients underwent dorsoventral fusion. We evaluated the surgical results and measured an objective outcome using the Oswestry Score, Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS). For radiological evaluation the Mimura and the Pathria Scores were used. RESULTS: There was no statistically significant difference between the two groups, when measured by the Oswestry Score, LBOS and VAS at the latest follow-up. The difference between the preoperative and actual VAS in each group was statistically significant (p < 0.001). Furthermore, there was no provable preoperative parameter in favour of either one of these therapies. CONCLUSION: Both methods for stabilisation methods of the lumbar spine had a comparable clinical outcome.

Uso de tornillos transpediculares en el tratamiento de la inestabilidad espinal / Treatment with transpedicular screws for spinal instability

Los tornillos transpediculares han sido usados clínicamente de una manera amplia en los últimos 20 años y han llegado a ser el método estándar para la fijación posterolateral y fusión de la columna dorsal, lumbar y sacra. En nuestro medio el uso de ese tipo de instrumentación es muy limitado debido a la poca disponibilidad de estos sistemas en el mercado local y al costo de los mismos. En manos de cirujanos espinales entrenados y experimentados este sistema tiene una elevada tasa de seguridad, efectividad y menor número de complicaciones que cualquiera de los otros sistemas de instrumentación disponibles en nuestro medio. Presentamos los resultados preliminares del primer estudio prospectivo en nuestro país sobre este tipo de instrumentación en 33 pacientes sometidos a fijación espinal con tornillos transpediculares, haciendo también una revisión bibliográfica del tema, exponemos nuestras experiencias y los resultados obtenidos.CONCLUSION: El sistema transpedicular puede ser usado de forma confiable tanto en trauma como en patología degenerativa de la columna dorsal y lumbosacra. La fijación nos permite conseguir una remisión de dolor espinal en el 100% de los casos, una buena tasa de fusión ósea, mínimas complicaciones y reicorporación temprana de los pacientes a sus actividades...(AU)

Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle.

STUDY DESIGN: We evaluated the trajectory of transpedicular screws in the cervical spine using axial computed tomography (CT). OBJECTIVES: To provide a safe transpedicular screw trajectory by measuring the dimensions of the cervical pedicle and evaluating the entrance points and the insertion angles of transpedicular screws. SUMMARY OF BACKGROUND DATA: The morphology of the cervical pedicle has been studied, but few in vivo CT-based studies of pedicle dimensions and transpedicular screw placement in the cervical spine have been reported. METHODS: The dimensions of the pedicles (C3-C7) were determined in 30 patients with cervical spinal lesions from CT images. The space available for transpedicular screws (SAS) was defined as the distance between two parallel lines tangential to the spinal canal and the transverse foramen, respectively. SAS was evaluated at 25 degrees and 50 degrees insertion angles. RESULTS: SAS at a 25 degrees insertion angle (SAS-25) ranged from 4.7 to 5.4 mm. SAS at 50 degrees (SAS-50) ranged from 6.1 to 6.6 mm. SAS-25 and SAS-50 were significantly different. Four-millimeter-diameter screws would fit in all 120 C3-C6 vertebrae studied at 50 degrees, but 20 (17%) would not fit at 25 degrees. CONCLUSIONS: Axial CT measurements should facilitate transpedicular screw fixation in the cervical spine. We believe that the screw insertion angle should be close to 50 degrees, which is the mean pedicle transverse angle from C3-C6. The entry point of the pedicle screw should be located as laterally as possible in the posterior surface of the lateral mass.