Open discectomy as treatment for herniated nucleus pulposus of the lumbar spine.

Open discectomy is the "gold standard" for operative intervention in patients with herniated lumbar discs whose conservative treatment has failed. Over 60 years the indications for surgery and the expected success rates have been clearly elucidated. The specific patient selection and determination of surgical procedures continues to evolve. Recurrent herniations occur at a low rate, and serious complications are rare.

Displaced transverse fracture of the sacrum with nerve root injury: report of a case with successful operative management.

A displaced transverse fracture of the sacrum occurred in a young woman along with lumbar transverse process fractures, displacement suggesting instability in flexion, and nerve root injury, all features common to this injury. Open decompression, reduction, and Harrington rod fixation were successful for this patient, but the method is not recommended for all sacral fractures.

Odontoid fracture complicating ankylosing hyperostosis of the spine.

Ankylosing hyperostosis of the spine (Forestier's disease) is a distinct clinical entity which must be differentiated from ankylosing spondylitis (Marie-Strumpell's disease) and hypertrophic spondylosis. In the case presented, the distinction was made by clinical, roentgenographic, and postmortem pathologic findings. This case had the unique and previously unreported feature of complication by a fracture of the odontoid. The patient's particular circumstances led to the decision to treat the fracture by posterior arthrodesis, though this is not necessarily recommended for all spinal fractures occuring in this disease.

Femoral shaft fracture with ipsilateral hip dislocation in a child.

A child victim of low speed violence was found to have a fractured femur and dislocation of the ipsilateral hip. This combination of injuries in a child is very rare. The dislocation was not initially recognized because of absence of suggestive history, symptoms, and signs. After recognition, open reduction of the hip dislocation was achieved through a posterior approach. One month later an osteotomy at the femur fracture allowed the leg to fall to neutral while maintaining the femoral head in the most desirable position.

Obscure distal femoral epiphyseal injury.

Undisplaced type I epiphyseal fracture of the distal femur in the adolescent athlete may mimic injury to a ligament. Roentgenographic examination with the knee under stress will reveal the diagnosis, thereby avoiding unnecessary arthrotomy and dictating appropriate treatment and follow-up.

Displaced fracture of the lumbosacral spine with delayed cauda equina deficit: report of a case and review of literature.

A 41-year-old man with a fracture of the upper sacrum and forward and downward displacement of the superior sacral fragment and upper spine on the lower sacrum, developed partial deficit of cauda equina function. Similar fractures rarely have been reported. Signs of lumbar pain, contusion, and fractured transverse processes should lead the surgeon to carefully examine the radiologic fractures of the area of injury; otherwise, this lesion may heal unrecognized. With the spine in flexion, the fracture may create mechanical instability. Early closed or open reduction is theoretically ideal. Surgical treatment must be weighed in terms of the risks and needs of the individual.