A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results.

Patients suffering from neurogenic intermittent claudication secondary to lumbar spinal stenosis have historically been limited to a choice between a decompressive laminectomy with or without fusion or a regimen of non-operative therapies. The X STOP Interspinous Process Distraction System (St. Francis Medical Technologies, Concord, Calif.), a new interspinous implant for patients whose symptoms are exacerbated in extension and relieved in flexion, has been available in Europe since June 2002. This study reports the results from a prospective, randomized trial of the X STOP conducted at nine centers in the U.S. Two hundred patients were enrolled in the study and 191 were treated; 100 received the X STOP and 91 received non-operative therapy (NON OP) as a control. The Zurich Claudication Questionnaire (ZCQ) was the primary outcomes measurement. Validated for lumbar spinal stenosis patients, the ZCQ measures physical function, symptom severity, and patient satisfaction. Patients completed the ZCQ upon enrollment and at follow-up periods of 6 weeks, 6 months, and 1 year. Using the ZCQ criteria, at 6 weeks the success rate was 52% for X STOP patients and 10% for NON OP patients. At 6 months, the success rates were 52 and 9%, respectively, and at 1 year, 59 and 12%. The results of this prospective study indicate that the X STOP offers a significant improvement over non-operative therapies at 1 year with a success rate comparable to published reports for decompressive laminectomy, but with considerably lower morbidity.

Treatment of slipped capital femoral epiphysis resulting from juvenile renal osteodystrophy.

Severe bilateral slipped capital femoral epiphysis (SCFE) secondary to renal osteodystrophy is infrequent at any age. Management was a significant dilemma in the 3-year-old child we report because of the degree of slippage and our concern over the sequelae of premature capital physeal closure. Fixation without physeal closure was obtained by inserting a specially fabricated screw without threads across the physis after the slippage had been reduced with traction.

Intraspinal pathways taken by sublaminar wires during removal. An experimental study.

The neurological complications of segmental sublaminar stabilization that have been reported by other authors led us to perform a cineradiographic study of the pathways in the spinal canal that were taken by wires as they were being removed. The single wires were removed by pulling on the wire while keeping the wire perpendicular to the lamina; by winding the wire on the wire-extractor, with the wire being kept as nearly parallel with the lamina as possible (the roll-up technique); or by pulling on the wire while keeping the wire parallel with the lamina. During removal, thirty-four single wires conformed to the lamina and forty-one single wires compressed the dura. The roll-up technique caused the most erratic pathways. Double wires, although they were removed together, assumed independent pathways unless a wire-extractor guide was used. These findings suggest that the removal of sublaminar wires may cause dural compression in the clinical situation.

Legal control and alcohol in the United States and India.

Arrest data provide an index of public concern regarding alcohol-related activities of certain groups within a society. Any differences in these data may reflect the differences in the extent to which their conduct is viewed and reacted to as problematic behavior requiring legal control. In this paper we compare the official statistics regarding alcohol arrest data of adults and juveniles in the United States, India in general, and a "dry" Indian state, Tamil Nadu. The United States, India, and Tamil Nadu are similar in that the proportion of juveniles arrested for alcohol-related convictions compared to juveniles arrested for all offenses is about the same (i.e., 8%). But proportionately more of the young people, compared with adults, in the United States are subjected to arrest for liquor law violations, although a greater proportion of adults, compared to juveniles, are arrested for public drunkenness. In India generally, and Tamil Nadu in particular, juvenile vis-à-vis adult arrests for liquor law offenses are equal to their proportions in the population. That is, in contrast to India, alcohol law enforcement in the United States is specifically directed at regulating the drinking behavior of young people.