Measuring quality of life in back patients: comparison of Health Status Questionnaire 2.0 and Quality of Life Inventory.

This paper is a reliability and validity test of the Health Status Questionnaire (HSQ) 2.0. In addition, the Quality of Life Inventory (QOLI) is compared with the HSQ 2.0 to assess concurrent validity. The study is unique because these instruments are assessed for the first time using a sample of chronic back patients. Practitioners will therefore now be able to evaluate important quality of life issues and treatment changes in this population. The HSQ 2.0 was generally found to be valid for these patients. However, two scale domains were not differentiated due to unique characteristics of spinal disease patients. The QOLI, due to the limitation of measuring only psychological well-being, did not measure problems specific to back patients.

Anterior lumbar fusion options. Technique and graft materials.

The biomechanical requirements of the ideal lumbar interbody fusion are important in the surgical treatment of the vertebral endplates and graft selection. A series of 45 patients with anterior lumbar fusion were reviewed retrospectively. The fusion was performed with a composite construct consisting of femoral allograft cross-sections and allograft cancellous bone. Preparation of vertebral endplates consisted of scraping the endplate until punctate bleeding appeared. The major part of the endplate was preserved to withstand interspace distraction and stability. A 97% fusion rate was achieved based on flexion and extension analysis with a six- to 12-month follow-up period. A final average interspace distraction of 2.39 mm was reported. The graft should consist of a rigid structure that exceeds physiologic loads anticipated in the postoperative period, and the composition to promote arthrodesis. Anterior lumbar fusion with femoral allograft is an excellent procedure, but long-term further follow-up studies and statistical data are essential.

Progressive myelopathy secondary to odontoid fractures: clinical, radiological, and surgical features.

Late-onset progressive myelopathy, years after odontoid fracture, is considered a rarity. Sixteen patients with diagnosis of their odontoid fractures delayed from four months to 45 years have been studied and treated. Three had forgotten about the injury and, in the rest, the significance had been minimized by their clinicians. Fifteen patients had characteristic C-2 nerve root pain and 10 had noted weak hands and walking difficulties. Fifteen patients had Type II fractures, which were mobile in 11; hypertrophic pseudoarthrosis was marked in two. In seven patients it was confirmed at surgery that all or part of the transverse ligament was interposed in the fracture. Transoral surgery, combined with a variety of posterior fusion techniques, has allowed cord decompression, an understanding of the pathomechanics, and sound posterior bone fusion with arrest of the myelopathic condition. Measurements of craniovertebral angles and cord cross-sectional area in this series revealed a rough correlation, but the most striking relationship was between length of delay in diagnosis and diminished cord area in both non-union and malunion, suggesting a progressive injury mechanism. It is proposed that late myelopathy following odontoid fracture may be more common than hitherto believed and should be considered in the evaluation of patients with cervical spondylosis. The condition may be progressive. Finally, non-union may be due to interposition of the transverse ligament.

An anatomic study of subtalar instability.

Subtalar instability has been recognized as a cause of ankle symptoms. The purpose of this anatomic study is to determine the ligament damage required to produce subtalar instability, and to define a radiographic technique to demonstrate it. Ten fresh adult cadaver ankles were dissected. Selective sectioning of the calcaneofibular ligament, capsule, and interosseous ligaments of the subtalar joint were done. Radiographic documentation of subtalar opening was recorded, using a lateral and Brodan's view. Sectioning of the calcaneofibular ligament alone produced a 5-mm opening of the subtalar joint. When combined with sectioning of the interosseous ligament, a 7-mm opening was produced. This was reproduced with a plantar flexion-supination load to the foot. Instability of the ankle joint (talar tilting) was produced only when loading caused additional tearing of the anterior talofibular ligament. This study suggests that surgical repairs to correct lateral ankle instability should include repair or substitution of the calcaneofibular ligament if subtalar instability is a consideration.