Spinal fusion in degenerative disc disease.

Low back pain caused by degenerative disc disease is of such intensity in a low percentage of cases that surgery is indicated. Surgery must not only stabilize, but it must above all correct the deformity, recovering the disc space. Among all of the methods available circumferential fusion with a double combined approach, that is, anterior and posterior, is held to be the most effective.

Stenosis of the nerve root canal caused by disc resorption.

Stenosis of the nerve root canal caused by isolated resorption of a lumbar disc is a frequently observed pathology, but one about which the orthopaedist still knows relatively little. Henry Crock was the first to reveal its principal pathogenetic factor, disc resorption, and to accurately describe the syndrome and its surgical treatment. A total of 22 patients operated according to Henry Crock's indications and followed-up after 2 years were reviewed. In 20 cases decompression alone was performed, while in 2 cases anterior fusion and MOSS instrumentation were associated. Of the 22 patients submitted to decompression 17 revealed complete regression of pain. Three cases failed: 1 patient had previously been treated with chymopapain, while 3 are awaiting anterior fusion to treat persistent lumbar pain. Follow-up is not sufficient for the two patients submitted to anterior fusion.

In vitro observations of iron-doped bioactive glasses.

Several in vitro tests are necessary to evaluate the biological compatibility of materials used to manufacture implants for humans or animals. These tests will indicate whether these materials can be tolerated when implanted in vivo. Since ceramic materials are suitable for coating layers, it was decided to study their performance by adding certain oxides as doping agents. This paper describes their influence in vivo in some preliminary tests and in vitro for iron trioxide only. This work attempts to ascertain the range of doping to maintain the bioactivity characteristics and in particular the influence of iron trioxide as a doping agent in the bioactive glass. To do so the adhesion of baby hamster kidney cells to bioactive glasses doped with different concentrations (2 and 4 wt%) of this compound was quantified. The base glass without iron oxide was used as a control as 0 wt% doping. In a second phase, a coating of fibronectin, a glycoprotein that plays an important role in cell binding and spreading on substrates, was quantified on the same surfaces. It was shown that the cell avidity for the surfaces of the materials increases with increased doping of iron oxide. The values are significantly higher than those observed for the base glass. Fibronectin adsorption quantification showed a similar trend, with values of adsorption similar for the doped samples and higher than that of the non-doped glass. It was demonstrated that iron trioxide induces an increase in cell adhesion capability with bioactive glass surfaces and the capability of adhesion of the fibronectin to act as a substrate on the same surfaces.

[Double-contrast arthrography in recurrent luxations of the shoulder]. / L'artrografia a doppio contrasto nella lussazione recidivante della spalla.

One hundred and ninety-three shoulder arthrographies were performed between 1979 and 1985 on patients affected by recurrent dislocations. The diagnostic doubt was cleared up in 162 cases (83%). Arthrographic diagnosis was confirmed by pathological findings in 92% of the patients who underwent surgery. The double-contrast technique under local anaesthesia with anterior access is suggested, since it allows several arthrograms in different projections. Thus, an analytic study of the articular damage can be carried out. The patterns of each projection are briefly shown. Revision of case histories points out that: a) the use of arthrography should always be assessed on a clinical-radiological basis for each patient; b) there is no doubt as to the usefulness of this examination as a direct means of exploration, as far as the articular damage is concerned, not only as an aid to future surgery, but also in the follow-up of the results of the treatment in the long run.

A comparative study of trochanteric and basicervical fractures of the femur treated with the Ender and McLaughlin techniques.

Endomedullary nailing as proposed by Ender is an important alternative in the treatment of trochanteric and basicervical fractures of the femur (Amici et al., 1980; Carret et al., 1980; Ender, 1970; Kempf et al., 1979; Zinghi et al., 1979). Rush's concept (Eiffel Tower, for the distal epiphysis) is reproposed with some variations and transposed to the femoral neck. The aim of the operation differs from that of the nail and plate technique in that, instead of trying to achieve anatomical reconstruction, an immediate functional by-pass of the fractured part is attempted. After using this technique for three years, we compared the old method, which we had not abandoned, the McLaughlin nail and plate, with the new Ender nail.