Indirect decompression for a prior severe C1-2 dislocation causing progressive quadriparesis.

Combined anterior and posterior surgery is frequently chosen for the treatment of prior, severe C1-2 dislocations that occurred during early childhood because of the difficulty in achieving reduction and satisfactory decompression. The authors treated a prior, severe C1-2 dislocation that was causing progressive quadriparesis. The patient was a 14-year-old boy who had suffered a C1-2 fracture-dislocation at 3 years of age and had been treated with a Minerva body jacket cast. The treatment involved posterior C1-2 segmental screw fixation, without direct bone decompression or additional surgery. Satisfactory neural decompression was achieved with the techniques used, and complete bone union was confirmed. The patient showed satisfactory neurological recovery at the 5-year follow-up assessment.

Gender difference of symptom severity in lumbar spinal stenosis: role of pain sensitivity.

BACKGROUND: Given that there are gender differences in pain perception, it is likely that there are differences in pain responses between men and women with lumbar spinal stenosis (LSS). Furthermore, these differences may lead to different degrees of impairment in both daily activities and quality of life between men and women. OBJECTIVE: To elucidate the difference of LSS symptom severity between genders in relation to pain sensitivity. STUDY DESIGN: Retrospective analysis of prospectively collected data. METHODS: A total of 160 patients who had symptomatic degenerative lumbar spinal stenosis completed a series of questionnaires on their first visit in the outpatient clinic, including a pain sensitivity questionnaire (PSQ) (total PSQ and PSQ-minor), Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain, and Short Form-36 (SF-36). Using magnetic resonance images, the degree of canal stenosis and disc degeneration were graded based on the method by Schizas and the Pfirrmann classification, respectively. Symptom severity, pain sensitivity, and radiologic findings were compared between men and women. In each gender group analysis, the correlation between pain sensitivity and symptom severity was analyzed. RESULTS: After adjustment for age and the grade of disc degeneration, the pain sensitivity represented by total PSQ and PSQ-minor was significantly higher in women than in men. Moreover, there was a higher VAS for back pain/leg pain and ODI in women compared to men after adjustment for body mass index (BMI), age, and the grades of canal stenosis and disc degeneration. After additional adjustment for pain sensitivity including total PSQ and PSQ-minor, there was no difference in VAS for back pain/leg pain between genders. On the SF-36 women demonstrated a lower quality of life than men in terms of Physical Function, Role Physical, Bodily Pain, General Health, and Physical Component Summary. Each gender group analysis showed that pain sensitivity was associated with symptom severity and disability caused by LSS in both women and men. LIMITATIONS: The present study did not evaluate psychological factors including catastrophizing and/or undiagnosed personal traits which possibly can influence the severity of symptoms from LSS. CONCLUSIONS: Women showed increased low back pain and leg pain due to degenerative LSS compared to men. The current study demonstrates that this difference in symptom severity may be partly mediated by pain sensitivity.

Association of benign joint hypermobility with spinal segmental motion and its clinical implication in active young males.

STUDY DESIGN: A retrospective case-control analysis of prospectively collected data. OBJECTIVE: First, to evaluate spinal intervertebral mobility in patients with joint hypermobility (JHM) and matched controls without JHM, and second, to investigate the influence of JHM on back pain, disability, and general health status in young males. SUMMARY OF BACKGROUND DATA: Despite the significance of benign JHM in the musculoskeletal feature, there have been no studies regarding low back pain and segmental motion in subjects with JHM. Furthermore, the clinical significance of the excessive segmental motion in young males with JHM remains unknown. METHODS: The JHM group included 32 subjects who had Beighton scale score of 4 or more according to 9° Beighton scale. The age-matched 32 young males without JHM were selectively included in the control group. In both groups, Oswestry Disability Index (ODI), visual analogue pain scale (VAS) for back pain, and Short-Form 36 was assessed. Radiological sagittal plane motions for each segment and whole lumbar spine were calculated as the difference between the Cobb angle measurements in the flexion and extension plain radiographs. In the lateral radiograph with neutral standing position, the intervertebral disc heights were also measured at each segment. RESULTS: The JHM group showed significantly larger range of motion and higher intervertebral disc height at each matched segment than the control group. The JHM group had significant increased VAS for back pain and ODI score, compared with control group. The Short-Form 36 physical function, role physical, role emotional, and physical component summary in the JHM group were significantly lower than in the control group. CONCLUSION: This study shows that young males with JHM were found to have excessive lumbar segmental motion that was associated with increased low back pain, disability, and limited physical activity.

The influence of pain sensitivity on the symptom severity in patients with lumbar spinal stenosis.

BACKGROUND: The symptom severity of back pain/leg pain is not correlated with the severity of degenerative changes and canal stenosis in lumbar stenosis. Considering the individual pain sensitivity might play an important role in pain perception, this discordance between the radiologic findings and clinical symptoms in degenerative lumbar stenosis might originate from the individual difference of pain sensitivity for back pain and/or leg pain. OBJECTIVE: To determine the relationship among the clinical symptoms, radiologic findings, and the individual pain sensitivity in the patients with degenerative lumbar spinal stenosis. STUDY DESIGN: Retrospective analysis of prospectively collected data. SETTING: A spine center in the department of orthopedic surgery. METHODS: In 94 patients who had chronic back pain and/or leg pain caused by degenerative lumbar spinal stenosis, a medical history, a physical examination, and completion of a series of questionnaires, including pain sensitivity questionnaire (PSQ) [total PSQ and PSQ-minor], Oswestry Disability Index (ODI), Visual Analog Pain Scale (VAS) for back pain, and Short Form-36 (SF-36) were recorded on the first visit. Radiologic analysis was performed using the MRI findings. The grading of canal stenosis was based on the method by Schizas, and the degree of disc degeneration was graded from T2-weighted images with the Pfirrmann classification. The correlations among variables were statistically analyzed. RESULTS: Total PSQ and PSQ-minor were not dependent on the grade of canal stenosis after gender adjustment. VAS for leg pain and back pain was highly associated with the total PSQ and the PSQ-minor. Total PSQ and PSQ-minor were also significantly associated with ODI. Among SF-36 scales, the PSQ minor had significant correlations with SF-36 such as bodily pain (BP), Role-emotional (RE), and Mental Component Summary (MCS) after control of confounding variables such as body mass index (BMI), age, and the grade of canal stenosis/disc degeneration. Total PSQ was significantly associated with the SF-36 RP, BP, and RE. Furthermore, after adjustment for gender and pain sensitivity, there was no significant association between the grade of canal stenosis and VAS for back pain/leg pain and ODI, and no correlation was found between the grade of disc degeneration and VAS for back pain/leg pain and ODI, either. LIMITATIONS: The multiple lesions of canal stenosis and/or disc degeneration and the grade of facet degeneration were not considered as a variable. CONCLUSION: The current study suggests that the pain sensitivity could be a determining factor for symptom severity in the degenerative spinal disease.

Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft.

Our aim was to evaluate the alteration in angle of posterior slope of the tibia and the degree of patellar height following medial opening wedge high tibia osteotomy(HTO) using autologous tricortical iliac bone graft in 32 consecutive patients. Twenty three females and nine males underwent medial opening wedge high tibia osteotomy (HTO) using autologous tricortical iliac bone graft in 34 knees (33 primary medial compartment osteoarthritis and 1 idiopathic osteonecrosis of medial tibial condyle). The posterior slope of tibia was determined by the proximal tibial anatomical axis. Patellar height was measured by the Insall-Salvati and the Blackburne-Peel ratios. Preoperative and postoperative (last follow up) values of these three parameters were compared. The intra- and interobserver variability of these methods was determined before and after operation. At the end of mean follow up of 3 years this procedure produced no significant change in posterior slope. Pre and postoperative posterior slope were 8.7 degrees+/-3.6 degrees and 8.2 degrees+/-2.8 degrees respectively (P=0.412). Pre and postoperative Insall-Salvati ratios were 0.93+/-0.10 and 1.05+/-0.11 respectively (P<0.001). The Insall-Salvati ratio increased in 94% of patients and patellar ligament length was significantly increased. The distance between the patellar and tibiofemoral joint line decreased in 82% of patients. The mean Blackburne-Peel ratio declined from 0.71+/-0.12 to 0.61+/-0.13 (P<0.001). Twenty six percent of postoperative Blackburne-Peel values satisfied the radiographic criterion for patellar infera (Blackburne-Peel ratio<0.54). There was no difference in the intra-and interobserver variability of measurements either before or after HTO. Opening wedge HTO using autologous tricortical iliac bone graft with internal fixation and early mobilisation prevented change in posterior slope of tibia, lengthened the patellar ligament and elevated the tibiofemoral joint line when the mean ratio of anterior and posterior gap at the osteotomy site was around two-thirds.