Union after multiple anterior cervical fusion. 21 cases followed for 1-6 years.

With a mean follow-up of 3 (1-6) years, we report on 21 patients who underwent multiple level cervical fusion, using autologous iliac crest grafts. Dissectomies were performed in 14 patients and corpectomies in another 7. Instrumentation was used in all patients with corpectomies and in 2 patients who underwent 2-level and 3-level dissectomies. Non-union occurred in 1 patient at 1 level. Graft displacement requiring reoperation was observed in 2 patients with massive corpectomies, in 1 of them as a consequence of trauma. In both patients complete bony fusion was obtained after reoperation and no other complications were observed. We conclude that the success rate with multiple-level fusion is comparable to that of single-level fusion when adequate fixation is achieved.

Lumbosacral arthrodesis with louis technique. Review of 186 cases.

A retrospective study was carried out of 186 patients surgically treated by lumbosacral arthrodesis using Louis plates from 1981 to 1989 with an average follow-up of 7.2 years (range 3-11). The average age of the patients was 42.2 years (range 11-71). The indication for surgery was a herniated disc and segmentary instability in 29% (54 patients), spondylolysis or spondylolisthesis in 26.3% (49 patients), arthrosis in 11.3% (21 patients), instability (narrowing of the disc space and zygapophyseal hypertrophy) and stenosis in 5.9% (11 patients), tumour in 5.4% (10 patients), fractures in 0.5% (1 patient) and combinations of the above in 21.5% (40 patients who mainly had a herniated disc and associated spinal stenosis). Iliac crest autograft was used in 33 cases (17.7%), bank allograft in 5 (2.6%), and in the other 148 patients the graft was obtained from the arthrodesis bed. After follow-up we observed loosening of the screws in 20 patients and screw rupture in 10. We only documented 2 cases of pseudarthrosis using dynamic X-radiography. We conclude that the Louis plate is a simple method that leads to lumbosacral arthrodesis with a low rate of pseudoarthrosis.

Eosinophilic granuloma of the spine with and without vertebra plana: long-term follow-up of six cases.

Vertebral eosinophilic granuloma is a rare condition frequently associated with vertebra plana. In this paper we present six patients with eosinophilic granuloma of the spine; three were without vertebra plana, which represents a diagnostic problem. The mean follow-up was 9 years, (range 2 to 23) and the mean age was 10.8 years at diagnosis. All complained of pain with no neurological deficit. The lesions were located on the vertebral bodies of C4, T9, T10, L1, L2, and L5, respectively. Histologic confirmation of diagnosis was obtained in all patients, two by puncture and four by open biopsy. The patients with vertebra plana (T10, L1, and L5, respectively) were treated conservatively. Long-term follow-up demonstrated total healing of the vertebral body in two and partial rebuilding 8 years after diagnosis in one. Patients without vertebra plana (C4, T9, and L2, respectively) underwent curettage and bone grafting. In the patient with T9 location, a T8-10 anterior arthrodesis with autogenous rib graft was performed. The outcome was satisfactory in all.

[Histiocytosis X]. / Histiocitosis X.

We make a clinical and bibliographical review in diagnosis and treatment of Histiocytosis X, who includes three components: Eosinophylic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe syndrome. We had 28 cases, with an average age of 11.8 years. Eighteen (64%) were males and 10 (36%) females. Seventeen were solitary lesions and 8 had multiple skeletal lesions. Three patients had generalized disease: 2 with Hand-Schüller-Christian disease and 1 with Letterer-Siwe syndrome. The femur lesion was frequently observed among the solitary lesions and the cranium involvement in the multiple skeletal lesions. The total number of lesions was 47. The treatment depended on the location, the clinical manifestations and the number of lesions. The patients with solitary lesions (17) were treated with curettage and bone grafting in 6 cases, segmental resection in 3 cases, only curettage in 3, radiotherapy in one and 4 patients didn't receive treatment. The patients with multiple lesions (8), were treated surgically (4 cases), only radiation therapy (2 patients), with surgery and radiotherapy (1) and one patient had no treatment. The generalized disease was treated with surgery of the main lesion depending in the clinical manifestations and chemotherapy and radiotherapy. The prognosis was good in almost all the patients and we observed regression of the disease even without specific treatment. The case of acute generalized disease died due to systemic complications.

Surgical treatment of the radial nerve lesions associated with fractures of the humerus.

Twelve patients who were surgically treated for radical nerve injuries associated with fractures of the humerus are reviewed. The average follow-up was 6 years (range 1-10). The mean time to full recovery was 19 months (range 12-40). Three fractures were open, and nine were closed. Seven of the fractures were located in the distal third of the humerus; two were in the middle third; two were segmental, involving both the middle and the distal thirds of the shaft; and one was supracondylar. All patients received initial treatment of the fracture in other medical units. The mean interval between the lesion and surgical treatment of the nerve injury was 6 months (range 25 days to 15 months). Perineural fibrosis at the lesion site was observed in four patients. Three nerves were found entrapped in the callus. In two cases the nerve was found to be partially divided, and in three cases a total section was observed. The techniques employed were microsurgical reconstruction with interfascicular grafting using sural nerve in six patients, neurolysis in five cases, and tendon transfers in one case. Excellent and good results were obtained in 91% of cases. In the case with a poor result, tendon transfers were made, with an acceptable functional result.

Radial shortening for the treatment of Kienböck's disease.

Twelve patients with Kienböck's disease were treated by radial shortening. Eight patients were in stage II and four in stage III. After an average of 5 years, relief of pain was satisfactory in 10 patients; 8 were in stage II before operation and 2 in stage III. Two patients were dissatisfied because they had persistent pain; both were in stage III before surgery. The range of motion improved moderately. Nonunion at the site of radial osteotomy did not occur. Radiographs at follow up showed consolidation and healing of the lunate in 2 patients, nonprogression of the disease in 9 and increase of the carpal collapse in 1. The procedure helps to prevent further collapse of the lunate especially in stage II and in some patients in stage III.

Monostotic fibrous dysplasia of a cervical vertebra.

Fibrous dysplasia has been frequently reported to involve the spine in the polyostotic form, but only rarely in the monostotic form of the disease. The present case demonstrates monostotic fibrous dysplasia of the fourth cervical vertebra. We present the plain radiographic, CT-scan, scintigraphy and histologic examinations. C3-C4 posterior and anterior arthrodesis was performed. The post-operative follow-up was satisfactory.