Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review.

STUDY DESIGN: Case report and literature review. OBJECTIVE: To illustrate that ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in a Caucasian patient and that timely surgery can lead to a good outcome. SETTING: Nottingham, UK. METHODS: Proximal multiple contiguous ossified thoracic ligamenta flava from T3/T4 to T5/T6 causing acute myelopathy was diagnosed in a Caucasian man based on history and examination followed by magnetic resonance imaging and computed tomography scanning. The literature is reviewed for all reported cases of ossified ligamenta flava causing myelopathy in Caucasians. RESULTS: Following prompt diagnosis and T3 to T5 laminectomies, our patient made near-complete neurological recovery over a 10-month period. This condition usually affects the lower thoracic spine. Although chronic and subacute myelopathy secondary to this circumstance has been reported in Caucasians, acute myelopathy has not been reported and proximal thoracic involvement has been reported twice. CONCLUSION: Ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in Caucasians. Prognosis following decompressive surgery is usually good.

Vertebral osteomyelitis as a complication of Crohn's disease.

Vertebral osteomyelitis arising from an enteric fistula in patients with inflammatory bowel disease is rare. We report on a patient with Crohn's disease who developed an enteric fistula, resulting in a presacral abscess and vertebral osteomyelitis involving the L4 and L5 vertebral bodies and related disc spaces. This was managed by a defunctioning colostomy with drainage of the pre-sacral abscess. The vertebral lesion was successfully managed non-operatively.

Use of a hydroxyapatite-coated hemiarthroplasty in the management of subcapital fractures of the femur.

A prospective clinical trial has been conducted comparing the use of a hydoxyapatite-coated bipolar hemiarthroplasty and an uncemented bipolar prosthesis in the treatment of displaced subcapital fractures of the femur. The trial was conducted over 1 year, 82 patients suffering displaced subcapital fractures of the femur were included. The patients were followed up for 1 year postoperatively. The functional result was significantly superior in the hydroxyapatite-coated group. Characteristic changes were found on radiographs both proximally and distally, indicating that distal stem fixation with proximal stress shielding had occurred.

Clinical experience with a new artificial bone graft: preliminary results of a prospective study.

This prospective study was carried out to determine the efficacy, benefits and safety of an artificial bone grafting material. The material used was a mixture of porous calcium phosphate ceramic with the addition of bovine fibrillar collagen and autogenous bone marrow. This mixture has been used successfully as a bone graft in 11 patients with delayed and non-union of long bones.

Surgery for malignant extradural tumours of the spine.

We have reviewed 41 patients with malignant extradural tumours of the spine treated by anterior decompression for cord compression, or uncontrolled back pain or both. An anterior operation alone was performed in 37 cases, four had combined or staged anterior and posterior decompression. An anterior operation on its own achieved major neurological recovery in 18 of the 33 cases with neurological loss (56%); only four remained unchanged. Eleven had minor improvement but not enough to allow them to walk or to regain bladder function. No patient with complete paraplegia gained a useful neurological recovery. Back pain was improved in 30 of the 41 patients (73%), sound internal fixation being important in this respect. There were four early deaths and another 23 died from disseminated disease after a mean survival of 4.1 months. Fourteen patients are still alive with a mean survival of 14 months.

A pathological fracture of the femur through a histiocytic granuloma.

We present the first reported case of a fracture through a granuloma in the shaft of the femur of a child with histiocytosis X. This fracture united with conservative management but without resolution of the granuloma.

A study of the influence of posterior column sensory sparing on initial presentation of cervical injuries on the ultimate prognosis.

From previous papers from five separate Spinal Injury Centres, namely Perth, Western Australia, Stoke Mandeville, U.K., Heidelberg, Germany, Tokushima, Japan and South West Region, U.S.A., a total of 665 patients with cervical spine injuries have been extracted. These were grouped according to the Frankel classification on neurological status on admission and again on discharge. This has been used to assess the prognosis on the initial classification of the ultimate neurological recovery, as is indicated by the tabulated results. A small group of Perth patients have been further reviewed, the Frankel B group were sub-divided into B1, posterior column sparing only, and B2, fuller sensory sparing, to assess any difference in ultimate outcome. With only small numbers available at present, no major prognostic significance has been demonstrated by using such a division.

Adolescent idiopathic thoracic scoliosis. A prospective trial with and without bracing during postoperative care.

Fifty patients with adolescent idiopathic scoliosis treated by posterior fusion and Harrington instrumentation augmented by a Cotrel bar or by sublaminal Luque wires were studied in a prospective trial to ascertain the need for postoperative bracing. Twenty-five patients wore a plaster brace postoperatively for six months, while 25 were managed without a brace. The mean loss of correction from the first standing postoperative radiograph to one obtained two years later was 7 degrees in the braced group, and 6.3 degrees in the unbraced group, the difference not being statistically significant. We conclude that postoperative bracing is unnecessary after augmented Harrington instrumentation.