Segmental motion adjacent to anterior cervical arthrodesis: a prospective study.

STUDY DESIGN: Prospective, observational study. OBJECTIVE: The present study describes in a prospective setting the kinematics changes occurring at segments adjacent to a one-level cervical arthrodesis. SUMMARY OF BACKGROUND DATA: The development of adjacent segment disease has been noticed by many clinicians. Whether symptoms develop due to fusion induced accelerated spondylosis or due to a natural development in a predisposed person is currently under debate. The motivation for introducing motion preservation procedures in the neck is primarily to protect the patients from developing symptomatic adjacent disc disease. To accept this rationale, it has to be demonstrated that a fusion creates an unfavorable biomechanical situation at adjacent levels. METHODS: Forty-six patients underwent standard anterior cervical decompression and fusion using a cylindrical cage implant. Lateral radiographic views of the cervical spine in flexion and extension were obtained before surgery, and at 12 months of follow-up. Employing Distortion Compensated Roentgen Analysis, rotational and translational motion at adjacent levels was quantified prospectively. RESULTS: Rotational and translational motion at adjacent cranial and caudal levels did not exhibit a significant change between the preoperative state and the state 12 months after the operation. CONCLUSION: The assumption of an iatrogenically caused increased mobility by a one-level cervical fusion could not be confirmed 12 months after surgery.

Bony flexion-distraction injury of the lower lumbar spine treated with instrumentation without fusion and early implant removal: a method of treatment to preserve lumbar motion: two-year follow-up of a teenage patient.

Most single level bony flexion-distraction injuries can be treated in a brace. Internal fixation is required, however, when a patient fails brace treatment. Instrumentation is routinely left in place for a year or more and in an unfused spine can lead to early degenerative changes of the facets and disks. Implant removal once healing has occurred can preserve motion segments in the lumbar spine and offer an advantage in a young patient over instrumentation and fusion. A case report is presented of a 17-year-old female treated successfully with internal fixation without fusion of a bony flexion-distraction injury of the lower lumbar spine with early implant removal and 2-year follow-up.

[Criteria to notify to the authorities the occupational lumbar trait diseases]. / Criteri per la denuncia ex D.M. 27/4/04 delle spondilodiscopatie del tratto lombare e dell'ernia discale lombare.

To carry out the requirement of notification according to the Italian law D.M. 27/4/04 in relation to the item "Manual handling of loads made continuously during working shift" it is necessary to clarify some quantitative and chronological aspects regarding the exposure and to precise the nature of the diseases to be notified. To fulfil their choices doctors at the moment can not rely on quantitative referrings based on the evidence and wide spread accepted, but they basically have operative indications partly taken from literature and stil under validation. However, to carry out the requirement of the law and to avoid choices not based on considered criteria, we propose some operative criteria deriving from the knowledge that at the moment seems more consolidated and accepted in the occupational and previdential medicine.