International orthopaedics
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We retrospectively reviewed the outcome of posterolateral fusion (PLF) in 136 patients with lumbar spondylolisthesis (LS), who had undergone posterior decompression laminectomy with foraminotomy and PLF using laminectomy bone chips as bone graft, with reduction of the slipped vertebra with transpedicle screws, between 1993 and 2003. Diagnosis of LS was confirmed by plain lumbar radiography, with computed tomography (CT) scan or magnetic resonance imaging (MRI) studies performed to confirm an associated condition, such as ruptured disc and spinal stenosis. The outcome of spinal fusion was good with 129 (94.85%) patients attaining solid fusion, while failed fusion was noted in seven (5.15%) patients. ⋯ Additionally, no complications, such as wound infection, were encountered. Proper decortication of the posterior paravertebral gutters with an osteotome and removal of all soft tissues from the laminectomy bone chips are significant factors contributing to the successful outcome of the laminectomy bone chips in PLF. The fusion rate obtained with this type of autogenous bone graft is comparable to that of the iliac bone crest autogenous graft; hence, it is a good substitute for the iliac crest bone autogenous graft in performing PLF in treating lumbar spondylolisthesis.
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Meta Analysis
Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials.
We performed a meta-analysis of randomised controlled trials to investigate the effectiveness of surgical fusion for the treatment of chronic low back pain compared to non-surgical intervention. Several electronic databases (MEDLINE, EMBASE, CINAHL and Science Citation Index) were searched from 1966 to 2005. The meta-analysis comparison was based on the mean difference in Oswestry Disability Index (ODI) change from baseline to the specified follow-up of patients undergoing surgical versus non-surgical treatment. ⋯ This difference in ODI was not statistically significant and is of minimal clinical importance. Surgery was found to be associated with a significant risk of complications. Therefore, the cumulative evidence at the present time does not support routine surgical fusion for the treatment of chronic low back pain.
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Little information is provided in the literature describing an efficient reduction technique for pelvic ring disruption. The aim of this study is to assess the use of the transcondylar traction as a closed reduction technique for vertically unstable fracture-dislocations of the sacro-iliac joint. Twenty-four pelvic ring disruptions were treated with attempted closed reduction followed by percutaneous screw fixation. ⋯ Two posterior screws and a complementary anterior fixation is typically required to avoid further displacement in case of sacral fractures. However, an open approach should be preferred in both cases of crescent iliac fracture-sacroiliac dislocation and transforaminal fracture associated with peripheral neurological deficit. A vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction.