European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Lifting restrictions postoperatively are quite common, but there appears to be little scientific basis for them. Lifting restrictions are inhibitory in terms of return to work and may be a factor in chronicity. The mean functional spinal motion unit stiffness changes with in vitro or computer-simulated discectomies, facetectomies and laminectomies were reviewed from the literature. ⋯ The adjusted NIOSH guidelines provide a reasonable way to estimate weight restrictions and accommodations such as lifting aids. Such restrictions should be as liberal as possible so as to facilitate, not prevent, return to work. Patients need more advice regarding lifting activities and clinicians should be more knowledgeable about the working conditions and constraints of a given workplace to effectively match the solution to the patient's condition.
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To evaluate the effect of brace treatment on self-image in patients with adolescent idiopathic scoliosis, 54 consecutive patients admitted for brace treatment were interviewed before bracing. A prevalidated questionnaire including the following five aspects of self-image was used: (1) body-image, (2) self-perception of skills and talents, (3) emotional well-being, (4) relations with family, and (5) relations with others. As a control group, the answers of 3465 normal school children were used. ⋯ Neither were there any statistically significant differences between the answers of the scoliosis patients in the pre-bracing and follow-up interviews. This was valid for the total score as well as for each subscale item score. It is concluded that wearing the brace does not affect the self-image of adolescents with idiopathic scoliosis negatively.
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Telemeterized internal spinal fixation devices were implanted in ten patients. The loads acting on the fixators were compared for different body positions, including standing, sitting, and lying in a supine, prone, and lateral position. Implant loads differed considerably from patient to patient depending, for example, on the indication for surgery and the surgical procedure. ⋯ Flexion bending moments were significantly higher in upright than in lying body positions. Loads on the fixators were not higher for sitting than for standing. Patients who have undergone mono- or bisegmental spine stabilization should therefore be allowed to sit as soon as they can leave the bed.
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Case Reports
The 'MW' sacropelvic construct: an enhanced fixation of the lumbosacral junction in neuromuscular pelvic obliquity.
Fixation to the lumbosacral spine to correct pelvic obliquity in neuromuscular scoliosis has always remained a surgical challenge. The strongest fixation of the lumbosacral junction has been achieved with either a Galveston technique with rods or screws or with iliosacral screws. We have devised a new fixation system, in which iliosacral screws are combined with iliac screws. ⋯ The whole sacropelvis is thus encompassed by a maximum width (MW) fixation, which gives an 'M' appearance on the pelvic radiographs and a 'W' appearance in the axial plane. We report on our surgical technique and the early results where such a technique was used. We feel that this new means of fixation (by combining the strongest fixation systems) is extremely solid and should be included in the wide armamentarium of sacropelvic fixation.
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Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. ⋯ Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.