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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The goal of this systematic literature review was to determine, for patients with degenerative disc disease, which method of single-level anterior cervical interbody fusion using the anterior approach gives the best clinical and radiological outcome. The number of new techniques for obtaining a solid fusion has increased rapidly, but the rationale for choosing between different techniques is unclear. Randomised comparative studies on anterior cervical interbody fusions were identified in a sensitive Medline, Cochrane and Current Contents database search. ⋯ Good clinical outcome (disability, pain and symptoms) ratings varied from 66% to 82%. A meta-analysis to determine the best method for an anterior interbody fusion could not be performed due to the heterogeneity of the methods reported and because no standard outcome parameter was used. From this systematic literature review, a gold standard for the treatment of degenerative disc disease could not be identified.
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An analysis was made of 1176 whiplash-type neck distortions taken from a total of 3838 restrained car driver incident reports. The percentage of whiplash-type neck distortion among injured drivers increased from less than 10% in 1985 to over 30% in 1997. Most occurred in head-on crashes or crashes with multiple collisions; only 15% occurred in rear-end collisions. ⋯ A correlation between the severity of the accompanying injuries and duration of complaints was found. Lack of adequate follow-up for patients with less severe injuries posed considerable difficulties for this retrospective study. In order to better evaluate this problem, prospective studies are necessary, with documentation including diagnosis, treatments, complaint duration and type.
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A high rate of failure of the internal fixation of unstable spinal fractures in complete cord injured patients was noted in patients referred to the Salisbury Spinal Centre who had been stabilised with a Hartshill rectangle. This prompted a review of the operative notes, radiographs and clinical outcomes of all patients referred to the centre with a Hartshill rectangle in situ. All patients identified with a complete spinal cord injury and Hartshill rectangle were identified. ⋯ The failure to use bone graft at the time of stabilisation was significantly (P < 0.001) related to risk of failure. The application and use of the Hartshill is not a technically challenging procedure; however, if the system is to be used, it must be used correctly. Failure to correctly apply the rectangle and to use bone graft will lead to an unacceptably high rate of failure.
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Case Reports
Thoracolumbar distraction fractures in advanced pregnancy: a contribution of two case reports.
Thoracolumbar trauma in pregnant women is an important topic, though rarely discussed in the pertinent literature. Two consecutive cases of thoracolumbar distraction injuries in advanced pregnancy are presented. Conservative treatment failed in both cases; surgical management was necessary on a delayed basis using compression instrumentation. ⋯ A theoretical analysis of the pathomechanics is carried out in an attempt to explain the specificity of flexion-distraction injuries in victims in an advanced stage of pregnancy. The authors suggest that the spine pivots about the fetus, and so is injured more in tension than in compression. The damage is mainly to soft-tissue structures, while anterior column compression and axial loading are less important.