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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Whiplash, a common injury following motor vehicle crashes, is associated with high costs and a prognosis that is variable and difficult to predict. We studied the profile of recovery from whiplash and assessed whether presenting signs and symptoms directly after the crash were predictive of whiplash prognosis. We formed a population-based incident cohort of all 2627 individuals who sustained a whiplash injury resulting from a motor vehicle crash in the province of Québec, Canada, in 1987, and followed these patients for up to 7 years. ⋯ In contrast, using a classification of injury severity previously proposed by the Québec Whiplash Associated Disorders Task Force, the median recovery time varied from 17 to only 123 days. We conclude that whiplash patients presenting with several specific musculoskeletal and neurological signs and symptoms will have a longer recovery period. These patients can easily be identified and closely monitored and targeted for the evaluation of early intervention programmes aimed at managing whiplash patients with a poor prognosis.
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Comparative Study
Biomechanical compression tests with a new implant for thoracolumbar vertebral body replacement.
The authors present an investigation into the biomechanical functioning of a new titanium implant for vertebral body replacement (Synex). Possible indications are fractures and/or dislocations with damage of the anterior column, posttraumatic kyphosis and tumors of the thoracolumbar spine. The construction must be supplemented by a stabilizing posterior or anterior implant. ⋯ A significant (P < 0.001) correlation (R = 0.89) between Fmax and BMD was found. Synex was found to be at least comparable to MOSS concerning the compressive performance at the vertebral end-plate. A possible consequence of the significantly higher mean compression forces between 1 and 2 mm displacement might be decreased collapse of the implant into the vertebral body in vivo.
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We operated on 26 patients with cervical spine disorders (13 with traumatic lesions, 3 with spinal stenosis and myelopathy, 1 with osteomyelitis and 9 with metastasis) with posterior stabilization. A new implant system (Cervi-Fix) based on rods, enabling a choice of either screw or laminar hook fixation in a free combination, was used. The system was evaluated for ease of use, for safety, regarding complications related to the system, and for efficacy, regarding loss of correction and signs of instability. ⋯ Loss of correction was observed in one patient. We found constructs with few vertebral fixation points, especially with screws, easy to handle, whereas multiple-claw constructs were time consuming. This implant system seems to be versatile, safe and efficient, but could be improved by the development of instruments for the insertion of the hooks.
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Forty-six patients with lumbar spondylolysis and mild isthmic spondylolisthesis were managed with direct repair of the defect with or without facet joint fusion in the affected segment. There were 24 males and 22 females, ranging in age from 15 to 56 years (average, 38.2 years). These patients had experienced clinical symptoms due to spondylolysis for between 4 months and 20 years (average, 5.3 years). ⋯ There was no significant difference in outcome between the spondylolytic/spondylolisthetic patients with non-degenerative disc, who were treated with direct repair of defect only, and those with degenerative disc, who additionally underwent a fusion procedure (P > 0.05). The present series demonstrates a satisfactory result and a high rate of bony healing of the pars defect by this operative procedure in patients with lumbar spondylolysis and mild isthmic spondylolisthesis. Preoperative assessment of the disc degeneration with MRI is of great assistance in making the protocol choice of whether to opt for fusion.
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The present study investigates the diagnostic value of rotatory computed tomography (CT) examinations in normal subjects and patients with whiplash associated disorders (WAD), with the aim of reproducing earlier findings of rotatory CT studies. Forty-seven WAD patients with persistent complaints after a rear-end collision (non-cranial contact acceleration/deceleration trauma) were enrolled in this study. To guarantee a maximally homogeneous study population, only WAD patients with a marked passive cervical retroflexion restriction were included. ⋯ Excessive RR values were only found at C0/C1. A traumatic lesion of the ligaments at C0/C1, which prevent vertical translation of the skull with regard to the atlas, is hypothesised. The results of the discriminant analysis of the RR values make this method applicable for the individual WAD patient in daily practice.