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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Posterior ligamentous complex (PLC) components have an orderly sequence of rupture. However, it is still unclear how many structures have to be damaged to consider it disrupted. We aim to establish imaging criteria, which can define the complex as competent or incompetent. ⋯ Following PLC rupture sequence, ISL edema with facet distraction seems not to be enough to define a posterior tension band incompetence. It is the further step of SSL rupture what gives the key to PLC incompetence.
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To investigate whether the presence of Modic changes type I (MC I) found on preoperative MRI scans represent a risk factor for persistent back pain 12 months after surgery amongst patients operated for lumbar disc herniation. ⋯ Patients with preoperative MC I can expect less but still significant improvement of back pain 1 year after microdiscectomy, but not if they smoke cigarettes.
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Long spinal deformity fusions in elderly patients continue to be controversial. However, there is a growing population of elderly patients with spinal deformities that may be optimally treated by reconstructive surgery requiring a long fusion to the sacrum. This study evaluated clinical outcomes in elderly (>65) adult deformity patients who underwent posterior instrumented reconstruction consisting of fusion from the thoracic spine to the sacrum with iliac fixation. ⋯ Properly selected patients 65 years of age and older who have substantial sagittal imbalance, a considerable disease burden, and a lesser degree of mental distress can obtain as much clinical benefit as their younger counterparts (≤55 years of age) 2 years following spinal deformity surgery that requires fusion from the thoracic spine to the sacrum with segmental instrumentation and iliac fixation.
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Randomized Controlled Trial
Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting.
We analysed baseline measures from an RCT involving adults with low back pain (LBP) with or without referred leg pain, to identify self-report items that best identified clinically determined nerve root involvement (sciatica). ⋯ In this primary care population seeking treatment for LBP with or without leg pain, we found no clear set of self-report items that accurately identified patients with nerve root pain. When accurate case definition is important, clinical assessment should be the method of choice for identifying LBP with possible nerve root involvement.
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Injuries of the occipital condyles are rare. While the majority of occipital condyle fractures can be treated conservatively, surgery is recommended in craniocervical misalignment and instability. Open reduction and temporary occipito-cervical stabilization might be an alternative to fusion or halo treatment. ⋯ The C7 fracture was stabilized and fused from anterior and posterior. The occipital condyle fracture was reduced and temporarily stabilized from C0-C3 from posterior. Bony healing occurred after 6 months and consequently the internal fixator was removed to preserve upper cervical mobility.