Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 1999
Comparative StudyModified Gallie technique versus transarticular screw fixation in C1-C2 fusion.
The effectiveness of a modified Gallie technique versus Magerl and Seeman transarticular screw fixation was compared in the management of 27 patients with symptomatic atlantoaxial instability. Twelve patients were treated using a modified Gallie technique and postoperative halo vest immobilization. Atlantoaxial arthrodesis occurred in seven (58%) patients, stable fibrous union occurred in one patient, and pseudarthrosis with recurrent instability developed in four (33%) patients. ⋯ To ensure that safe transarticular screw placement is possible, preoperative fine cut axial computed tomography with reconstructions is required to assess vertebral artery position and C2 isthmus anatomy. A proportion of patients have anatomy unsuitable for screw placement. Traditional wiring techniques are indicated in these patients.
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Clin. Orthop. Relat. Res. · Feb 1999
Early versus delayed surgery for acute cervical spinal cord injury.
The optimal timing of surgical intervention in cervical spinal cord injuries has not been defined. The goals of the study were to investigate changes in neurologic status, length of hospitalization, and acute complications associated with surgery within 3 days of injury versus surgery more than 3 days after the injury. All patients undergoing surgical treatment for an acute cervical spinal injury with neurologic deficit at two institutions between March 1989 and May 1991 were reviewed retrospectively. ⋯ This study indicates that patients who sustain acute traumatic injuries of the cervical spine with associated neurologic deficit may benefit from surgical decompression and stabilization within 72 hours of injury. Surgery within 72 hours of injury in patients sustaining acute cervical spinal injuries with neurologic involvement is not associated with a higher complication rate. Early surgery may improve neurologic recovery and decrease hospitalization time in patients with cervical spinal cord injuries.
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Clin. Orthop. Relat. Res. · Feb 1999
ReviewExpansive laminoplasty for myelopathy in ossification of the longitudinal ligament.
Laminectomy, which had long been used for treatment of cervical spondylotic myelopathy, including ossification of the longitudinal ligament in the cervical spine, had numerous complications such as postoperative malalignment of the cervical spine and vulnerability of the spinal cord caused by total removal of the posterior structures. In 1977 Hirabayashi devised an open door expansive laminoplasty, which is a relatively easier and safer procedure than laminectomy, that eliminated such problems by preserving the posterior elements. ⋯ At present, authors consider all patients with cervical spondylotic myelopathy candidates for expansive laminoplasty except for those having preoperative kyphosis and single level lesion without canal stenosis. Two remaining problems of expansive laminoplasty to be solved are prevention of C5,C6 radicular pain and/or paresis, the most frequent complication that occurs in approximately 5% to 10% of the patients, although most complications resolve spontaneously within 2 years, and correction of nonlordotic alignment to lordosis which are essential for posterior decompression effect of expansive laminoplasty by allowing the spinal cord to shift dorsally.
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Neuromuscular function in New Zealand White rabbits was evaluated after thigh tourniquet compression in the directly compressed quadriceps muscles and the distal tibialis anterior by measuring isometric contractile function after supramaximal stimulation of the motor nerve. Tourniquet compression resulted in markedly decreased force production beneath and distal to the tourniquet. Two days after compression, maximal quadriceps force production was decreased to 46% of control values with 125 mm Hg compression and 21% of control values after 350 mm Hg compression. ⋯ Three weeks after compression, quadriceps function had returned to 94% of control value after 125 mm Hg compression and 83% after 350 mm Hg. Tibialis anterior function returned to 88% of control values after 125 mm Hg thigh compression and 83% after 350 mm Hg. Clinically, the use of lower inflation pressures may minimize the complications of tourniquet use and enhance postoperative recovery.