Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2002
Comparative StudySubtalar arthrography in recurrent instability of the ankle.
Subtalar arthrography was done in 37 feet of 35 patients in whom recurrent instability of the ankle was diagnosed. There were 16 male and 19 female patients, with a mean age of 29.1 years (range, 11-56 years). The mean interval between the injury and arthrography was 4 years 3 months (range, 6 months-22 years). ⋯ The findings of the two groups were significantly different when examined for leakage into the ankle, leakage into the peroneal tendon sheath, and the presence of the lateral recess. Presence of contrast medium in at least two of these three positive arthrographic findings showed 92.3% sensitivity and 87.5% specificity in making the diagnosis of calcaneofibular ligament injury. Subtalar arthrography is valuable in making the diagnosis of calcaneofibular ligament injury in recurrent instability of the ankle.
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Clin. Orthop. Relat. Res. · Jan 2002
ReviewThe use of allograft bone and cages in fractures of the cervical, thoracic, and lumbar spine.
The advantages of allograft tissues and cage devices in anterior spinal reconstruction for trauma is the absence or minimization of donor site morbidity and unlimited choices of graft shapes and sizes. Osteoinductive matrices often are added to these grafting alternatives to improve healing rate and success. ⋯ Currently, autologous iliac crest is the most popular grafting material in the cervical region although cylindrical cages are gaining popularity. As the material properties of cage devices improve to better match the modulus of elasticity of host vertebral bone, their frequency of use undoubtedly will increase in spinal trauma and other spinal disorders.
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Clin. Orthop. Relat. Res. · Jan 2002
ReviewThe use of interbody cage devices for spinal deformity: a biomechanical perspective.
Spinal instrumentation has revolutionized the treatment of spinal deformities and offers a plethora of techniques and designs to surgically treat deformity conditions. The authors address the biomechanical properties afforded by various posterior and anterior spinal instrumentation mechanisms, with and without intervertebral reconstruction, and the principles associated with optimal reconstruction techniques. The integration of multiple strategies can improve anterior and posterior construct stiffness in the treatment of spinal deformities. ⋯ Moreover, anterior load-bearing structural grafts and interbody devices have been shown to increase construct stiffness, decrease the incidence posterior implant failure, permit the use of smaller diameter longitudinal rods, and may enhance the rate of successful spinal arthrodesis. From a biomechanical standpoint, treatment of medium to high-grade spondylolisthesis with stand-alone interbody or transvertebral cages, in the absence of supplemental posterior fixation, is contraindicated. Collectively, the included studies reinforce the principles of load sharing between the anterior and posterior spinal columns and affirm the biomechanical dominance of anterior column support in circumferential spinal arthrodesis.
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A prospective analysis of consecutive patients who had lumbar fusion using the unilateral transforaminal posterior lumbar interbody fusion with pedicle screw fixation is presented to assess the clinical and radiographic outcomes of the transforaminal posterior lumbar interbody fusion procedure and describe the technique and indication in the treatment of degenerative disease of the lumbar spine. Forty patients treated with transforaminal posterior lumbar interbody fusion for degenerative diseases of the lumbar spine (with anterior column deficiency) were followed up for a minimum of 3 years (mean, 3.4 years; range, 3-3.9 years). Radiographic assessment included plain and flexion and extension radiographs. ⋯ Eighty-five percent of patients had excellent or good clinical outcome(s). The unilateral transforaminal posterior lumbar interbody fusion provides bilateral anterior column support through a unilateral approach. The patients had high fusion rates and patient satisfaction as reported with similar complications found in other methods commonly used for spinal decompression and stabilization.
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Clin. Orthop. Relat. Res. · Jan 2002
Comparative StudyAnterior column support in surgery for high-grade, isthmic spondylolisthesis.
The literature is confusing as to the need for anterior column fusion in the surgical treatment of patients with high-grade dysplastic spondylolisthesis. The current authors present an analysis of consecutive pediatric patients treated surgically for high-grade spondylolisthesis with and without anterior column structural support with emphasis on fusion rates, segmental kyphosis correction, and functional outcomes. Thirty-seven surgical procedures were done in 31 patients for Meyerding Grade 3 or Grade 4 isthmic dysplastic spondylolisthesis. ⋯ The incidence of pseudarthrosis was 39% (seven of 18 patients) in Group 1 and 0% (0 of 19) in Group 2. All seven patients who had pseudarthrosis achieved solid fusion with a second procedure involving circumferential fusion with anterior column structural grafting. Outcomes regarding pain after treatment, function, and satisfaction were high in those patients who achieved solid fusion regardless of surgical procedure.