Clinical orthopaedics and related research
-
We analyzed 124 papers published in the English language literature to define the indications and timing of surgery in spinal TB and to evaluate the outcome of various surgical procedures for kyphosis and neural outcome. Surgery in spinal tuberculosis is indicated for diagnostic dilemma, neural complications, and prevention of kyphosis progression. Up to 76% canal encroachment is compatible with a normal neurologic state as the spinal cord tolerates gradually developing compression. ⋯ Its outcome in a long-segment disease needs observation. The correction of healed kyphosis requires multistage surgery and is fraught with complications. Prospective studies are needed to define surgical approach, steps, stages, problems, and obstacles to correct severe kyphosis in spinal TB.
-
Late-onset paraplegia is best avoided by correcting severe kyphosis in the active, healing, or healed stages of spinal tuberculosis. We report 16 patients with dorsal or dorsolumbar spinal TB--nine with paraplegia, seven without paraplegia--who underwent kyphus correction. Nine patients had active, five partially treated, and two healed disease. ⋯ All but one patient with neural deficit showed complete neural recovery. Mean kyphosis correction was 27.3 degrees (range, 9 degrees-42 degrees). Mean correction loss on 1-year followup was 1.4 degrees (range, 0 degrees-4 degrees).
-
Clin. Orthop. Relat. Res. · Jul 2007
Review Meta AnalysisTreatment of acute scaphoid fractures: systematic review and meta-analysis.
Whether operative treatment is a better option than nonoperative treatment for acute nondisplaced or minimally displaced fractures of the scaphoid is controversial. The type of cast that should be used for nonoperative treatment is not known. We performed a systematic review and meta-analysis of randomized and quasirandomized trials to evaluate the effect of operative versus nonoperative treatment and the effect of different casting methods for nonoperative treatment of acute scaphoid fractures on nonunion rate, return to work, grip strength, range of wrist motion, complications, patient evaluation, and incidence of osteoarthritis. ⋯ Operative treatment of acute nondisplaced or minimally displaced fractures of the scaphoid waist does not provide greater benefits regarding nonunion rate, return to work, grip strength, range of wrist motion, or patient satisfaction than cast immobilization; however, it causes more complications and, perhaps, a higher risk of scaphotrapezial osteoarthritis. There is no evidence from randomized trials to determine whether operative treatment is superior to nonoperative treatment for an acute proximal pole fracture of scaphoid bones. There is insufficient evidence to determine which type of cast should be used in nonoperative treatment of nondisplaced scaphoid fractures.
-
Clin. Orthop. Relat. Res. · Jul 2007
Review Historical ArticleTuberculosis of the spine: a historical review.
Almost all ancient civilizations described tuberculous bacilli in their old scripts, and these bacteria have been found in prehistoric skeletal remains. The clinical availability of specific antitubercular drugs was the most important breakthrough in managing spinal tuberculosis. Any attempt at surgical excision of the disease prior to the antitubercular era met with serious complications, dissemination of disease and high mortality (nearly 50%). ⋯ For a classic spondylodiscitis when surgery is required for débridement and decompression, an anterior approach through an extrapleural anterolateral route or through transpleural route is recommended. Healthy posterior elements should not be jeopardized by surgery. The real control of tuberculous disease requires a serious and sustained global effort to eliminate immunocompromised states, poverty, malnutrition, and overcrowding.
-
Clin. Orthop. Relat. Res. · Jul 2007
Multicenter StudyBuckling collapse of the spine in childhood spinal tuberculosis.
We prospectively followed 61 children under 15 years of age at the time of diagnosis to identify the risk factors for deformity progression. The children had 63 lesions and a minimum of 15 years followup. All exhibited an increase in deformity during the active disease phase, but 26 of 63 (41%) continued to progress during the quiescent phase until the growth was complete. ⋯ These patients' vertebral segments above the level of destruction underwent severe sagittal rotation resulting in horizontal vertebrae with vertical growth plates, which resulted in longitudinal overgrowth of the vertebral segments. Risk factors for buckling collapse included an age of less than 7 years at the time of the disease, thoracolumbar involvement, loss of more than two vertebral bodies, and presence of radiographic spine-at-risk signs. Children at risk for buckling collapse must be carefully watched and the spine stabilized to avoid a massive increase in deformity.