Journal of spinal disorders
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A retrospective review of 36 patients treated with posterior cervical plating and autogenous iliac crest bone graft was performed to evaluate the results of posterior cervical plating in terms of fusion, outcome, technique, and complications. Numerous methods of cervical stabilization have been described with varying fusion rates and complications. Compared to wiring techniques, there is little information concerning the results of posterior cervical plating. ⋯ The use of titanium implants allowed operative CT and MR imaging without the excessive artifact associated with stainless steel implants. Posterior cervical plating with lateral mass fixation and bone grafting offers a reliable method of achieving fusion. Bicortical lateral mass screws are less likely to loosen than unicortical screws, and no major complications occurred.
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The use of allografts continues today for the purpose of spinal fusion. The literature is conflicting on the effectiveness of allografts in spinal fusion as compared with autografts. Numerous variables affect fusion, including age, sex, smoking status, type of surgery, and anterior versus posterior surgery. ⋯ Frozen allografts resorbed in three of five cases, and partial fusions were achieved in the remaining cases. When a mixture of autograft and freeze-dried allograft was used, grade 1 solid fusion was achieved in four of eight cases and partial fusions were achieved in the others. Bone densitometry results also showed that autograft sites gave significantly greater bone density, followed by mixture, frozen allografts, and freeze-dried allografts in this order.(ABSTRACT TRUNCATED AT 250 WORDS)
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After institutional review defined an unacceptable mortality rate in nonoperative treatment of elderly patients with odontoid process fracture without neurological deficit, we undertook a prospective study to determine the influence of early surgical stabilization on perioperative mortality in geriatric odontoid process fracture patients without neurologic injury. Analysis suggests that acute perifracture mortality in this high-risk group can be significantly decreased and potentially eliminated by this approach.
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We report our preliminary experience with 27 patients who underwent surgery for posterior spinal arthrodesis using the hydroxylapatite-coated Diapason screws. Each of the patients was considered to have a condition that was mechanically risky from the surgical standpoint. The results were good for patients with lytic spondylolisthesis and were excellent for patients with osteoporosis, but were generally less successful for patients requiring "long lever arm" fixations and those with degenerative scoliosis.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Pain from the lumbar zygapophysial joints: a test of two models.
One hundred seventy-six consecutive patients with chronic low-back pain and no history of previous lumbar surgery were studied to test the clinical criteria of Fairbank et al. and Helbig and Lee for zygapophysial joint pain. All patients underwent a history, examination, and a series of zygapophysial joint injections or blocks of the medial branches of the dorsal ramus with lignocaine. ⋯ None of the clinical features tested was found to be associated with response to the confirmatory block. The Fairbank et al. and Helbig and Lee criteria were shown to be unreliable in distinguishing pain of zygapophysial joint origin from pain of other origins.