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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Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. ⋯ Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.
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Various conditions such as fracture, dislocation, tumor, or infection adversely affect the vertebral body and lead to instability. Restoration of a stable anterior column is essential for normal spinal biomechanics. Various biological and mechanical spacers have been used to reconstruct the anterior column after corpectomy. ⋯ For patients presenting with neurological symptoms (n = 4), the recovery was complete in three and partial in one. No patient was made neurologically worse, and there were no vascular injuries intra- or postoperatively. The study suggests that TSM-bone graft composite offers excellent biomechanical stability in the immediate postoperative period, permitting progressive maturation of the fusion mass.
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Reconstruction of anterior iliac crest bone graft donor sites: presentation of a surgical technique.
This study is a prospective evaluation of the reconstruction of anterior iliac crest bone graft donor sites using a technique developed by the authors. We present the technique and the initial results obtained with its use in 15 patients followed up for a period ranging from 6 to 16 months. ⋯ Clinical evaluation of the patients found a good cosmetic appearance of the reconstruction site, and the rib segments used showed good radiologic integration. Partial resorption of the segments was observed in two patients, with no effects on the cosmetic result.
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The purpose of this study was to determine prognostic criteria for return to work 9-12 years after standard nucleotomy for herniated nucleus pulposus confirmed by CT. From 1985 until 1988, 182 patients (102 male, 80 female, mean age 45 years) with a single-level herniated nucleus pulposus were operated on for the first time. In summer 1997, an average of 10.2 years after the operation, 101 of 182 patients (55.5%) returned a standardised questionnaire. ⋯ Group II contained 57 patients, of whom 18 worked only part of the time, 9 had changed to a lighter full-time job, 23 had taken early retirement, and 7 were receiving a pension. Patients in group I were significantly younger (38 vs. 51 years), had a smaller proportion of patients with more than 20% overweight (27% vs. 44%), had a smaller proportion of severe, grade 0 and 1, motor dysfunction (0% vs. 16.3%), had been operated sooner (within 3 days: 52.3% vs. 19.3%), had undergone fewer re-operations for recurrence of the herniation (4.5% vs. 21.1%), and had worked less frequently in physically demanding jobs (6.7% vs. 22.8%). We concluded that when there is a relative indication for herniated nucleus pulposus surgery, it should be limited to patients aged below 40 years, with slight motor dysfunction, who work in physically undemanding jobs, so as to make a satisfactory long-term result more likely.
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The progression of kyphosis in myelomeningocele is independent of skeletal growth and requires early operative correction and stabilization to prevent a loss of sitting ability. In severe cases, only vertebrectomy makes it possible to achieve correction, stability and skin-closure without tension. In 14 patients with myelomeningocele gibbus, kyphectomy was performed, removing two vertebral bodies on average. ⋯ In three cases, kyphosis reappeared cranial to the fused segments, requiring ventral stabilization. With respect to increasing kyphosis angle, an early intervention should be aimed at. A secondary operation can be necessary, if surgery is performed without taking care of the growth potential.