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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An analysis was made of 1176 whiplash-type neck distortions taken from a total of 3838 restrained car driver incident reports. The percentage of whiplash-type neck distortion among injured drivers increased from less than 10% in 1985 to over 30% in 1997. Most occurred in head-on crashes or crashes with multiple collisions; only 15% occurred in rear-end collisions. ⋯ A correlation between the severity of the accompanying injuries and duration of complaints was found. Lack of adequate follow-up for patients with less severe injuries posed considerable difficulties for this retrospective study. In order to better evaluate this problem, prospective studies are necessary, with documentation including diagnosis, treatments, complaint duration and type.
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The objective of this study was to determine which discoligamentous structures of the lower cervical spine provide significant stability with regard to different loading conditions. Accordingly, the load-displacement properties of the normal and injured lower cervical spine were tested in vitro. Four artificially created stages of increasing discoligamentous instability of the segment C5/6 were compared to the normal C5/6 segment. ⋯ In axial rotation, only the stage 4 instability showed a significantly increased ROM and NZ compared to the intact FSU. For lateral bending, no significant differences were observed. Based on these data, we conclude that flexion/extension is the most sensitive load-direction for the tested discoligamentous instabilities.
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Comparative Study
Titanium-alloy enhances bone-pedicle screw fixation: mechanical and histomorphometrical results of titanium-alloy versus stainless steel.
Several types of pedicle screw systems have been utilized to augment lumbar spine fusion. The majority of these systems are made of stainless steel (Ss), but titanium-alloy (Ti-alloy) devices have recently been available on the market. Ti-alloy implants have several potential advantages over Ss ones. ⋯ Bone ongrowth on Ti was increased by 33% compared with Ss (P < 0.04), whereas no differences in bone volume around the screws were shown. Mechanical binding at the bone-screw interface was significantly greater for Ti pedicle screws than for Ss, which was explained by the fact that Ti screws had a superior bone ongrowth. There was no correlation between the screw removal torque and the pull-out strength, which indicates that the peripheral bone structure around the screw was unaffected by the choice of metal.
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Clinical Trial Controlled Clinical Trial
Outcome scores in degenerative cervical disc surgery.
Forty-six consecutive patients with neck pain and arm radiculopathy were treated with anterior cervical discectomy and fusion. All patients had neurological symptoms corresponding to a herniated disc and/or spondylosis at one or two cervical levels, verified by magnetic resonance imaging. The patients were stabilized with an anterior graft and randomized to either fixation with a CSLP plate or no internal fixation. ⋯ We conclude that the modified Million Index and Oswestry Index are clinically useful tools in the evaluation of outcome after degenerative cervical disc surgery. The clinical benefits of plate fixation were minimal. The outcome after surgery, measured with the Oswestry Index, Million Index and VAS for arm and neck pain, seems to correlate well with the classification of outcome by Odom.
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Thirty-nine consecutive patients, 22 male and 17 female with an average age of 37.6 years, with traumatic spondylolisthesis of the axis were reviewed. The cause of injury in 75% of the patients was a road traffic accident. The fractures were classified according to Effendi et al., the type II fractures were further divided into three subgroups: flexion, extension and listhesis injuries. ⋯ However, further distinction of the type II injuries regarding their stability is mandatory. Type II spondylolisthesis injuries are unstable, with a high number of associated injuries, a great potential for neurological compromise and significant complications associated with non-operative treatment. The majority of type II extension and type II flexion injuries can be successfully treated with nonrigid external immobilisation.