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
-
To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. ⋯ After adjusting for the effects of sociodemographic characteristics, initial pain and symptoms, post-crash mood, prior health status and collision-related factors, those who expected to return to work reported global recovery 42% more quickly than those who did not have positive expectations (HRR = 1.42, 95% CI 1.26-1.60). Knowledge of return to work expectation provides an important prognostic tool to clinicians for recovery.
-
There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a Goel-Harms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005-2007). ⋯ All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.
-
Originally aimed at treating degenerative syndromes of the lumbar spine, percutaneous minimally invasive posterior fixation is nowadays even more frequently used to treat some thoracolumbar fractures. According to the modern principles of saving segment of motion, a short implant (one level above and one level below the injured vertebra) is generally used to stabilise the injured spine. Although the authors generally use a short percutaneous fixation in treating thoracolumbar fractures with good results, they observed some cases in which the high fragmentation of the vertebral body and the presence of other associated diseases (co-morbidities) did not recommend the use of a short construct. ⋯ At the 1-year follow-up, all patients except one, who died 11 months after the operation, did not show any radiologic signs of mobilisation or failure of the implant. Based on the results of the present series, the long percutaneous fixation seems to represent an effective and safe system to treat particular cases of vertebral lesions. In conclusion, the authors believe that a long implant might be an alternative surgical method compared to more aggressive or demanding procedures, which in a few patients could represent an overtreatment.
-
Anterior procedures in the cervical spine are feasible in cases having anterior aetiologies such as anterior neural compression and/or severe kyphosis. Halo vests or anterior plates are used concurrently for cases with long segmental fixation. Halo vests are bothersome and anterior plate fixation is not adequately durable. ⋯ Postoperative imaging demonstrated screw exposure in one screw, but no pedicle perforation. APS and plate fixation is useful in selected cases of multisegmental anterior reconstruction of cervical spine. However, the adequate familiarity and experience with both cervical pedicle screw fixation and the imaging technique used for visualising the pedicle during surgery are crucial for this procedure.
-
The clinical outcome of patients with symptomatic lumbar spinal stenosis (LSS) was assessed during a follow-up period of 2 years after X-Stop implantation. The X-Stop is the most commonly used interspinous distraction device in patients with neurogenic intermittent claudication due to LSS. Between 2003 and 2007, more than 1,000 patients were examined in our centre with symptoms of intermittent claudication due to spinal stenosis. ⋯ Concerning the operative technique, a minimally invasive implantation with preservation of the interspinous ligament is appropriate. Functional (upright-) MRI examinations were able to demonstrate the positional-dependent stenosis. If available, fMRI represents the most helpful radiologic examination in assessing the outcome of interspinous spacer implantation.