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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Comparative Study
Symptom profile of persons self-reporting whiplash: a Norwegian population-based study (HUNT 2).
The aetiology of chronic whiplash associated disorder (WAD) is unclear and the condition has been perceived both as a chronic pain disorder, based on the injury to the neck, and as a functional somatic disorder. Based on the hypothesis that chronic WAD should be perceived as a functional somatic syndrome, we compared the symptom profile of persons with chronic WAD with the profile of persons with a functional somatic disorder, and with the profile of persons with an organic pain disorder. A sample of 55,046 persons participating in a Norwegian population-based health study (HUNT 2) was divided into four study groups: chronic WAD, fibromyalgia, rheumatoid arthritis, and controls (none of these disorders). ⋯ The fibromyalgia group had an even higher prevalence of all symptoms, while the rheumatoid arthritis group showed an increase in the prevalence of particularly pain and stiffness symptoms and also a minor increase in the prevalence of other symptoms compared to the control group. We conclude that this study provide evidence in favour of the hypothesis that chronic WAD should be perceived as a functional somatic syndrome. Persons with chronic WAD had a symptom profile more similar to people with a functional somatic disorder than an organic pain disorder, consisting of a wide array of symptoms, not only predominantly pain symptoms.
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The present method of C2 laminar screw placement relies on anatomical landmarks for screw placement. Placement of C2 laminar screws using drill template has not been described in the literature. The authors reported on their experience with placement of C2 laminar screws using a novel computer-assisted drill guide template in nine patients undergoing posterior occipito-cervical fusion. ⋯ Postoperative computed tomographic (CT) scanning was available for allowing the evaluation of placement of thirteen C2 laminar screws, all of which were in good position with no spinal canal violation. This study shows a patient-specific template technique that is easy to use, can simplify the surgical act and generates highly accurate C2 laminar screw placement. Advantages of this technology over traditional techniques include planning of the screw trajectory is done completely in the presurgical period as well as the ability to size the screw to the patient's anatomy.
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Previous studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs). MRI and particularly the short tau inversion recovery (STIR) sequence are very sensitive for detecting vertebral edema as a result of fresh fractures or micro-fractures. Therefore, it has a great therapeutic relevance in differentiating vertebral deformities seen by conventional X-ray and CT scans. ⋯ This study confirms the diagnostic benefits of an MRI scan before performing a kyphoplasty. For 16 out of 28 patients, the therapeutic plan was changed because of the information obtained by preoperative MRI. Preoperative MRI helped to generate the correct surgical strategy, by demonstrating the correct location of injury and by detecting concomitant diseases.
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Cervical pedicle screw fixation is an effective procedure for stabilising an unstable motion segment; however, it has generally been considered too risky due to the potential for injury to neurovascular structures, such as the spinal cord, nerve roots or vertebral arteries. Since 1995, we have treated 144 unstable cervical injury patients with pedicle screws using a fluoroscopy-assisted pedicle axis view technique. The purpose of this study was to investigate the efficacy of this technique in accurately placing pedicle screws to treat unstable cervical injuries, and the ensuing clinical outcomes and complications. ⋯ Pre- and postoperative tracheotomy was required in 20 (13.9%) of the 144 patients. However, the tracheotomies were easily performed, because those patients underwent posterior surgery alone without postoperative external fixation. The placement of cervical pedicle screws using a fluoroscopy-assisted pedicle axis view technique provided good clinical results and a few complications for unstable cervical injuries, but a careful surgical procedure was needed to safely insert the screws and more improvement in imaging and navigation system is expected.
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Case Reports
Staged corrective surgery for complex congenital scoliosis and split cord malformation.
Congenital scoliosis associated with split cord malformation raises the issue on how to best manage these patients to avoid neurologic injury while achieving satisfactory correction. We present the case of a 12-year-old girl who first presented when she was 11-year old with such combination but without much physical handicap or neurological deficit. The corrective surgery offered at that time was refused by the family. ⋯ In this grand round case, we discuss all the different option of treatment of congenital scoliosis associated with split cord malformation. In a medical environment where spinal cord monitoring is lacking, we recommend an initial release followed by skull and bifemoral traction over several days to monitor the neurologic status of the patient. Once optimal correction is achieved with the traction, a posterior instrumentation can be safely done.