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Current concepts in cervical spine surgery: Editorial comment
No full textCurrent concepts in cervical spine surgery: Editorial commen
Cervical spine surgery: An historical perspective
No full textBackground: Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of successes and failures. Questions/purposes: To identify these successes and failures, we selectively reviewed historical literature on cervical spine surgery with respect to the development of (1) surgical approaches, (2) management of degenerative disc disease, and (3) methods to treat segmental instability. Methods: We performed a nonsystematic review using the keywords "cervical spine surgery" and "history" and "instrumentation" and "fusion" in combination with "anterior approach" and "posterior approach," with no limit regarding the year of publication. Used databases were PubMed and Google Scholar. In addition, the search was extended by screening the reference list of all articles. Results: Innovative surgical approaches allowed direct access to symptomatic areas of the cervical spine. Over the years, we observed a trend from posterior to anterior surgical techniques. Management of the degenerative spine has evolved from decompressive surgery alone to the direct removal of the cause of neural impingement. Internal fixation of actual or potential spinal instability and the associated instrumentation have continuously evolved to allow more reliable fusion. More recently, surgeons have developed the basis for nonfusion surgical techniques and implants. Conclusions: The most important advances appear to be (1) recognition of the need to directly address the causes of symptoms, (2) proper decompression of neural structures, and (3) more reliable fusion of unstable symptomatic segments. © The Association of Bone and Joint Surgeons® 2011
Spontaneous fusion of L5 spondyloptosis: Should we learn from nature?
No full textA 36-year-old man with spondylolisthesis diagnosed at
age 9 presented as an outpatient complaining of episodic
low back pain. There were no neurologic signs or symptoms.
Plain radiographs demonstrated L5 spondyloptosis, with
a large fragment of the body of L5 apparently fused to the anterosuperior aspect of the sacrum (Fig. 1, arrows). This was
confirmed on computed tomography (Fig. 2, arrows). Magnetic resonance imaging revealed spinal stenosis (Fig. 3).
Physical therapy was prescribed, and the patient has kept
up his active lifestyle that includes working as a plumber
and participating in motocross. The treatment of highgrade spondylolisthesis is controversial, as opinion is divided
between in situ fusion techniques and reduction with stabilization and L5 vertebral body resection [1–5]. Although in
situ fusion does not correct the deformity, it has a lower risk
of neurologic injury [4,5]. This unique case of a spontaneously fused L5 vertebra supports the use of in situ arthrodesis
for the treatment of nontraumatic spondyloptosi
Pitfalls in Cervical Spine Surgery. Avoidance And Management Of Complications.
No full textSpinal surgery is a unique area in the process of continuous development. New skills are applied daily in this delicate field by the spinal surgeon: this professional can be either an orthopaedic surgeon or a neurosurgeon dedicated to the treatment of spinal diseases. This book offers a comprehensive approach and reviews all of the possible errors encountered by spinal surgeons in the clinical practice. It is mainly directed towards young surgeons approaching spinal surgery and also to experienced surgeons with regards to complications related to the latest technologies in the spinal field. This approach of treating and understanding problems in cervical spine surgery is unique and will guide the reader towards an improved level of attention regarding pitfalls in cervical spine surgery, therefore fostering the ability of preventing major complications and medicolegal consequences
Sciatic nerve compression by a gluteal vein varicosity
No full textA 36-year-old woman complained of mild low back pain
and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging
showed a L5–S1 disc degeneration. Low back pain resolved
after two epidural steroid injections, but she developed
a refractory sciatica worsened by supine and sitting positions.
Physically, the patient had pain and contracture over the left
piriformis muscle. Straight Leg Raising test was negative.
No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses
the sciatic nerve just behind the left hip (Figure). The patient
refused surgery and was managed by diet finalized to weight
loss, physical therapy, and centrally acting muscle relaxants
(pridinol mesylate) with complete resolution of the symptoms
in 1 month. The presence of an atypical sciatica in the absence
of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosit
Metastatic epidural spinal cord compression
No full textIntroduction: Metastatic epidural spinal cord compression (MESSC) is a frequent event in patients affected by solid tumor metastases. Current available approaches for MESCC include corticosteroids, radiotherapy and surgery. In the last few years, surgery has evolved from decompression by laminectomy alone, with the introduction of instrumentation systems by metalware (screws and hooks), and this has been associated to an improvement of clinical results compared to radiotherapy alone.Areas covered: In this narrative review, we outline the phases of management of cancer patients affected by MESSC, and discuss the timing of treatments, their impact on the Quality of life (QoL), and the relative benefits and harms of surgery and radiotherapy.Expert commentary: Despite the fact that clinical and surgical trials will be required to determine the most appropriate surgical technique and timing of surgery, we do expect a newer and more important role for radiotherapy in the management of MESCC patients in the next future. In particular, the implementation of radiotactic stereosurgery as adjuvant to decompressive surgery is expected to increase in the next few years, above all in those patients that can be candidate to the so called separation surgery
Hip fractures in children and adolescents
No full textFemoral neck fractures account for <1% of the fractures in children, and are produced by high energy trauma. The most commonly accepted treatment for such fractures is gentle manual anatomical reduction and internal fixation, yielding a healing rate between 80% and 90%
Intervertebral disc regeneration: from the degenerative cascade to molecular therapy and tissue engineering
No full textLow back pain is one of the major health problems in industrialized countries, as a leading source of disability in the working population. Intervertebral disc degeneration has been identified as its main cause, being a progressive process mainly characterized by alteration of extracellular matrix composition and water content. Many factors are involved in the degenerative cascade, such as anabolism/catabolism imbalance, reduction of nutrition supply and progressive cell loss. Currently available treatments are symptomatic, and surgical procedures consisting of disc removal are often necessary. Recent advances in our understanding of intervertebral disc biology led to an increased interest in the development of novel biological treatments aimed at disc regeneration. Growth factors, gene therapy, stem cell transplantation and biomaterials-based tissue engineering might support intervertebral disc regeneration by overcoming the limitation of the self-renewal mechanism. The aim of this paper is to overview the literature discussing the current status of our knowledge from the degenerative cascade of the intervertebral disc to the latest molecular, cell-based therapies and tissue-engineering strategies for disc regeneration. Copyright (c) 2013 John Wiley & Sons, Ltd
RC-QOL score for rotator cuff pathology: Adaptation to Italian
No full textWe translated and adapted the English RC-QOL (rotator cuff quality of life) questionnaire into Italian and performed reliability and validity evaluations of the Italian RC-QOL version in patients with rotator cuff tears. The RC-QOL English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The RC-QOL questionnaire was then administered to 22 subjects (range 45-74 years) with a diagnosis of rotator cuff tears. For test-retest evaluation, the 22 patients were asked to complete the questionnaire at first examination, and 30 min following the end of this examination. The intraclass correlation coefficient for the 22 patients was 0.94 (95% CI = 0.85-0.98), indicating a high reliability. There were no significant differences between the scores immediately after the consultation and 30 min later. The Italian and the English versions of the RC-QOL questionnaire evaluate the same aspects of clinical severity in patients with rotator cuff tears. © 2009 Springer-Verlag
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