Purpose

Ultrasound of the neonatal and infantile hip is a useful tool in diagnosis and treatment of the developmental dysplasia of the hip (DDH), especially given the fact that numerous cases of DDH do not present any findings in the clinical examination.

Background: Misplaced pedicle screws are associated with significant complications during posterior spinal instrumentation.

Purpose: The purpose of this study is to evaluate the efficacy of triggered electromyographic stimulation in predicting the appropriate placement of pedicle screws.

Study Design: Prospective clinical trial.

Patient Sample: Fifteen consecutive patients (3 males; 12 females).

Outcome Measures: Not applicable.

Materials and Methods: All patients underwent posterior thoracolumbar spine fusion. Surgery was performed for spondylolisthesis, spinal stenosis, degenerative scoliosis and fractures. All patients received continuous electromyographic monitoring during surgery. During insertion of pedicle screws the integrity of the medial pedicle cortex was tested by stimulating each screw head with a monopolar pedicle probe stimulator and recording the compound muscle action potentials. A threshold of 7 mA and below was considered indicative of pedicle breach. Intraoperative screw placement was verified with the use of image intensifier. Finally, all patients following surgery underwent plain radiographs and CT scan of the operated region to evaluate the position of the pedicle screws.

Results: One hundred and fourteen pedicle screws were inserted from T7 to S1 in all patients. There were no myogenic responses at the threshold tested. No screw had to be repositioned intraoperatively. There were no new neurologic deficits recorded following surgery. Review of the radiographs and CT scans obtained following surgery revealed no medial pedicle cortex breach. There were two screws that violated the lateral pedicle cortex, without any subsequent complications for the patients.

Conclusions: Our study suggests that the absence of myogenic responses following stimulation at a threshold of 7 mA and below during pedicle screw placement, is a strong indicator that no medial pedicle cortex breach has occurred.

Aims: The evaluation of the results becoming from the use of demineralized bone matrix (DBM) in the bone defects.

Methods: In the present study the above substance was implanted during the period 2000–2002 (28 months) to 24 patients, 11 males and 13 females average age 39.1 for the males and 60 for the females. As a cause was referred in 12 patients the fall, in 3 patients the car crash, in 5 patients following the removal of osteosynthesis materials, in 2 patients the bone cysts, in 1 patient fracture of ankle joint following fusion and in 1 patient a pseudarthrosis. The implantation of DBM concerned 8 hips, 4 femurs, 6 knees, 1 humerus, 1 forearm, 1 ankle, 2 metacarpal and 1 phalanx. All the fractures as well the fusion were treated through internal fixation. There was a regular post op follow-up and concerned the clinical and x-ray examination per month until the total incorporation of the graft (12 weeks).

Results: In all patients the total incorporation of the DBM was accomplished in a brief period of time, depended on the place of implantation without having local or systemic side effects. We have to remark the early signs of bone shadow around the 3rd week, as well the incorporation of the matrix around the 12th week in the x-ray findings.

Conclusions: The use of DBM in bone defects could play an important role to the filling of bone defects due to fractures or benign cysts as a result of its incorporation and without inducing local or systematic side effects.