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Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 371 - 371
1 Mar 2004
Caceres E Ruiz A Del Pozo P Ubierna M de Frutos AG
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Aim: To evaluate the role of selective arterial embolization of Aneurysmal Bone Cyst of the mobile spine (C1-L5). Ten to 35% of aneurysmal bone cyst arises from the mobile spine. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. No previous series analyses this aspect. Methods: Fourteen cases of Aneurysmal Bone Cyst of the mobile spine were retrospectively reviewed. All charts, radiographs, and images were reviewed allowed for oncologic and surgical staging of these cases. The mean follow-up was 3,5 years (2,5y Ð 11y) and the mean age at diagnosis was 22 years. Lumbar and cervical spine was more frequently involved (5 cases cervical and 5 lumbar). Histologic diagnosis was obtained in all cases. A slow and gradual onset of pain was the constant symptom. In all cases an arterial study was performed and in thirteen cases a selective arterial embolization (SAE) was performed. Six of them were repeated Results:Only two patients shows complete ossiþcation of the cyst without surgery (T10 and T1) and was curative. All the others patients received surgical treatment (curettage or en bloc excision) In three of them a recurrence of disease was diagnosed 6, 8 and 12 months later. Two of the most recent cases shows a little lityc area without symptoms Conclusions: Selective arterial embolization seems NOT be sufþcient to obtain ossiþcation of Aneurysmal Bone Cyst o mobile spine


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 135 - 135
1 Feb 2004
García-de Frutos A Cáceres-Palou E Ubierna-Garcés M Ruiz-Manrique A del Pozo-Manrique P Domínguez E
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Introduction and Objectives: This is a retrospective study on the treatment of lumbar degenerative disk disease (LDDD) using intervertebral arthroplasty. The lack of uniformity in the treatment of LDDD, persistence of pain even with solid fusion, and the possibility of changes over the fusion site have encouraged us to seek other solutions for this condition. Total intervertebral arthroplasty has been proposed as a possible alternative for selected cases of LDDD.

Materials and Methods: Between November 1999 and July 2002, 16 patients with LDDD were treated surgically using third-generation total intervertebral arthroplasty (Link SB Charité III) with a chromium-cobalt alloy and ultra-high molecular weight (UHMW) poly-ethylene. Average follow-up time was 14 months (6-36 months), and average age was 42 years (35–52). There were 11 females and 5 males. All patients underwent radi-olographic studies, CT scan, MRI, and discography (minimum 2 levels). Indications included LDDD of one to three segments, absence of root tension signs, absence of complete disc collapse, and iconography including concordant discography. LDDD was primary in 11 cases and post-discectomy in 5 cases. Surgery was indicated when at least 6 months of conservative treatment failed to yield results. Blood loss and length of hospital stay were compared to a similar group that underwent posterolateral arthrodesis. Pain, function, and degree of disability were evaluated before and after surgery using GEER (1999) instruments for the evaluation of degenerative lumbar pathology. Increase in height of the posterior intervertebral space and segmentary lordosis were also measured.

Results: Preoperative VAS: 7.8; postoperative VAS: 2.3. Disability index (Oswestry) was 41.3% preoperative and 10.8% postoperative. Average increase in height of posterior intervertebral space was 2.4mm, and mean segmental lordosis was 19.5°, which remained constant through the end of the follow-up period. Average hospital stay was 4.8 days (3–15) compared with 7.5 (5–18) for a group of patients who underwent suspended arthrodesis of L4–L5 with a much smaller quantity of blood loss. No infections were found. Complications: One patient developed an epidural haematoma, which was treated conservatively. Another developed a postoperative retroperitoneal haematoma, which was also treated conservatively. In neither case was there an adverse effect on the outcome of the procedure. One patient showed malpositioning of the prosthetic components on follow-up radiographs, with poor clinical progression at one year postoperative. The patient was treated with posterolateral fusion and right L5 foraminotomy. No infections were seen.

Discussion and Conclusions: Treatment of LDDD with intervertrebral arthroplasty was shown to be effective in the short term, if strict guidelines are followed. Aggressive surgical management is highly inferior to conventional arthrodesis. A longer follow-up period is needed to confirm the validity of this treatment. Technical error in malpositioning of the components in one case caused a poor result.