Aims

There is evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision.

Aims

Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.

Aims

High-energy injuries can result in multiple complications, the most prevalent being infection. Vancomycin powder has been used with increasing frequency in orthopaedic trauma given its success in reducing infection following spine surgery. Additionally, large, traumatic injuries require wound coverage and management by dressings such as negative pressure wound therapy (NPWT). NPWT has been shown to decrease the ability of antibiotic cement beads to reduce infection, but its effect on antibiotic powder is not known. The goal of this study was to determine if NPWT reduces the efficacy of topically applied antibiotic powder.

In patients with osteoporosis there is always a strong possibility that pedicle screws will loosen. This makes it difficult to select the appropriate osteoporotic patient for a spinal fusion. The purpose of this study was to determine the correlation between bone mineral density (BMD) and the magnitude of torque required to insert a pedicle screw. To accomplish this, 181 patients with degenerative disease of the lumbar spine were studied prospectively. Each underwent dual-energy x-ray absorptiometry (DEXA) and intra-operative measurement of the torque required to insert each pedicle screw. The levels of torque generated in patients with osteoporosis and osteopenia were significantly lower than those achieved in normal patients. Positive correlations were observed between BMD and T-value at the instrumented lumbar vertebrae, mean BMD and mean T-value of the lumbar vertebrae, and mean BMD and mean T-value of the proximal femur. The predictive torque (Nm) generated during pedicle screw insertion was [-0.127 + 1.62 × (BMD at the corresponding lumbar vertebrae)], as measured by linear regression analysis. The positive correlation between BMD and the maximum torque required to insert a pedicle screw suggests that pre-operative assessment of BMD may be useful in determining the ultimate strength of fixation of a device, as well as the number of levels that need to be fixed with pedicle screws in patients who are suspected of having osteoporosis

Aims

High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique.

Aims

Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.

1. The case is described of a twenty-nine-year-old man with back pain due to an extensive vascular malformation replacing the major part of a vertebral body. 2. Treatment was by transthoracic ligation of the segmental vessels, with irradiation and spinal fusion later. 3. The importance of demonstrating the origin of the thoraco-lumbar supply to the anterior spinal artery is emphasised

Aims

The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management.

The modified Schollner costoplasty is a cosmetic procedure for the correction of rib prominence deformity in scoliosis. We present the results of the procedure in 21 patients who had previously undergone spinal fusion for scoliosis. We found the procedure to be well tolerated without major complications. Objective cosmetic improvement was achieved in all but one case. All but one patient considered the procedure to have been of cosmetic benefit

The reproduction of symptoms on arthrography of the lumbar facet joint has been accepted as a screening procedure before localised spinal fusion. We studied the histology of 127 facet joints removed at operation from 84 patients, who had previously had facet arthrography. The specificity of the arthrographic results for degenerative joint disease was 75% but their sensitivity was only 59%. This gave a positive predictive value of 85%, but a negative predictive value of only 43%. We conclude that the production of symptoms during facet arthrography is of little value as a screening procedure

Distraction fractures of the upper lumbar spine are most often associated with the wearing of seat-belts. Twenty patients with this spinal fracture were reviewed and half of them had intra-abdominal injuries. Eight patients required an exploratory laparotomy. Three distinct patterns of distraction fractures have been identified. Open reduction, local spinal fusion and Harrington instrumentation are recommended for unstable fractures and for those with neurological involvement. Four cases of non-union are included ln the series. Legislation for the compulsory wearing of seat-belts should encompass improvements in design and stricter criteria for installation

1. Forty-six cases of congenital spondylolisthesis (Newman's Group 1) have been studied. The diagnostic criteria were lumbo-sacral subluxation, deficient development of sacral neural arches and superior facets, and attenuation and elongation of the pars interarticularis, with or without a defect in continuity. 2. Intertransverse lumbo-sacral fusion is a safe and reliable method of treatment. 3. Stabilisation is not complete before two years. 4. Spinal fusion is indicated in all patients with significant symptoms during the period of growth, but in adult patients only if conservative treatment fails

1. A new operation of body-to-body intervertebral fusion by grafts introduced through a posterior approach is described. This is a preliminary report of early results, with follow-up to two years, which seems to be encouraging. 2. In spondylolisthesis, abnormal mobility of the loose posterior neural arch is believed in itself to cause nerve root pressure, and excision of the arch is an important part of the operation. 3. In the few cases where spinal fusion is needed after removal of a prolapsed intervertebral disc—and the proportion is now very low—posterior intervertebral fusion has proved very satisfactory

Operation on the hips of patients with myelomeningocele is often followed by stiffness or ankylosis. Excision of the upper end of the femur for this condition frequently fails because of extensive new bone formation. Twelve excisions in eight patients are reported. Six of these patients had recently had spinal fusion operations; the consequent loss of ability to compensate for hip stiffness by spinal flexion had made sitting difficult or impossible. Excision or even re-excision of the upper femur failed in most cases. Careful assessment of hip mobility before spinal operations in these patients is essential and osteotomy rather than excision of the upper femur is advised

This prospective study was performed to determine the true incidence of deep vein thrombosis of the lower limb in children who had undergone halo-femoral traction to correct scoliosis before operation. Bilateral ascending phlebography of the lower limbs was performed on 54 children two days before spinal fusion and Harrington rod instrumentation. Two patients developed clinical evidence of thrombosis whilst on traction. This diagnosis was confirmed by phlebography. The other 52 children had no clinical evidence of thrombosis and their venograms were normal. The incidence of thrombosis was 3.7 per cent and clinically silent thrombosis did not occur

A study of spondylolysis and spondylolisthesis in 142 children and adolescents is reported. In twelve of the seventy-nine patients followed for over a year the affected vertebra slipped further by 10 per cent or more. Increasing slip occurred mainly during the adolescent growth spurt, and was greater when spinal bifida or other vertebral anomalies were present. If at presentation the slip is less than 30 per cent then further slip beyond 30 per cent is unlikely. Decompression posteriorly is advised when signs of nerve pressure are present. Indications for spinal fusion are suggested; the intertransverse method of fusion was used in sixty-nine patients

A survey has been undertaken of the various complications of halo-pelvic distraction in 118 patients with scoliosis prior to spinal fusion. In the first sixty-two patients the standard solid distraction rods were employed. The neurological complications included ten cases of cranial nerve lesions and two cases of paraplegia, one of them permanent. Springs were then incorporated in the distraction rods so as to allow direct readings ofthe distraction forces, and a total force of 18 kilograms was not exceeded in the last fifty-six patients. No further serious neurological complications occurred, but the amount of correction achieved in the adolescent and juvenile idiopathic types of scoliosis was reduced