U-shaped sacral fractures: surgical treatment and quality of life.

Background: U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain if not diagnosed and treated properly.

No evidence for the effectiveness of bracing in patients with thoracolumbar fractures.

Background And Purpose: The use of braces is widespread in patients with thoracolumbar fractures. The effectiveness of bracing, however, is controversial. We sought evidence for the effect of bracing in patients with traumatic thoracolumbar fractures based on outcome and length of hospital stay (LOS).

Suspected atlantoaxial rotatory fixation-subluxation: the value of multidetector computed tomography scanning under general anesthesia.

Study Design: Clinical case reports and radiologic study.

Objectives: To emphasize the value of computed tomography (CT) scan under general anesthesia in order to prevent misdiagnosing atlantoaxial rotatory fixation-subluxation in children with acute torticollis.

Summary Of Background Data: A "cock-robin" posture clinically characterizes painful rotatory fixation of the atlantoaxial joint in children.

Endovascular graft for late iatrogenic vascular complication after anterior spinal instrumentation: a case report.

Study Design: Case report.

Objective: To describe an endovascular treatment option for (late) vascular complications after anterior spinal instrumentation.

Summary Of Background Data: Severe progressive scoliosis is a well-known feature in Marfan's disease.

Esophageal perforation associated with cervical spine surgery: report of two cases and review of the literature.

Background/aims: Esophageal perforation after anterior cervical spine surgery is a rare complication with various clinical presentations and treatments.

Methods: Two cases of esophageal perforation after anterior cervical spine surgery are described, one occurring in the immediate postoperative period and one several years after plate stabilization of the cervical spine.

Results: Primary suturing of the acute perforation and diversion of the salivary flow by means of T-tube placement after delayed presentation allowed successful healing of the esophageal defects.

Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures.

The surgical management of post-traumatic thoracolumbar kyphosis remains controversial. The need for combined procedures is subject to debate, especially for post-traumatic kyphosis after simple type A fractures. The aim of this retrospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome after mono-segmental surgical treatment using an anterior procedure alone (group 1, n = 10 patients) and using a one-stage combined anterior and posterior procedure (group 2, n = 15 patients) for post-traumatic thoracolumbar kyphosis after simple type A fractures.

Clinical outcome and radiographic results after operative treatment of Scheuermann's disease.

The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal plane correction after removal of the posterior instrumentation was analysed. The indication for surgery was a thoracic kyphosis greater than 60 degrees in adolescents and adults with persistent back pain, which failed to respond to conservative treatment.

Results of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure.

A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47 years. The Medizip was used in 20 surgical knee wounds, 20 hip wounds and 20 orthopaedic spine wounds.

Crohn's disease presenting as life-threatening ileal bleeding.

We report a case of Crohn's disease in a 32-year old Saudi male. The disease presented with severe, life-threatening ileal bleeding necessitating an urgent laparotomy and 100 cm of ileum and ascending colon was resected. The bleeding source was several ulcers in an inflamed ileum and histopathologic examination revealed typical findings of Crohn's disease with a chronic, transmural inflammation, non-caseating granuloma and the Ziehl-Neelsen stain was negative.

Upper thoracic spinal fractures in trauma patients - a diagnostic pitfall.

The diagnosis of upper thoracic spinal fractures in multiple-trauma patients remains a challenge. The clinical findings are often difficult to detect, especially in the presence of other (extremity) fractures, head injuries or in patients on respiratory support. The findings of chest radiographs and plain spinal films are described in a series of 23 patients with an upper thoracic spinal fracture.

Comparison of two types of surgery for thoraco-lumbar burst fractures: combined anterior and posterior stabilisation vs. posterior instrumentation only.

This retrospective study compares clinical outcome following two different types of surgery for thoracolumbar burst fractures. Forty-six patients with thoracolumbar burst fractures causing encroachment of the spinal canal greater than 50% were operated on within 30 days performing either: combined anterior decompression and stabilisation and posterior stabilisation (Group 1) or posterior distraction and stabilisation using pedicle instrumentation (AO internal fixator) (Group 2). We evaluated: neurological status (Frankel Grade), spinal deformities, residual pain, and complications.

A comparison of myogenic motor evoked responses to electrical and magnetic transcranial stimulation during nitrous oxide/opioid anesthesia.

Unlabelled: Transcranial motor evoked potentials (tc-MEPs) are used to monitor spinal cord integrity intraoperatively. We compared myogenic motor evoked responses with electrical and magnetic transcranial stimuli during nitrous oxide/opioid anesthesia. In 11 patients undergoing spinal surgery, anesthesia was induced with i.

Influence of isoflurane on myogenic motor evoked potentials to single and multiple transcranial stimuli during nitrous oxide/opioid anesthesia.

Objective: Transcranial motor evoked potentials (tc-MEPs) are used to monitor the spinal cord intraoperatively. Volatile anesthetics considerably depress amplitudes of tc-MEPs. This study was undertaken to determine whether multipulse stimulation might overcome this depressant effect.

[One hundred years of orthopedics in the Netherlands. IV. Spinal abnormalities].

In recent years there has been spectacular progress in the approach to various disorders of the spinal column. Owing to improved methods of osteosynthesis there is no longer so much need for long periods of postoperative bed rest. Of all the scolioses, idiopathic scoliosis is most common.

Differential effects of nitrous oxide and propofol on myogenic transcranial motor evoked responses during sufentanil anaesthesia.

We have compared the effects of 50% nitrous oxide and propofol, each administered concurrently with sufentanil, on the amplitudes and latencies of the compound muscle action potential (CMAP) response to transcranial electrical stimulation. Using a crossover design, 12 patients undergoing spinal surgery were exposed to both 50% nitrous oxide and propofol, the latter in a bolus-infusion regimen. Six patients received nitrous oxide first and six received propofol first.

The use of ketamine or etomidate to supplement sufentanil/N2O anesthesia does not disrupt monitoring of myogenic transcranial motor evoked responses.

Intraoperative monitoring of myogenic transcranial motor evoked responses (tc-MERs) requires an anesthetic technique that minimally depresses response amplitudes. Acceptable results have been obtained during opioid/N2O anesthesia, provided that the concentration of N2O does not exceed 50%. However, this technique may necessitate supplementation with additional agents to achieve adequate depth of anesthesia.

Dreams: the convergence of neurobiologic and psychoanalytic perspectives.

Fromm's Aristotelian statement that "Dreaming is a meaningful expression of any kind of mental activity under the condition of sleep" (Fromm, 1951, p. 25) is similar to a modern neurobiological conclusion about the dreaming process. The current data from the neurosciences lead to the definition of dreams as a neuropsychological event during sleep whose manifest contents are affect laden, visual, auditory, and kinesthetic.

The use of a circumferential cathode improves amplitude of intraoperative electrical transcranial myogenic motor evoked responses.

Measurement of motor evoked responses to transcranial electrical stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways. Since most anesthetics significantly reduce motoneuronal excitability, optimal stimulation paradigms should be sought. We compared the efficiency of stimulus delivery using two different configurations of the cathode component of the stimulating electrode pair (circumferential: Fz, F3, F4, A1, and A2 versus a single cathode at Fz).

Improved amplitude of myogenic motor evoked responses after paired transcranial electrical stimulation during sufentanil/nitrous oxide anesthesia.

Background: Measurement of motor evoked responses to transcranial stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways in the brain and spinal cord. However, clinical application of tc-MER monitoring is hampered because most anesthetic techniques severely depress the amplitude of motor evoked responses. Because paired electrical stimuli increase tc-MER responses in awake subjects, we examined their effects in anesthetized patients undergoing surgery.

Neurologic injury after insertion of laminar hooks during Cotrel-Dubousset instrumentation.

Background Data: Although the use of Cotrel-Dubousset (CD) instrumentation has improved results of operative treatment of scoliotic deformities, this technique may be associated with increased risk of neurologic injury.

Case Histories: Two cases of neurologic complications immediately after insertion of lumbar laminar hooks during CD instrumentation for correction of scoliosis are reported.

Methods: Between 1986 and 1992, the authors performed 220 CD instrumentations for various spinal deformities.

Cellular hemangioma and angioblastoma of the spine, originally classified as hemangioendothelioma. A confusing diagnosis.

Study Design: The authors report two cases of vascular tumors of the spine, classified originally as benign and malignant hemangioendothelioma, and after revision, as cellular hemangioma and angioblastomatosis, respectively.

Objectives: Problems in interpretation of the confusing term hemangioendothelioma and treatment modalities for vascular tumors of the spine are discussed.

Summary Of Background Data: Hemangioendothelioma is a confusing term and is often used to cover bewilderment at the biological behavior of a vascular tumor.

Variability of somatosensory cortical evoked potentials during spinal surgery. Effects of anesthetic technique and high-pass digital filtering.

The effects of anesthetic technique (nitrous oxide or propofol) and high-pass digital filtering on within-patient variability of posterior tibial nerve somatosensory cortical evoked potentials (PTN-SCEP) were compared prospectively in two groups of 20 patients undergoing spinal surgery. Average P1N1 amplitude was significantly higher and P1N1 amplitude variability lower during propofol/alfentanil anesthesia than during nitrous oxide/alfentanil anesthesia. Off-line 30-Hz high-pass digital filtering significantly reduced P1N1 amplitude variability without decreasing P1N1 amplitude.

Anterior decompression and stabilization of thoracolumbar burst fractures by the use of the Slot-Zielke device.

Between July 1983 and November 1986, 29 patients with thoracolumbar burst fractures underwent a one-stage operation consisting of anterior decompression by subtotal vertebrectomy, reduction, and stabilization with the Slot-Zielke device. The mean follow-up was 3.1 years.

Anterior decompression and stabilization of thoracolumbar burst fractures using the Slot-Zielke-device.

A retrospective study was performed on 62 patients treated for thoracolumbar burst fractures. The Fracture Study Protocol of the Scoliosis Research Society was used for data collection. The first group consisted of 29 patients, treated between July 1983 and November 1986 with an one-stage operation consisting of anterior decompression by subtotal vertebrectomy, reduction and stabilization with the Slot-Zielke device.