Cost-Benefit Analysis of Routine Bone Biopsy During Augmentation of Osteoporotic Vertebral Compression Fractures.

Study Design: Multi-center prospective study.

Objective: To analyze the cost of routine biopsy during augmentation of osteoporotic vertebral compression fractures (VCF) and the affect it has on further treatment.

Summary Of Background Data: Vertebroplasty (VP) and Balloon Kyphoplasty (BKP) are accepted treatments for VCF.

Anxiety and depression predict poor outcomes in arthroscopic subacromial decompression.

Background: Subacromial impingement is common and frequently treated with arthroscopic subacromial decompression (ASD); however, its efficacy has recently been questioned. Poor surgical outcomes have been associated with anxiety and depression within other orthopedic subspecialties but not within this group of patients. We hypothesized that anxiety and depression are associated with worse outcomes after ASD.

The management of high-grade spondylolisthesis and co-existent late-onset idiopathic scoliosis.

Introduction: It is relatively common for a scoliosis deformity to be associated with a lumbar spondylolisthesis in adolescents (up to 48 % of spondylolistheses). In the literature two types of curve have been described: 'sciatic' or 'olisthetic'. However, there is no consensus in the literature on how best to treat these deformities.

Major neurological deficit following anterior cervical decompression and fusion: what is the next step?

Introduction: Major neurological deficit following anterior cervical decompression and fusion (ACDF) is a rare event, with incidences of up to 0.2 % now reported. Post-operative MRI is mandatory to assess for ongoing compression of the cord.

The role of arthroscopy in the treatment of functional instability of the ankle.

Background: Ankle sprains are common, the majority resolving with functional rehabilitation. Some patients are left with symptoms of functional instability (FI). Ankle arthroscopy in those with symptoms of FI is not well covered in the literature.

Safety of fluoroscopy guided percutaneous access to the thoracic spine.

Background: Fluoroscopy-guided percutaneous access to thoracic vertebrae is technically demanding due to the complex radiological anatomy and close proximity of the spinal cord, major vessels and pleural cavity. There is a trend towards computed tomography (CT) guidance due to a perceived reduction in the risk of spinal canal intrusion by instrumentation causing neurological injury. Due to limited access to CT guidance, there is a need for safe fluoroscopy-guided percutaneous access to the thoracic spine.

Freehand determination of the trajectory angle for cervical lateral mass screws: how accurate is it?

Different methods of lateral mass screw placement in the cervical spine have been described with separate trajectories for each technique in the sagittal and parasagittal planes. In the latter, plane 30° has been recommended in the modified Magerl's technique as the optimum angle to avoid injury to the vertebral artery and nerve root. The estimation of this angle remains arbitrary and very much operator dependant.

Lumbar microdiscectomy versus sequesterectomy/free fragmentectomy: a long-term (>2 y) retrospective study of the clinical outcome.

Study Design: Retrospective cohort study.

Objective: To compare the long-term outcome of microdiscectomy versus sequestrectomy/free fragmentectomy for lumbar disc herniation.

Summary Of Background Data: Conventional lumbar microdiscectomy involves substantial excision of disc material from the intervertebral disc space to prevent reherniation.

Lamina-guided lateral mass screw placement in the sub-axial cervical spine.

Lateral mass (LM) screws are commonly used in posterior instrumentation of the cervical spine because of their perceived safety over pedicle screws. A possible complication of cervical LM screw placement is vertebral artery injury or impingement. Several screw trajectories have been described to overcome the risks of neurovascular injury; however, each of these techniques relies on the surgeon's visual estimation of the trajectory angle.

The ipsilateral lamina-pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

Pedicle screws in the sub-axial spine are infrequently used because of concerns over their safety and difficulty in placement, despite their superior pullout strength. In the sub-axial cervical vertebrae, we have observed that the lamina appears to project at right angles to the ipsilateral pedicle axis. The aim of this investigation was to confirm the lamina orientation as a reliable landmark for pedicle screw placement.

Percutaneous approach to the upper thoracic spine: optimal patient positioning.

Percutaneous access to the upper thoracic vertebrae under fluoroscopic guidance is challenging. We describe our positioning technique facilitating optimal visualisation of the high thoracic vertebrae in the prone position. This allows safe practice of kyphoplasty, vertebroplasty and biopsy throughout the upper thoracic spine.

Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature.

Sacral insufficiency fractures (SIFs) are an increasingly recognised cause of back pain in the elderly. They can cause significant pain and disability in the elderly population and until recently, the mainstay of treatment has been analgesia and physical therapy. We undertook a review of the literature looking at the outcome with various operative techniques currently used in the treatment of SIF.