Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO Comprehensive Classification.

Background: The incidence of spinal fractures varies from 1% to 17% in alpine skiing injuries. Distinctions have been made regarding the differences in the mechanisms of injury and fracture types between skiing and snowboarding. Although fracture patterns have been described, there have not been any detailed descriptions of the specific fracture types and subgroups.

Observer agreement in assessing flexion-extension X-rays of the cervical spine, with and without the use of quantitative measurements of intervertebral motion.

Background Context: Flexion-extension X-rays are commonly used to identify abnormalities in intervertebral motion, despite little evidence for the reliability of the information that clinicians derive from these test.

Purpose: Quantify observer agreement on intervertebral motion abnormalities assessed with and without the use of computer-assisted technology.

Study Design: Assess interobserver agreement among clinicians when they evaluate cervical flexion-extension X-rays using the methods they now use in clinical practice, and compare this to observer agreement when the same clinicians reassess the X-rays using computer-assisted technology.

Lumbar isthmic defects in teenagers resulting from stress fractures.

Background Context: An accepted classification of spondylolysis exists. However, etiology remains controversial. There are several reports supporting acquired stress fractures in the etiology of this condition, although radiographic evidence of an acquired fracture in a given individual is very rare.

Disc herniation after lumbar fusion.

Study Design: Eight patients with a herniated disc after lumbar spinal fusion are reported. Their clinical features, imaging studies, and management are reported.

Objectives: To identify the incidence and features of disc herniation above a spinal fusion, and to describe their management.

Analysis of circumferential lumbar fusion outcome in the treatment of degenerative disc disease of the lumbar spine.

This study reviews the results of circumferential fusion in patients with degenerative disc disease who are at high risk for achieving spinal fusion. The fusion rate was 100% and the satisfactory clinical outcome slightly more than 50% in a patient population known to have high risk factors for a poor outcome.

Pseudarthrosis of the lumbar spine. Outcome after circumferential fusion.

Study Design: Twenty-five patients with a pseudarthrosis after previous spinal fusion surgery were reviewed after a circumferential fusion was performed.

Objectives: To determine the fusion rate and its relation to outcome, i.e.

Traumatic pneumomyelography. A marker of spinal column injury in the face of innocuous spine fractures: two case reports.

Study Design: A report of two cases of spinal column injury.

Object: To document the presence of air within the spinal canal following spinal fractures.

Summary Of Background Data: Only two previous cases of air in the spinal canal have been reported in the English literature.

An unusual cause of lumbar discitis.

Study Design: Case report.

Objective: To identify an unusual cause of lumbar discitis.

Summary Of Background Data: Discitis resulting from a foreign body has not been reported in the English-language literature.

Semirigid instrumentation in the management of lumbar spinal conditions combined with circumferential fusion. A multicenter study.

Study Design: Patients with the diagnosis of degenerative disc conditions or spondylolisthesis undergoing circumferential fusion with posterior pedicle screw fixation using a semirigid rod were reviewed.

Objectives: To determine the effectiveness of this approach in achieving a spinal fusion and satisfactory clinical outcome, and to determine the complications associated with the procedure.

Summary Of Background Data: The use of instrumentation to stabilize the lumbar motion segments and thereby enhance the fusion rate has been proposed in a number of studies.

Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.

Study Design: Thirty-five patients with spinal fractures in a series of 1019 patients deteriorated neurologically while in the hospital. Thirty-two were available for review.

Objectives: To determine whether there was a preponderance of a fracture type associated with early neurologic deterioration.

Iliac crest reconstruction after tricortical graft harvesting.

Twenty-eight patients underwent anterior iliac crest reconstruction after the harvesting of autogenous tricortical graft. The anterior iliac crest was reconstructed using the resected rib from the thoracoabdominal approach. The authors evaluated graft site pain and residual deformity, radiographic evidence of rib incorporation, and the incidence of lateral femoral cutaneous nerve injury.

A comprehensive classification of thoracic and lumbar injuries.

In view of the current level of knowledge and the numerous treatment possibilities, none of the existing classification systems of thoracic and lumbar injuries is completely satisfactory. As a result of more than a decade of consideration of the subject matter and a review of 1445 consecutive thoracolumbar injuries, a comprehensive classification of thoracic and lumbar injuries is proposed. The classification is primarily based on pathomorphological criteria.

Canal clearance in burst fractures using the AO internal fixator.

The purpose of this study was to evaluate the ability of posterior distraction delivered by the AO internal fixator to effect a satisfactory reduction of the intraspinal fragments in burst fractures. The overall decompression achieved was from an initial compromise of 54% to a residual encroachment of 40%. Canal clearance proved most effective when carried out in the first 4 days, with an initial canal compromise of between 34 and 66%.

Scoliosis Research Society. Multicenter spine fracture study.

This study consisted of 1,019 spinal fracture patients followed prospectively for 2 years. Sixty-four physicians from 12 countries participated. The purpose of the study was to determine: 1) the relationship between neurologic deficit and fracture type, level, and spinal canal compromise; 2) the neurologic outcome comparing surgical versus nonsurgical treatment and anterior versus posterior surgery; and 3) the relationship of pain to both kyphotic deformity and to surgical and nonsurgical treatment.

Flexion distraction injuries of the thoracolumbar spine: a review.

Flexion-distraction injuries of the thoracolumbar spine and the "seat belt syndrome" are reviewed. The incidence, pathogenesis, classification, diagnosis, and treatment of these injuries are discussed.

Analysis of sagittal plane instability of the lumbar spine in vivo.

Segmental instability secondary to degenerative disc disease may result in chronic low-back pain. In the sagittal plane, segmental instability can be characterized during lumbar motion from full extension to full flexion. The authors studied this movement using a translational method for the kinematic analysis, implementing a new concept known as the instability factor.

Results of a locking-hook spinal rod for fractures of the thoracic and lumbar spine.

The results of a consecutive series of 110 patients treated with the locking-hook spinal rod are presented. A prospective protocol was completed in 95 patients. Pain was absent or mild in 93%.

Posttraumatic ligamentous disruption of the cervical spine, an easily overlooked diagnosis: presentation of three cases.

Three patients with hyperflexion sprain of the cervical spine secondary to motor vehicle accidents are discussed. One patient exhibited tetraplegia and the other two only had paresthesia of the upper and/or lower extremities at the scene of the accident. All patients were young with no evidence of degenerative disc disease or osteoarthritis.

Accuracy of pedicular screw placement in vivo.

The accuracy of pedicular screw placement was assessed in 40 consecutive patients treated with the AO "Fixateur Interne." Postoperative CT scans were used to measure canal encroachment from the medial border of the pedicle, the angle of insertion and the point of entry. Eighty-one percent of the screws were placed within 2 mm of the medial border of the pedicle and 6% had 4-8 mm of canal encroachment with two patients developing minor neurological complications that spontaneously resolved.

Rationale for the management of flexion-distraction injuries of the thoracolumbar spine based on a new classification.

A new classification of flexion-distraction injuries of the spine is described based on the bony and soft tissue injuries to the posterior complex and the anterior column. In addition, the classification includes the status of the vertebral body, that is, the association of a wedge-compression fracture or a burst injury. The soft tissue component provides a rationale for surgical intervention.

Decompression and circumferential stabilization of unstable spinal fractures.

A technique of anterior decompression of the spinal canal with anterior strut grafts, followed by posterior instrumentation and local fusion, is described in a group of 18 patients with unstable thoracolumbar fractures. All patients were found to have greater than 50% encroachment of the spinal canal and a preoperative kyphosis of 21.8 degrees.