Comparison of dynamic cervical implant versus anterior cervical discectomy and fusion for the treatment of single-level cervical degenerative disc disease: A five-year follow-up.

By London Spine
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Comparison of dynamic cervical implant versus anterior cervical discectomy and fusion for the treatment of single-level cervical degenerative disc disease: A five-year follow-up.

Clin Neurol Neurosurg. 2017 Dec 05;164:103-107

Authors: Zhu C, Yang X, Wang L, Hu BW, Liu LM, Wang LN, Liu H, Song YM

Abstract
OBJECTIVE: To compare clinical and radiographic outcomes of dynamic cervical implant(DCI) with anterior cervical discectomy and fusion(ACDF) in the treatment of single-level cervical degenerative disc disease (CDDD) 5 years after surgery.
PATIENTS AND METHODS: Forty-three patients with DCI were matched one-to-one with patients with ACDF based on age, gender, and operative segment in this retrospective study. All patients had been followed up for more than 5 years. Radiological assessments included heterotopic ossification(HO), adjacent segment degeneration (ASD), intervertebral height (IH), range of motion (ROM) at C2-7, the implanted level and adjacent levels. Clinical parameters included Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) and Short Form-36 scores(SF-36). Patients were also asked to rate their postoperative satisfaction at final follow-up.
RESULTS: The postoperative ROM of C2-7 and ROM at the implanted level in the DCI group were higher than those in the ACDF group. The ROM at the implanted level in the DCI group was maintained at 2 years postoperatively but decreased at final follow-up (10.7° vs 4.5°). The rate of HO in the DCI group was 46.5% (20/43). The rate of ASD was comparable between the two groups (16.3% vs 20.9%). The JOA, VAS, NDI, and SF-36 scores were comparable between two groups and improved postoperatively. However, the proportion of patients who reported their level of satisfaction as being very satisfied, or somewhat satisfied was larger in the ACDF group than that in the DCI group (95.3% vs 79.1%).
CONCLUSIONS: DCI resulted in better ROM of C2-7 and the implanted level than ACDF did. The clinical outcomes were similar between two groups. However, the ROM at the implanted level decreased at final follow-up in the DCI group, which may contribute to patient dissatisfaction. The long-term outcomes were not that satisfactory especially due to the deviation from its original intention as a non-fusion technique. As such, we have not used DCI in the past 2 years.

PMID: 29220729 [PubMed – as supplied by publisher]

People with chronic low back pain have poorer balance than controls in challenging tasks.

By Kamruz Zaman
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People with chronic low back pain have poorer balance than controls in challenging tasks.

Disabil Rehabil. 2017 Mar 10;:1-7

Authors: da Silva RA, Vieira ER, Fernandes KB, Andraus RA, Oliveira MR, Sturion LA, Calderon MG

Abstract
PURPOSE: To compare the balance of individuals with and without chronic low back pain during five tasks.
METHOD: The participants were 20 volunteers, 10 with and 10 without nonspecific chronic low back pain, mean age 34 years, 50% females. The participants completed the following balance tasks on a force platform in random order: (1) two-legged stance with eyes open, (2) two-legged stance with eyes closed, (3) semi-tandem with eyes open, (4) semi-tandem with eyes closed and (5) one-legged stance with eyes open. The participants completed three 60-s trials of tasks 1-4, and three 30-s trials of task 5 with 30-s rests between trials. The center of pressure area, velocity and frequency in the antero-posterior and medio-lateral directions were computed during each task, and compared between groups and tasks.
RESULTS: Participants with chronic low back pain presented significantly larger center of pressure area and higher velocity than the healthy controls (p < 0.001). There were significant differences among tasks for all center of pressure variables (p < 0.001). Semi-tandem (tasks 3 and 4) and one-leg stance (task 5) were more sensitive to identify balance impairments in the chronic low back pain group than two-legged stance tasks 1 and 2 (effect size >1.37 vs. effect size <0.64). There were no significant interactions between groups and tasks.
CONCLUSIONS: Individuals with chronic low back pain presented poorer postural control using center of pressure measurements than the healthy controls, mainly during more challenging balance tasks such as semi-tandem and one-legged stance conditions. Implications for Rehabilitation People with chronic low back had poorer balance than those without it. Balance tasks need to be sensitive to capture impairments. Balance assessments during semi-tandem and one-legged stance were the most sensitive tasks to determine postural control deficit in people with chronic low back. Balance assessment should be included during rehabilitation programs for individuals with chronic low back pain for better clinical decision making related to balance re-training as necessary.

PMID: 28282992 [PubMed – as supplied by publisher]

Proposed alternative revision strategy for broken S1 pedicle screw: radiological study, review of the literature, and case reports.

By London Spine
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Proposed alternative revision strategy for broken S1 pedicle screw: radiological study, review of the literature, and case reports.

Spine J. 2013 Apr 19;

Authors: Elgafy H, Miller JD, Benedict GM, Seal RJ, Liu J

Abstract
BACKGROUND CONTEXT: There have been many reports outlining differing methods for managing a broken S1 screw. To the authors’ best knowledge, the technique used in the present study has not been described previously. It involves insertion of a second pedicle screw without removing the broken screw shaft. STUDY DESIGN: Radiological study, literature review, and two case reports of the surgical technique. PURPOSE: To report a proposed new surgical technique for management of broken S1 pedicle screws. METHODS: Computed tomography (CT) scans of 50 patients with a total of 100 S1 pedicles were analyzed. There were 25 male and 25 female patients with an average age of 51 years ranging from 36 to 68 years. The cephalad-caudal length, medial-lateral width, and cross-sectional area of the S1 pedicle were measured and compared with the diameter of a pedicle screw to illustrate the possibility of inserting a second screw in S1 pedicle without removal of the broken screw shaft. Two case reports of the proposed technique are presented. RESULTS: The left and right S1 pedicle cross-sectional area in female measured 456.00±4.00 and 457.00±3.00 mm(2), respectively. The left and right S1 pedicle cross-section area in male measured 638.00±2.00 and 639.00±1.00 mm(2), respectively. There were statistically significant differences when comparing male and female S1 pedicle length, width, and cross-sectional area (p<.05). At 2-year follow-up, the two case reports of the proposed technique showed resolution of low back pain and radicular pain. Plain radiograph and CT scan showed posterolateral fusion mass and hardware in good position with no evidence of screw loosening. CONCLUSIONS: The S1 pedicle dimensions measured on CT scan reviewed in the present study showed that it may be anatomically feasible to place a second screw through the S1 pedicle without the removal of the broken screw shaft. This treatment method will reduce the complications associated with other described revision strategies for broken S1 screws.

PMID: 23608561 [PubMed – as supplied by publisher]

Primary results of Kienböck’s disease treated using balloon kyphoplasty system.

By London Spine
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Primary results of Kienböck’s disease treated using balloon kyphoplasty system.

Arch Orthop Trauma Surg. 2012 May;132(5):677-83

Authors: Chen W, Wang J, Pan J, Zhang Q, Shao X, Zhang Y

Abstract
OBJECTIVE: Kienböck’s disease is difficult to treat and optimal treatments for stages II to III continue to elude investigators. We hypothesized that impacting the ischemic cancellous trabeculae and increasing the strength and rigidity of the lunate with balloon kyphoplasty can prevent lunate collapse, relieve the symptoms, and increase wrist range of motion. The purpose of this study was to demonstrate the feasibility of percutaneous balloon kyphoplasty for treatment of stage II to III Kienböck’s disease.
METHODS: The study group comprised five patients (two in stage II, three in stage III). All were treated with balloon kyphoplasty. Pain, strength, and wrist flexion/extension range of motion were evaluated preoperatively and postoperatively. The Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score were used to evaluate outcomes. Patient satisfaction was also assessed. Comparisons between preoperative and postoperative data were made with SPSS software.
RESULTS: Clinical data were collected at a mean of 26.6 months (range 24-28 months) postoperatively. Pain was significantly reduced from 6.8 ± 0.8 in the visual analog scale preoperatively to 0.6 ± 0.9 at the 24-month follow-up. Strength and range of motion were improved postoperatively in all patients. The mean DASH score was 11.3 (range 6.7-18.3), and the mean Mayo Wrist Score was 78 (range 75-80). All five patients returned to their previous occupations.
CONCLUSIONS: Balloon kyphoplasty can prevent lunate collapse, reduce pain, and improve wrist function of patients with stage II to III Kienböck’s disease. Further studies regarding the feasibility of this new approach are warranted.

PMID: 22065146 [PubMed – indexed for MEDLINE]