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Day: February 22, 2019

Primary diffuse leptomeningeal gliomatosis as a rare cause of pain in cervical spine.

By wp_zaman
Related Articles

Primary diffuse leptomeningeal gliomatosis as a rare cause of pain in cervical spine.

BMC Cancer. 2016;16(1):182

Authors: Sivák Š, Kantorová E, Kurča E, Marcinek J, Slávik P, Michalik J, Nosáľ V

Abstract
BACKGROUND: Primary diffuse leptomeningeal gliomatosis (PDLG) is a very rare neuro-oncological disease, with only 90 cases of PDLG described in medical literature so far.
CASE PRESENTATION: We present a case report of a 56-years-old female patient, who was originally hospitalized due to cervical spine pain lasting several months. Despite complex diagnostics and treatment, the neurological state of the patient progressively deteriorated. Patient died 10 months after the first reported symptom. Postmortem pathological findings resulted in the diagnosis of PDLG.
CONCLUSIONS: Affection of the cervical spine in early stages of PDLG is rare and has been described in only six patients so far. PDLG is a fatal neuro-oncological disease and it must be kept in mind in the differential diagnosis of persistent back pain syndromes.

PMID: 26944049 [PubMed – as supplied by publisher]

Biomechanical Evaluation of the Pedicle Screw Insertion Depth Effect on Screw Stability Under Cyclic Loading and Subsequent Pullout.

By wp_zaman

Biomechanical Evaluation of the Pedicle Screw Insertion Depth Effect on Screw Stability Under Cyclic Loading and Subsequent Pullout.

J Spinal Disord Tech. 2014 Oct 10;

Authors: Karami KJ, Buckenmeyer LE, Kiapour AM, Kelkar PS, Goel VK, Demetropoulos CK, Soo TM

Abstract
STUDY DESIGN:: A biomechanical ex vivo study of the human lumbar spine.
OBJECTIVE:: To evaluate the effects of transpedicular screw insertion depth on overall screw stability and pullout strength following cyclic loading in the osteoporotic lumbar spine.
SUMMARY OF BACKGROUND DATA:: While much is known about the clinical outcomes of spinal fusion, questions remain in our understanding of the biomechanical strength of lumbar pedicle screw fixation as it relates to screw sizing and placement. Biomechanical analyses examining ideal pedicle screw depth with current pedicle screw technology are limited. In the osteoporotic spine, optimized pedicle screw insertion depth may improve construct strength, decreasing the risk of loosening or pullout.
METHODS:: A total of 100 pedicles from 10 osteoporotic lumbar spines were randomly instrumented with pedicle screws in mid-body, pericortical and bicortical depths. Instrumented specimens underwent cyclic loading (5000 cycles of ±2 Nm pure flexion moment) and subsequent pullout. Screw loosening, failure loads and energy absorption were calculated.
RESULTS:: Cyclic loading significantly (P<0.001) reduced screw-bone angular stiffness between pre-fatigue and post-fatigue conditions by 25.6±17.9% (mid-body), 20.8±14.4% (pericortical) and 14.0±13.0% (bicortical). Increased insertion depth resulted in lower levels of reduction in angular stiffness which was only significant between mid-body and bicortical screws (P=0.009). Pullout force and energy of 583±306 N and 1.75±1.98 Nm (mid-body), 713±321 N and 2.40±1.79 Nm (pericortical), and 797±285 N and 2.97±2.33 Nm (bicortical) were observed, respectively. Increased insertion depth resulted in higher magnitudes of both pullout force and energy, which was significant only for pullout force between mid-body and bicortical screws (P=0.005).
CONCLUSION:: Although increased screw depth led to increased fixation and decreased loosening, additional purchase of the stiff anterior cortex is essential in order to reach superior screw-bone construct stability and stiffness.

PMID: 25310387 [PubMed – as supplied by publisher]

A retrospective study of posterior malleolus fractures.

By wp_zaman
Related Articles

A retrospective study of posterior malleolus fractures.

Int Orthop. 2012 Sep;36(9):1929-36

Authors: Xu HL, Li X, Zhang DY, Fu ZG, Wang TB, Zhang PX, Jiang BG, Shen HL, Wang G, Wang GL, Wu XB

Abstract
PURPOSE: In this retrospective study, we evaluated the treatment effect of ankle joint fracture surgery involving the posterior malleolus, and discuss relevant factors influencing the occurrence of traumatic arthritis of the ankle joint.
METHODS: A total of 102 cases of ankle joint fractures involving the posterior malleolus in five large-scale skeletal trauma centres in China, from January 2000 to July 2009, were retrospectively analysed in terms of surgical treatment and complete follow-up. Ankle joint mobility, posterior malleolus fragment size, articular surface evenness, Ankle-Hindfoot Scale of the American Orthopedic Foot and Ankle Society (AOFAS) score, and imaging scale score for arthritis were recorded. The degree of fracture pain during rest, active movement, and weight-bearing walking, and satisfaction with treatment were evaluated using a visual analogue scale (VAS).
RESULTS: The average AOFAS score was 95.9, excellence rate was 92.2 %, and average VAS scores for degree of fracture pain during rest, active movement, and weight-bearing walking were 0.15, 0.31, and 0.68, respectively. Thirty-six cases showed arthritic manifestations. Ankle joint mobility along all directions on the injured side was lower than that on the unaffected side. There was no obvious difference in treatment effect between the fixed and unfixed posterior malleolus fragment groups for all and for fragment size of < 25 %; between fixing the posterior malleolus fragment from front to back or from back to front; or between elderly patients (≥ 60 years old) and young patients (< 60 years old). There was a distinct difference in the treatment effect between articular surface evenness and unevenness for all and for fragment size of ≥ 25 %.
CONCLUSIONS: For all 102 cases of ankle joint fracture involving the posterior malleolus, the treatment effect was satisfactory. Restoration of an even articular surface, especially when fragment size ≥ 25 %, should be attempted during treatment.

PMID: 22777382 [PubMed – indexed for MEDLINE]