The Luque trolley revisited. Review of nine cases requiring revision.

This study is a retrospective review of nine patients who underwent Luque instrumentation without fusion from 1982-1984. Average age at surgery was 9 years. Average preoperative curve was 51 degrees (30 degrees-70 degrees). All nine patients have had at least one revision. All of the revisions were technically difficult secondary to extensive fibrosis and weakened laminar bone. Spontaneous fusion was documented in all nine patients, limiting further correction. Final follow-up curves averaged 51 degrees (25 degrees-90 degrees). Average gain in spinal height was 5.8 cm (2.3 in) but only a small portion was derived from the instrumented levels. Segmental spinal instrumentation without fusion in immature patients was not effective in control of spinal deformity, nor did it allow anticipated growth under the instrumented regions.     

The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification

We studied 100 consecutive patients with potentially unstable fractures and fracture-dislocations by multiplane computed tomography. The mechanism of failure of the middle osteoligamentous complex of the spine (posterior longitudinal ligament, posterior part of the vertebral body, and posterior annulus fibrosus) was determined by three-dimensional analysis. Three modes of middle-column failure were used to classify the injuries: axial compression (seventy-three patients), axial distraction (fifteen patients), and translation within the transverse plane (twelve patients). Fifty of eighty-six patients who were evaluated in the acute phase of injury underwent operative stabilization, and the mechanism of middle-column disruption determined the type of instrumentation that was used. Compression and distraction injuries of the middle complex could be appropriately treated by Harrington distraction and compression instrumentation, respectively. However, in translational injuries (torn posterior longitudinal ligament) routine Harrington instrumentation was contraindicated due to the risk of overdistraction. Translational injuries were associated with the greatest degree of instability and often had complete ligament discontinuity at the level of the affected vertebrae. Patients with a translational injury had the most severe neural deficits (six of eleven patients studied acutely having a complete spinal cord lesion). Translational injuries of the middle column were treated by segmental spinal instrumentation to provide strong fixation with minimum risk of neural sequelae from passing sublaminar wires. Moreover, postoperative use of a cast over insensate skin was not required. Computed tomography was more sensitive than any other modality in the diagnosis of disruption of the posterior elements in unstable burst fractures, and computer-reconstructed sagittal images were accurate in evaluating the nature of facet-joint failure in distraction injuries. Computed tomography with metrizamide proved superior to either conventional tomography or myelography alone in localizing the site of neural canal compromise in acute thoracolumbar injuries. The mode of failure of the middle osteoligamentous complex as visualized by computed tomography determined the pattern of spinal injury, the severity of the neural deficit, the degree of instability, and the type of instrumentation required.     

Lower Extremity Compartment Syndrome In An Adolescent With Spinal Cord Injury

Abstract

Objective: Describe the unusual complication of lower extremity compartment syndrome occurring in an adolescent with spinal cord injury (SCI).

Methods: Case presentation.

Results: A 17 -year-old male with C5 ASIA A complete SCI developed a compartment syndrome of his lower leg on the ninth day postinjury. Presenting signs included an equinus deformity of the foot, blackened induration over the anterior tibia, circumferential erythematous markings over the calf, large urticarial lesions over the knee, and calf swelling. The presumed etiology of the compartment syndrome was excessive pressure from elastic wraps, which were placed over gradient elastic stockings. Pressures were 51 mmHg in the superficial posterior; 50 mmHg in the deep posterior; 33 mmHg in the anterior; and 34 mmHg in the peroneal compartments. The patient also developed rhabdomyolysis with myoglobinuria. In addition to supportive care, the patient underwent a dual incision fasciotomy for compartment release.

Conclusions: The development of lower extremity compartment syndrome was probably a result of excessive pressure applied by elastic wraps. Elastic wraps should be used with caution in individuals with SCI.

J Spinal Cord Med. 2001 ;24:278–283