Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment

BACKGROUND: Pulmonary function in patients with adolescent idiopathic scoliosis many years after posterior spinal surgery or brace treatment has not been documented. METHODS: A consecutive group of patients treated by posterior fusion or a brace at least 20 years previously was investigated. 90% attended a clinical follow up. Lung volumes were determined before treatment in 251 patients, 1.4 years after surgery in 141 patients, and 25 years after surgery or start of brace treatment in 110 patients. Vital capacity (VC) was calculated as percentage predicted according to height and age and the results were corrected for loss of height due to scoliosis. Scoliosis angles were measured and smoking habits were recorded. An age and sex matched control group was also examined with the same questionnaire and pulmonary function tests. RESULTS: VC increased from 67% predicted immediately before surgery to 73% (p<0.001) after surgery and to 84% (p<0.001) at the present follow up, mean change 10.8% (95% CI 9.5 to 12.1). In the brace treated patients VC increased from 77% predicted before treatment to 89% (p<0.001) 25 years after start of treatment, mean change 12.3% (95% CI 10.5 to 14.1). The mean Cobb angle at the present follow up study was 40 degrees in both surgically and brace treated patients. The present results of lung volumes did not correlate with pretreatment or post-treatment Cobb angles or smoking habits. CONCLUSIONS: Patients treated by posterior fusion or a brace gradually increase their pulmonary function up to 25 years after treatment. Smoking and curve size are not risk factors for reduced pulmonary function.     

Neurotropism in nerve regeneration: an immunohistochemical study

A rectangular pseudomesothelial-lined chamber was used to elucidate the hypothesis that in adult rats neurotrophic factors are formed after nerve injury and may influence regeneration of peripheral nerves. The proximal end of a cut sciatic nerve was inserted into one corner of the chamber. In one group of animals the distal end of the cut sciatic nerve was implanted in the diagonally opposite corner of the chamber. In another group we just introduced the proximal end of the sciatic nerve; no distal implant was used. The organization, length and direction of the nerve fibres, regenerating from the proximal end of the sciatic nerve, was visualized immunohistochemically with the aid of antibodies against neurofilaments at 2, 3 and 4 weeks after surgery. When a distal sciatic nerve segment was used, nerve fibres regenerating from the proximal cut end of the sciatic nerve showed an organized growth across the chamber, formed bundles and grew into the diagonally implanted nerve piece. If there was no distal implant, the growth of the randomly directed nerve fibres ceased after about two weeks, resulting in formation of a neuroma-like structure. Increased immunoreactivity of the trophic peptide insulin-like growth factor I (IGF-I, somatomedin C) was demonstrated in the regenerating nerve, most evidently in reactive Schwann cells. It is concluded that a positive neurotropic effect is exerted on growing nerve fibres by injured, reactive peripheral nerve tissue. There could tentatively be a relation between nerve regeneration and local formation of trophic factors.     

Chronic pain—the end of the welfare state?

The problem of low back pain has reached epidemic proportions in the industrialized nations. The predicament of back pain is common, 30–40% of our populations from 10–65 years old report such trouble to occur on a monthly basis. In 1–8% this results in work-disabling back pain. Only in very few of these patients can physicians diagnose a definite pathoanatomical cause for the pain. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. Sweden, with 100% sickness benefits, has the highest disability rate.Few non-surgical methods have proven effective in rendering the patient better for him to return to work. Even fewer studies demonstrate any benefit from surgery, simple open removal of a proven disc hernia being the only exception. For patients with unproven diagnostic labels such as facet arthritis, degenerative disc disease, internal disc resorption and instability, no evidence exists that any type of surgery is cost-effective.     

Patient draping and staff clothing in the operating theatre: a microbiological study

Fallout of bacteria and contamination at the wound site were studied during a standardized orthopaedic operation using sedimentation plates and a bacterial sampler. The procedure was performed in either a conventionally ventilated operating theatre or in an ultraclean air enclosure. The staff was dressed in either an all-cotton system (working clothes and theatre gown) or cotton working clothes in combination with Ventile theatre gown, or a laminate disposable theatre gown, or finally a polypropylene coverall and a laminate theatre gown. The patients were draped in cotton or laminate. The study was done during 5 periods. The most striking effect was seen when the combination of the coverall and the laminate theatre gown was used. The fallout in the conventional theatre was then at the same level as in the ultraclean air. It was even less than using Ventile gowns and laminate drapes in ultraclean air. The contamination at the wound site showed the same pattern. However, least contamination was recorded when laminate gowns and laminate drapes were used in ultraclean air.     

A locking hook spinal rod system for stabilization of fracture-dislocations and correction of deformities of the dorsolumbar spine. A biomechanic evaluation

Existing internal fixation systems for the injured or deformed spine present problems with overdistraction and control of the contoured rod necessary for transverse forces. A locking hook spinal rod avoids these problems by using a locking cover to secure the lamina in the hook and meshing radial grooves to lock the contoured rod to both the upper and lower hooks in 6 degrees intervals of rotation. The 7-mm stainless-steel rod is 50% stronger than the 1/4-in Harrington rod and also avoids the weakening effect of the notches. Cadaver spine testing gives nearly a threefold increase in failure strength (125 +/- 17 Nm versus 44.1 +/- 2.1).