Association between MRI findings and clinical outcomes in a period of 5 years after lumbar spine microdiscectomy

European Journal of Orthopaedic Surgery & Traumatology - To evaluate the associations between magnetic resonance imaging (MRI) findings and pain, disability and quality of life before surgery...     

Management of thoracolumbar spine fractures

Background contextTraumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability.PurposeTo review the most current information regarding the pathophysiology, injury pattern, treatment options, and outcomes.Study designLiterature review.MethodsRelevant articles, textbook chapters, and abstracts covering thoracolumbar spine fractures with and without neurologic deficit from 1960 to the present were reviewed.ResultsThe thoracolumbar spine represents a unique system from a skeletal as well as neurological standpoint. The rigid rib-bearing thoracic spine articulates with the more mobile lumbar spine at the thoracolumbar junction (T10 - L2), the site of most fractures. A complete examination includes a careful neurologic examination of both motor and sensory systems. CT scans best describe bony detail while MRI is most efficient at describing soft tissues and neurological structures. The most recent classification system is that of the new Thoracolumbar Injury Classification and Severity Score. The different fracture types include compression fractures, burst fractures - both stable and unstable -, flexion-distraction injuries and fracture dislocations. Their treatment, both operative and non-operative depends on the degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex. Minimally invasive approaches to the care of thoracolumbar injuries have become more popular, thus, the evidence regarding their efficacy is presented. Finally, the treatment of osteoporotic fractures of the thoracolumbar spine is reviewed, including vertebroplasty and kyphoplasty, their risks and controversies, and senile burst fractures, as well.ConclusionsThoracolumbar spine fractures remain a significant source of potential morbidity. Advances in treatment have minimized the invasiveness of our surgery and in certain stable situations, eliminated it all together.     

Vertebral body reconstruction with injectable hydroxyapatite cement for the management of unstable thoracolumbar burst fractures: a preliminary report

The aim of this prospective study was to evaluate the efficacy of an injectable hydroxyapatite cement in combination with long posterior transpedicular instrumentation, without fusion, for the treatment of unstable thoracolumbar burst fractures. Ten patients with this type of fracture were treated in the period 1999-2000 with bisegmental posterior transpedicular stabilisation above and below the fracture site, indirect reduction of the fracture, and transpedicular injection of hydroxyapatite cement into the fractured vertebral body. Postoperatively the mean Cobb kyphotic deformity angle (CKDA) and vertebral compression index (VCI) were statistically improved (p < 0.001). Both variables deteriorated slightly between surgery and follow-up after +/- 39 months; this was statistically not significant for the CKDA (p > 0.05), but significant for the VCI (p < 0.001). These data suggest that hydroxyapatite cement can be a reliable way to reinforce the fractured vertebral body in the thoracolumbar region.     

Dall-Miles cable and plate fixation system in the treatment of periprosthetic femoral fractures: a review of 20 cases

PURPOSE: To assess the effectiveness of Dall-Miles cables and plates in the treatment of periprosthetic femoral fractures around hip arthroplasties. METHODS: We retrospectively reviewed 20 cases of periprosthetic femoral fracture treated with the Dall-Miles cable and plate system between November 1999 and December 2002 in James Paget Hospital in the United Kingdom. Demographic data, fracture type, and surgical outcome of the patients were reviewed and assessed. RESULTS: Of the 20 cases of periprosthetic femoral fracture, one was of Vancouver type A, 15 were of type B1, and 4 were of type C. The mean age at operation was 78.5 years (range, 68-90 years) with a male to female ratio of 11:9. The mean time to union was 3.9 months (range, 3-8 months), and the mean follow-up period was 19.4 months (range, 1-4 years). 15 patients achieved satisfactory results, including 2 delayed unions that healed with a residual varus deformity of 15 degrees in the femoral component. Three patients developed deep-seated wound infections. No nonunion of fractures or fixation system failures occurred. CONCLUSION: The Dall-Miles cable and plate fixation system alone is a sufficient treatment for most periprosthetic femoral fractures. In the management of B1 fractures, there was no significant difference in clinical outcome, despite the various combinations of cables and screws used for stabilisation of the plate. However, in cases of comminution at the fracture site, junctional grafting with morsellised autograft may be used in addition to internal fixation to accelerate union.     

A mathematical model of mortality dynamics across the lifespan combining heterogeneity and stochastic effects

The mortality patterns in human populations reflect biological, social and medical factors affecting our lives, and mathematical modelling is an important tool for the analysis of these patterns. It is known that the mortality rate in all human populations increases with age after sexual maturity. This increase is predominantly exponential and satisfies the Gompertz equation. Although the exponential growth of mortality rates is observed over a wide range of ages, it excludes early- and late-life intervals. In this work we accept the fact that the mortality rate is an exponential function of age and analyse possible mechanisms underlying the deviations from the exponential law across the human lifespan. We consider the effect of heterogeneity as well as stochastic factors in altering the exponential law and compare our results to publicly available age-dependent mortality data for Swedish and US populations. In a model of heterogeneous populations we study how differences in parameters of the Gompertz equation describing different subpopulations account for mortality dynamics at different ages. Particularly, we show that the mortality data on Swedish populations can be reproduced fairly well by a model comprising four subpopulations. We then analyse the influence of stochastic effects on the mortality dynamics to show that they play a role only at early and late ages, when only a few individuals contribute to mortality. We conclude that the deviations from exponential law at young ages can be explained by heterogeneity, namely by the presence of a subpopulation with high initial mortality rate presumably due to congenital defects, while those for old ages can be viewed as fluctuations and explained by stochastic effects.     

Improving Communication Between Children with Autism and Their Peers Through the ‘Circle of Friends’: A Small‐scale Intervention Study

Background The ‘circle of friends’ is an educational approach that facilitates the inclusion of children with disabilities into the school community by engaging their peer group in supporting the individual proactively. The present small‐scale study examines the efficacy of this intervention in improving the communication (and ultimately social) skills of pre‐school aged children with autism. Methods Five children identified with autism aged between 3.10 and 4.7 years participated in the study – three in the intervention and two in the control group. The ‘circle of friends’ was applied for 30 min on a weekly basis at a nursery setting for a period of 3 months with the active involvement of one teacher and five peers of each child with autism. The effects of the intervention were systematically examined by means of an observation schedule which recorded the number of responses and initiation attempts – both unsuccessful and successful – of all participating children with autism during baseline, post‐intervention and at 2 months follow‐up. Results The statistical analysis of the data revealed that children in the intervention group had significantly lower unsuccessful response and initiation rates at post‐intervention and follow‐up than children in the control group. Moreover, children in the intervention group had significantly higher successful response and initiation rates at post‐intervention and follow‐up than those in the control group. Conclusions The recorded changes in the interaction patterns indicate that the ‘circle of friends’ is a powerful intervention that, if carefully applied, can improve the social skills of children with autism and their ability to communicate, and ultimately facilitate their ‘inclusion’ in mainstream settings. Further larger‐scale longitudinal research is needed to examine the long‐term benefits of the approach for children with autism and the broader changes in the nexus of relations within the mainstream environment.     

Effectiveness of electric stimulation of the vastus medialis muscle in the rehabilitation of patients after total knee arthroplasty

OBJECTIVE: To investigate the possible effect of electric muscle stimulation (EMS) of the vastus medialis on the walking speed, Hospital for Special Surgery (HSS) knee score, and Physiological Cost Index (PCI) of patients during rehabilitation after total knee arthroplasty (TKA). DESIGN: Prospective, randomized controlled trial. SETTING: Various departments at a district general hospital in the United Kingdom. PARTICIPANTS: Thirty patients with unilateral osteoarthritis of the knee admitted for elective TKA were randomly assigned to 1 of 2 groups (15 per group): control and treatment. Both groups received standard physical therapy. The treatment group also received EMS of the vastus medialis. INTERVENTION: EMS (40Hz, 300micros) of the vastus medialis muscle for 4 hours a day, starting on postoperative day 2, over the first 6 postoperative weeks. MAIN OUTCOME MEASURES: Changes in walking speed, HSS knee score, and effort of walking as measured by the PCI. RESULTS: A statistically significant increase in walking speed was observed in the treatment group in relation to the control group at both 6 weeks (P=.0002) and 12 weeks (P<.0001) postoperatively. No statistically significant difference was observed in relation to the PCI or the HSS knee score variables. CONCLUSIONS: Application of EMS after TKA resulted in a statistically significant improvement in patients' walking speed. There was also a carry-over effect after the discontinuation of treatment.