AIM OF THE STUDY: To evaluate the midterm radiographic behaviour of femorocortical allograftrings (FCA) in lumbosacral fusions in patients with disabling low back pain. METHODS: The radiographs of 41 patients with a minimum follow-up of 2 years were analysed by an independent orthopedic radiologist. The fusion rate was determined on lateral tomograms routinely obtained at 3 months intervals. On lateral radiographs the posterior intervertebral disc height as well as the segmental lordosis were measured. Changes of the allografting such as mottling, resorption and incorporation were registered. RESULTS: The fusion rate was 95.2%. Time to radiographic fusion averaged 8.7 months (2-34 months) and in 66.1% radiographic fusion occurred without significant subsidence. In 18.6% fusion with subsidence resulted from resorption of the FCA and in 15.3% the FCA had protruded into the vertebral body. The posterior intervertebral disc height increased postoperatively by 1.9 millimeters on average. However, postoperative height loss was the rule and occurred within the first 12 postoperative months, resulting in a negligible final gain in height of 0.3 millimeters on average. The final gain in segmental lordosis was 1.3 degrees on average. Complete graft incorporation occurred in 16 of 62 segments (25.8%). CONCLUSION: The described technique has proven to be highly effective in achieving a high fusion rate with a stable midterm graft behaviour.

Adult↗

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Anterior and posterior correction and fusion for paralytic scoliosis.

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Adolescent↗

PubMedDate not supplied

Combined staged anterior and posterior correction and fusion of the spine in scoliosis following poliomyelitis.

The problems with severe forms of scoliosis following poliomyelitis include the associated muscle imbalance, soft tissue contractures and pelvic obliquity. Such deformities militate against optimal correction and maintenance of that correction and their treatment is often marred by pseudarthroses. Seventeen patients with an average curve of 93 degrees have been treated and followed for up to 38 months. Preliminary traction was used in 8 patients, then a staged anterior and posterior correction and fusion was done, using Dwyer's instrumentation of the major curve in all and a Harrington rod to supplement the posterior fusion in eleven patients. With this technique the major curve was corrected by 80 per cent with an average 2 per cent loss over 18 months. No pseudarthroses were seen when the Harrington rod was used. Great care must be taken if halo-pelvic traction is to be used for patients with pelvic obliquity, for preliminary correction halo-femoral traction will often be adequate. In the more severe forms of paralytic scoliosis a combined staged anterior and posterior correction and fusion should be considered if the aim is maximal correction of the scoliosis and avoidance of pseudarthroses.

Adolescent↗

PubMedDate not supplied

Experimentally induced hypermobility in the lumbar spine. A pathologic and radiologic study of the posterior ligament and annulus fibrosus.

Experimental destructive lesions were produced at autopsy in the lumbar discs of nine spines including 29 radiologically normal adult lumbar intervertebral discs. Limited transverse surgical division of the posterior longitudinal ligament and adjacent annular fibers were performed followed by, in addition, the removal of the intervertebral nucleus pulposus. Without interfering with any other major structure, radiologic evidence of hypermobility was recorded in 20 of 29 normal intervertebral segments. The patterns of movement were measured by standardized radiologic criteria. The available evidence suggests that localized damage to the region of the posterior longitudinal ligament and adjacent annulus fibrosus can produce radiologic patterns of hypermobility.

Adolescent↗

PubMedDate not supplied

Reduction of severe spondylolisthesis. A preliminary report.

This report describes the development of a technique for reduction and fusion of spondylolisthesis that includes posterior mobilization with alartransverse fusion, halo-femoral traction with the patient in some extension, and finally, anterior interbody fusion of the lumbosacral joint. The report emphasizes the technique, which has been employed in the care of 8 patients thus far.

Child↗