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ABSTRACT: Hemivertebrae are most commonly seen in the thoracic and lumbar regions but sacral hemivertebrae are very rarely seen. While
performing a radiographic search for a study on congenital scoliosis in patients with congenital heart disease, an 11-month-old
boy who was treated surgically for congenital heart disease in 1997 was found to have a sacral hemivertebra with no thoracic
or lumbar scoliosis. He was almost symptom free and had no complaint regarding his sacral hemivertebra including back-pain
in this 7-year period. In the radiographic study, sacral 2–3 hemivertebrae with segmentations were detected which did not
cause thoracic or lumbar scoliosis.
Les hémivertèbres le plus généralement sont vues dans les régions thoraciques et lombaires alors que les hémivertèbres sacrées
sont très rarement rencontrées. Lors d’une recherche radiographique sur la scoliose congénitale chez des patients ayant une
cardiopathie congénitale, un nourrisson âgé de 11 mois qui avait été traité chirurgicalement pour sa cardiopathie congénitale
en 1997, s’est avéré être porteur d’une hémivertèbre sacrée en dehors de toute scoliose thoracique ou lombaire. Il était presque
sans symptômes et n’a eu aucune plainte concernant son hémivertèbre sacrée, ni même des lombalgies basses pendant une période
d’observation de sept ans.. Dans l’étude radiographique, des hèmivertèbres S2-S3 furent trouvées, avec segmentation mais sans
scoliose thoracique ou lombaire.
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 15(4):316-318. · 0.10 Impact Factor
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ABSTRACT: Cobb method has been shown to be the most reliable technique with a reasonable measurement error to determine the kyphosis in fresh fractures of young patients. However, measurement errors may be higher for elderly patients as it may be difficult to determine the landmarks due to osteopenia and the degenerative changes. The aim of this study is to investigate the intrinsic error for different techniques used in evaluation of local sagittal plane deformity caused by OVCF. Lateral X-rays of OVCF patients were randomly selected. Patient group was composed of 28 females and 7 males and the mean age was 62.7 (55-75) years. The kyphosis angle and the vertebral body height were analyzed to reveal the severity of sagittal plane deformity. Kyphotic deformity was measured by using four different techniques; and the vertebral body heights (VBH) were measured at three different points. The mean intra-observer agreement interval for kyphosis angle measurement techniques ranged from +/-7.1 to +/-9.3 degrees while it ranged from +/-4.5 to +/-6.5 mm for VBH measurement techniques. The mean interobserver agreement interval for kyphosis angle ranged from +/-8.2 to +/-11.1 degrees , while it was between +/-4.5 to +/-6.5 mm for vertebral body height measurement techniques. This study revealed that although the intra and interobserver agreement were similar for all techniques, they are still higher than expected. These high intervals for measurement errors should be taken into account when interpreting the results of correction in local sagittal plane deformities of OVCF patients after surgical procedures such as vertebral augmentation techniques.
European Spine Journal 01/2008; 16(12):2126-32. · 1.97 Impact Factor
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ABSTRACT: This case report aims at presenting a unique case of simultaneous bilateral traumatic dislocation with right side anterior and the left side posterior together with bilateral acetabular fracture. Under general anesthesia, closed reduction of both hips was carried out. The case presented represents an unusual, severe combination of injuries resulting from a high-speed motor-vehicle accident. Traumatic hip dislocation represents a true orthopedic emergency. Given the severity of the associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy.
Archives of Orthopaedic and Trauma Surgery 11/2007; 127(8):643-6. · 1.37 Impact Factor
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ABSTRACT: Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods.
Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared.
In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019).
Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.
The Journal of Bone and Joint Surgery 03/2007; 89(2):324-31. · 3.27 Impact Factor
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ABSTRACT: This study analyses radiological outcome of titanium mesh cages used for anterior column support following corpectomy in the thoracic and lumbar spine in 34 patients with a minimum three-year follow-up. The aim of the study was to assess the complications and radiological outcomes of patients with structural cages implanted into the anterior column. Titanium mesh cages for the anterior column became popular for anterior column reconstruction following discectomy and corpectomy. Few clinical studies are published assessing their efficacy as a structural graft after corpectomy and factors for the development of settling and correction loss are not investigated enough. Thirty-four patients with minimum 3-year follow-up were analysed radiologically for correction achievement, cage settling and fusion inside the mesh cage. The effect of fixation technique, anatomical localisation and diagnosis for the development of settling were analysed. Measurements of preoperative and early postoperative local kyphotic angle revealed that a mean correction of 27 degrees (range: 8 to 60) was obtained. While no dislodgement or fracture of titanium mesh cages was observed, there was a mean correction loss of 4 degrees and settling (> 2 mm) was noted in 6 patients. Short posterior and only anterior instrumentation systems were associated with settling. The anatomical location and diagnosis did not affect the development of cage settling. Following corpectomy and mesh cage implantation, isolated anterior fixation or short posterior fixation do not provide enough stability, and correction loss and settling can occur.
Acta orthopaedica Belgica 12/2005; 71(6):726-31. · 0.40 Impact Factor
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ABSTRACT: This case report presents a 66-year-old woman with multiple vertebral hemangiomas causing spinal cord compression at different levels with a long symptom-free interval between episodes of compression. She presented with back pain and progressive weakness and numbness in her lower limbs for 3 months. Ten years earlier, she had had a symptomatic T4 vertebral hemangioma operated successfully, and had made a full recovery. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine revealed multiple thoracic and lumbar vertebral hemangiomas. Extraosseous extension of a hemangioma at T9 was causing spinal cord compression. Selective embolization was performed preoperatively, and cord decompression was achieved via anterior T9 corpectomy. The patient's neurological status improved rapidly after surgery. After a course of radiotherapy, she was neurologically intact and could walk independently. One year later, MRI showed complete resolution of the cord edema at T9, and showed regression of the high signal intensity that had been observed at unoperated levels. These findings indicated diminished vascularity and reduced aggression of the tumor.
European Spine Journal 10/2005; 14(7):706-10. · 1.97 Impact Factor
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ABSTRACT: The aim of this study was to compare the biomechanical properties of 4 different biceps tenodesis techniques.
Biomechanical experiment.
Four groups of fresh sheep shoulders (28 total) with similar shape characteristics were used. Biceps tenodesis was performed using the following techniques: group 1 (n = 7), tunnel technique; group 2 (n = 7), interference screw technique; group 3 (n = 7), anchor technique; and group 4 (n = 7), keyhole technique. Each construct was loaded to failure and the groups were compared with respect to maximum load in Newtons and deflection at maximum load in millimeters. The results were statistically analyzed with 1-way analysis of variance, the Bonferroni post hoc test and the Student t test or the nonparametric Mann-Whitney U test.
The calculated average maximum loads were 229.2 +/- 44.1 N for the tunnel technique, 243.3 +/- 72.4 N for the interference screw, 129.0 +/- 16.6 N for the anchor technique, and 101.7 +/- 27.9 N for the keyhole technique. Statistical testing showed no statistically significant differences between groups 1 and 2, groups 3 and 4, or groups 2 and 3 with respect to maximum load and deflection at maximum load (P = .09/P = .49, P = .41/P = .79, and P = .06/P = .82 for load/deflection in the 3 comparisons, respectively). However, all other group comparisons revealed significant differences for both parameters (group 1 v group 4 [P < .01/P < .01]; group 1 v group 3[P < .01/P = .01]; and group 2 v group 4 [P = .007/P = .003]).
The strongest construct was made with the interference screw technique, followed by the tunnel, anchor, and keyhole techniques. There were no statistically significant differences between the interference screw and tunnel techniques with respect to maximum load or deflection at maximum load.
Although it is difficult to extrapolate in vitro data to the clinical situation, the interference screw technique has better initial biomechanical properties and may produce improved clinical outcomes.
Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2005; 21(8):992-8. · 3.02 Impact Factor
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ABSTRACT: This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature.
A 73-year-old woman underwent surgery for lumbar spinal stenosis. A dural tear occurred during decompression, and the patient developed remote cerebellar hemorrhage on postoperative Day 2.
The cerebellar hemorrhage was treated surgically, and a biopsy of hemorrhagic brain parenchyma revealed an arteriovenous malformation.
Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.
Neurosurgery 08/2005; 57(1 Suppl):E215; discussion E215. · 2.79 Impact Factor
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ABSTRACT: The aim of this study was to determine whether prematurity is important with respect to hip typing and planning of treatment/follow-up in newborns assessed with the Graf's ultrasonography method. Between January 1998 and 2003, 1592 neonates; preterm (n=432) and term (n=1160), had their hips ultrasonographically evaluated with Graf typing. There were no statistical differences between the two groups with respect to the numbers of hips that required follow-up assessment, or treatment. The results suggest that prematurity is irrelevant and use of chronological age as opposed to corrected age for prematurity will further simplify diagnosis and planning of follow-up and treatment in the Graf system for neonatal hip assessment.
Journal of Pediatric Orthopaedics B 06/2005; 14(3):168-71. · 0.47 Impact Factor
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ABSTRACT: A rabbit model was used to assess the nature of healing tissues in hyaline cartilage defects and to compare the healing in defects treated with pedunculated synovium grafts to those in defects without synovial grafting. Both knees of 28 1-year-old rabbits were operated. A 3 x 2-mm cartilage defect that exposed cancellous bone was created in the non-weight-bearing area of each medial femoral condyle. Each right-knee defect was covered with a pedunculated synovial graft obtained from the same joint, and the left-knee defects were left uncovered as controls. Groups of rabbits were sacrificed at 3, 6, 12, and 24 weeks postsurgery. Sections from each knee were stained with hematoxylin-eosin and safranin O-fast green staining, and were immunohistochemically stained for type II collagen. The healing at each site was histologically scored, and the intensity of staining for type II collagen was graded. At 12 and 24 weeks, statistical comparisons of histological scores revealed significantly more hyaline cartilage tissue in the synovium-grafted defects. At 24 weeks, these same defects showed significantly more type II collagen. Thus, pedunculated synovium transplantation appears to hold promise as a method for repairing hyaline cartilage defects.
Journal of Investigative Surgery 18(3):115-22. · 1.09 Impact Factor
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ABSTRACT: This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years' follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.
Advances in Therapy 21(5):335-42. · 2.11 Impact Factor
