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Study design We followed a longitudinal observational design with 2 assessment points, presurgery and postsurgery, in 83 consecutive patients undergoing single-level lumbar discectomy. Objective Prognostic data can be gathered from commonly used generic outcome measures to identify patients at risk of persistent leg pain-associated chronicity, following lumbar discectomy SUMMARY OF BACKGROUND DATA:: Suboptimal results observed, following open lumbar discectomy, have been connected to the interplay among presurgery pain characteristics, functional and psychosocial adaptations like persistent pain, disability, and depression. Outcome predictive qualities have been recently attributed to well-known outcome measures. However, most studies on prognostic indicators use multiple tools designs, inhibiting clinical application. Here we elaborate on predictive indications identified in 2 generic patient-rated questionnaires, Short Form-36 (SF-36) and McGill Pain, as many of their domains can evaluate factors related to unfavorable outcomes. Methods For the prognostic value calculations, multivariate logistic [Short-Form McGill Pain Questionnaire (SF-MPQ)] and linear regression models (SF-36) were fitted to investigate the association between presurgery and postsurgery scores. In all models, the presurgical score at question was assigned as the dependent variable while age, sex and presurgery score at question were the independent variables. Results Overall, a statistically significant amelioration in both SF-MPQ and SF-36 scores was observed postsurgically. For the SF-MPQ leg cramping, gnawing, burning, and aching pain symptoms, when present presurgically, were the least responsive to treatment. For the SF-36, mental scores overall were less responsive than physical equivalents postoperatively, while general health perception improved only marginally. Differences in pain level scores did not correlate with an equivalent reduction in postsurgery anxiety and depression indices. Conclusions SF-MPQ and SF-36 can assist in treatment decision, as they can readily identify patients at risk of unfavorable outcomes even in primary/clinical settings. The above findings additionally suggest a wider scope of clinical use for the above questionnaires allowing parallel processing and interpretation of the same patient data. Levels of evidence Level I.

Minimal invasive surgery has gained popularity among hip surgeons and patients. Based on early studies, the method is described as a very promising alternative, with low dislocation rates, resulting in a non-traumatic procedure and early functional return. However, complication rates arising of the recent studies raise concern about the applied technique. The aim of the study is to present the clinical results and intra- and post-operative complications of the AMIS procedure in patients with osteoarthritis of the hip, managed with total hip arthroplasty with positioning table, in a 5 years follow up. One senior hip arthroplasty surgeon performed all surgeries. Three hundred eighteen consecutive patients (195 females, 123 males) were clinically and radiologically evaluated, postoperatively 2, 6 and 12 months. Mean patient age was 69.7 years (24 to 88). There was significant improvement according to Harris-Hip Score, ODI, SF-36 scales. The mean incision length was 7.5cm (6 to 8cm). The mean operating time was calculated at 85 minutes. The patients were discharged on the second post-operative day, able to walk with partial weight bearing. One month post-operative, the patients were advised for full weight bearing walking without crutches. Intraoperative complications included two femoral perforations. Postoperative complications included two patients with femoral fractures; one with dislocation; two with superficial infections; three with wound complications; three with femoral stem aseptic loosening; one with ceramic inner fracture and two acetabular component protrusion in the same patient, among which only the last patient had reoperation in both hips. Anterior Minimal Invasive Surgery of the hip is a non-traumatic procedure, associated with reduced pain, faster recovery and no major complications, but requires higher experience level from the hip surgeon.

30 patients with idiopathic scoliosis were treated by posterior spinal arthrodesis using the Luque (8 patients) and Hartshill (22 patients) rodding systems with sublaminar segmental wiring. Patients were followed for 2 to 6 years. In most cases, postoperative correction exceeded safety correction limits (lateral bending film plus 10 degrees). Final correction was 55%, while derotation was not significant (average 3 degrees). No neurological deficit was noted. Postoperative bracing was not applied and there was 1 patient with broken rods (Luque trolley system without fusion) and 1 patient with broken wires in 4 segments. Allogenic blood transfusion was avoided in 19 patients by preoperative donation of autologous blood, in combination with salvage of intraoperative shed blood. We found segmental spinal wiring with either rods or rectangles to be a safe method for correction of scoliosis in experienced hands. It offered satisfactory stability and fusion rate with no need for external support.

IntroductionThe transverse and sagittal inner and outer pedicle diameter of thoracic and lumbar vertebrae were measured with an electronic caliper and with CT scan. To determine the validity of CT scan measurements, comparing with those taken by an electronic caliper.Material and MethodsA total of 12 anatomic skeletal specimens were acquired from T1 to L5 in the mean age of 69.6 years. Each vertebral pedicle was measured with an electronic caliper and CT scan. A total of 1632 measurements of 408 pedicles were taken. The data were collected and analyzed using the t-test. The comparison of the measurements between left and right pedicle, males and females, as well as between electronic caliper and CT scan was evaluated.ResultsThe sagittal diameter of the pedicle was always bigger than 7mm. In the mid-thoracic area (T3-T8), the transverse outer diameter could be less than 4mm, so there is need of use of pediatric screws (

This article evaluates the effectiveness of autotransfusion in reducing the need for allogenic transfusion following primary total knee replacement.

This retrospective study assessed the diagnostic accuracy and clinical usefulness of the Harlow Wood needle biopsy for spinal lesions. The medical records of 238 patients (138 men and 100 women) who underwent closed spine biopsy from 1987 through 1997 were reviewed. Patient age ranged from 21 to 83 years. Lesions involved the thoracic vertebrae in 127 patients, the lumbar vertebrae in 99 patients, and the sacrum in 12 patients. Cultures of the biopsy specimens were examined histopathologically and cytologicalIy. One hundred twenty-four patients were diagnosed with a spinal infection, and 68 patients were diagnosed with a tumor. In the remaining 46 patients, the biopsy specimens were negative for infection or neoplasia in 20 patients and not diagnostic in 26 (10.9%) patients. There were no major complications. The Harlow Wood needle biopsy is a simple, repeatable procedure with satisfactory diagnostic accuracy (89.1%) and can be performed on an outpatient basis.

Background The pullout strength of pedicle screws is influenced by many factors, including diameter of the screws, implant design, and augmentation with bone cement such as PMMA. In the present study, the pullout strength of an innovative fenestrated screw augmented with PMMA was investigated and was compared to unaugmented fenestrated, standard and dual outer diameter screw. Methods Twenty four thoracolumbar vertebrae (T10-L5, age 60 to 70 years) from three cadavers were implanted with the four different pedicle screws. Twelve screws of each type were instrumented into either left or right pedicle with standard screw paired with unaugmented and dual outer diameter screw paired with augmented fenestrated screw in any given vertebra. Axial pullout testing was conducted at a rate of 5 mm/min. Force to failure (Newtons) for each pedicle screw was recorded. Results The augmented fenestrated screws had the highest pullout strength, which represented an average increase of 149%, 141%, and 78% in comparison to unaugmented, standard, and dual outer diameter screws, respectively. Pullout strength of unaugmented screws was comparable to that of standard screws, however it was significantly lower than dual outer diameter screws. Conclusions Fenestrated screws augmented with PMMA improve the fixation strength and result in significantly higher pullout strength compared to dual outer diameter, standard and unaugmented fenestrated screws. Screws with dual outer diameter provided enhanced bone-screw purchase and may be considered as an alternative technique to increase the bone-screw interface in cases where augmentation using bone cement is not feasible. Unaugmented screws can be left in the pedicle even without cement and provide similar pullout strength to standard screws.