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Study Design: Prospective randomized controlled study., Objective: To compare the outcome of indirect decompression by means of the X-Stop (Medtronics Inc., Minneapolis, MN) implant with conventional decompression in patients with neurogenic intermittent claudication due to lumbar spinal stenosis., Summary of Background Data: Decompression is currently the "gold standard" for lumbar spinal stenosis but is afflicted with complications and a certain number of dissatisfied patients. Interspinous implants have been on the market for more than 10 years, but no prospective study comparing its outcome with decompression has been performed., Methods: After power calculation, 100 patients were included: 50 in the X-Stop group and 50 in the decompression group. Patients with symptomatic 1- or 2-level lumbar spinal stenosis and neurogenic claudication relieved on flexion were included. X-Stop operations were performed under local anesthesia.The mean patient age was 69 (49-89) years, and the male/female distribution was 56/44. Minimal dural sac area was in all cases except two 80 mm or less.The noninferiority hypothesis included 6, 12, and 24 months of follow-up, and included. intention-to-treat as well as as-treated analyses.The primary outcome meansure was the Zürich Claudication Questionnaire, and the secondary outcome measures was the visual analogue scale pain, Short-Form 36 (SF-36), complications, and reoperations., Results: The primary and secondary outcome measures of patients in both groups improved significantly. The results were similar at 6, 12, and 24 months and at no time point could any statistical difference between the 2 types of surgery be identified. Three patients (6%) in the decompression group underwent further surgery, compared with 13 patients (26%) in the X-Stop group (P = 0.04). Results were identical in intention-to-treat and as-treated analyses., Conclusion: For spinal stenosis with neurogenic claudication, decompressive surgery as well as X-Stop are appropriate procedures. Similar results were achieved in both groups, however, with a higher number of reoperations in the X-Stop group. Patients having X-Stop removal and decompression experienced results similar to those randomized to primary decompression., Level of Evidence: 1.

In this prospective study, the clinical outcome in the early course as well as the long-term results were analyzed after automated percutaneous lumbar discectomy (APLD). Thirty consecutive patients are included, all with a contained lumbar disc herniation on magnetic resonance imaging. There was a significant reduction in the sciatic pain and straight leg raising (SLR) test postoperatively at all the different measurements in the early course except for the sciatic pain at 2 weeks. On the same occasions, there was no change in the back pain or the Oswestry score. Ten patients needed subsequent open surgery. For the remaining patients, the long-term result showed a significant and unchanged improvement in the sciatic pain and SLR. In addition, the Oswestry score had now significantly improved. The failure rate of APLD turned out to be unacceptably high in this study, because 38% of the patients needed subsequent open surgery. However, an early satisfactory course also seemed to imply a beneficial long-term prognosis.

The authors evaluated the size of the disc herniation with magnetic resonance imaging (MRI) before and after surgery in patients undergoing automated percutaneous lumbar discectomy (APLD) and compared the MRI findings with the early clinical outcome. This study includes 20 consecutive patients with a contained lumbar disc herniation. Sequential MRI were performed immediately before and after surgery, on the day of surgery, and 6 weeks after surgery. The development of pain, nerve root tension sign (SLR), and neurological findings were analyzed, as was the need for subsequent open surgery. There was no significant difference in the maximum protrusion of the disc herniation between the three measurements. The sciatic pain improved significantly on the first day after surgery but not at 1 week or 6 weeks after surgery. The SLR was reduced significantly after surgery and at 1 and 6 weeks after surgery. There was no correlation between the MRI findings and the early clinical outcome. Seven patients needed subsequent open surgery. The findings indicate that the effect of APLD is not mediated by reducing the size of the disc herniation. In this small series of patients, APLD was ineffective in the treatment of a contained lumbar disc herniation. There was no correlation between the MRI findings and the early clinical outcome.

Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.

Postural equilibrium has been quantified by stabilometry in 57 patients with adolescent idiopathic scoliosis aged 10-16 years. Treatment was required in 39 cases whereof 18 were placed under observation only. The control group comprised 32 healthy children of the same age. An experimental design was made to vary the degree of difficulty of upright standing in four different test situations. The postural sway was analysed in the sagittal and lateral direction as well as in the area of total sway. The scoliotic patients had a significantly poorer postural control compared with the healthy children in all the tests. The difference was most pronounced in tests in which the proprioceptive functions were most important for maintaining the postural equilibrium. The left convex patients had quantitatively more pronounced reactions than the right convex patients. Patients with small curvatures, i.e., patients placed under observation only, had significantly increased postural sway compared with patients with more severe deformity. This fact, together with findings in patients with double primary curvatures, and the results of the study of brace effects, indirectly indicate the possibility of a postural disequilibrium as a contributory causative factor in adolescent idiopathic scoliosis.

An analysis of lateral predominance of 51 patients with adolescent idiopathic scoliosis is presented. Determination of handedness, the dominant foot, and the dominant eye was performed. Postural equilibrium was studied by stabilometry, and the vestibular function was evaluated with electronystagmography. Central and peripheral nervous function were evaluated as reflected by electroencephalography and nerve-conduction velocity measurements. Results were compared with those obtained for a control group and were evaluated with special reference to convexity and location of the curve. Significant differences were found between patients with right convex curves and those with left convex curves in the distribution of eye predominance and in labyrinthine sensitivity. The direction of convexity was correlated with the predominant labyrinth for both groups. An analysis of these findings indicates that they can be of pathogenetic importance.

Measurements of nerve conduction velocity (NCV) in the peroneal and median nerves have been performed in 47 patients with adolescent idiopathic scoliosis (AIS). The results did not reveal any pathology neither asymmetries correlated to convexity of scoliosis. Patients requiring treatment showed significantly lower sensory nerve conduction velocity of median nerve than those under observation. All values, however, were within normal limits. The findings gave no support to any theory that polyneuritis or polyneuropathy is involved in AIS.

Postural sway has been quantified with stabilometry during caloric labyrinthine stimulation in an erect posture in 49 patients, aged 10--16 years, with adolescent idiopathic scoliosis. Thirty-two healthy children of the same age constituted a control group. The scoliotic patients tended to have an increased postural sway during labyrinthine stimulation on the convex side compared to the effects on the concave side. Significant differences were observed when left and right scoliotic patients were compared with the controls. The results can be explained by an asymmetric sensitivity in the labyrinth or by a dysfunction in the postural control mechanisms at the brain stem level.

This is a prospective study of 52 consecutive patients with impingement syndrome of the shoulder who underwent an anterior acromioplasty according to Neer with rotator cuff repair and/or a resection of the lateral end of the clavicle added where it was indicated. There was a full-thickness tear in 14 cases. The follow-up was 11 months. The overall results were excellent-good in 40 patients and fair-poor in 12 patients. If two out of three of the following criteria were present, the patient had an increased risk for a fair or poor result: age greater than 50 years, sick leave greater than 6 months, or an associated cervical problem.

An EEG study was carried out on 57 children, aged 10--16 years, with idiopathic scoliosis. Treatment (brace or surgery) was required in 37 cases; 20 were being observed only. Controls were 10- to 16-year-old healthy children meeting well-defined criteria of normality. Thirty-four of the scoliotics fulfilled these criteria, thus providing a group matching the controls except for the presence of scoliosis. Thus, any differences occurring could, with reasonable probability, be referred to the disease in question. The comparison with healthy children showed a generally greater EEG pathology in the scoliotics. This was the case in all patients, even those meeting the same criteria of normality as the controls. A highly significant difference was noted in the occurrence of paroxysmal activity. Type and localization of abnormally (bilaterally synchronous discharges) indicated involvement of subcortical structures. Comparison within the scoliotic group showed that EEG abnormalities were not correlated with the magnitude of the disease except for the variable "paroxysmal activity at rest". Patients submitted to observation only presented paroxysmal activity significantly more often than patients requiring treatment. The localization of abnormality within the hemispheres did not agree or disagree systematically with the convexity of the curve. A possible relationship between the higher incidence of scoliosis in females and the higher sensitivity to afferent stimuli as found in the female EEG is also discussed.

An electro-nystagmographic study of labyrinthine function was performed in 56 patients with adolescent idiopathic scoliosis (AIS)aged from 10 to 16 years. Forty-seven patients had major structural single curvatures, and nine patients had double-primary scoliosis and were analysed separately. Treatment was required in 36 cases while 20 were being observed only. Thirty healthy children of the same ages constituted a control group. Spontaneous nystagmus (SN) and positional nystagmus (PN) were found in 24 out of the 47 patients with single curvatures and in only one subject in the control group (P less than 0.001). No significant correlation was noted between direction of convexity and nystagmus. Neither did the frequency of SN or PN differ significantly between patients requiring treatment and patients submitted to observation only. Significant differences were observed in the caloric response between right and left scoliotic patients (P less than 0.05). The right convex patients had a sensitivity dominance in the right labyrinth and the left convex patients in the left labyrinth. There were no significant differences between right- and left-beating nystagmus. A dysrhythmic nystagmus occurred in the scoliotic patients with significantly increased frequency (P less than 0.05). The results are discussed with special reference to aetiology in AIS. It was difficult, however, to draw any definite conclusion as to whether the findings may indicate a causative factor in relation to the idiopathic curvature or whether they might be a feed-back effect from the deformed spine.