Surgical treatment of a hangman's fractures is technically demanding, even when using the standard open procedure. In this case report, a type II hangman's fracture was treated by percutaneous posterior screw fixation, without a midline incision, using intraoperative, full rotation, three-dimensional (3D) image (O-arm)-based navigation. A 48-year-old woman was injured in a motor vehicle accident and diagnosed with a unilateral hangman's fracture associated with subluxation of the C2 vertebral body on C3. After attaching the reference arc of the 3D-imaging system to the headholder, the cervical spine was screened using an O-arm without anatomical registration. Drilling and screw fixation were performed using a guide tube while referring to the reconstructed 3D-anatomical views. The operation was successfully completed without technical difficulties or neurovascular complications. This percutaneous procedure requires less dissection of normal tissue, which may allow earlier recovery. However, further validation of this procedure for its effectiveness and safety is required.
Female ; Humans ; Imaging, Three-Dimensional ; Mandrillus ; Middle Aged ; Motor Vehicles ; Spine

STUDY DESIGN: Prospective study with simple randomization. PURPOSE: To evaluate the results of anterior spinal instrumentation, debridement and decompression of cord and compare it with results of a similar procedure done without the use of anterior instrumentation. OVERVIEW OF LITERATURE: Use of anterior spinal instrumentation in treatment of tubercular spondylitis is still an infrequently followed modality of treatment and data regarding its usefulness are still emerging. METHODS: Thirty-two patients of tubercular paraplegia with involvement of dorsal and dorso-lumbar vertebrae were operated with anterior spinal cord decompression, autofibular strut grafting with anterior instrumentation in 18 patients and no implant in 14 patients. Results were compared on the basis of improvement in Frankel grade, correction of local kyphosis, decrease in canal compromise and further progression of kyphosis. RESULTS: The mean local kyphosis correction in the immediate postoperative period was 24.1degrees in the instrumented group and was 6.1degrees in the non instrumented group. The mean late loss of correction of local kyphosis at 3 years follow-up was 1.7degrees in the instrumented and 6.7degrees in the non instrumented group. The mean improvement in canal compression was 39.5% in the instrumented group and 34.8% in the non instrumented group. CONCLUSIONS: In treatment of tubercular spondylitis by anterior debridement and decompression of the spinal cord and autofibular strut grafting, the use of instrumentation has no relation with the improvement in neurological status, however the correction of local kyphosis and prevention of further progression of local kyphosis was better with the use anterior spinal instrumentation.
Debridement ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Paraplegia ; Postoperative Period ; Prospective Studies ; Spinal Cord ; Spine ; Spondylitis ; Transplants ; Tuberculosis

STUDY DESIGN: Prospective longitudinal study. PURPOSE: To determine if preoperative psychological status affects outcome in spinal surgery. OVERVIEW OF LITERATURE: Low back pain is known to have a psychosomatic component. Increased bodily awareness (somatization) and depressive symptoms are two factors that may affect outcome. It is possible to measure these components using questionnaires. METHODS: Patients who underwent posterior interbody fusion (PLIF) surgery were assessed preoperatively and at follow-up using a self-administered questionnaire. The visual analogue scale (VAS) for back and leg pain severity and the Oswestry Disability Index (ODI) were used as outcome measures. The psychological status of patients was classified into one of four groups using the Distress and Risk Assessment Method (DRAM); normal, at-risk, depressed somatic and distressed depressive. RESULTS: Preoperative DRAM scores showed 14 had no psychological disturbance (normal), 39 were at-risk, 11 distressed somatic, and 10 distressed depressive. There was no significant difference between the 4 groups in the mean preoperative ODI (analysis of variance, p = 0.426). There was a statistically and clinically significant improvement in the ODI after surgery for all but distressed somatic patients (9.8; range, -5.2 to 24.8; p = 0.177). VAS scores for all groups apart from the distressed somatic showed a statistically and clinically significant improvement. Our results show that preoperative psychological state affects outcome in PLIF surgery. CONCLUSIONS: Patients who were classified as distressed somatic preoperatively had a less favorable outcome compared to other groups. This group of patients may benefit from formal psychological assessment before undergoing PLIF surgery.
Depression ; Follow-Up Studies ; Humans ; Leg ; Low Back Pain ; Outcome Assessment (Health Care) ; Prospective Studies ; Psychological Tests ; Risk Assessment ; Spinal Fusion ; Spine ; Surveys and Questionnaires

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the surgical results of computer-assisted C1-C2 transarticular screw fixation for atlantoaxial instability and the usefulness of the navigation system. OVERVIEW OF LITERATURE: We used a computed tomography (CT)-based computer navigation system in planning and screw insertion in Magerl's procedure, which provides the most rigid atlantoaxial fusion, to avoid risk of vertebral artery (VA) tear by avoiding high-riding VA during screw insertion. METHODS: Twenty patients who underwent atlantoaxial fusion under the CT-based navigation system were studied. The mean observation period was 33.5 months. The evaluated items included the existence of VA stenosis by preoperative magnetic resonance angiography, surgical time, blood loss volume, Japanese Orthopaedic Association (JOA) score and Ranawat's pain criteria before surgery and at final follow-up, postoperative screw position evaluated by CT, and bony fusion. RESULTS: The mean operation time was 205 minutes, with the mean blood loss volume of 242 ml. The mean JOA score was 11.6 points before surgery and 13.7 at final follow-up. Occipital and/or cervical pain presented before operation was remitted or resolved in all patients. Evaluation of screw insertion by CT revealed correct penetration to atlantoaxial joints, with a perforation rate of 2.6%. There was no complication, including VA tear, and all patients who were followed-up during one year or more after surgery achieved bony fusion. Some subjects who appeared inappropriate for surgery from CT images were assessed as eligible for surgery based on the evaluation results obtained using the navigation system. CONCLUSIONS: It was demonstrated that the CT-based navigation system is an effective support device for Magerl's procedure.
Asian Continental Ancestry Group ; Atlanto-Axial Joint ; Congenital Abnormalities ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography ; Neck Pain ; Operative Time ; Retrospective Studies ; Vertebral Artery

STUDY DESIGN: This is a prospective study. PURPOSE: To develop a methodological approach for conducting ultrasound-guided lumbar facet nerve block by defining essential ultrasound-guided landmarks in order to assess the feasibility of this method. OVERVIEW OF LITERATURE: The current role of ultrasound guidance for musculoskeletal intervention treatments has been reported upon in previous literature. METHODS: Ultrasound-guided facet nerve block was done in 95 segments for 50 patients with chronic back pain by facet arthropathy. After the surface landmarks of the spinous process and iliac crest line were confirmed, longitudinal facet views were obtained by a curved array transducer to identify the different spinal segments. The spinous process and facet joint with transverse process were delineated by transverse sonograms at each level and the target point for the block was defined as lying on the upper edge of the transverse process. The needle was inserted toward the target point. After a contrast injection, the placement of the needle and contrast was checked by fluoroscopy. RESULTS: Eighty-seven segments (91.6%) could be guided successfully to the right facet nerve block by using ultrasound. After fluoroscopic control, 8 needles had to be corrected because of problems with other segments (3 cases) and lamina placements (5 cases). For the 42 patients who underwent successful block by ultrasound, however, the mean visual analogue score for back pain was improved from 6.2 +/- 0.9 before the block to 4.0 +/- 1.0 after the block (p = 0.001). CONCLUSIONS: Ultrasound-guided longitudinal facet view and the surface landmarks of the spinous process and iliac crest line seems to be a promising guidance technique for the lumbar facet nerve block technique.
Back Pain ; Deception ; Fluoroscopy ; Humans ; Lumbosacral Region ; Needles ; Nerve Block ; Prospective Studies ; Transducers ; Zygapophyseal Joint

STUDY DESIGN: This was a retrospective study of patients who had developed a dural tear after thoracic and lumbar spine surgery that was not recognized during the surgery, and was treated either by lumbar drainage or over-sewing of the wounds. PURPOSE: To revisit the treatment strategies in postoperative dural leaks and present our experience with over-sewing of the wound and lumbar drainage. OVERVIEW OF LITERATURE: Unintended durotomy is a frequent complication of spinal surgery. Management of subsequent cerebrospinal fluid leakage remains controversial. There is no distinct treatment guideline according to the etiology in the current literature. METHODS: The records of 368 consecutive patients who underwent thoracic and/or lumbar spine surgery from 2006 throug h 2010 were retrospectively reviewed. Seven cerebrospinal fluid fistulas and five pseudomeningoceles were noted in 12 (3.2%) procedures. Cerebrospinal fluid diversion by lumbar drainage in five pseudomeningoceles and over-sewing of wounds in seven cerebrospinal fluid fistulas employed in 12 patients. Clinical grading was evaluated by Wang. RESULTS: Of the 12 patients who had a dural tear, 5 were managed successfully with lumbar drainage, and 7 with oversewing of the wound. The clinical outcomes were excellent in 9 patients, good in 2, and poor in 1. Complications such as neurological deficits, or superficial or deep wound infections did not develop. A recurrence of the fistula or pseudomeningocele after the treatment was not seen in any of our patients. CONCLUSIONS: Pseudomeningoceles respond well to lumbar drainage, whereas over-sewing of the wound is an alternative treatment option in cerebrospinal fluid fistulas without neurological compromise.
Drainage ; Fistula ; Humans ; Recurrence ; Retrospective Studies ; Spine ; Wound Healing ; Wound Infection

No abstract available.
Spondylolisthesis*

Spondylolysis from pars fracture is a common injury among young athletes, which can limit activity and cause chronic back pain. While current literature has examined the relative benefits of surgical and conservative management of these injuries, no study has yet compared outcomes between conventional direct repair of pars defects and modern minimally invasive procedures. The goals of surgery are pain resolution, return to play at previous levels of activity, and a shorter course of recovery. In this review, the authors have attempted to quantify any differences in outcome between patients treated with conventional or minimally invasive techniques. A literature search was performed of the PubMed database for relevant articles, excluding articles describing conservative management, traumatic injury, or high-grade spondylolisthesis. Articles included for review involved young athletes treated for symptomatic spondylolysis with either conventional or minimally invasive surgery. Two independent reviewers conducted the literature search and judged articles for inclusion. All studies were classified according to the North American Spine Society standards. Of the 116 results of our initial search, 16 articles were included with a total of 150 patients. Due to a paucity of operative details in older studies and inconsistencies in both clinical methods and reporting among most articles, little quantitative analysis was possible. However, patients in the minimally invasive group did have significantly higher rates of pain resolution (p<0.001). Short recovery times were also noted in this group. Both groups experienced low complication rates, and the majority of patients returned to previous levels of activity. Surgical repair of spondylolysis in young athletes is a safe and practical therapy. Current literature suggests that while conventional repair remains effective, minimally invasive procedures better clinical outcomes. We await further data to conduct a more thorough quantitative analysis of these techniques.
Athletes* ; Back Pain ; Humans ; Minimally Invasive Surgical Procedures ; Return to Sport* ; Spine ; Spondylolisthesis ; Spondylolysis*

STUDY DESIGN: Clinical trial. PURPOSE: To evaluate the effectiveness of a multidisciplinary group-based intervention on improving pain and disability among Iranian nurses with chronic low back pain in Tehran, Iran. OVERVIEW OF LITERATURE: Although low back pain (LBP) is one of the most important health problems, the challenge remains on how to find an effective intervention to reduce pain and related disabilities. METHODS: Overall, 136 eligible nurses with chronic mechanical LBP were classified into two groups. The intervention group (n=66 participants) participated in a physiotherapy educational program (for 120 minutes) plus a health educational program based on predictive constructs of the social cognitive theory (for 120 minutes). These interventions were delivered by a physiotherapist and a health education specialist. The control group (n=70 participants) participated in a physiotherapy educational program (for 120 minutes). Disability rate, pain severity, and back pain prevention behavior were measured initially and at 3- and 6-month follow-up visits using the visual analogue scale, Roland-Morris Disability, and Nursing Low Back Pain Preventive Behaviors Questionnaire. Data were analyzed by SPSS ver. 16. RESULTS: There were statistically significant differences between the two groups in the main outcome measures immediately after the educational program and at 3- and 6-month follow-up visits. Preventive behaviors of participants in the intervention group were improved at 3- and 6- month follow-up visits (p<0.001). The mean scores of predictive constructs regarding LBP preventive behaviors in the intervention group were improved after 3 and 6 months (p<0.001). Finally, in the intervention group, pain severity and disability were decreased significantly. CONCLUSIONS: This study showed that a multidisciplinary educational program intervention can be an effective approach for reducing LBP and related disabilities among nurses.
Back Pain ; Follow-Up Studies* ; Health Education ; Humans ; Iran* ; Low Back Pain* ; Nursing Staff* ; Nursing* ; Outcome Assessment (Health Care) ; Physical Therapists ; Specialization

STUDY DESIGN: Whiplash injury is a prevalent and often destructive injury of the cervical column, which can lead to serious neck pain. Many approaches have been suggested for the treatment of whiplash injury, including anti-inflammatory drugs, manipulation, supervised exercise, and cervical collars. Cervical collars are generally divided into two groups: soft and rigid collars. PURPOSE: The present study aimed to compare the effect of soft and rigid cervical collars on immobilizing head and neck motion. OVERVIEW OF LITERATURE: Many studies have investigated the effect of collars on neck motion. Rigid collars have been shown to provide more immobilization in the sagittal and transverse planes compared with soft collars. However, according to some studies, soft and rigid collars provide the same range of motion in the frontal plane. METHODS: Twenty-nine healthy subjects aged 18–26 participated in this study. Data were collected using a three-dimensional motion analysis system and six infrared cameras. Eight markers, weighing 4.4 g and thickened 2 cm² were used to record kinematic data. According to the normality of the data, a paired t-test was used for statistical analyses. The level of significance was set at α=0.01. RESULTS: All motion significantly decreased when subjects used soft collars (p<0.01). According to the obtained data, flexion and lateral rotation experienced the maximum (39%) and minimum (11%) immobilization in all six motions using soft collars. Rigid collars caused maximum immobilization in flexion (59%) and minimum immobilization in the lateral rotation (18%) and limited all motion much more than the soft collar. CONCLUSIONS: This study showed that different cervical collars have different effects on neck motion. Rigid and soft cervical collars used in the present study limited the neck motion in both directions. Rigid collars contributed to significantly more immobilization in all directions.
Head* ; Healthy Volunteers* ; Immobilization* ; Neck Pain ; Neck* ; Range of Motion, Articular ; Whiplash Injuries