STUDY DESIGN: We retrospectively reviewed the cervical myelopathy patients who underwent anterior or posterior surgery. OBJECTIVES: This study was undertaken to analyze the preoperative radiologic evaluation and the results of the treatment of cervical myelopathy. SUMMARY OF LITERATURE REVIEW: The surgical treatment of cervical myelopathy consisted of anterior/posterior or combined surgery according to lesion site, symptoms, number of involved sequents or prevalence of the surgeon. Material and METHODS: We reviewed the clinical and radiological aspects of 28 patients Preoperative plain radiographs and MRI were evaluated with clinical symptoms. Postoperative clinical evaluation was performed according to the Robinson's criteria. RESULTS: On plain lateral radiographs, spinal canal diameter were 13.4+/-2.6/12.5+/- 1.7mm, Pavlovratios were 0.78+/-0.09/0.66+/-0.08, spondylosis indices were 1.70/1.80mm, and the antero-posterior compression ration of spinal cord were 42.4+/-8/44.0+/-6% for anterior surgery and posterior surgery group each. The results of 15 patients who received anterior decompression and interbody fusion were excellent in 11, good in 2, and fair in 2 cases. The results of 13 patients who underwent laminoplasty were excellent in 9, good in 3, and fair in one case. CONCLUSIONS: The patients who have Pavlov ratio less than 0.8 and spondylosis index more than 1.5mm on plain radiograph are vulnerable to developing myelopathy. It is better to do anterior decom pression and interbody fusion in patients who have one or two segments involved and kyphotic deformity of the cervical spine. Otherwise, patients who involve more than 3 segments and narrow spinal canal can be managed using laminoplasty posteriorly.
Congenital Abnormalities ; Decompression ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases* ; Spine ; Spondylosis

Purpose: The purpose of this study was to evaluate the mortality of patients over eighty years old with femoral neck fractures that have been treated with bipolar endoprostheses. Materials and Methods: We retrospectively studied 37 patients out of a total of 83, who suffered from hip fractures and were treated with surgery from 2000 through December 2004. We attempted to distinguish the differences between the 8 patients who died (Group A) and the 29 patients who lived (Group B). The variables that we analyzed, were: age, sex, operative time, the time period from admission to surgery, the time period from admission to discharge, the ASA score, and any medical comorbidities. Results: In Group A, 2 patients died within 1 month, 2 died between 1 and 6 months, 1 died between 6 and 12 months, and 3 died after 1 year. There were statistical differences between Group A and Group B with respect to two variables: the time period from admission to, and medical comorbidities. Conclusion: There were significant correlations with an increase in the mortality rate among patients with lung disease, female patients in general, and delays in surgery. Therefore, particular care should be paid to patients with these variables.
Comorbidity ; Female ; Femoral Neck Fractures ; Hip Fractures ; Hip* ; Humans ; Lung Diseases ; Mortality* ; Operative Time ; Retrospective Studies

No abstract available.

This study was performed to analyze the clinical, radiological results of 70 patients with isthmic spondylolisthesis and 30 patients with degenerative spondylolisthesis who were underwent with wide decompression, reduction with transpedicular screw system and posterolateral fusion from Mar. 1990 to Dec. 1995. In this study we excluded posterior lumbar interbody fusion, circumferential fusion or decompression method for sondylolisthesis. The mean follow up duration was 29 months. The most common level was L5-Sl in isthmic group (36 patients, 51%), and L4-5 in degenerative group (23 patients, 77%). The clinical result were analyzed according to Kirkaldy-Willis criteria. The satisfactory result were obtained 90% in each group. Screw failure occured in unstable level with severe slip angle, so anterior column support may be recommended in this group. Pedicle screw fixation and wide decompression augmented with posterolateral bone graft is a satisfactory alternative method for degenerative and isthmic spondylolisthesis.
Decompression ; Follow-Up Studies ; Humans ; Spondylolisthesis* ; Transplants

No abstract available.
Head* ; Necrosis*

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the outcome of percutaneous vertebroplasty (VP), with kyphoplasty, in the treatment of osteoporotic painful vertebral compression fractures (VCF). SUMMARY OF LITERATURE REVIEW: There is much controversy relating to the treatment of painful osteoporotic VCF. Recent analytical data exists on VP and kyphoplasty. MATERIALS AND METHODS: A consecutive group of patients, undergoing VP and kyphoplasty at our institution, between July 2000 and November 2002, were retrospectively reviewed. A total of 23 patients underwent 25 VP procedures under local anesthesia, and 8 underwent 8 kyphoplasty procedures, 3 under general and 5 under local anesthesia. A radiological assessment was achieved by the percentage of height restored, using both the preoperative and postoperative radiographs. The Visual analog scale (VAS) scores, obtained pre and postoperatively were used for the clinical assessment. The activity levels were assessed preoperatively, after discharge and at the last follow up period, by the ambulatory stati. RESULTS: The VP restored 27.62% (anterior*) and 30.26% (middle**) of the lost height. The kyphoplasty restored 35.52% (anterior*) and 53.43% (middle**) of the lost height (P=0.3334*, P=0.0264**). The postoperative pain was improved in all patients after both procedures. The postoperative VAS score was 3.826 after the VP and 2.875 after the kyphoplasty (P=0.5647). The activity levels were improved in all patients after both procedures. CONCLUSIONS: The kyphoplasty was more efficient in restoring the middle vertebral body height than the VP in the treatment of osteoporotic painful VCF. However, both procedures showed similar clinical improvements in the pain and restoration of the anterior vertebral body height in the treatment of painful osteoporotic VCF. Both kyphoplasty and VP safely increased the vertebral body height, decreased the acute back pain and quickly returned geriatric patients to higher activity levels, resulting in an increased independence and quality of life.
Anesthesia, Local ; Back Pain ; Body Height ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Osteoporosis ; Pain, Postoperative ; Quality of Life ; Retrospective Studies ; Vertebroplasty* ; Visual Analog Scale

STUDY DESIGN: A retrospective study. OBJECTIVES: To verify the advantages of adding gentle reduction and posterior lumbar interbody fusion (PLIF), using a cage to the usual posterolateral fusion (PLF), with pedicle screw instrumentation, in the surgical treatment of spinal stenosis with isthmic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The stabilization of isthmic spondylolisthesis, following decompression, is difficult. The PLIF, with a cage, offers anterior column support, reduction and a broad fusion base. MATERIALS AND METHODS: 31 patients were treated with wide decompression, pedicle screws fixation, PLF and PLIF, and followed up for more than 1 year. The degrees of slippage were grades I and II in 20 and 11 patients, respectively. The grade I patients were treated with gentle reduction of the slippage in the disc space, using a leverage maneuver with a Cobb's spinal elevator. The grade II patients were treated with the insertion of a pedicle screws, fixation of rods, reduction and distraction, and then insertion of a cage. After the procedure all the patients were evaluated for the reduction of spondylolisthesis, restoration of the disc space, radiological bony union and clinical results. RESULTS: Ninety percent of the patients were rated as excellent or good. Fusion of the PLIF occurred in all patients. The average reduction in the spondylolisthesis was 42.6 and 47.8% in the grade I and II patients, respectively. The average restorations of the disc spaces were 46.9 and 100.2% in the grade I and II patients, respectively. The maintenance of the reduction and disc height were excellent in the final follow-up radiographs. CONCLUSIONS: Adding gentle reduction and PLIF, using a cage, to the usual posterolateral fusion, with pedicle screw instrumentation, in the surgical treatment of spinal stenosis, with isthmic spondylolisthesis, showed satisfactory results in the reduction of the spondylolisthesis, the restoration of the disc height, the bony union and clinically.
Decompression* ; Elevators and Escalators ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis*

A peroneal dislocation is a rare disease that is often misdiagnosed as a simple sprain and can be treated inadequately in the acute phase.For this reason, it is important to have an appropriate diagnosis in the early stages because it can progress to chronic and recurrent conditions. Surgical treatment is considered mainly when progressing to chronic recurrent dislocation. Recently, patients with an acute peroneal dislocation tend to prefer surgical treatment, so accurate initial diagnosis and management are very important. This paper reports a case of chronic recurrent peroneal tendon dislocation in both ankle joints, which was treated by a superior peroneal retinaculum reconstruction and a groove deepening procedure.

Spontaneous epidural hematoma (SEH) is an uncommon cause of spinal cord compression. It tends to occur in patients at high risk for hemorrhage. Various medications are associated with SEH, including antiplatelet agents, anticoagulants, and thrombolytics. Because patients usually present with neurologic deficits, early diagnosis and proper management are required to achieve full recovery. The principal management is surgical evacuation of the SEH via laminectomy. We present a case of a 51-year-old woman on both oral aspirin and intravenous heparin who subsequently developed a SEH.
Anticoagulants ; Aspirin ; Early Diagnosis ; Female ; Hematoma ; Hematoma, Epidural, Spinal ; Hemorrhage ; Heparin ; Humans ; Laminectomy ; Middle Aged ; Neurologic Manifestations ; Platelet Aggregation Inhibitors ; Spinal Cord Compression

PURPOSE: To describe the technical skills and to estimate the clinical outcomes of port-hole decompression preserving the posterior ligaments during lumbar spinal stenosis surgery. MATERIALS AND METHODS: Between March 2014 and March 2016, a total of 101 patients who underwent port-hole decompression were retrospectively analyzed. The mean age was 71.3 years (58–84 years) and there were 46 males and 55 females. The mean follow-up period was 18 months. Degenerative spondylolisthesis was observed in 24.8% of patients (25/101). Port-hole decompression was performed by removing the central portion of the distal part of the upper lamina with a burr. Then, the contralateral side of ligamentum flavum and hypertrophied facet joints were removed. We estimated the lumbar lordotic angle using radiographs, and measured the depth from skin to upper lamina central area using magnetic resonance imaging axial images. We estimated the mean slip angle and mean degree of slip in preoperative and postoperative radiography in standing flexion and extension. We also measured the operational time, length of skin incision, and blood loss. The clinical results were estimated by a walking distance caused by neurologic intermittent claudication, visual analogue scale, and Oswestry disability index. RESULTS: Most patients were generally older, and the mean lordotic angle was 25.3°, which is considered to be lower when compared with younger people. The mean depth from skin to lamina was mean 5.4 cm. With respect to the radiological results, there were no significant differences between the preoperative and postoperative groups. The operation time, length of skin incision, and bleeding were not increased proportionally to the operation level. The walking distance caused by neurologic intermittent claudication, visual analogue scale, and Oswestry disability index of the post-operative group were all improved compared with the pre-operative group. CONCLUSION: The port-hole decompression, which decompresses the contralateral side while preserving the posterior ligaments and facet joints may be a useful technique for elderly patients with multiple level stenosis, minimizing spinal segmental instability.
Aged ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Intermittent Claudication ; Ligaments ; Ligamentum Flavum ; Magnetic Resonance Imaging ; Male ; Radiography ; Retrospective Studies ; Skin ; Spinal Stenosis ; Spondylolisthesis ; Walking ; Zygapophyseal Joint