1/32. The aetiology of congenital angulation of tubular bones with constriction of the medullary canal, and its relationship to congenital pseudarthrosis.It is suggested that there is a group of cases of congenital angulation of tubular bones in which the lesion is a defect of ossification of the primary cartilaginous anlage and in which neurofibromatosis is not implicated. It appears that in this group the prognosis with regard to the resolution of deformity and the prevention of pseudarthrosis with conservative treatment or relatively simple surgical procedures is better than that in the neurofibromatous type.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
2/32. forearm pseudarthrosis--neurofibromatosis: case report.A 3 1/2-year-old white girl with neurofibromatosis sustained left radius and ulna fractures. The radius was sclerotic with no medullary canal at the fracture site, and the ulna was hypoplastic distal to the fracture. The fractures failed to unite when immobilized in a long arm plaster cast for 5 months and pseudarthrosis developed. Three subsequent operative attempts to obtain union of the pseudarthrosis by means of internal fixation and bone grafting over the next 30 months were also unsuccessful, and the pseudarthrosis persisted. The forearm was supported in a custom molded leather brace until the child was 13 1/2 years old and had reached skeletal maturity. Osseous union was then operatively obtained using dual onlay tibial cortical and cancellous bone grafts. There has been no recurrence of the pseudarthrosis 3 years and 2 months after bone grafting. The author recommends postponing surgical attempts to achieve union of the forearm bone pseudarthrosis associated with neurofibromatosis until the patient reaches skeletal maturity.- - - - - - - - - - ranking = 0.25keywords = canal (Clic here for more details about this article) |
3/32. Spinal cage retrieval and assessment of biologic response.Implant retrieval programs have been effective in understanding implant failure and biomaterial compatibility in joint arthroplasty; however, its application has not been extended extensively to the assessment of spinal constructs and implants. The objective of this study is to determine the efficacy of implant retrieval analysis as a standard for the assessment of explanted spinal implants. The limitations of clinical radiographic assessment of fusion through metal interbody devices are also identified. The implant analysis protocol is shown through a case report of a titanium mesh spinal fusion cage retrieved from a 54-year-old woman who had a pseudoarthrosis at the T12 cage interface. The implant analysis techniques include backscattered electron imaging, high-resolution contact radiography, histology, and fluorochrome analysis. An implant retrieval analysis program similar to the one discussed in the presented case study will enable an accurate assessment of outcomes of these commonly used implants and will guide future development.- - - - - - - - - - ranking = 19.872980406391keywords = spinal (Clic here for more details about this article) |
4/32. Spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis: a case report.STUDY DESIGN: We report on a 69-year-old male who had severe back pain due to spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis. OBJECTIVE: To describe a rare clinical entity and successful treatment by spinal fusion with a 4-year follow-up. SUMMARY OF BACKGROUND DATA: There have been a few reports of spontaneous symptomatic pseudoarthrosis of an intervertebral space associated with diffuse idiopathic skeletal hyperostosis, but there have been no reports of surgical treatment for this clinical condition. methods: Plain radiographs of the patient, who was admitted to our hospital with severe back pain but no history of trauma, revealed manifestations of diffuse idiopathic skeletal hyperostosis and a pseudoarthrosis at the T11-T12 intervertebral space. Posterior instrumentation from T9 to L2 and anterior bone grafting at the T11-T12 intervertebral space were performed. RESULTS: The patient has been followed for 4 years and is currently asymptomatic. CONCLUSIONS: A rare case of spontaneous symptomatic pseudoarthrosis at the T11-T12 intervertebral space with diffuse idiopathic skeletal hyperostosis was treated successfully by spinal fusion.- - - - - - - - - - ranking = 13.248653604261keywords = spinal (Clic here for more details about this article) |
5/32. pseudarthrosis and pseudopseudarthrosis of ankylosing spondylitis-report of 2 cases.pseudarthrosis is a well known, late complication of ankylosing spondylitis associated with extensive discovertebral junction destruction and fracture of the posterior elements. In contrast, the term "Pseudopseudarthrosis" is published in the recent literature to portray similar roentgenologic findings of discovertebral destruction but without bony break of the posterior arch. In this article, each complication is presented by a single case using the demonstration of plain film and computed tomography studies to compare their differences in the posterior spinal elements.- - - - - - - - - - ranking = 6.6243268021304keywords = spinal (Clic here for more details about this article) |
6/32. Reversal of anterior cervical fusion with a cervical arthroplasty prosthesis.This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level. Six months after the original surgery, he underwent re-exploration. decompression and arthroplasty were effected at the C6-C7 level. The old fusion was removed at the C5-C6 level and remobilized, and an arthroplasty was performed. At discharge, the patient's neck pain and hand symptoms had improved, and he had motion demonstrable on radiologic imaging at C5-C6. This is the first reported case of reversal of a cervical fusion with re-establishment of motion and represents an alternate acceptable management of pseudoarthrosis or recent spinal fusion.- - - - - - - - - - ranking = 6.6243268021304keywords = spinal (Clic here for more details about this article) |
7/32. Allograft bone in spinal fusion for adolescent idiopathic scoliosis.OBJECTIVE: The purpose of this long-term study was to determine the efficacy of allograft bone for spinal fusion for adolescent idiopathic scoliosis. Prior studies comparing allograft and autograft have been short term. methods: This multicenter retrospective study was carried out on 111 patients with 132 total curves fused for adolescent idiopathic scoliosis. Minimum follow-up was 5 years (average 72 months). A variety of segmental instrumentation was used, with most being dual-rod, multiple-hook constructs. RESULTS: Average preoperative curve was 59 degrees with immediate correction to 29 degrees (51%) and final follow-up of 32.24 degrees (45.4%). Average loss of correction was 3.5 degrees (5.9%). There were three pseudarthroses, one infection, and no rod breakage. CONCLUSION: pseudarthrosis rate of 2.7% and loss of correction of 5.9% are comparable with or better than those in previous reports using autogenous bone graft and either segmental or nonsegmental instrumentation.- - - - - - - - - - ranking = 33.121634010652keywords = spinal (Clic here for more details about this article) |
8/32. Posterior transcanal lumbar interbody fusion for septic vertebral fracture pseudarthrosis and sitting imbalance.STUDY DESIGN: Case report. OBJECTIVE: To describe a new method to treat septic pseudarthrosis of the lumbar spine via a transcanal approach. SUMMARY OF BACKGROUND DATA: Septic pseudarthrosis of the spine after multiple unsuccessful anterior and posterior surgeries for vertebral fracture represents a challenge for spine surgeons. methods: Septic pseudarthrosis associated with dorsal fistula developed in a 40-year-old paraplegic man after unsuccessful combined anterior and posterior instrumentation for L3-burst fracture and sagittal sitting imbalance caused by collapsing spine. RESULTS: The instrumentation was removed together with meticulous pseudarthrosis debridement, fistula excision, and intravenous antibiotics plus continuous irrigation. Three months later, the pseudarthrosis area was approached via a posterior transcanal route because of the preceding multiple anterior transperitoneal and retroperitoneal surgeries. Posterior interbody instrumentation and fusion were performed with titanium mesh cages filled with autologous iliac bone graft. Pedicle screw-rod instrumentation was additionally applied to reinforce the interbody fusion and restore lumbar lordosis. Following this operation, the patient was ambulated with a custom made plastic jacket in his wheelchair. The postoperative course was uneventful, and the patient regained his sitting ability progressively. Four months later, the blood count analysis was within normal limits. Radiologically, there was a complete fusion at the level of instrumentation, while the preoperative lost lumbar lordosis was sufficiently restored. The patient was reemployed 6 months after surgery in his previous work in a sitting position, and, during the last observation 4 years later, he had normal labor analysis and lumbar lordosis. CONCLUSION: This extremely rare case focuses on the use of the transcanal approach to treat adequately lumbar septic pseudarthrosis and restore lumbar lordosis in definitively paraplegic patients in whom no anterior approach can be used.- - - - - - - - - - ranking = 1.75keywords = canal (Clic here for more details about this article) |
9/32. Long-term follow-up of vascularized bone grafts for the reconstruction of tibial nonunion: evaluation with computed tomographic scanning.Ten cases of reconstruction of the tibia with vascularized bone grafts were evaluated by computed tomographic (CT) scanning. In all cases the grafts were placed because of pseudarthrosis. The patients ranged in age from 20 to 64 years. The duration of follow-up was 1-9 years. In six cases fibular grafts were used to bridge the defect and in four cases iliac crest grafts were used. No additional bone grafts were placed after the initial operation. The pseudarthroses were classified into three types: type N--no bony defect (4 cases); type P--partial bony defect (3 cases); and type C--complete segmental bone loss (3 cases). Our evaluation showed that the grafts used to treat the type N and type P pseudarthroses were the same shape and size as at the time of placement. The grafts used to treat the type C pseudarthroses were hypertrophied, although the medullary canal of the graft remained the same size as at the time of placement. hypertrophy was a result of an extraperiosteal reaction. The fibular grafts were square rather than triangular in cross section. It was concluded that mechanical loading is important in promoting hypertrophy of the graft.- - - - - - - - - - ranking = 0.25keywords = canal (Clic here for more details about this article) |
10/32. paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis.BACKGROUND CONTEXT: Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS. PURPOSE: To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS. STUDY DESIGN/SETTING: Case report/Osaka University Graduate School of medicine, Suita, japan. PATIENT SAMPLE: A 55-year-old man with a 27-year history of AS. OUTCOME MEASURES: Case report. methods: A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11-T12 level after infliximab therapy. RESULTS: After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted. CONCLUSIONS: Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.- - - - - - - - - - ranking = 46.370287614913keywords = spinal (Clic here for more details about this article) |
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