1/23. Salvage of a malpositioned anterior odontoid screw.STUDY DESIGN: Description of surgical technique with case correlation. OBJECTIVE: This article presents an alternative approach to anterior odontoid screw salvage in a patient with established nonunion. SUMMARY OF BACKGROUND DATA: Type II odontoid fractures are often treated surgically because of their risk of nonunion. Anterior odontoid screw fixation offers stable fixation without loss of atlantoaxial motion. treatment failure may occur despite adequate screw placement but is more likely when fixation is inadequate. The traditional solution is a posterior fusion. In selected cases the surgeon may want to revise the anterior instrumentation with the hope of retaining as much C1-C2 motion as possible. methods: A 43-year-old man presented 16 months after Type II odontoid fracture treated by anterior odontoid screw fixation. He had neck pain, instability, and a pseudarthrosis confirmed on radiographs. The screw was excessively long, piercing the C3 vertebral body and providing inadequate fixation. To avoid posterior fusion, a modified anterior approach was used. An entry point was selected 10 mm lateral to the midline, along the anterior rim of the C2 vertebral body. A large-diameter lag screw was then passed to the tip of the fragment. An angled curette was introduced into the fracture gap through the interval between the odontoid and the C1 ring. Autogenous bone was packed into the gap and along the old screw tract. RESULTS: At the 2-year follow-up the patient had a solid union with no neck pain, no headaches, no radicular symptoms, and excellent range of motion. The approach is described. CONCLUSION: In properly selected patients an anterior revision approach can provide a better outcome than posterior cervical fusion. This modified approach allows placement of an adequate fixation screw in a vertebra damaged by previous screw failure.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/23. Fractures of the posterior part of the body and unilateral spinous process of the axis: a case report.STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To present a case of the fractures of the posterior part of the body and unilateral spinous process of the axis. SUMMARY OF BACKGROUND DATA: A few authors have described fractures involving the body of the axis. Fractures of the posterior part of the body and unilateral spinous process of the axis are extremely rare. methods: A fracture of the posterior part of the body and unilateral spinous process was treated nonsurgically by a halo and a philadelphia brace. The relevant literature was reviewed. RESULTS: Solid bony union was shown by plain radiographs and computed tomography. The patient was free of pain and obtained a full range of motion. CONCLUSION: The presumed mechanism of injury in the fracture described here was flexion and axial rotation.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
3/23. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report.STUDY DESIGN: A case of bilateral pedicle stress fracture is reported, and the literature is reviewed. OBJECTIVES: To report the rare case of bilateral pedicle stress fracture after instrumented posterolateral fusion, and to investigate the contributing factors. SUMMARY OF BACKGROUND DATA: A 62-year-old man underwent revision spinal surgery for adjacent-segment degeneration. decompression and instrumented posterolateral fusion from L1 to L3 were performed after removal of the previously inserted pedicular screws. In the patient's history, he had undergone L3-L5 instrumented posterolateral fusion for spinal stenosis 6 years previously. At 1 year after the revision surgery, he presented with severe progressive low back pain. Computer-assisted tomogram and bone scan demonstrated bilateral L4 pedicle stress fracture. To the best of the authors' knowledge, only two cases of pedicle stress fracture after lumbar posterolateral fusion have been reported. methods: This study reviewed the reported patient's medical record, his imaging studies, and related literature. The possible factors contributing to bilateral pedicle stress fractures were investigated. RESULTS: In the reported case, the features of radiographic studies confirmed bilateral pedicle stress fracture. The involved vertebra was L4. In all three cases reported so far, including the current case, the site of the pedicle stress fracture was at the junction of the pedicle and vertebral bodies. CONCLUSIONS: Bilateral pedicle stress fracture occurs as a complication of posterolateral lumbar fusion. Pedicle weakening by prior inserted screws and persistent anterior motion after posterolateral fusion are the contributing factors.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
4/23. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature.STUDY DESIGN: Clinical case report of bilateral stress fractures of the pedicle in a female athlete presenting with back pain. OBJECTIVES: To report this unusual case and surgical treatment and to review the relevant literature. SUMMARY OF BACKGROUND DATA: low back pain is a frequent complaint in athletes, with the majority of cases being related to muscular or soft tissue etiology. spondylolysis, or pars fracture, is the most common injury of the neural arch. Stress fracture of the pedicle is a much less common occurrence. Bilateral pedicle fractures in an otherwise healthy athlete has not been previously reported in the orthopedic literature. methods: A 19-year-old female athlete presented with low back pain limiting sports and daily activities. Radiographic workup revealed bilateral stress fractures of the pedicles of the L5 vertebra. Circumferential fusion of the L5-S1 segment was performed after failure of conservative treatment. Anterior interbody structural allograft and a vertical mesh cage were combined with instrumented posterolateral fusion using segmental pedicle screws and autogenous iliac crest bone graft. RESULTS: The patient achieved complete pain relief, solid fusion, and return to normal function. CONCLUSIONS: In this uncommon case of bilateral stress fractures of the pedicle, circumferential fusion assures full immobilization of the injured motion segment and assures a high probability of successful healing.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
5/23. chiropractic care of a geriatric patient with an acute fracture-subluxation of the eighth thoracic vertebra.OBJECTIVE: To describe the chiropractic care of a geriatric patient with complaints of midthoracic and low back pain. CLINICAL FEATURES: A 74-year-old woman sought chiropractic care with complaints of thoracic spinal pain following a fall. palpation findings included hypertonicity and tenderness along with painful muscle spasms in the paraspinal musculature of the thoracolumbar spine. Limited range of thoracolumbar motion was found on extension and lateral flexion, most notably on right lateral flexion, with pain. Radiographic examination revealed a compression fracture at T8, in addition to spinographic listings. Signs of sprain injury were also detected at T8. INTERVENTION AND OUTCOME: The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxations and at the T8 fracture-subluxation. The patient's response to care was positive. CONCLUSION: This case report describes the clinical features, care, and results of 1 geriatric patient with a thoracic compression fracture-subluxation treated with specific chiropractic procedures. The patient had an apparent decrease in pain as a result of the treatment. Due to the inherent limitations of a case report, it is inappropriate to generalize this outcome.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
6/23. Acetabular reduction osteotomy using surgical dislocation of the hip joint for treatment of a malunited acetabular fracture.INTRODUCTION: Acetabular fractures remain a challenge for the orthopedic and trauma surgeon, with frequently poor outcome in terms of pain and lack of motion and high rate of posttraumatic arthritis especially in badly reconstructed fractures where the anatomy was not restored. Surgical treatment of malunited acetabular fractures is often necessary, although it can be very complex. CASE PRESENTATION: We report a young woman who sustained both column fracture with central dislocation of the femoral head in which the posterior wall fragment was initially not fixed anatomically. CONCLUSIONS: Surgical dislocation of malunited acetabular fractures is a relatively new therapeutic option that provides full access to the femoral head and acetabulum without compromising the blood supply to the femoral head. Our results show that it can also be of great help in restoring malunited acetabular fractures.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
7/23. Electrical twitch obtaining intramuscular stimulation (ETOIMS) for myofascial pain syndrome in a football player.BACKGROUND: Flare up of acute lower back pain associated with myofascial pain syndrome (MPS) may require various forms of treatment including activity restriction and bracing. Electrical twitch obtaining intramuscular stimulation (ETOIMS) is a promising new treatment. It involves the use of a strong monopolar electromyographic needle electrode for electrical stimulation of deep motor end plate zones in multiple muscles in order to elicit twitches. CASE REPORT: An elite American football player with MPS symptoms failed to respond to standard treatments. He then received ETOIMS which completely alleviated the pain. After establishing pain control, the athlete continued with a further series of treatments to control symptoms of muscle tightness. CONCLUSIONS: ETOIMS has a promising role in pain alleviation, increasing and maintaining range of motion, and in providing satisfactory athletic performance during long term follow up.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
8/23. Anterior screw fixation for a pediatric odontoid nonunion: a case report.STUDY DESIGN: A case of an odontoid nonunion in a child treated with anterior screw fixation. OBJECTIVES: To demonstrate that an anterior screw procedure can be performed with an odontoid nonunion with resultant fusion to maintain range of motion. methods: A 15-year-old boy presented with pain in his neck following a rugby football injury. Admission plain radiographs and computed tomography scan demonstrated an odontoid nonunion. Radiographs of a previous cervical spine injury 2 years before demonstrated a missed odontoid fracture. RESULTS: The child was initially treated conservatively with halo vest immobilization, which did not result in healing. Direct anterior screw fixation was performed and the fracture united 5 months following surgery. DISCUSSION: The nonunion was asymptomatic for 2 years until the second injury when it became clinically symptomatic. It did not respond to conservative treatment and was unstable on screening requiring operative intervention. CONCLUSIONS: Very few cases have been reported of pediatric odontoid nonunions. If the fracture pattern allows, then direct anterior screw fixation should be considered in order to maintain range of motion at the atlantoaxial articulation.- - - - - - - - - - ranking = 0.66666666666667keywords = motion (Clic here for more details about this article) |
9/23. Pars screw fixation of a hangman's fracture: technical case report.OBJECTIVE AND IMPORTANCE: Traumatic spondylolisthesis of the axis may be treated by external immobilization or surgical fixation. CLINICAL PRESENTATION: We report the case of a 23-year-old man who sustained an Effendi Type II fracture of the axis, for which halo immobilization did not provide adequate stability. INTERVENTION: The unstable fracture was treated by placing lag screws in the pars interarticularis of C2, which reduced the fracture directly but sacrificed no normal spinal motion. The patient developed a solid fusion, and cervical alignment was normal at his 6-month follow-up examination. CONCLUSION: Although this technique has been reported previously, it is more commonly used in multilevel cervical fusions than for stand-alone repair of C2. Management options, anatomy, and technical considerations for the treatment of traumatic spondylolisthesis are reviewed.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
10/23. Internal fixation without fusion of a flexion-distraction injury in the lower cervical spine of a three-year-old.BACKGROUND: Reported surgical treatment of unstable pediatric cervical spine injuries typically involves posterior fusion with internal fixation, usually with posterior wiring. PURPOSE: To discuss management issues in the treatment of an unstable Salter-Harris type I pediatric cervical spine injury and surgical intervention without fusion. STUDY DESIGN: A case report. methods: Summary of the management of an unstable flexion-distraction injury in a 3-year-old child is presented with literature review. RESULTS: A rare unstable flexion distraction injury of the pediatric cervical spine was successfully treated with posterior wiring without fusion. The wires underwent fatigue failure and maintenance of motion achieved without instability at 2-year follow-up. CONCLUSIONS: In select physeal injuries of the pediatric cervical spine, internal fixation can provide stability while healing occurs, with avoidance of fusion and maintenance of motion.- - - - - - - - - - ranking = 0.66666666666667keywords = motion (Clic here for more details about this article) |
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