Lumbar Spinal Stenosis: Surgical Considerations--Richard J. Nasca, MD
Spinal stenosis is an acquired or congenital narrowing of the spinal or nerve-root canals. Surgical treatment is often effective. Acquired spinal stenosis most commonly occurs in those with degenerative disk disease and arthritic facets. If the degenerative process stabilizes and there is adequate room to accommodate the neural contents, symptomatic patients become asymptomatic. Residual stability after decompression must be assessed in patients having multilevel decompression. Fusion may be indicated. In women with osteoporosis coexisting with degenerative scoliosis and spinal stenosis, decompression for concave nerve-root compression and fusion are necessary. Spinal fusion is not indicated in patients with lumbar spinal stenosis having unilateral decompression for lateral stenosis. Patients with central-mixed stenosis may not need fusion. Patients with spinal stenosis after laminectomies and diskectomies had better results when arthrodesis was done in conjunction with repeated decompression. Arthrodesis with instrumentation and decompression is recommended for patients with degenerative spondylolisthesis. (Journal of the Southern Orthopaedic Association 11(3):127–134, 2002)
The Cooper River Bridge Run Study of Low Back Pain in Runners and Walkers--Shane K. Woolf, MD, William R. Barfield, PhD, Paul J. Nietert, PhD, Arch G. Mainous III, PhD, and John A. Glaser, MD
Investigations dedicated to examining relationships between low back pain (LBP) and factors specific to running and walking are limited. Current literature suggests runners and walkers may have a lower relative risk for significant LBP. The purpose of this study was to investigate the incidence, prevalence, and possible risk factors for LBP among a group of runners and walkers. A survey was administered to participants who registered for either a 10-kilometer run or 4-mile recreational walk. A total of 539 responses were received. Previous history of LBP was reported by 74% of respondents overall. Prevalence of LBP at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for LBP. We believe these findings warrant further investigation. This knowledge may benefit not only athletes in training, but other fitness enthusiasts, including casual runners and walkers and those who jog or walk to rehabilitate low back injuries. (Journal of the Southern Orthopaedic Association 11(3):136–143, 2002) Key words: athletes, chronic, joggers, low back pain, runners, treatment, walkers
Carpal Tunnel Release: Efficacy and Recurrence Rate After a Limited Incision Release--David Simms Ruch, MD, Charles N. Seal, MD, Matthew Scott Bliss, MD, and Beth Paterson Smith, PhD
We retrospectively studied the postoperative outcomes of 51 patients treated for idiopathic carpal tunnel syndrome by method of a limited incision carpal tunnel release. Patients were assessed to determine: 1) palmar tenderness, 2) scar tenderness, 3) relief of symptoms, 4) complications, and 5) recurrence. Short-term follow-up included patient evaluations at 2 weeks, 4 weeks, and 10 weeks; a mean of 2.5 years of follow-up also was obtained. Postoperatively, nocturnal symptoms resolved by the 2-week visit. Palmar tenderness was noted as minimal or absent between the 4-week and 10-week visits in 47 of the 51 patients (92%). Symptom and function scores improved from 4.24 and 4.00 preoperatively to 1.18 and 1.19 postoperatively. At a mean of 2.5 years after surgery, none of the patients reported recurrent symptoms. (Journal of the Southern Orthopaedic Association 11(3):144–147, 2002) Key words: carpal tunnel, compressive neuropathy, median nerve
Biomechanical Evaluation of Fixation of Clavicular Fractures--Ignacio R. Proubasta, MD, Juan P. Itarte, MD, Enric P. Caceres, MD, Manel P. Llusa,MD, Javier M. Gil, MD, Josep A.E. Planell, MD, and Maria Pau M. Ginebra, MD
Reproducible fractures of the midshaft of the clavicle were created in 14 fresh frozen human cadaveric clavicles. Under the three-point bending loading by a materials testing machine, the load to failure of fixation of the clavicular fractures treated with steel reconstruction plates (five specimens) and Herbert cannulated bone screw (nine specimens), was compared with a group control formed by five specimens of clavicles without osteosynthesis material. No statistically significant differences were observed between the three groups. In consequence and in terms of biomechanics, in clavicular acute fractures, both plating and intramedullary Herbert cannulated bone screw may be utilized in the treatment of these lesions. (Journal of the Southern Orthopaedic Association 11(3):148–152, 2002) Key words: biomechanics, clavicular fractures, osteosynthesis
Results of Simultaneous Bilateral Total Knee Replacement: A Study of 1208 Knees in 604 Patients--Jose Alemparte, MD, Gonzalo Vazquez-Vela Johnson, MD, Richard L. Worland, MD, FACS, Douglas E. Jessup, MD, and Jonathan Keenan, FRCS (Tr and Orth)
Bilateral symptomatic knee arthritis is a common clinical problem. There are conflicting opinions as to the advisability of simultaneous sequential bilateral total knee replacement. Complication rates of primary unilateral knee replacement are well documented and there are several small series that compare the two techniques. The objective of this study was to identify the complication rate of simultaneous sequential bilateral total knee replacement in a large patient population. Over a 13-year period, 604 primary bilateral sequential simultaneous total knee replacements (1208 knees) were performed. Office notes and hospital charts were retrospectively reviewed to obtain age, sex, diagnosis, knee alignment, associated comorbidities, operative protocol, transfusions, and complications. The study results showed 5.1% local and 15.3% systemic complications and 0.7% mortality rate (none in the past 9 years). With appropriate patient selection and operative technique, patients who present with bilateral symptomatic knee arthritis can enjoy the benefits of simultaneous sequential bilateral total knee replacement without increasing their risks of complications. (Journal of the Southern Orthopaedic Association 11(3):153–156, 2002) Key words: bilateral, sequential, simultaneous, total knee replacement
Outcomes of Posterolateral Versus BAK Titanium Cage Interbody Lumbar Fusion in Injured Workers: A Retrospective Cohort Study--M. Scott DeBerard, PhD, Alan L. Colledge, MD, Kevin S. Masters, PhD, Rand L.
Schleusener, MD, and John D. Schlegel, MD
Lumbar fusion has been criticized for variable patient outcomes, though little is known regarding how outcomes vary across procedures. We examined outcomes of posterolateral versus BAK interbody lumbar fusion in workers’ compensation cases. A medical record review and a follow-up survey were completed. The sample included 185 posterolateral and 185 lumbar interbody fusions. An outcome survey was conducted an average of 5 years after surgery. Arthrodesis rates, satisfaction, function, and health were better for the BAK interbody lumbar fusion cohort. Results suggest greater efficacy of the BAK interbody approach over posterolateral approaches to lumbar fusion in compensated patients. (Journal of the Southern Orthopaedic Association 11(3):157–166, 2002) Key words: lumbar fusion techniques, patient outcomes, titanium cages, workers' compensation
Biostructural Augmentation for the Treatment of Osteonecrosis: Rationale, Technique, and Case Example--Alex Leali, MD, Joseph Fetto, MD, and James J. Hale, MD
Avascular necrosis of the hip is a common disease that usually affects a young and active patient population. As the disease progresses, the undermined structural integrity of the subchondral bone leads to articular collapse and subsequent osteoarthrosis. The ideal treatment is one that hinders or arrests the progression of the disease, averting articular collapse and joint replacement surgery. A surgical strategy is described that attempts to address the multiple factors involved in the progression of the disease. This is accomplished through a modified core decompression procedure combined with the insertion of two interference screws into the subchondral plate to provide structural support and the use of osteoinductive material (i.e., demineralized bone matrix) in an effort to accelerate the bone healing process. (Journal of the Southern Orthopaedic Association 11(3):167–171, 2002) Key words: avascular necrosis, biological augmentation, osteonecrosis, structural augmentation, surgical technique
Multifocal Osteonecrosis and Human Immunodeficiency Virus Infection--David E. Attarian, MD
Over the past decade, a causal relationship between infection with human immunodeficiency virus (HIV) and osteonecrosis has been proposed. This case report (the first example presented in the English orthopaedic literature) of multifocal (>3 sites) osteonecrosis in a patient with HIV infection highlights the current scientific knowledge regarding incidence, predisposing risk factors, proposed biologic mechanisms, and clinical orthopaedic management. This information may become increasingly relevant for the orthopaedic clinician as more patients with HIV infection live longer. (Journal of the Southern Orthopaedic Association 11(3):172–173, 2002)
The Pink Pulseless Hand--David Simms Ruch, MD, Charles N. Seal, MD, L. Andrew Koman, MD, and Beth Paterson Smith, PhD
The management of a child with a perfused, pink, but pulseless upper extremity following reduction and pinning of a type III supracondylar humerus fracture remains controversial. The authors present the initial treatment, evaluation, operative findings, and postoperative course of a 6-year-old with a pink pulseless hand. Review of the literature is included, as well as recommendations regarding operative management. (Journal of the Southern Orthopaedic Association 11(3):174–178, 2002)