RESUMEN
The purpose of this study was to determine whether the addition of pedicle screws and rods to a fusion of two or more vertebrae of the lowest three motion segments of the lumbar spine increases the incidence or severity of transition zone change (TZC) above or below the fused area. A study group of 52 patients who had a fusion with fixation and a control group of 31 who had a nearly identical operation but without fixation were obtained. Radiographs and computed tomography scans of the area of study were taken preoperatively and were repeated approximately 7 years after the operation. Results showed that the addition of pedicle screw fixation does not increase the incidence or severity of TZC in the first 7 years after surgery.
Asunto(s)
Vértebras Lumbares/cirugía , Dispositivos de Fijación Ortopédica/efectos adversos , Complicaciones Posoperatorias/etiología , Fusión Vertebral/métodos , Columna Vertebral/diagnóstico por imagen , Femenino , Humanos , Incidencia , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Seudoartrosis/epidemiología , Seudoartrosis/etiología , Radiografía , Estudios RetrospectivosRESUMEN
Unilateral fusion of the lumbar spine is rarely necessary or indicated. However, in patients with a "far-out syndrome" requiring decompression or in cases where unilateral posterior element resection is necessary for any reason, it may be both necessary and indicated. This unilateral destabilization effectively removes one leg of the tripod, rendering that intervertebral joint potentially unstable. The charts and radiographs of 13 patients (seven men, six women) with an average age of 60 years (range, 25 to 76) who underwent unilateral fusion were retrospectively reviewed. Follow-up time ranged from 12 1/2 to 2 years with a median follow-up of 8 years. Eleven of the fusions were at one level, and two were at two levels. Seven patients had a far-out syndrome secondary to degenerative scoliosis; four were secondary to spondylolisthesis. Two patients had an osteoid osteoma involving a pedicle. A paraspinal approach was used in the majority of patients. Autologous bone graft was used in all patients. Unilateral pedicle screw fixation was used in the last patient in the series. The fusion rate was 85% (11/13). Three patients were smokers, two of whom developed pseudarthrosis. Disc space height did not appear to affect fusion rate. There was no progression of slip noted in any of the patients. One complication was noted in this group: a moderate postoperative infection, which cleared spontaneously.
Asunto(s)
Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/cirugía , Raíces Nerviosas EspinalesRESUMEN
Ninety-nine patients were studied prospectively after spine fusion augmented with the Wiltse pedicle screw fixation system. Follow-up ranged from 12 to 34 months, averaging 20 months. There were 33 men and 66 women. Their ages ranged from 20 to 86, with the average age of 52. This was the first spine surgery in 23 patients. Seventy-six patients had had prior spine surgery. Spine fusion was attempted at one to four levels of the lumbosacral spine. Major perioperative complications were seen in seven patients (7%). Hardware failure was seen in seven cases (7%). Union was assessed by radiographs at 1 year or more after surgery in 82 patients (85%). In those 82 patients, union was seen in 56 (68%) and nonunion in 26 (32%). Change in lordosis was measured in 54 patients. The average change was a loss of 1.7 degrees lordosis per level fused. A questionnaire was answered by 79 patients (81%). Overall, 55 (70%) stated that they had some benefit from surgery, ten (13%) had no change, and 13 (17%) were worse.
Asunto(s)
Tornillos Óseos , Vértebras Lumbares/cirugía , Dispositivos de Fijación Ortopédica , Fusión Vertebral , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Radiografía , Enfermedades de la Columna Vertebral/cirugía , Factores de TiempoRESUMEN
Two hundred fifty-seven high school track athletes from 17 teams were observed prospectively for one complete season (77 days) to study the incidence and types of injuries and to establish the relationship among injuries, duration of training, and individual performance ability. One hundred seventy-four (68%) of the athletes were male and 83 (33%) were female. A total of 41 injuries was observed over this period of time. One injury occurred for every 5.8 males and every 7.5 females. On the average, an injury resulted in 8.1 days of missed practice, 8.7 days for males and 6.6 days for females. Sprinting events were responsible for 46% of all injuries. The majority (83%) of injuries involved the lower extremities. Management of these injuries varied greatly. A direct correlation was noted between performance level of the athlete and incidence of injuries. The average noninjured athlete ranked at the 57.4 percentile based on best seasonal performance while the average injured athlete ranked at the 75.4 percentile. This direct relationship was present for both sexes and within all events, although some variation was noted within these separate groups.