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PURPOSE: Purpose of the study was to analyze in a retrospective way the clinical and radiographic outcome of three different surgical techniques in patients who underwent anterior cervical fusion. METHODS: Eighty-six patients affected by symptomatic cervical disc herniation or spondylosis underwent cervical anterior fusion. Patients were divided in three groups considering the surgical technique. Clinical outcomes were evaluated by Visual Analog Scale, Odom's criteria, Neck Disability Index. Radiographic evaluation included standard and functional X-rays. RESULTS: At 7 years mean follow-up, a comparable improvement in clinical symptoms was observed in all groups. Radiographic findings showed a solid fusion in all patients but seven cases in group 2 showed a subsidence of the cage. CONCLUSIONS: As shown by the obtained clinical and radiographic results, the anterior interbody fusion with stand-alone peek cage containing ß-tricalcium phosphate could be considered an effective and reliable procedure.

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INTRODUCTION: Posterior dynamic stabilisation (PDS) aims at relieving lumbar discogenic pain and preserving adjacent levels from accelerated degeneration. PURPOSE: To evaluate the results of a novel PDS system in 32 adult patients affected by chronic low back pain (CLBP) due to degenerative lumbar spine instability (DLSI). METHOD: A progressive follow-up for 12 months of 32 patients, with collection of complete clinical (ODI and VAS back + leg) and radiological data (resting + functional radiographs and MRI). RESULTS: Mean ODI scores improved from 49 to 6%, VAS back from 5 to 1 and VAS leg from 7 to 2. Twenty-two patients underwent fusion of a lower lumbar segment and stabilisation of an upper segment (hybrid fusion) whereas ten underwent dynamic stabilisation. In 16/32 patients, decompression was added to treat radicular pain. Motion in non-fused instrumented levels was unrestricted on functional X-rays and MRIs did not show significant morphologic changes. Four patients (12.5%) had unchanged functional and pain scores while two (6.3%) suffered worsening low back pain necessitating implant removal and spinal fusion. No infection, no new neurologic deficit or implant failure was recorded. CONCLUSIONS: The 1 year follow-up shows that the tested PDS system is able to provide a significant improvement in pain and disability scores when applied to patients affected by DLSI. The system does not provide better clinical results when compared to similar trials on posterior fusion. Further follow-up is ongoing to investigate the potential preservation of adjacent levels from accelerated degeneration.

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Direct repair of spondylolisthesis can save a functional segment in young patients with slight slipping. Since 1968 many surgeons have proposed different technical solutions to obtain the isthmic repair. Their results changed according to the technique used, the extent of listhesis and the age of the patient. The aim of our study was to perform a retrospective review on the long-term results of the direct repair of spondylolisthesis, according to the different techniques used. We operated 62 patients for isthmic repair, with three different techniques, from 1994 to 2007. We analysed the clinical and radiographic results of 52 cases, with an average follow-up of 9 ± 3 years (range 2-15). Ten patients were lost to the follow-up. The results were different depending on the technique used. Good or excellent clinical outcome by Odom's criteria were observed in the 83.3% of patients operated with the modified Scott technique. These results are better than those obtained in the group of patients operated with the Scott (62.5%) and the Buck technique (28.5%). Patients with clinical and radiological failure, who then underwent spinal fusion, were 57% with the Buck technique, 12.5% with the Scott technique and 2.7% with the Scott modified technique. The reasons for a new operation were symptomatic pseudarthrosis and progression of slipping. In conclusion, the pars defect repair is a helpful technique in lumbar spondylolisthesis, especially in young patient with slight slipping and painful symptoms resistant to conservative treatment. In our experience, the modified Scott technique seems to provide a better outcome than the Scott and Buck techniques.

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In order to minimize the risks of homologous blood transfusion during surgery for spinal deformity, we perform a blood-saving procedure consisting of both intraoperative methods and auto-transfusion techniques. In this paper we compare our experience in the year 1989 with that of the past decade. When auto-transfusion was used, there was a decrease in intraoperative blood loss and only 4% of the patients required homologous transfusions.

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Forty-eight cases of posterior vertebral arthrodesis for scoliosis, performed with or without instrumentation, were examined using computed tomography (CT) scanning to study the evolving fusion mass. The authors observed that the fusion mass area is more voluminous in the cases performed without instrumentation than in the ones performed with instrumentation, and that 2 years after fusion the bone mass shows already a considerable increase. For the cases operated with Harrington's technique, the increase of the fusion mass is very slow and becomes considerable 5 years after operation. In both series, the section of the fusion masses at the apex of the curve is asymmetric (with prevalence on the concave side), with an area of central resorption that shows the structure of a long bone (box section).

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The evaluation of vertebral rotation and torsion in idiopathic scoliosis is important both in treatment and prognosis. Standard radiography may be used to calculate only rotation but computerized tomography (CT) allows for an exact evaluation of both rotation and torsion. However, it is non feasible to use this method routinely. The purpose of this study is to compare the values obtained by CT scanning with those obtained on radiographic examination by the most commonly used methods of measuring rotation. We also evaluated the morphology of the vertebral canal and its relationship with the dural sac. Forty-seven idiopathic scoliotic curves were included in the study. The Perdriolle method of radiographic measurement of vertebral rotation is the one that most accurately reveals the true extent of the deformity. Vertebral torsion occurred early in 92% of the curves examined. Deformity of the vertebral canal was rarely observed, even in sever cases. The dural sac at the dorsal level was always shifted towards the concavity of the curve.

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Thirty patients who had posterior vertebral fusion for scoliosis, performed without metallic implants, were examined using computer-assisted tomography to study the configuration of the evolving fusion mass. It was observed that the deposition of bone followed lines of force, according to Wolff's Law. The greatest amounts of bone at the apex of the curve on the concave side indicate that flexion-compression forces are greater at this point. Further, it was observed that usually the fusion mass, seen in section, has a hollow "box-section" shape, which means that a resorption of unstressed central bone occurs. The hypothesis that the torsional forces are the predominant forces acting on the scoliotic spine can explain the characteristic "box-section" of the CT scans obtained.

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The authors report their experience in the development of a computerized recording system in their scoliosis unit. The form of documentation used must be designed to comply with the memory of the available computer. Following a detailed analysis of the various fields comprising the documentation proforma, the technical methods used to minimise errors while loading the maximum number of cases into the computer are discussed. Complex statistical analyses are possible only with the aid of computerized documentation and it is hoped this will be used more frequently in future in departments specialising in the problems of vertebral deformity. The formulation of a common documentation proforma for scoliosis would unify the terminology, and make it possible to introduce comparability and homogeneity into the clinical data as well as the results of different techniques.

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The authors analyse a consecutive series of 150 vertebral arthrodeses for scoliosis in which Risser's plaster technique was used as the only method of achieving correction. The results are analysed in relation to the most important factors in order to make them suitable for comparison with similar cases treated by the Harrington instrumentation method, the main justification for which is the reduced period of immobilisation. The results of the Risser technique compare favourably with those of the Harrington technique, in addition to which they showed several advantages.

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Since January 1979 spinal fusions for scoliosis have been carried out at the Galeazzi Orthopaedic Institute in Milan using normovolaemic haemodilution. The object is to eliminate the risks of blood transfusion and to reduce thromboembolic complications. The method is indicated in patients who are not anaemic and when the blood loss during operation can be controlled. This paper analyses the results in 95 consecutive spinal fusion operations for scoliosis. The authors conclude that the method can be safely used for this type of operation, particularly in young patients with moderate scoliosis (a curve of 50 degrees to 60 degrees). The aim of the operation in these cases is to improve the appearance of the back and prevent further deformity.

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