The functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors.

To date two main techniques are used in arthroscopic full-thickness rotator cuff tears, the conventional knot-tying suture bridge technique and the knotless technique. We evaluated whether there is a difference in clinical outcome using both techniques. Our patients underwent arthroscopic treatment of full-thickness rotator cuff tears, and we retrospectively evaluated clinical function, strength and surgery time. Eighty-three shoulders operated between September 2012 and December 2013 were included in the study. We had nineteen patients in the knotless group, and sixty-four in the knot-tying group. In addition, we performed preoperatively radiological (magnetic resonance imaging-MRI) conformation of full-thickness rotator cuff tear in our patients. For clinical evaluation, we used Quick Disabilities of the Arm, Shoulder and Hand score (q-DASH) and the Shoulder Pain and Disability (SPADI) score, and we measured the strength of a range of motion postoperatively using a conventional dynamometer. The patients were evaluated preoperatively, and at 6, 9, and 12 months postoperatively. The follow-up period was 12 months. The scores in both treatment groups improved at twelve months follow-up, but there was no statistical difference between both groups at twelve months after surgery; q-DASH score between groups (p = 0.092) and SPADI score (p = 0.700). Similarly, there was no statistical difference between the groups in regard to strength, surgery time, and range of motion at the twelve months follow-up. Our data confirm that both techniques may be used successfully to repair full-thickness rotator cuff tears with very good functional outcome.Level of evidence IV.

Chance fracture in an older patient with positive sagittal imbalance and previous lumbar arthrodesis: what can be done?

The Chance fracture occurs frequently in school-aged patients' population and is related to flexion-distraction injury in motor vehicle accidents. It is so called seat-belt syndrome because the seatbelt lies over the abdomen. After sudden deceleration bends the child around the lap belt causing injuries to the abdomen, and the spine (e.g., Chance fracture). The Chance fracture after a low energy fall in elderly patient's population has rarely been reported. We present an 82 years old patient who suffered unrecognized Chance fracture after a low energy fall. The management of this patient with positive sagittal imbalance and previous arthrodesis consisted of decompression, Smith-Petersen osteotomy and posterior pedicle screw instrumentation.

Acute neck pain caused by atlanto-axial instability secondary to pathologic fracture involving odontoid process and C2 vertebral body: treatment with radiofrequency thermoablation, cement augmentation and odontoid screw fixation.

INTRODUCTION: Cervical spine metastases are relatively rare entities. Only about 10 % of all spinal metastases can be found in this localization. Magnetic resonance imaging and computed tomography are routinely used for early detection. The initial, clinical examination and patients' complaints may not always be very prominent. Treatment of such lesions is very challenging and needs to consider patient's comorbidities, quality of life and life expectation. Surgery for these lesions should always be performed in specialized spine units. CASE PRESENTATION: We present here a clinical history of a 67-year-old male with acutely occurring neck pain and some neck discomfort for last 2 weeks. No previous neck pain history or trauma. There were no neurological symptoms, only a slight tremor in the left upper extremity. The detailed past medical history of the patient revealed chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM type II), and smoking 30-pack-year. The first cervical spine X-ray did not demonstrate any pathological findings. We performed a CT scan, which demonstrated a lytic lesion involving the vertebral body of C2 with collapse of odontoid process and subsequent C1-C2 instability. In the next step, because of no medical history of cancer, we performed CT scan of the chest and abdomen, and found a suspicious mass in the right main bronchus and liver. We suggested a bronchial biopsy of the mass but the patient refused this procedure and requested only surgery for the C2 lesion. The patient underwent the described surgical procedure through high anterior cervical approach. We collected the tissue for histology, and performed radiofrequency thermoablation, cement augmentation, and odontoid screw fixation. The patient made an uneventful recovery and 2 weeks after surgery he was able to start his palliative chemotherapy for bronchial carcinoma, which was diagnosed based on biopsy acquired during this procedure. DISCUSSION: There are no specific guidelines regarding treatment of secondary lesions of C2 with instability at C1-C2 level. We describe here an interesting approach for the management of lytic lesions of C2 which may be used also at other levels of cervical spine. We did not observe any leakage of cement into the spinal canal. This procedure allows for fast recovery of patients, with early unrestricted range of motion, and beginning of early chemotherapy.

Posterior resection and fusion of a lumbosacral hemivertebra in a case of dipygus.

Dipygus or pygomelia is an incomplete form of twinning due to the incomplete division of the embryonic disc. This extremely rare condition consists in the presence of an accessory limb that generally inserts into the buttock or perineum. Associated anomalies such as duplication of the genitourinary or the intestinal tract are frequent, and recurrently appear associated with spinal anomalies such as congenital scoliosis due to hemivertebra. We present our experience with a 20-year-old girl, the first and only case of dipygus recorded and treated in Switzerland, who came to us complaining of increasing low back pain along with a progressive congenital scoliosis due to the presence of a hemivertebra between L5 and S1, which was removed in a single stage exclusively through a posterior approach.

Reliability and consequences of intraoperative 3D imaging to control positions of thoracic pedicle screws.

INTRODUCTION: The insertion of thoracic pedicle screws (T1-T10) is subject to a relevant rate of malplacement. The optimum implantation procedure is still a topic of controversial debate. Currently, a postoperative computed tomography is required to evaluate the screw positions. The present study was undertaken to clarify whether intraoperative 3D imaging is a reliable method of determining the position of thoracic pedicle screws. METHODS: This prospective study involved 40 consecutive patients with thoracic spinal injuries, with intraoperative 3D scans being performed to determine the positions of 240 pedicle screws in T1-T10. The results of the 3D scans were compared with the findings of postoperative CT scans, using a clinical classification system. RESULTS: The positions of 204 pedicle screws could be viewed by means of both 3D and CT scans and the results compared. The 3D scans achieved a sensitivity of 90.9 % and a specificity of 98.8 %. The rate of misclassification by the 3D scans was 2.5 %. Nine pedicle screws were classified as misplaced and their position corrected intraoperatively (3.8 %). No screws required postoperative revision. CONCLUSIONS: Performing an intraoperative 3D scan enables the position of thoracic pedicle screws to be determined with sufficient accuracy. The rate of revision surgery was reduced to 0 %.

Open dorsal vertebroplasty of the axis.

Vertebroplasty of the axis is always a challenging procedure. We report the case of a young, HIV-positive patient suffering from an osteolytic metastasis of the axis. An open dorsal vertebroplasty was performed. A leakage of the cement formed a new cortical bone of the massa lateralis of C2, and stabilized the C1-C2 articulation by an arthrodesis-like effect. Durable pain relief and stabilization were obtained. The location of the cement, although atypical, had all desired effects of a conventional vertebroplasty. The intra-articular injection of cement into the facets for stabilization and pain relief could be considered in the future.

Intraoperative three-dimensional fluoroscopy assessment of iliosacral screws and lumbopelvic implants stabilizing fractures of the os sacrum.

INTRODUCTION: Percutaneous iliosacral screw fixation of unstable sacrum fractures has gained popularity since its introduction in the 1990s. The combination with lumbopelvic implants allows the application even in situations of higher instability. Both manual and navigated screw insertion in the sacrum and vertebra bodies shows unchanged relevant malpositions. The current standard to control the screw position is postoperative computed tomography. The study presents the results of assessment of these implants by intraoperative three-dimensional fluoroscopy. METHODS: From January 2008 through March 2009, 14 patients had stabilization of the dorsal pelvic ring with iliosacral screws alone or in combination with lumbopelvic implants. Intraoperative 3D fluoroscopy was performed to evaluate the position of the implants stabilizing the posterior pelvic ring. RESULTS: Fourteen iliosacral screws and eight pedicle screws were depicted. In all patients, we were able to adequately evaluate the placement of iliosacral screws, lumbar pedicle screws and iliacal screws. As a consequence of intraoperative 3D scan a lumbar pedicle screw was corrected. The entire scanning procedure required 5 min. The time for analyzing the 3D scan took 3 min. CONCLUSIONS: Intraoperative 3D fluoroscopy is a valuable tool for intraoperative assessment of iliosacral screws and lumbopelvic implants. The technique should help us to detect intraoperative malplacement of the screws more reliably than conventional fluoroscopy and allows an immediate correction of malplaced implants. Therefore, a postoperative computed tomography to control the position of implants is dispensable.