Degenerative Cervical Disc Disease: Long-term Changes in Sagittal Alignment and Their Clinical Implications After Cervical Interbody Fusion Cage Subsidence: A Prospective Study With Standalone Lordotic Tantalum Cages.

STUDY DESIGN: A retrospective, observational study of prospectively collected outcomes. OBJECTIVE: To investigate the long-term clinical course of anterior cervical discectomy and fusion with interbody fusion cages (ACDF-IFC) with lordotic tantalum implants and to correlate the radiologic findings with the clinical outcomes, with special emphasis on the significance and the influence of implant subsidence. SUMMARY OF BACKGROUND DATA: Cage subsidence is the most frequently reported complication after ACDF-IFC. However, most reports fail to correlate cage subsidence with lower fusion rates or with unsatisfactory clinical results. METHODS: Forty-one consecutive patients with symptomatic degenerative cervical disk disease with failure of conservative treatment were included. All patients underwent 1-/2-level ACDF-IFC with lordotic tantalum implants. The mean follow-up was 4.91 years. RESULTS: The final follow-up fusion rate was 96.96% (32/33). The interspace height (IH) at the affected levels was significantly incremented after implant insertion, and despite a gradual loss in the height over time, the final follow-up IH was significantly higher than that measured preoperatively (P<0.0001). Anterior IH and posterior IH lost 55.8% and 76.2% of the initially incremented height, respectively, with a final increase of 72% in the AIH-PIH height differential. Implant subsidence (>3 mm) occurred in 11 disk spaces (26.82%). Preoperative and postoperative IH were significantly higher in subsidence patients; however, there was no difference in the final follow-up IH (P>0.05). Patients with ≥3 years of follow-up (n=29) did not demonstrate further significant subsidence beyond the second year. Regarding C1-C7 lordosis, the segmental Cobb angle, the cervical Visual Analogue Scale, and Neck Disability Index questionnaires, no difference between patients with or without final follow-up endplate subsidence was encountered. CONCLUSIONS: Until fusion occurs, tantalum cage settlement into the vertebral body is to be expected. Further subsidence could be the result of segmental adaptative changes. Graft subsidence did not affect the clinical outcome in any of our patients during long-term follow-up. The occurrence of dynamical implant subsidence had a positive effect on cervical lordosis, especially at the posterior IH.

Dolor difuso del medio pie del atleta. Fractura por estrés del hueso navicular / Midfoot diffuse pain in the athlete. Stress fracture of the navicular bone

La fractura por estrés del hueso navicular es una lesión poco común entre la población general, que generalmente se presenta en deportistas de alto rendimiento. Su clínica inicial indolente suele provocar un diagnóstico inicial impreciso y un tratamiento tardío. A su evolución natural, la pseudoartrosis del hueso navicular puede producir una profunda desestructuración irreversible del mediopie del deportista. Presentamos un caso de un ex-deportista profesional de élite que sigue manteniendo una alta actividad física, que refería dolor en la región dorsomedial del mediopie. Diagnosticado inicialmente de periostitis, dos meses después se documenta la fractura por estrés del hueso navicular de su pie derecho. A pesar de su baja frecuencia y su clínica poco especifica, las fracturas por estrés del hueso naviculardeben estar siempre presentes en el diagnostico diferencial del dolor difuso del mediopie del deportista. Realizamos una breve revisión del diagnóstico diferencial del dolor en el mediopié del deportista, así como las opciones de tratamiento de la fractura por estrés del hueso navicular y periodos de recuperación e incorporación al deporte tras el tratamiento. El tratamiento ortopédico ofrece buenos resultados en estadíos poco evolucionados, puede evitar el tratamiento quirúrgico, y devolver al deportista a su nivel competitivo inicial (AU)

The stress fracture of the navicular bone is an uncommon injury among the general population, who generally appears in high performance sportsmen/women. Its indolent initial symptomatology provokes an initial vague diagnosis and a late treatment. To its natural evolution, the pseudoarthrosis of the navicular bone can produce a deep irreversible destructuration of the midfoot of the sportsman/woman. We present a case of an elite professional ex-sportsman who continues supporting a high physical activity, which was complaining of pain in the dorsomedial right midfoot. Initially diagnosed of peryostitis, two months later a navicular bone stress fracture of his right foot could be confirmed. In spite of its low frequency and its unspecific symptomatology, the navicular bone stress fractures must be always present in the differential diagnosis of the diffuse pain of the midfoot of the sportsman/woman. A brief review of the differential diagnosis of the pain in the midfoot of the sportsman/woman is presented, as well as the options of treatment of the stress fracture of the navicular bone, and periods of recovery and incorporation to the sport after the treatment. The orthopaedic treatment offers good results in non evolutionated cases, can avoid the surgical treatment, and return to the athlete to his/her competitive initial level (AU)