Micro-decompression for lumbar spinal stenosis: the early outcome using a modified surgical technique.

We describe a modified technique of micro-decompression of the lumbar spine involving the use of an operating microscope, a malleable retractor and a high-speed burr, which allows decompression to be performed on both sides of the spine through a unilateral, hemi-laminectomy approach. The first 100 patients to be treated with this technique have been evaluated prospectively using a visual analogue score for sciatica and back pain, the MacNab criteria for patient satisfaction, and functional assessment with the Oswestry Disability Index. After a period of follow-up from 12 months to six years and four months, sciatica had improved in 90 patients and back pain in 84 patients. Their result was graded as good or excellent by 82 patients according to the MacNab criteria, and 75 patients had subjective improvement in their walking distance. Late instability developed in four patients. Lumbar micro-decompression has proved to be safe, with few complications. Postoperative instability requiring fusion was uncommon, and less than using traditional approaches in published series.

Milch's classification of paediatric lateral condylar mass fractures: analysis of inter- and intraobserver reliability and comparison with operative findings.

This study aimed to test the usefulness and validity of two versions commonly quoted in the literature of the Milch classification of paediatric supracondylar mass fractures. Anteroposterior and lateral elbow radiographs of 10 consecutive acute paediatric lateral condylar mass fractures requiring open surgical reconstruction were presented to six observers in order to assess inter- and intraobserver reliability of both versions. Accuracy of classification was compared with intraoperative findings. Observers agreed with the operative findings in only 50% of cases. There was poor interobserver (kappa<0.2) and moderate intraobserver agreement (kappa<0.6) for both versions. Thus Milch's classification was not found to be a useful tool.

The thrust plate prosthesis in the treatment of osteoarthritis of the hip. Clinical and radiological outcome with minimum 5-year follow-up.

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis. We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded. Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41-67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were 'very satisfied' with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.

Preservation of vascular tissue under hypothermic conditions.

BACKGROUND: Preservation of vascular tissue plays a crucial role in the success of organ transplantation. We investigated and compared the performance of 4 preservation solutions at preserving vascular tissue over 24, 48, and 72 h under hypothermic conditions. MATERIALS AND METHODS: Rat aortic segments were stored in University of Wisconsin (UW), Modified University of Wisconsin (mUW), EuroCollins (EC), and Bretschneider Histidine-tryptophan-ketoglutarate (HTK) solutions at 4 degrees C for 24, 48, and 72 h. Functional assessment was performed by measuring smooth muscle cell contraction and endothelium-dependent relaxation after stimulation with phenylephrine and acetylcholine, respectively, in an organ bath. RESULTS: UW and EC solutions were superior to the other solutions for endothelial cell preservation and were not statistically different from each other at any time (P < 0.05). Smooth muscle cell (i.e., contractile) preservation was best achieved with UW solution for up to 72 h. HTK appeared to function well at 24 h, but at 48 and 72 h, there was a major decline in contractile response and relaxation. CONCLUSION: UW solution appears to be superior for the preservation of the functional integrity of vascular tissue stored under hypothermic conditions up to 72 h.