Decompressive surgery for typical lumbar spinal stenosis.

Between 1991 and 1992, 103 consecutive patients (average age, 65 years) underwent decompressive surgery for treatment of typical lumbar spinal stenosis. Clinical results at 1-year followup revealed that four patients had revision surgery. At 2- to 5-years followup, there were no additional revision surgeries. Two patients underwent revision surgery for a deep infection, and two underwent revision surgery for a superficial infection. Outcome results showed that 77 patients completed the questionnaire, 15 were lost to followup and 11 died. Postoperative results showed that 64 of 77 patients had no or mild pain, 72 of 77 patients stated that they were satisfied or somewhat satisfied with their overall results of surgery, and 73 of 77 were satisfied with pain relief. Younger patients had greater improvement in function and a greater reduction in severity scores. However, satisfaction was similar in both groups. Survivorship results (failure was revision surgery) showed at the end of 4 years, a patient had a 95% chance of not having revision surgery. Statistically, there was no association between outcome and cofactors such as scoliosis, spondylolisthesis, number of levels decompressed, discectomy, or smoking. Satisfaction rates for older patients were similar to patients younger than 65 years although physical function scores and severity scores were less.

Surgical management of posterior shoulder instability in a ten-year-old boy: a case report and literature review.

Posterior shoulder instability is an uncommon clinical entity. It is even more rare in the pediatric population. We report the case of a 10-year-old boy who experienced recurrent posttraumatic posterior shoulder instability that eventually required surgical intervention. A review of the literature revealed no previous report of surgical management of nonobstetrical posttraumatic posterior glenohumeral instability in a skeletally immature individual.

Idiopathic scoliosis. The clinical value of radiologists' interpretation of pre- and postoperative radiographs with interobserver and interdisciplinary variability.

STUDY DESIGN: A retrospective analysis of radiographic reports of 161 consecutive patients with idiopathic scoliosis at the authors' institution. OBJECTIVES: To compare various radiographic findings that directly affect surgical decision-making and the evaluation of postsurgical outcomes to determine the usefulness of information gathered from radiologists' multiple duplicate reading of films. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, there are no previous studies on the readings of scoliosis films by radiologists and surgeons. METHODS: The patient pool was drawn from the private practices of two board-certified orthopaedic surgeons. Each set of radiographs was read by one of seven board-certified radiologists and by one of the two surgeons. The two reports of each radiograph were compared. The factors included in the reports were scoliosis deformity, scoliosis type, curve progression, curve magnitude, levels of the curve, kyphosis, lordosis, the presence of instrumentation, and the presence of a fusion. RESULTS: The radiologists and orthopedic surgeons mentioned the presence of scoliosis in 95% and 99.4% of their reports, respectively. The type of scoliosis was mentioned in 5% of reports by radiologists and in 99.4% by orthopedists. Progression of the curve was documented in 16.7% of the radiologists' reports and in 98.4% of orthopedists' reports. The magnitude of the curve was stated in 12.6% of the radiologists' reports, compared with 98.1% of the orthopaedists' reports. The levels of the curve were documented in 10.6% and 95.6% of reports by the radiologists and orthopedists, respectively. Radiologists mentioned kyphosis and lordosis in 28% and 26.5% of reports, respectively. These same two entities were mentioned in 98.2% and 79.4% of reports by the orthopedists. Finally, the radiologists noted the presence of instrumentation and of a fusion in 77.8% and 68.3% of reports, respectively. Orthopedists mentioned these same two entities in 84.4% and 100% of reports, respectively. In the radiologists' reports on the presence of instrumentation, 20% were mislabeled or improperly identified. Seven percent of the fusions documented by the radiologists were incorrect because they were recorded before biologic fusion could have taken place. In all these categories, the radiologists provided information in excess of the orthopedic reports a total of 1.9% of the time. Of this 1.9% additional information, 36.8% was incorrectly read or mislabeled. The other 63.2% of the additional information (1.9% of the total) did not elucidate anything of real clinical significance that was missed by the orthopedic surgeons (e.g., a tumor in the lung). CONCLUSIONS: These findings show that the attending orthopedic spine surgeons gained little useful information from the radiologists' multiple duplicate reading of films.

Interference screw position and hamstring graft location for anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction with hamstring tendon graft and interference screw fixation has recently been considered. Concerns for the use of interference screws with soft tissue grafts include damage to the graft during screw insertion, decreased fixation strength, and a decrease in the bone-tendon contact area for healing within the tunnel when the screw is placed in an eccentric position. This last concern could be addressed by placing the interference screw centrally between the four limbs of the hamstring graft. The purpose of this study was to determine the mode of failure, the pullout force, and graft slippage before graft fixation failure of hamstring tendons fixed with an interference screw positioned eccentrically in relation to the hamstring tendons verses an interference screw positioned centrally between the four graft limbs. The semitendinosus and gracilis tendons were harvested from six, fresh cadaveric specimens. Each tendon was divided into two segments of equal length. Both the semitendinosus and gracilis tendon segments were looped to form four strands. The specimens were then fixed with a bioabsorbable interference screw in the two different positions and pulled from a standardized polyurethane foam. All tendons in both groups failed by pulling out from between the interference screw and tunnel, regardless of the screw position. No tendon was cut by the screw in either group. There was no significant difference between the forces required to produce specific amounts of graft slippage between the two fixation techniques tested. There was no significant difference between the average total slippage at maximum pullout, 11.8 mm for the screw placed in the eccentric position and 13.7 mm for the screw placed in the central position. The maximum pullout force averaged 265.3 N for the screw placed in the eccentric position, and 244.7 N for the screw placed in the central position; these values were not significantly different. Placement of the interference screw in the central position did not compromise strength and it improves graft contact within the bone tunnel. Interference screw fixation, when applied against a bone plug, has been shown to consistently have a pullout force of more than 400 N.

Ulnar collateral ligament tear with concomitant extensor pollicis brevis and extensor pollicis longus disruptions: a case report.

A patient with a tear of the thumb ulnar collateral ligament and simultaneous extensor pollicis brevis and extensor pollicis longus disruptions is reported. No report of a similar constellation of injuries was found in the literature.

Acute fatty liver of pregnancy: laparoscopy-assisted diagnosis.

We report a case of fatty infiltration of the liver in a 27-year-old Hispanic woman. She went to an outside hospital in her third trimester of pregnancy with abdominal pain, jaundice, peripheral edema, and diffuse intravascular coagulation. An emergent cesarean section was performed, and she developed symptoms of acute hemorrhagic pancreatitis and altered mental status. She was transferred to Harbor County Hospital, where a computed tomography scan showed a fatty liver, and a liver biopsy confirmed the diagnosis of fatty liver of pregnancy. Prompt recognition and immediate termination of pregnancy with intensive, supportive care are essentials in the management of fatty liver of pregnancy.