Posterior dynamic neutralization and hybrid stabilization in degenerative spine diseases: long-term clinical and radiological outcomes.

Dynamic spinal stabilization aims to reduce some of the problems inherent with traditional fusion. The aim of our study is to analyse clinical and radiological outcomes and to identify the causes of clinical failure in patients who underwent posterior dynamic neutralization or posterior hybrid stabilization because of degenerative lumbar spine diseases. We retrospectively analysed 80 patients at 7.1 years mean follow-up (Range: 5.1 - 8.3 years): 50 were treated with Dynamic Stabilization System (Dynesys) (mean age 47 years old) and 30 with Dynamic Transition Option (mean age 48 years old). We performed clinical pre-and post-operative evaluation using Visual Analogue Scale (VAS), Oswestry Low Back Pain Scale (ODI) and X-rays study. Results: we reported an important reduction of VAS from 7 to 2 (p<.001) and minimal disability in 65% of the patients, moderate disability in 18.2%, severe disability in 12.5% and crippling back pain in 4.3%. X-ray analysis showed a significative decrease of 3.5° with respect to the preoperative values, exactly 2° in neutral position postop, 1.2° in flexion postop and 2.5° in extension postop. Data showed greater reduction of extension than flexion in postoperative period. Dynamic neutralization limits more the extension than flexion. The correct preoperative planning, the careful selection of patients and the meticulous surgical technique are mandatory to avoid clinical failures. It is very important to identify the correct screw positioning and to avoid excessive pre-tensioning of the implant. Posterior dynamic neutralization and hybrid stabilization are valid alternative to spinal fusion in degenerative spine disease.

Articular facets syndrome: diagnostic grading and treatment options.

Approximately 80% of the adult population suffers from chronic lumbar pain with episodes of acute back pain. The aetiology of this disorder can be very extensive: degenerative scoliosis, spondiloarthritis, disc hernia, spondylolysis, spondylolisthesis and, in the most serious cases, neoplastic or infectious diseases. For several years, the attention of surgeons was focused on the articular facets syndrome (Lilius et al. in J Bone Joint Surg (Br) 71-B:681-684, 1998), characterised clinically by back pain and selective pressure soreness at the level of the facets involved. The instrumental framework highlights widespread zigoapophysary arthritis and hypertrophy/degeneration of articular facets due to a functional overload. This retrospective study analyses the patients who arrived at our observation and were treated with a neuroablation using a pulsed radiofrequency procedure, after a CT-guided infiltration test with anaesthetic and cortisone. From the data collected, it would seem that this procedure allows a satisfactory remission of the clinical symptoms, leaving the patient free from pain; furthermore, this method can be repeated in time.

Elastic stabilization alone or combined with rigid fusion in spinal surgery: a biomechanical study and clinical experience based on 82 cases.

The authors report their experience with the treatment of lumbar instability by a kind of spine stabilization. The elastic stabilization, which follows a new philosophy, is obtained by an interspinous device, and should be used alone in degenerative disc disease, recurrent disc herniation and in very low grade instability, or in association with rigid fusion for the prevention of pathology of the border area. In collaboration with bioengineers, we carried out an experimental study on a lumbar spine model in order to calculate stresses and deformations of lumbar disc during simulation of motion, in physiological conditions and when elastic stabilization is combined with rigid fusion. Results suggest that elastic stabilization reduces stresses on the adjacent disc up to 28 degrees of flexion. Based on this preliminary result, we began to use elastic stabilization alone or combined with fusion in 1994. To date, we have performed 82 surgical procedures, 57 using stabilization alone and 25 combined with fusion, in patients affected by degenerative disc disease, disc herniation, recurrence of disc herniation or other pathologies. Clinical results are satisfactory, especially in the group of patients affected by recurrent disc herniation, in whom the elastic device was used alone.

[Kinesitherapy in lumbago]. / La kinesiterapia nelle lombalgie.

Since most back pain syndromes are due to excessive and long-lasting incorrect postures, we think that such illness may benefit from kinesiotherapy. There must be considered 2 types of back pain: disc pain and static pain. We advise to patients various self control techniques and muscle potentiating gymnastics. Besides these techniques, other adjuvant therapies may be prescribed.

[Diagnostic support of arthrographic study in recent sprains of the ankle]. / Apporto diagnostico dell'indagine artrografica nelle distorsioni recenti di tibio-tarsica.

The Authors assert, through the valuation of forty recent cases of ankle injury, submitted to the arthrographic research, the validity of such method for the valuation of ligament injuries and for the topographic orientation of the same injuries.

[Considerations on various spinal pains]. / Considerazioni su alcune rachialgie.

Any nerve root irritation from about T6 to L1 is able to carry about parietal and visceral pain in the abdomen, owing to the metameric distribution of the splanchnic and somatic afferent ways along the dorsal roots at all these levels. The cause of abdominal segmental neuralgia are numerous. Radicular abdominalgia is a syndrome of painful and paresthetic sensations, which involve both somatic and visceral components of one or more segments, according to the metameric law. In the osteo-arthrosis in the dorsal intervertebral joints is a most common cause of radicular syndromes simulating intra-abdominal surgical conditions.

[Psychological aspects of lumbago]. / Aspetti psicologici delle lombalgie.

We have focused our attention on some forms of mixed back pain associated to psychological disturbances. After a set of through multidisciplinary test, the patients were administered different therapics, both symptomatic and pharmacological. For its social importance we suggest to start the idoneus therapy as soon as possible.