Effect of anesthetic variables on dermatomal somatosensory-evoked potential monitoring in elective lumbar spinal surgery.

We studied 108 adult cases of elective lumbar surgery using dermatomal somatosensory-evoked potential (DSEP) monitoring to evaluate its usefulness due to concern over potential neurologic injury during pedicle screw insertion. Both surgeons used all of the necessary precautions required during surgery so that DSEP monitoring was not the "primary," but rather a backup system for operative security. Quality tracings were obtained in 71% of cases; anesthetic difficulties being the major cause of poor monitoring. There were no neurological complications related to pedicle screw insertion. We found that DSEP monitoring was an excellent method to verify intraoperative neurological status, but required a high degree of cooperation between the anesthesiologists, monitoring technician, and surgeons. In today's cost-containment environment, its usefulness is subjected to the expertise of the spine surgeon and the hospital setting.

Thoracolumbar spinal fractures--concepts of treatment.

The treatment of thoracolumbar spinal fractures has evolved significantly in the last 50 years. Clear classification systems now allow physicians to predict which fracture patterns will require surgery and which may be adequately treated non-operatively. These indications, as well as a brief overview of thoracolumbar spinal fracture care, are presented.

Closed-wound drainage systems. The Solcotrans Plus versus the Stryker-CBC ConstaVAC.

Ninety-six patients (63 females and 33 males) who underwent total joint arthroplasty or spinal reconstructive surgery were randomized to receive either a Solcotrans Plus or a Stryker-CBC ConstaVAC closed-wound drainage system. A binomial test showed that the Stryker-CBC ConstaVAC system was significantly preferred over the Solcotrans Plus system for ease of use, as reported by nurses. However, Solcotrans Plus was more cost-effective because a larger volume of blood shed by a patient could be reinfused while maintaining the standards of the American Association of Blood Banks. The difference in the occurrence of side effects between the two systems was not statistically significant.

Anterior spine fusion using Zielke instrumentation for adult thoracolumbar and lumbar scoliosis.

Analysis of adult patients undergoing anterior spine fusions with Zielke instrumentation between January 1983 and November 1986 was performed. Objectives were to review results of surgical treatment and identify factors affecting results. Charts, 3 foot standing anteroposterior and lateral and supine maximal side bending radiographs were reviewed. Subjective data were obtained by telephone. There were 26 patients, average age 41 years. Average radiographic follow-up was 48 months. Indications were pain and curve progression. Average correction was 63% of the instrumented curve. Average change of lordosis was 8 degrees and kyphosis was 6 degrees. Apical vertebral rotation corrected an average of 37%. Complications were: eight hardware failures, one deep infection, and two psychiatric events. The high-risk groups: curves greater than 60 degrees, patients older than 50 years of age, and rigid curves.

Luque interpeduncular segmental fixation of the lumbosacral spine.

Interpeduncular segmental fixation of the lumbar and lumbosacral spine with Luque screws and plates is becoming increasingly popular. In this retrospective study, 52 consecutive patients treated with this technique were followed for 16 to 44 months (average, 21). Indications for surgical arthrodesis included lumbar instability from degenerative disease (16 cases), spondylolisthesis (25 cases), pseudarthrosis (eight cases), fracture (two cases), and tumor (one case). Fusion with instrumentation spanned one level in nine patients, two in 38 patients, three in four patients, and four in one patient. Patients wore a rigid lumbar orthosis for an average of six months (range, two to 16). Ten complications occurred in nine patients: two superficial wound infections, four neurologic complications, three loosened screws, and one broken screw. An overall fusion rate of 96% was achieved; pseudarthrosis is suspected in one case and failed arthrodesis secondary to trauma in a second patient. At four months postoperatively, solid unions had resulted in most of the cases, as seen roentgenographically. All patients reported decreased back pain; however, one patient is addicted to narcotics. Twenty-five of the 29 patients employed were able to return to work at an average of six months postoperatively.

Rotatory olisthesis in idiopathic scoliosis.

Lateral subluxation of one vertebral body upon another (rotatory olisthesis) has been associated with increased incidence of back pain in scoliosis. This study was undertaken to identify the presence of and characterize rotatory olisthesis and its association with the following parameters: age, sex, curve type, curve magnitude, level of occurrence, region within curves, primary vs. secondary curves, severity of slip, and association with pain. Charts of 636 patients were reviewed for the presence or absence of pain. Curve measurements and the occurrence of rotatory olisthesis were noted. Rotatory olisthesis was statistically unrelated to the occurrence of pain associated with idiopathic scoliosis. It was significantly associated with increasing age and curve magnitude. Lumbar curves with rotatory olisthesis were more likely to be associated with radicular pain.

Championship Car Racing Accidents and Injuries.

In brief: Sixty-nine race car drivers were surveyed in a study of the Indianapolis 500 from 1981 to 1984 and the 1984 Championship Auto Racing Teams (CART) series. The purpose was to evaluate the frequency of accidents and the nature of the resulting injuries that occur in Indianapolis-type race cars. Findings revealed that lower extremity injuries occurred most frequently. Accident frequency was one per 1,414 miles of racing in the CART series and one per 3,000 miles at the Indianapolis Motor Speedway. The number of accidents per injury was 9.5 in the CART series and 3.2 at Indianapolis, compared with 8.2 on US highways. This study suggests that current technology, which has shifted the spectrum of injuries from life-threatening to limb-threatening on the race track, could be applied to everyday highway safety as well.

Controlled mobilization of patients undergoing reconstructive spinal surgery: preliminary comparison of the kinetic therapy table vs the Foster frame.

Controlled mobilization is necessary in certain situations during the management of patients undergoing reconstructive spinal surgery. Chart review of 39 patients (20 maintained on the Roto-rest bed, 19 maintained on the Foster frame) was undertaken. Both beds protected spinal stability and no delays occurred in any staged surgical procedure. Patients maintained on the Roto-rest bed did have a significantly higher incidence of skin problems (p less than .05), but had no pulmonary emboli. Pulmonary emboli occurred in two of the 19 patients maintained on the Foster frame. Successful use of the Roto-rest bed was dependent upon skilled nursing personnel who were knowledgeable in the mechanical aspects of the bed and could provide a sense of security for the patient. No evidence was found that the Roto-rest bed affected the patients' use of postoperative analgesics. Both beds provided adequate controlled mobilization. Consideration of the patients' total medical profile would determine the choice of bed.

Onchocerciasis of the flexor compartment of the forearm: a case report.

A 36-year-old white male schoolteacher presented with a painless, semifluctuant mass on the volar aspect of his forearm and symptoms of ring finger tenosynovitis and median nerve compression. At operation there was a widespread infestation of the flexor tendon compartment, the carpal tunnel, and the tendon sheaths of the ringer finger with Onchocerca volvulus, a filarial nematode, not previously reported in the these tissues.

Conservative total hip arthroplasty: a procedure to conserve bone stock. Part I: analysis of sixty-six patients. Part II: analysis of failures.

Pain relief, function, and range of motion in surface replacement hip arthroplasty is comparable to the Charnley-type conventional arthroplasty. Patients with primary and secondary degenerative hip disease are the most suitable candidates for surface replacement. Previous operations, especially mold arthroplasty, increases incidence of failure. Osteopenia, obesity, or congenital deficiency of the acetabulum also increases the incidence of failure. Intraoperative preservation of abductor continuity and rigorous postoperative abductor strengthening are necessary to insure the success of the procedure. A minimum of 18 months is necessary to adequately evaluate the procedure. Acetabular loosening is avoidable. Hemispherical reaming of the femoral head did not contribute to femoral component loosening. Traumatic femoral neck fracture is a concern, but atraumatic femoral neck fracture can be avoided through improved operative technique, and by a program of rehabilitation of hip musculature. The procedure is indicated in the relatively young, well-motivated, non-obese patient with degenerative joint disease who has normal hip musculature.