Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn.

Nucleoplasty is effective in reducing both mechanical and radicular low back pain: a prospective study in 87 patients.

STUDY DESIGN: A prospective study of all patients with either mechanical back pain or radicular back pain who underwent nucleoplasty and were followed up prospectively. OBJECTIVE: To investigate the effectiveness of nucleoplasty procedure in terms of pain and quality of life using the visual analog scale and Oswestry disability questionnaires. SUMMARY OF BACKGROUND DATA: Nucleoplasty is a method of increasing popularity in the past few years. It has a role when dealing with pain of spinal origin either radicular or both radicular and mechanical after conservative treatment has failed and before open procedure. METHODS: Eighty-seven patients with a minimal follow-up of 1 year were prospectively followed after they underwent nucleoplasty procedure for either radicular or a combination of radicular and mechanical low back pain. All patients underwent physical examination and completion of visual analog scale score and Oswestry Disability questionnaires after 1, 3, 6, and 12 months. Thirty-nine of them were followed after 2 years. RESULTS: After 1 month, 66 patients (76%) were satisfied with the results. After 3 months, 60 patients (69%) had significant pain relief, whereas in 27 cases (31%) there was no improvement. After 6 months of follow-up, 57 patients (66%) had pain relief and in 30 cases (34%) there was no effect. At 12 months of follow-up, 55 patients (65%) showed good results and 30 patients (35%) had no effect. In the case of the 39 patients who were followed for 24 months, 23 patients (59%) had significant pain relief. A statistically significant reduction in the Oswestry index was also noted for the series in all intervals. Minor complication occurred in 23 patients (26%) who had transient discomfort and burning pain at the insertion site of the nucleoplasty wire. CONCLUSIONS: We concluded that the nucleoplasty technique is a safe and effective procedure for radicular or combined radicular and mechanical low back pain and should be used in selected cases before open surgery after conservative treatment has failed.

Long-term follow-up of revision decompressive lumbar spinal surgery in elderly patients.

STUDY DESIGN: A retrospective study of elderly patients (more than 65 y of age) who underwent surgery for lumbar spinal stenosis between 1990 and 2000 was carried out. Among all these patients, the patients who underwent revision surgery were studied. OBJECTIVE: To quantify the risk of reoperation in patients who underwent decompressive lumbar surgery and to analyze the connection between different variables before the primary surgery to the risk of surgical revision. SUMMARY OF BACKGROUND DATA: Lumbar decompressive spinal surgery is a very common procedure. However, the tendency of restenosis with clinical effect on the patients increases with time. Outcome studies reported that rate of reoperation has ranged from 0% to 23%. No studies so far analyzed the rate of reoperation in elderly patients in long-term follow-up and the different variables that contributed to it. METHODS: Between 1990 and 2000, 357 patients more than 65 years of age underwent decompressive surgery for lumbar spinal stenosis with a mean follow-up of 64 months. Thirty-one patients (8.7%) were reoperated at least once. Twenty-five of them (81%) were followed. Demographic data, body mass index, associated comorbidities, preoperative risk as assessed by the scale of the American Society of Anesthesiology, type of surgery, pain perception by Visual Analog Scale, duration of symptoms, clinical presentation, walking ability (distance in meters), the level of basic activities of daily living was evaluated by the Barthel index, and overall satisfaction from the surgery were recorded and analyzed. For comparison between the reoperated patients and patients who were not reoperated, another group of 25 patients who were not reoperated (of our cohort) was studied. These patients were matched to the reoperated patients in terms of age (±2 y), sex, body mass index, and time elapsed since surgery (±3 mo). RESULTS: Overall rate of revision surgery was 8.7% in a period of 70 months follow-up. Twenty-one patients (80%) underwent 1 revision surgery, 4 patients (16%) underwent 2 revisions, and 1 patient (4%) had 3 revisions. The mean pain-free interval was 26 months. There were no sex differences in the rate of reoperation (10% in females and 7% in males, P>0.05). Although that only 36% of the patients were very or somewhat satisfied with overall revision results, significant improvement in pain perception (change in Visual Analog Scale score of 4.84, P<0.001) and in functional status (Barthel index increased in 15.2 points, P<0.001) were found after revision surgery. Six cases (19%) were operated in the first 2 years, 16 cases (52%) in the first 4 years, 24 cases (77%) in the first 6 years, and additional 7 cases (23%) were reoperated more than 6 years after the first operation. CONCLUSIONS: Even in reoperated elderly patients with spinal stenosis without spinal fusion, an improvement in functional status and somewhat in pain perception can be anticipated.

A comparison of two new technologies for percutaneous vertebral augmentation: confidence vertebroplasty vs. sky kyphoplasty.

BACKGROUND: Cement vertebroplasty has been performed for over a decade to treat painful osteoporotic vertebral compression fractures (OVCFs). Kyphoplasty is considered a further step in the evolution of vertebral augmentation. OBJECTIVES: To evaluate the efficiency and safety of two systems to treat OVCF: Confidence Vertebroplasty (CV) compared to Sky Kyphoplasty (SK). METHODS: This prospective study included 45 patients with OVCF. Fourteen were treated with CV and 31 with SK. An imaging evaluation using a compression ratio (height of anterior vs. posterior wall) and local kyphotic deformity (Cobb angle) was performed prior to the procedure and 12 months later. Evaluation of pain was carried out using a visual analogue scale. RESULTS: The mean compression repair was 12% in the CV group compared to 25% in the SK group. Mean kyphotic deformity restoration achieved using CV was 41% compared to 67% using SK. In both groups the pain severity was equally reduced by a mean of 43%. CONCLUSIONS: The SK system is technically superior in restoring the vertebral height and repairing the kyphotic deformity, an advantage that was not manifested in pain relief - the most important variable. Both systems have a high level of safety. The cost-benefit balance clearly favors the CV system.

23Na and 2H magnetic resonance studies of osteoarthritic and osteoporotic articular cartilage.

In this study, the short component of the (23)Na T(2) (T(2f)) and the (23)Na and (2)H quadrupolar interactions (nu(Q)) were measured in bone-cartilage samples of osteoarthritic (OA) and osteoporotic (OP) patients. (23)Na nu(Q) was found to increase in osteoarthritic articular cartilage relative to controls. Similar results were found in bovine cartilage following proteoglycan (PG) depletion, a condition that prevails in osteoarthritis. (23)Na nu(Q) and 1/T(2f) for articular cartilage obtained from osteoporotic patients were significantly larger than for control and osteoarthritic cartilage. Decalcification of both human and bovine articular cartilage resulted in an increase of (23)Na nu(Q) and 1/T(2f), showing the same trend as the osteoporotic samples. Differences in the ratio of the intensity of the large (2)H splitting to that of the small one in the calcified zone were also observed. In osteoporosis, this ratio was twice as large as that obtained for both control and osteoarthritic samples. The (2)H and (23)Na results can be interpreted as due to sodium ions and water molecules filling the void created by the calcium depletion and to calcium ions being located in close association with the collagen fibers. To the best of our knowledge, this is the first study reporting differences of NMR parameters in cartilage of osteoporotic patients.

The Fixion expandable stem hemiarthroplasty for displaced femoral neck fracture: technical features and pilot study.

BACKGROUND: Management of displaced femoral neck fracture in elderly patients is challenging due to the patient's high risk profile, poor quality bone stock and muscle weakness. MATERIALS AND METHODS: Fifty-one patients with displaced (Garden 3-4) intracapsular femoral neck fractures were treated with a newly designed Fixion expandable stem hemiarthroplasty implant and followed thereafter for a minimum of 6 months. RESULTS: Thirty patients (58.8%) had concomitant diseases graded 3-4 by the ASA scoring system. Two patients (4.8%) incurred deep wound infections that necessitated hardware removal. One case (2.6%) of dislocation was treated by closed reduction. Forty-two patients (82.4%) survived >6 months and cooperated with the study protocol. Mild groin/thigh pain was reported by 11 patients (26.2%). Twenty-six (61.9%) had lost 1-2 out of 4 grades of mobility. CONCLUSIONS: Fixion implant may be considered a further step in the evolution of femoral joint hemiarthroplasty. In the short term, it has proven to be as effective as cemented implant and to be user-friendly for the surgeon. It is also anticipated to be feasible whenever revision is required.

Static and Dynamic Balance in Adults Undergoing Lumbar Spine Surgery: Screening and Prediction of Postsurgical Outcomes.

INTRODUCTION: Balance and fall risk before and after lumbar surgery was assessed to determine whether balance at baseline predicts long-term postsurgical outcomes. METHODS: Forty-three patients in the United States and Israel performed the single-leg stance (SLS) test, four square step test (FSST), and 8-foot up-and-go (8FUG) test before and 2 to 4 months after lumbar spine surgery. They completed the Oswestry Disability Index (ODI) and pain rating before and 12 months after lumbar surgery. RESULTS: From baseline to follow-up, the SLS time was 3.74 seconds longer (P = 0.01), the FSST time was 1.94 seconds faster (P < 0.001), and the 8FUG time was 1.55 seconds faster (P = 0.02). Before surgery, 26% of the patients were considered high fall risk according to the FSST and 51% according to the 8FUG. Postsurgery, all patients could complete the physical tests, but 26% remained at high fall risk according to the 8FUG and 7.5% according to the FSST. The three physical measures together explained 30% of the variance in postsurgical ODI scores (P = 0.02). Age was not correlated with performance. DISCUSSION: Risk of falling is higher than surgeons suspect. Balance tests (ie, SLS, FSST, and 8FUG) are quick and easy to administer. The findings support the importance of screening for balance and fall risk in adults undergoing lumbar spine surgery.

Late results of surgery for herniated lumbar disk as related to duration of preoperative symptoms and type of herniation.

BACKGROUND: Ten to 40% of patients who have undergone state-of-the-art surgery for HLD do not obtain relief of pain. The relationship among timing of surgery for HLD, type of herniation, and clinical outcome, questioned in the present study, has rarely been referred to as an individual medical factor. METHODS: Sixty-three patients belonging to a single ethnic group were called in 2 to 5 years after surgery and scored for change in severity of HLD-related pain (VAS) and current disability as scored by a functional rating system (Spangfort). RESULTS: Patients with noncontained herniation (group 1), as compared with those with contained herniation (group 2), had had more intense radicular pain preoperatively (mean VAS, 8.3 vs 6.5), had a shorter history of pain (mean, 7.4 vs 15.8 weeks), and enjoyed a better functional outcome (good or fair in 96.4% vs 74.3%). Those in group 1 with a preoperative pain history of 6 weeks or less showed a greater decrease in pain intensity than those with a pain history of 6 to 12 weeks. Group 2 patients had had a longer preoperative history of symptoms than any in group 1 (>12 weeks in all) and showed an intermediate decrease in pain intensity. CONCLUSIONS: Patients with noncontained herniation who do not show signs of improvement should be offered elective surgery after 6 to 8 weeks of observation; those having contained herniation should be advised that a certain degree of benefit can be expected from surgery, however late.

Treatment of postdiscectomy low back pain by percutaneous posterior lumbar interbody fusion versus open posterior lumbar fusion with pedicle screws.

BACKGROUND CONTEXT: Up to a fifth of the patients who had discectomy undergo spinal fusion because of disabling low back pain. PURPOSE: To compare the clinical outcome of percutaneous posterior lumbar interbody fusion (PPLIF) to that of open posterior lumbar fusion (PLF). STUDY DESIGN/SETTING: Two surgical methods that were tried in sequence at a university affiliated hospital. PATIENT SAMPLE: Sixty patients with disabling postdiscectomy low back pain. OUTCOME MEASURES: Pain intensity was scored on a visual analog scale (VAS) and the degree of disability was scored by the Oswestry disability index (ODI). METHODS: Thirty patients were treated by PPLIF. The outcome, after 24 months or more, was compared retrospectively with that of 30 consecutive suitable subjects who had been treated by PLF with pedicle screw fixation by the same surgeons for the same indication. RESULTS: In the PPLIF group, as compared with PLF group, mean operating time was shorter, blood loss was negligible, and mean hospital time was halved. By the last follow-up visit (greater than or equal to 2 years), pain and disability in PLF group had diminished by 31.9% and 20.1%, respectively. The corresponding figures in PPLIF group were 55.4% and 42.7%, respectively. CONCLUSIONS: In the context of postdiscectomy low back pain, PPLIF has proven, thus far, to be a safe procedure with improved clinical results.

Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians.

The purpose of our prospective study is to evaluate the surgical outcome among patients aged 80 years and above, who underwent surgery for lumbar spinal stenosis. We assessed patients' clinical and demographic data, procedures, perioperative complications, preoperative and postoperative pain intensity, basic activities of daily living (BADL), patients' satisfaction, the need for repeated surgery, and overall mortality. Thirty-nine patients more than 80 years of age were operated in our institution in the last decade. Twenty-five of them were followed-up with a mean 36.8 months after the operation. The Barthel index was used to evaluate pre and postsurgery ADL, and the visual analogue scale (VAS) was used to evaluate pain. The satisfaction rate of the patients before and after the operation and the complication rate were also evaluated. A significant reduction in VAS (P < 0.001) and a significant increase in the Barthel index (P < 0.001) were recorded. Seventy-six percent of the patients were very satisfied or somewhat satisfied with the operative results. Fifty-two percent of the patients had complications (0.9 complications per patients), however, about half of them were minor. No operative or perioperative mortality was noticed and the overall hospital stay for these elderly patients was 3.6 days on average. Surgery in very old elderly patients is safe and effective in the treatment of spinal stenosis, who did not respond well to the conservative treatment. The surgery did not increase the associated morbidity and mortality and most of the patients benefited from the surgery in terms of reduction in pain, increase in ADL and walking ability and overall increase in the satisfaction rate.

Efficacy and complications of patient-controlled analgesia treatment after spinal surgery.

BACKGROUND: Postoperative pain is one of the most common therapeutic problems in hospitals. Patient-controlled analgesia has gained popularity over the last decade in dealing with this problem. The goal of this article is to examine the effect of PCA in patients who underwent spinal fusion and to measure its effect on the different sexes and age groups. METHODS: Two hundred thirty-seven patients who underwent spinal fusion for lumbar instability at our institution comprise this study. All patients received PCA in a certain protocol. Pain was measured according to the VAS, and any complications due to the use of PCA were recorded. RESULTS: Patient-controlled analgesia reduced the VAS in all age groups. Reduction in VAS was higher in the age group of 60 years or more. No significant differences in VAS reduction were noted between males and females. In 40% of our patients, complications were recorded. Eight percent reported more than 1 complication. However, these complications were nonfatal, and all patients responded well to conservative treatment. On termination of the study, most patients (213/237) were satisfied with the PCA procedure for reducing their pain. CONCLUSION: We conclude that PCA is an effective and safe method with high satisfaction rate in postoperative pain control in patients who undergo spinal fusion.

En bloc resection of a C4 chordoma: surgical technique.

The prognosis of aggressive benign and low-grade malignant tumors in the spine as in the limbs, seems to be mostly related to the feasibility of en bloc resection, while in the treatment of high-grade malignant tumors the protocols of treatment include the combination of chemotherapy, radiation and surgery. Indications, criteria of feasibility and surgical technique are extensively reported for the thoracic and lumbar spine. In the cervical spine few cases are reported of resection, due not only to anatomical constraint, but also to the rarity of finding a tumor accomplishing the criteria of feasibility. A case of double-approach vertebrectomy finalized to remove en bloc the body of C4 for a stage IA chordoma is reported. The first stage was posterior, aiming to remove the posterior healthy elements by piecemeal technique. The anterior approach consisted of contemporary right and left prevascular presternocleidomastoid approaches The specimen was submitted for the histological study of the margins, which resulted tumor-free. This technical note is finalized to confirm that en bloc resection of the vertebral body through total vertebrectomy is feasible in the midcervical spine by double approaches, provided the tumor involves only layers B and C, maximum extension sectors 5-8.

Pain perception during the rehabilitation phase following traumatic hip fracture in the elderly is an important prognostic factor and treatment tool.

PURPOSE: To evaluate the role of pain perception on admission to geriatric rehabilitation on the functional recovery after rehabilitation treatment in elderly patients with hip fracture and on the length of stay. METHOD: One hundred and sixty-five community dwelling elderly 65-year-old and over (mean age of 78 years), following recent operated traumatic hip fracture without clinical evidence for another acute medical or surgical condition were assessed regarding age, sex, chronic medical conditions, pre-fracture functional status, type of fracture and of operation, pain perception, and cognitive status. Pain was measured using the Visual Analogue Score (VAS). Functional status was measured using the Functional Independence Measurement (FIM). Activities of Daily Living (ADL) were assessed using the Katz index. RESULTS: The average VAS score on admission was 7.38 +/- 1.20 and on discharge 3.67 +/- 1.18. Pain on admission inversely correlated to family support, function prior to fracture and cognitive status on admission, and correlated positively with depressed mood. With every increase of one point in VAS on admission above 4 points, the FIM on discharge decreased by 8.77 and the length of stay increased by 4.76 days. CONCLUSIONS: Pain intensity may add a valuable dimension for the prognostic evaluation of the patients with hip fractures. Inadequate early patient assessment and associated treatment impact on the patients' functional outcome, prolonged duration of rehabilitation treatment, and therefore, in addition to socio-economic effect, increase the cost to the local health care setting.

Lumbar spine surgery in Israeli Arabs and Jews: a comparative study with emphasis on pain perception.

BACKGROUND: Surgery for spinal stenosis is a frequent procedure in elderly patients. Presentation, hospital course, and outcome of disease including pain perception may vary among patients of different ethnic origin. OBJECTIVES: To evaluate whether differences in various medical indicators can explain differences in pain perception between two ethnic groups. METHODS: We conducted a case-control study on the experience of two spinal units treating a mixed Arab and Jewish population, and compared the data on 85 Arab and 189 Jewish patients undergoing spinal lumbar surgery. RESULTS: Arab patients were younger (P = 0.027), less educated (P < 0.001), had a higher body mass index (P = 0.004) and included a higher proportion of diabetics (P = 0.013). Preoperative pain intensity (P = 0.023) and functional disability (P = 0.005) were more prominent, and factors associated with pre- or postoperative pain perception differed between the two ethnic groups. Despite these differences, results on follow-up were similar with respect to pain perception and level of disability. CONCLUSIONS: A better understanding of ethnic differences is crucial for predicting surgery outcomes.

Novel reconstruction technique for an isolated plantar calcaneonavicular (SPRING) ligament tear: A 5 case series report.

BACKGROUND: It is usually accepted that acquired flatfoot deformity after injury is usually due to partial or complete tear of the posterior tibial tendon (PTT), with secondary failure of the other structures which maintain the medial longitudinal arch, such as the plantar calcaneo-navicular (SPRING) ligament. It is unusual to find an isolated Spring Ligament (SL) tear, with an intact TP tendon. METHODS: The medial arch reconstruction technique of an isolated SL tear in 5 patients is presented discussed in this paper. In these 5 cases the clinical presentation mimicked PTT dysfunction. The operative regimen consisted of three steps: direct repair of the ligament, primary reconstruction of the SL by using FiberWire® (Arthrex, Inc) and a medial calcaneal osteotomy. RESULTS: American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score improved from 55.8 (range, 34-74) before surgery to 97.6 (range, 91-100) at more than one year follow-up. No recurrence of the flatfoot deformity was observed at 10 years follow-up. CONCLUSION: SL tear should be suspected in cases of clinical presentation of medial arc collapse even when PTT is intact. In such cases of isolated SL tear reconstruction of the torn ligament using the method described is recommended.

Endovascular treatment of an open cervical fracture with carotid artery tear.

The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report.

B-twin expandable spinal spacer for posterior lumbar interbody stabilization: mechanical testing.

Posterior lumbar interbody fusion is an accepted surgical technique to treat disabling lower back pain due to degenerative disc disease. In the techniques that prevail, installation of large fixed-size twin cages dictate the sacrifice of the posterior stabilizing structures. Moreover, excessive retraction of the dural sac imposes potential neurological hazard. The authors present a novel technique based on a spacer capable of threefold expansion once it has been installed in the disc space. The spacer was laboratory tested under controlled loading conditions. Strength and fatigue tests of an isolated spacer were performed using an artificial model. Pullout resistance and ultimate compression strength of the surgical construct were evaluated using a cadaveric specimen. The yield force and the ultimate force for the single spacer averaged 2660 +/- 483 N and 4313 +/- 420 N, respectively, while the endurance limit at 5 million cycles averaged 931 N. The single-spacer resistance to pullout averaged 556 +/- 207 N, while the ultimate compressive strength of bone-spacer interface averaged 3399 +/- 136 N for a pair of spacers. The results of the study indicate that the B-twin ESS is expected to withstand the loads imposed upon it during everyday activity and resist migration or significant subsidence until fusion is achieved.

Effective dose reduction in spine radiographic imaging by choosing the less radiation-sensitive side of the body.

BACKGROUND CONTEXT: X-ray absorption is highest in the organs and tissues located closest to the radiation source. The photon flux that crosses the body decreases from the entry surface toward the image receptor. The internal organs absorb x-rays and shield each other during irradiation. Therefore, changing the x-ray projection angle relative to the patient for specific spine procedures changes the radiation dose that each organ receives. Every organ has different radiation sensitivity, so irradiation from different sides of the body changes the biological influence and radiation risk potential on the total body, that is the effective dose (ED). PURPOSE: The study aimed to determine the less radiation-sensitive sides of the body during lateral and anterior-posterior (AP) or posterior anterior (PA) directions. STUDY DESIGN: The study used exposure of patient phantoms and Monte Carlo simulation of the effective doses. PATIENT SAMPLE: Calculations for adults and 10-year-old children were included because the pediatric population has a greater lifetime radiation risk than adults. OUTCOME MEASURES: Pediatric and adult tissue and organ doses and ED from cervical, thoracic, and lumbar x-ray spine examinations were performed from different projections. METHODS: Standard mathematical phantoms for adults and 10-year-old children, using PCXMC 2.0 software based on Monte Carlo simulations, were used to calculate pediatric and adult tissue and organ doses and ED. The study was not funded. The authors have no conflicts of interest to declare. RESULTS: Spine x-ray exposure from various right (RT) LAT projection angles was associated with lower ED compared with the same left (LT) LAT projections (up to 28% and 27% less for children aged 10 and adults, respectively). The PA spine projections showed up to 64% lower ED for children aged 10 and 65% for adults than AP projections. The AP projection at the thoracic spine causes an excess breast dose of 543.3% and 597.0% for children aged 10 and adults, respectively. CONCLUSIONS: Radiation ED in spine procedures can be significantly reduced by performing x-ray exposures through the less radiation-sensitive sides of the body, which are PA in the frontal position and right lateral in the lateral position.

Scoring systems to evaluate elderly patients with hip fractures.

PURPOSE: To report about different scales and scoring systems used to evaluate elderly patient with hip fracture during the acute post-fracture phase and during post-operative rehabilitation. METHODS AND RESULTS: Report of the different scales from a literature review. CONCLUSIONS: Standard validated scales are one of the tools to perform such an evaluation process as objectively as possible and to evaluate surgical, medical and rehabilitative management in these elderly patients. These scales are only a complementary tool, and they cannot replace physical examination. However, these validated tools are probably more accurate than just clinical impression. The appropriate combination of clinical experience and these scales may well contribute to a better care of elderly patients with hip fractures.

The effects of general vs spinal anesthesia on frontal cerebral oxygen saturation in geriatric patients undergoing emergency surgical fixation of the neck of femur.

STUDY OBJECTIVE: To assess the effect of regional vs general anesthesia on transcranial cerebral oxygen saturation (rSo2). DESIGN: Prospective, randomized, open-label study. SETTING: Large referral hospital. PATIENTS: Sixty American Society of Anesthesiologists physical status I, II, and III geriatric patients at least 60 years of age, undergoing surgical fixation of the neck of femur. INTERVENTIONS: Patients were randomized to receive either general (group GA) or spinal (group S) anesthesia. In all cases, frontal rSo2 was measured for a 10-minute preoperative control period, throughout the surgical procedure, and for 10 minutes postoperatively. MEASUREMENT AND MAIN RESULTS: The frequency of a decrease in rSo2 below baseline preoperative levels was significantly (P < .0001) higher in group S. However, the number of patients in whom at least one dip below baseline was recorded was similar between the groups. By contrast, general anesthesia was associated with a significantly higher rSo2 when compared with spinal anesthesia. Logistic regression revealed no correlation between changes in blood pressure, heart rate, or peripheral oxygen saturation and the frequency of rSo2 dips below baseline. CONCLUSION: Cerebral oxygen saturation is likely patient specific and independent of the anesthetic technique administered. Spinal anesthesia is associated with a higher incidence of cerebral desaturation. However, the number of patients in whom at least one dip below baseline was recorded was similar between the groups.