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Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1968 and 1973 forty nine patients suffering from poliomyelitic scoliosis were treated surgically at the Rizzoli Institute. They were due to asymmetrical paralysis and contracture in the muscles of the trunk and limbs. Associated pathological conditions were found, such as pelvic obliquity, and vascular and trophic changes due to ganglionic lesions. The differing incidence and combination of these factors gave rise to various clinical types of spinal deformity. The average severity of curve was 39 degrees, the localisation was predominantly central, the average extent was ten vertebrae, and there was a marked predominance of right convexity (twenty nine out of thirty six). The rate of progression was maximum during puberty and almost negligible after bony maturity. It was greater in males and was unfavourably affected by the severity and asymmetrical distribution of the paralysis, by the early appearance of the disease, by high localisation of the deformity, and by the erect posture in patients who were ambulant. The most frequent visceral complications were in the respiratory system (ten patients with a deficit over 50%), followed by cardiac changes. Surgical treatment was adopted in patients with progressive curves over 60 degrees, because of the inevitable deterioration in their general condition and the tendency of the deformity to become fixed. Pre-operative correction by Halo-traction results (52% correction) than Risser plasters (38%). Posterior arthrodesis by Harrington's method was carried out in all the more recent cases (forty four). Post-operative plaster was maintained for eight months and then replaced by an orthopaedic corset. At bony maturity there was an averaged improvement of 35% in the angle of curvature, and an average improvement of 6% in vital capacity. The best corrections were obtained in patients under fourteen (42%), in dorso-lumbar scoliosis (40%) and in patients with curves above 100 degrees (38%). There was an average increase in height of 9.1 cms and a reduction in the gibbus of 3.4 cms. The complications included one traumatic pneumothorax, eight pseudarthroses, and breakage of the distraction rod in two cases resulting in complete relapse of the deformity. In six cases the upper hooks became loos and there were two cases of postoperative staphylococcal infection. In the distally sited curves our present policy is towards combining posterior arthrodesis with Dwyer's anterior interbody fusion.
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PMID:Surgical treatment of poliomyelitic scoliosis. 102 7

Posterior alloplastic fixation of a damaged spinal portion was accomplished in 68 patients. In 20 cases fracture was associated with spinal dislocation. In such cases when a compressive spinal fracture is accompanied with insignificant signs of spinal concussion one should follow an expectation policy, since an early operation may be inherent in some additional trauma and result in inhibition of regenerative processes. For spinal fixation Lavsan was employed in 23 patients, a tightening device-in 28, metallic CITO plates-in 17. In 6 objects fixation with the plates was associated with arthrodesis of intervertebral junctures. Late results were studied in 49 patients. In 40 cases the results were good, in 4-satisfactory, in 5-poor. The best results were noted in fixation of the damaged portion with the plates, these should be preferred to other fixators in fracture-dislocation of the spine.
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PMID:[Surgical fixation of the spine in fractures in the thoracic and lumbar segments]. 122 47

The long-term results of spinal arthrodesis were evaluated in fourteen children and adolescents who had severe spondylolisthesis. Twelve patients had an in situ posterior arthrodesis and the other two had, in addition, open reduction. The two patients who had open reduction lost correction when the rods were removed. At long-term follow-up, which averaged 11.9 years, all patients had a solid fusion and their activities were unrestricted. Two patients were dissatisfied with the cosmetic result. No intraoperative or postoperative complications occurred in association with the in situ arthrodeses that were performed alone. Posterior in situ arthrodesis proved to be an effective, reliable, and safe treatment for severe spondylolisthesis.
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PMID:Spinal arthrodesis for severe spondylolisthesis in children and adolescents. A long-term follow-up study. 270 18

Seventy-six consecutive surgical cases of paralytic neuromuscular spinal deformity were retrospectively analyzed. Posterior arthrodesis with segmental spinal stabilization with Luque L-rods, sometimes preceded by anterior release, was done in all cases. The infection rate of 14.5% was observed to be markedly higher in patients with myelodysplasia. Deep placement of the rods lateral to the spine and well beneath full-thickness skin is recommended to reduce the incidence of this complication.
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PMID:Segmental spinal instrumentation for neuromuscular spinal deformity. 270 47

Posterior arthrodesis is a preferred treatment for posttraumatic instability of the cervical spine. While most surgical constructs yield predictably high rates of fusion in satisfactory alignment, certain injury patterns involving fractures of the lamina or spinous processes may preclude rigid immobilization by simple wiring techniques. Plate fixation of the posterolateral masses has been advocated for such injuries. The purpose of this biomechanical study was to test the relative stiffness provided by different posterior fusion constructs, including lateral mass plating. All testing was performed on fresh, unembalmed cadaveric spines divided into two vertebral segment units. Muscular tissue was stripped from the specimens, but all discal and ligamentous structures were preserved. Four different posterior fixation constructs were tested. These included 1) Rogers interspinous wiring, 2) Halifax laminar clamps, 3) bilateral 1/3 tubular plates on the lateral masses, using unicortical screws, and 4) bilateral 1/3 tubular plates on the lateral masses, using bicortical screws. Stiffness measurements were taken in both flexion and extension on all specimens. Yield strength and fatigue strength of the spines were not measured. It was found that 1/3 tubular plates secured with bicortical screws to the lateral masses provided the highest mean stiffness. Less stiffness was found in spines stabilized by Halifax clamps, interspinous wiring, and plates secured with unicortical screws. There was, however, no statistically significant difference in stiffness provided by any of these four implants. It was concluded that there is no advantage in plate fixation over standard fusion constructs in augmenting the stiffness of posterior fixation of the cervical spine.
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PMID:Posterior plating of the cervical spine. A biomechanical comparison of different posterior fusion techniques. 319 91

In a retrospective review of the cases of thirteen skeletally immature children and adolescents (four to eighteen years old) with instability of the upper part of the cervical spine (occiput to fifth cervical vertebra), we determined the efficacy of posterior arthrodesis and halo-cast immobilization in the management of this condition. The patients were divided into two groups: those with congenital vertebral anomalies alone (fusion or structural defects, or both) and those with cervical anomalies and systemic disorders (dwarfism, juvenile rheumatoid arthritis, Down syndrome, and cerebral palsy). Two patterns of instability were found: instabilities at intervertebral joints adjacent to vertebral fusions, and instabilities located in vertebral defects. For all patients treatment included a posterior arthrodesis with external immobilization by a halo cast, and in two patients internal fixation with wire was also used. Solid arthrodesis was obtained in the twelve patients who were treated with autogenous grafts (iliac cancellous bone in eleven and rib bone in one), and a non-union developed in a child who was treated with bank-bone rib segments. Posterior cervical arthrodesis with wire fixation carries some risk of neural injury and often is not applicable in children with anomalous vertebrae. Spine fusion using delicate exposure, decortication using an air-drill, and placement of autogenous cancellous iliac grafts with external immobilization by a halo cast minimizes the risk of neural damage and is a reliable way to obtain a solid arthrodesis.
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PMID:The surgical treatment of instability of the upper part of the cervical spine in children and adolescents. 669 57

Many authors consider that satisfactory consolidation of fractures of the pedicles of the axis can be regularly obtained by conservative procedures. These lesions appear to be benign as far as their neurological complications are concerned, and yet a review of the world literature shows that 30 p. cent are treated surgically. In the limited number of cases where operation is justified, anterior arthrodesis through the sternomastoid with fixation by a plate appears to be less dangerous and more reliable than applying screws to the pedicles. Excellent functional results can be expected. Posterior arthrodesis appears to be less reliable, and gives poor functional results, and should be reserved for cases in which there is a combined fracture of both the odontoid and the pedicles. Anterior arthrodesis appears to be a logical choice, requiring no special surgical skills, as confirmed by the review of 257 cases reported in the published literature.
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PMID:[Value of anterior arthrodesis in the treatment of fractures of the pedicles of the axis (author's transl)]. 702 65

We reviewed the results of spinal arthrodesis for congenital spinal deformity in forty-nine patients who were younger than five years old. The minimum follow-up was five years, and eleven patients had completed their growth. Posterior arthrodesis alone was found to be effective in most scoliotic patients. There was minimum bending of the fusion mass in most patients, almost no creation of lordosis, and minimum effect on torso-lower limb relationships. For congenital kyphosis, posterior arthrodesis was highly effective, giving better eventual correction than when both anterior and posterior arthrodesis was done.
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PMID:The results of spinal arthrodesis for congenital spinal deformity in patients younger than five years old. 706 59

The use of Halifax interlaminar clamps in posterior arthrodesis for atlanto-axial instabilities has recently been reported. The four Anderson II fractures submitted were surgically treated by posterior arthrodesis with Halifax clamps and bilateral "H" shaped bone-grafts obtained from the iliac crest. Only in the first case--initially treated without fusion--a review of the system became necessary due to the loosening of one clamp. No post-operative neurological complications appeared and non malunion or nonunion occurred at follow-up. Posterior arthrodesis with Halifax clamps does not involve any complication connected with the use of metal wire and the association of posterior fusion by lateral "H" shaped bone grafts ensures a stable and physiological reduction of dens fractures and atlanto-axial luxations/subluxations often associated.
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PMID:Halifax interlaminar clamps for posterior atlanto-axial arthrodesis with spinal fusion by "H" bone+graft. 789 Nov 90

Forty-one patients with rheumatoid arthritis involving the cervical spine had a posterior cervical arthrodesis. They were followed for a minimum period of seven years. The diagnoses prior to surgery included cranial settling, atlantoaxial subluxation, subaxial subluxation, and any combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone graft. In addition, one patient had an anterior vertebrectomy, and two had transoral resection of the odontoid. Follow-up consisted of a subjective questionnaire, standard radiographs, and physical examination, including a neurologic exam. This information was compared to preoperative data available in the patient's medical record, postoperative data, and the information obtained in a similar study undertaken in 1987. At the time of follow-up, thirteen patients were known to be dead. One patient could not be located. Of the remaining twenty-six patients, eighteen underwent the full examination, including physical exam and radiographs. The remaining nine patients were contacted and interviewed, but were unavailable for exam and radiographs. All patients considered the operation a success. Only one patient at follow-up had a non-union. This was stable over time. No patient had a deterioration in neurologic function. There was no significant degeneration or instability seen at levels adjacent to the fused segments as compared to the rest of the cervical spine. Posterior cervical spine arthrodesis for rheumatoid involvement of the neck is a safe, efficacious procedure with no significant deterioration of effects over time.
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PMID:Cervical spine arthrodesis in rheumatoid arthritis: a long-term follow-up. 820 61


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