Transpedicular screws in the cervical spine and cervicothoracic junction can be applied safely and with high accuracy in a conventional technique. Cannulated screws and the use of separate stab incisions from C3-C6 with a trocar system allow for reduced screw misplacement rates. The CAS system leads to significantly reduced screw misplacement rates. Therefore, because of the potential risk of injury to the vertebral artery and neural elements, the use of a CAS system seems to be beneficial, especially for pedicle instrumentation C3-C6.

Overall, vertebroplasty has a low complication rate. Nevertheless, severe complications can occur. The majority of these are related to cement extrusion. The rate of cement leakage is often obtained by X-ray, with only a single leak registration per vertebra. Detection rate of leaks in comparison with CT and inter-observer reliability for X-ray is, in large parts, unknown. We conducted this study to determine the value of fluoroscopy and X-ray used to detect cement leakage as compared to CT scans. Intraoperative findings in lateral fluoroscopy by the surgeon, and postoperative findings in X-rays by two orthopaedic surgeons, were compared with CT scans for the same study group. Multiple cement leakage was considered, and agreement rate was determined. The detection rate for leaks was 34% for lateral X-ray and 48% for lateral and AP view. Additional AP views only enhanced the detection of leaks in the segmental veins. The agreement rate between fluoroscopy/X-ray and CT scans ranged between 66% and 74%, while inter-observer reliability showed only fair agreement. The rate of cement leaks in vertebroplasty is high if multiple leaks are considered in CT scans. Detection rates using X-rays are low and complicated by only fair inter-observer agreement. Leaks in the basivertebral veins are frequently misinterpreted and can lead to severe complications. Therefore, CT scans should be obtained to calculate the exact leakage rate and to assess persistent or new pain occurring postoperatively.

BackgroundChronic low back pain (CLBP) and chronic neck pain (CNP) have become a serious medical and socioeconomic problem in recent decades. Patients suffering from chronic pain seem to have a higher prevalence of sleep disorders.PurposeTo calculate the prevalence of sleep deprivation in patients with CLBP and CNP and to evaluate the factors that may contribute to sleep impairment.MethodsThis study was a retrospective evaluation of 1016 patients with CNP and CLBP who consulted an orthopedic department at a university hospital. Factors assessed were gender, age, diagnosis, grade of sleep deprivation, pain intensity, chronification grade, and migrational background. Pearson’s chi-squared test was performed to calculate the relationship between these factors and the grade of sleep deprivation. Regression analysis was performed to explore the correlation between the grade of sleep deprivation and age, pain intensity, and chronification grade.ResultsA high prevalence of sleep deprivation (42.22%) was calculated in patients with CNP and CLBP, even when analgesics had been taken. About 19.88% of the patients reported serious sleep impairments (ie, <4 hours of sleep per night). The grade of sleep deprivation did not correlate with the gender or age distribution. A significant relationship was found between the grade of sleep deprivation and pain intensity, failed back surgery syndrome, and patients with a migrational background. There was a moderate relationship with intervertebral disc disease and no relationship with spinal stenosis.ConclusionSleep disturbance should be assessed when treating patients with CNP or CLBP, especially in patients with higher pain intensity, failed back surgery syndrome, and a migrational background. Further research is needed to explore the complex relationship of sleep disturbance and chronic pain.

Posterior instrumentation of the cervical spine has become increasingly popular in recent years. Dissatisfaction with lateral mass fixation, especially at the cervico-thoracic junction, has led spine surgeons to use pedicle screws. The improved biomechanical stability of pedicle screws and transarticular C1/2 screws allows for shorter instrumentations and improves the repositioning possibilities. Nevertheless, there are potential risks of iatrogenic damage to the spinal cord, nerve roots or the vertebral artery with both techniques. Therefore, the aim of this study was to evaluate whether C1/2 transarticular screws and transpedicular screws can be applied safely and with high accuracy in the cervical spine and the cervico-thoracic junction using a computer-assisted surgery system (CAS system). Posterior instrumentation was performed using the Brainlab VectorVision System (BrainLAB, Heimstetten, Germany) in 19 patients. Surface matching was used for registration. We placed 22 transarticular screws C1/2, 31 cervical pedicle screws, 10 high thoracic pedicle screws and one lateral mass screw C1. The screw position was evaluated postoperatively using CT with multiplanar reconstruction in the screw axis of each screw. None of the transarticular screws or pedicle screws was significantly (>2 mm) misplaced and no screw-related injury to vascular, neurogenic or bony structures was observed. No screw revision was necessary. The mean operation time was 144 min (90-240 min) and the mean blood loss was 234 ml (50-800 ml). C1/2 transarticular screws, as well as transpedicular screws in the cervical spine and the cervico-thoracic junction, can be applied safely and with high accuracy using a CAS system. Computer-assisted instrumentation is recommended especially for pedicle screws at C3-C6.

The purpose of this study was to evaluate the early radiological outcome after ultrasound-monitored treatment of developmental dysplasia of the hip (DDH) and to examine whether there was a correlation between the initial severity of DDH, measured by ultrasound, and the severity of residual dysplasia on the radiograph at the first follow-up. At the beginning of ultrasound-monitored treatment, the sonographic findings of 90 children (72 girls, 18 boys, mean age 7.2 weeks) with DDH (29 unilateral, 61 bilateral) were staged according to the Graf classification and assigned to four categories. Treatment was continued until normal ultrasound findings were reached. At the time children started walking (mean age 14.8 months), an anteroposterior radiograph of the pelvis was performed. The acetabular index was measured and classified according to the normal values of the hip joint, as described by Tönnis. The ultrasound findings expressed by the Graf classification were compared with the acetabular index measured at radiographic follow-up. Although normal values in ultrasound were reached before abduction splinting was discontinued, at the time of radiological follow-up, 59 hips (32.8%) showed mild residual dysplasia and another 53 hips (29.4%) showed severe residual dysplasia according to the criteria of Tönnis. Statistically, there was no significant correlation between the Graf classification and the radiological outcome at follow-up. Even after successful ultrasound-monitored treatment, a risk for residual dysplasia remains. Therefore, radiological follow-up of every hip treated once is necessary. We found no correlation between the severity of DDH measured by ultrasound and the subsequent presence of residual dysplasia at radiological follow-up.

This study shows that neither monosegmental instrumented fusion nor monosegmental posterior dynamic stabilization with Dynesys alter the ROM of the cranial and caudal adjacent levels. Consequently, monosegmental posterior dynamic stabilization with Dynesys has no effect with regard to adjacent segment mobility compared with monosegmental fusion.

Study Design. Retrospective study of 55 consecutive patients with spinal metastases secondary to breast cancer who underwent surgery.Objective. To evaluate the predictive value of the Tokuhashi score for life expectancy in patients with breast cancer with spinal metastases.Summary of Background Data. The score, composed of 6 parameters each rated from 0 to 2, has been proposed by Tokuhashi and colleagues for the prognostic assessment of patients with spinal metastases.Methods. A total of 55 patients surgically treated for vertebral metastases secondary to breast cancer were studied. The score was calculated for each patient and, according to Tokuhashi, the patients were divided into 3 groups with different life expectancy according to their total number of scoring points. In a second step, the grouping for prognosis was modified to get a better correlation of the predicted and definitive survival.Results. Applying the Tokuhashi score for the estimation of life expectancy of patients with breast cancer with vertebral metastases provided very reliable results. However, the original analysis by Tokuhashi showed a limited correlation between predicted and real survival for each prognostic group. Therefore, our patients were divided into modified prognostic groups regarding their total number of scoring points, leading to a higher significance of the predicted prognosis in each group (P Ͻ 0.0001), and a better correlation of the predicted and real survival.Conclusion. The modified Tokuhashi score assists in decision making based on reliable estimators of life expectancy in patients with spinal metastases secondary to breast cancer.

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