No abstract

We report on 14 patients with tuberculosis of the spine treated by operation. All had disease of three or more vertebrae with involvement of both the anterior and posterior columns and a progressive kyphotic deformity in spite of conservative treatment. We consider such spines to be 'unstable' and have found that anterior as well as posterior fusion with instrumentation is necessary.Résumé Nous rapportons 14 cas de patients atteints de tuberculose rachidienne traitée chirurgicalement. Tous avaient une affection de trois vertèbres ou plus, avec une atteinte de la colonne antérieure et de la colonne posté-rieure et une cyphose progressive malgré le traitement conservateur. Nous avons considéré de telles colonnes vertébrales 'instables' et avons trouvé qu'une double instrumentation, antérieure et postérieure était nécessaire.

A total 12 consecutive children with secondary deformities following total obstetric brachial plexus palsy were included in this retrospective study. In all patients, the main complaints were two socially disabling hand postures: the "beggar's" hand and/or the "unshakable" hand. All children had a supinated forearm with no active pronation and were teased by their friends, who called them "beggars." When the impairment was severe and involved the right hand and wrist, children also complained that they were not able to shake hands. The management approach to these children was described, with the main aim of surgery being the correction of the abnormal posture. Other simultaneous tendon transfers were also performed to improve hand function if there were suitable musculotendinous units. Successful reconstruction was accomplished in all patients. Preoperatively, some children refused to go to school because of teasing, and most did not want to interact socially. After surgery, all children attended school regularly, and parents reported much better social interaction. However, the functional gain was never enough to dramatically improve the daily use of the limb. The contralateral normal limb remained the dominant one for all daily activities, including writing and eating.

The aim of this study is to define paediatric lateral humeral condyle fractures prone to later displacement. The authors reviewed 106 children who were treated surgically for this fracture. There were 74 boys and 32 girls with an age range of 3-10 years. The study included 27 minimally displaced and 79 displaced fractures. The average follow-up was 50 months. Binary logistic regression model indicated that 6-8-year-old children with minimally displaced fractures and who underwent immediate surgery have a better chance for satisfactory results. The authors concluded that routine use of 2 mm displacement for treatment decisions should be changed to avoid delayed surgery.

IntroductionSpondylolysis is nowadays considered to be an acquired lesion originating in early childhood, and is not found in infants [1,10,12,14,15]. It affects the fourth and fifth lumbar vertebrae in more than 95% of cases [12]. Wiltse et al. classified spondylolistheses into four types [16], of which the isthmic variety is the most common, especially in children and adolescents, and is thought to be acquired in origin [15]. Spondyloptosis indicates any slip greater than 100% [5], and this has only ever been observed in the dysplastic type [6].The association between spondylolysis and spondylolistheses is well known, but there has been no previous report, to the best of our knowledge, of as many multiple defects in one patient as the case we present here. Case reportA 15-year-old female student presented with an 8-year history of chronic lower back pain, with radiation into the left lower limb during the last 2 years. The pain was aggravated by activities and there was no history of precipitating events. The parents of the girl were close relatives.The girl walked with a waddling gait. There was an obvious lumbar hyperlordosis with lumbosacral kyphosis. She had limitation of flexion of lumbar spine. Straight leg raising was limited to 70°bilaterally, which was due to hamstring muscle tightness. She had no neurological deficit. The mother was found to have isthmic spondylolisthesis of L5/S1.Radiographs showed bilateral spondylolyses at L2, 3 and 4, with grade I isthmic spondylolisthesis at the L3/4 level. There was also a spondyloptosis at L4/5, with domed L5 and elongated pars interarticularis. L5 was sacralized with vertical sacrum below it (Fig. 1). (Sacralization of L5 was confirmed by radiographs taken of the chest and thoracic vertebrae). The myelogram revealed complete obstruction of the thecal sac with compression and narrowing of the thecal sac at the L4/5 level (Fig. 2).The patient was managed surgically by a three-stage operation. The first stage was through a posterior approach, where posterior decompression and laminectomy at the L4/5 level was done. This included excision of the elongated pars down to the pedicles of L4. The second stage was a retroperitoneal corpectomy of L4, and was performed 1 week after the first. Through a flank incision, L4 was approached after mobilization of the vessels medially and ligation of the left iliolumbar vessels. The discs above and below were completely excised, the lower one was in front of and above the domed L5. L4 was then excised using an osteotome and rongeurs.Abstract An unusual case of a combination of multiple bilateral spondylolyses (L2, 3 and 4), spondylolisthesis at L3/4, spondyloptosis at L4/5 and sacralization of L5 in a teenage female is described. The patient had severely increasing lower back pain radiating to the left lower limb. Radiography identified the abnormalities and myelography revealed complete obstruction and compression of the thecal sac at the L4/5 level. The case was treated surgically by posterior decompression, corpectomy and fu...