Francesco Ciro Tamburrelli

Carpal tunnel syndrome : Indication for surgical treatment based on electrophysiologic study

A prospective study of 50 hands from 45 consecutive patients surgically treated for idiopathic carpal tunnel syndrome was conducted to determinate the recovery capacity of the median nerve after open surgical release. Subjects were evaluated by clinical history, physical examination, and electrophysiologic testing. Motor and sensory terminal latencies and motor and sensory conduction velocities were examined before surgery and 2 weeks, 2 months, and 6 months after surgical decompression. All patients showed improvement of postoperative electrophysiologic values; the amount of improvement was dependent on the degree of preoperative impairment. Complete restoration of clinical and electrophysiologic nerve function was observed only in patients with mild carpal tunnel syndrome.

Surgical prognosis in carpal tunnel syndrome: usefulness of a preoperative neurophysiological assessment

In this study 37 CTS hands underwent pre‐ and post‐operative (15 days, 2 and 6 months) evaluation of median nerve distal motor latency (DML) and sensory nerve conduction velocities (SNCV: I digit and III digit‐wrist). Pre‐operatively, CTS hands were classified as mild (decreased SNCV, normal DML), moderate (decreased SNCV, increased DML) or severe (absent sensory nerve action potentials, increased DML). Post‐operatively, all hands presented clinical and neurophysiological improvement. The three groups of patient showed different clinical and neurophysiological responses to nerve decompression: we observed a rapid restitutio ad integrumin mild group, an improvement with normalisation in about 50% of the hands in moderate group, and a high percentage of restore of the sensory responses with no normalisation in severe group. A marked improvement of sensory symptoms was observed in all cases, but some degree of motor and/or sensory deficit was still present six months after surgery in more advanced cases. Preoperative electrophysiological assessment of median nerve function in CTS hands have an important role in predicting the outcome of surgical decompression.

Association between IL-6 and MMP-3 gene polymorphisms and adolescent idiopathic scoliosis : A case-control study

Study Design. Case-control study. Objective. As inflammation plays a key role in the etiology of intervertebral disc degeneration, we suggest a possible contribution of pro-inflammatory gene polymorphisms in the pathogenesis of adolescent idiopathic scoliosis (AIS). Summary of Background Data. The nucleus pulposus of scoliotic discs responds to exogenous stimuli by secreting interleukin-6 (IL-6) and other inflammatory cytokines. The association between matrix metalloproteinases (MMPs) and disc degeneration has been reported by several investigators. A human MMP-3 promoter 5A/6A gene polymorphism regulates MMP-3 genes expression, while the G/C polymorphism of the promoter region of IL-6 gene influences levels and functional activity of the IL-6 protein. Methods. We conducted a case-control study to investigate whether the 5A/6A polymorphism of the MMP-3 gene and the G/C polymorphism of the promoter region of IL-6 gene were associated with susceptibility to AIS. Results. The frequency of the 5A/5A genotype of MMP-3 gene polymorphism in patients with scoliosis was almost 3 times higher than in controls (30.2% vs. 11.2%, p 0.001), and the frequency of the G/G genotype of IL-6 gene polymorphism in patients with scoliosis was almost 2 times higher than in controls (52.8% vs. 26.2%, P < 0.001). 5A/5A genotype of MMP-3 gene polymorphism and G/G genotype of IL-6 gene polymorphism are independently associated with a higher risk of scoliosis (odds ratio, respectively, 3.34 and 10.54). Conclusion. This is the first study that has evaluated the possibility that gene variants of IL-6 and MMPs might be associated with scoliosis and suggests that MMP-3 and IL-6 promoter polymorphisms constitute important factors for the genetic predisposition to scoliosis.

Intraneural cyst of the peroneal nerve

Abstract A 15-year-old girl was referred to us because of foot drop. The motor deficit was characterized by a peculiar fluctuating course related to sporting activity: improvement of symptoms during no-sport periods and worsening during sport training. Neurophysiological examination revealed marked global impairment of muscles innervated by the peroneal nerve. Ultrasound and MRI showed a mass in close proximity to the neck of the fibula extending in a tubular fashion. At operation an intraneural lesion was found and was totally removed. Histology revealed that it was an intraneural cyst. A hypothesis on the pathogenesis was drawn up. One year after the operation a clinical and neurophysiological follow-up was performed.

A rare cause of lumbar radiculopathy: spinal gas collection.

The presence of gas in the intervertebral disk space, known as the vacuum phenomenon, is a relatively common radiologic finding, especially on computed tomographic investigation. In a few cases, the gas can be collected into the lumbar spinal canal and can also compress the nerve root. To date only seven cases of symptomatic lumbar radiculopathy caused by a bubble of gas are reported in the literature. The presence of gas inside a narrowed disk and the collection of gas in the spinal canal suggest a communication between the two structures. A case of lumbar radiculopathy caused by a collection of gas in the spinal canal provided the authors the opportunity to study this rare condition by magnetic resonance imaging. Magnetic resonance imaging had not been used before in the referred cases and proved conclusively the discal origin of the gas.

Carpal tunnel syndrome : Neurophysiological results of surgery based on preoperative electrodiagnostic testing

Fifty-three hands with carpal tunnel syndrome had pre- and postoperative evaluations of median nerve distal motor latency (from wrist to thenar muscles) and orthodromic sensory nerve conduction velocity (from thumb and middle finger to wrist). At 6 months we observed a neurophysiological return to normal in all cases with normal preoperative distal motor latency and in about 50% of the hands with preoperative distal motor latency between 4 and 6 ms. Prolongation of the distal motor latency over 6 ms was not followed by return to neurophysiological normality, although some degree of sensory function was restored in the majority of cases.

Osteoblastoma of the atlas

A case of cervical spine (atlas) osteoblastoma in a 14-year-old patient is reported. Osteoblastoma is a rare primary bone tumour and in young patients it mainly occurs in the spine. Occurrence in the cervical tract is uncommon and in the atlas it is very rare. Only two other cases were found in our literature review.

Posterior percutaneous reduction and fixation of thoraco-lumbar burst fractures

BACKGROUND Treatment of A3 thoraco-lumbar and lumbar spinal fractures nowadays remains a controversial issue. Percutaneous techniques are becoming very popular in the last few years to reduce the approach-related morbidity associated with conventional techniques. HYPOTHESIS Purpose of the study was to analyze the clinical and radiological outcome of patients who underwent percutaneous posterior fixation without fusion for the treatment of thoraco-lumbar and lumbar A3 fractures. MATERIALS AND METHODS Sixty-three patients, having sustained a single-level thoraco-lumbar fracture, underwent short segment percutaneous instrumentation and were retrospectively analyzed. sagittal index (SI) was calculated in all patients. Clinical and functional outcome were evaluated by Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form General Health Status (SF-36). RESULTS Average operative blood loss was 82 mL (50-320). Mean pre-operative SI in the thoraco-lumbar segment was 13.3° decreased to 5.8° in the immediate postoperative with a mean deformity correction of 7.5. Mean pre-operative SI in the lumbar segment was 16.5° decreased to 11.3° in the immediate postoperative with a mean deformity correction of 5.2. Not statistically significant correction loss was registered at 1-year minimum follow-up. Constant clinical conditions improvement in the examined patients was observed. CONCLUSION Percutaneous pedicle screw fixation for A3 thoraco-lumbar and lumbar spinal fractures is a reliable and safe procedure. LEVEL OF EVIDENCE Level IV. Retrospective study.

Degenerative facet joint changes in lumbar percutaneous pedicle screw fixation without fusion

BACKGROUND Aim of the study was to evaluate degenerative lumbar facet-joints changes after percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar fractures. MATERIALS AND METHODS Thirty patients underwent short PPSF without fusion. CT-scan was performed in the pre- and post-operative time at four, eight and 12 months. The six zygapophyseal joints adjacent the fractures level were evaluated. RESULTS At four months patients showed no differences between pre- and post-operative joint radiographic aspect. At eight and 12 months, CT-scan demonstrated a progressive degeneration only in the middle joints respectively in 21.42% and in 76.92% of the cases. All 10 disrupted facet joints showed progressive degenerative changes at eight and 12 months. CONCLUSION Lumbar percutaneous fixation without fusion induces little degenerations essentially collocated in the middle joints close to fracture level at eight and 12 months. In the proximal and distal joints adjacent the screws degenerative changes can be seen only when associated to pedicle-screw encroachment.

Imaging of Lumbar Spondylolysis

This article reviews the imaging findings in spondylolysis, which represents a stress fracture of the pars interarticularis that is secondary to chronic low-grade trauma. The incidence of spondylolysis in the general population is approximately 6%, but it reaches 63% in those engaging in certain spo