Spiros G. Pneumaticos

The effects of rotation on radiographic evaluation of the tibiofibular syndesmosis.

Radiographs of 12 normal cadaveric lower extremities were prepared with each extremity in seven increments of axial rotation, ranging from 5° of external rotation to 25° of internal rotation. The tibiofibular clear space, the tibiofibular overlap, the width of the tibia and fibula, and the medial clear space were measured on each film. The width of the tibiofibular clear space (syndesmosis A) averaged 3.9±0.9 mm (range, 2 to 5.5 mm), but did not change significantly with rotation. Its size was independent of the size of tibia and fibula. All other measurements changed dramatically with rotation. In our specimens, a true mortise view of the ankle joint was obtained by internally rotating the extremity an average of 13.6±0.7° (range, 12.0° to 17.0°). Based on our results the width of the tibiofibular clear space on the anterior-posterior view is the most reliable parameter for detecting widening of the syndesmosis on plain radiographs. However, due to its variability among different individuals, comparison views of the contralateral extremity are warranted for confirmation of clinical suspicion of syndesmosis disruption.

Biomechanical Consequences of Sequential Plantar Fascia Release

Plantar fascia release has long been a mainstay in the surgical treatment of persistent heel pain, although its effects on the biomechanics of the foot are not well understood. With the use of cadaver specimens and digitized computer programs, the changes in the medial and lateral columns of the foot and in the transverse arch were evaluated after sequential sectioning of the plantar fascia. Complete release of the plantar fascia caused a severe drop in the medial and lateral columns of the foot, compared with release of only the medial third. Equinus rotation of the calcaneus and a drop in the cuboid indicate that strain of the plantar calcaneocuboid joint capsule and ligament is a likely cause of lateral midfoot pain after complete plantar fascia release.

The effects of early mobilization in the healing of achilles tendon repair

Twenty-four male New Zealand rabbits underwent suture repair of a tenotomy of the left achilles tendon. The rabbits were randomized into two groups of 12 animals; in group (A), the ankle was immobilized by pinning for 35 days, while in the group (B), the ankle was immobilized for only 14 days followed by active mobilization. Following sacrifice at 35 days postoperatively, the retrieved tendons were evaluated by biomechanical testing and histologic examination. Approximately 50% of stretching occurred in the first four days; average overall elongation was 9.5±1.0 mm and 12.7±1.5 mm (p = 0.102) and average stiffness recovery was 67.4±2.0% and 82.9±1.9% (p = 0.0004) for groups A and B respectively. Histologically both groups demonstrated traces of disorganized neo-collagen fibers at the repair site as early as the fourth day with subsequent appearance of more mature collagen. The results obtained from our study favor early mobilization of the repaired tendon, which seems to restore the functional properties of the tendons more rapidly than continuous immobilization of an identical surgical repair.

Scoliosis associated with lumbar spondylolisthesis: a case presentation and review of the literature.

BACKGROUND CONTEXT The association between scoliosis and spondylolisthesis is well documented, but criteria and methods for managing the deformity in patients with debilitating pain are not clear. PURPOSE To describe correction of scoliosis by internal fixation of the spondylolisthesis. STUDY DESIGN Case report of a patient with scoliosis developing in association with spondylolisthesis. METHODS A 17-year-old female presented with a 6-month history of back and leg pain. No spinal curvature was noted in radiographs taken at the onset of symptoms. Significant curvature appeared during the 6-month history of pain in association with an L5-S1 spondylolisthesis. The spondylolisthesis was repaired with posterior pedicle screw instrumentation. RESULTS The pain and the spinal curvature almost completely resolved after surgery, and the outcome remained excellent 14 months after surgery. CONCLUSION In the properly diagnosed patient, surgical repair of the spondylolisthesis can relieve pain and correct spinal curvature.

The role of radionuclides in primary musculoskeletal tumors beyond the 'bone scan'.

Radionuclides represent a means of functional imaging, which is able to reflect the metabolic state of tissues. Recently developed radiotracers and older radiotracers with newer applications, imaged through single photon emission computed tomography (SPECT) and positron emission tomography (PET), can provide significant information in the diagnosis, grading, therapy response or recurrence of primary musculoskeletal tumors. The unique ability of these radiotracers to demonstrate non-invasively the efflux pump rate, which is a common reason of therapy failure, as well as the metabolic and proliferative rates of the tumors should be a powerful tool in the orthopaedic oncology in the evaluation of musculoskeletal tumors.

Sensitivity and specificity of dural sac and herniated disc dimensions in patients with low back-related leg pain

Narrow spinal canals or herniated discs can be associated with leg pain. However, it is not known whether quantitative measurements of the spinal canal or herniated disc are sensitive and specific for low back‐related leg pain. The size and cross‐sectional area of the dural sac and any herniated discs were measured from magnetic resonance imaging examinations of 22 asymptomatic individuals and 44 patients with sciatica. The sensitivity and specificity of these measurements were determined. In this small population of patients, a dural sac anteroposterior (AP) diameter of 10.2 mm at the L3‐4, L4‐5, or L5‐S1 vertebral levels was 74% sensitive and 74% specific for leg pain. Based on measurements in symptomatic patients, a herniated disc with an AP diameter of approximately 3 mm was over 95% sensitive and 95% specific. However, if the AP diameters of herniated discs in symptomatic patients were compared with similar measurements in asymptomatic controls, the most sensitive and specific threshold value was 6.8 mm. These findings must be confirmed in a larger population before they are applied clinically. J. Magn. Reson. Imaging 2000;12:439–443.

Diskography in the Evaluation of Low Back Pain

Abstract Diskography is evolving to play a crucial role in the evaluation of axial low back pain, especially in regard to surgical decision making. Despite advances in other forms of imaging, diskography remains unique in that it is the only test that seeks to provoke a pain response during the study. It has been suggested that patients with axial low back pain who experience a concordant pain response during diskography are more likely to respond favorably to surgical intervention. However, the efficacy of using this potential correlation is dependent on the technical application and interpretation. The validity of diskography remains controversial, in part because postdiskography surgical outcomes have been inconsistent. Therefore, in select patients with recalcitrant back pain, diskography remains a second‐line diagnostic modality that is used to clarify surgical indications. Despite well‐defined guidelines, the technical aspects of diskography and its interpretation are still evolving.

OPEN VERSUS CLOSED REPAIR OF THE ACHILLES TENDON : AN EXPERIMENTAL ANIMAL STUDY

This experimental animal study compared the healing patterns between open and closed treatments of Achilles tendon tenotomies. Twenty-four male New Zealand rabbits underwent tenotomy of the left Achilles tendon and were randomized into two groups, treated with either open surgical repair or closed management. After the death of the animal, the retrieved tendons were submitted for biomechanical and histological testing. The total elongation of the open treatment group was 9.5 ± 1.0 mm compared with 21.2 ± 3.4 mm for the closed treatment group (P = 0.008), and the regain of stiffness was 67.4 ± 2.0% and 48.9 ± 5.3%, respectively (P = 0.132). Histological evaluation demonstrated similar healing patterns in both groups.

Prediction of successful discectomy using MRI quantitation of dural sac and herniated disc dimensions.

Objective:  To evaluate the ability of magnetic resonance imaging (MRI) quantitation of disc prolapse and dural sac to identify those who would benefit from discectomy.

Association between bone scintigraphy features of spinal degeneration and anthropometric and demographic variables

BACKGROUND AND OBJECTIVES Bone scintigraphy is a molecular imaging technique routinely used for the evaluation of benign and malignant bone abnormalities. This study aimed at evaluating spinal degenerative changes detected by bone scintigraphy and determining associations between image features and patients’ anthropometric and demographic variables. MATERIAL AND METHOD In a cross-sectional study, 64 men and 52 women underwent bone scintigraphy. Experts identified all image regions suggesting degenerative joint disease (DJD) and classified region intensity on a 3-point scale. Image characteristics were correlated to the patients’ body mass index (BMI), age, weight, height, activity level, and sex. Data analysis included descriptive statistics and association coefficients. RESULTS DJD was found in 53 patients (46%). In men, there was weak but statistically significant correlation between DJD and activity level, and DJD and age, but not BMI or weight. In women, only a weak, not statistically significant, linear correlation was found between DJD and BMI, and DJD and weight. CONCLUSION Molecular imaging with bone scintigraphy showed that spinal degenerations are associated with different anthropometric and demographic features in men and women. Interestingly, no association was found between DJD and increased body weight in men while a weak association may exist in women. The results prompt for additional studies to better determine the risk factors for DJD and low back pain in male and female patients. LEVEL OF EVIDENCE Diagnostic study, Level II (retrospective study).