Advanced Degenerative Disease Research Articles

A Comparative Study of 1-Year Postprocedural Outcomes in Transcatheter Mitral Valve Repair in Advanced Primary Mitral Regurgitation: PASCAL vs. MitraClip.

Both the MitraClip and PASCAL systems offer transcatheter edge-to-edge repair (TEER) solutions for mitral regurgitation. Evidence indicates a lower technical success rate for TEER in complex degenerative mitral regurgitation (DMR) cases. We conducted a retrospective analysis of patients who underwent transcatheter edge-to-edge therapy for primary mitral regurgitation with advanced anatomy, defined as mitral regurgitation effective regurgitant orifice area (MR-EROA) ≥0.40 cm2 or large flail gap (≥5 mm) or width (≥7 mm) or Barlow's disease, that completed follow-up after 1 year. Our criteria were met by 27 patients treated with PASCAL and 18 with MitraClip. All patients exhibited a significant, equivalent short-term reduction in MR-EROA, mitral regurgitation vena contracta diameter (MR-VCD), regurgitant volume, and clinical status. At 1 year follow-up, reductions in MR-VCD, regurgitant volume, and MR-EROA remained significant for both groups without significant differences between groups. MR-Grade ≤ 1+ was achieved in 18 (66.7%) and 10 (55.6%) patients, respectively. At follow-up, no difference in hospitalization for cardiac decompensation was observed. Overall death was similar in both groups. Our study suggests that both the PASCAL and MitraClip systems significantly reduce mitral regurgitation even in advanced degenerative diseases. Within our limited data, we found no evidence of inferior performance of the PASCAL system.

DEPRESSION INFLUENCES POSTOPERATIVE PAIN AND DISABILITY IN PATIENTS UNDERGOING LUMBAR SPINAL FUSION: PRELIMINARY DATA OF A PROSPECTIVE STUDY

Chronic low back pain (CLBP) is the most common cause of disability worldwide, and lumbar spine fusion (LSF) is often chosen to treat pain caused by advanced degenerative disease when clinical treatment failed certain cases, the post-surgical outcomes are not what was expected. Several studies highlight how important are. In psychological variables during the postoperative spine surgery period. The aim of this study is to assess the role of preoperative depression on postoperative clinical outcomes. We included patients who underwent LSF since December 2021. Preoperative depression was assessed administering Beck Depression Inventory questionnaire (BDI). And pain and disability were evaluated at 1, 3, and 6 months, administering respectively Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI). As statistical analysis Mann-Whitney test was performed. We included 46 patients, 20 female (43,5%) and 26 male (56,5%) with an average age of 64,2. The population was divided in two groups, fixing the BDI cut-off point at 10. Patients with BDI < 10 points (N=28) had normal mental health status, instead patients with BDI > 10 points (N=16) had depressive disorders. At 3 months patients with healthy mental status reported statistically significant reduction of pain (U = 372,5, p = .006) and improvement of disability but without statistical significancy (U = 318, p = 0,137). At 6 months patients without psychological disease reported statistically significant reduction of pain (U = 342, p = 0,039) and disability (U = 372,5, p = 0,006).This study demonstrates the correlation between pre-existing depressive state and poorer clinical outcomes after spine surgery. These results are consistent with the literature. Therefore, during the surgical decision making it is crucial to take psychological variables into account in order to predict the results after surgery and inform patients on the potential influence of mental status.

Lumbar lateral interbody fusion: step-by-step surgical technique and clinical experience.

Lateral lumbar interbody fusion (LLIF) is a minimally invasive surgical approach used to treat a variety of degenerative and deformity conditions of the lumbar spine such as advanced degenerative disease, degenerative scoliosis, foraminal and central stenosis. It has emerged as an alternative to the traditional posterior and anterior lumbar approaches with some potential benefits such as lower blood loss and shorter hospital stay. In this article, we provide our single institutional surgical experience including main indications and contraindications, a step-by-step surgical technique description, a detailed preoperative imaging assessment with a focus on magnetic resonance imaging (MRI) psoas anatomy, operative room (OR) setup and patient positioning. A descriptive surgical technical note of the following steps is provided: positioning and fluoroscopic confirmation, incision and intraoperative level confirmation, discectomy and endplate preparation, implant size selection and insertion and final fluoroscopic control, hemostasis check and wound closure along with an instructional surgical video with tips and pearls, postoperative patient care recommendations, common approach-related complications, along with our historical clinical institutional group experience. Finally, we summarize our research experience in this surgical approach with a focus on LLIF as a standalone procedure. Based on our experience, LLIF can be considered an effective surgical technique to treat degenerative lumbar spine conditions. Proper patient selection is mandatory to achieve good outcomes. Our institutional experience shows higher fusion rates with good clinical outcomes and a relatively low rate of complications.

Patient-Reported Outcome Measure for Cartiva® Synthetic Cartilage Replacement in Advanced Degenerative Disease of the Hallux Metatarsophalangeal Joint - A Single Surgeon Series

Cartiva® Synthetic Cartilage Implant (SCI) was introduced in our department in 2016 as an alternative treatment for advanced degenerative disease of the hallux metatarsophalangeal joint requiring fusion but would rather prefer to maintain joint movement.

Recent developments in the design and synthesis of benzylpyridinium salts: Mimicking donepezil hydrochloride in the treatment of Alzheimer's disease.

Background: Alzheimer’s disease (AD) is an advanced and irreversible degenerative disease of the brain, recognized as the key reason for dementia among elderly people. The disease is related to the reduced level of acetylcholine (ACh) in the brain that interferes with memory, learning, emotional, and behavior responses. Deficits in cholinergic neurotransmission are responsible for the creation and progression of numerous neurochemical and neurological illnesses such as AD. Aim: Herein, focusing on the fact that benzylpyridinium salts mimic the structure of donepezil hydrochlorideas a FDA-approved drug in the treatment of AD, their synthetic approaches and inhibitory activity against cholinesterases (ChEs) were discussed. Also, molecular docking results and structure–activity relationship (SAR) as the most significant concept in drug design and development were considered to introduce potential lead compounds. Key scientific concepts: AChE plays a chief role in the end of nerve impulse transmission at the cholinergic synapses. In this respect, the inhibition of AChE has been recognized as a key factor in the treatment of AD, Parkinson’s disease, senile dementia, myasthenia gravis, and ataxia. A few drugs such as donepezil hydrochloride are prescribed for the improvement of cognitive dysfunction and memory loss caused by AD. Donepezil hydrochloride is a piperidine-containing compound, identified as a well-known member of the second generation of AChE inhibitors. It was established to treat AD when it was assumed that the disease is associated with a central cholinergic loss in the early 1980s. In this review, synthesis and anti-ChE activity of a library of benzylpyridinium salts were reported and discussed based on SAR studies looking for the most potent substituents and moieties, which are responsible for inducing the desired activity even more potent than donepezil. It was found that linking heterocyclic moieties to the benzylpyridinium salts leads to the potent ChE inhibitors. In this respect, this review focused on the recent reports on benzylpyridinium salts and addressed the structural features and SARs to get an in-depth understanding of the potential of this biologically improved scaffold in the drug discovery of AD.

Total ankle arthroplasty with the use of Zimmer prosthesis and a review of the results of previous research conducted in this field.

The aim of this article is to describe surgical technique and early results of Total Ankle Replacement (TAR) from lateral approach using Zimmer TM prosthesis. The study uses theoretical knowledge which is the result of research conducted by other authors, and practical knowledge due to the fact that our center performs that type of operation. Arthrodesis as the current standard in the treatment of advanced degenerative ankle disease, apart from its advantages, also has many disadvantages. The relative durability and reduction of the patients' pain have been achieved at the expense of the adjacent joints. Their accelerated arthrosis is the result of compensatory loads as a consequence of change in foot biomechanics. That determined implementation of solutions that will guarantee elimination of pain in the ankle joint, preserve its motor function and improve gait, while having no negative impact on the mobility of adjacent joints.

Is it the time of a paradigm shift from intra-articular corticosteroid injections to regenerative medicine in osteoarthritis? review article

This article addresses the best practice in managing osteoarthritis (OA), weighing the benefits and risks of various intra-articular therapies. For many decades we had used intra-articular injections of corticosteroids (IACSs) as the only option after analgesics and physical therapy to help symptoms in patients who suffer from mild to moderate OA until they get ready for joint replacement. In advanced degenerative diseases, particularly in the elderly, we go directly to surgery except when there are multiple comorbidities, then surgery is not an option; thus, IACS injection is the only option left. Furthermore, in individuals suffering from renal disease, peptic ulcer, diabetes, or heart failure, we cannot use regular non-steroidal anti-inflammatory medicines, going the only option for frequent IACSs. Several kinds of literature suggest some harmful effects of IACSs. These include accelerated OA of the cartilage, subchondral insufficiency fracture, joint infection, and osteonecrosis. As the science progresses, regenerative therapies (RTs) emerge, including hyaluronic acid (HA), platelet-rich plasma (PRP), and mesenchymal stem cell (MSC) therapy. RTs carry an excellent safety profile compared to IACSs. That shift in paradigm by moving away from using IACSs in OA to those RTs has shown more prolonged symptomatic effects, slowing or stopping the progression of OA and sometimes regeneration of the cartilage and surrounding tissues.

Narrative Review of the Mechanism of Hip Prosthesis Dislocation and Methods to Reduce the Risk of Dislocation.

Total hip arthroplasty (THA) is one of the most effective surgical procedures. It improves quality of life, increases range of motion, and reduces pain in patients with hip joint degeneration. THA allows patients to return to everyday social and professional activities. Therefore, today it is the best approach to treatment of several chronic conditions affecting the hip joint, including advanced degenerative diseases, avascular necrosis, and some traumatic events. The aim of this study was to present the mechanism of hip prosthesis dislocation, associated risk factors, and the factors reducing the risk of dislocation, as well as its consequences and methods of risk minimization.Hip dislocation is a common complication following THA. It is responsible for up to 2% to 3% failures of primary replacements, increasing even to 10% in extreme cases of patients highly predisposed to this condition. In most cases, technical errors during implant placement are responsible for the incidence. The measures taken to prevent complications include activities aimed at correct implant insertion and the selection of the most appropriate type of implant for the patient, depending on individual needs.We summarized the current knowledge of implant dislocation to help surgeons understand the changes in biomechanics of the hip after its replacement and the impact of each particular element that participates in it. This knowledge can enable a surgeon choose the most favorable surgical method and the most appropriate implant to reduce the risk of implant dislocation.

Effectiveness of therapy with low-dosage masitinib on pulmonary hypertension in dogs: a pilot study

The purpose of this pilot study was to assess the efficacy of long-term masitinib therapy at low doses on echocardiographic, cardiovascular, haematological, and blood biochemical indicators, as well as clinical symptoms in dogs with pulmonary hypertension (PH) caused by advanced chronic degenerative mitral valve disease or heartworm disease. Seven client-owned dogs with severe PH were recruited prospectively and given low-dose masitinib orally, 3 mg/kg body weight (approximately one-fourth of the recommended antineoplastic dosage), q24h, for 123–928 days. Examinations were performed prior to masitinib administration, as well as 1, 2, 3, 6, and 12 months later. At 1–12 months, low-dose masitinib significantly reduced systolic pulmonary arterial pressure (P < 0.05 or 0.01) and dramatically improved clinical symptoms. Low-dose masitinib treatment improved right ventricular function indicators such as right atrium/aorta ratio, maximum tricuspid regurgitation velocity, right ventricular Tei index, and tricuspid annular plane systolic excursion, without worsening left ventricular function indicators. These findings suggest that low-dose masitinib may be effective as an adjunctive therapeutic for chronic heart failure in dogs with PH and may increase the survival of PH dogs.

Evolution of Complex Spine Surgery in Neurosurgery: From Big to Minimally Invasive Surgery for the Treatment of Spinal Deformity.

Spinal instrumentation for adult spinal deformity dates back to the surgical correction of secondary complications from infectious processes, such as Pott's disease and poliomyelitis [1]. With the population aging at a longer life expectancy today, advanced degenerative spinal diseases and idiopathic scoliosis supersede as the most common causes of adult spinal deformity. Correction of the thoracolumbar malignment, specifically, has rapidly evolved with the burgeoning success of spinal instrumentation. The objective of this chapter is to review the metamorphosis of operative principles for adult thoracolumbar deformity, from aggressive osteotomies in the posterior bony elements to minimally invasive surgery (MIS) at the intervertebral disc space.

Spinal pseudogout is a joker. Commentary on “Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases”

In this issue, Moon et al. provide a detailed report on two cases of Calcium pyrophosphate deposition disease (CPDD), causing compression of the spinal cord and conus medullaris requiring surgical decompression and reconstruction [[1]Moon A.S. Mabry S. Pittman J.L. Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: a report of two cases.North American Spine Society J (NASSJ). 2020; 3: 100026https://doi.org/10.1016/j.xnsj.2020.100026Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. Both cases presented on elderly patients, with known advanced degenerative disease of the spine. In both cases the mass was likely forming from the facet joint and both cases presented with a combination of severe pain and symptoms of neural compression (in different degrees, causing alteration of the spinal cord motor tracts in one case and unilateral lower limb pain mimicking radiculopathy in the second one). Both patients gained full resolution of symptoms and neurological function after surgery. A number of cases of CPDD affecting the spine have been described in the literature, but most reports include one or few cases, which suggests that CPDD requiring surgery is relatively unfrequent. This is in contrast with the finding of high prevalence (as high as 25%) of deposits of calcium pyrophosphate in the cervical spine of patients with pseudogout affecting peripheral joints [[2]Moshrif A. Laredo J.D. Bassiouni H. et al.Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients.Semin Arthritis Rheum. 2019; 48: 1113-1126https://doi.org/10.1016/j.semarthrit.2018.10.009Crossref PubMed Scopus (31) Google Scholar]. While the association of pseudogout with lumbar and cervical stenosis has been well described, some aspects of this condition deserve some attention. The prognosis of spinal canal decompression in patients with CPDD does not seem to be worse than that on patients with degenerative lumbar stenosis [[3]Ariyawatkul T. Pichaisak W. Chavasiri C. Vamvanij V. Wilartratsami S. Luksanapruksa P. The role of calcium pyrophosphate dihydrate deposition in the postoperative outcome of lumbar spinal stenosis patients.Asian Spine J. 2019; 13: 1001-1009https://doi.org/10.31616/asj.2018.0280Crossref PubMed Scopus (2) Google Scholar]. CPDD can also need to be distinguished from other spinal conditions, such as tumors [[4]Turaga S. Thomas M. Savy L. Schreiber B.E. Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review.BMJ Case Rep. 2019; 12 (Published 2019 Dec 2)e231508https://doi.org/10.1136/bcr-2019-231508Crossref PubMed Scopus (6) Google Scholar], spinal infection [[5]Bridges K.J. Bullis C.L. Wanchu A. Than K.D. Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report.J Neurosurg Spine. 2017; 27: 145-149Crossref PubMed Scopus (12) Google Scholar], hematoma of the yellow ligament [[6]Cruz-Conde R. Berjano P. Buitron Z. Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine.Spine. 1995; 20: 1506-1509https://doi.org/10.1097/00007632-199507000-00012Crossref PubMed Scopus (42) Google Scholar]. One of the two cases in this report presented with severe spinal sagittal misalignment that might be related to either the spinal cord compression or inflammation of the facet joints, and resolved after surgery, which suggests that CPDD can also be misinterpreted as spinal deformity of functional nature [[7]Redaelli A. Berjano P. Aebi M. Focal disorders of the spine with compensatory deformities: how to define them.Eur Spine J. 2018; 27: 59-69https://doi.org/10.1007/s00586-018-5501-8Crossref PubMed Scopus (9) Google Scholar]. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Download .pdf (.12 MB) Help with pdf files Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two casesNorth American Spine Society Journal (NASSJ)Vol. 3PreviewSpinal calcium pyrophosphate deposition disease (CPPD) is uncommon, and often resembles more common spine pathologies causing pain and neural compression. Here, we present two unusual cases of CPPD of the cervical and thoracolumbar spines. Full-Text PDF Open Access

Initial evaluation of outcomes of surgical treatment of patients with advanced degenerative disease of the first metatarsophalangeal joint

Initial evaluation of outcomes of surgical treatment of patients with advanced degenerative disease of the first metatarsophalangeal joint

Simultaneous Bilateral Minimally Invasive Direct Anterior Approach Total Hip Arthroplasty with fast track Protocol.

Advanced degenerative hip joint disease is bilateral in approximately 20% of cases, prompting questions of whether it is necessary to perform two separate surgical procedures, whether simultaneous bilateral hip replacement makes the surgical treatment too extensive, and whether it significantly affects the postoperative course. The study analysed the duration of hospitalisation, perioperative complications, and the need for blood transfusion in 30 patients (27 men and 3 women) with bilateral hip osteoarthritis who underwent simultaneous bilateral total hip replacement from a minimally invasive direct anterior approach followed by a fast track protocol for optimisation of perioperative management between 2014 and 2017. The mean age of patients was 60.2 years (range 43 to 77 years) and the mean follow-up period was 28 months (range 18 to 48 months). Mean duration of hospitalisation was 4.5 days (range 3 to 9 days). A total of 4 patients (13%) required allogeneic blood transfusion. No patient developed thromboembolic or infectious complications or implant dislocation after surgery. Apart from one case where the acetabulum was not selected correctly, which resulted in postoperative loosening, there were no other significant medical events potentially related to the surgical treatment. Simultaneous bilateral total hip arthroplasty using a minimally invasive direct approach and a fast track protocol for optimisation of perioperative management does not increase the need for perioperative blood transfusion or the number of surgical complications and constitutes a safe, effective, and recommendable method of treatment in patients with advanced bilateral degenerative disease of the hip joints.

Response to comment from Dr. Yassari et al.

We appreciate for the thoughtful insight of Dr. Yassari et al . We would like to stress that we are not against navigation, on the contrary, we believe that it has important place in spinal surgery. We completely agree that there are excellent indications for navigation; “advanced degenerative disease, revision procedures, patients with complicated and severe deformity, minimally invasive spine surgery, and complicated spinal tumours” as it was very well put in the comment. In fact, in our institution we frequently use 3D image-based navigation to insert cervical pedicle screws or for the percutaneous procedures. Nevertheless, the idea of our paper was to present series of patients, which were neither complex nor challenging. Moderate scoliosis cases included to the study, one might call “routine”, “everyday cases”. Results of our studies suggest that in this group of patients’ applications of navigation is not beneficial and in view of significantly increased radiation it does not seem to be justified.

Radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy.

Objective: To determine the radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy (HTO).Design of study: Descriptive case series.Study duration and settings: The present study was a descriptive case series carried out at the Orthopedic Departments of District Head Quarter Hospital Faisalabad affiliated with Faisalabad Medical University, Faisalabad from Jan 2014 to March 2018.Methodology: This study involved 40 patients of both genders, aged between 40 and 65 years having advanced degenerative disease of knee limited to medial compartment of joint. These patients were treated by medial open wedge high tibial osteotomy (OWHTO) and outcome was evaluated after 5 years of surgery in terms of radiological knee mechanics, functional outcome scores, and arthroscopic evidence of cartilage regeneration in the medial compartment. A signed written consent was taken from every patient.Findings: There was a female predominance with a male-to-female ratio of 1:4. The mean age of the patients was 53.2 ± 6.9 years. The values of the radiographic parameters significantly changed from pre-operative condition after HTO; mechanical tibiofemoral angle [MTFA, (−8.1 ± 1.2° vs. 2.5 ± 1.2°; p-value < 0.0001)], tibial plateau inclination [TPI, (5.3 ± 1.1° vs. 3.4 ± 1.1°; p-value < 0.0001)], knee joint line orientation relative to the ground [G-KJLO, (0.3 ± 0.1° vs. 4.6 ± 1.5°; p-value < 0.0001)], and ankle joint line orientation relative to the ground [G-AJLO (8.3 ± 3.2° vs. 2.3 ± 1.7°; p-value < 0.0001)]. There was significant improvement in patient’s functional status; KOOS-ADL score (45.5 ± 7.8 vs. 73.7 ± 8.6; p-value < 0.0001), International Knee Documentation Committee (IKDC) score (42.4 ± 6.9 vs. 68.5 ± 12.7; p-value < 0.0001), International Knee Society (IKS) score (149.4 ± 11.9 vs. 179.4 ± 10.2; p-value < 0.0001), Knee Society Score [KSS, (54.2 ± 5.6 vs. 69.7 ± 12.7; p-value < 0.0001)], and Hospital for Special Surgery [HSS, (50.8 ± 3.3 vs. 64.8 ± 10.7; p-value < 0.0001)]. 42.5% patients showed excellent regeneration of femoral and 30.0% patients showed excellent regeneration of tibial cartilage in the medial compartment.Conclusion: By significantly alternating the knee biomechanics, HTO was found to unload the medial compartment leading to regeneration of the articular cartilage and significant improvement in patient’s symptoms and quality of life. It is therefore recommended in the management of patients with arthritic changes limited to medial compartment only.

Lumbar intervertebral disc allograft transplantation: the revascularisation pattern.

Fresh frozen intervertebral disc allograft transplantation has been reported to be a viable treatment option for advanced degenerative disc diseases, but rapid degeneration of the postoperative allograft was found. Loss of nutrient supply is believed to be the most likely inducer because the disc allografts have to endure in an ischaemic environment until the nutrient pathway is re-established. The aim of this study was to focus on the revascularisation of the disc allograft after transplantation in goats. Twenty male goats were used in this study. Intervertebral disc allograft transplantation was performed at L4/L5. Groups of five goats were killed at 1.5, 6 and 12m postoperatively, respectively. The transplanted segments were harvested, fixed, sagittally cut and decalcified for H&E staining and immunochemistry to observe the blood vessel formation at the endplates, anterior outer annulus, posterior outer annulus, inner annulus and the nucleus. The blood vessel density and the sectional vessel area were measured. Blood vessels were first found in the marrow space of the bony endplate and the outer annulus at 1.5month postoperatively. Then, they were able to penetrate to reach the cartilaginous endplate and the inner annulus after 6months. Interestingly, the endplate area possessed the most abundant blood vessels, with the highest level of vessel density and area at the final follow-up. None of these newly formed vessels invaded the nucleus during the observation period. Revascularisation of the postoperative disc allograft has been determined, but its pattern was different from that in adult normal discs, suggesting that the typical nutrient diffusion pattern may be affected after transplantation.

Birmingham hip resurfacing versus cementless total hip arthroplasty in patients 55 years or younger: A minimum five-year follow-up

ObjectiveThe optimal reconstructive method for advanced degenerative hip disease in young adults is a topic of ongoing discussion. The purpose of this study is to report the largest single institution experience from the United States on the outcomes of Birmingham hip resurfacing (BHR) vs. cementless total hip arthroplasty (THA) in patients 55 years or younger at a minimum follow-up of five years. Currently, BHR is the only FDA-approved hip resurfacing implant available in the US. MethodsA cohort of 505 patients representing all BHR cases performed at our institution between 2006 and 2010 was compared with an identical size cohort of consecutive patients who underwent primary cementless THA. Exclusion criteria were age greater than 55 years, non-elective cases, revision procedures, and those performed for fractures, tumors, or by low-volume arthroplasty surgeons. THAs with metal on metal articulation were also excluded. Outcomesassessed were all-cause reoperations, complications, patient satisfaction, and mortality. After exclusions, 442 patients with BHR and 327 with THA were included. ResultsMean follow-up was 73.2 months. After controlling for potential confounding factors, multivariate analyses showed significant increase in the rates of revision surgery (p<0.001), overall complications (p<0.001), all-cause reoperations (p=0.014), and mortality (p<0.001) in the THA cohort. Component loosening was the most common cause for revision in the THA group. Patients with THA were also less likely to be satisfied (p=0.046). ConclusionsThis is largest US study to report on the midterm outcomes of BHR vs. THA. The results demonstrate favorable results for BHR in patients 55 years or younger. Long-term multicenter studies are needed to better understand the optimal patient characteristics when deciding between THA versus BHR.

Documented neurological diseases in camelids

Neurological disease has a wide range of causes in llamas and alpacas, but is most often related to infectious (viral or bacterial), metabolic, toxic and traumatic causes. As a consequence, the neurological manifestation of a systemic illness has to be differentiated from conditions that principally affect the peripheral or central nervous system. Subtle differences in the clinical manifestation and pathophysiology of neurological diseases do exist between camelids and other species. However, diagnostic tools similar to those used in other species are often essential to establish an etiological diagnosis. For example, while spinal radiography may be sufficient to identify traumatic conditions and bony lysis or sclerosis in animals with advanced degenerative vertebral disease, computed tomography or magnetic resonance imaging may be required to better evaluate patients with subtle changes.

Comparison of Patients Undergoing 1st MTP Fusion With and Without Lag Screw Fixation for the Treatment of Hallux Rigidus

Comparison of Patients Undergoing 1st MTP Fusion With and Without Lag Screw Fixation for the Treatment of Hallux Rigidus

Lordosis manoeuvre in the diagnosis of lumbar facet syndrome

In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming.In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. HypothesisThe new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies. Materials and methodsA prospective study was conducted on a series of 68 patients (01/01/2012–30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. Exclusion criteriaDeformity and instability using a physical. ObjectiveTo determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). StatisticsR package software. ResultsThe LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105).There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. ConclusionsA new test for diagnosis of LFS is presented that is reliable, quick, and simple.Clinical examination is more reliable than imaging test for the diagnosis of LFS.