http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Mon, 20 May 2013 14:47:55 +0000 http://www.hindawi.com/journals/aop/2013/806267/ Objective. Posterior dynamic stabilization is an effective alternative to fusion in the treatment of chronic instability and degenerative disc disease (DDD) of the lumbar spine. This study was undertaken to investigate the efficacy of dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2. Modic types 1 and 2 degeneration can be painful. Classic approach in such cases is spine fusion. We operated 88 DDD patients with Modic types 1 and 2 via posterior dynamic stabilization. Good results were obtained after 2 years of followup. Methods. A total of 88 DDD patients with Modic types 1 and 2 were selected for this study. The patients were included in the study between 2004 and 2010. All of them were examined with lumbar anteroposterior (AP) and lateral X-rays. Lordosis of the lumbar spine, segmental lordosis, and ratio of the height of the intervertebral disc spaces (IVSs) were measured preoperatively and at 3, 12, and 24 months after surgery. Magnetic resonance imaging (MRI) analysis was carried out, and according to the data obtained, the grade of disc degeneration was classified. The quality of life and pain scores were evaluated by visual analog scale (VAS) score and Oswestry Disability Index (ODI) preoperatively and at 3, 12, and 24 months after surgery. Appropriate statistical method was chosen. Results. The mean 3- and 12-month postoperative IVS ratio was significantly greater than that of the preoperative group (). However, the mean 1 and 2 postoperative IVS ratio was not significantly different (). Furthermore, the mean preoperative and 1 and 2 postoperative angles of lumbar lordosis and segmental lordosis were not significantly different (). The mean VAS score and ODI, 3, 12, and 24 months after surgery, decreased significantly, when compared with the preoperative scores in the groups (). Conclusion. Dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2 was effective. Olcay Eser, Cengiz Gomleksiz, Mehdi Sasani, Tunc Oktenoglu, Ahmet Levent Aydin, Yaprak Ataker, Tuncer Suzer, and Ali Fahir Ozer Copyright © 2013 Olcay Eser et al. All rights reserved. Tue, 30 Apr 2013 11:26:24 +0000 http://www.hindawi.com/journals/aop/2013/970703/ Knee arthroplasty is used to treat patients with degenerative joint disease of the knee to reduce pain and restore the function of the joint. Although patient outcomes are generally quite good, there are still a number of patients that are dissatisfied with their procedures. Aside from implant design which has largely become standard, surgical technique is one of the main factors that determine clinical results. Therefore, a lot of effort has gone into improving surgical technique including the use of computer-aided surgery. The latest generation of orthopedic surgical tools involves the use of robotics to enhance the surgeons’ abilities to install implants more precisely and consistently. This review presents an evolution of robot-assisted surgical systems for knee replacement with an emphasis on the clinical results available in the literature. Ever since various robotic-assistance systems were developed and used clinically worldwide, studies have demonstrated that these systems are as safe as and more accurate than conventional methods of manual implantation. Robotic surgical assistance will likely result in improved surgical technique and improved clinical results. Nathan A. Netravali, Feimo Shen, Youngbae Park, and William L. Bargar Copyright © 2013 Nathan A. Netravali et al. All rights reserved. Mon, 29 Apr 2013 13:40:29 +0000 http://www.hindawi.com/journals/aop/2013/437570/ Objective. To compare the clinical and radiographic outcomes in patients of different ages who underwent the Dynesys stabilization. Methods. This retrospective study included 72 patients (mean age 61.4 years) with one- or two-level lumbar spinal stenosis who underwent laminectomy and the Dynesys (Zimmer Spine, Minneapolis) dynamic stabilization system. Thirty-seven patients were younger than 65-year old while the other 35 were older. Mean followup was 46.7 months. Pre- and postoperative radiographic and clinical evaluations were analyzed. Results. The mean calibrated disc signal (CDS) at the index level was significantly improved from preoperatively to postoperatively (). Screw loosening occurred in 22.2% of patients and 5.1% of screws. The improvement in CDS at index level was seen to be significant in younger patients but not in older patients. Overall, the mean visual analogue scale (VAS) of back pain, VAS of leg pain, and the Oswestry disability index (ODI) scores improved significantly after operation. There were no significant differences in pre- and postoperative VAS and ODI and screw loosening rates between the younger and older patients. Conclusions. There is significant clinical improvement after laminectomy and dynamic stabilization for symptomatic lumbar spinal stenosis. Intervertebral disc rehydration was seen in younger patients. Li-Yu Fay, Jau-Ching Wu, Tzu-Yun Tsai, Tsung-Hsi Tu, Ching-Lan Wu, Wen-Cheng Huang, and Henrich Cheng Copyright © 2013 Li-Yu Fay et al. All rights reserved. Mon, 15 Apr 2013 09:29:48 +0000 http://www.hindawi.com/journals/aop/2013/753470/ Fusion and rigid instrumentation have been currently the mainstay for the surgical treatment of degenerative diseases of the spine over the last 4 decades. In all over the world the common experience was formed about fusion surgery. Satisfactory results of lumbar spinal fusion appeared completely incompatible and unfavorable within years. Rigid spinal implants along with fusion cause increased stresses of the adjacent segments and have some important disadvantages such as donor site morbidity including pain, wound problems, infections because of longer operating time, pseudarthrosis, and fatigue failure of implants. Alternative spinal implants were developed with time on unsatisfactory outcomes of rigid internal fixation along with fusion. Motion preservation devices which include both anterior and posterior dynamic stabilization are designed and used especially in the last two decades. This paper evaluates the dynamic stabilization of the lumbar spine and talks about chronologically some novel dynamic stabilization devices and thier efficacies. Tuncay Kaner and Ali Fahir Ozer Copyright © 2013 Tuncay Kaner and Ali Fahir Ozer. All rights reserved. Thu, 11 Apr 2013 09:53:53 +0000 http://www.hindawi.com/journals/aop/2013/710621/ Multiple factors have been identified as contributing to polyethylene wear and debris generation of the acetabular lining. Polyethylene wear is the primary limiting factor in the functional behavior and consequent longevity of a total hip arthroplasty (THA). This retrospective study reviewed the clinical and radiographic data of 77 consecutive THAs comparing in vivo polyethylene wear of two similar acetabular cup liners. Minimum follow-up was 7 years (range 7–15). The incidence of measurable wear in a group of machined liners sterilized with ethylene oxide and composed of GUR 1050 stock resin was significantly higher (61%) than the compression-molded, GUR 1020, O2-free gamma irradiation sterilized group (24%) . Clinically, at a 9-year average followup, both groups had comparable HHS scores and incidence of thigh or groin pain, though the machined group had an increased incidence of osteolysis and annual linear wear rate. Thomas B. Pace, Kevin C. Keith, Estefania Alvarez, Rebecca G. Snider, Stephanie L. Tanner, and John D. DesJardins Copyright © 2013 Thomas B. Pace et al. All rights reserved. Thu, 11 Apr 2013 08:10:08 +0000 http://www.hindawi.com/journals/aop/2013/738252/ Conventional posterior dynamic stabilization devices demonstrated a tendency towards highly rigid stabilization approximating that of titanium rods in flexion. In extension, they excessively offload the index segment, making the device as the sole load-bearing structure, with concerns of device failure. The goal of this study was to compare the kinematics and intradiscal pressure of monosegmental stabilization utilizing a new device that incorporates both a flexion and extension dampening spacer to that of rigid internal fixation and a conventional posterior dynamic stabilization device. The hypothesis was the new device would minimize the overloading of adjacent levels compared to rigid and conventional devices which can only bend but not stretch. The biomechanics were compared following injury in a human cadaveric lumbosacral spine under simulated physiological loading conditions. The stabilization with the new posterior dynamic stabilization device significantly reduced motion uniformly in all loading directions, but less so than rigid fixation. The evaluation of adjacent level motion and pressure showed some benefit of the new device when compared to rigid fixation. Posterior dynamic stabilization designs which both bend and stretch showed improved kinematic and load-sharing properties when compared to rigid fixation and when indirectly compared to existing conventional devices without a bumper. Dilip Sengupta, Brandon Bucklen, Aditya Ingalhalikar, Aditya Muzumdar, and Saif Khalil Copyright © 2013 Dilip Sengupta et al. All rights reserved. Wed, 10 Apr 2013 16:28:06 +0000 http://www.hindawi.com/journals/aop/2013/637362/ Introduction. Posterior Dynamic stabilization using the interspinous spacer device is a known to be used as an alternative to rigid fusion in neurogenic claudication patients in the absence of macro instability. Actually, it plays an important in the management of adjacent segment disease in previously fused lumbar spine. Materials and Method. We report our experience with posterior dynamic stabilization using an interspinous spacer. 134 cases performed in our institution between September 2008 and August 2012 with different lumbar spine pathologies. The ages of our patients were between 40 and 72 years, with a mean age of 57 years. After almost 4 years of follow up in our patient and comparing their outcome to our previous serious we found that in some case the interspinous distracter has an important role not only in the treatment of adjacent segment disease but also in its prevention. Results and Discussion. Clinical improvement was noted in ISD-treated patients, with high satisfaction rate. At first, radicular pain improves with more than 3/10 reduction of the mean score on visual analog scale (VAS). In addition, disability score as well as disc height and lordotic angle showed major improvement at 3 to 6 months post operatively. And, no adjacent segment disease was reported in the patient operated with interspinous spacer. Conclusion. The interspinous spacer is safe and efficient modality to be used not only as a treatment of adjacent segment disease but also as a preventive measure in patients necessitating rigid fusion. Antoine Nachanakian, Antonios El Helou, and Moussa Alaywan Copyright © 2013 Antoine Nachanakian et al. All rights reserved. Tue, 09 Apr 2013 09:09:34 +0000 http://www.hindawi.com/journals/aop/2013/270565/ Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations. A. F. Ozer, F. Keskin, T. Oktenoglu, T. Suzer, Y. Ataker, C. Gomleksiz, and M. Sasani Copyright © 2013 A. F. Ozer et al. All rights reserved. Thu, 04 Apr 2013 14:02:46 +0000 http://www.hindawi.com/journals/aop/2013/391260/ Both clinical and biomechanical problems affecting the shoulder joint suggest that investigators should study force transmission into and out from the scapula. To analyze force transmission between the humeral head and the glenoid, one must know the position of the glenoid. Studies have analyzed the position of the scapula from the positions of three palpable points, but the position of the glenoid relative to three palpable points has not been studied. Dry scapulae () were subjected to X-rays and a critical angle, (which relates the plane determined by the three palpable points on the scapula to a plane containing the glenoid center and the first two palpable points) was calculated. The mean value for was degrees. The obtained allows us to determine the position of the glenoid from three palpable points. This information could be used in calculation of forces across the shoulder joint, which in turn would allow optimizing the choice of strengthening exercises. Jordan H. Trafimow and Alexander S. Aruin Copyright © 2013 Jordan H. Trafimow and Alexander S. Aruin. All rights reserved. Sun, 31 Mar 2013 13:48:58 +0000 http://www.hindawi.com/journals/aop/2013/451956/ Spinal rigid instrumentations have been used to fuse and stabilize spinal segments as a surgical treatment for various spinal disorders to date. This technology provides immediate stability after surgery until the natural fusion mass develops. At present, rigid fixation is the current gold standard in surgical treatment of chronic back pain spinal disorders. However, such systems have several drawbacks such as higher mechanical stress on the adjacent segment, leading to long-term degenerative changes and hypermobility that often necessitate additional fusion surgery. Dynamic stabilization systems have been suggested to address adjacent segment degeneration, which is considered to be a fusion-associated phenomenon. Dynamic stabilization systems are designed to preserve segmental stability, to keep the treated segment mobile, and to reduce or eliminate degenerative effects on adjacent segments. This paper aimed to describe the biomechanical aspect of dynamic stabilization systems as an alternative treatment to fusion for certain patients. D. U. Erbulut, I. Zafarparandeh, A. F. Ozer, and V. K. Goel Copyright © 2013 D. U. Erbulut et al. All rights reserved. Thu, 28 Mar 2013 16:35:27 +0000 http://www.hindawi.com/journals/aop/2013/460792/ Introduction. Pirogow’s amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score). Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used. Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow’s amputation) only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility. Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference. M. Bueschges, T. Muehlberger, K. L. Mauss, J. C. Bruck, and C. Ottomann Copyright © 2013 M. Bueschges et al. All rights reserved. Tue, 26 Mar 2013 12:03:44 +0000 http://www.hindawi.com/journals/aop/2013/143801/ Ten percent of the 250,000 proximal femur fractures that occur in the United States each year are malreduced into a varus position after treatment. Currently, there is no cephalomedullary nail available that allows the physician to dynamically change the lag-screw-to-nail angle. The Variable Angle Nail (VAN) was designed to allow movement of the lag screw relative to the shaft of the nail. This study compared the characteristics of the VAN to the Gamma 3 nail via finite element analysis (FEA) in stiffness and fatigue. The results of the FEA model with the same loading parameters showed the Gamma 3 and the VAN with lag-screw-to-nail angle of 120° to have essentially the same stiffness values ranging from 350 to 382 N/mm. The VAN with lag-screw-to-nail angles of 120°, 130°, and 140° should be able to withstand more than 1,000,000 cycles from 1,400 N to 1,500 N loading of the tip of the lag screw. The Gamma 3 should be able to last more than 1,000,000 cycles at 1,400 N. In summary, the VAN is superior or equivalent in stiffness and fatigue when compared to the Gamma 3 using FEA. Amir Matityahu, Andrew H. Schmidt, Alan Grantz, Ben Clawson, Meir Marmor, and R. Trigg McClellan Copyright © 2013 Amir Matityahu et al. All rights reserved. Mon, 25 Mar 2013 11:39:19 +0000 http://www.hindawi.com/journals/aop/2013/125960/ Background. The purpose of this study was to report on any prognostic factors that had a significant effect on clinical outcomes following arthroscopic Type II SLAP repairs. Methods. Consecutive patients who underwent arthroscopic Type II SLAP repair were retrospectively identified and invited to return for follow-up examination and questionnaire. Statistical analysis was performed to determine associations between potential prognostic factors and failure of SLAP repair as defined by ASES of less than 50 and/or revision surgery. Results. Sixty-two patients with an average age of years met the study criteria with a mean followup of 3.3 years. There were statistically significant improvements in mean ASES score, forward elevation, and external rotation among patients. Significant associations were identified between ASES score less than 50 and age greater than 40 years; alcohol/tobacco use; coexisting diabetes; pain in the bicipital groove on examination; positive O’Brien’s, Speed’s, and/or Yergason’s tests; and high levels of lifting required at work. There was a significant improvement in ASES at final followup. Conclusions. Patients younger than 20 and overhead throwers had significant associations with cases requiring revision surgery. The results from this study may be used to assist in patient selection for SLAP surgery. Rachel M. Frank, Shane J. Nho, Kevin C. McGill, Robert C. Grumet, Brian J. Cole, Nikhil N. Verma, and Anthony A. Romeo Copyright © 2013 Rachel M. Frank et al. All rights reserved. Sun, 24 Mar 2013 11:53:37 +0000 http://www.hindawi.com/journals/aop/2013/837167/ Unicompartmental knee arthroplasty (UKA) allows replacement of a single compartment in patients with limited disease. However, UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics. This study examined the accuracy of dynamic, real-time ligament balancing using a robotic-assisted UKA system. Surgical data obtained from the computer system were prospectively collected from 51 patients (52 knees) undergoing robotic-assisted medial UKA by a single surgeon. Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place. Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan, with 83% of cases within 1 mm at 0°, 30°, 60°, 90°, and 110° of flexion. Ligamentous laxity of  mm at 30° of flexion was corrected successfully to  mm (). Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic, real-time soft-tissue balancing to help restore natural knee kinematics, potentially improving implant survival and functional outcomes. Johannes F. Plate, Ali Mofidi, Sandeep Mannava, Beth P. Smith, Jason E. Lang, Gary G. Poehling, Michael A. Conditt, and Riyaz H. Jinnah Copyright © 2013 Johannes F. Plate et al. All rights reserved. Thu, 28 Feb 2013 18:29:28 +0000 http://www.hindawi.com/journals/aop/2013/914148/ Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity. Ignacio Carbonel, Angel A. Martínez, Elisa Aldea, Jorge Ripalda, and Antonio Herrera Copyright © 2013 Ignacio Carbonel et al. All rights reserved. Thu, 21 Feb 2013 15:22:03 +0000 http://www.hindawi.com/journals/aop/2013/959305/ Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears. Michael J. Carroll, Kristie D. More, Stephen Sohmer, Atiba A. Nelson, Paul Sciore, Richard Boorman, Robert Hollinshead, and Ian K. Y. Lo Copyright © 2013 Michael J. Carroll et al. All rights reserved. Thu, 17 Jan 2013 14:05:58 +0000 http://www.hindawi.com/journals/aop/2013/874090/ Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications. Tunc Oktenoglu, Ali Fahir Ozer, Mehdi Sasani, Yaprak Ataker, Cengiz Gomleksiz, and Irfan Celebi Copyright © 2013 Tunc Oktenoglu et al. All rights reserved. Wed, 09 Jan 2013 09:44:40 +0000 http://www.hindawi.com/journals/aop/2013/403580/ Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails. A. Panagopoulos, P. Tsoumpos, K. Evangelou, Christos Georgiou, and I. Triantafillopoulos Copyright © 2013 A. Panagopoulos et al. All rights reserved. Wed, 26 Dec 2012 15:53:19 +0000 http://www.hindawi.com/journals/aop/2012/218385/ Posterior nonfusion pedicle-screw-based stabilization remains a controversial area of spine surgery. To date, the Dynesys system remains the most widely implanted posterior nonfusion pedicle screw system. We review the history of Dynesys and discuss clinical outcome studies and biomechanical evaluations regarding the Dynesys system. Indications for surgery and controversies are discussed. Recommendations are made regarding technical implantation. Neel Anand and Eli M. Baron Copyright © 2012 Neel Anand and Eli M. Baron. All rights reserved. Wed, 26 Dec 2012 09:57:54 +0000 http://www.hindawi.com/journals/aop/2012/629698/ Interspinous spacers were developed to treat local deformities such as degenerative spondylolisthesis. To treat patients with chronic instability, posterior pedicle fixation and rod-based dynamic stabilization systems were developed as alternatives to fusion surgeries. Dynamic stabilization is the future of spinal surgery, and in the near future, we will be able to see the development of new devices and surgical techniques to stabilize the spine. It is important to follow the development of these technologies and to gain experience using them. In this paper, we review the literature and discuss the dynamic systems, both past and present, used in the market to treat lumbar degeneration. Cengiz Gomleksiz, Mehdi Sasani, Tunc Oktenoglu, and Ali Fahir Ozer Copyright © 2012 Cengiz Gomleksiz et al. All rights reserved. Wed, 19 Dec 2012 15:06:16 +0000 http://www.hindawi.com/journals/aop/2012/467571/ The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease. Lewis L. Shi and T. Bradley Edwards Copyright © 2012 Lewis L. Shi and T. Bradley Edwards. All rights reserved. Tue, 18 Dec 2012 08:23:09 +0000 http://www.hindawi.com/journals/aop/2012/861598/ Proximal humerus fractures are common injuries, especially among older osteoporotic women. Restoration of function requires a thorough understanding of the neurovascular, musculotendinous, and bony anatomy. This paper addresses the relevant anatomy and highlights various management options, including indication for arthroplasty. In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Of these, the proximal humerus locking plate is the most widely used. Arthroplasty is generally reserved for comminuted 4-part fractures, head-split fractures, or fractures with significant underlying arthritic changes. Reverse total shoulder arthroplasty is reserved for patients with a deficient rotator cuff, or highly comminuted tuberosities. Ekaterina Khmelnitskaya, Lauren E. Lamont, Samuel A. Taylor, Dean G. Lorich, David M. Dines, and Joshua S. Dines Copyright © 2012 Ekaterina Khmelnitskaya et al. All rights reserved. Thu, 06 Dec 2012 16:07:06 +0000 http://www.hindawi.com/journals/aop/2012/984950/ Degenerate shoulder tendons display evidence of hypoxia. However tendons are relatively avascular and not considered to have high oxygen requirements and the vulnerability of tendon cells to hypoxia is unclear. Cultured human tenocytes were exposed to hypoxia and the cellular response detected using QPCR, Western blotting, viability, and ELISA assays. We find that tenocytes respond to hypoxia in vitro by activating classical HIF-1α-driven pathways. Total hypoxia caused significant tenocyte apoptosis. Transcription factors typically involved in hypoxic response, HIF-1α and FOXO3A, were upregulated. Hypoxia caused sustained upregulation of several proapoptotic proteins known to mediate hypoxia-induced apoptosis, such as Bnip3 and Nix, but others were unchanged although they were reportedly hypoxia-sensitive in other cell types. Antiapoptotic proteins Bcl2 and Bcl-xL were unchanged by hypoxia. Normal human tenocytes expressed all isoforms of the hypoxia-induced vascular growth factor VEGF except VEGF-D. Hypoxia markedly upregulated VEGF-A mRNA, followed by increased VEGF protein secretion. However treatment with VEGF did not improve tenocyte survival. As a protective strategy for tenocytes at risk of hypoxic death we added prosurvival growth factors insulin or platelet rich plasma (PRP). Both agents strongly protected tenocytes from hypoxia-induced death over 48 h, suggesting possible efficacy in the acute postrupture tendon or integrating graft. Min Liang, Hannah R. Cornell, Nasim Zargar Baboldashti, Mark S. Thompson, Andrew J. Carr, and Philippa A. Hulley Copyright © 2012 Min Liang et al. All rights reserved. Tue, 04 Dec 2012 16:22:08 +0000 http://www.hindawi.com/journals/aop/2012/387829/ Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis. Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation. Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Conclusions. Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection. Nicola Massy-Westropp, Stuart Simmonds, Suzanne Caragianis, and Andrew Potter Copyright © 2012 Nicola Massy-Westropp et al. All rights reserved. Tue, 04 Dec 2012 09:47:08 +0000 http://www.hindawi.com/journals/aop/2012/930543/ Background. We introduce a novel description system of shoulder pathoanatomy. Its goal is to provide a comprehensive three-dimensional picture, with an additional component of time; thus, we call it the 4D code. Methods. Each line of the code starts with right versus left and a time designation. The pillar components are recorded regardless of pathology; they include subscapularis, long head of biceps tendon, supraspinatus, infraspinatus, and teres minor. Secondary elements can be added if there is observed pathology, including acromioclavicular joint, glenohumeral joint, labrum, tear configuration, location and extent of partial cuff tear, calcific tendonitis, fatty infiltration, and neuropathy. Results. We provide two illustrative examples of patients which show the ease and effectiveness of the 4D code. With a few simple lines, significant amount of information about patients’ pathology, surgery, and recovery can be easily conveyed. Discussion. We utilize existing validated classification systems for parts of the shoulder and provide a frame work to build a comprehensive picture. The alphanumeric code provides a simple language that is universally understood. The 4D code is concise yet complete. It seeks to improve efficiency and accuracy of the communication, documentation, and visualization of shoulder pathology within individual practices and between providers. Laurent Lafosse, Tom Van Isacker, Joseph B. Wilson, and Lewis L. Shi Copyright © 2012 Laurent Lafosse et al. All rights reserved. Mon, 03 Dec 2012 11:31:15 +0000 http://www.hindawi.com/journals/aop/2012/351714/ Brian R. Subach, Thomas C. Schuler, Mark R. McLaughlin, Paul J. Slosar, Christopher H. Comey, and Najeeb M. Thomas Copyright © 2012 Brian R. Subach et al. All rights reserved. Sun, 02 Dec 2012 09:50:12 +0000 http://www.hindawi.com/journals/aop/2012/692869/ Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs) and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care. Matthew J. Teusink, Nazeem A. Virani, John A. Polikandriotis, and Mark A. Frankle Copyright © 2012 Matthew J. Teusink et al. All rights reserved. Wed, 28 Nov 2012 08:46:57 +0000 http://www.hindawi.com/journals/aop/2012/424268/ Posterior dynamic stabilization (PDS) indicates motion preservation devices that are aimed for surgical treatment of activity related mechanical low back pain. A large number of such devices have been introduced during the last 2 decades, without biomechanical design rationale, or clinical evidence of efficacy to address back pain. Implant failure is the commonest complication, which has resulted in withdrawal of some of the PDS devices from the market. In this paper the authors presented the current understanding of clinical instability of lumbar motions segment, proposed a classification, and described the clinical experience of the pedicle screw-based posterior dynamic stabilization devices. Dilip K. Sengupta and Harry N. Herkowitz Copyright © 2012 Dilip K. Sengupta and Harry N. Herkowitz. All rights reserved. Tue, 20 Nov 2012 13:48:50 +0000 http://www.hindawi.com/journals/aop/2012/151348/ Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined. Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly. Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint. Marc A. Tanner, Bryan P. Conrad, Paul C. Dell, and Thomas W. Wright Copyright © 2012 Marc A. Tanner et al. All rights reserved. Tue, 20 Nov 2012 10:02:16 +0000 http://www.hindawi.com/journals/aop/2012/903850/ The scapula plays a critical role in the association between the upper extremity and the axial skeleton. Fractures of the scapula account for 0.4% to 1% of all fractures and have an annual incidence of approximately 10 per 100,000 inhabitants. Scapular fractures typically result from a high-energy blunt-force mechanism and are often associated with other traumatic injuries. The present review focuses on the presentation, diagnosis, and treatment of fractures of the scapula. Indications for surgical treatment of glenoid fossa, scapular neck, and scapular body fractures are presented in detail. Finally, the authors’ preferred surgical technique, including positioning, approach, reduction, fixation, and post-operative management, is described. Pramod B. Voleti, Surena Namdari, and Samir Mehta Copyright © 2012 Pramod B. Voleti et al. All rights reserved.