Abstracts of current literature

Abstract

S OF CURRENT LITERATURE / 63 Pickett, GE, Soelen J van, Duggal N. Controversies in Cervical Discectomy and Fusion: Practice Patterns Among Canadian Surgeons. Can J Neurol Sci 2004;31:478-483. Objective: Optimal fusion technique and peri-operative management of patients undergoing anterior cervical discectomy (ACD) is unclear.We document current practice patterns among Canadian spinal surgeons regarding the surgical management of single level degenerative cervical spondylosis. Methods: We conducted a web-based survey of neurosurgeons and spinal orthopedic surgeons in Canada. We asked questions pertaining to the management of single level cervical degenerative disc disease causing radiculopathy and/or myelopathy, including frequency of fusion following single-level discectomy, preferred fusion technique, indications and frequency of use of anterior plating, and use of an external cervical orthosis following surgery. Demographic factors assessed included training background, type and length of practice. Results: Sixty respondents indicated that their practice involved at least 5% spine surgery and were included in further analysis. Neurosurgeons comprised 59% of respondents, and orthopedic surgeons 41%. Fusion was employed 93% of the time following ACD; autologous bone was the preferred fusion material, used in 76% of cases. Neurosurgeons employed anterior cervical plates in 42% of anterior cervical discectomy and fusion cases, whereas orthopedic surgeons used them 70% of the time. External cervical orthoses were recommended for 92% of patients without plates and 61% of patients with plates. Surgeons who had been in practice for less than five years were most likely to be performing spinal surgery, using anterior cervical plates, and recommending the postoperative use of cervical orthoses. Conclusion: Practice patterns vary among Canadian surgeons, although nearly all employ fusion and many use instrumentation for single-level ACD. Training background, and type and length of practice influence practice habits. Henrichs A. A Review of Knee Dislocations. J Athl Train 2004;39:365 369. Objective: To inform health care professionals about the various mechanisms of this little-known injury, as well as its potentially limb-threatening complications. In addition, keys to immediate recognition and the importance of a thorough rehabilitation program are stressed. Data Sources: I searched MEDLINE (1966–2000) using the key words knee dislocation, knee injury, and tibiofemoral dislocation. Data Synthesis: Knee dislocations are uncommon but very serious injuries. Because the joint may spontaneously reduce before the examiner reaches the patient, the examiner must be aware of the potential complications and rule out any neurovascular damage immediately. Conclusions/Recommendations: Prompt recognition of this injury and proper care combined with an extensive rehabilitation program can greatly improve the prognosis for the patient. Neurovascular integrity should be assessed routinely for several days after the injury to ensure that complications do not develop. Melo MD, Obeid G. Osteonecrosis of the Maxilla in a Patient with a History of Bisphosphonate Therapy. J Can Dent Assoc 2005;71:111-113. Bisphosphonates, which inhibit osteoclasts, alleviate many of the devastating consequences of metastatic bone disease. However, bisphosphonates may play a role in the development of osteonecrosis of the jaws. We report our experience in the management of a patient with a history of bisphosphonate therapy who presented with osteonecrosis of the jaws following dental extraction to make others, particularly the broader dental community, aware of this potential complication. We also review the pharmacologic properties of bisphosphonates and their possible role in the pathophysiology of osteonecrosis. Until more is known about the role of bisphosphonates in the development of osteonecrosis of the jaws, we recommend that measures be taken to prevent osteonecrosis in those at risk, including, when feasible, a dental consultation before initiating bisphosphonate therapy. Jensen A, Nolet PS, Diwan MA. Oral squamous cell carcinoma: an atypical presentation mimicking temporomandibular joint disorder. J Can Chiropr Assoc 2004;48:266–272. A 50-year-old female presented to a chiropractic clinic with left jaw pain consistent with temporomandibular joint disorder. Examination revealed a large ulcerated mass on the posterolateral margin of the tongue which was later