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Villafane J.H.,IRCCS Don Gnocchi Foundation | Herrero P.,San Jorge University
Journal of Hand Therapy | Year: 2016

In an attempt to decrease pain and increase function in patients with CMC OA, these authors have described the combination of two techniques that can be performed to treat this common problem. Before applying the techniques, each therapist must determine if the application of the technique falls within their scope of practice. – KRISTIN VALDES, OTD, OT, CHT, Practice Forum Editor © 2016 Hanley & Belfus

Berjano P.,Istituto Ortopedico Galeazzi | Cecchinato R.,Istituto Ortopedico Galeazzi | Sinigaglia A.,Istituto Ortopedico Galeazzi | Damilano M.,Istituto Ortopedico Galeazzi | And 4 more authors.
European Spine Journal | Year: 2015

Introduction: Adult deformity combined with sagittal malalignment is a pathology that decreases patient’s quality of life and that requires surgical correction to achieve clinical improvement. Spine osteotomies are usually performed to restore alignment of the spine, even if these techniques are associated with high intraoperative risks, revision rates and relevant mortality rates. Anterior column realignment (ACR) is a new technique that allows large corrections through a minimally invasive lateral approach to the spine after release of the anterior longitudinal ligament. Materials and methods: Preoperative and postoperative full-standing X-rays of 12 patients who underwent ACR procedure were retrospectively reviewed. Spinopelvic alignment parameters of sagittal balance were measured on standing full-spine radiographs. Any intraoperative or postoperative complication was reported, as technical notes such the number of treated levels, associated XLIFs and cases of revision surgery. Results: 11 out of 12 patients had a complete data set and were enrolled in this study. The mean preoperative and postoperative lumbar lordosis values were, respectively, −20° ± 17° and −51° ± 9.8° (p < 0.001), while a mean value of 27° of lordosis were restored at a single ACR level. Two major complications occurred, a bowel perforation and a postoperative early infection of the posterior wound that required surgical debridement. Conclusions: Preliminary data show that ACR allows corrections similar to those obtained with a Pedicle Subtraction Osteotomy, avoiding risks related to this technique. © 2015, Springer-Verlag Berlin Heidelberg.

Berjano P.,Istituto Ortopedico Galeazzi | Langella F.,nd University of Naples | Damilano M.,Istituto Ortopedico Galeazzi | Pejrona M.,Istituto Ortopedico Galeazzi | And 4 more authors.
European Spine Journal | Year: 2015

Introduction: Lumbar fusion has been found to be a clinically effective procedure in adult patients. The lateral transpsoas approach allows for direct visualization of the intervertebral space, significant support of the vertebral anterior column, while avoiding the complications associated with the posterior procedures. The aim of this study is to determine the fusion rate of inter body fusion using computed tomography in patients treated by extreme lateral intersomatic fusion (XLIF) technique. Materials and methods: All patients intervened by XLIF procedure between 2009 and 2013 by a single operating team at a single institution were recruited for this study. A clinical evaluation and a CT scan of the involved spinal segments were then performed with at least 1-year follow-up following the standard clinical practice in the center. Results: A total of 77 patients met inclusion criteria, of which 53 were available for review with a mean follow-up of 34.5 (12–62) months. A total of 68 (87.1 %) of the 78 operated levels were considered as completely fused, 8 (10.2 %) were considered as stable, probably fused, and 2 (2.6 %) of the operated levels were diagnosed as pseudarthrosis. When stratified by type of graft material complete fusion was obtained in 75 % of patients in which autograft was used to fill the cages, compared to 89 % of patients in which calcium triphosphate was used, and 83 % of patients in which Attrax™ was used. Discussion: Reports of XLIF fusion rate in the literature vary from 85 to 93 % at 1-year follow-up. Fusion rate in our series corroborates data from previous publications. The results of this series confirm that anterior inter body fusion by means of XLIF approach is a technique that achieves high fusion rate and satisfactory clinical outcomes. © 2015, Springer-Verlag Berlin Heidelberg.

Ferrari S.,University of Padua | Manni T.,Private Practice | Bonetti F.,Private Practice | Villafane J.H.,IRCCS Don Gnocchi Foundation | Vanti C.,University of Padua
Chiropractic and Manual Therapies | Year: 2015

Background: Several clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice. Methods: We searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales. Results: Six papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97). Conclusions: The data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients. © Ferrari et al.

Chiarotto A.,Private Practice | Chiarotto A.,Research Office | Fernandez-de-las-Penas C.,Rey Juan Carlos University | Castaldo M.,Private Practice | Villafane J.H.,IRCCS Don Gnocchi Foundation
Pain Medicine (United States) | Year: 2013

Objective: To investigate whether bilateral deep tissue pressure hyperalgesia exists in individuals with unilateral thumb carpometacarpal osteoarthritis (CMC OA). Methods: A total of 32 patients with CMC OA (29 females and 3 males, aged 69-90 years old) and 32 healthy matched controls (29 females and 3 males, aged 70-90 years) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over the first CMC joint, the hamate bone and the lateral epicondyle in a blinded design. Mixed models analyses of variance were conducted to determine the differences in pressure pain sensitivity between groups and sides. Results: The results showed that PPTs were significantly decreased over the first CMC joint (F=6.551, P=0.012) and the hamate bone (F=9.783, P=0.002) but not over the lateral epicondyle (F=2.712, P=0.102) in patients with thumb CMC OA as compared with healthy controls; patients with unilateral thumb CMC OA exhibited bilateral pressure pain hyperalgesia in both hands compared with healthy people. PPTs were not significantly associated to the intensity of pain (all, P>0.05). Discussion: This study revealed bilateral localized pressure pain hypersensitivity over the hand in individuals with unilateral thumb CMC OA, suggesting spinal cord sensitization mechanisms in this population. Future studies should analyze the presence of widespread pressure pain sensitivity in patients with thumb CMC OA to further determine the presence of central sensitization mechanisms. © 2013 American Academy of Pain Medicine 14 10 October 2013 10.1111/pme.12179 MUSCULOSKELETAL SECTION Original Research Articles Original Research Article Wiley Periodicals, Inc.

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