摘要:

Cervical spondylotic myelopathy causes substantial neurologic dysfunction in older patients. Surgery is the predominant treatment for this disease, but controversy exists over which surgical approach is most appropriate for a given presentation. This article briefly reviews recent studies on the different surgical options for the treatment of cervical spondylotic myelopathy.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

This review covers original studies from the past 2 years pertaining to the use of instrumentation in the treatment of degenerative disease of the cervical spine. Although the use of anterior instrumentation in single-level anterior diskectomy and fusion remains controversial, good evidence now exists that the use of anterior cervical plates leads to improved clinical results in patients undergoing two-level diskectomy and fusion. Several anterior cervical plating systems are currently available, but those systems that employ unicortical screw fixation and incorporate a locking mechanism for fixing screws to the plate appear to provide optimal stability along with minimal risk to neurovascular structures. Numerous methods have been introduced for posterior fusion and instrumentation of the cervical spine. Staying abreast of evolving indications and recognized pitfalls of these techniques can provide the surgeon with a powerful armamentarium for treating degenerative disease of the cervical spine. Finally, several new techniques for accomplishing occipitocervical fusion are presented.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The rate of failure to obtain a solid bone fusion in spine arthrodesis may be as high as 45%, and the incidence of morbidity associated with autogenous iliac crest bone graft harvest may approach 30%. Extensive work is currently underway to improve the healing success and decrease the morbidity associated with conventional bone-grafting material of autogenous iliac crest. Several in vivo studies with various bone morphogenetic proteins have yielded promising results, but substantially higher doses of protein have been required in nonhuman primates and in limited human trials. Problems with delivery vehicles for BMP-based bone graft substitutes have limited their application for spinal fusion. Alternative osteoinductive proteins and new delivery methods are currently under investigation to circumvent this problem. Recently, local gene therapy for spine fusion with the complementary DNA of novel osteoinductive proteins has shown some promise in stimulating expression of the genes needed to initiate the cascade of osteoinduction. Advances in local gene therapy may lead to a minimally invasive technique for the induction of bone formation and hopefully improved treatment for patients with a variety of spine disorders. The studies reviewed herein examine these novel biologic and genetic modalities and their possible role in spinal fusion.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The appropriate treatment of thoracolumbar injuries continues to be a controversial topic. Operative versus nonoperative treatment, anterior versus posterior surgery, and timing of operative intervention are some of the issues still being debated. Newer procedures for the treatment of osteoporotic compression fractures have also been the topic of several recent papers. In this review, we address several controversies regarding the treatment of thoracolumbar trauma and offer treatment recommendations.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

With the increasing trend toward ambulatory surgery, many ideas are being tried to facilitate this advance. One such idea is the use of the operating microscope to reduce wound size. There is a tug-of-war between the Orthopedic and Neurosurgical disciplines as to whether the microscope is a useful adjunct to surgery for degenerative lumbar spine problems. Although numerous studies show no difference in the outcomes between standard diskectomy and microsurgical diskectomy, these authors are firmly in the camp of using the operating microscope. A recent study has shown that the operating microscope leads to safer and faster diskectomy on an outpatient basis. In addition, the use of the operating microscope has been extended to many other procedures for the degenerative lumbar spine. The open diskectomy, whether microscope-assisted or not, remains the “gold-standard” for treatment of the lumbar disk herniation. Barriers to lessen scar tissue need further study before the technique is universally accepted.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Cauda equina syndrome is rare, but when it does occur it can lead to poor outcomes with significant legal implications. Controversy exists as to whether the timing of surgical intervention may affect these outcomes. Recent studies have reinforced that early surgical decompression may be beneficial to early return of function. Expeditious surgery is, however, only one factor that can affect outcome in this syndrome.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Tuberculosis of the spine is still a common disease in some endemic regions and is returning to developed countries. The development of the polymerase chain reaction technique and magnetic resonance imaging in the past decade has greatly improved diagnostic accuracy. Combination chemotherapy remains the most important and effective treatment, whereas surgical intervention can help in achieving earlier fusion and less late deformity. Early results of spinal instrumentation with or without fusion appear to be promising in further enhancing good outcome.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Perinatal brachial plexus palsy (PBPP) has been traditionally classified into three types: upper plexus palsy (Erb's) affecting the C5, C6, and ± C7 nerve roots, lower plexus palsy (Klumpke's) affecting the C8 and T1 nerve roots, and total plexus palsy. Although most cases will resolve spontaneously, the natural history of the remaining cases is influenced by contractures of uninvolved muscle groups and subluxation or dislocation of the shoulder and elbow. Microsurgical nerve repair has demonstrated to provide improved outcomes compared to conservative treatment, while advancements in secondary reconstruction have offered significant improvements in the performance of activities of daily living for older children with unresolved plexus palsy.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Spine injury in children thankfully is still a relatively rare injury. The incidence of pediatric spine injuries has been reported as 2% to 5% of all spine injuries. The biological differences of children make differences in fracture patterns and alter the management necessary for successful treatment. The other factors that affect fracture production and associated injuries are head size relative to the body size, flexibility of the spine and supporting structures, the growth plates, and the elasticity and compressibility of the bone. The majority of compression injuries in children are made up of falls from a height. Spinal injuries in children remain a challenge despite some technical changes in assessment and treatment.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Fibromyalgia and widespread pain were common in Gulf War veterans with unexplained illness referred to a rheumatology clinic. Increased tenderness was demonstrated in the postmenstrual phase of the cycle compared with the intermenstrual phase in normally cycling women but not in users of oral contraceptives. Patients with fibromyalgia had high levels of symptoms that have been used to define silicone implant-associated syndrome. Tender points were found to be a common transient finding associated with acute infectious mononucleosis, but fibromyalgia was an unusual long-term outcome. The common association of fibromyalgia with other rheumatic and systemic illnesses was further explored. A preliminary study revealed a possible linkage of fibromyalgia to the HLA region. Patients with fibromyalgia were found to have an impaired ability to activate the hypothalamic pituitary portion of the hypothalamic pituitary adrenal axis as well as the sympathoadrenal system, leading to reduced corticotropin and epinephrine response to hypoglycemia. Much interest has been expressed in the literature on the possible role of autonomic dysfunction in the development or exacerbation of fatigue and other symptoms in chronic fatigue syndrome.Mycoplasma genusandmycoplasma fermentanswere detected by polymerase chain reaction in patients with chronic fatigue syndrome. It was reported that myofascial temporomandibular disorder does not run in families. No major therapeutic trials in fibromyalgia, chronic fatigue syndrome, or myofascial pain syndrome were reported over the past year. The effectiveness of cognitive behavioral therapy and behavior therapy for chronic pain in adults was emphasized. A favorable outcome of fibromyalgia and chronic fatigue syndrome in children and adolescents was reported.

ISSN:1041-9918    

出版商:OVID    

年代:2000

数据来源: OVID