摘要:

Study Design.The Shuttle Walking Test (SWT), the Swiss Spinal Stenosis (SSS) Questionnaire, the Oxford Claudication Score (OCS), and the Oswestry Disability Index (ODI) were administered to patients with lumbar spinal stenosis and neurogenic claudication.Objective.To determine reliability of the SWT, the SSS (Q1–12), the OCS, and the ODI in lumbar spinal stenosis assessment.Summary of Background Data.Reliability data for exercise tests in lumbar spinal stenosis are lacking.Methods.To determine reliability, 32 clinic patients with lumbar spinal stenosis were assessed twice, with 1 week between assessments. Retrospective data from 17 patients assessed before surgery and 18 months after surgery for lumbar spinal stenosis were used to investigate the use of reliability in a clinical setting.Results.Test–retest reliability in terms of the intraclass correlation coefficient (ICC) was 0.92 for the SWT, 0.92 for the SSS, 0.83 for the OCS and 0.89 for the ODI. The mean percentage scores were 51 for the SSS, 45 for the OCS, and 40 for the ODI. To achieve 95% certainty of change between assessments for a single patient, the SSS would need to change by 15, the OCS by 20, and the ODI by 16. The mean SWT was 150 m, with a change of 76 m required for 95% confidence. Cronbach’s alpha was 0.91 for the SSS, 0.90 for the OCS, and 0.89 for the ODI. The change in ODI correlated most strongly with patient satisfaction after surgery (&rgr; = 0.80;P< 0.001).Conclusions.Fluctuations in a patient’s symptoms result in wide individual confidence intervals. Performance on the SSS, OCS, and ODI questionnaires are broadly similar, the most precise being the condition-specific SSS. The SWT gives a snapshot of physical function, which is acceptable for group analysis. Use of the SWT for individual assessment after surgery is feasible.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later.Objective.To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain.Summary of Background Data.Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage.Methods.At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants’ computerized records.Results.The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1–4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P< 0.05).Conclusions.Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A retrospective study of blood transfusion practices after posterior lumbar spine surgery was performed.Objectives.To determine the overall use rate of autologous blood donations for different spine surgeries, and to identify the risk of requiring additional allogeneic blood transfusions.Summary of Background Data.In an attempt to avoid allogeneic blood transfusions and its associated risks, patients frequently are asked to donate autologous blood before many elective spine surgeries. There is a lack of published data on the use rate for these autologous blood donations, and on their ability to prevent allogeneic blood exposure.Methods.A retrospective review of hospital charts and blood bank records was conducted on 191 consecutive patients who had undergone three categories of lumbar spine surgery: laminectomy alone, laminectomy with a noninstrumented posterolateral fusion, and laminectomy with an instrumented posterolateral fusion.Results.Nearly 80% of the autologous blood donated by patients who underwent simple laminectomies was wasted. However, the vast majority (70–90%) of patients who underwent fusion used their autologous blood. In the patients who underwent fusion, autologous blood donations decreased the risk of allogenic blood transfusions by 75% in noninstrumented fusions and 50% in instrumented fusions, as compared with the patients who elected not to donate blood before the fusion (P< 0.05). A substantial number of patients who underwent instrumented fusions (nearly 40%) required additional allogeneic blood transfusions despite predonation of blood.Conclusions.Autologous blood donations are indeed advantageous in decreasing allogeneic blood usage of patients undergoing fusion, but additional methods of blood conservation (intraoperative salvage and preoperative erythropoietin) seem necessary to diminish the allogeneic blood requirements further, especially in those patients undergoing instrumented lumbar fusion.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A human cadaveric investigation was conducted to determine the effect that a side-opening injection cannula in monopedicular percutaneous vertebroplasty had on the vertebrae filling pattern.Objectives.To assess the filling pattern in vertebroplasty using a monopedicular technique, and to compare a standard front-opening filling cannula with a side-opening cannula.Summary of Background Data.Vertebroplasty is an effective treatment for osteoporotic vertebral fractures. Clinical and biomechanical investigations show its efficacy even in asymmetrical filling patterns. However, the risk of cement extravasation is a major concern with this technique.Methods.Two different bone cement–injecting cannulas were compared: a standard front-opening cannula (8 gauge, 6 inches long) and a cannula of the same dimensions with a side-opening at its distal end. Eight pairs of osteoporotic nonfractured cadaver vertebrae (T10–T11) were augmented with low-viscosity polymethylmethacrylate under axial C-arm control. The filling pattern was assessed semiquantitatively. The cross-section in its lateral extension was divided into four equal bands, and the appearance of the cement in each respective zone was assessed after cement injections of 2, 4, and 8 mL. The extravasation of bone cement also was monitored.Results.With the side-opening cannula, the cement flow reached Zone 3 in six of eight cases, whereas with the front-opening cannula, the polymethylmethacrylate was observed in Zone 3 in only three cases. In no case was the cement observed in Zone 4. In five of eight cases using front-opening cannulas, extravasation into the vessels was observed after 3 to 4 mL of bone cement had been injected. No extravasation was noted with the use of the side-opening cannula unless the amount of cement exceeded 8 mL.Conclusions.A side-opening cannula can improve the cement-filling pattern in monopediclular vertebroplasty, as compared with a standard front-opening cannula. The risk of extravasation is diminished if the cement flow is directed medially.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Evaluation of the long-term results for single fully segmented hemivertebrae were subjected to single-stage excisionviaposterior approach alone.Objectives.To describe the long-term results of this procedure.Summary of Background Data.In the case of congenital spinal deformity caused by a single, full hemivertebra, excision of the hemivertebra is ideal for obtaining a good correction percentage even in short segments. Recently, single-stage excision of a hemivertebra using a combined anterior and posterior approach has been reported.Methods.Five patients with a hemivertebra underwent surgery. The hemivertebra involved the thoracolumbar region in three cases and the lumbosacral region in two cases. After removal of a lamina of the hemivertebra, the body of the hemivertebra was visualized easily because the spinal cord had deviated to the concave side of the curve. The vertebral body, along with its cranial and caudal discs, was curetted with this approach. Thereafter, bone chips were grafted into the defect created by vertebrectomy. The results of this surgical procedure, especially those observed during long-term follow-up evaluation, were investigated.Results.For patients with a thoracolumbar hemivertebra, scoliosis improved from 49° ± 6° to 22.3° ± 3.5°, for a 54.3% correction. The correction ratio for kyphosis was 67.4%. Over an average 12.8-year follow up period, loss of scoliotic curvature correction was only 3.7°. In contrast, the hemivertebral correction ratio for patients with a lumbosacral hemivertebra remained 32.5% because of difficulty using internal fixation associated with patient age. At the most recent follow-up assessment, one patient exhibited deterioration of coronal spinal balance.Conclusion.The described procedure was less invasive because it avoided an anterior approach, yet it yielded satisfactory long-term results for thoracolumbar hemivertebrae.Methods.Eight patients with spinal deformity involving a hemivertebra underwent surgery using the aforementioned procedure and were followed up for more than 10 years. One of these patients required an additional operation after loosening of internal fixation. The deformity of another patient involved a wedged vertebra rather than a hemivertebra. Still another patient could not be followed because of her move to a new address. After the exclusion of these three patients, the study included five patients.Of the five patients in the study, four were boys and one was a girl. Their mean age at the time of surgery was 10 years (range, 3.6–13.7 years). The mean follow-up period was 12.8 years (range, 11.5–14.9 years). The hemivertebra involved the thoracolumbar region in three cases and the lumbosacral region in two cases (Table 1). All of the patients with a thoracolumbar hemivertebra exhibited regional kyphosis. To determine operative invasiveness, volume of blood loss was reviewed from the clinical records along with transfusion and operative time. The correction ratios of both the main curve in the standing anteroposterior film and the kyphosis in the lateral standing film were evaluated. The correction ratio of the compensatory curve created above or below the main structural curve also was investigated. Loss of correction for both the main curve and the kyphotic angle in the sagittal plane were reviewed. For cases of lumbosacral hemivertebra, a perpendicular line was drawn from the center of the C7 vertebral body, and the distance from this line to the center of the sacrum was measured to examine pre- and postoperative spinal balance.Table 1. Patient DataF = female; M = male; D&C = distraction and compression; C = compression rod.Operative Procedure.After induction of general anesthesia, the patient was placed in the prone position with the abdomen relieved of all pressure on rolls. The back was prepared and draped in routine fashion. A longitudinal skin incision was made on the back at the center of the hemivertebra. Paravertebral muscle was retracted laterally, and the lamina was explored. The lamina of the hemivertebra was identified and removed with its attached transverse process. Epidural bleeding was controlled with thrombin-soaked Gelfoam (Pharmacia Corp., Peapack, NJ). The dural sac usually had deviated to the concave side of the curve. Generally, the hemivertebrae in the thoracolumbar region also had deviated dorsolaterally because of the kyphotic deformity. The vertebral body of the hemivertebra could therefore be identified posteriorly. Because the pedicle of the hemivertebra was thicker than usual, cancellous bone in the vertebral body was curetted easilyviathe pedicle. Thereafter, the body of the hemivertebra was resected completely with a high-speed drill. In the pediatric spine, these procedures can be performed easily because the vertebral body is encapsulated by cartilage and periosteum, which is thicker than in the adult spine.After the vertebral disc and endplate in both the cranial and caudal adjacent segments had been curetted, bone chips obtained during curetting of the vertebral body were inserted in the defect. For thoracolumbar hemivertebrae a Harrington compression rod then was applied to the convex side of the curve and a Harrington distraction rod to the concave side (Figure 1). The facet and the lamina to which internal fixation had been applied were decorticated on both the concave and convex sides of the curve. All the bones removed during the laminectomy were used as graft material throughout the area along with the bones grafted from the iliac crest.Figure 1. The operative procedure.A, After the longitudinal skin incision, paravertebral muscle is retracted laterally and the lamina of the hemivertebra identified.BandD, The lamina is removed with its attached transverse process. The spinal cord usually has deviated to the concave side of the curve. Therefore, the body of the hemivertebra is easily recognized.CandE, The vertebral discs above and below the hemivertebra and the vertebral body of the hemivertebra is curettedviaa posterior approach. A compression device then is applied to the convex side of the curve and the curetted space closed.Internal fixation was not performed in one 3-year-old patient with a lumbosacral hemivertebra. In this case, after curettage of the vertebral body without removal of disc tissue either above or below the vertebral body, a cast was applied to correct the deformity without any bone grafting. In another patient with a lumbosacral hemivertebra, the discs above and below the vertebral body were curetted, and interbody bone graft was performed with application of a compression device to the convex side of the curve alone.Results.Blood loss in this procedure ranged from 110 to 1360 mL (mean, 660 mL), and the volume of transfusion averaged 200 mL. The operative time ranged from 225 to 425 minutes (mean, 350 minutes). In the patients with a thoracolumbar hemivertebra, the main structural curve was corrected from 49° to 22.3° on the average, and the correction ratio ranged from 46.9% to 60% (mean, 54.3%). For compensatory curves, 31.4% correction was obtained in the upper curve and 61.3% in the lower curve (Table 2). For sagittal curvature, thoracolumbar regional kyphosis was corrected from 48° to 15° on the average, and the correction ratio was 67.4% (range, 58–77.6%). At the most recent follow-up visit, correction loss averaged 3.7° (Table 3).Table 2. Correction Ratio and Loss in Each PatientTable 3. Correction Ratio and Loss of Regional Kyphosis in Each Patient With Thoracolumbar HemivertebraIn the patients with a lumbosacral hemivertebra, scoliosis was corrected from 34.5° to 23.5°, and the correction ratio averaged 32.5%. The upper compensatory curve exhibited 41.4% correction (Table 2). In this type of deformity, decompensation of spinal balance becomes a problem.Table 4shows the changes in coronal spinal balance from before to after surgery as well as the change observed at the most recent follow-up visit. In one patient decompensation of spinal balance had completely recurred from regrowth of the hemivertebral body.Table 4. Changes in Coronal Spinal Balance* Number indicates distance (cm) between the center of C7 and the perpendicular line drawn to the center of the sacrum.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID