摘要:

Study DesignThe authors assessed the clinical and imaging findings and late outcome in 50 patients with whiplash-type neck distortions (17 men, 33 women, mean age 33 years).Summary of Background DataEarly symptoms are neck pain, stiffness, and sometimes radiating pain; later bizarre symptomatology poses intricate clinical and medicolegal problems. Pathoanatomic studies indicate that soft tissue injuries may be overlooked.MethodsRepeated clinical and radiographic examinations (plain and flexion-extension radiograms and contrast magnetic resonance imaging evaluated with a new grading system); surgical findings; follow-up were performed after 1 and 5 years by an independent observer neurologist.ResultsNeck pain persisted in 24 patients; radiating pain developed within 6 weeks in 19 patients. Two patients with segmental instability had posterior fusions and complete pain relief. Eight patients with severe radiating pain and large disc protrusions on magnetic resonance had nine surgically confirmed fresh disc herniations. Discectomy and fusion alleviated pain in these patients, whereas symptoms largely persisted in the conservatively treated patient.ConclusionsA high incidence of discoligamentous injuries was found in whiplash-type distortions. Most patients with severe persisting radiating pain had large disc protrusions on MRI that were confirmed as herniations at surgery. Neck and radiating pain were alleviated by early disc excision and fusion.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThe presence and abundance of inflammatory cells was studied immunocytochemically in lumbar disc herniations (DH) and macroscopically normal discs for comparison.ObjectivesThe objective of the study was to characterize inflammatory cells that appear in herniated disc tissue and to study the relative abundance of various types of inflammatory cells.Summary of Background DataOnly few macrophages were observed in control discs, whereas abundant macrophages were present in half of the DH.Other types of inflammatory cells were less often abundant in the present material. In about a third of the DH interleukin-1 beta-expressing cells were also observed.MethodsTwenty-four DH and control tissue from five discs were studied immunocytochemically, using specific monoclonal antibodies to various types of inflammatory cells and interleukin-1 beta. The results were compared with corresponding clinical data. Macrophages were studied with an antibody to CD68 antigen and Ber-MAC3 antibody separately.ResultsThe obtained results suggest a variable inflammatory cell response in DH, which seems to be often dominated by macrophages at the time of operation. Thus previous suggestions of sometimes very active inflammation in DH tissue are supported.ConclusionsInflammation may be important in disc tissue pathophysiology, possibly also in discogenic pain mechanisms.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectivesThis study characterized the defect using neuroimmunologic and inflammatory cell analysis.Summary of Background DataSpondylolysis/spondylolisthesis is thought to be caused by a congenital weakness and mechanical stress causing a fracture associated with defective healing. Most of the spondylolysis patients are asymptomatic and the mechanisms of pain in symptomatic patients are unknown.MethodsTissue from the spondylolysis defect was collected from seven patients undergoing posterolateral fusion operations.ResultHistologic examination disclosed delayed union/pseudoarthrosis with fibroblasts and macrophages in a pseudosynovial lining membrane and occasional perivascular infiltrates containing mainly CD2 lymphocytes and CD11b monocytes/macrophages. In a vascularized connective tissue stroma PGP 9.5, synaptophysin and neurofilament staining disclosed perivascular nerves, which did not extend to the synovial lining layer and which mainly represented postganglionic sympathetic nerve fibers but also calcitonin gene-related peptide and substance P containing sensory fibers.ConclusionsPain in spondylolysis/spondylolisthesis might derive from the spondylolytic defect itself, probably from stretching of the local neural elements rather than from their sensitization/stimulation by local inflammatory mediators. The resemblance of neuroimmuno histochemical changes compared with those reported in the nonunion of long bones and the sparsity of stromal innervation, indicate that the characteristic defective healing is in part due to lack of neurogenic influences.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThe current prospective longtudinal study examined the predictive value of psychological, somatic and social variables for the prediction of the short- and long-term follow-up in 111 consecutively selected patients with acute radicular pain and a lumbar disc prolapse or protrusion.ObjectivesThe criteria for the therapy outcome were the intensity of persistent pain at the time of the discharge from the hospital and 6 months later and the application for early retirement at the 6 month follow-up.MethodsAs for the psychological predictors, we examined depression (Beck Depression Inventory BDI), daily hassles (kiel Interview of the Subjective Situation KISS), pain coping strategies (Kiel Pain Inventory KSI), and Health locus of control (GKÜ). As somatic predictors, we assessed the duration of pain before treatment, previous operations, paresis, disc displacement, scoliosis, adipositas, treatment, and age. As social predictors, we assessed the social status, occupational characteristics, and the duration of inability to work.ResultsThe results indicated that persistent pain was best predicted by combination of somatic (degree of disc displacement), psychological (depression and the pain coping strategies avoidance behavior, endurance strategies, nonverbal pain behavior and search for social support), and social parameters (social status and sitting position) with a correct prediction in 86%. The application for early retirement at the 6 month follow-up was best predicted by depression and stress at work.ConclusionsThe results lead to several hypotheses about biopsychosocial interrelations within the chronification of radicular pain and provide the clinician with a short screening instrument for early diagnosis of chronification.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectivesThis study evaluated the incidence of lumbar isthmic spondylolisthesis among subjects permanently disabled because of low back pain syndromes.Summary of Background DataPrevious information pointed to whether spondylolisthesis is associated with more frequent or intensive low back pain than that found in the general population. One may expect severe deformity, neurologic deficits, and hence impairment and disability accompanying such a spinal disorder. However, natural history of spondylolisthesis has also been reported to be benign.MethodsFiles from 952 subjects receiving temporary or permanent disability pension because of musculoskeletal disorders of the vertebral column were investigated; 81% had low back pain syndromes. From the radiologic reprot of the lumbar spine, which was available in 519 (70%) cases, the radilogic findings were recorded.ResultsIn 2.5%, isthmic lumbar spondylolisthesis was present. In more than half of the subjects, the location of the defect was on L4. Only minor neurologic findings were present.ConclusionsThe finding that the incidence corresponds well with the incidence in the normal population may suggest that lumbar isthmic spondylolisthesis does not invariably lead to severe impairment or disability, although location of the defect at the level proximal to L5 may be connected to an increased risk for permanent low back disability.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThis study examines the growth and development of the lumbar spinal canal with emphasis on early life.ObjectiveChanges in dimensions of the canal were investigated throughout life.Summary of Background DataSeven hundred and fifteen lumbar vertebrae were examined from the Spitalfield Collection of Skeletons at the Natural History Museum, London.MethodsUmmagnified silhouette pictures were taken of the canals with a specially designed photographic box. Computerized image analysis provided the accurate measurements.ResultsRegarding the midsagittal diameter and the cross-sectional area, the cranial four lumbar vertebrae were already fully matured in infants. At L5 there was significant increase up to 4 years of age when the midsagittal diameter was even larger than in the adult. The interpedicular diameter significantly increased at L1 until 10 years of age, at the other levels until adulthood, as did the perimeter at L4 and L5 until 14 years of age. The shape of the canal was assessed by measuring the circularity, the 'trefoilness' and the situation of the centroid. The first measurement significantly decreased with age, the trefoilness increased until adulthood, and the centroid of the canal approached the vertebral body. In spines with spina bifida occulta, the lumbar canal was significantly larger proximal to the lesion than in the unaffected spines.ConclusionThe lumbar spinal canal exhausts its growth potential by infancy as regards the midsagittal diameter and the cross-sectional area. Thus, in the case of delayed development, it is not capable of catch-up growth.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectivesThe authors studied complications of transpedicular stabilization methods.Summary of Background DataOne hundred and sixty-three consecutive transpedicular stabilization procedures were performed between January 1987 and December 1991. The indications for stabilization were trauma (33 cases), metastatic spinal disorder (30 cases), spinal stenosis (33 cases), spondylolisthesis (27 cases), ankylosing spondylitis (6 cases), low back pain (22 cases), and miscellaneous (12 cases). Methods, Patients records and the entire series of radiographs for each case were scrutinized by independent observers. All per-and postoperative complications, including implant loosening and fatigue, were recorded. Clinical and radiographic survivorship analyses of the implants were performed.ResultsEarly complications were unusual and none were associated with permanent morbidity. The probability of not having the implant removed in the first postoperative year was 85%. There was a 40% risk of radiographic failure, defined as loosening or implant fatigue, at 6 months. The outcome was more favorable in cases in which anterior vertebral interbody fusion was also performed.ConclusionsTranspedicular fixation is a safe procedure with a low incidence of serious per- and early postoperative complications. The mechanical durability of transpedicular fixators used alone is a cause for concern.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ObjectivesThe authors developed and evaluated an electrophysiologic method for minimizing the risk of nerve root trauma associated with the placement of pedicle screws during transpedicular lumbosacral fixation in humans.Summary of Background DataVarious methods have been evaluated to reduce the high complication rates associated with lumbosacral transpedicular fixation, but none are without significant limitations or drawbacks. Using a pig model, we previously developed a technique for assessing, by electrophysiologic means, the potential risk associated with placement of a screw at a given site. In this report, the authors describe their experience with this technique in patients.MethodsElectromyogram (EMG) was monitored from eight lower extremity muscles bilaterally. Square wave electrical shocks (200 μsec, 7 mA) were delivered through the instruments used to form and evaluate each pedicle hole, and through the screw itself if placement was deemed safe. Provided that the instruments used (e.g., awl, tap, probe) do not exit from bone in any direction below the entry point, the resistance of bone to the 7 mA stimulus intensity is high enough such that no nerve roots are stimulated, and the EMG traces remain flat. Conversely if EMG is evoked, it warns of a potential perforation in a pedicle wall or in the anterior body.ResultsThe authors evaluated this technique in 18 patients in whom a total of 102 screws were placed. Based on results of electrophysiologic and palpatory evaluation, 68% of the screws were placed in a satisfactory manner. Electrophysiologic evidence of a perforation, which could not be confirmed by palpation or visulization, was seen in another 13% of this total. The remaining 19% of screw placements involved sites where a defect was missed originally by palpation alone, but was located based on electrophysiological testing combined with palpation and visualization (11%), and where a perforation was initially palpated (8%). There was no postoperative morbidity associated with malpositioned screws.ConclusionOur results indicate that the technique is sensitive and, based on early clinical results, reliable in the detection of perforations in pedicle screw placement. Moreover, the method is inexpensive, rapid, and easily implemented into a standard intraoperative monitoring protocol.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Study DesignThe sheep model was used to investigate the development of disc degeneration after outer anular tearing.ObjectivesThe authors determined whether plate fixation promotes healing of peripheral anular tears and thereby minimizes disc degeneration.Summary of Background DataA limited outer anular tear (similar to the rim lesion) in the sheep lumbar disc causes progressive and irreversible degeneration within 6 months. Incomplete healing of the tear may result from continued movement in the vicinity of the lesion.MethodsIn 15 sheep, a cut 4 X 10 mm was made in the lateral anulus of two nonadjacent lumbar discs, and a metal plate was fixed across one. Three sheep were killed immediately, and the remainder were killed after 6 months for histologic examination.ResultsThere were no significant differences in propagation of the cut through the inner anulus, extent of healing, or extent of nuclear degeneration, between plated and nonplated motion segments after 6 months. Vascularization of the cartilage endplate was significantly increased on the operated side (p < 0.001), but remained unchanged on the nonoperated side.ConclusionsDisc degeneration was not prevented by this method of plate fixation, despite similar but limited healing of the outer anulus tear in both plated and nonplated levels.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID