摘要:

To define further the effectiveness of nonsurgical therapy for idiopathic scoliosis, predefined criteria were established for selection and data retrieval from studies of therapy and natural history, and the results were synthesized quantitatively. Only studies of patients with no more than a 50° Cobb angle scoliosis were considered. Twenty-four reports were eligible. There was a fivefold proportion of failures among patients with scoliosis> 30° at the start of therapy but no difference in progression between different kinds of nonsurgical therapies or between treated and untreated patients; these were the main findings of this quantitative analysis. These data cannot be used to prove the effectiveness or ineffectiveness of nonsurgical therapy for idiopathic scoliosis, and experimental controlled studies of different therapies seem to be justified both on ethical and scientific grounds. The findings of this overview can be used for their planning.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The change in back shape after Luque segmental sublam-inar instrumentation was assessed in the frontal, sagittal, and transverse planes in 61 patients with adolescent idiopathic scoliosis using the Integrated Shape Investigation System (ISIS) and standard radiographic techniques, Luque instrumentation was found to be an effective method of correcting thoracic and thoracolumbar curves in the frontal plane with a 59% and 63% respective reduction in the size of the preoperative Cobb angle. Despite the frontal plane correction, however, the ISIS scan showed that of the 40 single thoracic curves, the rib hump was reduced in only 6 patients, was unchanged in 27 patients, and was worsened slightly in 7 patients. By contrast, thoracolumbar and lumbar curves were corrected in all three planes with a significant cosmetic Improvement.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To evaluate the results of posterolateral fusion alone (66 patients) and combined posterolateral and anterior fusion (39 patients)in situ, 105 consecutive patients younger than 25 years of age with spondylolisthesis, retrospectively were examined clinically and radiologically. The follow-up rate was 98% after a mean of 8.2 years (range, 2.0–15.3). Pre- and postoperative progression of slip was rare (6% and 1%, respectively), and no prognostic factors were found. The definite pseudarthrosis rate was 6%. In patients with low- and high-grade slip, 67% and 88% (respectively) were satisfied at follow-up, suggesting that the indication for operative treatment in patients with low-grade slip is relative.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The radiologic progression of spondylolisthesis during a long-term follow-up was studied in 272 children and adolescents. There were 134 girls and 138 boys. The mean age at the first visit was 14.3 years (girls, 13.8 years; boys, 14.9 years). The radiologic follow-up time was 14.8 years on average (range, 5–32). The operation was done in 190 patients younger than 20 years of age. Fusionin situ, using a posterior or posterolateral technique, had no statistically significant effect on progression. Surgically treated patients did not differ from conservatively treated patients. Ninety percent of the slip, on average, had already occurred at the time of the first radiologic examination compared with the final amount of slip. More than 10% progression occurred in 62 patients, mainly within the first year postoperatively or after the first examination. Progression of the lumbosacral kyphosis and sinking of the vertebral body was noted in severe slips. Although female gender and dysplasia (spina bifida) at the lumbosacral junction were more frequent in severe slips, they statistically had no value in predicting progression. A wedge form of L5 or sacral rounding also had no prognostic value. These were secondary to the slip and expressed it but did not predict it. The only radiologic variable with predictive value of progression was the percentage amount of the primary slip. In age groups corresponding to the growth spurt in early puberty (girls, 9–12 years; boys, 11–14 years), there was a tendency to progress.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In 311 patients (160 girls and women and 151 boys and men) with lumbar spondylolysis/spondylolisthesis 30 years of age or younger at diagnosis and with at least two separate examinations available, radiographs were evaluated retrospectively to estimate the magnitude of slip progression in relation to age and to search for possible prognostic factors of progression. The mean age at diagnosis was 16.2 years, and the mean observation time was 3.8 years. Nine patients (3%) had a slip progression (defined as an increase > 20%). The magnitude of progression per year was low (0.6%). No prognostic factors for progression were found.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A study was conducted to investigate the variability of interpretation of plain lumbar spine radiographs by rheumatologists in benign low-back pain (LBP). Intra- and interobserver agreement in classifying the presence of primary radiologic abnormalities according to preestablished criteria was assessed by the Kappa statistic in 115 anteroposterior and lateral radiograms. A significant variability of interpretation was observed for many findings often considered important in benign LBP, Particularly, low levels of agreement were observed for apophyseal joint abnormalities, Schmorl's nodes, spondylolysis, and structural deviations. Elaboration and validation of better standardized criteria for the main radiologic abnormalities is needed to improve the reliability of interpretation of lumbar spine radiographs.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Leg-length inequality was measured from radiographs at the level of the vertices of the femoral heads in 247 men and women aged 35–54 years. Of these, 53 had never had any low-back problem, but they had considerable variation in leg-length inequality (mean SD, 5.5 ± 4.1 mm; range, up to 20 mm). This group of symptom-free individuals did not differ from a group of 78 persons who had disabling low-back pain (LBP) during the previous 12 months (mean SD, 5.3 ± 4.0 mm; range, up to 17 mm). The adjusted relative risks (odds ratios) of having LBP ever and of disabling pain during the last 12 months were 0.78 (95% confidence interval, 0.43–1.17) and 1.02 (0.68–1.38), respectively, for an increase of 5 mm in leg-length inequality. The results from this study make an association between mild leg-length inequality and LBP questionable.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Four hundred twenty-nine pregnant women who had back pain before pregnancy and 375 pregnant women with no previous back pain were followed at regular intervals from the 12th week of pregnancy until delivery; back-pain complaints were recorded. Overall, back pain occurred twice as often in the group with a back-pain history (period prevalence) (P< 0.001). The point prevalence of back pain in weeks 12, 24, 30, and 36 was three times higher in the group who had had back pain before pregnancy indicating that pain was not only more prevalent but also lasted longer in that group. Women who had been pregnant previously tended to have an increased risk of back pain, and there was a statistically significant correlation between multiparity and longer periods of back pain (P< 0.001). Young age increased the risk of back pain (P< 0.001). Pain intensity was higher in the younger women during the first part of their pregnancies but not later on (P< 0.05).

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19–29 years) and in 16 male nonathietes (age range, 23–36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts and the nonathletes were pooled. Male elite gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Oxygen concentration gradients in the intervertebral disc were calculated to examine the effects of exchange area and disc thickness on oxygen concentrations and oxygen flux into the disc. The concentration gradients were determined using the two-dimensional Poisson equation with experimental values for oxygen consumption rate and oxygen diffusion. The calculated gradients were steep, and the oxygen concentrations in the center of thick discs were low, in agreement with experimental gradients. The results support the hypothesis that maximum cell density in the disc is determined by nutrient supply and that exchange area and disc thickness are critical parameters.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID