摘要:

Since its formation 20 years ago, the International Society for Study of the Lumbar Spine has stimulated basic and clinical research, Because few disorders of the lumbar spine are lethal, our usual goal is to improve the quality of life of our patients by relieving pain and improving function. To do so, we must continuously improve the quality of the preventive, diagnostic, and treatment methods we employ. If quality is our goal, we need to be precise In our definition, understand how we measure it, and most importantly, be explicit in how we will improve it. Also,wemust understand that our work is being conducted in a shrinking world, where all industrialized nations are profoundly concerned about the costs of health cars.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

At Thomas Jefferson University Hospital, 102 consecutive patients treated in a halo vest orthosis were randomized into one of two torque protocol groups based on their date of birth. The pins of patients who were born in even-numbered months were inserted with 8 inch-lbs of torque and those born in odd-numbered months were inserted with 6 inch-lbs. All patients were placed in an identical model halo using a standardized technique of application. The patients were followed prospectively, and all potential complications were evaluated by a member of the orthopedic attending staff, using protocols established at the onset of the study. Statistical analysis indicated no significant differences in halo pin loosening, infection, pain, or scarring between the torque protocols, but there was a trend toward a higher complication rate in the 8-inch-lbs group. There was no direct evidence of skull penetration in either group, and no patients developed a deep infection. Based on the results of this study, we conclude that insertion torque has no significant effect on halo pin complications within the ranges tested by this study. Our current protocol calls for routine insertion of halo pins with 6 inch-lbs of torque.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A retrospective study was performed to evaluate the radiographic changes that occurred at spinal levels adjacent to fused vertebrae after anterior cervical fusion. One hundred six patients with cervical spondylotic myeloradiculopathy (88 men, 18 women) were followed for an average of 8.5 years. The average age at follow-up was 64 years. Forty-two patients underwent a single-level fusion, 52 had a two-level fusion, and 12 had three Ievels fused. Seventeen patients who underwent additional surgery after anterior fusion also were reviewed, withanaverage Follow-up period of 2.3 years. Postoperatively, cervical flexion-extension resulted in significantly increased movement about the vertebral inters pace at the upper adjacent level. An increment of posterior slip of the vertebra immediately above the fusion level, with associated spinal canal compromise of less than 12 mm, significantly affected neurologic results. Patients with multilevel fusions notably exhibited these radiographic abnormalities at adjacent levels. Spinal canal stenosis, when associated with dynamic spinal canal stenosis In the vertebra above the Fusion level, affected late neurologic results. Results of salvage laminoplasty were not satisfactory. Unnecessarily extended longer fusion must be avoided.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This article reports eight patiante who underwent posterior decompressive surgery for myeloradiculopathy caused by calcium crystal deposition in the ligamentum flavum of the cervicial spine. All were women with an average age of 72 years and showed neurologic improvement postoperatively, four patients had diabetes mellitus, and knee meniscus calcification on radiographs were noted in four patients. The ligamentum flavum of C5–6 and C6–7 were sites frequently involved, Crystallographic examination confirmed resected deposits as calcium pyrophosphate dihydrate crystal in all patients and additional hydroxyapatite crystal in two. Histology confirmed marked degeneration in elastic fibers about the calcium deposits. This pathologic condition is possibly spinal manifestation of systemic calcium crystal deposition, disease.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Searching for a muscle stretch reflex that is innervated by the high cervical cord, the authors discovered the scapulohumeral reflex (Shimizu)-SHR (Shimizu). The testing maneuver, localization of the reflex center, its clinical significance, and the designation of the SHR (Shimizu) are dealt with in this report. The SHR is elicited by tapping the tip of the spine of the scapula and acromion in a caudal direction. The SHR is classified as hyperactive only when an elevation of the scapula or an abduction of the humerus have been clearly defined after tapping at these points. Two hundred twenty-five patients with cervical spine disorders, 90 normal individuals, and 17 patients with cerebrovascular strokes were examined. The incidence of hyperactive SHR was highest among several neurologic abnormalities in spastic cases with craniovertebral or high cervical lesions, and all cases with hyperactive SHR in the cervical spine disorder group exhibited neural compressive factors at the high cervical region. The major muscles participating in the SHR are considered to be the upper portion of the trapezius, the levator scapulae, and the deltoid. According to the anatomic level of compressive factors and the postoperative course of the activity in hyperactive SHR cases, the reflex center of the SHR is clinically presumed to be located between the posterior arch of C1 and the caudal edge of the C3 body. Hyperactive SHR provides useful information about dysfunctions of the upper motor neurons cranial to the C3 vertebral body level.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

An electronic digital inclinometer was used to obtain normative data on cervical mobility from 58 normal subjects. They consisted of 28 males (age range, 17–61) and 30 females (age range, 19–62). The measurements were taken from occiput to T1 in flexion-extension, lateral bend, and axial rotation, isolating the regional motion by measuring simultaneously the upper and lower margins of the eight mobile segments. A comparison of radiographs and inclinometer measures showed excellent correlations (r> 0.9997,P> 0.05). Normative data are presented. Gender-specific regional mobility differences occurred only in cervical extension, whereas no consistent age-related differences were found. Stiffer individuals could be found in either gender or any age group, but rigidity in one plane did not necessarily predict rigidity in another.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Forty-five patients who had residual symptoms after lumbar spine surgery were re-evaluated and underwent additional surgery. After a minimum of 2 years' follow-up these patients' results were reviewed to determine what variables might predict long-term outcome. Age, number of previous operations, and psychological diagnosis were not statistically significant, but a non-compensable injury, ability to return to work after surgery, a negative history of litigation, and achieving a solld fusion were statistically significant in predicting a good outcome. In this study of 45 patients who had repeat surgery, 82% were Improved at an average follow-up of 28.2 months. Intrathecally enhanced computed tomography, magnetic resonance imaging, discography, and computed tomography- discography are required to thoroughly evaluate the previously operated lumbar spine, because a single Imaging study showed surgical abnormalities in only 61% of the patients in this study.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The authors retrospectively studied seven patients who had in situ fusion as adolescents for high-grade (IV, V) spondylolisthesis unresponsive to more conservative means. All patients achieved solid bony union; their pain was relieved; and hamstring whether crouch gait or any other abnormalities could be demonstrated in patients exhibiting clinical parameters of success. Each patient underwent gait analysis, radiographic analysis, and a physical slight degrees of forward trunk lean during varying phases of gait accompanied increased trunk extension accompanied by limited hip flexion. Two patients were essentially normal. The authors were unable to quantity residual crouch in these patients with solidly fused high-grade spondylolisthesis.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To prevent recurrence and avoid the second operation, the authors analyzed the clinical features and surgical outcome of 214 patients (157 males and 57 females) who underwent lumbar microdiscectomy, 16 of whom required second operation. The mean age was 34,6 years (range, 12–62 years). The average Follow-up period was 4 years 5 months. The overall incidence of second operation was 7.5%. Second operation was performed because of recurrence of herniation in nine patients, and residual bony compression at the lateral recess in two, The incidence of second operation was significantly higher in teenagers than in patients in other age decades (P> 0.01), and In patients with protrusion-type hernietion than in those with extrusion-type or sequestretion-type hemiation (P> 0.01). To prevent the necessity for second operation, careful and thorough discectomy, especially deep to the posterior longitudinal ligament, and decompression at the lateral recess are useful.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID