摘要:

Study DesignAn anatomic study was performed to investigate the ligamentum flavum of the human lumbar spine.ObjectivesTo describe accurately the interlaminar portion of ligamentum flavum, and to determine if there is an insertion onto the anterosuperior surface of the caudal lamina.Summary of Background DataThe insertions of the ligamentum flavum onto its adjacent laminas were classically described by Naffzinger. His description has been recounted by others. It has been the authors' observation that there is a slip of inferior ligamentum flavum that inserts onto the anterosuperior surface of the caudal lamina. Review of the literature revealed only anecdotal observations that support the authors' finding. A clear anatomic description of this structure is important to the surgeon who frequently enters the spinal canal at this anatomic site.MethodsThirty human lumbar ligamenta flava from six fresh frozen lumbar spines were studied macroscopically, with particular attention paid to the insertions onto the adjacent laminas.ResultsThe ligamentum flavum consists of a superficial and a deep component. It is continuous in the midline. The superficial ligamentum flavum inserts onto the superior edge and posterosuperior surface of the caudal lamina. The deep ligamentum flavum inserts for a variable distance onto the anterosuperior surface of the caudal lamina.ConclusionsThere is an inferoventral slip of the ligamentum flavum that attaches to the anterosuperior surface of the caudal lamina. This slip is the inferior portion of the deep ligamentum flavum. When the ligamentum flavum's superficial layer is selectively released, the inferoventral slip of the ligamentum flavum's deep layer remains attached to the anterosuperior surface of the caudal lamina and remains between the surgeon and the dura.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignUsing magnetic resonance imaging, this study analyzed the anatomic characteristics of the iliolumbar ligament insertion on humans.ObjectivesTo resolve certain anatomic questions about the manner of insertion of the iliolumbar ligament.Summary of Background DataThe data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region.MethodsTwenty-eight iliolumbar ligaments of 14 adult volunteers were analyzed with magnetic resonance imaging. The images were acquired along the transversal planes (from inferior to superior) and coronal planes (from the ventral to the dorsal) of the lumbosacral region.ResultsThe anterior band of the iliolumbar ligament (broad and flat) originates from the anterior-inferior-lateral part of the L5 transverse process and expands as a wide fan before inserting on the anterior part of the iliac tuberosity below the posterior band. The posterior band of the iliolumbar ligament originates from the apex of the L5 transverse process and is thinner than the anterior with a round section, and it inserts on the iliac crest (from the anterior margin to the apex).ConclusionsThe minor width of the area of insertion on the iliac crest of the posterior band (and therefore its lower resistance with the mechanical overloads) could explain the frequency of the painful syndromes related, by some authors, to an enthesopathy of this ligament.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study compared the effectiveness of two transpedicular screw placement techniques: blind screw placementversusscrew placement after direct determination of the superior, medial, and inferior borders of the pedicle through the opening of a “window” by the partial laminectomy and tapping technique.ObjectivesTo determine if the incidence and severity of pedicle violations resulting from transpedicular screw placement could be reduced by direct determination of the superior, medial, and inferior borders of the pedicle through the opening of a “window” by partial laminectomy.Summary of Background DataSeveral studies regarding transpedicular screw fixation for unstable cervical spine injuries have been reported, but none has addressed the effectiveness in lowering the incidence of pedicle violation by opening a “window” by partial laminectomy for direct determination of the superior, medial, and inferior borders of the pedicle and using the tapping technique before and in planning for screw placement.MethodsEight adult cadaveric cervical spines (40 vertebrae from C3 to C7) were used for this study. Two groups were formed according to screw placement techniques. The first group was composed of 38 blinded transpedicular screw placements. The second group was composed of 40 screw placements using the partial laminectomy and tapping technique. After transpedicular screw placement, all specimens were evaluated radiographically and visually for violation of the pedicle.ResultsA decrease in the incidence and severity of pedicle violation was seen in the second group with opening of the lamina and tapping technique compared with the blind screw placement group. However, the percentage of screws found to violate the pedicle with the opening of the lamina and tapping technique still was relatively high.ConclusionsTranspedicular screw placement in the cervical spine is difficult, and a high percentage of violations of the pedicle wall occur. This technique should not be used routinely.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignA 5-year longitudinal interview and questionnaire-based survey of back pain in adolescents.ObjectivesTo determine the natural history of back pain during adolescence in boys and girls, and to explore the influence of sports participation and lumbar flexibility.Summary of Background DataPrevious data on low back pain and flexibility in adolescents have come largely from cross-sectional studies with differing definitions and age groups. A longitudinal study would offer a more detailed description of aspects of the natural history of back pain.MethodsA cohort of 216 11-year-old children was given a structured questionnaire about back pain. Follow-up evaluation was annual for 4 more years. Lumbar sagittal mobility was measured in first and last years. Life-table analysis was the chosen statistical method.ResultsAnnual incidence rose from 11.8% at age 12+ to 21.5% at 15+ years. Lifetime prevalence rose from 11.6% at age 11+ to 50.4% at age 15+ years. Experience of back pain was frequently forgotten. Recurrent pain was common, usually manifesting as such rather than as progression from a single episode; few children required treatment. Back pain was more common in boys than girls, especially by age 15 years. There was a positive link between sports and back pain only for boys. Severity and flexibility were not related to sex, treatment, or sport.ConclusionsBack pain in adolescents is common; it increases with age and is recurrent, but in general does not deteriorate with time. Much of the symptomatology may be considered a normal life experience, probably unrelated to adult disabling trouble.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThe effect of a workplace-based early intervention program on perceptions of pain and disability in nurses with low back injury was studied using a preinterventionversuspostintervention design with concurrent control group.ObjectivesTo examine the relationship and changes over time between pain and disability measures in two groups of back-injured nurses-those who received the early intervention program (study) and those who were not offered the program (control).Summary of Background DataThe relationship between back pain and disability is not straightforward. The effects of an intervention program on changes in perceptions of pain and disability over time have not been widely reported.MethodsThe Oswestry Low Back Disability Questionnaire and a visual analog pain scale were administered to 46 study nurses and 137 control nurses at time of injury and at 6 months after injury. Correlation and regression analyses were used to explore the relationships between the two measures. Changes over time were compared with analyses of variance.ResultsPain and disability were positively correlated in both groups at time of injury and at follow-up evaluation. Mean scores for pain and disability were lower at follow-up evaluation than at initial injury in both groups; study nurses had significantly (P< 0.01) lower scores at 6 months than nurses in the control group. Disability at time of injury predicted disability at 6 months only for nurses in the control group.ConclusionsThis workplace-based early intervention program decreased levels of pain and disability in back-injured nurses and altered the relationship between these two variables over a 6-month time interval.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study designA longitudinal, prospective, observational cohort study.ObjectivesTo assess the relationship between clinical back status and reported pain locations during and after pregnancy.Summary of background dataBack pain during pregnancy is a frequent clinical occurrence, even during the early stages of pregnancy. The cause is unclear. There are few data describing the results of a general physical examination of the back during pregnancy and there are no data on serial examinations. Such data could provide information about what structures cause the pain, which might have implications for the choice of treatment.MethodsA cohort of 200 consecutive women attending an antenatal clinic was observed throughout the pregnancy terms, and repeated measurements of back pain and its possible determinants were taken using questionnaires and physical examinations in a standardized way, including a series of tests of configuration, mobility, and pain provocation.ResultsPain provocation tests were better at discriminating among women who reported back pain from women who reported no back pain from tests of configuration or mobility. The discriminatory power of the tests was better in the lower part of the spine than in the upper part. The best discrimination was achieved by combining some of the tests.ConclusionsThe results indicate that not one but several pain-releasing structures may be involved. These are probably the various pelvic ligaments, which may form a functional unit. These findings may have therapeutic implications.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study designThe neurologic outcome in patients with conservatively managed incomplete closed traumatic cervical spinal cord injuries was evaluated using the motor scoring system and the Frankel classification.ObjectivesTo show that the motor scoring of recovery system combined with functional Frankel grading will make the documentation of final neurologic outcome more accurate for future comparisons of various methods of treatment.Summary of Background DataThe influence of surgical and pharmacologic methods of treatment on recovery remains debatable.MethodsSixty-three consecutive patients with incomplete cervical injuries who were admitted to the hospital within 2 days after injury were included. All patients were treated conservatively with 6 weeks of bedrest and 6 weeks of mobilization with neck support.ResultsFive patients had neurologic deterioration, and all but one patient recovered without surgery. The evaluation of 44 patients who were observed for more than 12 months showed that the preservation of sharp sensation below the level of injury was an indicator of a good prognosis in patients whose injuries were classified as Frankel B, and the degree of recovery of these patients according to the motor score system was comparable with that of patients who were classified as Frankel C. All patients classified as Frankel C who did not deteriorate recovered in Frankel grade. All but one of the patients in the Frankel D group recovered full motor power. The degrees of motor deficit and recovery did not correlate with the mechanism or the degree of the injury of the spinal axis.ConclusionConservative treatment remains a good option for patients with incomplete cervical cord injuries. It is hoped the current study will be a good basis for comparison of the neurologic outcomes of different treatment modalities.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study of professional drivers is a part of a longitudinal record linkage study of all economically active men in Denmark, identified on January 1, 1981. Information about the main occupation was identified in 1980. The cohort was followed for first hospitalization with prolapsed cervical intervertebral disc until December 31, 1990.ObjectivesTo examine the risk of prolapsed cervical intervertebral disc in all Danish professional drivers, and to analyze exposures of the male drivers in a sample of all Danish male drivers.Summary of Background DataOnly a few studies on occupation and prolapsed cervical intervertebral disc have been published. These studies suggest that professional driving may be a risk factor for development of prolapsed cervical intervertebral disc. Drivers are exposed to whole-body vibrations, heavy lifting, and a sedentary position. Other potential exposures are accelerations and decelerations and whiplash accidents. Such exposures may be involved in the causation of prolapsed cervical intervertebral disc.MethodsA standardized hospitalization ratio was calculated for each subgroup of drivers using all economically active people as the standard. Additional exposure information was extracted from a national survey on work environment.ResultsAlmost all men in occupations involving professional driving had a statistically significant elevated risk of being hospitalized with prolapsed cervical intervertebral disc.ConclusionsProfessional driving is a risk factor for prolapsed cervical intervertebral disc.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis article evaluates how an immature spine responds to anterior débridement surgery (without bone grafting) for spinal tuberculosis during growth and development. Sixty-three patients were studied, 29 of whom were children aged 10 years or less at the time of surgery, whereas the remaining 34 subjects were adults. These patients were the subject of the Medical Research Council Working Party's prospective study, started in Hong Kong in the mid-1960s.ObjectivesTo evaluate how an immature spine responds to débridement surgery for tuberculosis, during growth and development, to determine whether there are differences in the longitudinal pattern of deformity between children and adults, and to determine the influence of disproportionate spinal growth on the progression of deformity in children.Summary of Background DataAll patients were followed prospectively for a mean period of 19.6 years after débridement surgery. The mean age at surgery for children (n = 29) was 4.3 years and for adults (n = 34) 35.3 years.MethodsThe kyphos and deformity angles were measured from lateral spinal radiographs obtained at preoperative evaluation and postoperatively at 6 months, 1 year, 5 years, and at final follow-up evaluation using an electronic digitizer.ResultsThe results showed that the longitudinal pattern of changes in the mean kyphos and deformity angles in young children presented a picture slightly different from that in adults. The mean angles were increased at the 6-month and at 1-year evaluations after débridement surgery in both groups. Afterward, in children there was some spontaneous correction in these mean angles, whereas in adults these angles showed variation according to the site of lesion during the follow-up years. Statistical analysis according to the site of spinal lesion showed that in thoracic tuberculosis, there was an increase in kyphos and deformity angles at the 6-months postoperative evaluation (more in children than in adults). There were no significant changes in these angles from the 1-year to the final follow-up evaluations. In thoracolumbar tuberculosis, there were significant increases in kyphos and deformity angles at the 6-month postoperative evaluation, and thereafter adults did not show any significant change until final follow-up examination, whereas children showed a tendency toward spontaneous correction, although this finding was not statistically significant. In lumbar tuberculosis, there was an equal tendency toward spontaneous correction in children and adults from 1 postoperative year onward.ConclusionsThe authors could find no evidence of disproportionate posterior spinal growth, which has been suspected in the past to be a factor involved in contributing to progression of kyphotic deformity after anterior débridement surgery for spinal tuberculosis.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study is a prospective, controlled study of the effect of intraoperative and postoperative blood loss during spinal surgery on serum cefazolin level.ObjectivesTo determine what effect, if any, intraoperative blood loss has on serum antibiotic levels, and to determine if adjustment of the dose or dose interval is appropriate in operative cases of significant blood loss.Summary of Background DataThe problem of infection at the operative site after posterior spinal fusion with internal fixation is significant. It commonly has been accepted that blood loss results in a more rapid clearance of antibiotic.MethodsNineteen patients scheduled for elective spinal fusion with internal fixation were enrolled in this study. Each patient served as his or her own control. Baseline cefazolin clearance was determined the week before surgery. Cefazolin clearance again was determined intraoperatively. Blood loss was recorded throughout the procedure.ResultsThe mean blood loss was 650 mL. There was no significant difference between preoperative and intraoperative cefazolin clearance, and there was no correlation between blood loss and cefazolin level.ConclusionsIt is not necessary to give cefazolin at a dosing interval of less than 4 hours with blood losses of up to 1200 mL. This will maintain the antibiotic concentration well above the minimum inhibitory concentration.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID