摘要:

Study Design.Prospective evaluation of the location of the center of gravity during supine, standing, and gait.Objective.Develop methods to quantify center of gravity locations in patients with scoliosis and controls and to evaluate the merit of the quantitative assumptions relative to spinal fusion surgery.Summary and Background Data.The center of gravity, or balance point of the body, is generally considered to be the single best estimate of the body’s location. To date, investigators have not examined the body’s center of gravity location to assist surgical planning to maintain and/or restore coronal and sagittal plane balance, nor have they used center of gravity location to help assess surgical outcomes.Materials and Methods.The whole-body center of gravity (MR-COG) was determined for three subjects from magnetic resonance imaging data obtained supine. The whole-body center of gravity was also determined using subject specific (SS-COG) and literature-based (STD-COG) segment center of gravity locations in conjunction with a video motion capture system obtained supine, standing and during gait.Results.Differences existed among the three methods of determining COG locations in supine, with the SS-COG and MR-COG being most closely aligned. Results from gait data indicated typical anterior/superior and right/left COG shifts during the gait cycle. The SS-COG method consistently determined a COG location inferior to the STD-COG method; however, variation within the gait cycle was similar. Shifts in COG locations relative to a coordinate system fixed in the pelvis were more than 5 cm in the superior/inferior direction, approximately 4 cm in the anterior/posterior direction, and minimal in the left/right direction.Conclusions.Methods have been developed to determine locations of the whole body COG in both preoperative and postoperative subjects undergoing spinal fusion surgery and controls. The methods are robust to include men and women, subjects with and without instrumentation, and subjects in various positions including gait.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Case report.Objectives.To report a peculiar case of the cervical spine that ensued after a sudden harsh extension along with its prompt evaluation and managementSummary of Background Data.Fractures of the cervical spine do occur and are usually inconsequential because of the rarity of accompanying neurologic complications. Accordingly, they are often treated conventionally.Materials and Methods.Cervical radiographies and magnetic resonance imaging were performed to depict the fracture.Results.Cervical radiographies demonstrated the C7 fracture in our patient but the magnetic resonance imaging also disclosed a T1 fracture. He was treated by physical therapy and close follow-up.Conclusions.This type of an unexpected incident in daily life can be seen and it should always orient the clinicians toward being vigilant against concomitant vertebral fractures or neurologic complications. And once it is proven that the spinal cord is not compromised, one might feel comfortable in treating solely these inconsequential fractures conventionally.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.The first case of intraspinal synovial cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability is presented.Objectives.To describe the diagnosis and successful treatment of a synovial cyst of the C1-C2 junction in a patient with rheumatoid arthritis and atlantoaxial instability.Summary of Background Data.Intraspinal synovial cysts of the C1-C2 junction are extremely rare. Neither association with rheumatoid atlantoaxial instability nor communication with the C1-C2 facet joints and the subarachnoid space has been previously reported in a synovial cyst of the C1-C2 junction.Materials and Methods.The clinical and radiologic features of a 71-year-old woman with a symptomatic synovial cyst of the C1-C2 junction with rheumatoid atlantoaxial instability are detailed. Posterior atlantoaxial fusion alone was performed.Results.Preoperative magnetic resonance images demonstrated a large cystic mass around the dens, compressing the spinal cord. The mass was of low signal intensity on T1-weighted images, was of high signal intensity on T2-weighted images, and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Computed tomograms performed after myelography disclosed the cyst around the dens communicating with the subarachnoid space and the C1-C2 facet joints. Spontaneous regression of the cyst was identified on the magnetic resonance images 3 months after surgery. One year after surgery, myelopathic symptoms were improved.Conclusion.An intraspinal cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability was reported. Computed tomograms after myelography were useful in delineating the relationships among the synovial cyst, facet joints, and the subarachnoid space. Spontaneous regression of the cyst and clinical improvement were achieved by C1-C2 posterior fusion alone.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A series of six case reports.Objective.The case reports demonstrate successful use of gadolinium contrast for visualization of spinal injection procedures.Summary of Background Data.A variety of spinal injection procedures were performed with gadolinium contrast. Adequate visualization was accomplished with gadolinium in performing these injections and demonstrated that it is a viable alternative to nonionic iodinated contrast materials.Materials and Methods.The case reports included a chart review, performance of spinal injections with gadolinium under fluoroscopic guidance, and postprocedure follow-up at 2 and 12 weeks.Results.Gadolinium was visible under fluoroscopy in all six cases, demonstrating its value in performing spinal injection procedures as an alternative to nonionic iodinated contrast materials.Conclusion.Gadolinium is a viable alternative to nonionic iodinated contrast materials for visualization of spinal injection procedures.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A case of disseminated tuberculoma in the spinal cord and brain is reported.Objectives.To present a case of disseminated tuberculoma in the spinal cord and brain and to describe the unusual pathologic features and clinical presentation.Summary and Background Data.Intramedullary tuberculoma concomitant with intracerebral disseminated tuberculoma is rare. Only one other case has been reported in the world literature. This represents the second reported case of this unusual lesion.Materials and Methods.The authors report a 67-year-old man with miliary tuberculosis of the lung and started on antituberculous therapy. His pulmonary complaints were resolved, but he presented acute paraparesis caused by tuberculomas in the thoracolumbar spinal cord. MRI showed more tuberculomas in the brain stem, cerebellum, and cerebral hemispheres.Results.After 6 months, the patient’s muscle power gradually improved with a combination of medical and surgical management.Conclusions.Our experience indicates that antituberculous medication is effective in managing multiple central nervous system tuberculomas. The purpose of surgical intervention is to decompress the cord or brain when progressing neurologic defects occur and to examine the tissue pathologically.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A randomized clinical trial with 4-week and 6-month follow-up periods.Objective.To compare the effect of a fear-avoidance–based physical therapy intervention with standard care physical therapy for patients with acute low back pain.Summary of Background Data.The disability reduction strategy of secondary prevention involves providing specific treatment for patients that are likely to have chronic disability from low back pain. Previous studies have indicated that elevated fear-avoidance beliefs are a precursor to chronic disability from low back pain. However, the effectiveness of physical therapy intervention based on a fear-avoidance model is unknown.Methods.Sixty-six consecutive patients referred to physical therapy with low back pain of less than 8 weeks’ duration were randomly assigned to receive fear-avoidance–based physical therapy (n = 34) or standard care physical therapy (n = 32). The intervention period lasted 4 weeks for this study. Disability, pain intensity, and fear-avoidance beliefs measures were recorded before and after treatment. A 6-month follow-up of the same measures was obtained by mail.Results.An intention-to-treat principle (last value forward) was used for data analyses that tested the primary and secondary hypotheses. The prediction of disability at 4 weeks and 6 months after treatment was significantly improved by considering the interaction between the type of treatment and the initial level of fear-avoidance beliefs. Both groups had significant within group improvements for disability and pain intensity. The fear-avoidance treatment group had a significant improvement in fear-avoidance beliefs, and fear-avoidance beliefs about physical activity were significantly lower than the standard care group at 4 weeks and 6 months after treatment.Conclusion.Patients with elevated fear-avoidance beliefs appeared to have less disability from fear-avoidance–based physical therapy when compared to those receiving standard care physical therapy. Patients with lower fear-avoidance beliefs appeared to have more disability from fear-avoidance–based physical therapy, when compared to those receiving standard care physical therapy. In addition, physical therapy supplemented with fear-avoidance–based principles contributed to a positive shift in fear-avoidance beliefs.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A prospective, randomized, clinical study with a 2-year follow-up.Objectives.To analyze the effect of three different rehabilitation strategies for lumbar spinal fusion patients.Summary of Background Data.Fifteen percent to 40% of lumbar spinal fusion patients are not expected to improve significantly over a 2-year period. Optimization of present forms of rehabilitation could possibly further improve the outcome.Materials and Methods.Between 1996 and 1999, 90 patients who had undergone lumbar spinal fusion were 3 months after surgery randomized to one of three different rehabilitation groups. Video group participants watched a video of exercises for training and were subsequently and only once provided instruction regarding their use. The back-café group was provided the same program as the video group, but as a supplement met with a back-café with other fusion-operated patients three times over an 8-week period. The training group was provided physical therapy training twice weekly for 8 weeks. Functional outcome was evaluated at 6, 12, and 24 months after surgery by use of the low back pain rating scale and a questionnaire covering daily functions, work status, and a patient’s contact with the primary sector.Results.By 2-year follow-up, the back-café and video groups had less pain compared with the training group (P< 0.03). The back-café group was better at performing daily functions such as carrying bags of market items (P< 0.01), getting up from a chair (P< 0.01), and ascending staircases (P< 0.01) compared with the video and training groups. More in the back-café group resumed working after surgery compared with the two other groups (P< 0.04). The video group had significantly more contacts with general practitioners, physical therapists, and so on compared with the back-café and training groups (P< 0.001).Conclusion.The patients in the back-café group were significantly better at accomplishing a succession of daily tasks compared with the video and training groups 2 years after lumbar spinal fusion. At the 2-year follow-up the training group had a significant pain problem compared with the video and back-café groups. The video group had significantly more treatment demands outside the hospital system. This study demonstrates the relevance of the inclusion of coping schemes and questions the role of intensive exercises in a rehabilitation program for spinal fusion patients.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective.The first quantitative analysis of the innervation of the lumbar intervertebral disc is presented.Methods.A sheep model was used allowing evaluation of the whole motion segment. Four sheep spines were used. One was processed for PGP 9.5 immunofluorescence and three were processed for PGP 9.5 immunoperoxidase histochemistry. A count was made of the densities of innervation of the endplate and anulus, and these were compared.Results.There is no significant difference between endplate and anulus innervation densities. The endplate innervation is concentrated centrally adjoining the nucleus. The richest area of innervation is in the perianular connective tissue.Discussion.The lumbar intervertebral disc has a meager innervation. This is concentrated in the perianular connective tissue and the central endplate. Although receptor threshold is more closely related to nociceptive function than innervation density, these findings have important implications for any treatment of discogenic pain.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.The authors investigated the association of L5 proximal nerve root injury with spinal cord neuronal apoptosis (histologic) and whether exogenous erythropoietin therapy might reduce apoptosis/or pain (behavioral).Objectives.The first objective was to determine whether nerve root crush induces specific programmed cell death of spinal neurons in the dorsal and ventral horn and whether this is correlated with pain behaviors. The second objective was to determine if exogenous erythropoietin might reduce apoptosis and/or pain.Summary of Background Data.Whether spinal neuronal apoptosis is correlated with pain behaviors following nerve root injury remains unknown. It has been hypothesized that neuroprotective factors may alleviate pain behaviors by protecting neurons from death. Erythropoietin is a hematopoietic growth factor that recently has been demonstrated as a potent neuroprotective factor against ischemic damage in the brain. The effects of erythropoietin on pain and spinal cord neurons have not been examined.Methods.Sprague-Dawley rats received a L5 proximal nerve root crush injury or sham operation and were separated into two treatment groups for subcutaneous injection: 1) vehicle; 2) recombinant human erythropoietin, 2680 U/kg. The rats were sacrificed, and spinal cords were removed for apoptotic and immunohistochemical analysis at 0, 1, and 3 days after surgery. To determine whether recombinant human erythropoietin prevented mechanical allodynia in animals with nerve root crushes (n = 12/group), both treatment groups were tested for pain behaviors using the von Frey test at −1, −2, −3, 1, 3, 7, 11, and 14 days after surgery.Results.After nerve root injury, apoptotic neurons increased by 80% in the ipsilateral spinal cord and moderately in contralateral spinal cord in vehicle-treated animals compared to uninjured controls. Recombinant human erythropoietin reduced (P< 0.05) neuronal apoptosis in both superficial dorsal and ventral horns of the spinal cord. This corresponded with identification of erythropoietin and its receptors on spinal neurons and reductions in TNF–&agr; colocalization in ventral horn neurons. Mechanical allodynia developed in the corresponding ipsilateral hind paw within 1 day and was sustaineduntil day 14. Recombinant human erythropoietin-treated animals demonstrated faster recovery from mechanical allodynia compared with vehicle-treated controls (P< 0.05).Conclusions.Our findings indicated that L5 proximal nerve root crush increased neuronal apoptosis in the superficial dorsal and ventral horn that correlated with mechanical allodynia. Exogenous recombinant human erythropoietin facilitated receptor-mediated neuroprotection of spinal cord neurons and faster recovery from mechanical allodynia. Erythropoietin may be a potential therapeutic factor for patients with low back pain by providing pain relief and neuroprotection.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Disc pressure and fixator load were measured in anin vitrosetup and compared toin vivomeasurements with the identical transducers from the two groups participating in this study.Objectives.The goal of thisin vitrostudy was to determine the magnitude of trunk muscle forces during flexion and extension. The loading conditions in this study accounted for body weight, local and global muscles, and forces resulting from the support of the abdominal soft tissue in different postures. Resulting intersegmental motions and intradiscal pressure in each segment and the six load components in both rods of an internal fixator were determined.Summary of Background Data.The spine is primarily stabilized by muscle forces, which greatly influence spinal loads. However, little information exists on the magnitudes of trunk muscle forces during postures like flexion and extension of the upper body.Methods.Seven human cadaveric lumbar spines were mounted in a spine tester and adjusted to different degrees of flexion and extension of the upper body with different hip flexions. For each specimen, a total of 124 load cases were studied. They included combinations of a vertical compressive load, a follower load and forces pulling with cables at a plate fixed at the cranial end of the specimen to simulate rectus abdominis, erector spinae, and a supporting force of the abdomen. The muscle forces were varied until the external moment, necessary to keep the lumbar spine specimen in the examined posture, was zero. This was achieved with different muscle force combinations. Loads on internal fixators as well as intradiscal pressure and intersegmental rotation at all levels were measured. The muscle force combination that caused intradiscal pressures and loads in the internal fixator closest to those measuredin vivowere assumed to be the muscle forces which can be expectedin vivo.Results.Generally, intradiscal pressure was closer toin vivomeasurements than the fixator loads. The force in the m. erector spinae increased with the flexion angle but was only slightly influenced by extension. The estimated forces in the erector spinae were 100 N for standing, 130 N for 15° extension, and 520 N for 30° flexion of the upper body. Little influence was found on the intersegmental motion.Conclusion.In vitroloading conditions can be approximated closely toin vivoconditions with the simulation of an axial preload, local, and global muscles. This novel approach can help to estimate muscle forces, which can usually not be measured. The results from this study provide important input for FEM models, which may then allow the investigation of different load cases.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID