摘要:

Study Design.Radiographic and direct quantitative measurements were made of the cortical and the trabecular anatomy of the sacrum.Objectives.To define the trabecular patterns and the cortical thickness of the sacrum.Summary of Background Data.The sacrum is a frequent site of internal fixation. In previous anatomic studies, investigators have focused on specific dimensional measurements of the sacrum, whereas others have described the anatomic course of the anterior sacral neurovascular or visceral structures. Computed tomographic imaging also has been used to quantify the sacral trabecular bone density. The internal architecture of the sacrum has yet to be described in detail.Methods.Seventeen cadaveric sacra were studied by computed tomographic imaging and then were sectioned at 3-mm intervals in the axial or sagittal plane. The cortical thickness of each section was measured under microscopic visualization. The sections were radiographed with high-resolution imaging to delineate their trabecular patterns.Results.The trabecular bone was densest adjacent to the endplates. The sacral body trabeculae were arranged in a cruciate pattern, and bony atrophy occurred in a systematic fashion. An alar void was a consistent finding in all specimens with definable boundaries. The cortical thickness was uniform throughout the surface of each specimen. The computed tomographic images correlated with the anatomy observed in the cadaveric sections.Conclusion.The internal bony architecture of the sacrum has several consistent features. The relatively uniform cortical thickness seen in each sacral specimen may have clinical significance in the internal fixation of this region.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.The opinions of orthopedic surgeons and neurosurgeons were compared regarding appropriate management of selected cervical injuries and the timing of stabilization.Objective.To determine whether there is consistency of opinion regarding the management of cervical trauma.Summary of Background Data.Numerous forms of management for cervical trauma exist, but there are few consistent recommendations. No previous study has been done to determine uniformity of preferences of the surgeons who manage these injuries.Methods.Thirty-one orthopedic surgeons and neuro-surgeons were given a brief clinical situation and pertinent radiographic studies of five selected cervical injuries. Management options included halo and nonhalo orthoses, traction, and various forms of anterior and/or posterior procedures. The surgeons rated, in whole numbers from 1 to 10, their opinions on the appropriateness of each technique. Each surgeon was given a case of a "generic" cervical injury, in which stabilization was required and for which preoperative alignment was adequate in traction. They gave opinions on the timing of stabilization, with a choice of four time frames. Four neurologic situations were rated, ranging from intact to complete cord injury.Results.Of 46 possible responses to the five test cases regarding appropriateness, 18 ranged from 1 to 10, the largest possible variation. Only 2 had a range of 5 or less, implying better consensus among tested surgeons. Mean values ranged from 1.9 to 9.5. Agreementamong respondents regarding appropriateness was slight with a range of κ statistics from 0.09 to 0.14. Of 16 possible responses regarding timing, 14 were within a range of 8 or higher. Within 24 to 72 hours was the generally preferred time frame, with all possible responses showing a range of 3 or 4. Results of a multiple analysis of variance showed no significant differences among respondents.Conclusion.There is a large variety of opinion regarding appropriateness of specific operative and nonoperative management procedures and surgical timing among the surgeons polled who manage cervical trauma. This implies that there is no widely accepted standard management procedure for many of these injuries.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A prospective, randomized, double-blind study comparing high-dose methylprednisolone with placebo.Objectives.To evaluate the efficacy of high-dose methylprednisolone when administered within 8 hours after whiplash injury.Summary of Background Data.Whiplash injury often results in chronic symptoms. The management of whiplash injuries is controversial, and pharmacologic therapy has received little evaluation. In recent reports, dysfunction of the central nervous system has been indicated in several cases. Methylprednisolone administered within 8 hours after the injury to patients with acute spinal cord injury has been demonstrated to improve the outcome. This procedure was also adopted in a randomized study of cases of whiplash injury in car accidents.Methods.Forty patients, 22 men and 18 women with a mean age of 35 years (range, 19-65), were included in the study, 20 in each of two groups. They were treated for whiplash injury, which they had sustained in car accidents. The patients were enrolled if their diagnoses were complete and treatment had begun within 8 hours after injury. Disabling symptoms severe enough to prevent the patient from returning to work, number of sick days before and after injury, and sick-leave profile after injury were used as parameters for the evaluation of the effects of the treatment. Baseline demographic data were controlled for when statistical analysis had been performed.Results.At the follow-up examination 6 months after initial treatment, there was a significant difference in disabling symptoms between the actively treated patients and the placebo group (P= 0.047), total number of sick days (P= 0.01), and sick-leave profile (P= 0.003).Conclusions.The results of this study indicate that acute treatment with high-dose methylprednisolone may be beneficial in preventing extensive sick leave after whiplash injury. However, the number of patients studied was small, and therefore further prospective, controlled studies are needed.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A retrospective study of cervical disc herniation using results of repeated magnetic resonance imaging examinations.Objectives.To clarify the cervical disc herniation morphological changes over time in order to establish a strategy for treatment.Summary of Background Data.In the authors' previous magnetic resonance imaging follow-up study of patients with lumbar disc herniation, spontaneous regression was observed in the sequestration-type lesions, and it was found that the tendency toward regression differed based on the anatomic position of extruded disc material.Methods.Thirty-eight patients with cervical disc herniation who underwent repeated magnetic resonance imaging examinations were studied. The changes over time in herniated disc size were evaluated using this imaging technique. Evaluation showed the characteristics of those in whom spontaneous regression was found, such as extrusion pattern, and the clinical outcome was evaluated by symptoms.Results.In 15 patients (40%), the volume of herniated material was decreased. The interval from onset of symptoms to the initial examination was significantly shorter in the regression group than in the group that showed no change in disc herniation. By extrusion pattern, cervical disc herniation, which was divided into migration type on sagittal view and lateral type on axial view, most frequently exhibited spontaneous regression. All of the patients with radicular pain and upper limb amyotrophy were treated successfully with conservative therapy.Conclusion.Although the possibility of the combination of hemorrhage and disc material could not be denied, active resorption of herniated material probably occurred during the acute phase. Extruded material exposed to the epidural space may be resorbed more quickly than that beneath the ligament. Vascular supply probably plays a role in the mechanism of resorption. The phase and position of extrusion were the significant factors affecting cervical disc herniation resorption. It was demonstrated that examination performed during the acute phase usingmagnetic resonance imaging is necessary for elucidation of the pathogenesis of cervical disc herniation, and that migrating, lateral-type herniations regress so frequently that conservative treatment should be chosen not only for patients with radicular pain, but also for those with upper limb amyotrophy.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.The medical records and serial spine radiographs of 59 consecutive patients with congenital scoliosis caused by unilateral unsegmented bar with contralateral hemivertebrae were reviewed.Objectives.To study the presentation, natural history, and treatment of these patients.Summary and Background Data.This is the least common type of congenital scoliosis.Methods.The mean age at diagnosis was 4 years 1 month. Forty-three patients were observed without treatment for a mean of 6 years and 1 month. Prophylactic arthrodesis was performed in 10 patients before they were 5 years old. Thirty-five patients had a corrective procedure and arthrodesis after they were 5 years old.Results.Thoracolumbar curves had the worst prognosis: without management all but two exceeded 50° when the patients were 2 years old. All untreated curves exceeded 88°. Midthoracic curves had only a slightly less severe prognosis, and all but one exceeded 40° by the time the patient was 2 years old. All untreated curves exceeded 70°. In eight of the 14 patients whose congenital curves had their apexes at T5, T6, or T7, a long secondary structural curve developed on the opposite side in the thoracolumbar region, and this contributed significantly to the overall deformity. Occult intraspinal anomalies were present in 24 patients (41%). Surgical treatment after the patient was 5 years old was not successful in producing significant correction of these severe rigid deformities.Conclusion.These patients have the most rapidly progressive and severely deforming of all types of congenital scoliosis. All midthoracic, thoracolumbar, and lumbar curves require immediate prophylactic surgical treatment by anterior and posterior arthrodesis-preferably in the first year of life.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A retrospective evaluation of the outcome of surgical management of progressive scoliosis in institutionalized patients with frequent, uncontrolled, generalized tonic clonic seizures.Objectives.To determine the safety and stability of internal fixation devices in patients with progressive scoliosis and intractable seizures.Summary of Background Data.Progressive scoliosis is a common problem in severely disabled patients. It has been the belief among some spine physicians that the coexistence of intractable seizures with progressive scoliosis is a contraindication for surgery, because most of the thoracic and lumbar spine is fixed and "unyielding" after internal fixations, increasing the risk of vertebral fractures. There have been reports of fracture of fixation devices, particularly Harrington rods, under conditions of massive trauma or mechanical stress, such as seizures.Methods.The authors reviewed the outcome of six profoundly retarded institutionalized patients with a history of intractable seizures who underwent internal fixation of the spine between 1984 and 1987 because of progressive scoliosis. Seizure types and frequency of convulsion were obtained from the institutional charts. Follow-up radiographs of the spine obtained at 1, 3, and 6 months after the surgery and once a year thereafter were reviewed by the radiologist and orthopedic surgeon with special attention paid to fractures, stability of the fusion, and integrity of the instrumentation.Results.Six patients underwent spinal fusion with internal spinal fixation, four patients with Harrington rods and two with Luque rods. All patients had refractory tonic clonic seizures ranging from 11 to 80 generalized tonic clonic convulsions per year for the 10-year follow-up period after surgery. There were no fractures, subluxation, or pseudoarthrosis of the fused vertebrae or the vertebral bodies adjacent to the fusion. There were no fractures of the instrumentation.Conclusions.The authors' findings suggest that when appropriate fusion is attained, the use of internal fixation devices is not contraindicated in the management of progressive scoliosis in patients with intractable seizures.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A cross-sectional study was used to determine whether limited range of motion in the hip was present in 100 patients-one group with unspecified low back pain and another group with signs suggesting sacroiliac joint dysfunction.Objectives.To determine whether a characteristic pattern of range of motion in the hip is related to low back pain in patients and to determine whether such a pattern is associated with and without signs of sacroiliac joint dysfunction.Summary of Background Data.The sacroiliac joint is often considered a potential site of low back pain. Problems with the sacroiliac joint, as well as with the low back, have often been related to reduced or asymmetric range of motion in the hip. The correlation between sacroiliac joint dysfunction and hip range of motion, however, has not been thoroughly evaluated with reliable tests in a population of patients with low back pain.Methods.Passive hip internal and external rotation goniometric measurements were taken by a blinded examiner, while a separate examiner evaluated the patient for signs of sacroiliac joint dysfunction. Patients with sacroiliac joint dysfunction were further classified as having a left or a right posteriorly tilted innominate.Results.The patients with low back pain but without evidence of sacroiliac joint dysfunction had significantly greater external hip rotation than internal rotation bilaterally, whereas those with evidence of sacroiliac joint dysfunction had significantly more external hip rotation than internal rotation unilaterally, specifically on the side of the posterior innominate.Conclusions.Clinicians should consider evaluating for unilateral asymmetry in range of motion in the hip in patients with low back pain. The presence of such asymmetry in patients with low back pain may help identify those with sacroiliac joint dysfunction.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.This prospective study includes normal control subjects and patients with focal lesions of the spinal cord investigated by transcranial magnetic stimulation.Objectives.To establish a stable method to elicit motor evoked potentials from cervical to lumbar segmental levels and to apply the method that would allow the localization in patients with restricted cord lesion. Thirty-four healthy subjects (10 women, 24 men) and 17 patients with focal spinal lesions were admitted to this study.Summary of Background Data.The focal cord lesions and injuries were previously evaluated by the records of lower limb muscles after cortical stimulation, but this method did not demonstrate the vertebral levels at which the lesions were located.Methods.The paravertebral myotomal-evoked potentials were recorded in different segmental levels (T1, T6, T12, and L3) from paravertebral muscles, using surface and needle electrodes by transcranial magnetic stimulation in normal control subjects and patients.Results.In normal control subjects, paravertebral myotomal-evoked potentials were obtained from T1, T6, T12, and L3 paravertebral muscles with both recording techniques (surface and needle electrode). From T1 to L3 latencies of paravertebral myotomal-evoked potentials increased gradually (from 10 msec to 17 msec) in normal control subjects. The levels of spinal cord lesions were obtained reliably in 14 of 17 patients with thoracic-lumbar spinal cord lesions, by using both electrophysiologic methods. In 11 of 14 patients, the lesions produced total conduction block, at and below the lesion level. In the remaining 3 patients slowing of intersegmental conduction was observed along the focal cord lesion.Conclusions.The paravertebral myotomal-evoked potentials obtained by surface electrode from paravertebral muscles and by midline needle electrode in the intrinsic rotatory muscles of the spine were useful in localizing lesions in the spinal segments in most of the patients with thoracic-lumbar cord lesions.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID