ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Blood losses and transfusions have been analyzed prospectively for 63 lumbar fusion operations in 55 patients. The mean intraoperatlve loss was 550 ml, with a further 336 ml in postoperative drains. Factors increasing intraoperative loss included posterior vs. anterior approach, the use of instrumentation, multiple levels fused, male vs. female, and younger age. For anterior procedures (without instrumentation and using homograft bone) and single-level posterolateral fusions (PLF) without instrumentation, neither predeposit nor Intraoperative salvage (cell saver) was required. Single-level PLF with instrumentation and two-level PLF without instrumentation required either cell saver or predeposit of one or two units. Multiple-level PLF with Instrumentation and all 360° procedures required cell saver and two units of predeposit. Two patients received homologous blood.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Postoperative analgesia using continuous epidural morphine or a single intrathecal injection of morphine has been compared with standard patient-controlled analgesia (PCA) in lumbar fusion patients. Pain relief with epidural morphine was dramatic in some cases (3/12) but was not predictable, and catheter displacement was a frequent occurrence. A single intrathecal bolus of morphine had no advantage over PCA alone. Complications of both intraspinal techniques included nausea and pruritis. No respiratory depression was observed.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effective thoracic and lumbar pedicle diameter as related to screw size for that pedicle was studied in six fresh-frozen human cadaver spines. Measurements of the pedicle were obtained before screw insertion using axial and coronal reformatted computed tomographic (CT) Images, as well as graduated sounding of the pedicle. After sequentially loading each pedicle with increasingly larger screws, measurements were taken of the outer cortical diameters. Plastic deformation of the pedicle preceded pedicle fracture or cutout when the screw thread diameter became larger than the endosteal diameter or within 80% of the outer cortical diameter as measured from the CT scan. Pedicle screws did not obtain cortical purchase within the pedicle.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The AO spinal internal fixation system uses 5.0 mm diameter transpedicular Schanz screws with 7.0 mm diameter fully threaded stainless steel rods. Originally developed for the treatment of thoracolumbar and lumbar spine fractures, it can be used for a variety of spinal disorders. A prospective study has been carried out, and the first 48 patients have been reviewed. The results for those patients with fractures are excellent. In burst fractures, It has been possible to decompress the canal and restore lordosis. In only half of the cases of spondylolisthesis has it been possible to improve the degree of slip. The fixator has provided rigid stabilization for a variety of other spinal problems.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Thirty-seven patients underwent surgery for late posttraumatic kyphosis in the lumbar, thoracolumbar, or thoracic spine. Indications for surgery included: increasing deformity, pain, and persistent neurologic deficit with paraparesis in eight, and development of late spinal stenosis in a further nine patients. All patients underwent anterior correction with Kostuik-Harrington instrumentation. Seventeen patients with neurologic deficit underwent decompression over appropriate levels as well. No posterior fusions or instrumentation were carried out. Stable arthrodesis with correction of the deformity occurred in 36 of 37 patients with only one nonunion. Pain was reduced significantly in 78% of patients. Late neurologic improvement of a significant functional degree occurred in three of eight paraparetics. All patients with spinal stenosis had relief of their symptoms and signs.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this study was to determine the efficacy of intraoperative ultrasound monitoring in the reduction and stabilization of thoracolumbar burst fractures of the spine. Thirty-one patients underwent a posterior approach for reduction and stabilization of a thoracolumbar burst fracture, with complete follow-up available on 26. Intraoperative real-time sonography was used for monitoring retropulsed fragments during distraction and fracture impaction. Computed tomography was used to compare preoperative canal compromise and postoperative reduction. Average canal compromise preoperatively was 66.5%, and the average canal compromise postoperatively was 18.7%. Neurologic function was not changed in 16, improved in ten, and worsened in none. Average hospital stay was 21.6 days. No complications were directly attributable to the use of the ultrasound. The authors believe that ultrasonography provides a safe and accurate method of intraoperatively evaluating reduction of burst fracture of the thoracolumbar spine from the posterior approach.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this study was to detect any changes in the erector spinae muscles In patients undergoing surgery for lumbar disc herniation (LDH) and to analyze which factors (sex, age, the level and site of disc protrusion, and duration of symptoms) would be related to these changes. The percentage of mean area of the type I fibers was significantly larger in males and in the older age group (P< 0.05), due to the decreasing size of type lla and llb fibers. Patients with LDH have: 1) angulated and selective atrophy of type II fibers with a higher type llb/lla ratio; 2) with increasing age and duration of symptoms, more marked atrophy of type II fibers; and 3) other unspeciflc pathologic changes.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this study was to Investigate the healing of surgically created defects in the anulus fibrosus in an effort to determine the healing potential of this structure. Four identical lesions were made In the anulus fibrosus of ten dogs at levels L2-L5. Two dogs were killed at 3, 6, and 9 weeks. Four dogs were killed at 12 weeks. The spines were harvested during a 3- to 12-week period and evaluated grossly and microscopically. Our study demonstrated that a stab wound of the anulus has a limited healing potential and the persisting defect could provide a pathway for irritating nuclear fluid escape onto perlneural tissue, possibly resulting in persistent lowback pain.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A test battery was used to measure abdominal and back muscle strength and endurance In 20 patients at least 1 year after surgical diskectomy. There were ten men and ten women. Data on Isometric and isokinetic performance were compared with previously reported normal values. The data showed that every strength parameter tested except male isokinetic flexion strength showed at least a 30% decrease when compared with normal values. Compared with strength data on these same patients immediately after surgery, a 2-tailed Studentttest demonstrated a significant difference only In male isokinetic strength (P< 0.10) and in female isokinetic strength (P< 0.05). No other difference was found in isometric strength or endurance compared with data obtained from these patients 4 to 6 weeks postoperatively. From these data, it is obvious that more intensive physical therapy is necessary to improve postoperative strength in patients undergoing surgical diskectomy. These data allow for the design of specific isometric, isokinetic, and endurance rehabilitation programs for the postoperative diskectomy patient.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID