摘要:

Study Design.This is a retrospective long-term clinical and roentgenographic review of 50 patients who underwent anterior discectomy and fusion for painful cervical disc disease. The patients were reviewed by the senior author.Objective.To evaluate the long-term effectiveness of anterior cervical discectomy and fusion and identify clinical and roentgenographic factors that may increase the chances of recurrent problems.Summary of Background Data.Many studies have demonstrated the initial effectiveness of this procedure; however, there are no previously published reports that include the results of a 21-year follow-up period.Methods.Office charts and hospital records were used to obtain information about diagnosis, surgery, and complications. On follow-up examination, all patients were interviewed and examined, and roentgenograms were obtained.Results.Forty-eight patients had initial pain relief, and of these, 32 remained pain-free an average of 21 years after surgery. Sixteen had recurrent pain an average of 7.2 years after surgery. Eight of these required surgery for disc disease at an adjacent level. The abrupt onset of pain was the only clinical or roentgenographic factor that correlated with recurrent pain.Conclusion.Anterior cervical discectomy and fusion yield excellent initial results. However, patients must be cautioned that recurrent symptoms can occur, and, in a small percentage of patients, the symptoms may be severe enough to require additional surgery.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.Cross-sectional study of cervical involvement in rheumatoid arthritis.Objectives.To clarify the correlation between the deterioration of cervical lesions and the systemic progression of rheumatoid arthritis.Summary of Background Data.The natural course of cervical lesions varies. To date, no systemic parameter has been clarified to predict the progression.Methods.One hundred seventy-three patients with rheumatoid arthritis participated in this study. The authors studied the progression of cervical lesions and investigated the relation between the types of cervical subluxation at the end of study and the following four variables: the serum level of C-reactive protein, the number of joints with erosion, carpal height ratio, and disease subset (least erosive subset, more erosive subset, and mutilating disease subset).Results.Of the 173 patients, 55 already had cervical subluxation before entering the study. During the follow-up period, 44 patients deteriorated radiographically, and 77 (45%) had cervical involvement, including involvement of upper cervical lesions in 65 patients, upper lesions combined with subaxial subluxation in 10, and subaxial subluxation alone in 2. The upper cervical subluxation progressed in the order of anterior atlantoaxial subluxation, atlantoaxial subluxation combined with vertical subluxation, and vertical subluxation alone. Deterioration of upper cervical lesion and occurrence of subaxial subluxation were closely correlated with an elevation of serum C-reactive protein level, an increase in the number of joints with erosion, and a decrease in the carpal height ratio. The incidence of cervical involvement and the extent of deterioration were different among the disease subsets.Conclusions.The serum level of C-reactive protein, the number of joints with erosion, and the carpal height ratio correlated closely with the extent of the cervical subluxation. The average C-reactive protein values during the follow-up period correlated with progression of the cervical lesions. The classification of rheumatoid disease subset was useful for predicting the terminal feature of the cervical lesions.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.The risk factors of patients with and without radiculopathy after laminoplasty of the cervical spine were compared retrospectively.Objectives.To study the association between risk variables and postlaminoplastic radiculopathy to clarify the pathogenesis of radiculopathy and to devise preventive measures.Summary of Background Data.Radiculopathy after cervical laminoplasty on the expanded side has been attributed mainly to traumatic surgical techniques, whereas radiculopathy on the hinged side has been attributed to traction, tethering, or kinking of the nerve root that has resulted from posterior shift of the spinal cord from the preoperative position. There is still much divergence of opinion concerning the risk factors for the outbreak as well as the prevention.Methods.Of 365 patients who had undergone laminoplasty, 20 patients (5.5%) developed postoperative radiculopathy. Using data from postoperative computed tomography scans and other sources, these patients were compared with 211 patients with no radiculopathy, who had undergone laminoplasty during the same period, to identify risk factors related to patient characteristics and surgical techniques.Results.Of various risk factors studied, the narrowest level of the spinal canal, preoperative symptomatic severity, flatness of the spinal cord assessed by computed tomography myelography at C4-C5, cervical curvature, anterior protrusion of the superior articular process as assessed by computed tomography scan, laterality of the osteophytes, and ossification of the posterior longitudinal ligament could not significantly discriminate between patients with and without postoperative radiculopathy. The angle of lamina as measured by using computed tomography scans obtained after expansion in the patients with radiculopathy was greater than 68° on the opened and hinged sides and was significantly greater than the angle in patients without radiculopathy (P< 0.05). The incidence of radiculopathy on both the opened and hinged sides was significantly higher in patients in whom the bony gutter had been cut on the lateral side of the medial aspect of the zygapophyseal joint.Conclusion.Any one of patients' characteristics could not be correlated with postoperative cervical radiculopathy in this study. To prevent postoperative radiculopathy, it may be important during surgery to place the bony gutter on the medial side of the zygapophyseal joint and to keep the slope of the opened lamina within 60°.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A retrospective study by an independent observer of a consecutive series of 67 cases of adolescent idiopathic scoliosis presenting with a King II curve pattern.Objectives.To demonstrate the validity of a selective thoracic fusion as a treatment of King II curves with special attention to immediate postoperative and long-term trunk balance in the coronal and sagittal planes.Summary of the Background Data.The literature has been fairly controversial in terms of the recommended treatment of King II curve patterns in adolescent idiopathic scoliosis. The main confusion appears to be whether the thoracic curve alone or both curves should be instrumented and fused.Methods.Sixty-seven patients were identified as having had a selective posterior thoracic spine fusion with instrumentation between 1961 and 1994. None of these cases had a fusion of the lumbar spine. Preoperative radiographs were analyzed for determination of the appropriate fusion level using the criteria of the stable and neutral vertebra. Follow-up radiographs were evaluated for balance in the coronal and sagittal planes using the central sacral line on posteroanterior radiograph and the C7 sacral promontory line on lateral film.Results.At 2-year or greater follow-up, the unfused lumbar curve remained equal to or less than the corrected thoracic curve in 63 patients (94%). No patient required extension of fusion. Frontal plane balance analysis showed that 47 of the 67 patients had the T1 plumb line within 2 cm of the midline for an average decompensation of 8.7 mm. In no patient was the loss of balance greater than 3.8 cm. Sagittal plane balance analysis showed that only one patient had inferior junctional kyphosis greater than 10°. This did not require extension of fusion. There were no cases of superior junctional kyphosis.Conclusions.The concept of selective thoracic fusion in the King II curve pattern appears to be valid. These findings suggest that arthrodesis of the lumbar spine can be avoided when this pattern is properly diagnosed and appropriately treated. Proper identification of the stable and neutral vertebra and of the appropriate level of fusion are important to achieve good postoperative balance. Successful preservation of lumbar motion segments is important to long-term satisfactory outcome in adolescent idiopathic scoliosis.

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.Retrospective analysis of a spine imaging center's records of patients with chronic low back pain referred by tertiary care facilities.Objectives.1) To assess the interobserver reliability of detecting lumbar intervertebral disc high-intensity zone on T2-weighted magnetic resonance imaging, and 2) to assess the relation between high-intensity zone and discography or post-computed tomography in symptomatic patients with low back pain.Summary of Background Data.Two of the three previous studies on this subject found an association between high-intensity zone and the presence of Grade 4 anular disruption with discographic reproduction of patients' exact low back pain.Methods.Records of patients with low back pain who had undergone lumbar spine discography injection and post-computed tomography from June 1995 to August 1996 were reviewed. Two independent observers were asked to identify the presence of an high-intensity zone from the T12-L1 disc to L5-S1 on T2-weighted magnetic resonance images. With this data, interobserver reliability was assessed with the kappa statistic. Concordant high-intensity zone results were then compared with the Dallas Discogram rating for anular disruption and to patients' subjective pain response to discography injection. With this data, the sensitivity, specificity, and predictive values of high-intensity zone for detecting disc disruption and pain response were calculated.Results.The interobserver reliability for detecting a high-intensity zone in a given disc was fair to good (kappa = 0.57; 95% confidence interval = 0.44, 0.70). The sensitivity of high-intensity zone for detecting Grade 4 anular disruption and exact pain was poor (31%) but its specificity was relatively high (90%). The positive predictive value of a high-intensity zone was low (40%) for a severely disrupted and exactly painful disc.Conclusions.The interobserver reliability of detecting a high-intensity zone and the positive predictive value of the presence of a high-intensity zone for detecting a severely disrupted and exactly painful disc were much lower than previous studies have shown. The relatively low positive predictive value may be attributable to differences in sample characteristics or procedural variations, or suggest that a high-intensity zone is not indicative of exactly painful internal intervertebral disc disruption.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A study of postural control during one-footed and externally disturbed two-footed stance among healthy control subjects and patients with chronic low back pain at the beginning of a functional back restoration program and 6 months later at follow-up examination.Objectives.To study postural control cross-sectionally among control subjects and patients with low back pain, and to evaluate the effects of functional restoration on the postural control parameters in a follow-up examination.Summary of Background Data.Deficits of motor skills and coordination have been reported in association with musculoskeletal disorders. It has been found that patients with chronic low back pain have impaired psychomotor control, but the impairment is reversible with successful low back rehabilitation. It is insufficiently known how functional activation and intensive physical training affect postural control.Methods.Sixty-one healthy volunteers (32 men, 29 women) and altogether 99 patients with low back pain participated in the study. Sixty-eight patients (33 men, 35 women) had moderate and 31 (18 men, 13 women) had severe low back pain. Postural stability was measured with a force platform. In two-footed stance, vibration stimulation on calf and back muscles was used to disturb the balance. Center point of force-velocity (cm/sec), average position shift in anteroposterior direction (cm), and maximal position shift in lateral direction (cm) were used as the parameters.Results.Reliability of all tests was acceptable. Center point of force-velocity was the most sensitive parameter and the one-footed measurement the most sensitivetest for evaluating postural stability. At the beginning, the patients with severe low back pain had poorer one-footed postural control compared with the control subjects (P= 0.0003). The subgroup of patients with moderate low back pain participated in the restoration program. The outcome of the restoration program was considered good if the disability because of low back pain (Oswestry index) decreased during the restoration program and poor if the disability increased or did not change. The one-footed postural stability remained primarily at the same level as the initial results in the control and good outcome groups, but became significantly poorer in the poor outcome group. The difference between poor outcome and control groups was statistically significant (P= 0.04).Conclusions.Impaired postural stability seems to be one factor in multidimensional symptomatology of patients with chronic low back trouble. Postural stability is easily disturbed in case of impairment in strength, coordination, or effective coupling of muscles in the lumbar and pelvic area. Patients with chronic low back pain seem to experience impairment in these functions, which should be taken into consideration when back rehabilitation programs are planned.

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 retrospective cohort study.Objective.To describe the incidence and duration of low back pain in patients from the general working population in Norway who take at least 2 weeks of compensated absence from work.Summary of Background Data.There is a growing concern about the proportion and socioeconomic consequences of work absence resulting from low back pain, and exact figures on incidence and duration of work incapacity from low back pain in the general working population are needed.Methods.Cases were identified from files of the national medical insurance system, covering 90% of all employees in Norway. A total of 89,190 patients with low back pain were identified in 1995 and 1996, based on the International Classification of Primary Care (ICPC codes L02, L03, L84 and L86). Census data were used for the denominators.Results.The estimated overall 1-year incidence was 2.27%. It was significantly higher for women (2.72%) than for men (1.91%). The incidence increased with increasing age. The median (25th-75th percentile) duration of absence for all claimants was 43 days (25th-75th percentile, 23-103). Approximately 35% of claimants returned to work after 1 month, 70% had returned after 3 months, and 85% had returned after 6 months. Thirty percent of all claimants had low back pain with radiation, and the median duration of absence for these was 59 days (25th-75th percentile, 28-152 days)versus38 days (25th-75th percentile, 21-86 days) for claimants without radiating pain (P< 0.001).Conclusion.The results of this study reaffirm the burden of low back pain to society. The data show that the prognosis for the majority of this group of patients with low back pain, even for those with radiating symptoms, is generally good. From 6 to 20 weeks after onset, however, the return-to-work curve declined steeply among the individuals studied. Approximately 42% of those still off work after 6 months had not returned to work after 12 months, and were switched to permanent disability pension or other compensation forms.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.Six months of daily low back pain ratings for 94 individuals were tested for the influence of prevailing weather conditions during the spring, summer, and fall seasons. Intergroup differences were tested for study participants who reported weather sensitivity and for those who did not.Objectives.To investigate the relation between pain ratings and prevailing weather conditions in a population with chronic or recurrent low back pain.Summary of Background Data.Weather conditions have been reported to influence pain perception in some disease states, including low back pain. Investigations of this relation in chronic or recurrent low back pain have involved varied methodologies, and conflicting results have been reported.Methods.The effects of eight weather variables reported to influence musculoskeletal pain were tested on daily pain ratings. Apost hocweather sensitivity questionnaire was used to disperse 73 individuals into groups based on perceived weather sensitivity, and group differences were tested.Results.Significant effects on pain scores were found, most notably for temperature and vapor pressure. The magnitude of the effects were small compared with autocorrelation of an individual's own pain scores. Significant differences were found between the group of individuals who were insensitive to weather conditions and that of individuals with perceived sensitivity to cold temperatures. No significant intergroup differences were found for damp, rainy conditions or changes in barometric pressure.Conclusions.Weather conditions may influence subjective reporting of low back pain significantly. Although the effects are small in magnitude, they should be considered in clinical treatment of the patient with chronic, nonspecific low back pain. Pain scores may demonstrate greater interaction with certain weather conditions in individuals perceiving sensitivity to those conditions.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID