ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The traditional halo-vest rigidly grips the cranium, but not the torso. Unexpectedly large motion and forces in the cervical spine have been shown by others to be present during halo-vest wear. In an effort to reduce these motions and forces, an experimental vest has been designed. Motion of the vest on the thorax has been measured on four normal volunteers, for each of nine load types, for each of seven commercially available vests as well as the experimental vest. Despite its lighter weight and less cumbersome structure, the experimental vest has the lowest mobility score of all the vests tested.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Anterior stabilization with combined plate and bone fusion was performed after neural decompression on ten patients for spondylotlc cervical myelopathy, and for radiculopathy or trauma In three patients. Medial corpectomy was performed at one to four levels. Iliac crest or flbular bone grafts were secured by plates anchored to the graft and adjacent vertebral bodies. All patients were placed In Minerva braces postoperatively. There was successful fusion In all cases, and no graft dislodgement or kyphosis. Early Initiation of rehabilitation was achieved. Morbidity occurred In patients with severe spondylotic cervical myelopathy. This Included respiratory depression requiring relntubatlon In 2/13 procedures, dysphagia (2/13) from loosening of the screws or prominent hardware and graft, and screw loosening (2/13). Neurological Improvement was present In 85% (11/13) of patients. There was no deterioration of neurological function in any case. We conclude from this early follow-up that anterior bone fusion with supplemental plates provides effective stabilization for the unstable cervical spine. Greater morbidity risk exists in patients with severe spondylotic cervical myelopathy and spastic quadriparesis who required multilevel medial corpectomies and fusion.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

There are people who have no history of scoliosis who develop spinal deformity of a progressive nature as adults, associated with severe degenerative disc disease. The clinical syndrome associated with this deformity is not well documented. In an attempt to describe this clinical syndrome more precisely, 21 patients with the diagnosis of degenerative scoliosis were identified and reviewed. Review included history with pain drawings when available, physical examination, bone densities, and standing spinal roentgenograms. Patients with spinal compression fractures, spondylolyses, prior history of scoliosis or radiographic findings consistent with an idlopathic scoliosis were excluded. Our review shows that these patients can develop, along with progressive scoliosis, loss of lumbar lordosis with a resulting flat back deformity. These patients commonly present in the sixth decade with a predominantly stenotic symptom complex, but often lack the classic feature of relief in a sitting posture. The number of male and female patients was approximately equal. Roentgenogram findings show a high angle deformity over a short number of spinal segments and an absence of bony features associated with idlopathic scoliosis such as lateral vertebral wedging and alterations of the lamina. The Incidence of this condition remains to be established.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A dual hook system devised by Bobechko for use with Harrington and Moe distraction rods to eliminate postoperative orthotic support was employed In the surgical treatment of 57 patients with progressive scoliosis. Mean follow-up time was 33 months (range 15 to 56 months). Average correction was 51%, with an average loss of correction of 8°. Five patients required reinstrumentation, two of whom had dislodgement of both upper hooks during the first postoperative week; the other three had rod breakage which occurred 3 to 20 months after surgery. The results indicate that the dual hook system provides greater security of fixation than a single hook construct, but has the disadvantage of bulkiness, making it prominent in thin patients. Postoperative protection with bracing for 6–9 months continues to be recommended to guard against Instrument failure.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

An analysis of indications, techniques, results of stabilization and decompression of 100 consecutive spinal tumour cases was carried out. Localized metastatic disease is best operated anteriorly. Primary malignancies are best treated withen biocresection. Pain relief in metastatic disease is achieved by rigid stabilization. The unstable spine secondary to benign or malignant disease often requires stabilization for alleviation of pain; 132 stabilization procedures were performed in 100 patients. There were nine benign and 91 malignant tumors Including 71 metastatlc. Indications for stabilization were pathological fracture or following decompression. Anterior approaches including implant stabilization were used in those with metastatic disease limited to one to two levels or where significant kyphosls existed. Posterolateral decompression with Luque rod stabilization was indicated where disease was more widespread. In metastatlc disease acrylic cement was used both anteriorly and posteriorly together with implant stabilization. Eighty-one percent had good to excellent relief of pain; 68 patients had neurological deficits. Significant neurological return was achieved in 40% of posterior decompressions and 71% of anterior decompressions in metastatic disease. All patients with benign tumors have solid fusions. In malignant disease the use of cement provided stability without loss of fixation in 87 of 91 procedures. Complications were 4% Infection and failure of two Harrington rods without wiring, one Luque rod and two anterior constructs. The average longevity of patients treated for metastatlc disease was 11.3 months.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fifty-four patients were treated by a standardized single stage anterior opening wedge and a posterior closing extension wedge osteotomy for back pain associated with postoperative loss of lumbar lordosis (iatrogenic flat back syndrome). Presenting complaints were fatigue, pain and a stooped posture. Etiological factors were, in descending order of frequency, distraction instrumentation with the lower end at the L5 or S1 vertebra, thoracolumbar junction kyphosis greater than 15°, especially if associated with a hypokyphotic thoracic spine, and degenerative changes above and below a previous fusion. Kostuik-Harrington Instrumentation was used anteriorly for the opening wedge and Dwyer cables and screws together with a midline plate were used posteriorly for the closing extension osteotomy. Malunion occurred in three patients, one requiring recorrection. Pain relief occurred in 48 (90%). Neurological complications occurred in two patients, one with permanent deficient. Follow-up averaged 4 years. Average preosteotomy lordosis L1–S1 was 21.5° and was restored to 49° (equal to the lordosis before the initial surgery) for an average correction of 29°, (range 24° to 63°). Prevention of this complication can be accomplished by maintaining normal lordosis at the time of initial surgery

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

An experimental investigation was carried out to create burst fractures and to evaluate the mechanisms and degree of reduction of the intracanal fragment with posterior instrumentation techniques in multisegmental human cadaver specimens. Reduction of the spinal fragment through kyphosis correction and distraction was evaluated using CT imaging. With kyphosis correction alone there was no decrease in canal compromise; in some cases there was a slight increase in canal compromise. Distraction, whether applied before or after kyphosis correction was the effective mechanism in reducing the fracture fragment. Kyphosis correction applied after distraction did not reduce the fragment further. Posterior devices that are used to treat burst fractures of the thoracolumbar spine with intracanal fragments should provide some form of distraction.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The effect of cross linkage on theIn vitrostability of paired Harrington distraction rods was studied in an unstable fracture model using calf spine segments. Cross linkage used in conjunction with sublaminar wires significantly improved torsional stability, improved lateral bending stability, and had no adverse affect on stability for axial, forward flexion, or extension loading compared to rods alone, rods with bridges, and wired rods.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Sixteen patients were treated with a new anterior internal fixation device after thoracolumbar or lumbar decompression, and fusion with bone grafting. Ten patients had acute burst fractures, four had metastatic tumors, and two had old, healed fractures with deformity. In the acute fracture group, eight patients had neurologic deficits and seven patients experienced improvement. Six patients had lesions of the conus medullarls, all of which improved. The four patients with metastatic tumors underwent surgery for back and leg pain and all gained significant relief. Two patients had correction of old fracture deformity with satisfactory outcome. Complications were minimal. The new anterior stabilization device provided early stability, allowed early patient mobilization, was easy to insert, and has a low profile. Late collapse, non-union, and kyphotic deformity have not been noted thusfar.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID