摘要:

Among 14 patients with unstable thoracolumbar fractures examined by both conventional radiography and CT, we found seven patients with a “new” common fracture pattern. This fracture pattern consisted of (1) superior disc injury, (2) crush fracture of the upper half of the vertebral body, (3) sagittal fracture (cleavage fracture) of the lower half of the vertebral body, (4) bone fragments in the spinal canal, and (5) laminar fracture. Five of the seven patients had sustained their injuries in vertical falls; all five had primary neurological deficit symptoms. We consider this fracture to be unstable.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The spinal mobility and sagittal configuration in 96 scoliotic patients treated according to Harrington were investigated with a Debrunner kyphometer and a Myrin inclinometer. The more distal the fusion limit in the lumbar spine, the more reduced was the lumbar lordosis and flexion. The patients' own estimation of lumbar rigidity and pain, scored on visual analogue scales, increased as the fusion limit increased distally. The results for the thoracic spine's sagittal configuration and mobility were analogous but the trend was less pronounced. The patients' estimation of thoracic rigidity had little correlation with the number of segments fused. This study shows that fusion of the lumbar spine below L3 is to be avoided, except when specifically indicated. Furthermore, the study shows that the present technique does not adequately preserve the sagittal configuration of the thoracic and lumbar spine.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior–posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location. The operated patients, the majority (76%) cosmetically pleased, functioned at the same level as age-matched controls in regard to marriage, child-bearing, sports activities, and job performance. Although, as a group, the operated patients were functionally and socially very well indeed, low-back pain was found statistically significantly more often in patients in whom fusion was carried down to L4 or L5, compared to the control subjects.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Forty-one patients with a possible diagnosis of neurogenic claudication were treated with Calcitonin for four weeks. Eleven responded with considerable improvement in their walking distance. Ten agreed to enter a randomized double-blind cross-over trial, and eight made a correct assessment. It is concluded that Calcitonin is effective in relieving symptoms of neurogenic claudication for some patients. Five patients have received the drug for over one year with no serious side effects, and two have not relapsed after discontinuing the drug. Patients likely to respond will probably have symptoms affecting both legs equally pain extending below the upper calf, limiting walking to under a mile; an abnormal myelogram; and no more than one inappropriate sign. They are more likely to be men in late middle age who have been engaged in manual work. The beneficial effect of Calcitonin is probably the result of an arterial shunt mechanism, whereby a reduction in skeletal blood flow provides for a deprived cauda equina.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

From 1973 to 1981, 94 patients suffering from low-back pain, with or without spread into the lower extremities, were candidates for therapeutic spinal cord stimulation. The etiology of pain in all cases was lumbosacral spinal fibrosis due to multiple myelographies and surgical interventions on the lumbar spine. The long-term results, based on a four-year follow-up, reveal a 60% subjective improvement of pain, a 40% substantial reduction of medication, and a 26% increase in working capacity. The concept of spinal arachnoiditis is reviewed and the term lumbosacral spinal fibrosis proposed. The treatment of this chronic painful and disabling disease is discussed.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A microcomputer was programmed to accept data on the history and physical findings of patients, with low-back pain, suspected of having a herniated lumbar intervertebral disc, then suggest a likely diagnosis, with probability, and make suggestions for further management. Formal decision analytic techniques were used to test for the threshold of diagnostic likelihood that would make the expected value of laminotomy for excision of a herniated disc greater than the expected value of non-surgical management. The program is recursive, using its results to update its data base, and become more “intelligent.” In a blinded evaluation, an expert could not detect a significant difference between the output of the computer and the diagnoses and treatment plans of ten clinicians.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Evidence based on electrical studies is presented for the standard and anomalous patterns of innervation of muscles supplied by the fifth lumbar and first sacral nerve roots.Although considerable controversy still exists, previous work in this field suggests that the L5 nerve root supplies tibialis anterior, extensor hallucis longus, extensor digitorum brevis, and the lateral head of gastrocnemius, while the S1 nerve root innervates the medial head of gastrocnemius, soleus, and abductor hallucis. In order to confirm the reliability of this data, the L5 and S1 nerve roots of 50 patients were electrically stimulated during surgery, and distally evoked responses in the relevant muscles were recorded, using surface electrodes. The results confirm the essential reliability of the proposed table of segmental innervation and also demonstrate that most muscles have a dual innervation, with one nerve root being dominant. However, eight patients (16%) exhibited a marked departure from the normal pattern. For example, it is clear that on occasion the extensor digitorum brevis and the lateral head of gastrocnemius can be supplied by S1 and the soleus and medial head of gastrocnemius can be supplied by L5.In a prospective study of 100 patients presenting with clinical evidence of lumbosacral nerve root entrapment, the level of nerve root involvement, as predicted by electromyography, was compared with the operative findings. Correct preoperative nerve root localization was achieved in 84%. At least half the failures in prediction are thought to be due to anomalies of innervation.A further study of 12 patients with disorders of bony segmentation revealed anomalous muscle innervation in seven, so that diagnostic errors may frequently be expected in this group. In clinical practice, whenever anomalous bony segmentation is encountered, the likelihood of variable nerve root innervation should be appreciated, and we recommend that both nerve roots in question should be explored at operation.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Fifty-four patients treated in a three-week in-patient rehabilitation program were randomly assigned to and accepted treatment with electroacupuncture (n = 17), TENS (low-intensity transcutaneous nerve stimulation, n = 18) and TENS-dead battery (placebo, n = 18). Outcome measures included estimates of pain (on a visual analogue scale) and disability by both physician and patient as well as physical measures of spine function. Two groups were constructed based on the absence of nonorganic physical findings (Valid group, n = 30) and the presence of two or more nonorganic physical findings out of a possible four (Invalid group, n = 10). Multivariate and univariate analyses of covariance were utilized to determine effects of treatment (acupuncture, TENS, placebo) and the effects of over-reporting (presence of excessive nonorganic physical findings). Statistically significant findings demonstrated that the acupuncture group enjoyed more relief ofpeak painand more relief ofpain on an average dayat the three-month return assessment. Additionally, the acupuncture group demonstrated greater improvement in extension trunk strength at the discharge assessment. The Invalid group were found to have a contaminating effect on the acupuncture results. Analysis also demonstrated associations between nonorganic physical findings and both personality traits (“Conversion V” profile on MMPI) and retention of an attorney. Researchers conducting clinical trials in chronic low-back pain patients should control for contamination by the presence of overreporters.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Techniques for assessing daily function in Patients with back pain are generally crude and limited in scope. We therefore examined a “health status” questionnaire, the Sickness Impact Profile (SIP) to assess its measurement characteristics in such patients. Eighty patients with mechanical low-back pain completed the SIP and a physical examination at a walk-in visit and again three weeks later. Test-retest reliability of the SIP was substantial. Biologic validity was confirmed by significant correlations with age, pain duration, spine flexion, straight leg raising, and pain severity. Validity of psychosocial subscales was confirmed by significant associations with patient anxiety and psychiatric problems. Scores changed in the expected directions when patients were evaluated three weeks later. The SIP is thus valid, reliable, sensitive to clinical changes, and comprehensively assesses a wide range of dysfunctions.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low-back and/or unilateral hip symptoms and 359 symptom free subjects. Statistically highly significant correlations of the symptoms and leg length inequality were observed. In the majority (79 and 89%), the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity. When correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved in the majority of the cases. The unilateral symptoms associated with mostly unrecognized leg length inequality of 5 to 25 mm were, at least in part, due to the biomechanical responses, like bending and rotational forces, needed for compensation of the lateral imbalance caused by leg length inequality.

ISSN:0362-2436    

出版商:OVID    

年代:1983

数据来源: OVID