ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The authors surveyed the Cervical Spine Research Society to compile a series of esophageal perforations following anterior cervical spine surgery. Twenty-two cases were assembled. Six occurred at the time of surgery, 6 in the postoperative period, and 10 weeks to months later. Eight surgeries were because of fracture. Hardware was implicated In 25% of cases occurring after surgery. Diagnosis was confirmed most often by direct vision at reexploratlon or esophography. Treatment usually consisted of drainage, repair, and parenteral antibiotics; 2 cases were successfully treated by enteral feeding and antibiotics alone. There was one fatality, and all patients required prolonged hospitallzatlon. Cervical fracture and the use of hardware may be associated with this complication. Clinical suspicion and esophography are important diagnostic tools. Drainage and parenteral antibiotics are recommended treatment.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In 1969 the authors started their prospective study to determine the natural history of atlanto-axial subluxation in patients suffering from rheumatoid arthritis. Between January 1969 and July 1971 they accumulated 41 cases of atlanto-axial subluxation. These patients were studied clinically and radiologically, and the initial findings were published In theJournal of Bone and Joint Surgery,Volume 55B, August 1973. All of these patients were followed clinically and radiologically until 1981 or until their demise. Roentgenographically, 61% have remained unchanged, 27% have shown progression of the atlanto-axial subluxation, and 12% showed decrease in the amount of atlanto-axial subluxation, Including one following surgery. During this 10-year period, 12 patients with atlanto-axial subluxation have died, two with historical evidence of neurologic damage. The remaining 10 patients have died from unrelated causes. Only 3 patients underwent surgical stabilization. This study concluded that the atlanto-axial subluxation is compatible with life, but some patients require surgical intervention.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Thirty-four patients with atlanto-axial instability due to rheumatoid arthritis were examined with plain x-ray views and functional magnetic resonance imaging (MR), and were neurologlcally evaluated. Transcranial brain stimulation was performed in 25 patients. In 22 cases, the authors observed inflammatory tissue thicker than 3 mm behind the odontoid peg. The spinal canal diameter was significantly decreased in the flexed position. Nine patients showed signs of cranial migration of the axis. The diameter of the spinal cord was measured to be 7.4 mm in the neutral position, and 6.5 mm in flexion. The difference between the diameter of the neutral and flexed positions was highly significant. Twelve of the 34 patients displayed clinical signs of cervical myelopathy, and 13 showed a significant delay of central motor latency, as calculated from the motor evoked potentials. Surgical Intervention, either by a posterior approach only or combined with a transoral dens and inflammatory tissue resection, is recommended in patients with progressive atlanto-axial instability, pathologic clinical and neurophysiologic findings, and a spinal cord diameter of less than 6 mm in flexion. Severe pain and cranial migration of the axis, as measured by the MRI, also justify a surgical Intervention.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Seventeen cases of Anderson and D'Alonzo Type II and “shallow” Type III fractures of the odontoid, treated by anterior screw fixation, were reviewed and compared with previously published series of fractures treated nonoperatively, treated with posterior C1-C2 arthrodeses, and with anterior screw fixation series. Although the nonunion rate (12%) and major complication rate (24%) In the present series were higher than those previously reported, the combined rates of all anterior screw fixation series were comparable to those of posterior C1-C2 arthrodesis studies. Three of the complications presented occurred In cases that In retrospect were inappropriate for the use of this technique. These included a verified nonunion and 2 individuals with markedly osteoporotic bone and unfavorable fracture type. Because of the difficulty involved In mastering anterior screw fixation of the dens, Its use should be limited to experienced spine surgeons with the appropriate surgical facilities.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Metastatic lesions of C1 and C2 most frequently present with severe pain and only rarely with neurologic involvement. The lesions are poorly visualized on plain roentgenogram and most often require bone scan and/or computed axial tomography (CAT) scan for definitive diagnosis. Delay in diagnosis is frequent in these patients (8 of 16). Radiation therapy and external mobilization yield satisfactory results for minor fractures or diffuse involvement without instability. Surgery is rarely indicated for decompression. However, in patients with C1 lateral mass involvement or severe C2 body destruction with instability, posterior stabilization gives excellent relief of pain. Onset after diagnosis of the primary tumor ranges from months to years. Survival is reasonable (mean, 9 months) after diagnosis of upper cervical spine Involvement. Understanding these characteristics and the occurrence of metastatic disease in the upper cervical spine allows earlier diagnosis with appropriate radiographic studies and prompt palliation of symptoms.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Motor evoked potential (MEP) produced by transcranlal electrical stimulation was recorded from an epldural electrode In 20 consecutive patients during upper cervical spine surgery. In 5 patients, transient attenuation to approximately 50% followed by complete recovery was observed, and no neurologic deficit was noted. One patient had complete loss of MEP and was left a respiratory quadriplegic. In 2 cases, MEP amplitudes increased after tumor extirpation and remarkable remissions were observed. The MEP correlated with clinical outcomes and was a useful monitoring technique for upper cervical spine surgery, free of complication. In cat experiments designed to analyze conducting pathways, the maximal amplitude of the initial spike of MEP existed In the ventromedlal spinal cord, which contains the extrapyramidal tracts. Motor evoked potential was proven to reflect motor function based on the spinal cord compression study.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Ascending myelopathy of the cervical spine is a clinical condition in which ascending paralysis manifests itself from 24 hours to 4 weeks after the initial Injury. One hundred thirty-four patients with spinal cord injury were reviewed; 80 underwent surgery and 54 were treated conservatively. Ten of the 54 patients who did not have surgery ascended one to four levels, whereas only 4 of the 80 patients who underwent surgery ascended to similar levels. Myelography demonstrated diffuse swelling of the cord that extended approximately two segments above and below the in|ured vertebrae. Magnetic resonance Imaging showed intrathecal hemorrhage within the first 2 weeks followed by cord atrophy within 4 weeks after the initial trauma. Thorough decompression of the cord with rigid internal fixation markedly reduced the Incidence of this complication.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID