摘要:

A retrospective review of 17 immature patients who underwent posterior spinal fusion of C1–C2 or C1–C3 was performed to establish the efficacy of the procedure, to determine the incidence of complications, and to identify those at high risk for complications. All had radiographic C1–C2 instability or dislocation. Etiologies included os odontoideum, fixed rotatory subluxation, atlantoaxial subluxation, type II dens fracture nonunion, and nonunion of a Hangman's fracture. Before surgery, 10 patients were neurologically intact, and seven had neurologic findings. Associated diagnosis included Down's syndrome in three and Ehler–Danhlos in one. Follow-up averaged 25 months. One neurologically intact patient had a C2 radiculopathy that resolved by 1 year. Three patients with Down's syndrome had complications: one with a preoperative Brown-Sequard syndrome had transient worsening in the immediate postoperative period, one with a preoperative myelopathy developed a late recurrence of a severe myelopathy that required odontectomy, and another sustained an intraoperative spinal cord contusion followed by postoperative quadriplegia and death due to respiratory failure. Of seven reporting neurologic symptoms before surgery, two had residual deficit in the late postoperative period. These two represented preventable technical errors. There were two nonunions, one of which required occiput to C2 fusion. In general, posterior spinal fusion of the upper cervical spine was found to be a reliable, safe, and predictable procedure, but extra caution should be employed when considering arthrodesis in patients with ongoing spinal cord compression, fixed dislocations, and inherited ligamentous laxity.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Forty-seven operations for posterior fusion of the upper cervical spine were reviewed for complications. Alarmingly, only 11 patients had an entirely uncomplicated course. Most complications were minor, but there were four nonunions, one requiring reoperation. Although seven patients had increased neurologic deficits after surgery, only one was permanent. There was one death due to technical error. Patients with significant instability, myelopathy, prior failed fusions, or unreducible dislocations are at high risk for perioperative neurologic complications.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Nine patients who had os odontoideum with posterior atlantoaxial instability are reviewed. Three parameters were measured on the lateral radiographs: the distance from the os odontoideum to the spinous process of the axis in extension (Dext), the distance from the os odontoideum to the posterior arch of the atlas (Datl), and the degree of instability (Inst). Patients were classified into four groups: Group I, local symptoms (N = 3); Group II, transient myelopathy (N = 0); Group III, progressive myelopathy (N = 6); and Group IV, cerebral symptoms (N = 0). The development of cervical myelopathy was not related to degree of instability but to distance from the os to the spinous process of the axis (Dext). Dext was more than 16 mm in Group I and less than or equal to 16 mm in Group III. Five of six patients in Group III underwent myelography. Based on myelographic findings, Group III was further subdivided into two groups, Group IIIA (N = 2) and Group IIIB (N = 3), according to the following characteristics: In Group IIIA, the distance from the os to the posterior arch of the atlas was more than 13 mm, and the spinal cord was impinged between the os odontoideum and the lamina of the axis in extension and reduced in flexion. In Group IIIB, Datl was less than or equal to 13 mm, and the spinal cord was compressed at the level of the atlas during flexion and extension. Stenotic Datl of 13 mm or less specifically defined severe cervical myelopathy. Surgical treatment for cervical myelopathy in os odontoideum with posterior instability is suggested as follows: in the absence of canal stenosis of the atlas (Group IIIA), atlantoaxial fusion in a reduced position is indicated; when associated with canal stenosis of the atlas (Group IIIB), laminectomy of the atlas followed by occiput-to-C2 arthrodesis is indispensable.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Many patients with “whiplash syndrome” experience unrelenting neck stiffness and pain. This abnormal muscular tension is postulated to be causally related to a central disorder of postural control, which has evolved secondary to injury of the inner ear labyrinthine structures. Moving platform posturography was used to demonstrate the presence or absence of a static or dynamic equilibrium disorder in 48 patients who had experienced the oscillation forces induced by a rear-end automobile collision. Other vestibular tests were used to document dysfunction of the semicircular canals and the otolith structures. A high percentage of patients were found to have faulty inner ear functioning leading to inefficient muscular control of balance and erect posture. Active perilymph fistulas were identified at surgery in seven patients.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

An magnetic resonance imaging artifact that simulates hypertrophic bone formation is described in patients who have had an anterior cervical discectomy. The magnetic resonance images of 26 patients with anterior cervical discectomy were retrospectively reviewed. Comparison was made to the available concurrent computed tomographic scans, computed tomographic myelograms, and operative reports. A bovine spine was drilled with a drill only at one level and with a metal suction tip in close proximity to the drill at another level, and magnetic resonance images were obtained. Artifact was present in 12 patients and absent in 14; this was confirmed in the 8 patients with comparison studies. Close correlation was seen with the prospective reading of the presence of artifact and operative drill use and the absence of artifact and no operative drill use in the seven patients with available operative reports. The bovine spine model showed no artifact at the drill-only level and significant artifact at the level where the metal suction tip was positioned next to the drill. Small metal flecks were seen grossly at the second level, but not on plain roentgenograms. The metallic magnetic resonance artifact seen in postoperative cervical spines is probably from small bits of metal from the metal suction tip as it occasionally hits the drill. Bone abnormalities seen on magnetic resonance imaging at the level of a previous anterior cervical discectomy may need a cervical computed tomogram to confirm the findings.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A consecutive series of 87 patients undergoing Smith–Robinson anterior cervical fusion were analyzed. Either freeze-dried tricortical iliac crest bone or tricortical autograft bone was used. Surgical technique was otherwise identical. Radiography showed delayed union at 3 months in 13% of patients with autograft and in 37% of patients with freeze-dried allograft. At 1 year, radiography showed nonunion in 8% of patients with autograft and in 22% of patients with allograft. One-level procedures had a delayed union rate of 7% for autograft and 21% for allograft. Nonunion in one-level procedures was 5% for both autograft and allograft. For two-level procedures, the nonunion rate was 17% for autograft and 63% for allograft. Graft collapse was more commonly seen with freeze-dried allograft (30%) than with autograft (5%). Relief of neck and arm pain, however, was similar in both groups.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study examined the ability of somatosensoryevoked and dermatomal-evoked potentials to predict motor return after acute spinal cord injury. Fifty-seven of 102 patients who were studied with somatosensory-evoked potentials and dermatomal-evoked potentials were followed for more than 1 year, and their initial electrophysiologic studies were correlated with motor improvement. No patient with a complete spinal cord injury on initial physical evaluation ever developed motor return. An initial examination demonstrating incomplete spinal cord injury heralded a result of walking or better in 56.4% of incomplete patients with spinal cord injury. Both the initial physical examination and evoked potentials were reasonable predictors of further motor improvement. However, evoked potentials added little or no useful prognostic information to the initial physical examination in either complete or incomplete spinal cord injury patient groups.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Axial computed tomographic scans were used to guide percutaneous needle biopsies in 76 patients with thoracic and lumbar spinal lesions. Prebiopsy evaluation included spine radiographs, radionuclide bone scans, computed tomographic scans, magnetic resonance imaging scans in some cases, and coagulation studies. Forty-five patients were diagnosed as having metastatic lesions, 11 infection, and 12 primary bone tumors. Of all patients, 34 had lytic vertebral lesions with significant collapse and questionable spinal stability. Six of those had a concomitant paravertebral mass. A clinical and pathologic correlation was completed for each of the cases studied. Histologic diagnosis confirming the clinical suspicion was obtained on the first biopsy attempt in 65 (86%) of the 76 cases.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Five intraspinal synovial cysts in four patients were evaluated with noncontrast magnetic resonance imaging and magnetic resonance imaging with the contrast agent gadolinium diethylenetriaminepentaacetic acid. Useful findings included demonstration of both solid and cystic components, early enhancement of the solid component and cyst periphery, delayed enhancement of the cyst, persistent enhancement of the solid component and cyst capsule, enhancement of the apophyseal joint, and recognition of a possible connection between the cyst and apophyseal joint. Although computed tomographic findings of synovial cysts are quite characteristic for the diagnosis in most cases, contrast magnetic resonance imaging may provide additional information for a more definitive diagnosis.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Aspergillosis involving either the vertebral body or the intervertebral disc is a rare cause of osteomyelitis of the spine. The following is a report of five cases of Aspergillus fumigatus infection of the spine treated successfully with amphotericin B and 5-flucytosine. In three patients, the diagnosis was established at closed-needle biopsy; two patients with paraplegia had an anterior decompression and fusion. The follow-up period ranged from 19 to 48 months.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID