摘要:

Twenty-one cervical facet capsules, taken from three normal human subjects, were examined to determine the type, density, and distribution of mechanoreceptive nerve endings in these tissues. Clearly identifiable mechanoreceptors were found in 17 of 21 specimens and were classified according to the scheme for encapsulated nerve endings established by Freeman and Wyke. Eleven Type I, 20 Type II, and 5 Type III receptors were identified, as well as a number of small, unencapsulated nerve endings. Type I receptors were small globular structures measuring 25–50 μm in diameter. Type II receptors varied in size and contour, but were characterized by their oblong shape and broad, lamellated capsule. Type III receptors were relatively large oblong structures with an amorphous capsule, within which a reticular meshwork of fine neurites was embedded. Free (nociceptive) nerve endings were found in subsynovial loose areolar and dense capsular tissues. The presence of mechanoreceptive and nociceptive nerve endings in cervical facet capsules proves that these tissues are monitored by the central nervous system and implies that neural input from the facets is important to proprioception and pain sensation in the cervical spine. Previous studies have suggested that protective muscular reflexes modulated by these types of mechanoreceptors are important in preventing joint instability and degeneration. It is suggested that the surgeon take steps to avoid inadvertently damaging these tissues when exposing the cervical spine.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Median frequency parameters of myoelectric signals were studied in 25 patients with osteoarthritis of the cervical spine and in 25 normal subjects. The median frequency parameters included initial median frequency and slope of the median frequency during 20%, 50%, 80%, and 100% of maximum voluntary contractions (MVC). The subjects performed sustained, isometric constant-force controctions of forward and backward bend of the cervical spine. The median frequency signals were obtained from the anterior (sternocleidomastoid) and posterior (upper trapezius) neck muscles. The results showed that at moderate and high forces (i.e., 50%, 80%, and 100% MVC) the anterior neck muscles in patients with osteoarthritis of the cervical spine fatigued faster than those of normal subjects. The posterior neck muscles in patients fatigued faster compared to normal subjects at high force levels (i.e., 80% and 100% MVC). This indicates a higher fatigue of the anterior and posterior neck muscles associated with arthritic changes of the cervical spine. Rehabilitation programs must consider these muscular changes to obtain optimal outcomes.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Follow-up at an average time of 7.8 years postoperatively on open-door expansive laminoplasty [EL] was carried out to determine the long-term results of surgery. Thirty-three patients had ossification of the posterior longitudinal ligament and 18 had cervical spondylotic myelopathy. The average age at operation was 54.7 years. Japanese Orthopaedic Association scores and recovery rates increased during the 3 years after surgery and then plateaued. Radiographically, average spinal canal diameter remained enlarged past 5 years' follow-up. Factors leading to worsening of clinical symptoms included age greater than 60 years (4 patients), loss of sagittal canal diameter (2 patients), progression of ossification (4 patients), and minor trauma (1 patient). Postoperative motor paresis due to C5 and C6 root damage recovered to 4 (manual muscle testing) in all patients within 6 years. The conclusion is that open-door EL is safe and leads to good results that are maintained for over 5 years.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The safety of an anterolateral cervical fusion, which facilitates stabilization without sacrifice of the anterior longitudinal ligament, recently has been brought into question. The purpose of this study was to assess the effect of an anterolateral cervical fusion on spinal cord blood flow and motor and sensory-evoked potentials in the presence of an incomplete spinal cord injury. In 12 sheep, a spinal cord injury was produced by the rapid inflation of an extradural balloon catheter; six of the animals had a cervical fusion. There was no significant difference in spinal cord blood flow or evoked potential responses obtained from the sheep that had an anterolateral cervical fusion, compared with the sheep that did not. Based on these results, it seems unlikely that this surgery has an adverse effect on recovery from spinal cord injury in the absence of operative mishap.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A retrospective study was undertaken to characterize and compare the perioperative course of 91 cases of one- and two-stage combined anterior and posterior spinal fusions over a 7-year period. The two patient populations were similar regarding preoperative characteristics and the number of levels fused. Significantly decreased operative and anesthesia time, operative blood loss, and postoperative hospital days were seen in the one-stage population compared to the two-stage cases (P< 0.05). For the spinal deformity subgroup, a longer chest-tube duration, decreased anesthesia time, and decreased postoperative hospital stay in the one-stage group were the only significant differences. Surgical treatment delays were noted in 8% of one-stage cases and in 23% of two-stage cases. Complications occurred in 53% of all cases, with a significantly higher major complication rate in patients with preoperative medical comorbidities who underwent two-stage combined fusion versus one-stage reconstruction. Higher complication rates were also associated with an age greater than 40 years, the presence of medical comorbidities, and cases treated with a thoracoabdominal anterior approach.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Advances in medicine, including diagnostic techniques and therapeutic procedures, have resulted in the ambulatory management of many diseases. A number of surgical procedures previously considered to require hospitalization now are offered on a routine basis as an outpatient or short-stay admission. Although the use of microdiscectomy for the treatment of virgin herniated disc in ambulatory patients has been reported in very limited numbers, it has not been applied to other problems, such as recurrent hemiated disc, far lateral disc, or foramenal stenosis. In addition, it only has been used in optimal patients. The authors analyzed a diverse group of patients who underwent outpatient microdiscectomy and found, for most patients studied, hospitalization was not necessary. Seventy-four patients were prospectively studied to determine whether unilateral root decompression for disc or stenosis could be accomplished on an ambulatory basis. Ninety percent of the patients were able to be discharged on the day of surgery. There was no significant morbidity related to the ambulatory approach. The authors also found a significant cost savings for third party reimbursers.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Fourteen patients with a previous lumbosacral fusion underwent neural decompression and fusion of a degenerated adjacent motion segment. The most common level was L3–L4, and there was an average of 3.2 (range 1–7) previous lumbosacral surgical procedures. The average interval from the first fusion until operative intervention on the degenerated adjacent segment was 11.5 years (range 3–29 years). Five patients had an uninstrumented fusion, of which only one progressed to arthrodesis. Three of these five patients with pseudarthrodsis after uninstrumented fusion—and the remaining nine patients—had fusions with instrumentation. Ten of twelve instrumented fusions progressed to solid arthrodesis. The pseudarthrosis rate of 80% was decreased to 17% with the use of supplemental instrumentation. There was a significant number of complications and poor results, especially in patients with advanced osteoporosis and those with a short interval between adjacent segment degeneration, respectively. Eleven of 14 patients reported some postoperative pain relief.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Posterior and posterolateral spinal fusion with the Steffee variable plating system have been performed on 176 patients at Walter Reed Army Medical Center since November 1985. This report covers the authors' early experience using the Steffee device on 39 patients. All of the 39 patients (100%) were available for a minimum follow-up of 2 years. Complications occurred in 26% of the patients. Radiographic pseudarthrosis occurred in 8% of the patients. The findings suggest that lumbar and lumbosacral fusion supplemented with Steffee plate instrumentation are associated with a low incidence of pseudarthrosis and acceptable morbidity overall.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Of 112 patients who entered the Medical Research Council's prospective study on the surgical management of spinal tuberculosis, 105 were available for review at a mean follow-up of 15.3 years postoperatively. All these patients were age 18 years or more at the time of surgery. Seventy-one patients had radical surgery; the remaining 34 underwent debridement surgery. The longitudinal changes in spinal deformity were evaluated using kyphus and deformity angles from lateral spinal radiographs obtained at praoperative evaluation, postoperatively at 6 months, 1 year, and 5 years, and at final follow-up. The mean kyphos and deformity angles showed correction after radical surgery at 6 months' evaluation; thereafter there were minimal varlations up to final follow-up. Those who underwent debridement surgery showed an increase in these angles at 6 months postoperative evaluation; thereafter there were practically no changes in thoracic and thoracolumbar tuberculosis, whereas in lumbar tuberculosis there was spontaneous correction from 1 year post-surgery onward. The changes in mean kyphos and deformity angles at 6 months postoperative evaluation from their preoperative values were significantly different between the two surgical groups, where radical surgery produced better correction. Thus, the choice of surgery—radical or debridement—is important in determining the fate of spinal deformity in the management of tuberculosis of the spine.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The contoured anterior spinal plate (CASP) was developed for secure fixation of the anterior thoracolumbar spine. This is a report of 38 patients with various spinal pathologies treated with this system. The results were excellent regarding plate fixation and fusion. Comments on surgical technique and indications are provided.

ISSN:0362-2436    

出版商:OVID    

年代:1994

数据来源: OVID