ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A case report is presented.Objectives.To report a rare complication of delayed cement displacement following percutaneous vertebroplasty.Summary of Background Data.Although percutaneous vertebroplasty is considered a minimally invasive procedure, it may result in several complications. To our knowledge, this is the first report of delayed cement displacement after percutaneous vertebroplasty.Methods.A 69-year-old man with T12 osteoporotic compression fracture received percutaneous vertebroplasty. One month after surgery, the patient complained of progressive severe back pain, and roentgenographic image revealed a breakdown of the anterior cortex of the T12 vertebral body with anterior displacement of the bone cement.Results.The complication was solved by one stage anterior and posterior operation: thoracoabdominal approach with removal of the displaced cement and posterior instrumentation from T11 to L1. The severe back pain with associated weakness improved after surgery.Conclusions.This complication is rare and likely to occur in treatment of osteoporotic vertebral fracture with avascular necrosis and anterior cortical defect.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A case of internal carotid artery impingement by the tip of a well-positioned C1–C2 transarticular screw is presented along with a pilot study involving radiologic and anatomic evaluation of human cadaveric specimens.Objective.To raise awareness that the internal carotid artery may be in close proximity to the anterior aspect of the atlas and at risk of injury during placement of C1–C2 transarticular screws or C1 lateral mass screws.Summary of Background Data.To our knowledge, no cases of internal carotid artery injury or impingement have been reported with screw fixation of the atlas.Methods.A case of internal carotid artery impingement by a C1–C2 transarticular screw is presented. The C1–C2 rotation appeared to place the internal carotid artery in the path of the screw, prompting a pilot study. Three fresh-frozen human cadaveric head and neck specimens were fixed in different degrees of rotation. Thin-section computed tomography of the specimens was obtained in the plane of the atlas. The frozen specimens were sectioned in the same plane as the computed tomography images. Measurements were taken to assess the location of the internal carotid artery relative to the anterior aspect of the atlas.Results.Cervical rotation does not have a predictable effect on the location of the internal carotid artery. Medial angulation of a screw placed in the lateral mass of C1 appears to increase the margin of safety for the internal carotid artery. The internal carotid artery varies in location and may be within 1 mm of the ideal exit point of a bicortical transarticular screw or a C1 lateral mass screw.Conclusions.The internal carotid artery is at risk during bicortical screw fixation of the atlas. We recommend a contrast-enhanced computed tomography to assess the location of the internal carotid artery before screw fixation of the atlas.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.In vitrobiomechanical assessment of spinal stability after corpectomy reconstruction.Objectives.To gain a more thorough understanding of the biomechanical properties of anterior plateversusdual rod systems used for anterior lumbar corpectomy reconstruction.Summary of Background Data.Vertebral corpectomy is commonly required in the treatment of several types of spinal pathology (fracture, tumor, infection). Stabilization with strut allograft and anterior instrumentation can be accomplished with one of several anterior implant systems. These include plate systems and rod-based systems with theoretically different structural properties.Methods.Two instrumentation systems, the ATL Z-plate and the Antares system, were each applied to 10 calf lumbar spines with a cortical strut graft reconstructing an L3 corpectomy defect. All spines were tested biomechanically to determine construct stiffness under physiologic loads in multiple planes and then tested in torsion to failure.Results.There was greater stiffness (P< 0.05) in all directions of bending (flexion, extension, lateral bending) for the Antares dual rod construct compared to the Z-plate constructs. No significant difference was noted in either torsional testing under physiologic loads or torque to failure between the groups.Conclusions.Although there was significantly greater resistance to bending with the dual rod construct, the ultimate selection of a system will require an individual analysis of implant profile, construct demand, and ease of use. Both systems provided secure initial fixation following lumbar corpectomy; however, the Antares system may increase the likelihood of graft incorporation in cases with greater instability and higher load demands.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Compare the effectiveness of two different techniques for the management of osteoid osteoma of the spine.Objective.To describe the technique, feasibility, and indications of two different minimally invasive surgical methods for the treatment of osteoid osteoma of the spine.Summary of the Background Data.Current treatment of osteoid osteoma of the spine is usually conventional surgical excision. The successful treatment of osteoid osteoma of the appendicular skeleton by percutaneous radiofrequency probe ablation is known; however, there have been only a few cases reported utilizing this method to treat osteoid osteoma of the spine. The high success rate of percutaneous transpedicle vertebral biopsy and diskectomy led us to believe this technique can also be applicable for the treatment of osteoid osteoma of the spine.Methods.Two patients with symptomatic osteoid osteoma of the spine underwent two different surgical managements with local anesthesia. In one patient, the osteoid osteoma was localized in the apex of the right L4 superior articular process joint. Under computed tomography guidance he underwent radiofrequency coagulation with the use of a radiofrequency generator at 90° for 240 seconds. The lesion in the second patient was located in the right pedicle of the T9 vertebra close to the exiting nerve root and was cored out by means of a special percutaneous instrument designed for percutaneous biopsy under fluoroscopic guidance.Results.Both patients experienced immediate relief of pain, resumed their regular activities, and also remained free of symptoms after the 2.5- and 3-year follow-up.Conclusion.Minimally invasive surgery can successfully be applied in the treatment of osteoid osteoma of the lumbar spine. When the nidus is not adjacent to the neural elements radiofrequency thermal ablation can be an effective and safe treatment of osteoid osteoma in the spine.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Report of a family affected with X-linked spondyloepiphyseal dysplasia tarda with special respect to radiologic alterations of the spine from puberty to the forth decade and to molecular analysis of the underlying genetic defect.Objectives.To report the typical radiologic presentation of patients with X-linked spondyloepiphyseal dysplasia tarda and the diagnostic tool of mutation screening for that disease in order to avoid confusion with similar occurrences.Summary of Background Data.Spondyloepiphyseal dysplasia tarda is a genetically heterogeneous disorder that frequently manifests itself with back pain starting around puberty. The X-linked recessive form (X-linked spondyloepiphyseal dysplasia tarda) affects males and is clinically characterized by an arm span markedly exceeding total height, a barrel chest deformity, and early development of degenerative joint disease. The disorder is caused by mutations in theSEDLgene located on Xp22.12-p22.31.Methods.Radiologic alterations of the cervical, thoracal, and lumbar spine were assessed in the affected family members and one suspected female carrier in correlation to age. All 6 exon codings for theSEDLgene were analyzed by primer cycle sequencing.Results.In 3 male patients from a French family, we identified a 5 base pair deletion inSEDL, exon 5 at position 267–271 (delAAGAC). Carrier status for the mutation could be confirmed in one female member of the family, which is inconspicuous in terms of spine and joint diseases. Radiologic abnormalities of the patients comprised generalized platyspondyly, a hump-shaped deformity of cervical, thoracal, and lumbar vertebral bodies as well as signs of retrospondylophytes, osteochondrosis, and spondylarthrosis.Conclusions.X-linked spondyloepiphyseal dysplasia tarda should be kept in mind as a differential diagnosis in men with early onset of back pain and radiologic abnormalities of the vertebral bodies comprising platyspondyly and a central hump.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Three-year follow-up of a prospective randomized trial in 97 patients exposed to whiplash trauma in motor vehicle collisions.Objectives.To compare the long-term efficacy of active intervention with that of standard intervention and the effect of earlyversusdelayed initiation of intervention.Summary of Background Data.There is no strong evidence for many treatments for whiplash-associated disorders. Some studies provide weak evidence supporting active intervention.Method.Patients were randomized to an intervention using frequent active cervical rotation complemented by assessment and treatment according to McKenzie’s principles or to a standard intervention of initial rest, recommended soft collar, and gradual self-mobilization. To test the time factor, interventions were either made within 96 hours or delayed 14 days from collision. The effects of the two interventions and the time factor on pain intensity, cervical range of motion, and sick leave were analyzed at 6 months and 3 years. Cervical range of motion at 3 years was also compared with that in matched, unexposed individuals.Results.Pain intensity and sick leave were significantly (P< 0.05) reduced if patients received active intervention compared with standard intervention. Delaying intervention 2 weeks did not affect outcome variables. However, at 3 years, only patients receiving early active intervention had a total cervical range of motion similar to that of matched unexposed individuals.Conclusion.In patients with whiplash-associated disorders, active intervention is more effective in reducing pain intensity and sick leave, and in retaining/regaining total range of motion than a standard intervention. Active intervention can be carried out as home exercises initiated and supported by appropriately trained health professionals.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.This study examines the gross anatomic changes in the chicken spine after pinealectomy and was undertaken because initial observation suggested that the pattern of curve development appears to be different from that reported in the literature.Objective.To characterize the spinal deformity in chickens after pinealectomy.Summary of Background Data.The most common curve pattern seen after pinealectomy in chickens is said to be thoracic curves with structural changes and rotation. This is based largely on radiographic observations and forms the basis of the claim that chicken and human adolescent idiopathic scoliosis are similar.Method.Thirty-five chickens were divided into 2 groups, a pinealectomy group (n = 25) and a control group with no surgery performed (n = 10). The spines were harvested at 3 months of age and examined visually, by radiographs and computed tomography scans.Results.Thirteen out of 25 (52%) of the pinealectomized chickens developed scoliosis. In contrast to previous studies, all the curves were located at the thoracolumbar junction with the apex at either T7 or L1. Structural changes including apical vertebral wedging, lordosis (mean of 14.3°), and rotation (mean of 14°) were seen in all cases. Pelvic wing deformity was seen in all cases and significantly contributed to the posterior rotational hump.Conclusion.The primary curve in these chickens is at the thoracolumbar junction. Previous reports of curve pattern based on radiographic findings would not have identified these as the thoracolumbar junction is obscured by the bony pelvis and heavy musculature. The finding of pelvic wing deformity has not been previously reported, and raises the question as to whether these curves are secondary to asymmetric muscle pull.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID