摘要:

Study Design.Cadavers were dissected anatomically to identify the course of the superior laryngeal nerve relative to the spinal column.Objective.To illustrate the anatomic relation of the SLN with respect to its vulnerability during anterior cervical spine procedures.Summary of Background Data.There is ample literature referencing the superior laryngeal nerve with respect to head and neck surgery. Detailed descriptions of the anatomy of the recurrent laryngeal nerve are quite extensive in both the spine and head and neck literature. To the authors’ best knowledge, no similar reports have delineated the anatomic relation of the superior laryngeal nerve in procedures on the anterior aspect of the cervical spine.Methods.Ten dissections were carried out on human cadavers to show the course of the superior laryngeal nerve. Particular attention was directed to the internal branch of the superior laryngeal nerve to show the overall anatomic relation relative to standard landmarks. These landmarks included the superior laryngeal and superior thyroid arteries, the split of the superior laryngeal nerve, and the intervertebral disc space.Results.The superior laryngeal nerve originates from the vagus nerve in the carotid sheath and bifurcates into internal and external branches. Distally, the internal branch of the superior laryngeal nerve courses in close proximity with the superior laryngeal artery and inserts within 1 cm superior to the superior laryngeal artery into the thyrohyoid membrane. With respect to the cervical spine, the distal of portion of the internal branch of the superior laryngeal nerve is located between the C3 and C4 vertebral bodies.Conclusions.The internal branch of the superior laryngeal nerve supplies innervation to the mucosa of the larynx and has an important sensory reflex that serves to protect the lungs from aspiration. Injury to this nerve can predispose the patient to life-threatening pneumonia. It is therefore imperative for the surgeon to recognize the location and course of this nerve to avoid injuring it. Injury most commonly occurs either by excessive retraction in different planes or by accidental ligation of the nerve.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.The health-related quality of life of 226 female patients with idiopathic scoliosis was compared with that in age-matched general population norms.Objectives.To describe and characterize health-related quality of life in women with idiopathic scoliosis, taking into account age, Cobb angle, and brace use.Summary of Background Data.Scoliosis may lead to multiple physical and psychosocial impairments depending on its severity. Previous studies have assessed generic health measures, functional status, body image, and self-image. Health-related quality of life data from patients with idiopathic scoliosis are still lacking.Methods.Women with idiopathic scoliosis completed an age-appropriate health-related quality of life questionnaire (either the 36-Item Short-Form Health Status Survey, SF-36, or the Berner Questionnaire for Well-Being). The results from this sample were compared with general population norms. In univariate and multivariate analyses it was determined whether age, Cobb angle, and brace use had an impact on health-related quality of life.Results.Compared with the age-matched general population norm, juvenile patients with idiopathic scoliosis were unhappier with their lives (P= 0.001). They reported more physical complaints (P< 0.001) and had lower self-esteem (P= 0.01) and higher depression scores (P= 0.021). Adult patients reported more psychologic (P< 0.001) and physical impairment than in the population norm (P< 0.001). These results were largely independent of age and Cobb angle.Conclusion.The results show that health-related quality of life can be impaired in patients with idiopathic scoliosis. Therefore, the psychosocial situation should be taken into account in the treatment of these patients.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants.Objectives.To gain insight into the consequences of low back pain for gait and to identify clinically useful measures for characterizing the quality of walking in patients with low back pain.Summary of Background Data.Gait studies in patients with low back pain have reported a decrease in walking velocity. In normal gait, in-phase pelvis-thorax coordination (synchronicity) evolves toward antiphase coordination (counterrotation) as walking velocity increases. This study examined the effect of walking velocity on pelvis and thorax rotations in patients with low back pain.Methods.Amplitudes of pelvis and thorax rotations were calculated, and spectral analyses were performed. Pelvis-thorax coordination was characterized in terms of relative Fourier phase, and coupling strength was assessed by means of cross-spectral analysis.Results.In comparison with healthy participants, relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher, whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h. No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations.Conclusion.In comparison with healthy participants, the gait of patients with low back pain was characterized by a more rigid, less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations. This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations, and that conservative therapy should use methods aimed at improving intersegmental coordination.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.This report describes a 51-year-old woman with a sacral metastatic meningioma that originated from an intracranial meningioma.Objectives.To describe an unusual presentation of a metastatic meningioma in the sacrum.Summary of Background Data.Extracranial metastases of meningioma are very rare. The phenomenon of metastasis may have more to do with the ability to invade the wall of a blood vessel than with the mitotic activity of a tumor. Therefore, metastases of the meningioma can occur even with a benign histologic picture in the original intracranial meningioma.Methods.A 51-year-old woman had experienced low back pain and sciatica of the left leg for several months. Plain radiographs of the lumbosacral spine showed an osteolytic lesion with an irregular margin that occupied the left side of the sacrum. Magnetic resonance imaging revealed a soft mass invading the left sacrum, ilium, and presacral space.Results.Surgical removal of the sacral tumorviaan anterior-posterior-anterior approach was done. Histopathologic examination revealed a metastatic meningioma with a meningotheliomatous histologic composition. Sixteen months after excision of the metastatic sacral lesion, the patient was ambulating freely and experiencing mild constipation and urine retention.Conclusions.In this case of metastatic meningioma in the sacrum, which is the first such report to the authors’ best knowledge, total excision of the tumor was successful.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case report of a sacral stress fracture causing low back pain in an athlete.Objective.To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players.Summary of Background Data.Low back pain is common both in the general population and in athletes. Athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain.Methods.The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature.Results.In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome.Conclusion.Sacral stress fractures should be included in the differential diagnosis of athletes with low back pain, particularly runners and volleyball players. To the authors’ best knowledge, this is the first report of a volleyball player with a sacral stress fracture. A review of the literature yielded 29 cases of sacral stress fractures in athletes, mainly runners.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A prospective and controlled study of perioperative use of combined local anesthetic and corticosteroid in lumbar disc surgery.Summary of Background Data.The anti-inflammatory mechanism of corticosteroids is considered to be caused by the inhibition of phospholipase A2, which plays an important role in the pain mechanism of lumbar disc problems. Although some authors have demonstrated that the use of intramuscular bupivacaine during lumbar discectomy resulted in a marked reduction of postoperative back pain, others have reported that the key intervention was probably the administration of epidural corticosteroid. The coadministration of these two drugs in lumbar disc surgery for the relief of postoperative back pain has yet not been studied adequately.Objectives.Assessment of the combined use of perioperative corticosteroids and bupivacaine for the relief of postoperative pain after lumbar disc surgery.Methods.Forty-four selected patients had acute-onset single-level unilateral herniated nucleus pulposus that were refractory to conservative management. All patients underwent lumbar disc surgery under standard general anesthesia. Before surgical incision, the skin and subcutaneous tissues were infiltrated with 10 mL of 1% lidocaine with 1:200,000 adrenaline to produce local vasoconstriction. During wound closure, 20 mL 0.9% saline in Group 1 (n = 22) and 20 mL 0.25% bupivacaine in Group 2 (n = 22) were injected into the paravertebral muscles and subcutaneus tissues. In addition, a piece of autologous fat taken from the wound was first soaked in 40 mg of methylprednisolone for 10 minutes, then placed over the exposed nerve root, and the remaining steroid was flushed into the wound in Group 2. The wound was closed after drug administration in both groups. In the postoperative period, all patients received 100 mg of meperidine intramuscularly when needed and were allowed to receive a second dose at least 4 hours later than the first dose for postoperative analgesia. Postoperative back pain intensity, heart rate, and mean arterial pressure were assessed 1, 3, 6, and 12 hours after the conclusion of surgery.Results.Visual analog scale pain scores for the postoperative recordings were lower in Group 2 than in Group 1, but these findings were not statistically significant. Patients in Group 1 received 77.3 ± 48.8 mg meperidine, and those in Group 2 received 31.8 ± 45.5 mg meperidine, for pain medication in the first 12 hours (P< 0.05). Heart rate and mean arterial pressure were not significantly different between the two groups in all recording periods.Conclusion.It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A descriptive anatomic investigation of the vasculature of the dorsal root ganglions.Objectives.To determine whether the blood supply of the various spinal ganglions is sufficiently consistent to derive a “generic” description and illustration that would be applicable to all spinal levels, and to ascertain whether this vascular pattern is inherently predisposed to the development of a closed compartment syndrome.Summary of Background Data.The few previous descriptions of spinal ganglionic vasculature do not include photographic evidence showing uniformity in the arterial distribution plan at all ganglionic levels. The venous drainage, although verbally reconstructed from microscopic sections, lacks any indication of its probable role in the etiology of a compartment syndrome.Methods.Three perinatal cadavers received latex/India ink injections, and their removed radiculomedullary systems were cleared, transilluminated, and macroscopically photographed. Paravertebral sections were grossly removed from the spines of two adult anatomic cadavers and received retrograde venous injections of a fine suspension of barium sulfate. The intervertebral foraminal tissues were then dissected from the bone, and radiographs of them were made. For comparative reference, a nerve root/ganglion complex of a rabbit was arterially injected with a more dilute preparation of the latex/India ink suspension.Results.Macroscopic photographs of perinatal dorsal root ganglions showed that the pattern of the intraganglionic arterial distribution was sufficiently consistent to allow a graphic rendering and labeling of a “generic” ganglion. The series of incomplete retrograde venous injections adequately indicated the pressure labile location of a periganglionic venous plexus.Conclusions.The common development, structure, and function of the human dorsal root ganglions have resulted in the evolution of a uniform nutritional vascular pattern that can be conceptualized in a single visual image. Its plan of a primarily internal arterialization with a superficial venous drainage renders it vulnerable to the ischemic conditions consequent on external pressures and/or internal edematous swelling. This vascular arrangement may contribute to a propensity for the ganglion to develop a compartment syndrome when subjected to compression by periforaminal degenerative or neoplastic space-occupying lesions.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A rabbit and rhesus monkey model of posterolateral intertransverse process spine arthrodesis was used.Objective.To test two new soft tissue compression resistant ceramic/collagen sponge carriers for recombinant human bone morphogenetic protein-2.Summary of Background Data.After determining that a plain collagen sponge was too compressible for large animals in a posterolateral fusion application, the authors demonstrated good bone induction using biphasic ceramic phosphate granules (60% hydroxyapatite/40% tricalcium phosphate) as the carrier matrix for recombinant human bone morphogenetic protein 2 in rhesus monkeys. A limitation of 60:40 biphasic ceramic phosphate was its slow resorption time caused by the high hydroxyapatite content, making radiographic detection of new bone formation very difficult.Methods.Adult New Zealand white rabbits (n = 14) underwent posterolateral spine arthrodesis at L5–L6 using 5:95 biphasic ceramic phosphate (5% hydroxyapatite/95% tricalcium phosphate) impregnated Type I collagen sponges (17 × 35 × 2.5 mm, two per side) loaded with 0.86 mg recombinant human bone morphogenetic protein 2. Additional rabbits (n = 14) received 60:40 hydroxyapatite-tricalcium phosphate granules as the carrier for bone morphogenetic protein 2. Adult rhesus monkeys (n = 6) underwent posterolateral arthrodesis at L4–L5 with ceramic/collagen sponge carrier loaded with 9 mg recombinant human bone morphogenetic protein 2 per side. Two monkeys received ceramic/collagen sponges containing 15:85 biphasic ceramic phosphate (15% hydroxyapatite/85% tricalcium phosphate) with two pieces per side; two received sponges containing 5:95 biphasic ceramic phosphate with two pieces per side, and two received sponges containing 5:95 biphasic ceramic phosphate with four pieces per side. The rabbits were killed after 5 weeks and the monkeys after 24 weeks; the spines were evaluated by manual palpation, radiographs, tensile mechanical testing (rabbits only), and histology.Results.The recombinant human bone morphogenetic protein 2 delivered in the 5:95 biphasic ceramic phosphate/collagen sponge achieved fusion in 100% of rabbits and had improved handling properties compared with the biphasic ceramic phosphate granules. Biomechanical results with 5:95 biphasic ceramic phosphate/collagen carrier were comparable to those obtained with the 60:40 biphasic ceramic phosphate granules and superior to those of autogenous bone graft (P< 0.05). The recombinant human bone morphogenetic protein 2 delivered in the 15:85 or the 5:95 biphasic ceramic phosphate/collagen sponge carrier (two pieces per side) induced fusion in nonhuman primates with normal bone histology, less residual ceramic, and more bone in the center of the carrier matrix in comparison with BCO granules alone. The 15:85 biphasic ceramic phosphate/collagen sponge resulted in fusion mass sizes closer to the original size of the matrix implanted than did the 5:95 biphasic ceramic phosphate/collagen sponge, which was considered a desirable feature. The monkeys with 9 mg recombinant human bone morphogenetic protein 2 spread over four sponges per side instead of two had half the effective recombinant human bone morphogenetic protein 2 concentration per sponge and inferior results.Conclusions.The new compression-resistant biphasic ceramic phosphate/collagen sponge matrices were biologically compatible with recombinant human bone morphogenetic protein 2 bone formation, resulted in biomechanically stiffer fusion masses than autograft, better space maintenance than plain collagen sponges, and improved handling and radiographic resorption properties over the ceramic carriers previously tested.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.The lumbar intervertebral discs of 135 subjects after autopsy were immunostained with antihuman heat shock protein 27 (HSP27) monoclonal antibody and antihuman heat shock protein 72 (HSP72) polyclonal antibody.Objectives.To present the data on metabolic changes that occurred in the chondrocytes of intervertebral discs during development and aging.Summary of Background Data.Heat shock proteins have been implicated in the progressive degeneration of articular cartilage in joint disease, such as rheumatoid arthritis and osteoarthritis. However, the role and expression of heat shock proteins in human intervertebral discs have received little study.Methods.One hundred thirty-five specimens of human intervertebral discs were stained with hematoxylin and eosin, alcian blue, and Masson’s trichrome and were immunostained with HSP27 and HSP72 by an indirect immunoperoxidase method. The relative amounts of HSP27 and HSP72 deposition were graded according to a semiquantitative scoring system.Results.Heat shock protein 72 accumulated in the cytoplasm of the chondrocytes of both endplate cartilage and nucleus pulposus during gestation and thereafter decreased with aging (age, ≤60 years), and HSP72 immunoreactivity increased in the chondrocytes of degenerative discs. In addition, HSP72 was located in the nuclei of certain chondrocytes of the degenerated nucleus pulposus and anulus fibrosus, was highly expressed in the chondrocytes of endplate cartilage during gestation and childhood, and thereafter decreased with aging. Furthermore, with the progressive degeneration of the endplate cartilage, HSP27 immunoreactivity increased. The degree of HSP27 immunoreactivity did not change significantly according to age in either the nucleus pulposus or the anulus fibrosus.Conclusions.Heat shock protein 27 and HSP72 are thus considered to be useful molecular indicators for degenerative change in intervertebral discs. Both HSP27 and HSP72 are presumed to play a role in cell protection from stress that is induced by mechanical and biologic factors causing intervertebral disc degeneration.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID