摘要:

Study Design.Intradiscal pressure and intersegmental rotation of human lumbar spines were measuredin vitro.Objectives.To determine the effect of a follower load on mechanical behavior at all levels of the lumbar spine.Summary of Background Data.Different loads have been proposed for studying the mechanical behavior of the lumbar spine. The influence of a follower load on intradiscal pressure at the different levels is unknown.Methods.Ten human cadaveric lumbar spines were loaded in the three main anatomic planes with pure moments of 3.75, 7.5, and 7.5 Nm plus a follower load of 280 N. Intradiscal pressure and intersegmental rotation were measured at all levels.Results.An additional follower load increased the intradiscal pressure, slightly reduced the intersegmental rotation for axial rotation, and hardly affected intersegmental rotation for lateral bending and flexion–extension.Conclusions.A superimposed follower load renders spinal loading with pure moments more physiologic.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.A questionnaire survey.Objectives.To collate and analyze the views of the delegates who attended the European Cervical Spine Research Society (CSRS) meeting on the use of methylprednisolone for acute traumatic spinal cord injury.Summary of Background Data.The NASCIS II and III studies reported improved neurologic recovery in patients who were treated with methylprednisolone within 8 hours of their acute traumatic spinal cord injury. A number of reported commentaries have criticized these trials. A recent audit in the authors’ regional spinal injuries unit in the United Kingdom found that a large percentage of patients were not receiving methylprednisolone. The authors decided to collate the views of the delegates at the CSRS regarding the use of steroids for acute traumatic spinal cord injury.Methodology.A questionnaire was created that took into account the positive reported findings as well as the criticisms of the NASCIS studies. Delegates who attended the European CSRS meeting completed this questionnaire.Results.Seventy-five percent of the delegates answered that they used or recommended methylprednisolone in the treatment of acute traumatic spinal cord injury. Nevertheless, the delegates had an average of 1.5 reservations about administering methylprednisolone. The most common reservation was that they did not think the improvement conferred to the patients by administering methylprednisolone had been clinically or functionally proven. There were reservations about the validity of the statistical analysis used in the NASCIS studies and by the omission of a placebo group in NASCIS III. The majority of the delegates thought it was not medicolegally negligent to withhold the administration of methylprednisolone in the treatment of acute traumatic spinal cord injury.Conclusion.The use of methylprednisolone in the treatment of acute traumatic spinal cord injury is still controversial. It would appear from a recent prospective audit at the authors’ spinal injuries unit that a large percentage of patients in the United Kingdom are not receiving methylprednisolone. Because so much doubt exists, the NASCIS studies should be repeated.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Design.Retrospective chart and radiographic review of all cases admitted to the authors’ hospital and diagnosed to have tuberculous spondylitis.Objective.To identify the frequency, presenting features, utility of diagnostic tests, and treatment outcome of spinal tuberculosis in a tertiary care center.Methods.All cases of spinal tuberculosis treated in the authors’ hospital over 14 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous spondylitis therapy were included. Outcome was assessed according to predefined criteria.Results.Between 1985 and 1998, 69 cases of tuberculous spondylitis were found,i.e., 5% of all tuberculous spondylitis cases diagnosed. The mean age was 52.8 years (range, 15–80 years), and 37 (53.6%) were male. Only five patients had a history of tuberculosis. The most frequent symptoms were backache (84%) and fever (32%), and the most frequent sign was spinal tenderness (45%). Nineteen (28%) patients had paraparesis and 12 (17%) had kyphosis. Except for elevated sedimentation rate (94.5%), the laboratory workup was not helpful. Both computed tomography and magnetic resonance imaging were found to be helpful in diagnosis, often with complementary information. Thirty-eight patients (55%) had thoracic spine involvement and 55 patients (80%) had paraspinal abscesses. Tissue aspirates had a yield of 70%, 35%, and 57% for granulomas, acid-fast bacilli smear, and culture, respectively. Medical therapy alone was given in 37 cases (54%), whereas 32 patients (46%) required additional surgical intervention, mainly those with spinal cord compression, spinal deformity, or risk of spinal instability. There was definite improvement in 63 cases (91%). The best outcome was in those patients presenting early before the occurrence of spinal deformity or neurologic symptoms.Conclusion.Tuberculous spondylitis is prevalent in the authors’ hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.A retrospective review of a series of cases with a complication of instrumented lumbosacral fusion.Objectives.To present a previously undescribed complication, early sacral or pelvic stress fracture, after instrumented lumbosacral fusion and to identify the risk factors associated with this complication.Background.There are a number of well-described complications of instrumented lumbosacral fusion, including delayed stress fracture of the pelvis. Early sacral or pelvic stress fracture after instrumented lumbosacral fusion has not been previously reported, to the authors’ knowledge.Methods.The authors present three cases of early stress fracture occurring at 2–4 weeks after surgery in patients who underwent instrumented multilevel lumbosacral fusions for degenerative lumbosacral disease.Results.Two patients had sacral fracture, which to the authors’ knowledge, has not been previously reported. Risk factors included lumbosacral instrumentation and fusion, osteoporosis in elderly women, and iliac crest bone graft procurement. All patients were treated conservatively, with restricted ambulation and gradual return to activity.Conclusion.This complication can cause significant morbidity and a delay in the patient’s return to function. A better understanding of the related biomechanical forces and preoperative risk factors may identify patients at risk and may aid in surgical planning and in expectations of postoperative recovery.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.This is a case report of a patient with hypertrophy of the posterior longitudinal ligament (HPLL) in the lumbar spine, with assessment of operative treatment and a 10-year follow-up using magnetic resonance imaging.Objectives.To report on the long-term outcome of a case of lumbar HPLL, to review the literature on case reports of HPLL, and to outline the pathology of HPLL in the lumbar spine.Summary of Background Data.There have been several reports of HPLL in the cervical spine and thoracic spine. However, the authors found no reports of this condition in the lumbar spine and no reports of long-term follow-up. Two types of pathology are associated with HPLL: primary hypertrophy of the ligament and secondary hypertrophy associated with intervertebral disc herniation.Methods.A 10-year follow-up evaluation of a 56-year-old man with HPLL at L2 is reported. The patient was observed using serial physical examinations, radiographs, and MRIs over 10 years. Because he did not respond to conservative management, surgical treatment was applied. After complete decompression by hemilaminectomy and resection of hypertrophied ligament, the nerve roots were freed of constriction through the neural foramens at L2 and L3.Results.One year after the operation the patient was asymptomatic without evidence of recurrence of the disease.Conclusions.HPLL is a very rare disease. This appears to be the first report of the disease in the lumbar spine.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.Randomized controlled trial with 12-month follow-up.Objectives.To determine whether the addition of neural mobilization to standard postoperative care improved the outcome of lumbar spinal surgery.Summary of Background Data.It has been suggested that neural mobilization should be performed after spinal surgery to prevent nerve root adhesions and improve outcome. However, to date, there is no convincing evidence of the value of neural mobilization.Methods.Eighty-one patients undergoing lumbar discectomy, fusion, or laminectomy at a private hospital in Sydney were randomly allocated to standard postoperative care or standard care plus neural mobilization. Neural mobilization included passive movements and active exercises designed to mobilize the lumbosacral nerve roots and sciatic tract. Primary outcome measures were global perceived effect measured on a 7-point scale, pain measured using visual analogue scales and the McGill Pain Questionnaire, and disability measured with the Quebec Disability Scale.Results.All patients received the treatment as allocated with 12-month follow-up data available for 76 patients (94% of those randomized). There were no statistically significant or clinically significant benefits provided by the neural mobilization treatment for any outcome.Conclusions.The neural mobilization protocol evaluated in this study did not provide an additional benefit to standard postoperative care for patients undergoing spinal surgery. The authors advocate that this protocol not be used in clinical practice.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.With the heterogeneity of the intervertebral disc as the focus, intervertebral discs from normal young rabbits were separated into nucleus pulposus (NP), inner anulus fibrosus (IAF), and outer anulus fibrosus (OAF) zones. Disc cells from each zone were isolated and propagated under monolayer and within agarose gel culture. The metabolism of these cultured disc cells was examined in terms of glycosaminoglycan (GAG) accumulation.Objectives.The object was to study the metabolism of disc cells derived from each zone and characterize them on the basis of GAG accumulation and composition.Summary of Background Data.It has been shown that three-dimensional culture systems, such as within-agarose gels or in alginate beads, permit long-term maintenance of the articular chondrocyte phenotypein vitro. However, little has been reported on how the metabolism of intervertebral disc cells, especially GAG accumulation, is affected by different culture conditions.Methods.Cells from each zone were subjected to monolayer or three-dimensional culture for up to 12 days. GAG accumulation in the different culture systems was analyzed using chemical, histologic, and immunohistologic methods. Differences of GAG and DNA content among NP, IAF, and OAF cells were statistically evaluated by analysis of variance. The data of keratin sulfate content in three-dimensional culture were compared with that in monolayer culture using nonparametric Mann-Whitney U test.Results.Monolayer culture revealed that increases in GAG content were significantly higher in IAF cells than in OAF cells. However, in three-dimensional culture GAG content was similar in the two groups. AF cells in three-dimensional cultures showed immunohistochemical localization of chondroitin sulfate and keratan sulfate, suggesting the existence of pericellular matrix. High performance liquid chromatography confirmed the expression of keratan sulfate in cultured cells.Conclusions.GAG accumulation in cultures of cells from different zones of the intervertebral disc varied according to the culture conditions used. The importance of choosing the appropriate culture systems to meet the objectives of a study should be emphasized.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study Design.This study analyzed the effects of the autologous nucleus pulposus (NP) on nerve root function using electrophysiologic methods.Objectives.To investigate the chronic effects of the NP applied to nerve roots and dorsal root ganglions (DRGs) on ectopic firing and nerve conduction velocity.Summary of Background Data.It was reported that ectopic firing in DRGs is involved in abnormal sensation such as sciatica and that ectopic firing was increased shortly after application of the NP to nerve roots. It was also reported that various inflammatory reactions occur around herniated NP clinically, which may affect nerve roots. However, the chronic action of NP on ectopic firing in the stage of inflammatory reaction is unknown.Methods.Forty-six rats were divided into three groups: nucleus pulposus (NP) group, sham group, and control group. In the NP group the autologous NP was applied to L4 and L5 nerve roots. At 1, 2, 4, and 8 weeks after treatment, antidromically propagated ectopic firing from nerve roots was recorded from the sural nerve, and the nerve conduction velocity between the cauda equina and sciatic nerve was analyzed. The frequencies of ectopic firing in the three groups were compared. The ratios of the nerve conduction velocities on the treatment side and opposite side were compared between the NP and sham groups.Results.The frequency was significantly higher in the NP group than in the sham group at 4 weeks. There were no significant differences among the three groups at 8 weeks. There was no significant difference in the treatment side/opposite side ratio of nerve conduction velocity between the NP and sham groups at any time point.Conclusions.Increased ectopic firing in the stage of inflammatory reaction to NP may be related to abnormal sensation.

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2001

数据来源: OVID