摘要:

Study Design.Normal, sham, and groups of chickens subjected to pinealectomy from which serum melatonin levels were measured and correlated with scoliosis development in a period of 5 weeks.Objectives.To measure serum melatonin levels in chickens subjected to pinealectomy and control chickens and correlate findings with development of scoliosis.Summary of Background Data.In a previous study by others, scoliosis developed in 100% of chickens subjected to pinealectomy, and serum melatonin levels were found to be reduced. Previous results in a study by the authors showed scoliosis developing in only approximately 55% of chickens that underwent pinealectomy.Methods.Young chickens were subjected to pinealectomy. Control groups consisted of sham operation and normal groups. Radiographs and blood samples were taken at weekly intervals to monitor scoliosis development and measure serum melatonin levels using radioimmunoassay techniques.Results.Scoliosis developed in only 52% of chickens that underwent pinealectomy, but all had low levels of serum melatonin and no circadian rhythm. The chickens in the two control groups maintained normal serum melatonin levels and rhythms.Conclusions.Pinealectomy in young chickens reduces serum melatonin levels and eliminates the melatonin circadian rhythm. It can also produce scoliosis, but low levels of serum melatonin are a poor predictor of development of scoliosis

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.Application of autologous nucleus pulposus on nerve roots and treatment with local application of lidocaine in the pig.Objectives.Studies of the effects of lidocaine on nucleus pulposus-exposed nerve roots.Summary of Background Data.Nerve root infiltration may improve radicular symptoms beyond the pharmacologic duration of local anesthetics, but the mechanisms for this effect are not known.Methods.Nucleus pulposus was harvested from a lumbar disc and placed onto the sacrococcygeal cauda equina in pigs. In Series 1, early lidocaine treatment of nucleus pulposus-induced nerve root injury, pigs received 2% lidocaine (n = 5) or saline (n = 5) before and after surgery. Nerve conduction velocity and histologic appearance were studied after 3 days. In Series 2, delayed lidocaine treatment of nucleus pulposus-induced nerve root injury, after 7 days 2% lidocaine was administered epidurally to nucleus pulposus-exposed (n = 4) and -nonexposed (n = 4) nerve roots. Nerve conduction velocity, muscle action potentials, and histologic appearance were assessed.Results.In Series 1, early treatment with lidocaine limited the reduction in nerve conduction velocity. The epidural inflammation was less in lidocaine treated animals. In Series 2, nerve conduction velocity was lower in nucleus pulposus-exposed animals than in nonexposed animals. The initial reduction of nerve conduction velocity and muscle action potential was similar between the groups, but the recovery of muscle action potential was slower and less complete in nucleus pulposus-exposed nerve roots. There was minimal histologic nerve injury in both series and in both protocols.Conclusions.Early treatment with lidocaine may reduce nucleus pulposus-induced nerve root injury. Lidocaine induced a delayed recovery in nerve roots exposed to nucleus pulposus. Further studies are needed to clarify the therapeutic effects of nerve root infiltration and the pathophysiology of nucleus pulposus-induced nerve root injury.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.The outcome of a herniated disc in patients with cervical myelopathy treated by laminoplasty without discectomy and in those treated conservatively was studied by magnetic resonance imaging.Objectives.To compare the surgical results of laminoplasty with those of anterior spinal fusion in patients with myelopathy caused by to cervical disc herniation and to make a treatment strategy for cervical disc herniation depending on these results.Summary of Background Data.Anterior discectomy and spinal fusion have had acceptable surgical results, but many complications have been reported, especially adjacent segment degeneration and bone graft complications.Methods.Forty-seven patients with cervical disc herniation were examined in this study. Of them, 32 patients (mean age, 56 years) underwent laminoplasty without resection of the herniated disc. Seven patients with mild cervical myelopathy and 8 patients with radiculopathy (mean age, 53 years) were treated conservatively. As a control group, 44 patients (mean age, 50.3 years) who underwent anterior spinal fusion were examined. All patients in the laminoplasty group also had congenital spinal canal stenosis in which the ventrodorsal canal diameter was less than 13 mm. The association between the outcome of a herniated disc and clinical features was investigated. The severity of myelopathy was evaluated according to the Japanese Orthopaedic Association's scoring system. Surgical outcomes were evaluated by the system of Hirabayashi for determining recovery rate.Results.The recovery rate averaged 67.9% in laminoplasty and 68.8% in anterior spinal fusion. There were no significant differences between the groups. No patients underwent anterior spinal fusion after laminoplasty. Follow-up magnetic resonance imaging showed regression of the size of the herniated disc in 15 of the 20 patients in the laminoplasty group and in 12 of 15 patients treated conservatively. In the MRI studies of the natural course of disc herniation, the size of the herniated disc decreased to almost half in 1 to 2 months and almost disappeared within 3 months after surgery.Conclusions.The size of the herniated disc in cervical lesions regressed as it does in the lumbar lesions. Laminoplasty for patients with narrowed spinal canals showed favorable surgical results. Therefore, the therapeutic method for cervical disc herniation should be chosen after taking the natural history of the disc herniation into consideration.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients.Objectives.To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury.Summary of Background Data.The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients.Methods.Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively.Results.The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P< 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group.Conclusion.Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.Retrospective cohort study.Objective.To determine which of TLSO, Charleston, or Milwaukee bracing best prevents curve progression and surgery in adolescent idiopathic scoliosis.Summary of Background Data.Bracing has been shown to prevent curve progression in idiopathic scoliosis, when compared with no treatment. However, there is little literature available comparing the effectiveness of different brace designs.Methods.One hundred seventy patients who completed brace treatment for adolescent idiopathic scoliosis between 1988 and 1995 were studied. Forty-five thoracolumbosacral orthoses, 95 Charleston braces, and 35 Milwaukee braces were used. Thoracolumbosacral orthoses and Charleston braces were used on comparable curves, whereas Milwaukee braces were used in a sub-group in which the other brace designs were considered inappropriate. Evaluated were the absolute increase in curve severity, the percentage of curves that progressed beyond 6° and 10° thresholds, and the percentage of patients who underwent surgery.Results.Age, Risser stage, curve size, and time braced and observed did not differ among groups. Mean progression of the curve during bracing was 1.1° with thoracolumbosacral orthosis, 6.5° with the Charleston brace, and 6.3° with the Milwaukee brace (P= 0.012; analysis of variance). Proportion of patients with more than 10° of curve progression was 14% with thoracolumbosacral orthosis, 28% with the Charleston brace, and 43% with the Milwaukee brace (P= 0.017; chi-square). The proportion of patients who underwent surgery was 18% with thoracolumbosacral orthosis, 31% with the Charleston brace, and 23% with the Milwaukee brace (P= 0.26; chi-square).Conclusions.The thoracolumbosacral orthosis was superior at preventing curve progression in adolescent idiopathic scoliosis.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Study Design.The psychometric properties and clinical use of a battery of physical performance measures were tested on 44 patients with low back pain and 48 healthy, pain-free control subjects.Objectives.Reliability, validity, and clinical use of nine physical performance measures were evaluated.Summary of Background Data.Although physical performance measures have potential use in evaluation, treatment planning, and determination of treatment outcome, there is sparse systematic investigation of their reliability, validity, and clinical use.Methods.Forty-four subjects with low back pain and 48 healthy pain-free subjects participated. The following physical performance measures were tested: distance walked in 5 minutes; 50-foot walk at fastest speed; 50-foot walk at preferred speed; 5 repetitions of a sit-to-stand task; 10 repetitions of a repeated trunk flexion task; timed up-and-go task; unloaded forward reach task; loaded forward reach task; and Sorensen fatigue test. Subjects were assessed twice on 2 days.Results.All measures had excellent intertester reliability (intraclass correlation coefficient [ICC]1,1>0.95). Test-retest (within session) reliability was adequate for all measures (ICC1,1>0.83) except repeated trunk flexion (ICC1,1>0.45) in the low back pain group. Test-retest (day-to-day) reliability ranged between 0.59 and 0.88 in the low back pain group and between 0.46 and 0.76 in the control group. Day-to-day reliability improved when the averages of two trials of repeated trunk flexion and sit-to-stand were used (0.76-0.91 low back pain group and 0.62-0.89 control group). Results of a multivariate analysis of variance showed a significant effect of group (F10,65= 3.52,P= 0.001). Results of univariate analyses showed significant group differences on all measures except the 50-foot walk at preferred speed and unloaded forward reach. Self-report of disability was moderately correlated with the performance tasks (r= 0.400 to −0.603).Conclusions.The results provide support for the use of these physical performance measures as a complement to patient self-report.

ISSN:0362-2436    

出版商:OVID    

年代:1998

数据来源: OVID