ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThe level of dorsal root ganglia that receives sensory afferent nerves from the anterior portion of the lower lumbar intervertebral disc was investigated in rats using a retrograde transport method.ObjectivesSometimes patients with lower lumbar disc lesions complain of inguinal pain that does not correspond to the dermatome of the injured nerve roots. To investigate the origin of the pain, the authors studied the sensory innervation to the anterior portion of the lumbar intervertebral disc.Summary of Background DataThe innervation to the posterior portion of the lumbar disc has been extensively investigated and has been reported to be segmental. However, little is known about the nerve supply to the anterior portion of the lumbar disc.MethodsThe retrograde transport method was used in rats. As tracers, horseradish peroxidase and choleratoxin B subunit were used. Horseradish peroxidase crystals were placed on the anterior portion of the L5-L6 disc, and choleratoxin B subunit was injected into the L5-L6 disc. The bilateral dorsal root ganglia were histologically examined.ResultsLabeling of L1 and L2 dorsal root ganglia neurons was recognized. No neurons were labeled in dorsal root ganglia of other levels, including the segmentally corresponding L5.ConclusionsUsing the retrograde transport method, the authors demonstrated that the anterior portion of the L5-L6 lumbar intervertebral disc was innervated from L1 or L2 spinal nerves in rats. These results appear to explain the reason why patients with lower lumbar disc lesions sometimes complain of inguinal pain corresponding to the L1-L2 dermatome.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThe present study describes anatomic observations on great medullary artery and intercostal arteries pertinent to thoracolumbar spinal surgery.ObjectivesThis study reveals the vulnerable course of the great medullary artery and its relationship to the lateral or posterolateral approach to thoracic spine.Summary of Background DataThere are no previous anatomic data on the length of the great medullary artery, its intradural course, its relationship with the anterior spinal artery, and the distance between two adjacent intercostal arteries.MethodsThe location of the intercostal arteries was defined, and the distance between two adjacent arteries was measured at a point on the lateral surface of the vertebra midway between its anteroposterior diameter. The intradural length of the great medullary artery and the angle it formed with the anterior spinal artery at the point of anastomosis were also measured.ResultsThe mean intradural length of the great medullary artery was 3.6 cm (range, 1.7-8.1 cm), and it passed over 1-3 disc spaces before joining the anterior spinal artery at a mean angle of 20.1° (range, 12-28°). The average distance between two adjacent intercostal arteries from T6 to L2 was 3.6 cm (range, 2.8-4.0 cm), which provides a safe window through which a herniated thoracic disc may be approached if surgery is indicated.ConclusionsThe acute angle between the great medullary artery and anterior spinal artery indicates that these two arteries are in close proximity for considerable length and are liable to be compressed together with the intervening vascular collaterals by a space-occupying lesion, such as disc herniation or a fractured fragment. The longer the intradural course of the great medullary artery, the more vulnerable it is to compression by disc herniation or fracture. The intercostal and lumbar arteries are located at the midportion of the lateral aspect of the vertebral bodies rather than at the level of intervertebral discs. Discectomy or decompression of the anterior thoracic canal may be accomplished through a lateral or posterolateral extracavitary approach between two intercostal or lumbar arteries.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignNinety disc herniations removed during surgery were studied by immunocytochemistry, using two different endothelial cell markers, to study the prevalence, morphology, and topography of blood vessels in disc herniations.ObjectivesTo increase the specific localization of even very small blood vessels present in disc herniations by using specific antibodies to endothelial cells; to study blood vessels comparatively with two different endothelial cell antibodies, comparing their prevalence; and to study blood vessel morphology and topographic relationships of blood vessels to other tissue elements, particularly disc cells.Summary of Background DataIn many previous macroscopic studies and in studies using conventional histologic methodology, blood vessels have been observed in degenerated and injured intervertebral discs. In a smaller patient sample, the authors previously observed blood vessels in approximately 80% of disc herniations by immunocytochemistry, the blood vessels colocalizing with macrophage cells. Many of these blood vessels are the product of very active neovascularization after disc tissue injury. The presence of such blood vessels has not, however, been studied in greater detail or in larger patient samples. Immunocyto-chemistry offers superior visualization and more specific localization and was thus used in the present study.MethodsThin frozen sections from 90 disc herniations were immunostained in parallel with von Willebrand factor and Ulex europaeus antibodies, both of which localize endothelial cells specifically. Indirect immunocytochemistry by avidin-biotin-peroxidase complex or alkaline phosphatase-antialkaline phosphatase were used for immunolocalization. Blood vessels were classified as being: +, abundant; (+), very few; or -, totally absent.ResultsThe prevalence of blood vessels in disc herniations was found in 82 of 90 (91%) disc herniations with von Willebrand factor antibody and in 75 of 90 (83%) disc herniations with Ulex europaeus antibody. In 59 disc herniations (66%), blood vessels were observed with both antibodies in parallel, whereas they were observed with neither antibody in only six of 90 disc herniations. Furthermore, the ratio of abundant to very few blood vessels was 73:9 with von Willebrand factor antibody and 63:12 with Ulex europaeus antibody, further supporting the abundance of blood vessels in disc herniations. Blood vessels were most prevalent in sequestrated discs, but they were also observed in six of eight protrusions. Dense blood vessel networks were observed to penetrate the disc tissue, and blood vessels were also present in areas of inflammatory cell infiltration. Topographically, blood vessels were, on several occasions and with both antibodies, seen to pass close by or to surround disc cells.ConclusionsBy immunocytochemistry with endothelial cell markers, blood vessels can be observed to be numerous, and their prevalence in herniated discs is very high, presumably as a result of a very intense neovascularization process after the disc injury. A close apposition to disc cells may suggest attempts to increase the nutrition of these cells and will influence the metabolism of the cells.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignDisc herniation and control discs were studied for the presence of immunoglobulins immunocytochemically.ObjectivesTo study a possible presence of immunoglobulin complexes in herniated disc tissue and to locate them at the tissue level by immunocytochemistry; to compare immunohistologic findings with those obtained in control disc tissue; and to compare the prevalences of immunoglobulin M and immunoglobulin G.Summary of Background DataIn herniated disc tissue, high activity of inflammatory phospholipase A2was previously demonstrated, and inflammatory cells were noted immunohistochemically. Immunoglobulins G and M were observed biochemically but have not been located at the tissue level.MethodsFifty-two disc herniations and three macroscopically normal fresh cadaver discs were managed by an identical immunocytochemical protocol, using monoclonal antihuman antibodies to immunoglobulins M and G.ResultsIn 29 of 52 disc herniations (56%), immunoglobulin M deposits were observed, and in 18 of 52 disc herniations (35%) immunoglobulin G could be demonstrated. Almost all the disc herniations where immunoglobulin G was present also contained immunoglobulin M deposits (except for two). In the control discs studied, neither immunoglobulin could be observed immunohistochemically. The immunoglobulin deposits were noted in areas where blood vessels were also present. Morphologically, immunoglobulin immunoreactivity resembling immune complexes was observed.ConclusionsThe results lend support to previous suggestions of inflammation and immune reaction in disc herniations, including previous biochemical studies suggesting immunoglobulin deposition. The exact role of the demonstrated immunoglobulins in disc tissue pathophysiology will have to be clarified further.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis was a prospective study to determine the potential effects of indomethacin on spinal fusions in the rat.ObjectivesTo determine if indomethacin exerts a deleterious effect on spinal fusions in the rat model.Summary of Background DataNonsteroidal anti-inflammatory drugs are a class of compound that affect bone osteogenesis during fracture healing and heterotopic ossification. Spinal fusion is a process that occurs via osteogenesis and, therefore, may be similarly affected.MethodsThirty-nine adult, Sprague-Dawley rats underwent a three-level posterior spinal fusion. Fusion was performed using morselized autogenous vertebral bone graft obtained via caudectomy and stabilized using a cerclage wiring technique. The 39 rats were divided into two groups consisting of 17 study animals and 22 control animals. The control group was injected with 1.5 cc of 0.9 normal saline subcutaneously for 12 weeks, whereas the test animals were injected on an identical schedule using 3 mg/kg of indomethacin sodium salt. Two control animals died, and three animals in the treatment group died of drug-related complications. Twelve weeks after surgery, all animals were killed, and the involved spinal segments were evaluated by direct manual examination. A fusion was probable if the spinal segments exhibited decreased scaled micromotion.ResultsSixty segmental levels in 20 control animals were assessed. Overall, 27 of 60 levels (45%) achieved fusion. In the indomethacin-treated group, 42 levels in 14 animals were evaluated. Overall, four of 42 levels (10%) achieved a fusion. Chi-square analysis demonstrated a significant difference (P<0.001) between the control and indomethacin-treated groups.ConclusionsThis study raises serious questions about the inhibitory effects of nonsteroidal anti-inflammatory drugs on spinal fusion. Clinically, the widespread use of nonsteroidal anti-inflammatory drugs in the postoperative period after spinal fusion may need to be avoided.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignA longitudinal cohort study design was used. All patients underwent a systematically and uniformly applied treatment program with increasing intervention as further pain control was needed. All patients were followed up by questionnaire evaluating function and symptoms.ObjectivesThe role of surgicalversusnonsurgical treatment of patients with cervical disc herniation has not been adequately studied. The majority of published data reflects surgical outcomes, with little available data regarding the outcome of nonoperatively treated patients. Frequently, these patients are treated surgically if they have neurologic loss or radiculopathy that persists after rest or minimal intervention. In the authors' clinic, patients with cervical herniated nucleus pulposus and radiculopathy are treated with an aggressive physical rehabilitation program.Summary of Background DataAll patients treated by the authors during a specified time period with a clearly defined diagnosis of cervical herniated nucleus pulposus were evaluated for outcome.MethodsTwenty-six consecutive patients with cervical herniated nucleus pulposus and radiculopathy were evaluated by an investigator other than the treating physician. The follow-up time was more than 1 year in all patients. Data analyzed included symptom level, activity and function level, medication and ongoing medical care, job status, and satisfaction. Inclusion criteria included a focal cervical disc protrusion of less than 4 mm identified on magnetic resonance imaging and a major complaint of extremity pain compatible with cervical radiculopathy. Exclusion criteria included severe central canal stenosis, symptomatic cervical myelopathy, or condition that precluded participation in the rehabilitation program. Management consisted of traction, specific physical therapeutic exercise, oral anti-inflammatory medication, and patient education. The majority of patients presented with neurologic loss.ResultsTwenty-four patients were successfully treated without surgery. Twenty patients achieved a good or excellent outcome, of these 19 had disc extrusions. Two patients underwent cervical spine surgery. Twenty-one patients returned to the same job. One patient retired.ConclusionMany cervical disc herniations can be successfully managed with aggressive nonsurgical treatment (24 of 26 in the present study). Progressive neurologic loss did not occur in any patient, and most patients were able to continue with their preinjury activities with little limitation. High patient satisfaction with nonoperative care was achieved on outcome analysis.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignRetrospective review of patient records with current clinical and radiographic assessment.ObjectiveTo evaluate the long-term result of anterior and posterior convex spinal growth arrest, with or without instrumentation, in managing infantile idiopathic scoliosis.Summary of Background DataThere were 12 male and 10 female patients studied, with a mean follow-up period of 10 years, 9 months. The mean Cobb angle before surgery was 65°. All had a rib vertebral angle difference more than 20°. The mean age at surgery was 6 years. Nine patients had epiphysiodesis alone; nine patients also underwent Harrington instrumentation simultaneously, and four underwent Harrington instrumentation 2-4 years later.MethodClinical evaluation and sequential measurements of Cobb angle were done.ResultsThe epiphysiodesis-only group had a mean preoperative Cobb angle of 72°, mean progression of curves of +12°, and mean rate of progression of +2.5° per year; the group's postoperative figures were 92°, +15°, and +3° per year, respectively. The epiphysiodesis and late Harrington rod group had a mean preoperative Cobb angle of 56°, mean progression of +12°, and a mean rate of progression of +5° per year; the group's postoperative Cobb angle averaged 62°, progression +6°, and rate of progression +1° per year. The epiphysiodesis with simultaneous Harrington rod group had a preoperative mean Cobb angle of 60°, mean progression of +18°, and mean rate of progression of +6° per year. After surgery, these improved to 58°, correction of 2°, and rate of correction of 0.5° per year.ConclusionCombined anterior and posterior convex spinal growth arrest alone does not prevent progression of deformity in infantile idiopathic scoliosis. The addition of posterior instrumentation can slow or arrest deformity progression but not reverse it.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID