摘要:

Together with other side effects, the clinical use of steroid appears to produce disorders in the spinal column, especially in young patients. However, morphologic details of steroid induced changes in the spinal column are little known. In this study, mice were treated with daily intramuscular injections of hydrocortisone at doses of 1, 5, and 10 mg/kg body weight for 1, 2, or 4 weeks after 2 weeks of age, and the cartilage plates of the lumbar vertebrae were examined, compared with controls, by light and electron microscopy. Cartilage plates consist of an outer zone, abutting the nucleus pulposus and an inner zone oriented toward the vertebral body. The outer zone is divided into a superficial layer and a deep calcified layer. With steroid therapy, chondrocytes in the inner zone and the superficial layer of the outer zone became degenerative or necrotic. In mice treated with 5 and 10 mg hydrocortisone/kg body weight, ossification appeared earlier in the deep calcified layer than in control animals. After 2 weeks of treatment, the cartilage tissue of the inner zone in mice treated with 10 mg hydrocortisone contained ossification gaps, columnar bone tissue, connecting the bony vertebral body, and the deep calcified layer of the outer zone. The thickness of each layer was measured by light microscopy. By hydrocortisone treatment, the whole of the cartilage plate decreased in thickness, the two cartilage layers of the inner zone and the superficial layer of the outer zone became thinner, and the calcified or ossified layer of the outer zone became widened. These changes were more significant in mice treated with larger doses and for longer periods. The results suggest that degenerative changes induced by steriod in the cartilage plate may suppress the growth of the spinal column and make the cartilage plates susceptible to mechanical stress, causing back troubles, which are often seen in children undergoing long-term steroid treatment.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Primary amyloidosis of bone is a rare disease process. When amyloid lesions do occur in bone, they are often associated with myeloma or other plasma cell dyscrasias. Because of Its rarity and its protean clinical and radiographic picture adequate biopsy tissue for histopathologic studies is essential for accurate diagnosis. This case presents a 43-year-old man with nondescript back pain and an impressive radiographic lesion in his lower thoracic spine demonstrating the need for careful diagnostic evaluation and a high incidence of suspicion. When occurring primarily in a localized anatomic area, the prognosis for survival is excellent, and cure can be expected by local excision and reconstruction, as necessary.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Thirty-four patients underwent surgery for late posttraumatic thoracolumbar kyphosis. Indications for surgery included increasing kyphotic deformity, pain, or increasing neurologic deficit. Procedures included anterior spinal fusion only, posterior spinal fusion only, anterior and posterior fusions as staged procedures, and anterior and posterior fusions under the same anesthetic. Eighteen of the patients with anterior fusions also underwent decompression of the spinal cord by resection of the vertebral body. Stable fusion with halt in progression of deformity was obtained in 33 of the 34 patients by following basic biomechanical principles.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Eight mechanically failed Harrington rods have been retrieved and examined clinically, metallurgically, and biomechanically to characterize the mode of instrument failure and to determine how future failure rates might be minimized. The results of the study indicated fatigue to be the mode of mechanical failure in all cases, however, in only one case was any significant metallurgical defect observed. Failure occurred at the ratchet-shaft junction in seven of eight cases with the remaining failure occurring at the midshaft region. This occurred in the rod with the metallurgical defect. The possibility of fatigue failure can be lowered by implementing both clinical and design considerations. Clinically, stress on the rod can be lowered by placing the ratchet-shaft junction as close to the hook as possible and by using the shortest rod possible. Both of these will minimize the moment arm at the vulnerable ratchet-shaft junction. Design modifications, including increased rod diameter, polishing the ratchet-shaft interface and material changes, can also be used to lower the stress on the rods and thus reduce the risk of mechanical failure.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The abdominal mechanism, utilizing intraabdominal pressure, has been described and numericized. Simulations show that the lumbodorsal fascia under control of the abdominal muscles contributes to reduce the stress at the intervertebral joint. The musculature of the lumbar spine is of primary importance in the control of the efficiency of the spinal mechanism. The system of loading, which results in observable physiologic response, maintains the compressive load at virtually 90° at the bisector of the disc for all weights and all angles of forward flexion.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Camptocormia is a rare low-back disorder involving an abnormal posture of extreme forward flexion. Most reports of camptocormia were of male military recruits during World Wars I and II. The differential diagnosis of the postural deformity, the psychologic formulation of camptocormia as a conversion disorder, and the treatments that have been used are reviewed. An unusual case of camptocormia in a female is presented to illustrate one psychologic basis and one form of effective treatment of this disorder.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Interpedicular distance, interfacet distance, midsagittal diameter, and cross-sectional area at the upper aspect of the fifth lumbar spinal canal were measured from the computed tomographic (CT) scans of the spine performed in a period of 1 year. The patients were divided into four groups. Group I (25 patients) was the normal control group. Group II comprised 29 symptomatic patients who were thought to have an L4–L5 herniated nucleus pulposus (HNP) by CT and did not undergo surgery. Group IIIA was made up of 24 patients who underwent an L4–L5 discectomy and had favorable results, and Group IIIB (3 patients) included those who failed to improve following surgery. The symptomatic patient with an L4– L5 HNP by CT who did not undergo operative treatment had a mean canal size as measured by midsagittal diameter and cross-sectional area that was smaller (P< 0.05) than in a normal control group. In the patients who required an L4–L5 discectomy, these same measurements were smaller (P<0.001) when compared with the nonoperative group. In the three failure patients, all four measurements were significantly smaller than in patients in Group IIIA with the interfacet distance and the cross-sectional area differences being the greatest (P< 0.001). The patients who are likely to undergo operative treatment have a midsagittal diameter that is < 1.6 cm and a cross-sectional area that is < 2.5 cm.2In the congenitally small canal the cross-sectional area more accurately reflects the degree of stenosis and a cross-sectional area that is < 2 standard deviations from the normal or < 2 cm2is considered to represent congenital spinal canal stenosis.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Conjoined origin anomalies of lumbosacral nerve roots, if incorrectly interpreted, could be misdiagnosed as disc herniations on computed tomography (CT). Several characteristic CT features of these anomalies are presented that should distinguish them from herniated discs. A conjoined root anomaly was found in approximately 2% of the 8,000 lumbosacral CT scans.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The use of somatosensory evoked potentials (SEPs) In localizing the level, extent, and laterality of nerve root entrapment is clinically important. In patients with lumbar spinal stenosis, this is especially true. This study defines a prospective investigation of 20 patients with preoperative SEPs of which 11 patients had intraoperative SEPs correlated with their computed tomographic (CT) scan and/or myelographic findings. The results confirm a high incidence of 4th and 5th lumbar and 1st sacral nerve root involvement. The posterior tibial nerve was abnormal in 95%, the peroneal in 90%, and the sural in 60% in the symptomatical lower extremity. Upper lumbar segments were barely affected as evident by the low incidence of saphenous nerve abnormality in only 12% of the patients. The posterior tibial nerve had the highest yield and was useful for screening. Bilateral lower extremity abnormalities were found in seven of 20 cases studied with two patients having bilateral symptoms and findings. Therefore, bilateral lower extremity SEP evaluation can reveal previously unsuspected pathology and is strongly recommended in preoperative evaluations. SEPs can serve as a useful intraoperative tool to guide the surgeon during a decompressive surgical procedure. SEPs are specifically helpful in spinal stenosis with a paucity of clinical findings and equivocal CT scan or myelographic studies. SEPs seem much more sensitive and effective than conventional electrodiagnostic tests in detecting spinal nerve root compression secondary to spinal stenosis.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The efficacy and safety of baclofen (30–80 mg daily) for the treatment of acute low-back syndrome were evaluated in a 14-day, double-blind, randomized study of 200 patients (100 baclofen, 100 placebo). Patients with initially severe or extremely severe symptoms (as opposed to moderate symptoms) benefitted most from treatment with baclofen. The incidence of adverse effects was significantly higher in the baclofen group; however, most were mild to moderate and disappeared in all but two patients who required a reduction in dosage, without reduced drug efficacy. Baclofen was shown to be effective, safe, and well-tolerated for the treatment of patients with acute low-back syndrome.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID