摘要:

Summary of Background Data.Extramedullary hematopoiesis is a common compensatory phenomenon to chronic hemolytic anemias including thalassemia. Several sites can be involved including the liver, the spleen, the lymph nodes, and other less common locations. Spinal cord compression may result in the rare cases wherein the hematopoietic develops intraspinally. Treatment of such conditions still is controversial.Objective.This article reviews the literature and reports two cases of thalassemia intermedia involving patients who presented with neurologic symptoms after acute spinal cord compression secondary to extramedullary hematopoiesis.Methods.The diagnosis was established by magnetic resonance imaging. Hypertransfusion therapy was used as our first-line treatment method.Results.Complete neurologic recovery was achieved. Improvement in the neurologic status started as soon as the first week of treatment.Conclusions.Clinical awareness is important for early diagnosis and prevention of irreversible neurologic complications in such cases. Magnetic resonance imaging is the radiologic method of choice for diagnosing extramedullary hematopoietic masses and for delineating the extent of spinal cord involvement. Hypertransfusion seems to be a promising treatment method that should be recommended as a first-line approach or as an adjuvant therapy to other methods.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A case is reported.Objective.To report a case of intraosseous lipoma involving the lamina of the first thoracic vertebra.Summary of Background Data.Intraosseous lipomas involving the spine rarely have been reported.Methods.An incidental intraosseous lesion of the lamina of the first thoracic vertebra documented on magnetic resonance imaging was surgically excised and pathologically evaluated.Results.The histologic findings were consistent with those for intraosseous lipomas previously reported in other bones.Conclusions.The authors present a rare case of an intraosseous lipoma involving the lamina of the first thoracic vertebra.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.The case of an 8-year-old girl with hereditary multiple exostosis presenting with atypical spinal curvature is reported.Objective.To describe a case of spinal curvature caused by an osteochondroma, illustrating the need for careful evaluation of patients with hereditary multiple exostosis presenting with “scoliosis.”Summary of Background Data.Osteochondromas have been known to arise in the spinal canal and to present with symptoms of neural compression. Spinal curvature is a rare presenting sign of osteochondromas.Methods.The patient’s medical and radiographic history is reviewed as well as the medical literature.Results.An 8-year-old girl with hereditary multiple exostosis was referred for possible thoracotomy and anterior decompression of a T4 osteochondroma thought to be causing an atypical “scoliosis.” Further examination, review of the radiographs, and computed tomography scan showed a large L4 osteochondroma encroaching on the neural elements. The patient’s neurologic symptoms and spinal curvature resolved in the 2 years after surgical excision of the lumbar osteochondroma.Conclusions.Patients with hereditary multiple exostosis and spinal curvature require further diagnostic evaluation to ensure that an osteochondroma in the spinal canal is not the cause of that curvature.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Ventilator weaning after staged revision anteroposterior spine fusion in a ventilator-dependent child with congenital scoliosis is reported.Objective.To describe the improvement of pulmonary performance after deformity correction in a patient with severe deformity and severe restrictive lung disease.Summary of Background Data.The effect of scoliotic deformity correction on postoperative pulmonary function is debatable. Recent prospective studies suggest that corrective surgery, especially that involving violation of the chest cage, adversely affect pulmonary function in patients with adolescent idiopathic scoliosis. For patients with severe deformity and severely compromised preoperative pulmonary function, the effect of deformity correction has not been well studied.Methods.A 15-year-old ventilator-dependent girl with progressive congenital thoracic scoliosis of 130° and a forced vital capacity of 18% underwent staged revision anteroposterior spine fusion. Anterior release, multiple vertebral osteotomies, apical vertebrectomy, and multiple internal thoracoplasties were performed. Five weeks later, when she was medically stable, she underwent posterior reconstruction with multiple vertebral osteotomies, apical vertebrectomy, and translation and cantilever corrective techniques using Isola instrumentation.Results.The patient’s pulmonary function was stable 6 months after surgery, and her forced vital capacity was 19%. Currently, 1 year after surgery, she has been weaned to night-only ventilation. Her walking ability has improved. Her spine is well balanced with a thoracic scoliosis of 40°, and she is neurologically intact.Conclusions.Surgical correction of a severe thoracic spinal deformity in the setting of severe restrictive lung disease can be performed successfully with stabilization of pulmonary volumes and improvement in pulmonary performance.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A case of posterior spinal cord syndrome in which magnetic resonance images showed predominant T2 hyperintense signal in the adjacent vertebral body is reported.Objectives.To present the case for abnormal bone marrow magnetic resonance signal in the radiologic diagnosis of posterior spinal cord syndrome and to review its significance.Summary of Background Data.Infarction in the region of posterior spinal arteries has been rarely described. This is attributable not only to the infrequent occurrence of infarction of posterior spinal arteries, but also to a lack of well-established diagnostic procedures. It is of clinical value to define diagnostic images of posterior spinal cord syndrome, especially early in the course of the disease.Methods.The subject was a 52-year-old man who was presented with acute nontraumatic myelopathy. Magnetic resonance imaging, performed serially after onset of the disorder from 5 hours to 11 months, was evaluated in comparison with neurologic findings. The literature was reviewed to discuss the magnetic resonance images of spinal cord infarction.Results.The neurologic findings were consistent with posterior spinal cord syndrome. A magnetic resonance image taken at 5 hours after onset of the syndrome showed T2 hyperintense signal in the T12 vertebral body. At 3 days after onset, T2 hyperintense signal became obvious in the posterior portion of the spinal cord at T9–T12 vertebral levels. Follow-up magnetic resonance imaging at 41 days, 8 months, and 11 months showed a decrease in the size and intensity of the T2 signal change in the spinal cord and T12 vertebral body. In the literature, T2 hyperintense bone marrow signal was defined in one case of posterior spinal cord syndrome and seven cases of anterior spinal cord syndrome.Conclusions.Associated bone marrow abnormalities likely reflect the underlying pathology of the blood supply to the vertebral body, and may be an additional key sign for radiologic diagnosis of posterior spinal cord syndrome.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A randomized controlled trial was conducted.Objective.To determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain.Summary of Background Data.Osteopathic manipulative treatment may be useful for acute or subacute low back pain. However, its role in chronic low back pain is unclear.Methods.This trial was conducted in a university-based clinic from 2000 through 2001. Of the 199 subjects who responded to recruitment procedures, 91 met the eligibility criteria. They were randomized, with 82 patients completing the 1-month follow-up evaluation, 71 completing the 3-month evaluation, and 66 completing the 6-month evaluation. The subjects were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group, and they were allowed to continue their usual care for low back pain. The main outcomes included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland–Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care.Results.As compared with the no-intervention control subjects, the patients who received osteopathic manipulative treatment reported greater improvements in back pain, greater satisfaction with back care throughout the trial, better physical functioning and mental health at 1 month, and fewer cotreatments at 6 months. The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects. There were no significant benefits with osteopathic manipulative treatment, as compared with sham manipulation.Conclusions.Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A randomized clinical trial was conducted.Objective.To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain.Summary of Background Data.Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions.Methods.For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status.Results.After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P= 0.023) and the SF-36 physical component (P= 0.029) after 4 weeks. Patient satisfaction was greater (P= 0.006) and return to full-duty work status more likely (P= 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P= 0.063). Median total medical costs for 1 year after injury were $1003.68 for the guideline-based group and $774.00 for the classification-based group (P= 0.13).Conclusions.For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A quasi-experimental study was conducted.Objective.To compare intraindividual differences between trunk flexion isometric force, fatigue during isometric contraction (isometric fatigue), and fatigue during sit-ups (dynamic fatigue).Summary of Background Data.Trunk flexion force and trunk flexion fatigue commonly are used to assess trunk flexion fitness. The use of one test is appropriate only if the tests are highly correlated.Methods.This study measured force and either isometric fatigue (time to task failure, n = 79) or dynamic fatigue (number of sit-ups in 2 minutes, n = 73) in self-selected, healthy secondary school (I-III) subjects. In 15 subjects, both isometric and dynamic fatigue were measured.Results.After control was used for upper body mass, the R2adjwas 0.34 between isometric force and isometric fatigue, 0.31 between isometric force and dynamic fatigue was, and 0.27 between dynamic fatigue and isometric fatigue. Including gender in the model did not affect the results.Conclusions.The lack of a high correlation between trunk flexion isometric fatigue, dynamic fatigue, and isometric force suggests that health care professionals should be careful to select the test that answers their particular needs or question.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.An anatomic study investigated the cervical dorsal rami and major cervical paravertebral muscles.Objective.To provide a detailed description of the cervical dorsal rami and important paravertebral muscles as a way of avoiding inadvertent injuries during the posterior approach.Summary of Background Data.No detailed anatomic studies of the nerves and the muscles in the posterior neck useful for the posterior approach have been reported previously.Methods.Running courses of the cervical dorsal rami of spinal nerves and the morphology of cervical major paravertebral muscles were studied using 14 cadavers. In four posterior approaches of cervical laminoplasty, subcutaneous facial exits of cutaneous nerves and the running course of the right C3 medial branches around facet joint were exposed for observation of living anatomy.Results.Every medial branch from the dorsal rami of the C3–C8 spinal nerves passed through an anatomic tunnel dorsolateral to the facet joint. The base of the tunnel was a bony gutter between neighboring facet joint capsules, and the roof was the tendon of the semispinalis capitis. In this tunnel, the medial branch had a little laxity in moving, and was assumed to be the most susceptible to iatrogenic injury during the operation. The semispinalis cervicis was composed with long muscle bundles. Each of these had only one or two innervating nerves from the dorsal rami of cervical spinal nerves. Cutaneous branches from the dorsal rami were found adjacent to every spinous process below the C2 spinous process in cadaveric studies. However, only two or three larger cutaneous nerves were discernible below the C5 or C6 spinous process in surgical approaches.Conclusions.With the posterior approach to the cervical spine, a precise knowledge of the cervical dorsal rami anatomy and the innervating patterns of the paravertebral muscles is necessary for avoidance of inadvertent injuries to the nerves.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID