摘要:

Children with severe cervical kyphosis present a difficult treatment challenge. The most common etiology of this deformity is extensive laminectomies, especially associated with postiaminectomy irradiation. The deformity can be rapidly progressive leading to neurologic involvement. With intact posterior elements, kyphosis can occur as a result of congenital, traumatic, metabolic or neoplastic processes. Treatment is directed towards early recognition, arrest of the progression of deformity, and improvement of neurologic symptoms. Patients with loss of posterior elements can be treated effectively by preoperative traction and a single-staged anterior release with strut fusion. Patients with intact posterior elements require preoperative traction, initial posterior osteotomies with intraoperative traction, then an anterior release with strut fusion. All patients need rigid postoperative halo immobilization for a minimum of 3 to 4 months to maintain position. Using these techniques, nine patients were treated surgically with satisfactory outcomes.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This report details eight patients who had bursting teardrop fractures of the cervical spinal column treated by decompressive vertebral corpectomy and anterior fusion with plate stabilization. The fracture involved C5 In six patients, C6 in one patient, and C7 in one patient. The neurologic deficit was complete in five and incomplete in three patients. At an average follow-up of 3 years, all grafts were fully incorporated, all cervical spinal columns were stable and had no deformity, and none of the fixation devices had loosened. All complete neurologic deficits have remained complete, and all patients with incomplete deficits have had significant recovery and are walking independently. There were no operative complications. After decompressive vertebral corpectomy, anterior plate stabilization followed by short-term halo-vest fixation is a safe and useful alternative for unstable bursting teardrop fractures of the cervical spinal column.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A technique of anterior decompression of the spinal canal with anterior strut grafts, followed by posterior instrumentation and local fusion, is described in a group of 18 patients with unstable thoracolumbar fractures. All patients were found to have greater than 50% encroachment of the spinal canal and a preoperative kyphosis of 21.8°. At follow-up 81% of patients with incomplete neurological lesions improved at least one Frankel Grade. Residual encroachment on the spinal canal was 4.6% and at follow-up the kyphotic angle was 17.1°. Complications included one anterior graft loosening (not requiring revision), three loosened rods, only one of which required revision, and one fractured Harrington rod which did not require revision. The authors conclude that this technique is an effective and safe method for treating unstable thoracolumbar injuries and is recommended if anterior instrumentation is unavailable.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A 29-year-old man with spastic paraparesis of insidious onset was discovered to have thoracic cord compression by a combination of kyphosis and thoracic disc herniation. Radiologic evaluation showed evidence of Scheuermann's disease, of which thoracic kyphosis is one manifestation. Neurologic signs are uncommon in Scheuermann's disease and few cases have been successfully managed with resolution of neurologic deficit. This patient made a virtually complete recovery after thoracic cord decompressions by costrotransversectomy and transthoracic approaches.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A series of 190 patients with lumbar spondylolisthesis treated operatively during the years 1948-80 at the mean age of 15.2 years (8-19 years) and reexamined 4-36 years (mean 11.2 years) later are presented. In 92 of them (48%) scoliosis (more than 5°) in association with olisthesis was seen. The slipping affected the fifth segment in 90 and fourth segment In two patients. The female predominance was characteristic in the scoliotic group. Dysplastic changes of the posterior arc were more often seen In the group of patients with scoliosis than in the nonscoliotlc group, and they also presented a more severe grade of slipping and lumbosacral kyphosis. The curve was usually mild and was situated In the lumbar area. Patients with a higher degree of lumbosacral kyphosis and more severe slipping also had a statistically higher degree of lumbar scoliosis. Operative treatment of spondylolisthesis consisted of posterior or posterolateral fusionIn situ,but two patients were treated using ventral fusion and three severe cases with removal of loose posterior element. Lumbar scoliosis classified as sciatic type disappeared in 25 out of 39 patients after lumbosacral fusion, suggesting the “sciatic muscle spasm” as an etlologic factor. The torsional type of curve resulting from asymmetrical slipping of the vertebra was also corrected in 19 out of 28 cases after fusion. At follow-up patients with remaining lumbar scoliosis represented more low-back pain than those without any curve. In our opinion lumbosacral fusion is indicated before lumbar curve changes to structural scoliosis in symptomatic patients. Thoracic or thoracolumbar scoliosis was not corrected by lumbosacral fusion and the upper curve was later separately treated operatively in six patients. Clinical and radiological evaluation of the lumbar spine in the initial stage of treatment and careful follow-up of the patients is essential in the planning of treatment of this combination of spinal disorders.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The treatment of severe refractory spasticity following spinal cord injury may raise challenging therapeutic problems. Classical approaches involve various types of myelotomies, rhizotomies and intrathecal injections of neurolytic substances. Alternative approaches include percutaneous rhizotomies and, more recently, the possible use of electrical stimulation of the spinal cord. Certain cases, however, may not be amenable to commonly accepted techniques. An operative technique is presented which involves a suprapubic incision for an infraperitoneal approach to a femoral and obturator neurectomy and an incision of the iliacus and psoas muscles bilaterally. This may be followed, when indicated, by a bilateral infragiuteal section of the sciatic nerves. This technique offers a viable surgical alternative to the treatment of spasticity following spinal cord injury in cases where other traditional methods are contraindicated or have failed.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Nucleus pulposus was taken at necropsy from five mongrel dogs and tested in an enzyme linked immunoabsorbent assay (ELISA) system designed to indicate the presence of IgG and IgM. This assay positively identified IgG. Agarose-bound Protein A was used to treat the nucleus pulposus material to extract the IgG. Repeating the ELISA using Protein A-treated nucleus pulposus showed that the ELISA was greatly diminished in activity, confirming the presence of whole molecules of IgG in nucleus pulposus.Investigators have postulated an Immunologic basis for spinal pain syndromes. None to date has demonstrated IgG In the nucleus pulposus. This IgG may be a mediator by which an inflammatory response is activated which contributes to the clinical picture of chronic back and radicular pain.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Intradiscal pressure and volume measurements were made In 84 fresh cadaveric lumbar spine disc spaces. The nucleus was injected with a roentgenographic contrast agent under fluoroscopic examination. The intrinsic pressure, the pressure at which the agent entered the disc, and the maximum pressure that the disc could hold were measured. The discs were graded for degeneration. The intrinsic and maximum pressures were found to be inversely related to disc degeneration grade, and directly related to each other. Relatively greater degeneration was found at lower levels of the lumbar spine as compared to the upper levels. The intrinsic disc pressure may prove to be a useful clinical tool in the evaluation of spinal integrity.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Flexion-extension moments occurring at the L5-S1 level of the spine were calculated when subjects lifted a box weighing from 50 to 250 N. Lifting was performed at normal and fast speed, and the lifts were performed using a freestyle and a leglifting technique. The peak moment increased linearly with increasing load. The moment/load relationship was significantly influenced by lifting speed, and a higher moment occurred at each load level when lifting fast. Lifting speed was reduced when the external load was increased, particularly when the load was 150 N and higher. Moments when lifting using the leglifting technique were lower than when lifting freestyle.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fifteen asymptomatic volunteers and 19 patients with current CT (GE 8800 CT/T) scans demonstrating either thecal sac contour distortion or nerve root displacement from disc rupture or spinal stenosis of the L4-L5 or L5-S1 levels judged to be at least moderate in severity underwent lumbar thermography. All patients were studied with an infrared telethermographic unit (AGA model 720M) employing the technical standards recommended by the Academy of Neuromuscular Thermography. The thermographic exams were interpreted independently and in a blind fashion by two radiologists. Of the 15 exams of symptomatic patients, six were interpreted as positive and consistent with nerve fiber irritation. Of the 19 exams of patients with demonstrated CT abnormalities, all had positive thermograms for nerve fiber irritation (specificity 60%, sensitivity 100%). It is concluded that lumbar thermography is a sensitive examination for detecting those patients who will demonstrate lumbar spinal CT abnormalities and should play an important role in the diagnostic screening of low-back pain syndrome patients.

ISSN:0362-2436    

出版商:OVID    

年代:1988

数据来源: OVID