摘要:

Study Design.A case report and literature review of Gorham disease involving the cervical spine.Objectives.To describe the clinical course and surgical management of Gorham disease of the cervical spine. The pathologic features and various treatment methods are also discussed.Summary of Background Data.Gorham disease is a rare idiopathic disease that possesses distinctive clinical, pathologic, and radiologic features. It is a variant form of osseous angiomatosis associated with massive osteolysis of bone. Eight cases with cervical involvement have been reviewed in the literature and five cases were fatal.Methods.We reported a 49-year-old man with Gorham disease of the cervical spine. Repeated surgical attempts to stabilize the cervical spine were required due to progression of the disease.Results.The patient has achieved a satisfactory functional outcome and remains fully independent.Conclusion.In summary, Gorham disease is a rare entity with an unclear etiology. The long indolent course with the presence of radiographic and pathologic findings usually provides the diagnosis. There is no consensus on treatment, and evaluation of the treatment options is difficult due to the unknown natural history.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Presented is a unique case report of a rare bone tumor: a benign fibrous histiocytoma (BFH) located in the posterior arch of C1 in a 6-year-old child.Objective.To describe a benign fibrous histiocytoma of bone and the differential diagnostic considerations based on the authors’ case report.Summary of Background Data.A BFH is a rare tumor composed of varying degree of fibroblast-like spindle cells, foam cells, and multinucleated giant cells. Approximately 86 cases have been reported in literature. Its exact nature remains somewhat controversial. A lesion may be designated a benign fibrous histiocytoma based on clinical, radiographic, and microscopic criteria.Materials and Methods.The clinical symptoms, plain radiographs, computerized tomography (CT), magnetic resonance images (MRI), bone scintigraphy, and histologic section of the lesion are discussed, evaluated, and compared with other benign bone lesions.Results.This case is, to the best of the authors’ knowledge, the first benign fibrous histiocytoma to be reported in the cervical spine of a child. Various benign lesions such as nonossifying fibroma, giant-cell tumor, fibrous dysplasia, aneurysmal bone cyst, osteoblastoma, and eosinophilic granuloma are included in the differential diagnosis.Conclusion.Benign fibrous histiocytoma is a rare skeletal tumor. Because of this and its nonpathognomonic microscopic features, the diagnosis can be somewhat troublesome. However, by systematically reviewing patient’s symptoms, tumor location, and radiographic and microscopic characteristics, other benign lesions can be eliminated. The diagnosis of a BFH is one of exclusion.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Case report.Objective.To report a previously undescribed complication of lumbar spinal surgery under prolonged hypotensive anesthesia.Background Data.Avascular necrosis of bone most commonly affects the femoral head. The etiology of the condition is understood in only 75% of cases. There have been no prior reports of this condition following lumbar spine surgery carried out under hypotensive anesthetic.Methods.Notes review, clinical examination, plain radiographs, and magnetic resonance imaging diagnosed three patients who developed avascular necrosis of the femoral heads (five joints in total) after surgery for lumbar spinal stenosis. All three were treated with total hip replacement (five joints), and the diagnosis of avascular necrosis was confirmed in two by histopathological examination.Results.All three patients have recovered full mobility following hip replacement surgery. None had any residual symptoms of lumbar spinal stenosis or hip disease, and none of them had shown any clinical evidence of avascular necrosis in any other bone.Conclusions.The development of avascular necrosis of the femoral heads following surgery for spinal stenosis may be due to hypotensive anesthesia, prone positioning on a Montreal mattress, or a combination of the two. Careful intraoperative positioning may reduce the risk of this occurring after spinal surgery. However, close postoperative surveillance and a high index of suspicion of worsening hip pathology in patients who appear to mobilize poorly after lumbar spinal surgery may be the only method of early detection and treatment for this condition.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Case report.Objectives.Report a surgical technique for dural reconstruction after vertebrectomy.Summary of Background Data.None available.Methods.Clinical case analysis: chordoma from T12 to L2 with infiltration of the dura.Results.Forty-six months after vertebral resection and reconstruction, the patient is disease free.Conclusions.Wideen blocresection is required for local control in chordoma. When the tumor permeates the dura, resection not including the dura is intralesional with high risk of local recurrence. Therefore, a proper wide resection consists in vertebrectomy removing the dura infiltrated by the tumor. The two-stage dural reconstruction had strongly limited the leakage of liquor during surgery, and the dural patch provided extra strength anteriorly, where the dural suture is more difficult.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before age 21 years with distraction and fusion using Harrington rods (surgically treated: n = 156; 145 females and 11 males) were followed-up at least 20 years after completion of the treatment.Objectives.To determine the long-term outcome in terms of back pain and function in patients surgically treated for adolescent idiopathic scoliosis.Summary of Background Data.Few reports on long-term outcome of back pain and function have previously been presented for this group of patients. Results presented are not conclusive regarding effects on back pain and its correlation to a fusion extending into the lower lumbar spine.Materials and Methods.One hundred forty-two (91%) of the patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination and evaluation of curve size (Cobb method) and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms were used. One hundred thirty-nine had complete follow-up. An age- and sex-matched control group of 100 individuals was randomly selected and subjected to the same examinations.Results.The deterioration of the curves was 3.5 degrees for all curves and eight (5.1%) of the patients treated with fusion had undergone some additional curve-related surgical procedure. The patients had significantly more degenerative disc changes than the controls. Lumbar pain, although mild (2.4 on visual analogue scale), was significantly more frequent among the patients than the controls (65 vs. 47%,P= 0.0079). Only 25% of the patients admitted daily pain, and analgesics were sparsely used. No major differences of back function and general health-related quality of life were noted between the patients or the controls. Except for having been on sick-leave ever because of the back (45% vs. 19%,P= 0.0040) no differences could be seen in sociodemographic variables between the groups. Furthermore, no differences could be found between patients fused to L3 or higher (n = 102) versus L4 or lower (n = 37). No correlation could be found between pain and its localization and various variables on the scoliotic curve, body mass index, or smoking.Persisting discomfort and/or sensory loss were noted significantly more often among the patients who had the autologous bone harvesting performed through a separate incision over the iliac crest (24.3%) than among those in whom this was performed through an elongated midline incision (4.6%,P= 0.0015).Conclusions.Minimal pain and no dysfunction occurred (mean) 23 years after fusion for adolescent idiopathic scoliosis compared with normal straight controls. Significantly more pain in the scar region occurred when bone graft from an incision over the posterior iliac crest was used for harvesting bone to the fusion compared with an incision performed as an elongation of the midline incision used for the scoliosis surgery.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Clinical and imaging findings of patients diagnosed with pyogenic sacroiliitis were retrospectively analyzed.Objectives.To characterize the clinical and magnetic resonance features of patients with acute pyogenic sacroiliitis without the usually known predisposing conditions and to investigate the diagnostic value of magnetic resonance imaging in detecting the early stages of pyogenic sacroiliitis.Summary of Background Data.Pyogenic sacroiliitis is relatively uncommon, and accurate diagnosis is frequently delayed due to lack of awareness by clinicians and nonspecific clinical presentation. There have been few reports that have evaluated the clinical features of acute pyogenic sacroiliitis and investigated the diagnostic capabilities of magnetic resonance imaging in detecting pyogenic sacroiliitis in the early stages.Methods.The clinical data of 9 patients (6 male, 3 female; average age 27.3 years) diagnosed with acute pyogenic infection of the sacroiliac joint were retrospectively analyzed. Magnetic resonance images as well as computed tomography of the sacroiliac joints were available in all cases. Seven of the patients underwent99mtechnetium bone scans.Results.All patients showed positive findings on magnetic resonance images, whereas99mtechnetium bone scans were positive in six of seven patients. Eight patients responded well to treatment with intravenous antibiotic therapy, whereas one patient required debridement of the sacroiliac joint following conservative treatment.Conclusions.Both magnetic resonance imaging and technetium bone scanning are sensitive for localizing occult sites of bone inflammation. Magnetic resonance imaging may provide more useful information than bone scanning by screening for abnormalities in the sacroiliac joint region. With prompt appropriate antibiotic therapy, clinical improvement of patients can be expected.

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

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Prospective study to assess the enhancement of spine fusion using a tissue engineering construct consisting of bone marrow cells genetically modified by adenovirus (Ad) vector-encoding bone morphogenetic protein-7 (BMP-7) seeded onto an allograft scaffold in a rat model.Objectives.To evaluate Ad transgene expression at the fusion site and the effect of AdBMP-7-treatment on fusion rates, mechanical stability, microscopic anatomy, and bone formation rates.Summary of Background Data.Nonunion is a major complication of spine fusion. Gene transfer may be an effective method for locally overexpressing BMP-7, a gene important for bone formation and regeneration to enhance allograft spine fusion.Materials and Methods.Bone marrow cells were treated with AdBMP-7 or Ad&bgr;gal (encoding the marker gene &bgr;-galactosidase), AdNull (with no gene), or no vector and implanted with allograft in a site of posterior spine fusion. Marker gene expression was assessed up to 14 days after administration. Fusions were evaluated at 8 weeks.Results.Ad gene expression was maximal on day 3, waning to background levels by 14 days. With AdBMP-7 treatment, radiographic fusion rate was 70% and mechanical fusion rate was 80%versus0% by either parameter in control groups. Fused AdBMP-7-treated spines had a 2.5-fold to 3.0-fold lower range of motion and 1.7-fold to 1.9-fold lower hysteresis than controls. Fusion masses of AdBMP-7-treated spines had the microscopic appearance of normal trabecular bone and showed a 23-fold higher uptake of fluorochrome indicating increased bone formation.Conclusions.Addition of AdBMP-7-modified marrow cells can enhance allograft spine fusion.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.A biomechanical study on cadaveric thoracic vertebrae using pullout strength, insertional torque, and bone mineral density to determine the optimal sagittal trajectory of thoracic pedicle screws.Objective.To perform a biomechanical study on cadaveric thoracic vertebrae using insertional torque, pullout strength, and bone mineral density to determine the optimal biomechanical sagittal trajectory for placement thoracic pedicle screws. We compared the straight-forward (paralleling the vertebral endplate) with anatomic trajectory (directed along the true anatomic axis of the pedicle).Methods.Thirty cadaveric thoracic vertebrae were harvested and evaluated with dual-energy x-ray absorptiometry to assess bone mineral density. Matched, fixed-head pedicle screws were then randomly assigned by side and placed using the straight-forward or anatomic technique under fluoroscopic visualization while recording the maximum insertional torque. Pullout strength testing was then performed.Results.The maximum insertional torque for the straight-forward technique was 2.58 ± 0.14 (SE) in pounds, whereas the anatomic technique averaged 1.86 ± 0.14 (SE) in pounds (P= 0.0005). The maximum insertional torque at the neurocentral junction for the straight-forward technique averaged 1.89 ± 0.17 (SE) in-lbs. (73% of maximum insertional torque), whereas the anatomic trajectory averaged 1.39 ± 0.11 (SE) in pounds (75% of maximum insertional torque) (P= 0.007). The average pullout strength using a straight-forward trajectory was 611 ± 50 (SE) N compared to the anatomic trajectory, which averaged 481 ± 54 (SE) N (P= 0.034). The pullout strength correlated with mean bone mineral density for both the straight-forward (r = 0.461,P= 0.027) and anatomic (r = 0.598,P= 0.004) techniques.Conclusions.The straight-forward technique results in a 39% increase in maximum insertional torque and a 27% increase in pullout strength compared to the anatomic technique. The maximum insertional torque at the neurocentral junction resulted in a 36% increase using the straight-forward techniqueversusthe anatomic trajectory. Bone mineral density directly correlates with pullout strength for both techniques.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID