摘要:

Discussions regarding spinal instability should be accompanied by a precise understanding of the definitions of the terms involved. The term instability is variably interpreted depending on the physiological conditions and clinical circumstances. Spinal instability has been defined as “the inability of the spine to limit excessive or abnormal spinal displacement during physiologic loading such that the neural elements are at risk of damage or irritation” (1). There are many concerns regarding this definition. For example, the concept of neurological risk may not be an appropriate component of this definition. This article discusses the etiologies and surgical management of instability of the thoracic and lumbar spine by first categorizing and defining the subtypes of instability. This is followed by the development of rational management schemes that are based on a fundamental understanding of the terminology and biomechanical concepts involved. A review of some of the basic concepts associated with the determination of stability and instability is presented. Instability types are important components of the overall scheme because the definition of stability and instability may vary, depending on the circumstances and the clinical concerns. The decision-making process and the available surgical options for the management of thoracic and lumbar instability are reviewed. Finally, management strategies, based on instability type, anatomical considerations, and surgical options, are discussed.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The purpose of this article is to review the evaluation and management of glomus jugulare tumors. These lesions are the second most common neoplasm of the temporal bone. They are richly vascular and are believed to originate in the chemosensory cells in the jugular region. These slow-growing tumors are rarely malignant and erode the jugular bulb and surrounding temporal bone along vascular planes and neural foramina. Morbidity results from involvement of the lower cranial nerves, the carotid artery, and intracranial extension. A complete head, neck, and cranial nerve examination and thorough radiographic testing are important for proper staging. Surgical resection is the mainstay of treatment. Radiotherapy is reserved for elderly patients, the medically infirm, or recurrent disease.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Dural arteriovenous fistulas (DAVFs) are abnormal connections that are located within the dura mater, usually within the walls of a dural sinus or involving an adjacent cortical vein. DAVFs are usually classified according to either the name of the dural sinus where the fistula exists or by the anatomic location where these shunts exist. In this review the experience of the past 8 years at the University of California at San Francisco Medical Center involving 268 patients with DAVFs is presented. Although the exact etiology of DAVFs remains unknown, they are believed to be acquired lesions in most cases. Clinical presentations may be highly variable and can frequently include intracranial hemorrhage. A thorough radiological evaluation is mandatory in all instances, not only to confirm the diagnosis but also to evaluate potential high-risk features and to plan treatment. Treatment options include noninvasive measures in selected cases, but the majority of patients will require obliteration of their fistula. This may be carried out by an endovascular route, by direct surgical attack, or through a combination of these two methods. Close cooperation between interventional neuroradiologists and neurosurgeons results in the safe and effective treatment of this condition in the vast majority of patients.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The history of interbody fusions has been long and the literature rich. This review details the evolution, thinking, and practice of spinal fusions in general and interbody methods in particular. Contrasts among the various fusion methods are presented, with an emphasis on recent developments, particularly the interbody fusion cages. Biomechanical data, clinical indications, patient selection, implant procedures, follow-up, and outcomes are discussed and, in part, compared among the principal three threaded fusion cage units: the Bagby and Kuslich (BAK) cage, the Michelson SDG cage, and the Ray threaded fusion cage (Ray-TFC). Non-threaded interbody spacers are presented; they are used in conjunction with pedicle screw and rod or plate stabilization. The future of bone growth technology is also reviewed. Results with interbody fusion cages indicate the likelihood that these methods will soon play a major role in the surgical treatment of spinal instability, or disabling discogenic pain syndromes.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID