摘要:

The ideal surgical treatment of multilevel cervical spondylosis remains unclear. This study analyzed the complications in using titanium cages and plating to reconstruct multilevel cervical corpectomies. This was a retrospective analysis of 21 consecutive patients who had multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. Sixteen had 2-level, one had 2.5-level, three had 3-level, and one had 3.5-level corpectomies. All had reconstruction with titanium cages and anterior plating. Thirty-three percent of the patients developed complications. Radiographs revealed bony consolidation in 95% of patients. Reconstructing multilevel cervical corpectomies with titanium cages and plating is associated with complications. Advantages include rigid immobilization and the avoidance of iliac crest bone graft harvesting. Major complications are largely the result of failures of the cage and plate construct, especially in patients with osteopenic bone. Supplemental posterior stabilization may be considered for cases with spasticity or greater than 2-level corpectomies with profound osteoporosis.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A retrospective study was performed on the operative results following osteoporotic burst fractures with neurologic compromise. We sought to investigate the results of operative decompression and stabilization in patients with neurologic deficit as a result of an osteoporotic burst fractures. We examined the postoperative radiographic outcomes, level of disability, functional outcomes, and complications. Compression fractures of the anterior vertebral column secondary to osteoporosis and minimal trauma are a common clinical entity. These fractures are often effectively treated by nonoperative means. However, compressive failure of the middle vertebral column can lead to retropulsion of vertebral body fragments with significant canal compromise and neurologic injury. Treatment of these more severe injuries becomes more difficult and is less well established. Functional outcomes and disability from pain have not been examined. Previous reports on this subject have documented generally good results but have given few specific data regarding outcomes. We retrospectively report on a series of 10 patients, from 1995 to 1998, with osteoporotic burst fractures, which led to varying degrees of neurologic compromise. There were nine female and one male patient with a mean age of 76 years. Nine of the 10 patients presented more than 1 month following the onset of neurologic symptoms; 70% of the fractures occurred at the thoracolumbar junction (T11–L2). Mean loss of anterior column height was 59%, with significant kyphosis (mean 28°) in nine of the 10 fractures. Mean canal compromise was 41%. At presentation, seven patients were Frankel grade D and three were Frankel grade C. All patients were treated operatively with decompression and arthrodesis. Mean time to follow-up was 16 months. Six of the 10 patients had improvement of their Frankel grade postoperatively and one deteriorated neurologically. Seven of the eight surviving patients completed the Oswestry questionnaire with a mean score of 44%, representing severe disability secondary to low back pain. The Physical Component score of the SF-36 was at or below the national mean for each patient. Complications were present in six of the eight surviving patients. Osteoporotic fractures are not benign. Careful evaluation for neurologic deterioration is warranted. Neurologic recovery occurred in six of the 10 patients; however, significant disability secondary to pain was common.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Many attempts have been made at donor site reconstruction to reduce postoperative pain following anterior cervical surgery. This study is a comparative analysis of the outcome of 46 patients undergoing single-level anterior corpectomy and fusion using iliac crest autograft performed by one surgeon (N.E.E.). Twenty-three patients had no donor site reconstruction, whereas the more recent 23 patients had iliac crest reconstruction using a MacroPore sheet (MacroPore, Inc., San Diego, CA) and Inductive Conductive Matrix (ICM, Sofamor Danek, Memphis, TN). Bodily Pain, assessed on the Short Form-36, obtained up to 12 months postoperatively, failed to demonstrate better pain relief following donor site reconstruction. Multiplanar CT studies obtained 6 months postoperatively documented 100% donor site fusion for the 23 reconstructed patients. Although iliac crest reconstruction failed to reduce Bodily Pain, it did result in 100% fusion.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Complications of the donor site after the harvest of corticocancellous bone graft from the posterior iliac crest are very common. The most common are chronic donor site pain, tenderness, and sensory disturbances. This study investigates the results of the midline, lumbar fascia splitting approach for harvesting bone graft in lower lumbar spine fusion and compares them with the classic separate incision approach. A retrospective study of 107 patients compares two groups. The first group of 56 patients (35 males and 21 females with an average age of 41.8 years) had bone graft taken by splitting the two layers of the lumbar fascia down to their attachment to the iliac crest. The second group of 51 patients (29 males and 22 females with an average age of 43.7 years) had a separate incision over the iliac crest. In the first group, 82.1% had no tenderness, 8.9% mild, 7.1% moderate, and only 1.8% severe tenderness over the donor site. In the second group, 45.1% had no tenderness, 21.6% mild, 17.6% moderate, and 15.7% severe tenderness over the donor site. Five patients of the separate incision group (9.8%) had a lump in the donor site compared with none in the “same incision” group. Sensory disturbances over the donor site were found in 5.4% of the first group and in 21.6% of the second group. Harvesting bone graft from the posterior iliac crest for lower lumbar spine fusion through a midline, fascia splitting approach was found superior to the traditional, separate incision approach.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

There have been no reports on the effects of the mixture ratio of local bone graft to artificial bone on the outcome of intervertebral bone fusion. The purpose of this study was to determine whether the mixture ratio of local bone removed from laminae and spinous processes to apatite- and wollastonite-containing glass ceramic (AWGC) granules affected fusion rates in spinal fusion. Posterolateral lumbar fusion at two levels without spinal instrumentation was performed in 35 patients who were diagnosed with lumbar spinal canal stenosis. The patients were randomly divided into three groups, each of which received a different mixture ratio of local bone to AWGC granules: 2:1, 1:1, and 1:2. The total mass of grafted bone was 20 g in all three groups. The fusion rate was approximately 80% in all three groups. Our results indicate that lumbar posterolateral fusion can be successfully achieved even when the mixture ratio of local bone graft to AWGC granules is 1:2.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We have analyzed the radiologic findings on the lumbar spine and the clinical symptoms in patients with rheumatoid arthritis (RA). A total of 106 patients who fulfilled the revised criteria of the American Rheumatism Association were subjected. All of the patients were asked to fill out a questionnaire about the existence of low back pain, leg pain, and leg numbness. Radiologic features of the lumbar spine, including scoliosis, spondylolisthesis, disc space narrowing, endplate erosion, osteophyte, and osteoporosis, were checked. Radiographs of the cervical spine were also taken. The clinical background of RA, such as mutilating disease or not, was assessed. Forty-two patients (40%) had the symptoms of low back pain. Abnormal radiologic findings in lumbar spine were detected in 57%. The prevalence of clinical symptoms tended to be higher in the patients with endplate erosion. Forty-two percent of the patients had both lumbar and cervical lesions. The prevalence of lumbar lesion was not high in the mutilating type of RA, except for facet erosion and severe osteoporosis. The patients with pulse steroid therapy revealed a higher prevalence of vertebral fracture. From these results, we concluded that lumbar lesions were frequently observed in patients with RA. The possibility of lumbar lesions as well as the lesions in the cervical spine and peripheral joints should be examined in patients with RA.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Little is known about the natural history of spinal alignment as it ages into the eighth and ninth decades. Fifty asymptomatic volunteers 70–85 years of age (mean 76 years) without any history of spine pain, trauma, or deformity were radiographed in the standing lateral position, from C7 to the pelvis including the hips. Measurements included segmental angulations, kyphosis, lordosis, and C7 plumb line balance. In addition, measurements of sagittal pelvic balance were made (pelvic incidence, tilting, sacral slope, and S1 overhang). Average kyphosis was 52° (range 29° to 79°); the average lordosis was −57° (range −96° to −20°). The C7 plumb line on average fell 40 mm anterior to the posterosuperior corner of S1. The anterior positioning of C7 was also positively correlated with age and decreasing lordosis. This provides further data into the natural history of the aging spine.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Multiple factors contribute to the pathogenesis of postlaminectomy deformity and instability of the cervical spine. The complex alterations in both static and dynamic biomechanics after laminectomy are incompletely defined. We sought to examine the role of the lamina in compressive load bearing across the vertebral body. Holographic interferometry was used to study the surface deformation of single axially loaded cervical vertebral bodies before and after hemilaminotomy, hemilaminectomy, and experimental acrylic laminar reconstruction. Our results showed that hemilaminotomy did not alter the surface deformation because of axial loading across the cervical vertebral body. However, gross alterations in surface deformation across the cervical vertebral body were consistently observed after hemilaminectomy. Experimental reconstruction of the laminar arch using acrylic restored the deformation pattern to the prelaminectomized baseline. Our results support a role for the lamina and the integrity of the laminar arch in axial load bearing across the cervical vertebral body. The altered axial load bearing may be a significant contributor to postlaminectomy deformity and instability. These findings offer an additional biomechanical advantage to minimal bony intervention for cervical spine pathology.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The definition of cervical spinal instability has been a subject of considerable debate and has not been clearly established. Stability of the motion segment is provided by ligaments, facet joints, and disc, which restrict range of movement. Moreover, permanent damage to one of the stabilizing structures alters the roles of the other two. Although manyin vitrostudies have been conducted to investigate cervical injuries, to date there are only limited finite element investigations reported in the literature on the biomechanical response of the cervical spine in these respects. A comprehensive, geometric, nonlinear finite element model of the lower cervical spine has been successfully developed and validated under compression, anterior–posterior shear, and sagittal moments. Injury studies were done by varying each spinal component independently from the validated model. Seven analyses were conducted for each injury simulation (model without ligaments, model without facets, model without facets and ligaments, and model without disc nucleus). Results indicate that the role of the ligaments in resisting anterior and posterior shear and flexion and axial rotation moments is important. Under other physiologic loading (anterior–posterior shear, flexion–extension, lateral bending, and axial rotation), the disc nucleus is responsible for the initial stiffness of the cervical spine. The results also highlight the importance of facets in resisting compression at higher loads, anterior shear, extension, lateral bending, and torsion. The results provide new insight through injury simulation into the role of the various spinal components in providing cervical spinal stability. These findings seem to correlate well with experimental results as well as with common clinical experience.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID