摘要:

Study Design.An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted.Objective.To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern.Summary of Background Data.The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise.Methods.In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography.Results.The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement of pelvis stabilityviamanual compression through the ilia reversed these differences.Conclusions.The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A useful modification of the Kerrison rongeur is reported.Objectives.To modify a rongeur of the Kerrison type to avert the problems associated with conventionally designed rongeurs.Methods.A commercial rongeur of the Kerrison type was equipped with a special chip collector attached immediately behind the cutting edge.Results.Conventionally designed rongeurs necessitate the continuous removal of resected bone chips. This time-consuming activity can be avoided easily by the use of the modified rongeur.Conclusions.The design of the chip collector fully met the expectations for the modification: no clogging of resected bone material, easy clinical use, and shorter operating times. The modified rongeur, available in two lengths (190 and 290 mm) and three sizes of the chip collector (diameter of 4, 6, and 8 mm) proved to be useful in clinical applications.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case of ossification on both sides of the ligamentum flavum in the cervicothoracic junction is described.Objectives.To review the pathology associated with ossification of the ligamentum flavum in the spine and its incidence at the cervicothoracic junction.Summary of Background Data.The literature on the common sites for ossification of the ligamentum flavum is reviewed. No report described ossification on the outer surface of the ligament presenting as ossification nodules on the medial side of the apophyseal joint.Methods.The clinical, radiographic, and pathologic features associated with ossification of the ligamentum flavum are presented. The ossified ligament grew into nodular masses on both surfaces: posterolaterally on the medial surface of the apophyseal joint and anteromedially on the undersurface of the lamina. The masses were connected by a film of elastic fibers from the remnant ligamentum flavum.Results.The symptoms and physical signs of cervical myelopathy improved after laminectomy and removal of the ossified ligament. There was no recurrence.Conclusion.The reported case adds to the literature on the pathology associated with ossification of the spinal ligaments.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case involving microradiographic and histopathologic analysis of an explanted human corpectomy mesh cage is reported.Objective.To describe the clinical circumstance, the radiographic appearance, and the histopathologic assessment of a titanium mesh device explanted from a two-level corpectomy.Summary of Background Data.To the authors’ knowledge, no published microradiographic or histopathologic reports have described a retrieved human corpectomy cage.Methods.The explanted device was stained using Osteochrome Villanueva bone stain and underwent routine decalcified histologic processing and embedding in polymethylmethacrylate. Midsagittal sections were prepared and polished to 100 &mgr;m for histologic and microradiographic analysis.Results.Microscopic analysis demonstrated normal-appearing lamellar and woven trabecular bone in close contact with the titanium implant interface. Further analysis of serial sections indicated that, on the average, 35% (range, 30–40%) of the inner device region contained trabecular bone.Conclusion.Osteosynthesis and bone remodeling can occur within titanium corpectomy cages.Methods.This study involved one titanium mesh device (Harms cage), 20 mm in diameter and 45 mm long, explanted from a two-level corpectomy clinical case. This device was retrieved, processed, and analyzed after informed patient consent and approval from the authors’ institutional review board.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Animal model study of three healthy commercial pigs was conducted.Objective.To determine whether near infrared spectroscopic monitoring of the spinal cord is feasible, and whether changes in near infrared spectroscopy correlate with changes in blood flow to the cord or operative maneuvers.Summary of Background Data.Near infrared spectroscopy is a noninvasive continuous monitoring tool capable of measuring absolute changes in the concentration of three chromophores: oxygenated hemoglobin, deoxygenated hemoglobin, and cytochrome aa3, the terminal enzyme in the electron transfer chain and a measure of cellular energy equilibrium. Near infrared spectroscopy has been used to monitor the brain intraoperatively in multiple circumstances. The authors hypothesized that near infrared spectroscopy could be used to monitor the spinal cord’s cellular energy equilibrium during spinal surgery (i.e., that vascular compromise could be identified before irreversible damage occurred).Methods.The posterior elements of the spine were exposed, and near infrared spectroscopy optodes (fiberoptic bundles) were sutured to either the lamina or the spinous processes of T9, T10, or both and directed toward the spinal cord. Interventions included manipulation of oxygen saturation and distraction of the T9–T10 disc space.Results.With reduced oxygen delivery (lower arterial oxygen saturation and blood flow), oxygenated hemoglobin concentration decreased and deoxygenated hemoglobin concentration increased. With distraction, blood volume (oxygenated hemoglobin plus deoxygenated hemoglobin) decreased, and cytochrome aa3became more oxidized. Changes were apparent within 1 second of the intervention beginning, and recovery to the baseline of near infrared spectroscopy occurred with relief of each intervention.Conclusions.This near infrared spectroscopy technique monitors changes in oxygenation of the spinal cord, and therefore appears capable of intraoperative warning about impending vascular compromise of the spinal cord.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case report and a literature review are presented.Objective.To describe and review the clinical presentations, characteristic findings from imaging studies, and treatment of synovial and ganglion cysts arising within the cervical spinal canal.Summary of Background Data.Synovial and ganglion cysts in the cervical spine are rare. To the authors’ knowledge, 24 sporadic cases in all, designated by various terms, have been reported in the literature.Methods.Three cases of synovial and ganglion cysts in the cervical spine are reported as well as a review of the literature.Results.Characteristic findings from imaging studies included a fluid-containing extradural lesion demonstrated on magnetic resonance images and gas content in the lesion demonstrated on ordinary or sagittally reconstructed computed tomography images. A laminectomy with removal of the cyst was the treatment of choice in most cases.Conclusions.Neither communication with an adjacent facet joint nor histopathology of the cyst wall provides a persuasive basis for differentiating ganglion, synovial cyst, and cyst arising from the ligaments. To accommodate the varied presentations, the authors propose a comprehensive term for these lesions: “degenerative intraspinal cyst.”

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A histologic and histochemical study was performed both in the autopsy of a human patient with cervical spinal cord compression caused by ossification of the posterior longitudinal ligament and in a tiptoe-walking Yoshimura mouse model of progressive cervical cord compression.Objectives.To clarify the mechanism of destructive pathologic changes in the spinal cord under chronic mechanical compression.Summary of Background Data.Under chronic compression, the spinal cord exhibits destructive changes considered to be causes of profound and irreversible motor paresis. Recently, some investigators have found that apoptosis in acute spinal cord injury induces both secondary degeneration at the site of injury and chronic demyelination of tracts away from the site of injury. However, the mechanism responsible for these destructive spinal cord changes under chronic compression remains unclear.Methods.The spinal cord was examined histologically, and an attempt was made to detect apoptotic cells using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling in both the autopsy of a human patient and tiptoe-walking mice exhibiting spinal cord compression.Results.Apoptotic cells were observed in the chronically compressed spinal cord in both the autopsy of a human patient and model mice. In tiptoe-walking mice exhibiting spinal cord compression, descending degeneration in the anterior and lateral columns and ascending degeneration in the posterior column were observed. The distribution of oligodendrocytes with positive results from terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling was similar to that for degeneration of the long tracts.Conclusions.Spinal cord cell apoptosis may produce destructive changes in the spinal cord under chronic compression, with a resulting irreversible neurologic deficit.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID