摘要:

An etiologic concept linking an impaired axial motor control system to the structural deformity of idiopathic Scoliosis (ISc) is proposed. Postural studies reveal that during quiet stance, adaptation is marked in conditions associated with visual control of sway, particularly of lateral sway; during imposed perturbations of the body, destabilized postural reactions are pronounced in tests requiring visual–vestibular coupling. Observations of visual and/or vestibular generated eye movements indicate ocular instability among a high proportion of the ISc. Previously, the authors argued that a direct relationship exists between visual and/or vestibular functioning and a disordered axial motor system. This was attributed to an aberrant brain stem mechanism. In this presentation, however, we propose that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits. Among the wide range of visual–vestibular variables studied, those representing processing of vestibular signals within the CNS yield the highest degree of correlation with the magnitude of the curve. Moreover, differences in vestibular processing between two subsets of ISc, namely ISc with (70%) and without (30%) normal academic achievement are significant. Variables referable to both vestibular and visual processing correctly classify 87% of the ISc with normal academic achievement and 100% of the ISc with a history of academic problems. The association between learning deficits, altered processing of vestibular information, and ISc suggest a unique syndrome complex, and an important role of cortical structures in the etiology of this disorder. The presence of a visuo-spatial perceptual impairment may be the common feature of ISc. In an attempt to restore perceptual dysfunction (by rearrangement), the ISc adopts a new axial and vestibular motor control strategy based upon recalibration or reinterpretation of proprioceptive signals arising from the axial musculature.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Spinal column duplication in association with other vertebral, gastrointestinal, and genitourinary tract anomalies is reported in a female infant. An embryologic explanation is postulated, in which the combination of anomalies is attributed to a single embryologic insult occurring the latter half of the third week of gestation.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Metastatic bone disease in 322 patients was analyzed to assess the frequency and behavior of disseminated carcinoma to the vertebral column. Breast, lung, and prostate neoplasms were the most frequent tumors of origin in the 55% of patients who had vertebral lesions. The lumbar spine was the site of the greatest number of metastases. Back pain did not occur in 36% of the 179 patients with spinal disease. Cord compression occurred in 20% of the patients with vertebral involvement, and prostate tumors were the most frequent neoplasm to cause epidural spinal cord impingement. Hypernephroma was the most common cancer to present as a neurologic deficit secondary to an undetected primary malignancy.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Mestastatic tumors of the spine often cause severe pain and paralysis because of deformity and neural encroachment. As oncology now extends the life expectancies of these patients, spinal decompression and stabilization is necessary. We consider that prophylactic stabilization of the spine is analogous to prophylactic nailing of a femur with a pathologic lesion. Both the femur and spine are weight-bearing structures. The advent of segmental instrumentation makes this a feasible accomplishment with minimal morbidity. Seventeen patients with metastatic disease of the spine at Rush-Presbyterian-St. Luke's Medical Center, Chicago, were reviewed. All maintained spinal stability postoperatively. Eleven of the 17 had significant pain relief for 3 months or more. Five of 11 paralyzed patients had significant neural recovery. A classification for treatment purposes regardless of tissue type was developed. Once classified, the surgical goals for these patients were to decrease pain, to preserve or to improve neurologic function and to mobilize the patient without external orthosis.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A description of two cases of intraspinal hemangiopericytoma is given, which join the 30 reported to date. The clinical features of this tumor rarely found in the CNS are compared with those of the same oncotype found at other sites. Surgical treatment is necessary, accompanied by radiotherapy. Spinal tumor embolization preoperatively is of benefit.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Thirty-six adult mongrel dogs underwent either a posterior C4–CS bone graft or methylmethacrylate–cerclage wire construction procedure to simulate the analogous human stabilization procedures. The dogs were divided into groups of six and allowed to live 1, 2, or 3 months after surgery. At the appropriate time they were killed and their C4–C5 spinal segments excised and studied radiologically, mechanically, and histologically. In addition, the C4–C5 spinal segments from 15 other mongrel dogs were excised and either left intact as normal (five) or prepared as one of the two constructs (five each) described above. They were also tested mechanically to provide immediate postoperative stability data. At some time during the first postoperative month the methylmethacrylate constructs lost mechanical stability. In addition, fibrous tissue was noted to have grown between the posterior laminal surface and the cement mass during this same time. Radiologically, loosening was obvious by the second postoperative month. The bone graft constructs were mechanically equivalent to or superior to the normal dogs by the second postoperative month. Likewise, they were well on their way to solid fusion radiologically and histologically by the same time. Impressed by the rapidity of deterioration in mechanical stability for the methylmethacrylate constructs, the authors further questioned their usefulness in cases of traumatic cervical spinal instability. The bone graft constructs continued to appear to be a reliable way to achieve ultimate spinal stability.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Spondylosis diffusely affects the vertebral column but is more pronounced in the cervical and lumbar regions where mobility is greatest. Of 214 patients treated for symptomatic spinal spondylosis, 63 patients (29%) were found to have symptoms related to the cervical spine alone: 123 (58%) had symptoms relative to the lumbar spine alone; 28 (13%) were found to have symptoms relative to both the cervical and lumbar spine in a retrospective clinical study. The incidence of occurrence of a narrow spinal canal was determined. In the patients with cervical spondylosis alone, 40 patients (64%) were found to have midcervical sagittal diameters below average. Eighty-seven patients (71%) with lumbar spondylosis had spinal canals below the average measurements. In the group of patients with combined disease of the cervical and lumbar spine, 18 of the 28 patients (64%) had spinal canal diameters below the accepted average values.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The degree of concavity (le, the scalloping) on the posterior surface of the lumbar vertebral bodies has been evaluated quantitatively by means of a simple measuring device. The scalloping in the median sagittal plane was found to differ from that in the lateral plane, near the pedicular attachments. In the medial plane, an increase in scalloping from L1–L4 was noted, with a subsequent decrease at L5. Laterally, the concavity deepened from L1–L5, the values here being larger than those medially at all levels. The results are discussed with respect to the anatomy of the dural sac and its contents, and the spinal nerves. Scalloping in the lateral sagittal plane is, especially at the fourth and the fifth lumbar levels, presumed to be caused mainly by pressure exerted by the spinal nerves. The medial scalloping is presumed to be partially due to hydrostatic pressure of the cerebrospinal fluid in the dural sac. This pressure will, at the edges of the superior and inferior end-plates, be counteracted by the tractional stresses of the fibers of the discal annulus fibrosus that are inserted at the vertebral margins. This effect contributes to the final shape of the vertebral bodies. The posterior vertebral surface constitutes part of the anterior wall of the spinal canal. Therefore its shape has relevance in cases of spinal stenosis, and some aspects of this relationship are discussed.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The relationship between the angulation of the facet joints and that of the caudad parts of the corresponding laminae in the transverse plane was investigated with computed tomography (CT) at the vertebral levels L3–L4, L4–L5,and L5–S1. At the level of L3–L4, both the facet joints and the caudad portions of the laminae tend toward a sagittal orientation, while at L5–S1 this is more toward the frontal plane. At the level of L4–L5, they occupy an intermediate position. A highly significant correlation between the orientation of these structures is demonstrated. The caudad parts of the laminae may be considered buttresses for the inferior articular processes of the same vertebra.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Intraosseous pressure (IOP) and cerebrospinal fluid pressure (CSFP) in the lumbar region were measured simultaneosly in two groups of patients with either spinal canal stenosis or disc herniation, to compare dynamic changes with positional changes, and to learn whether these pressure changes may have some role in the onset of claudication. IOP and CSFP showed almost the same change patterns with positional changes in two groups. They were lowest in the prone position and highest at the standing position. In standing with flexion, they were almost the same as in the prone position, but in extension they increased above the standing pressure. These dynamic pressure changes could act as a compression force to the cauda equina in the patient with spinal canal stenosis.

ISSN:0362-2436    

出版商:OVID    

年代:1985

数据来源: OVID