摘要:

Seventy-nine percent of 312 patients who underwent lumbar disc surgery were evaluated at least 10 years postoperatively (mean=13.7 years). Residual back and nerve root symptoms and functional impairment were equally as common among the 143 patients who underwent fusion as they were among the 64 patients who did not. Thirty percent of the patients whose spines were fused and 37.7% of those patients whose spines were not fused were considered longterm failures because of persistent symptoms or the need for reoperation. Thirty-seven percent of the fusion patients had persistent graft donor site symptoms. Examined patients showed a high percentage of residual neurologic defects. An unexplained positive Trendelenburg sign was present in 14.8% of the fusion patients and in 18.2% of the patients whose spines were not fused. Although retrospective studies often have problems of accuracy, this analysis confirms other observations that midline spinal fusion offers few benefits in the management of lumbar disc disease.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Forty-five patients who had lumbar disc surgery 10 or more years previously, and had required a second operative procedure, have been evaluated. Failures occurred up to 16 years after the first operation, and were most commonly due to pseudoarthrosis in the patients who underwent spinal fusion initially, and to recurrent disc lesions at the same level as previous surgery in the patients who did not have fusion. The clinical and functional results in the second group of patients who required a second procedure were comparable to those of patients who required only a single procedure. In contrast, patients who had undergone spinal fusion who required a second procedure had significantly worse clinical and functional results, both in comparison to the patients who did not undergo fusion as well as to patients who had had fusion as a single procedure. The only predictable, demonstrable source of failure was acquired spondylolysis. Frequently, repair of pseudoarthrosis did not lead to symptomatic relief. These data suggest that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Spinal kinematics concerns the kinds and amounts of motion the human spine undergoes during its normal physiologic movements. This paper is a review of the research in this area and provides information about past and current knowledge. The biomechanic terms essential for the precise and accurate description of spinal kinematics are defined, described, and exemplified. Requirements for a comprehensive description of spinal kinematics are presented to provide a perspective for present knowledge and future research. Finally, the current status of spinal kinematic research is described, and information about the ranges of motion of the human spine for various vertebral levels and for motion in different directions is provided.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

One hundred patients with lumbosacral adhesive arachnoiditis documented either directly at surgery or by unequivocal myelography served as the basis for this report on the pathologic process. Nomenclature for this disease, involving radiculitis, arachnoiditis, and adhesive arachnoiditis, is proposed. The entity appears not to be rare, as previously thought, but common in patients with severe back and/or leg pain and functional incapacitation due to the failed back surgery syndrome. While true incidence and relationship to a combination of causal factors remains to be accurately documented, the importance of Pantopaque in contributing to this disease process appears to be quite significant.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

This study reports an investigation of the canine arachnoid membrane using the scanning electronmicroscope (SEM) regarding the effects of contrast material on these structures. In the normal arachnoid membrane, two basic surface patterns were observed; one fenestrated and the other embossed with parallel fibers. Ventriculography was performed on 30 mongrel dogs divided into five groups: control, air, iophendylate, meglumine iothalamate, and Metrizamide. SEM study of the arachnoid membrane from basal cisterns showed no change after air ventriculography. After contrast agents were used, macrophages appeared and fenestrations became closed with a fibrin-like substance.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The results of a long-term study of 28 patients operated on for adhesive lumbar arachnoiditis are presented. The technique involved was microscopic lysis of adhesions. The first case of surgery was performed in 1966 and the last, in 1970, with followup through 1976. Numerous observations are made regarding the clinical picture and the appearance of arachnoiditis at the time of surgery. Some conclusions are drawn regarding the causes of this condition with some emphasis on the role of Pantopaque, multiple surgeries, and other trauma. The conclusion is that surgical attack on arachnoiditis is a straightforward surgical exercise that, when carried out with appropriate caution, produces no further neurologic deficits and some short-term improvement. However, the authors feel that this procedure should not be performed at the present time because there does not appear to be a method for preventing the reaccumulation of the scar tissue and subsequent recurrence of the symptoms.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The diagnostic and therapeutic courses of 68 patients with the discharge diagnosis of spinal arachnoiditis were reviewed. The combination of oil myelography and spinal surgery was the probable cause of arachnoiditis in almost all cases. The clinical presentation featured leg pain (90%), low-back pain (80%), and sphincter disturbance (25%). Motor, sensory, and reflex changes were present in two thirds of the cases, with a majority having defects attributable to bilateral or multiple root level involvement. Specific analysis of previous operative procedures, cerebrospinal fluid (CSF) studies, and myelographic patterns did not disclose any consistent correlation with the clinical presentation. Results are interpreted in light of prior clinical and experimental studies on the reaction of the meninges to trauma and myelography.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented. Lumbar spine surgery and the injection of contrast materials prior to the diagnosis of this condition are considered the most important factors in its genesis. In this series, there was microscopic evidence of arachnoiditis ossificans in 3 patients and arachnoiditis calcificans in 1 patient.

ISSN:0362-2436    

出版商:OVID    

年代:1978

数据来源: OVID