摘要:

Two hundred five patients with neck pain were evaluated clinically and roentgenographically for a minimum of 10 years after onset of symptoms. Seventy-nine percent had a decrease in pain, and 43% were free of pain; however, 32% had moderate or severe residual pain. Patients who had been injured and initially had severe pain were the most likely to have an unsatisfactory outcome; however, no other clinical features were of value in predicting the final result. The presence or severity of pain was not related to the presence of degenerative changes, the sagittal diameter of the spinal canal, the degree of cervical lordosis, or to any changes in these measurements over the evaluation period.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Sixty-four patients who had undergone multilevel cervical laminectomy were studied for postoperative spinal deformity and instability. Special attention was given to patients with cervical spondylosis (CS), ossification of the posterior longitudinal ligament (OPLL), and spinal cord tumors. Twenty-three (36%) of 64 patients showed postoperative changes in curvature type and 9 (14%) had developed spinal deformity (kyphotic or meandering-type curvature). In two juvenile patients, the deformity developed soon after operation and spinal fusion was required to prevent neurologic complications. In the adult cases, contrary to the hitherto accepted concept, long-term follow-up revealed the tendency of the deformity to develop more frequently in OPLL cases than in CS cases. Mobility of the cervical spine was reduced considerably after laminectomy, both in CS and OPLL cases. There was no adult patient who required further operation for severe deformity or instability after laminectomy. Extensive laminectomy, even including the C2 lamina, seemed to have no adverse effect on the stability of the cervical spine.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Forty-eight adult mongrel dogs underwent posterior exposure of C4–C5, fixation of the two posterior spinous processes together with a no. 20-gauge cerclage wire, posterior element decortication, wound irrigation and the following: bone fusions (application of a standard volume of iliac crest autograft), polymethylmethacrylate (PMMA) fusions (application of a standard volume of methylmethacrylate cement), Combination 1 fusions (application of onehalf the volume of graft used in the bone fusions, over the facet joints. Methylmethacrylate cement was pressed into position centrally to surround the posterior spinous processes and cerclage wire), Combination 2 fusions (application of the same volume of graft used in the bone fusions, over the facet joints. Methylmethacrylate cement was applied as in the Combination 1 fusions). For each preparation, six animals survived 2 weeks or 3 months. All had monthly lateral cervical radiographs. At the appropriate times, they were killed and their C4–C5 segments excised and studied mechanically and histologically. At 2 weeks all of the above preparations were mechanically inferior to normal C4–C5 segments in respect to at least one of the parameters studied. At 3 months, the bone fusions and both combination fusions had developed sufficient mechanical stability so that they were equivalent to normal segments. At this time, the PMMA fusions remained inferior to the “normals.” The mechanical data for the PMMA and both combination fusions was corroborated by the histology which demonstrated a fibrosynovial layer between the cement masses and underlying posterior element bone. In the 3-month combination fusions, the lateral aspects of the posterior elements had been spanned by a fusion mass. Clinical relevance: Previously, the authors defined some of the problems associated with constructs modeled by their PMMA fusions. This work confirms the previous research. It also demonstrates that ultimate spinal stability is produced by combination constructs. Because of the 2-week mechanical data, it is recommended that when combination constructs are used clinically, the patient's neck be protected by an external orthosis in the early postoperative period.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Twenty-six patients with unilateral facet dislocation of the cervical spine were analyzed to determine the best method of treatment of this injury, the incidence of late pain and instability, and the indications for surgical stabilization. This review showed that all patients with a unilateral facet dislocation of the cervical spine should be treated initially with halo traction in an attempt to obtain reduction. If reduction is obtained, then nonoperative treatment in the form of a halo thoracic apparatus may be the best method of treatment. Failure to obtain reduction with axial traction is an indication for open reduction and one-level posterior cervical fusion. Patients left in the displaced position and allowed to heal in that position usually develop late pain as a complication of this method of treatment.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

An objective method of measuring thoracolumbar vertebral rotation by using a suitable compass attached to an auxiliary tool is described. The jugular notch and xiphisternum are used ventrally and the spinous process on the same horizontal planes is used dorsally as reference points for spinal rotation. The method was tested on 39 adults. The mean of intratester and intertester correlation coefficients for the measurements was 0.79 (SD 0.11), with no essential difference between intratester and intertester reproducibility. The results also showed that the method is of considerable validity and, thus, is a supplement to noninvasive goniometric measurements of thoracolumbar mobility in the sagittal and frontal planes.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Ninety-one patients with idiopathic scoliosis, who underwent posterior spinal fusion and instrumentation from January 1977 to December 1982, were reviewed. All patients were 20 years or older at the time of surgery and none had undergone a prior surgical procedure. Indications for surgery included pain, progressive deformity, and pulmonary symptoms. All patients had a posterior spinal fusion with Harrington instrumentation and autogenous iliac bone graft, with the addition of segmental wiring in only eight. No patient had an anterior fusion or fusion to the sacrum. Follow- up averaged 3.5 years (range: 2 –7 years). The average correction at the time of surgery was 38%, and 32% at the time of last follow-up. Seventy-nine percent of the patients reported complete relief of the symptom(s) for which they had surgery. There were 34 complications in 30 (33%) patients. Pseudarthrosis occurred in 14 (15%), requiring 15 additional procedures to achieve a solid arthrodesis. Urinary tract infection occurred in 8 (9%) patients and Harrington hook dislodgement in 5 (5%). One patient sustained a partial paraparesis with recovery to a minimal deficit. No deaths occurred. Although largely successful, posterior fusion with Harrington instrumentation for adult scoliosis has a significant incidence of pseudarthrosis and instrumentation problems.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Kyphosis in the myelomeningocele patient population causes significant problems such as skin breakdown, recurrent infection, and decreased function. Kyphectomy has proved to be a satisfactory means of correcting the deformity, but postoperative stabilization to prevent recurrence of deformity continues to be a problem. Twelve patients with myelomeningocele kyphosis, measuring an average of 124°, were managed by posterior kyphectomy and segmental spinal instrumentation. After operation, the curves measured an average of 32.8°. With a follow-up period, 6–57 months, only one patient lost correction. The loss of correction was secondary to rod failure. Straight midline incision, ignoring previous incisions, can be used to approach the spine without risk of increased wound complications. Adequate immediate stable correction can be achieved by kyphectomy and segmental spinal instrumentation with anterior fixation to the pelvis that thus allows the patient to proceed more quickly to an improved functional level.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Three cases of Charcot spinal arthropathy in long-standing (>20 years) paraplegia are presented. In this group of patients with other known chronic infections, the differential diagnosis strongly favored osteomyelitis. Scanning techniques including technetium 99, indium 111, and computed tomography (CT) were used in the extensive work-up and were helpful, although not diagnostic. Closed needle and, in two cases, open biopsies eventually confirmed the diagnosis. The possible occurrence of this neuroarthropathy long after the onset of nonprogressive paraplegia should be kept in mind by those treating spinal cord injured patients.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To elucidate the effects of nutrition and oxygen deficiencies on the intervertebral disc, cell components of mouse intervertebral discs and their postmortem changes were observed by electron microscopy. The annulus fibrosus could be divided into an inner and outer region. The main cell components of the annulus fibrosus were fibroblast-like cells in the outer region and chondrocytes in the inner region. The nucleus pulposus consisted of massively packed notochordal cells. The cartilage plates could also be divided into two zones: articular cartilage and growth cartilage containing chondrocytes. Postmortem degenerative changes proceeded from the peripheral to the central parts of the intervertebral disc, ie, showing degeneration of first the fibroblast-like cells, next the chondrocytes, and finally, the notochordal cells. The findings suggest that cells situated at the periphery predominantly depend on aerobic metabolism, whereas the cells situated more centrally depend on anaerobic metabolism. Furthermore, postmortem changes of the nucleus pulposus were similar to age-related changes. The age-related changes or degeneration in the intervertebral disc appear to be related to deficiencies of nutrition or oxygen caused by changes in structures of the disc and the surrounding tissues.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Lumbar metrizamide myelography (LMM) has been associated with a high incidence of side effects. A total of 94 patients underwent LMM for suspected disc disease or spinal stenosis. In Group 1 a 22-gauge spinal needle was used. Containing the same amount and concentration of metrizamide, an 18-gauge spinal needle was used in Group 2 after which there was partial withdrawal of the metrizamide (average withdrawal: 73%). In Group 1 a total of 38% of patients experienced one side effect whereas 8.5% had two side effects. In Group 2 a total of 8.5% of patients experienced one side effect and 4.25% had two side effects. This study demonstrates a statistically (P <0.003) lower incidence of side effects with metrizamide withdrawal after myelography.

ISSN:0362-2436    

出版商:OVID    

年代:1987

数据来源: OVID