摘要:

This is a retrospective review of 26 patients with chronic intractable pain in which dorsal column stimulation was used as a salvage procedure. On follow-up of 12 to 42.7 months, 21 of the patients had diminished narcotic usage. Seventeen patients subjectively rated their pain relief as good to excellent. Another five patients reported some relief of pain. Two-thirds of the patients reported an increase in their ability to perform daily activities such as walking, stair climbing, and time spent sitting. There are still many technical problems that plague this procedure, as evidenced by a very high technical complication rate of lead migration and lead breakage. Whether or not results diminish over long-term follow-up remains to be seen.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In this paper, the authors present a deterministic simulation model, which they call Simulift, of trunk-muscle activity and intra-abdominal pressure during a sagittally symmetric trunk exertion. Simulift is a descriptive model that quantifies the time-varying loading of the spine based on observed internal forces. Recent findings about the time sequence of events during trunk motion and established equilibrium formulas provide the theoretical bases for the simulation. A profile of electromyographic activity in ten trunk muscles and intra-abdominal pressure is updated as simulated time passes, or as the trunk motion is simulated. Input to the model includes a list of motion-event times and a set of profile-component-behavior data. Simulift is an “impulse” model that computes instantaneous and time-integrated statistics on individual muscle activity, intra-abdominal pressure, compression, lateral shear, and anterior shear as the profile components of the simulated subject change. Computer results for the simulation model are presented.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

From January 1983 to March 1986 the authors have performed 88 consecutive lumbosacral spine fusion, enhanced with translaminar facet screws, as described by F. Magerl of St. Gallen, Switzerland. Forty-three patients have a follow-up of 12 months or greater, for a mean follow-up time of 16 months. The median time to fusion in this group was 6 months, with a range of 6 weeks to 10 months. Ninety-three percent of the patients were found to be clinically improved, and 91% of patients were judged solidly fused on evaluation of motion radiographs. Compared with our previously reported results for lumbar fusion without internal fixation, supplementation of lumbar fusion by translaminar facet screw fixation significantly improved the clinical results, as well as the time required for fusion, with no significant increased risk.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In acute nonsurvival studies, eight anesthetized lambs were subjected to cord compression at T13 by means of an epidural balloon distended to a pressure of 200 mm Hg for 40 minutes. Subsequent to withdrawal of the balloon, each animal received 30 mg/kg of methylprednisolone succinate in an intravenous bolus followed by a continuous infusion of 10 mg/kg/hr for the duration of the experiment. Spinal cord blood flow (SCBF) and spinal evoked potential (SEP) determinations were obtained sequentially prior to, during, and at ½, 1½, and 2½ hours following compression. In spite of the absence of ischemia following compression, SEPs failed to recover. Methylprednisolone had no apparent effect on blood flow or on the recovery of SEPs when compared with results in ten control animals that received saline alone.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Many victims of traumatic spinal cord injury (SCI) suffer immediate paralysis as well as a subsequent progressive worsening of the cord pathology. Certain sensorimotor functions that might otherwise have returned are irreversibly lost because of this delayed response. An understanding of the pathophysiology behind this progressive, self-destructive sequence is yet to be acquired; however, numerous proposals have been set forth involving processes such as edema formation, vascular changes, an inflammatory reaction, and destruction of the neuronal plasma membranes. In this review, the authors outline many of the chemical, anatomic, and functional changes associated with SCI as well as a number of treatment regimens that have been found to improve recovery from SCI (including parenteral glucocorticold therapy, localized cord cooling, calcium channel blockers, and opiate antagonism). From this, a number of mechanisms accounting for the mediation and/or prevention of the secondary destructive response are synthesized.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The present study compared the computed tomography (CT) scan muscle area/muscle density and isokinetic trunk strength of a group of spinal surgery patients (35 males and 11 females) 3 months postoperatively. Analyses showed trunk strength means to be below 50% of gender-specific “normal” values obtained by evaluating a normative sample. Extensor strength was more significantly affected than flexors. Single-cut CT scans performed at the time of isokinetic trunk strength assessment demonstrated psoas and erector spinae atrophy through a significant decrease in muscle density, with only a trend towards decreased cross-sectional area. Findings also indicated that there was a significant correlation between increased mechanical trunk strength performance and greater muscle density on CT scan. Strength was significantly lower for the male patients undergoing spinal fusion compared with those undergoing disc excision. However, no significant difference was found in strength measures between: males with high versus low pain level and working versus nonworking males at the time of evaluation.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Spinal cord concussion is a transient disturbance of spinal cord function, with or without vertebral damage and no demonstrable pathologic changes, that results from a rapid change in velocity following trauma, and resolves within 48 hours. In a retrospective review of patients with spinal injury referred to a tertiary care center, spinal cord concussion was observed in 3.7% of patients. Thirteen cases are presented. A variety of clinical presentations may occur, all of which can be explained on the basis of the magnitude or direction of acceleration of the spinal cord. The cervical cord is most commonly affected, but concussion can occur at any level of the spinal cord. Spinal cord concussion is often associated with pre-existing vertebral abnormalities that result in narrowing of the spinal canal or areas of hypermobility.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The goal of surgical treatment of metastatic spinal tumors is to maintain neurologic functioning without pain for the duration of the life expectancy. Of 28 patients in this series, 25 who had metastasis in the vertebral body underwent direct decompression by removal of the tumor, followed by vertebral reconstruction. A combined anterior or posterior instrumentation provided rigid spinal stability immediately after surgery. Three patients with involvement of the posterior part of the vertebra were treated by laminectomy for removal of the tumor, followed by posterior instrumentation. As a result, of nine patients who are alive with improved neurologic functions, seven have been ambulatory for an average duration of 13 months. Of 19 patients who have already died, recurrence of neurologic deficits was observed in five (26%), and 14 had no neurologic deterioration until they succumbed to the malignancy. Removal of the tumor and reconstructive surgery may be expected to produce satisfactory results

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Fifty consecutive patients underwent standardized surgical treatment for isthmic lumbosacral spondylolisthesis. Twenty-two (44%) had mechanical symptoms only and were treated within situfusion. Twenty-eight (56%) had back and radicular symptoms and underwent decompression and fusion. Follow-up averaged 40.4 months. Satisfactory results were achieved in 30 (60%). Patients under 30 and over 50 appeared to do better. Success rate was not related to degree of slippage. Success rate in compensation cases was 39%, versus 83% in non-compensation cases (P< 0.001); males, 53%, versus females, 78% (0.05 <P< 0.1); back pain only, 73%, versus radiculopathy, 50% (0.05 <P< 0.1); smokers, 48%, versus nonsmokers, 74% (0.05 <P< 0.1). Pseudarthrosis rate was 12%, and this correlated with failure (P<0.002). Thus, a trend towards an unsatisfactory outcome was seen in males, middle-aged individuals, those with a smoking habit, and patients with radicular symptoms. A compensable work situation and pseudoarthrosis had a profoundly negative influence on outcome.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In order to standardize the results of different biomechanical studies concerning stresses on lumbar discs, it may be useful to estimate the disc dimensions of the examined subjects and to refer the stress values to a unit surface area (square centimeter). The association between anthropometric parameters and discal areas at the L3-L4, L4-L5 and L5-S1 levels, examined by computed axial tomography, was studied in a group of 32 subjects (16 male; 16 female) with the aim of estimating lumbar disc areas with a simple method. Bony structure weight, which is computed by an equation that takes into account the diameters of the wrist, elbow, knee, and ankle and the stature, is the anthropometric parameter best associated with the areas of lumbar discs. The wrist diameter also shows a good association with the same areas. On the contrary, the association between body weight and disc areas was found to be less adequate for this purpose. The equations of the relative regression lines are reported as well as the criteria for their practical applications.

ISSN:0362-2436    

出版商:OVID    

年代:1989

数据来源: OVID