摘要:

The management of lumbar instability has evolved over the past 20 years based on a better understanding of the biomechanics of the lumbar spine, the advent of computed tomography, and the development of improved internal spinal stabilization instrumentation. Surgical management presently allows for decompression of the neural elements from the anterior, posterior, or lateral aspects. The lumbar vertebral column may be stabilized by anterior and posterior lateral arthrodeses augmented with anterior instrumentation or posterior instrumentation, or both, which may be used to produce distraction or compression by using various hooks and rods and pedicle screw fixation. Bony arthrodesis of the unstable lumbar segment remains the cardinal principle of management.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Most patients with chronic spinal disorders require some form of rehabilitation in order to improve their pain and reduce their disability. In the past decade, controlled trials with rehabilitative interventions such as work hardening and exercise have been reported in the literature. Understanding these studies provides a framework from which rational rehabilitation programs can be structured. The literature supports active exercise programs using exercise-to-quota principles. Passive modalities and home exercise programs are less effective than are active supervised programs.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Stereotactic thalamotomy was first used to treat patients with tremor due to multiple sclerosis (MS) in 1958. This article reviews the subsequent literature on thalamotomy together with the use of thalamic stimulators. A critical review of results and methodology is presented, with particular attention directed at four areas: patient selection, preoperative patient evaluation, operative procedure and results, and postoperative follow-up. Unfortunately much of the literature is deficient in one or more of these areas. Confirmation of either a diagnosis of MS or variant of MS disease was often not given, and preoperative descriptions of both the patients' tremor and general clinical status were often limited. Targets for stereotactic ablation generally covered the thalamic ventrolateral nuclear complex, although the subthalamic nucleus and thalamic reticular nuclei also had lesions. Physiological refinement of target locus was used in over half of the published series. Immediate and short-term abolition or significant reduction of tremor was reported in 92% of patients. Where data were available, ∼70% of patients still had reduced tremor 12 months after surgery. However, the functional status of many of these patients was not improved. Side effects associated with stereotactic thalamotomy varied considerably between series, but the 30-day mortality rate was 1%. Five patients have had thalamic stimulators implanted with promising early results. Exacerbation of MS by the thalamic surgery was not reported. Because the literature on thalamic surgery for tremor in MS patients is highly variable in quality, recommendations concerning factors to be considered in the design and reporting of similar clinical trials and series are made. Stereotactic thalamic surgery for tremor due to MS could possibly undergo a resurgence if newer immunomodulatory agents can arrest or retard the progress of the disease.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Chronic, medically intractable pain exists as one of the most vexing problems facing health care providers. The mainstays of chronic pain therapy include narcotic and nonnarcotic analgesics, physical therapy, anesthetic injection therapies, and psychological therapies. When such routine aggressive therapy has failed, and when patients have undergone multidisciplinary pain clinic evaluation, neurosurgical procedures may be indicated for the control of intractable pain. With advancing knowledge in the neurosciences and increased understanding of the anatomy and physiology of pain transmission and modulation, the neurosurgeon is in a unique position to provide a wide range of treatment options for patients with chronic intractable pain. This article presents a concise review of the current status of neurosurgical procedures used in the management of intractable pain, including ablative and augmentative procedures. For each procedure, the scientific rationale, indications, surgical technique, risks and complications, outcomes, and controversies are presented. By using a critical, scientific approach to these procedures, neurosurgeons can best be prepared to assist in the care of patients suffering from intractable pain.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The Brachial Plexus Clinic was established at Texas Children's Hospital in 1987. We have enrolled >500 infants in whom 95% of brachial plexus injuries were caused by birth trauma. Surgical intervention in those infants without improvement by 5 months of age has resulted in significant improvement (p < 0.05) in >85% of the infants followed for > 18 months.

ISSN:1050-6438    

出版商:OVID    

年代:1997

数据来源: OVID