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Biomedical subjects

E N Hanley

Publications and source records attributed to E N Hanley.

At least 55 records · Page 3Linked to original sources
PubMed1992

Immediate postoperative stability of the atlantoaxial articulation: a biomechanical study comparing simple midline wiring, and the Gallie and Brooks procedures.

A biomechanical study was undertaken to quantitate the immediate postoperative stability of the atlantoaxial articulation after stabilization by simple midline wiring, as well as the Gallie and Brooks procedures. Fresh adult cadaveric cervical spines were mounted for testing such that only the C1-2 motion segment and the load deflection curves generated in flexion, extension, and torsion moved. Spines were tested after the creation of a fracture at the base of the odontoid process with transection of the transverse ligament and after stabilization by each of the surgical techniques. Mean apparent stiffness values evaluated the biomechanical properties of these three commonly performed procedures. Although all tested procedures restored supraphysiologic mechanical properties in all modes tested (p less than 0.001), the Brooks technique was stiffer than the other two methods (p less than 0.001). Although many factors must be considered when selecting a particular surgical technique, the biomechanical data obtained in this study may be of assistance to the surgeon in choosing the type of construct for upper cervical stabilization and arthrodesis.

Adult↗
PubMed1992

Vascular surgery: possible adverse effect on extent of subsequent lower limb amputation.

The influence of previous vascular surgery on the level of amputation was examined retrospectively in 345 amputations (66 bilateral) in 279 patients with peripheral vascular disease. Seventy-two patients (38% diabetic) had previous vascular surgery on 74 limbs and 207 (65% diabetic) had no history of vascular surgery on 271 limbs. In patients with previous vascular surgery, above-knee amputation was done on 55% of limbs versus 71% of limbs in patients with no previous vascular surgery (P < .05), despite a lower incidence of diabetes in the former group. We conclude that although reconstructive vascular surgery is an effective treatment for vascular insufficiency, occasionally it not only fails, but is associated with an increased incidence of above-knee amputation.

Aged↗
PubMed1992

Junctional burst fractures.

Twenty-two patients with burst fractures in this mechanically and neurologically distinct region (T11-L2) were studied at injury and after acute surgical reduction and stabilization (antikyphosis and ligamentotaxis concept). Canal compromise averaged 42% (10-82%) before surgery, and at follow-up 14% (0-46%), segmental kyphosis 15 degrees (4 degrees-27 degrees) and 3 degrees (0 degree-15 degrees), and vertebral segment height 62% (41-85%) and 86% (60-100%), respectively. Incomplete patients gained an average of 1.8 Frankel subgrades. The described treatment can predictably recanalize the spine, correct deformity, and stabilize neurologic compromise. A significant correlation between postoperative neurologic status and the radiographic criteria under study could not be established.

Adolescent↗
PubMed1992

Types of anterior cervical grafts.

Anterior cervical diskectomy and fusion provide satisfactory results in most instances of cervical disk herniation and cervical spondylosis. A variety of interpositioned grafts have been described for such problems at one or two levels. Multiple level anterior decompression and fusion for patients with spondylotic myelopathy produce satisfactory results in most instances and are particularly effective when a degenerative kyphosis is present. Appropriate patient selection and attention to technical aspects of exposure, neural decompression, and graft procurement and placement directly influence the surgical outcome.

Bone Transplantation↗
PubMed1991

Vertebral column allografts for the treatment of segmental spine defects. An experimental investigation in dogs.

Vertebral column allografts, with their intervertebral discs, were implanted into thoracic spine defects (T7-T9) in 11 dogs in an attempt to re-establish spinal stability and preserve spinal biomechanics. Before implantation, the allografts were harvested under sterile conditions from similar-sized dogs and deep frozen at -80 C. The animals were followed for 18 months postoperatively. Radiographs demonstrated gradual loss of intervertebral disc height. Biomechanical analysis showed that the dogs with allografts had no significant difference in spine stiffness compared with normal spines in compression, flexion, and extension testing. Control spines that had been fused were significantly stiffer than the allograft spines in all modes tested (P less than 0.05). Histologic analysis showed incorporation of the allograft but with incomplete revascularization of the allograft's eighth thoracic body. This investigation found that vertebral body allografts with intervertebral discs can function successfully for 18 months in a canine model. This research may assist in the development of physiologic treatment for spinal deficiencies in humans.

Animals↗
PubMed1989

Surgical treatment of isthmic lumbosacral spondylolisthesis. Analysis of variables influencing results.

Fifty consecutive patients underwent standardized surgical treatment for isthmic lumbosacral spondylolisthesis. Twenty-two (44%) had mechanical symptoms only and were treated with in situ fusion. 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 less than 0.001); males, 53%, versus females, 78% (0.05 less than P less than 0.1); back pain only, 73%, versus radiculopathy, 50% (0.05 less than P less than 0.1); smokers, 48%, versus nonsmokers, 74% (0.05 less than P less than 0.1). Pseudoarthrosis rate was 12%, and this correlated with failure (P less than 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.

Age Factors↗
PubMed1989

Comparison of halo complications in adults and children.

A retrospective analysis of 128 patients who underwent halo vest application for a variety of cervical spine problems was undertaken to determine complications associated with its use. Ninety-three (72%) were available for review. In comparison with a recent report, the complication rate was much lower. Only 8% of adults had major problems, consisting of pin tract infection and significant pin loosening requiring replacement. However, 39% (5 of 13) children had major problems. This report details our method of halo application and follow-up care.

Adolescent↗
PubMed1989

Traumatic cervical spine injuries in childhood and adolescence.

Of 84 consecutive children and adolescents with traumatic cervical spine injuries treated over a 10-year period, 61 (73%) were available for review. Age ranged from the newborn period to 17 years. Analysis of injury type revealed four groups of roughly equal incidence: atlantoaxial rotary subluxation, upper cervical fracture or dislocation, lower cervical injury, and spinal cord injury without radiographic abnormality. Forty-four percent of patients incurred a neurologic injury. Falling from a height was the most common mechanism of injury. Apart from patients with complete neurologic deficits, the prognosis for these injuries is good.

Adolescent↗
PubMed1989

Thoracic spine fractures.

Fractures of the thoracic spine (T2-T12) should be considered as a separate entity because of the anatomic features of the rib cage and spinal canal in this region. Fifty-seven patients sustained this injury over a 10-year period (16% of thoracic, thoracolumbar, and lumbar fractures). Twenty-eight fracture dislocations, 25 compression fractures, and 1 burst fracture were seen. Three injuries, combining elements of a burst fracture and a dislocation, were designated "burst-dislocations." Apart from compression fractures, a direct blow was often the implicated mechanism of injury. Significant associated injuries were uncommon. Fracture-dislocations were often associated with neurologic injury and compression fractures with long-term pain. Operative treatment appeared to afford the best results for stabilization and pain relief.

Adolescent↗
PubMed1989

The development of low-back pain after excision of a lumbar disc.

One hundred and twenty consecutive patients who had primary excision of a lumbar disc at a single level for predominantly radicular symptoms were studied. Of these patients, eighty-seven (72 per cent) were available for comprehensive review. The duration of follow-up ranged from twenty-four to eighty-seven months (average, thirty-eight months). Radiculopathy was initially relieved in eighty-six (99 per cent) of the patients, although six patients (7 per cent) had recurrent herniation, which was successfully treated by reoperation. In an additional twelve patients (14 per cent), the operation was deemed a failure due to subsequent disabling low-back pain. Narrowing of the disc space was present radiographically in 98 per cent of the patients, but the amount of narrowing did not correlate with the degree of low-back pain, the age of the patient, or the length of time after operation. Factors predisposing to failure of the operation due to disabling low-back pain included coverage under Workmen's Compensation (p less than 0.00001), a history of more than fifteen pack-years of cigarette-smoking (average, one pack a day for fifteen years) (p less than 0.01), and an age of more than forty years (p less than 0.05).

Adolescent↗
PubMed1989

Decompression and luque rectangle fusion for degenerative spondylolisthesis.

Detailed follow-up at an average of 21.3 months is reported for 24 patients undergoing decompression and fusion with the Luque rectangle as a tension band device for spinal stenosis secondary to degenerative spondylolisthesis. Leg pain and back pain were improved at rates of 91% and 90%, respectively. The average distance walked increased from 1.1 blocks preoperatively to 6.8 blocks postoperatively. The fusion rate was 96%, and minimal slip progression was observed. The instrumentation is simple to perform and appears to have few complications.

Aged↗
PubMed1986

Decompression and distraction-derotation arthrodesis for degenerative spondylolisthesis.

Degenerative spondylolisthesis is the result of chronic disc degeneration with secondary segmental spinal instability. Localized collapse and translational and rotational vertebral subluxation result in low back pain and radiculopathy. Twenty patients with L4-5 degenerative spondylolisthesis having back pain and radiculopathy were treated with a combination of decompressive laminectomy and distraction arthrodesis with short parallel Harrington rods. Patients were ambulated immediately after operation. Minimum follow-up was 2 years (average, 31.6 months). Satisfactory results were obtained in 17 patients (85%). No intraoperative complications occurred. The spondylolisthesis progressed significantly in one patient and the Harrington rods loosened in another. The procedure appears to assist in reducing pathologic motion contributing to low back pain and to relieve traction or compression forces on neural structures by restoring spinal canal anatomy.

Adult↗
PubMed1986

Intraspinal synovial cyst simulating spinal stenosis. A case report.

Intraspinal synovial cysts are an unusual cause of lumbar nerve root compression. This case report describes one mimicking spinal stenosis. A differential diagnosis of other intraspinal cysts is discussed. When symptomatic, surgical excision of these cysts should provide good relief with minimal morbidity.

Aged↗