Search PubMed⌕ Search

Biomedical subjects

S R Garfin

Publications and source records attributed to S R Garfin.

At least 55 records · Page 3Linked to original sources
PubMed1996

Overlooked spine injuries associated with lumbar transverse process fractures.

Transverse process fractures of the lumbar spine often are considered benign fractures related to direct trauma or psoas muscle avulsion. Treatment of these usually stable injuries is primarily administered when the patient becomes symptomatic. However, significant force often is required to cause these injuries, and other injuries may occur concomitantly. For this study, all patients who presented with identified lumbar transverse process fractures were further evaluated radiographically with computed tomography for the detection of other possible spine injuries. Medical and radiology records of 28 consecutive patients who had plain radiographs and computed tomography scans taken of their lumbar spine were reviewed retrospectively; these patients presented with lumbar spine transverse process fractures between January 1, 1989 and June 30, 1992. Three of the 28 patients (11%) had a lumbar spine fracture that was identified by computed tomography but overlooked on plain radiographs. Approximately 11% of patients with major injuries may be misdiagnosed if only plain radiographs are used in the evaluation of transverse process fractures. Computed tomography scanning of all lumbar spine transverse process fractures resulting from acute trauma should be considered because this diagnostic measure decreases the risk of overlooking potentially serious injuries.

Diagnostic Errors↗
PubMed1996

Nutritional status in the patient with spinal infection.

Patients that undergo spinal reconstructive surgery are nutritionally at risk. The elderly, the chronically ill, and the developmentally disabled are often malnourished preoperatively. Those patients undergoing combined or staged anterior and posterior procedures often become malnourished in the postoperative period. Poor nutritional status is unequivocally associated with increased postoperative complications, including infectious complications. Close attention should be paid to the perioperative nutritional status of these patients and strong consideration given to preoperative and postoperative nutritional supplementation when indicated.

Aged↗
PubMed1996

Cervical Radiculopathy.

This article discusses the relevant anatomy, clinical presentation, diagnosis and surgical treatment for cervical radiculopathy. The etiology of cervical radiculopathy can play a role in the subsequent treatment of this problem. Both anterior and posterior surgical management is discussed.

Diagnosis, Differential↗
PubMed1995

Internal fixation (pedicle screw fixation) for fusions of the lumbar spine.

STUDY DESIGN: Literature review. OBJECTIVES: To illustrate the indications and potential complications of pedicle screw application in the lumbar spine. SUMMARY OF BACKGROUND DATA: Except for the treatment of severe spondylolisthesis (grades 3 and 4) at L5-S1, using autogenous bone graft and with device removal often fusion is obtained. Pedicle screw devices labeled for stabilizing the lumbar spine or correcting deformities in fusion procedures are currently considered Class III medical devices by the Food and Drug Administration, that is, investigational or experimental forms of spinal fixation. Recent clinical studies have attested to their usefulness and safety by qualified surgeons for selected surgical indications. METHODS: Literature synthesis. RESULTS: Segmental fixation increases the fusion rate and clinical success of indicated patients undergoing the procedure in lumbar spine operations, as it does in the treatment of fusion of long bone injuries, scoliosis, and other comparable surgeries. CONCLUSION: With this technology, surgeons can effectively reduce the pseudarthrosis rate, improve patient satisfaction and results of functional studies, and ultimately reduce the long-term cost to society as a result of effective initial posterior lumbar spine surgery.

Bone Screws↗
PubMed1995

Spinal nerve root compression.

The pathophysiology of sciatica is not completely understood, although our understanding of its causes is increasing. Mechanical alterations combined with inflammatory changes lead to pain. Compression alters nerve root conduction and compromises the nutritional support of spinal nerve roots (through intrinsic and extrinsic vascularity and cerebral spinal fluid percolation). Mechanical forces can lead to intraneural damage and functional changes in nerve roots. Chemical and metabolic effects can create an inflammatory response. Varying causes of inflammation coupled with varying degrees of compression can occur anywhere along the cauda equina or spinal nerve root, including the dorsal root ganglia, and contribute to the pain response and neurologic deficits associated with sciatica.

Animals↗
PubMed1995

Current management of cervical spine instability.

Instability of the cervical spine is a frequently occurring problem in a number of rheumatologic conditions. The importance of recognizing cervical instability lies in its close association with severe, sometimes irreversible, neurologic compromise that can lead to paralysis or even death. Operative stabilization of cervical instability prior to the onset of irreversible neurologic changes has been advocated. The problem, however, has been that no reliable method has accurately predicted which patients with cervical instability are at risk for spinal cord compression. It has been determined in recent studies that specific measurements of radiographic instability are strongly associated with worsening neurologic compromise. These measurements assess the space available for the spinal cord, and recommendations can be made for surgical stabilization in patients with cervical instability, prior to the onset of neurologic changes.

Arthritis, Rheumatoid↗
PubMed1995

Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment.

We used computerized tomographic scans and subsequent dissections to evaluate the position of ninety pedicle screws that had been inserted bilaterally into the fourth through twelfth thoracic vertebrae of five fresh-frozen cadavera. The screws had been inserted by five experienced spine surgeons without the use of radiographs or imaging studies. Of the ninety screws, thirty-seven were found to have penetrated the cortex of the pedicle. Twenty-one screws had penetrated the medial cortex and entered the spinal canal, and sixteen had penetrated the lateral cortex. The aorta and the esophagus were at greatest risk for injury after advancement of the screws beyond the anterior vertebral cortex. Computerized tomographic scans of the thoracic spine in nineteen living controls who did not have a spinal abnormality confirmed the proximity of the posterior mediastinal structures to the misplaced screws.

Aorta↗
PubMed1995

The halo skeletal fixator: current concepts of application and maintenance.

The halo device provides the most rigid cervical immobilization of all cervical orthoses. Despite its established efficacy, reported complications include pin loosening (36% to 60%), pin-site infection (20% to 22%), severe pin discomfort (18%), ring migration (13%), pressure sores (4% to 11%), unacceptable scars (9% to 30%), nerve injury (2%), dysphagia (2%), prolonged bleeding at pin sites (1%), and dural puncture (1%). Appreciation of skull anatomy and established application guidelines can help minimize these complications. A relative "safe zone" for anterior pin placement is located 1 cm above the orbital rim, superior to the lateral two thirds of the orbit. This position avoids injury to the nearby frontal sinus (medially), temporalis fossa (laterally), and sensory nerves (supraorbital and supratrochlear nerves medially, and zygomaticotemporal nerve laterally). Posterior pin positions are less critical, located roughly diagonal to the contralateral anterior pins. Pins should enter the skull perpendicular to the cortex, with the ring or crown sitting below the equator of the skull, passing about 1 cm above the helix of the ear. Pins are inserted at 8 in-lbs and re-tightened once at 48 hours. A loose pin can be re-tightened to 8 in-lbs if resistance is met; otherwise, a loose pin requires replacement in a nearby site. Superficially infected pins are managed with oral antibiotics and local pin care. Refractory infections require pin removal, parenteral antibiotics, and incision and drainage as indicated. Dysphagia (difficulty in swallowing), produced by exaggerated cervical extension, may necessitate repositioning of the C-spine. Dural pin puncture is managed with hospitalization, antibiotics, and elevation of the head of the bed to decrease cerebrospinal fluid pressure and allow dural healing.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1994

Vertebral artery location in relation to the vertebral body as determined by two-dimensional computed tomography evaluation.

STUDY DESIGN: This study analyzed the precise two-dimensional location of the vertebral artery within cervical vertebrae as determined by measurements obtained from axial computed tomographic images of the cervical spine. OBJECTIVE: To determine the margin of safety necessary to avoid vertebral artery laceration during central decompression and lateral nerve root decompression for cervical spinal stenosis. SUMMARY OF BACKGROUND DATA: Laceration of the vertebral artery is a rare but potentially catastrophic complication of anterior decompressive surgery of the cervical spine. METHODS: The mean, standard deviation, and 95% confidence interval of the mean of measurements localizing the vertebral artery within the vertebral body were calculated from 50 transaxial computed tomography images of each of the second through sixth cervical vertebrae. RESULTS: Both the mean interforaminal distance (from 25.90 +/- 1.89 mm at C3 to 29.30 +/- 2.70 mm at C6) and the average distance of the posterior border of the foramen transversarium from the ventral border of the spinal canal (from 2.16 +/- 1.18 mm at C3 to 3.53 +/- 1.56 mm at C6) increased from C3 to C6. CONCLUSIONS: According to our measurements, the risk of vertebral artery laceration is greater at more cephalad vertebrae during lateral extension of central decompressive procedures and lateral nerve root decompression. Because of the variability of these parameters between individuals, accurate individual preoperative localization of the vertebral arteries is recommended.

Adolescent↗