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T B Ducker

Publications and source records attributed to T B Ducker.

At least 37 records · Page 2Linked to original sources
PubMed1994

Rheumatoid arthritis. Neuroanatomy, compression, and grading of deficits.

STUDY DESIGN: The authors summarize published data regarding cervical spine involvement in rheumatoid arthritis, define the neurologic manifestations, and provide recommendations for management of these complex and difficult problems. OBJECTIVES: The authors attempted to accurately define the neurologic lesions resulting from rheumatoid involvement of the cervical spine despite the complexity of the neuroanatomy of the cervicomedullary region and the diversity of pathology. SUMMARY OF BACKGROUND DATA: Despite the long-standing recognition of cervical spine involvement in rheumatoid arthritis, appreciation of the different neurologic manifestations of this disease has been lacking or misunderstood. METHODS: The authors reviewed the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions that interact to create these complex and often confusing clinical situations. RESULTS: Rheumatoid arthritis produces encroachment on the brainstem and cervical spinal cord. The minimum space available at the craniocervical junction for the neural structures is 13 to 14 mm, which is fairly constant. Below C2, the available space is only 12 mm. When the amount of space reduced below this amount, there is, by definition, neural compression. The site of compression and/or repeated microcontusions will determine subsequent neurologic deficits. At the craniovertebral junction, neural compression and traumatic injury typically occur anteriorly at the pyramidal decussation producing cruciate paralysis with considerable weakness in both arms and minimal leg involvement. Cranial settling can result in lower medulla and cranial nerve dysfunction. Subaxial stenosis typically results in a more typical myelopathy. CONCLUSIONS: Accurate diagnostic studies are mandated to determine the location of compression and to fully appreciate the resultant neurologic deficits. To improve more complete comprehension of the neurologic manifestations of rheumatoid arthritis, the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions must be understood.

Animals↗
PubMed1994

Spinal cord injury. Role of steroid therapy.

STUDY DESIGN: The authors review the evidence supporting the role of glucocorticosteroids in spinal cord injury, critique published studies, and provide recommendations for steroid use in this complex and difficult problem. OBJECTIVES: The authors detail the evolution of the use of glucocorticosteroids for acute spinal cord injury and objectively assess the results of NASCIS I and II. SUMMARY OF BACKGROUND DATA: Glucocorticosteroids were first used in patients with acute spinal cord injury in the 1960s. An initial randomized clinical trial (NASCIS I) did not demonstrate a difference in outcome between the low- and high-dose steroid therapy. A subsequent study (NASCIS II) demonstrated that a treatment could enhance neurologic recovery. METHODS: The authors critically review the preclinical studies of glucocorticosteroids, NASCIS I and NASCIS II: The majority of the critique focuses on NASCIS II and independent analysis of the data generated by that trial. RESULTS: NASCIS II suggests clinical benefit from high-dose intravenous methylprednisolone therapy. The true benefit of steroid therapy is unclear because of the difference in outcome of the two placebo groups who entered the protocol before and after 8 hours. The initial promising results may be negated by the better recovery of the delayed treatment and/or untreated group of patients in the greater than 8-hour placebo group. However, until the raw patient data from NASCIS II is made available for independent review, the actual benefit of intensive steroid therapy will remain elusive. CONCLUSIONS: Even with the controversies and unresolved issues, we advocate initiation of intensive glucocorticosteroid therapy as soon as possible after acute spinal cord injury, and not beyond the first 8 hours. There is too much data available to arrive at any other conclusion.

Dose-Response Relationship, Drug↗
PubMed1993

Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation.

The coexistence of traumatic locked facets of the cervical spine and a herniated disc is not well described. The authors present a series of patients with traumatic locked facets who demonstrated a high incidence of associated disc herniation documented on magnetic resonance (MR) imaging. Thirteen patients with either unilateral (four cases) of bilateral (nine cases) locked facets of the cervical spine were analyzed retrospectively. Immediate closed reduction using traction and/or manipulation was attempted in the first nine cases treated and was successful in only three; however, the procedure was abandoned in three cases due to deterioration in the patient's clinical status. In the subsequent four patients, an MR image was obtained prior to attempts at closed reduction. All patients underwent MR imaging of the cervical spine. Of eight consecutive cases treated at the University of Michigan, frank disc herniation with fragmented disc in the canal was found in five while pathological disc bulging was found in the other three. All five cases contributed by other institutions had concurrent disc herniation. This series illustrates the importance of using MR imaging to document the presence of a herniated disc during the initial evaluation of a patient with traumatic locked facets of the cervical spine and prior to attempted reduction of the locked facets. Experience indicates that closed reduction of facet dislocation associated with disc rupture may result in increased spinal cord compression and neurological deficit. If a herniated disc is discovered, anterior discectomy and fusion would be favored as the initial therapy over attempts at closed reduction or operative posterior reduction.

Adolescent↗
PubMed1993

Os odontoideum.

Explore the source record for details and available documents.

Adult↗
PubMed1993

Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases.

Laminoforaminotomy performed with the patient in the sitting position with our improved techniques represents an effective treatment for cervical radiculopathy. We present the results of laminoforaminotomies performed in 172 patients with cervical radiculopathy during a 7-year period. The posterior approach in the surgical management of cervical radiculopathy is not only acceptable, but in certain cases is preferable to the anterior approach. When the abnormality is central, broad based and anterior, posterior procedures are unlikely to achieve decompression. However, with lateral or foraminal nerve root compression, the simpler posterior keyhole laminoforaminotomy works well. In our opinion, physicians advocating either procedure exclusively are not providing the patient with the optimal level of care. Our purpose is to present in detail our surgical technique in conjunction with an analysis of our long-term results in clinical situations in which our technique is clearly indicated.

Adult↗
PubMed1993

The posterior operative approach for cervical radiculopathy.

Cervical disc disease includes acute herniation and chronic disc degeneration with secondary changes in the associated bone. The latter may lead to the spectrum of cervical spondylitic stenosis, which is considered to be multilevel and may be more of a bony disease. Clinically, cervical disc disorders can be divided into several disorders. The disorder of true cervical radiculopathy is associated with lateral compression of the nerve root. When this condition is due to a lateral soft disc herniation or lateral bony stenosis, the posterior cervical laminoforaminotomy is commonly used. It is a procedure that works extremely well in the vast majority of patients and there is no risk of spinal instability; therefore, no fusion is required. The details of operative care have been described. In patients who have persistent radicular problems after a failed anterior cervical interspace procedure, the posterior cervical laminoforaminotomy with posterior wiring and fusion is a simple and effective operative option.

Cervical Vertebrae↗
PubMed1992

Lateral lumbar disc herniations.

True far lateral (extraforaminal) lumbar disc herniations are not rare. Diagnosis can be strongly suspected when high or mid-lumbar radiculopathies present clinically; diagnosis can be confirmed by computerized tomography and/or magnetic resonance imaging. When operative treatment is required, the off-midline paramedian exposure with little or no bone removal is the indicated procedure, produces little morbidity, and causes practically no low back disability.

Adult↗
PubMed1991

The use of freeze-dried allograft bone for anterior cervical fusions.

A consecutive series of 87 patients undergoing Smith-Robinson anterior cervical fusion were analyzed. Either freeze-dried tricortical iliac crest bone or tricortical autograft bone was used. Surgical technique was otherwise identical. Radiography showed delayed union at 3 months in 13% of patients with autograft and in 37% of patients with freeze-dried allograft. At 1 year, radiography showed nonunion in 8% of patients with autograft and in 22% of patients with allograft. One-level procedures had a delayed union rate of 7% for autograft and 21% for allograft. Nonunion in one-level procedures was 5% for both autograft and allograft. For two-level procedures, the nonunion rate was 17% for autograft and 63% for allograft. Graft collapse was more commonly seen with freeze-dried allograft (30%) than with autograft (5%). Relief of neck and arm pain, however, was similar in both groups.

Adult↗
PubMed1991

Fusion of the occiput to the upper cervical spine. A review of 37 cases.

This is the first report of a large series of patients undergoing preoperative traction to reduce spinomedullary compression from cranial settling. In all cases, an attempt was made to reduce the malalignment with Gardner-Wells or halo traction before posterior fusion. One patient required an anterior retropharyngeal decompression of the odontoid performed as a one-stage procedure at the time of the posterior operation, and two required subsequent anterior transoral-transpharyngeal resection of the odontoid. From 1974 to 1989, 37 patients underwent posterior occipital cervical arthrodesis. All cases presented with neurologic deficit, and most had signs of brain stem compression, such as L'hermitte's sign or Ondine's curse. The most common cause of basilar impression was rheumatoid arthritis, neoplastic destruction, previously failed C1-C2 fusion, or Down's syndrome. Mean postoperative follow-up was 2 years and 10 months; the patients with less than 2 years' follow-up were followed until successful fusion. Eight of 9 patients with L'hermitte's sign or Ondine's curse and 10 of 12 patients with intractable occipital pain were relieved of their symptoms after reduction and triple-wire stabilization-fusion. Eighteen of 25 patients with long tract signs improved after surgery. Interestingly, 14 (93.3%) of 15 patients with myelopathy improved when successful preoperative reduction of their deformity occurred, whereas only 4 (40%) of 10 patients with fixed basilar impression improved (chi 2 = 8.57, P = .014). Symptoms such as Ondine's curse, L'hermitte's sign, intractable occipital headache, and myelopathy are usually relieved by skeletal traction and posterior fusion without need of an additional transmucosal anterior procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗