Inclusion of fellowships within the training program of orthopaedic surgeons.
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Biomedical subjects
Publications and source records attributed to V Mooney.
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A randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed on 195 subjects. There were 98 subjects in the active group and 97 subjects in the placebo group. A brace containing equipment to induce an electromagnetic field was applied to patients undergoing interbody fusion in the active group, and a sham brace was used in the control group. In the active group there was a 92% success rate, while the control group had a 65% success rate (P greater than 0.005). The effectiveness of bone graft stimulation with the device is thus established.
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A prospective multi-institutional study was carried out to evaluate automated percutaneous discectomy in the treatment of lumbar disc herniations. Of the 327 patients who prospectively met the study criteria and were followed for longer than 1 year, 75.2% were successfully treated. When patients (n = 168) who prospectively did not meet the study criteria were treated, the success rate was 49.4%. One case of discitis was reported; otherwise, no other serious complications were noted, and specifically no vascular or nerve damage was encountered. This study indicates that automated percutaneous discectomy can be used successfully to treat lumbar disc herniations with minimal morbidity and emphasizes the need for proper patient selection.
The effects of mechanical vibration on bone ingrowth into porous hydroxyapatite implants and fracture healing were examined radiographically, histomorphometrically, and biomechanically in a rabbit model. Fifty-three female NZW rabbits were used in this study. These rabbits were divided into four separate studies to assess the effects of 20 and 60 min of vibration/day in both implant and osteotomy models as compared with the respective non-vibrated controls. For the implant model, coral hydroxyapatite goniopora rods were implanted bilaterally into tibiae and for the osteotomy model, bilateral fibulae were osteotomized. A resonant frequency of 25 Hz mechanical vibration was used. After periods of 2, 3, 4, and 6 weeks of vibration, the rabbits were killed and examined. For the implant model, there was no significant difference between control, 20, or 60 min of vibration/day with respect to the rate or amount of new bone ingrowth. For the fracture model, 60 min of vibration/day produced a significantly larger callus as compared with the non-vibrated controls (p less than 0.05), whereas 20 min of vibration/day did not. Although biomechanical testing demonstrated a general trend for increased strength in the vibrated animals, it failed to reach significance. These results suggest that the mechanical vibration used in the present study had a beneficial effect on callus volume, possibly due to the stimulation of secondary bone healing processes, but does not appear to promote bone ingrowth into a porous hydroxyapatite implant.
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.
A myoelectric protocol to objectively discriminate between test subjects based on trunk muscular performance differences (endurance) was investigated in a group of 11 healthy volunteers and ten industrial patients undergoing functional restoration for chronic disabling spinal disorders. The subjects performed a standardized exercise protocol, holding their upper torso unsupported for successive fixed-time trials while electromyographic (EMG) signals were recorded from erector spinae. A Fast Fourier Transform allowed calculation of the initial mean power frequency (MPF) for each trial. Isokinetic extensor trunk strength was independently measured at each session for comparison with myoelectric signal analysis. The investigation revealed significant differences in group statistics between patients in early rehabilitation and their subsequent tests, as well as between their initial test and the normal subject scores. However, test sensitivity for identifying patients with "low endurance" is questionable. There was no significant correlation between EMG initial MPF measures and isokinetic extensor trunk strength measures, even though all patients showed isokinetic improvement. Data suggest that the protocol used and myoelectric power spectrum temporal shifts may have some value for identification of individual subjects with endurance limitations (or fatigue resistance) in patients of this type. However, lack of a "gold standard" for comparison presents difficulties in documenting the value and validity with respect to endurance. The test may be of value to measure relative loads.
The majority of patients with low back pain offer no objective clinical findings on which to make a diagnosis on the basis of physical examination. Therefore a diagnostic categorization of complaint based on duration and location is proposed. The justification for this organization is the assumption that the majority of back pain is secondary to deterioration within the disc. Thus the appropriate treatment program is focused at methods designed to find the pain source, and look to the health of the disc. It is on this basis that various treatment approaches for the nine classifications are proposed.
This presentation proposes that the majority of persistent lumbar pain comes from chemical abnormalities within the disc. On this basis, a review of clinical experience and basic studies suggests that active mechanical therapy is the most rational approach to treat the disc. Avoidance of the habituation to pain and inactivity is supported. Rest treatment becomes a societal question rather than a medical question. Ultimately assessment of disc chemistry with appropriate instrumentation will allow the instillation of therapeutic agents within the disc itself. Extended rest, and passive physical therapy no longer have a rational place in the treatment of persistent back pain.
This study evaluates the degree of objectively quantified physical deconditioning of spinal surgery patients. The object is to evaluate the data in terms of the pain and disability claimed by 35 male and 11 female patients three months after spinal surgery. Among the males, two subgroups (i.e., disc excision or spinal fusion) were evaluated. All patients reported subjective indices of pain/disability and completed quantified tests of lumbar motion, sagittal trunk strength, lifting capacity, and bicycle ergometry. In general, true lumbar motion was markedly restricted to 50%-60% and trunk strength means were below 50% of gender-specific normative values. There were similar deficits for lifting capacity. Those who had spinal fusions tended to perform poorly, with a relatively high incidence of pain/disability. There were no differences found between the male group and subgroups who were gainfully employed or had a brief period of disability prior to surgery or had low subjective pain/disability. These results indicate that a patient's subjective pain/disability were not a reliable measure of functional capacity by three months postoperatively. Regardless of working status, pain level, or brevity of disability, there was a significant loss of performance ability and risk of persistent dysfunction after surgical treatment.
The effect of a pulsing electromagnetic field (PEMF) on bone ingrowth into porous hydroxyapatite (HA) and porous tricalcium phosphate (TCP) implanted in rabbit tibiae was studied. To quantitate the biological response, a recently developed method of surface measurement using a scanning electron microscope was used. The morphometrical findings in the HA pores demonstrated a significantly greater amount of bone and thicker bone trabeculae in the PEMF group as compared with the nonpulsed control group at 3 to 4 weeks postimplantation. No significant differences for these parameters were found in the TCP pores. Histologically, more bone and wider bone trabeculae were observed in the HA implants for the PEMF-treated animals at the early time periods when compared with those of the control animals. Alternatively, the histological findings of the TCP implants were similar between these two groups. These histological results tended to correlate with the morphometrical data. Together, these results suggest that accelerated bone formation and bone maturation occurred in response to PEMF in the HA pores but was without effect in the TCP pores. This stimulatory effect is most significant after 3-4 weeks of PEMF stimulation.
CT/discograms of 107 low-back patients were classified by annular degeneration, annular disruption, and pain response. These parameters were compared with the heights of the corresponding discs. Disc height correlated significantly with degenerative annular changes. Comparison of the painless and exact reproduction groups at the L5-S1 level showed a significant increase in exact pain reproduction in narrow discs compared with normal discs. Discs demonstrating slight degenerative changes were often painful but narrowing was detected only when degeneration increased to moderate or severe levels. Some severely degenerated discs were painless and only part of the severe group was narrow. Measuring disc height is a poor method for detecting early, painful degeneration changes.
Dynamic tests of trunk strength and lifting capacity have become more popular in recent years, offering certain advantages over static isometric tests in measuring patient progress in functional restoration programs for spinal disorders. However, equipment for performing such tests is expensive to buy, complex to run, and requires technical expertise and clinical volume unavailable in most physician offices. In this study, a new dynamic test known as Progressive Isoinertial Lifting Evaluation (PILE) is described, which draws upon prior psychophysical and isoinertial methods. An industrial sample of 61 male and 31 female incumbent workers were tested using the PILE, and a variety of anthropometric normalizing factors were evaluated. The isolation of an "Adjusted Weight" (AW) normalizing factor is documented, after which normative data are presented for male and female workers utilizing lumbar (0-30 inches) and cervical (30-54 inches) dynamic protocols.
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