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PubMed1990

[Evaluating performance in lumbar intervertebral disk damage following chemonucleolysis].

In spite of the good or excellent long-term results in 60% to 80% of the cases reported in the literature, the efficacy of the less invasive percutaneous nucleolysis in the treatment of therapy-resistant lumbar compression of the nerve root in patients with lumbar disk protrusion still remains controversial. On the one hand, there is discussion about the actual effectiveness of the enzymes injected and their local activity in bringing about the desired long-lasting nerve-root decompression. On the other hand, the presumed advantage of he method is questioned. It is said that postoperative morbidity is decreased and shortened, and that job rehabilitation is faster, especially with people performing hard physical work. More recently, the same can be said for the much-vaunted method of percutaneous automated diskectomy and nucleotomy. It was only possible to use these less invasive treatment techniques with approx. 10% of the author' patients with therapy-resistant lumbar compression syndromes of the nerve root caused by disk protrusion. In 85% of all patients treated, CNL produced a good or satisfactory result as regards the relief of sciatica and neurological disturbances. These long-term results cannot be transferred to job-rehabilitation results, as a critical review of 133 cases has shown. The authors were able to examine 108 of the 133 patients approx. one year after nucleolysis. In the group of businessmen, government officials, white-collar workers, and students, there was a correlation between long-term neurological results and job rehabilitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Chiropractic treatment of postsurgical neck syndrome with mechanical force, manually assisted short-lever spinal adjustments.

OBJECTIVE: To describe a case of postsurgical neck pain, after multiple spinal surgeries, that was successfully treated by chiropractic intervention with instrumental adjustment of the cervical spine. CLINICAL FEATURES: A 35-year-old woman had chronic neck pain for over 5 years after two separate surgeries of the cervical spine: a diskectomy at C3/4 and a fusion at C5/6. Surgeries were performed 6 months apart in an attempt to resolve persistent neck pain and spasm of the cervical musculature. Neither surgery was effective in relieving the patient's pain. Five years after the second surgery, a third surgery was recommended by the patient's physicians to alleviate the chronic pain. The patient sought chiropractic evaluation of her condition to avoid further surgical intervention. INTERVENTION AND OUTCOME: The patient was treated with conservative instrumental chiropractic manipulation, consisting of mechanical force, manually assisted short-lever spinal adjustments rendered with an Activator Adjusting Instrument (AAI) II. She comfortably tolerated the treatment and responded favorably to this therapy. All chronic symptoms had resolved within 30 days of instituting the chiropractic instrumental adjustments with an AAI. More interestingly, longitudinal examination over the next 2 years showed that the patient experienced no residual effects or further recurrences of her previous chronic problem after her initial course of chiropractic care. CONCLUSION: Chiropractic treatment of postsurgical neck syndrome may be effectively treated, in certain cases, by mechanical force, manually assisted adjusting procedures with an AAI. The use of instrumental adjustment methodology may provide chiropractic physicians with an effective alternative to manual manipulation in those cases in which the patient's surgical history or presenting symptoms make forceful manipulation of the spine, particularly performed at end range, inappropriate. This approach may be contemplated by physicians faced with managing this type of condition. Further study should be made in this regard, in an academic research setting, to determine the safest and most effective approaches to managing postsurgical patients in a chiropractic setting.

Adult↗

PubMed1988

Conservative management of lumbar disk herniation.

Treatment of lumbar disk herniation must be tailored to the individual patient. Bed rest, physical therapy, comfortable positioning, manipulation, drug therapy, and if necessary, hospitalization all have a place in the treatment of the acute phase. A surgical decision should be made only after thorough discussion with the patient. In patients with chronic or recurrent disk herniation, the prognosis for recovery from pain or dysfunction is often poor. Bed rest (if never tried before), physical therapy, biofeedback, stress management, rehabilitation programs, and drug therapy may be useful in alleviating discomfort and disability. Percutaneous diskectomy, while too new for accurate assessment, shows promise as a significant alternative to traditional lumbar laminectomy.

Acute Disease↗

PubMed1992

Postoperative physical therapy in temporomandibular joint arthroplasty.

This article offers a revised physical therapy treatment approach for rehabilitating a temporomandibular joint (TMJ) following arthroplastic surgical intervention. Surgical repair is only advised in those chronic cases where refractory symptoms affect the quality of the patient's life and prevent patients from carrying out their normal daily activities. Previous nonsurgical and surgical management usually fails to correct the problem in these types of cases. Rehabilitation guidelines discussed include plication, diskectomy (with or without interpositional implant), costochondral graft, fossa implant, and total joint replacement.

Arthroplasty↗

PubMed2000

Synovial chondromatosis of the left temporomandibular joint superficially resembling chondrosarcoma: a case report.

A 25 year-old woman was referred to the clinic complaining of pain in the left temporomandibular joint (TMJ) and trismus. According to the x-ray images, a solitary mass was observed in the anterior pouch of the lower joint cavity. The mass was removed by means of a synovectomy and a diskectomy. Upon light microscopic examination, the tissue removed showed high cellular activity. As a differential diagnosis, we had to consider the possibility of chondrosarcoma based on the histopathological features; however, since no invasive nor metastatic finding was recognized, we made a diagnosis of synovial chondromatosis despite its rare existence. Although there has been no sign of recurrence at present, we plan to carefully follow up with the patient.

Adult↗

PubMed1990

Synthesis of proteins from [35S]methionine by guinea pig megakaryocytes in vivo and time course of appearance of newly synthesized proteins in platelets.

The relationship of protein synthesis to megakaryocyte maturation has been studied in guinea pigs in vivo. Guinea pigs were injected with a single dose of [35S]methionine. Megakaryocytes and platelets were isolated daily for 4 days, and proteins from both cells were isolated by DEAE-Sephacel chromatography and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and fluorography. All proteins in megakaryocytes corresponding to stained bands on the SDS-PAGE gels were radiolabeled at 3 hours after injection. The greatest loss of radioactivity from the megakaryocytes occurred between 1 and 3 days after injection. Only trace labeling of platelet proteins was seen at 3 hours, representing almost entirely three bands at molecular weights 47,000, 52,000, and 66,000. At 24 hours only about 13% of the maximal labeling was present, but not all proteins were labeled. The maximal labeling was at 3 days. The pattern of labeling of platelets at 3 days was identical to that of megakaryocytes at 3 hours. The protein pattern of nonmegakaryocytic marrow cells was different from that of the platelets and megakaryocytes. Data presented here suggest that most protein synthesis in megakaryocytes is completed at least 24 hours before release of the platelets to the circulation, and suggest some specificity in the proteins that are synthesized at the terminal stages of maturation.

Animals↗

PubMed1994

Spinal instrumentation.

The past decade has seen a dramatic increase in the availability of spinal instrumentation devices, enabling surgeons to treat a variety of spinal disorders with improved results and lower morbidity. In each anatomic region new fixation systems exist. Improvement in fusion rates with supplemental plate fixation following anterior cervical diskectomies and reconstructions has been demonstrated; these devices can now be applied more safely than ever before. Posterior occipitocervical plating to the C-2 pedicle and C3-6 lateral masses can provide stable fixation despite incompetent posterior arch bony structures. Newer, more rigid anterior thoracolumbar instrumentation allows for correction of thoracolumbar and lumbar scoliosis along fewer levels and with better maintenance of lordosis and is also useful following anterior decompression for tumor and trauma. Segmental hook fixation of the posterior thoracolumbar spine has allowed for improved correction of deformity without increased morbidity or the need for postoperative bracing in many cases. Finally, the use of transpedicular screw fixation of the lumbosacral spine allows for excellent segmental fixation without intact posterior elements, including facet joints, and has significantly improved the fusion rate in lumbosacral fusions.

Humans↗

PubMed1993

Herniated thoracic disks: treatment and outcome.

The optimal surgical approach for thoracic disk herniation is controversial, and long-term follow-up is poorly documented. We retrospectively reviewed the records of 31 patients who underwent surgery for herniated thoracic disks at our institution during a 17-year period (1975-1992). Two patients had multiple disk herniations; 16 of 33 herniated disks occurred at or below the T10-11 level. There were three surgical approaches to diskectomy: laminectomy in four patients, transpedicular surgery in 12, and costotransversectomy in 15. Weakness resolved postsurgery in nine of 18 patients. One patient transiently deteriorated neurologically after a laminectomy, three had wound infections, and two required second operations for their herniated disks. Postsurgery half the patients with symptoms continued to have pain or weakness.

Adult↗

PubMedDate not supplied

Postoperative cervical spine: MR assessment.

The purpose of this article is to describe the variety of magnetic resonance (MR) findings in the cervical spine following anterior diskectomy and fusion (ADF), corpectomy, and postoperative complications. Toward that end, we retrospectively reviewed MR in 73 postoperative cervical spine patients and correlated the MR with their initial operative reports. Patients imaged within 1 month of ADF showed bone grafts as discrete rectangular areas of altered signal intensity within the central portions of the disk spaces. A spectrum of graft and vertebral body signal changes are seen up to 2 years following ADF. Patients studied greater than 2 years following ADF generally showed solid bony fusions without evidence of the graft or the original disk space. Bony canal stenosis at the operative site (19 of 73 cases) and disk herniations above or below the fusion sites (21 of 73 cases) were the most common postoperative findings. Hypertrophic bone was visualized as anterior extradural defect that was isointense (nine cases), hyperintense (four cases), or hypointense (eight cases) to the vertebral body on T1-weighted images. Disk herniations were evenly distributed above and below the fusion levels.

Bone Transplantation↗

PubMedDate not supplied

Retropsoas positioned bowel: incidence and clinical relevance.

PURPOSE: Our goal was to assess the incidence of retropsoas positioned large or small bowel in the population and to examine factors predisposing to its formation. METHOD: The presence of retropsoas positioned bowel was retrospectively studied in 1,852 abdominal CT examinations of 1,055 men and 797 women, 648 younger and 1,204 older than 50 years. All examinations were considered normal or demonstrated findings that were unrelated to the position of the bowel. RESULTS: Retropsoas positioned colon (RPC) was observed in 51 (2.8%) cases for the ascending and 45 (2.3%) for the descending colon. RPC appeared more frequently in younger (< 50 years) than older patients and in individuals with decreased amount of retroperitoneal fat. Retropsoas position of small bowel loops was observed in 11 (0.6%) patients, all exhibiting paucity of retroperitoneal fat. CONCLUSION: Because of its prevalence, retropsoas positioned bowel should be considered when performing percutaneous diskectomy or other interventional procedures in the posterior retroperitoneum.

Adult↗

PubMed1976

Postoperative infection of lumbar intervertebral disk space.

Sixteen cases of postoperative intervertebral disk space infection are reviewed. Most occurred after diskectomy, but one followed an unsuccessful attempt at a spinal anesthetic and two followed diskography. Treatment varied from aggressive surgery, either by a posterior, lateral, or anterior approach, to drain the infected disk space or spaces, to more conservative immobilization. Antibiotics were used in all cases. Needle biopsy is valuable in establishing diagnosis and identifying the organism and its antibiotic sensitivities. In some cases fusion occurred spontaneously from the infection; in others, fusion was a result of surgical fusion preceding or following the infection.

Adult↗

PubMedDate not supplied

Lumbar intervertebral disk herniation in teenage children: recognition and management of associated anomalies.

Herniated disks in children and adolescents can be extremely disabling and difficult to diagnose because of the paucity of neurologic abnormalities and the consequent suspicions of hysteria. The Laségue sign is often the only consistent positive finding, and when persisting without remission, justifies early diagnostic studies such as CT scanning, and electromyography. Myelography may be avoided if these studies are definitively diagnostic. The almost uniformly good results that follow diskectomy do not justify prolonged conservative care. Management is facilitated by awareness of often unrecognized structural abnormalities found in these patients. These include spinal stenosis, lateral recess narrowing, and transitional vertebra. Spinal fusion, while rarely indicated, should be considered where motion segment instability contributes to persistent backache. The management of 25 patients is recorded. Twenty-one of these presented with an anomaly worthy of record requiring modifications in surgical technique to provide proper decompression and lasting relief of symptoms.

Adolescent↗

PubMed2002

Dynamic left ventricular outflow obstruction during lumbar laminectomy as an unexpected cause of intraoperative hypotension.

We present a case of previously undiagnosed hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow obstruction in a woman anesthetized for lumbar hemilaminectomy and diskectomy. The treatment of her sudden unexplained hypotension was initially confounded by a diagnosis of compensated congestive heart failure and diuretic therapy. Swift intervention with transesophageal echocardiography revealed the tru pathology altering her intraoperative treatment and her subsequent chronic treatment for her heart condition.

Aged↗

PubMed2004

Conjoined lumbar nerve roots: a frequently underappreciated congenital abnormality.

Nerve root anomalies are frequently underrecognized on advanced imaging studies and may account for some percentage of failed spinal surgical procedures. The conjoined nerve root represents the most common nerve root anomaly. It is a well-known cause of false-positive readings for bulging and herniated disks in patients with purely axial neuroimaging studies. A retrospective evaluation of consecutive microsurgical lumbar diskectomies in 80 patients during a 5-year period was undertaken. A total of four patients (5%) were found intraoperatively to have evidence of a conjoined nerve root by the classification of Neidre. None was diagnosed preoperatively. Coronal magnetic resonance imaging offers the best means of visualizing a conjoined nerve root. The chance for a successful operation can be significantly enhanced if the surgeon is prepared to encounter this pathology.

Adult↗

PubMed2004

Long-term clinical manifestations of retained bullet fragments within the intervertebral disk space.

A retrospective review of 12 patients who were victims of penetrating trauma with a bullet or bullet fragments lodged within the intervertebral disk space was conducted. The objective of the review was to evaluate the potential systemic effects of lead resorption at long-term follow-up. Literature regarding the potential for lead toxicity due to retained bullet fragments within the intervertebral disk space is lacking. Between January 1969 and June 1993, a total of 238 patients with a gunshot wound to the spine were identified. Twelve of the 238 were found to have a bullet or bullet fragments within the intervertebral disk space. All patients were fully screened for evidence of plumbism. The average age at time of gunshot injury was 35.8 years; the average time for follow-up was 7.8 years. One of the 12 patients showed clinical evidence of plumbism. The patient subsequently underwent a partial laminectomy and diskectomy with excision of the bullet fragments. The patient's complaints, specific for plumbism, resolved 2 months postoperatively. We conclude that patients with retained lead-based bullet fragments in the intervertebral disk should be educated about the rare potential for plumbism due to partial bullet fragment resorption and that long-term observation for this disorder is recommended.

Adolescent↗

PubMed2003

Minimally invasive surgery for ablation of osteoid osteoma of the spine.

STUDY DESIGN: Compare the effectiveness of two different techniques for the management of osteoid osteoma of the spine. OBJECTIVE: To describe the technique, feasibility, and indications of two different minimally invasive surgical methods for the treatment of osteoid osteoma of the spine. SUMMARY OF THE BACKGROUND DATA: Current treatment of osteoid osteoma of the spine is usually conventional surgical excision. The successful treatment of osteoid osteoma of the appendicular skeleton by percutaneous radiofrequency probe ablation is known; however, there have been only a few cases reported utilizing this method to treat osteoid osteoma of the spine. The high success rate of percutaneous transpedicle vertebral biopsy and diskectomy led us to believe this technique can also be applicable for the treatment of osteoid osteoma of the spine. METHODS: Two patients with symptomatic osteoid osteoma of the spine underwent two different surgical managements with local anesthesia. In one patient, the osteoid osteoma was localized in the apex of the right L4 superior articular process joint. Under computed tomography guidance he underwent radiofrequency coagulation with the use of a radiofrequency generator at 90 degrees for 240 seconds. The lesion in the second patient was located in the right pedicle of the T9 vertebra close to the exiting nerve root and was cored out by means of a special percutaneous instrument designed for percutaneous biopsy under fluoroscopic guidance. RESULTS: Both patients experienced immediate relief of pain, resumed their regular activities, and also remained free of symptoms after the 2.5- and 3-year follow-up. CONCLUSION: Minimally invasive surgery can successfully be applied in the treatment of osteoid osteoma of the lumbar spine. When the nidus is not adjacent to the neural elements radiofrequency thermal ablation can be an effective and safe treatment of osteoid osteoma in the spine.

Adult↗

PubMed2004

Tortuous vertebral artery injury complicating anterior cervical spinal fusion in a symptomatic rheumatoid cervical spine.

STUDY DESIGN: A case report of a 60-year-old patient with rheumatoid arthritis who sustained injury of a tortuous vertebral artery after anterior cervical spinal fusion is reported. The literature relevant to this topic is reviewed. OBJECTIVE: To report the surgical injury of a tortuous vertebral artery resulting from rheumatoid arthritis and to stress the value of cross-sectional imaging in identifying this anomaly before surgery in these patients. BACKGROUND DATA: Rheumatoid arthritis causes well-known bony complications such as atlantoaxial and subaxial subluxation and spinal stenosis with spinal cord compression. Less emphasized is vertebral artery loop formation and vascular compression. Anomalous vertebral artery position could jeopardize otherwise successful anterior diskectomy and corpectomy in these patients. METHODS: A 60-year-old man with rheumatoid arthritis sustained a vertebral artery injury during anterior corpectomy, which resulted in cerebral and cerebellar infarction. RESULTS: Computed tomography and magnetic resonance imaging and angiography confirmed the medially deviated vertebral artery. A computed tomography scan confirmed the cerebral infarction that resulted from dissection and injury of the artery at the time of surgery. CONCLUSION: The patient with rheumatoid arthritis of the cervical spine could have associated tortuosity of the vertebral artery, mandating a thorough awareness of vascular anatomy before surgical decompression. Cross-sectional imaging effectively locates the position of the vertebral arteries and should be carefully studied before anterior cervical spinal fusion in these patients.

Cervical Vertebrae↗

PubMed2004

Long-term functional and anatomical follow-up of early detected spondylolysis in young athletes.

BACKGROUND: Spondylolysis defects detected by nuclear scintigraphy but not by plain radiographs represent early lesions. Functional outcome and eventual bony union of these defects are unknown. HYPOTHESIS: Defects with greater degree of healing shortly after treatment will proceed to full bony union and better long-term functional outcome. STUDY DESIGN: Longitudinal cohort study. METHODS: Forty young athletes with early detected spondylolysis (radiograph negative, nuclear scintigraphy positive) were divided into 3 stages of healing by computed tomography scan. Functional outcome was assessed 7 to 11 years later using the low back outcome score and other factors. Degree of bony healing was assessed in volunteers. RESULTS: Thirty-two of 40 subjects (80%) completed the survey. Twenty-nine of 32 (91%) had good or excellent low back outcome scores. None required spinal fusion, but 1 required partial diskectomy. Functional outcome did not differ based on initial computed tomography results. Radiographic follow-up was obtained in 11 volunteers. None of the 7 bilateral defects healed, and 3 of these progressed to grade 1 spondylolisthesis. All 4 unilateral defects healed fully with bone. CONCLUSIONS: Most young athletes conservatively treated for early spondylolysis maintain good functional outcome up to 11 years later. Unilateral defects can undergo full bony healing but may take longer than 12 weeks. Bilateral defects may undergo further degeneration and slip with time.

Adolescent↗