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PubMedDate not supplied

Observations on the treatment of lumbar disk disease in college football players.

Over a 4 year period, 12 college players were treated for diskogenic injury. The most common position affected was down-lineman. Symptoms consisted of low back and/or radicular pain. No players could recall the onset of symptoms relative to football activity; weightlifting was associated with symptoms in three cases. Tentative clinical diagnosis was herniated disk disease. Method of diagnosis in the athletic population is presented along with results of surgical treatment. Percutaneous diskectomy appears to be successful for disk herniations occurring at the L4-5 space or higher.

Athletic Injuries↗
PubMed1988

High-resolution MR imaging of sequestered lumbar intervertebral disks.

We retrospectively reviewed the MR examinations of 20 patients with surgically documented sequestered lumbar disks (free fragments). Sixteen of 20 cases demonstrated extradural masses that were distinct from the interspace of origin and had intermediate signal on T1-weighted images but increased signal on T2-weighted images. In 12 cases there was migration of the sequestered fragment. Sequestered disks that migrated away from the interspace had an irregular, oblong appearance, while those near the interspace were round in configuration. Additionally, the interspace of origin consistently demonstrated loss of signal on T2-weighted images when compared with intact lumbar disks. Sagittal 12-weighted images best depicted the absence of a high-signal pedicle contiguous with the interspace of origin in sequestered disks. These findings were applied to a prospective group of 20 patients undergoing lumbar diskectomy. There was an 89% sensitivity, 82% specificity, and 85% accuracy for MR in distinguishing sequestered disks from other forms of lumbar disk herniation. We conclude that high-resolution MR imaging is sensitive in detecting disk disease and specific in characterizing various subtypes of extradural defects. MR uses morphology as well as changes in signal intensity to make these distinctions.

Adult↗
PubMed1988

Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging.

During a 2-year period, 256 patients were screened for cervical radiculopathy and myelopathy with surface-coil MR images and plain films. Selected patients had follow-up examinations including CT, myelography, and CT myelography. Thirty-four of these patients underwent cervical spine surgery after MR imaging, which disclosed a total of 50 abnormalities in three major categories: herniated disks, bony canal stenoses, and intradural lesions. MR correctly predicted 88% of all surgically proved lesions compared with 81% for CT myelography, 58% for myelography, and 50% for CT. Missed herniated disks on either MR or CT myelography usually were the result of technically suboptimal studies caused by motion artifacts on MR and beam-hardening artifacts on CT myelography. Small osteophytes adjoining herniated disks sometimes were not predicted on MR, although such osteophytes invariably were seen on plain films and were palpable during standard anterior cervical diskectomy procedures. Herniated disks in the lateral root canals found in two patients appeared to be detected more readily by CT myelography than by MR. All proved lesions were detected by either screening MR images and plain films or by follow-up CT myelograms. MR replaced invasive evaluations by myelography and CT myelography in 32% of preoperative patients. We conclude that MR images, combined with plain films, offer an accurate, noninvasive test for the preoperative evaluation of cervical radiculopathy and myelopathy, while CT myelography is the preferred follow-up examination.

Cervical Vertebrae↗
PubMed1992

Gadopentetate dimeglumine-enhanced MR imaging of the postoperative lumbar spine: comparison of fat-suppressed and conventional T1-weighted images.

OBJECTIVE: Gadopentetate dimeglumine-enhanced T1-weighted MR imaging has been used to distinguish epidural fibrosis from recurrent disk herniation in the postoperative lumbar spine. Potential interpretative difficulties relate to detection of subtle contrast enhancement and distinction of enhanced tissue from surrounding epidural fat. The objective of this study was to evaluate the utility of fat-suppressed T1-weighted imaging in improving the depiction of postoperative abnormalities. SUBJECTS AND METHODS: Forty-one patients with recurrent signs and symptoms after previous laminectomy and diskectomy were examined with conventional and fat-suppressed T1-weighted imaging before and after IV administration of gadopentetate dimeglumine. MR images were analyzed for the presence or absence of an epidural soft-tissue mass located anterior and/or lateral to the thecal sac. When such masses were identified, their contrast enhancement behavior was characterized according to the volume, intensity, and pattern of enhancement. Epidural fibrosis was diagnosed by using established MR imaging criteria. In patients with evidence of recurrent disk herniation, diagnosis was based on surgery in six patients and on MR imaging findings in the remainder. RESULTS: Soft-tissue masses were present at 32 of the 43 levels operated on, representing epidural fibrosis (n = 21) or disk herniation (n = 11). Fat suppression improved depiction of contrast enhancement associated with sites of epidural fibrosis. The extent, intensity, and homogeneity of enhancement was greater with fat suppression than with conventional imaging, although the ability to distinguish epidural fibrosis from recurrent disk herniation was not improved. CONCLUSION: Use of the fat-suppression technique results in increased relative intensity and homogeneity of contrast enhancement associated with sites of epidural fibrosis. However, it does not result in significant improvement in the ability to differentiate fibrotic tissue from recurrent disk herniation. Fat suppression does not appear to be indicated for routine use in imaging of the postoperative lumbar spine, but may be useful as a problem-solving tool in selected patients.

Adult↗
PubMed2002

Fracture of L7 vertebral articular facets and pedicles following dorsal laminectomy in a dog.

A 6.5-year-old German Shepherd Dog underwent decompressive surgery for cauda equina syndrome. On the basis of intraoperative findings, the dorsal laminectomy was extended from L6 to S2. Partial dorsal annulectomies were also performed on the L6-7 and L7-S1 intervertebral disks. Two weeks following discharge, the dog had an acute onset of signs of pain and worsening of the neurologic status. Radiography and surgical exploration revealed bilateral fractures of the vertebral pedicles and caudal articular facets of L7. Vertebral stabilization was achieved with intramedullary pins and methylmethacrylate. The dog fully recovered. Although the destabilizing effect of various procedures on the vertebral column has been documented in vitro, vertebral fractures associated with instability have not been reported. Our description of a vertebral fracture following a cauda equina decompressive procedure in a dog emphasizes the need for caution when performing multi-level dorsal laminectomy and diskectomy.

Animals↗
PubMed1988

Evaluation and treatment of chemonucleolysis failures.

Fifty patients underwent chemonucleolysis for the treatment of lumbar disk herniations unresponsive to conservative therapy. In patients treated with chymopapain, unrelieved sciatica was the most common cause of clinical treatment failure. Eight patients (16%) experienced no relief or only a transient reduction in their radicular symptoms following chymopapain injection. All eight patients were clinically reevaluated and underwent repeat neuroradiographic studies. Computed axial tomography and lumbar myelography demonstrated persistent nerve root compromise at the level of the injected disk space. Open diskectomy was performed in all eight cases. Postoperatively, seven patients noted complete resolution of their radicular symptoms; one patient had intermittent low back and leg pain following surgery.

Adult↗
PubMed1995

Results of lumbar disk surgery in a city compensation population.

This is a retrospective analysis of 118 patients who underwent 132 operations in a city compensation setting for the treatment of lumbar disk disease from January 1976 to December 1987. Each of these patients had a work-related injury. There was a minimum 2-year follow up with an average follow up of 6.9 years. No patients were lost to follow up. The purpose was to determine what percentage of patients treated in a work-related setting could be expected to return to a sustained, pre-injury employment state following a carefully executed lumbar spine surgical procedure. Satisfactory surgical results were considered achieved only by those patients who returned to full-duty work status. Only 31 of the 118 patients (26%) returned to full duty and were considered satisfactory. Regarding the number of surgical procedures, 31 of 132 operations (23%) were successful. Sixteen reoperations in 13 patients all resulted in failure. Only 16 of the 64 patients (25%) treated with laminectomy and diskectomy alone had a satisfactory result. When a two-level, posterior lateral spinal fusion was added the success rate was increased to 44%, with 12 of 27 patients returning to work. Six patients with spinal stenosis underwent decompression laminectomy and entry level foraminotomies, and all had unsatisfactory results. Five patients with isthmic spondylisthesis underwent a Gill procedure and fusion. Only one of these patients (25%) returned to work. For a 2-year period chymopapain injection was given to 14 patients. Only two returned to work, with a 14% success rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Disability Evaluation↗
PubMed2002

Cauda equina syndrome caused by intervertebral lumbar disk prolapse: mid-term results of 22 patients and literature review.

This retrospective study analyzes the mid-term results of 22 patients who underwent diskectomy following a diagnosis of cauda equina syndrome due to prolapsed intervertebral lumbar disks (mean follow-up: 3 years and 9 months). Postoperatively, 17 of 22 patients had complete urinary function recovery within the follow-up period, 4 patients had a persistent stress incontinence, and 1 patient, incontinent 4 years postoperatively, required catheterization. Thirteen of 17 patients had recovery of motor deficits, 14 of 21 of sensory deficits, and 13 of 15 patients regained perianal sensation. There was no statistically significant difference concerning the time between onset of symptoms and surgical decompression and subsequent outcome. Complete evaluation must include imaging and urodynamic investigations. After an accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome appear satisfactory.

Adult↗
PubMed2002

Feasibility of a resorbable anterior cervical graft containment plate.

In this article we review the background of anterior cervical plating for one- and two-level diskectomy for degenerative disease and provide background justification for the design and testing of a cervical plate composed of a resorbable material. The design of the plate is discussed with special reference to modifications of implant design and implant tools compared with metallic plates that are necessary because of the different mechanical properties of the less rigid material. Our cadaveric and animal in vivo testing methodologies are described and a novel testing method for reliably quantifying graft containment is also described. Data from a representative sample are presented. Advantages and disadvantages of resorbable plating are discussed.

Absorbable Implants↗
PubMed1996

Diagnosis and management of lumbar disk disease.

Acute low-back pain is one of the most common problems encountered by primary-care physicians. A few patients have severe neurologic impairment or evidence of cancer or other serious underlying systemic illness. For such patients, a broad differential diagnosis must be considered, and a prompt work-up and specialty consultation may be necessary. For most patients with acute low-back pain, extensive laboratory and imaging tests are unnecessary, and rapid improvement can be expected with only simple treatment measures. Physical therapy is useful in patients with refractory symptoms. Magnetic resonance imaging and other sophisticated spinal imaging should usually be reserved for patients who are being considered for an operation. Surgical referral should be considered for the patient with a documented lumbar disk herniation that correlates precisely with clinical findings. Surgical treatment is usually elective in patients with persistent radicular pain and a mild to moderate neurologic deficit, urgent in patients with severe or progressive monoradiculopathy, and emergent in patients with the cauda equina syndrome. Lumbar diskectomy with magnified vision is the surgical procedure of choice, and success rates of 80 to 90% can be expected in properly selected patients.

Diagnosis, Differential↗
PubMed2003

[Postoperative evaluation of surgically treated cases with temporary silicone implant in temporomandibular joint].

We have carried out temporary silicone implants after diskectomies or arthroplasties in temporomandibular joint surgeries to avoid postoperative adhesion and to maintain articular space. We evaluated 19 joints in 15 patients who had received dacron-reinforced silicone implant after silicone sheet removal through follow-up for at least 6 months. The cases included temporomandibular joint disorder (10 joints in 9 patients), psoriatic arthritis (2 joints in 1 patient), ankylosis (4 joints in 3 patients) and synovial chondromatosis (2 joints in 2 patients). On the basis of the criteria of temporomandibular dysfunction for the results, they were classified as bad (4 patients). It is thought that factors other than the implant are related to the bad results in the postoperative evaluation. In this study, lymphadenopathy induced by exfoliated silicone debris could not be confirmed. The temporary silicone implant in the temporomandibular joint was thought to be useful.

Adolescent↗
PubMedDate not supplied

Thoracoscopic anterior instrumentation and fusion for idiopathic scoliosis.

Thoracoscopically assisted surgery is a new approach to access the anterior spine to perform biopsies, anterior releases, diskectomies, and anterior instrumentation and fusion for idiopathic thoracic scoliosis. This approach compromises the chest wall less than an open thoracotomy does because it uses several small portal incisions. It has been suggested that this approach allows fusion of fewer motion segments and better correction of curvature than does posterior spinal fusion and instrumentation. The technique, which is still evolving, is technically demanding, requiring advanced training and special instrumentation and anesthesia techniques.

Female↗
PubMed2000

[Acute liver failure revealing aorto-caval fistula].

We report the case of a 49-year-old woman with an aorto-caval fistula following lumbar diskectomy. Initial symptoms included isolated hepatalgia, and were later associated with jaundice and hepatomegaly, suggesting acute liver failure due to right heart failure. Only 9 previous cases of postoperative aorto-caval fistula have been reported and our case emphasizes the possibility of a pseudo-digestive presentation of high output arteriovenous fistula.

Acute Disease↗
PubMed2002

A case report of neurologically unstable fracture of the lumbosacral spine in a patient with ankylosing spondylitis.

INTRODUCTION: Fracture/dislocation is uncommonly reported in ankylosing spondylitis involving the lumbosacral spine. CLINICAL PICTURE: We report an 18-month follow-up of a case of neurologically unstable traumatic fracture of the lumbosacral spine in ankylosing spondylitis. TREATMENT/OUTCOME: Posterior decompression, alar-transverse fusion and instrumentation were performed. Anterior diskectomy and fusion were done 6 weeks later. There was solid bony fusion on follow-up and the patient had improvement of 2 Frankel grades and was able to ambulate. CONCLUSION: Combined approaches and longer fixations to stabilise the spine may be required. In the lumbosacral spine, this poses a problem vis-à-vis limited levels of fixation in the sacrum.

Accidental Falls↗
PubMed2002

[Single-stage combined anterior-posterior stabilization and fusion for superior and distant cervical spine fractures].

OBJECTIVE: To evaluate the applicability and safety of single-stage combined anterior-posterior stabilization and fusion for superior and distant cervical spine fracture. METHODS: Ten patients with superior and distant cervical spine fracture and/or dislocation aged 30 approximately 68, 8 males and 2 females, underwent single-stage combined anterior-posterior stabilization and fusion. For most cases, especially those whose inferior cervical fracture was without complete bilateral lock of small joints, anterior procedures were performed, including subtotal corpectomy or diskectomy and allograft iliac crest and plates placement, prior to the posterior procedures. For those cases with unstable superior cervical fracture and inferior cervical fracture with bilateral lock of small joints, posterior procedures, including the application of Apofix or Atlas instruments to reposition the atlanto-axial joint, were performed prior to anterior procedures. A hard cervical collar was used postoperatively in all patients. All patients were followed up for 29 months on average. RESULTS: Satisfying fusion and reduction was obtained in all 10 patients (100%). There were no cases of nerve root injury, strut graft extrusion, or plate or screw looseness or fracture. CONCLUSION: The combined single-stage anterior-posterior stabilization, reconstruction, and instrumentation procedure represents a viable option in the treatment of a group of patients with superior and distant cervical spine fracture. The technique provides immediate rigid stabilization of the cervical spine, eliminates the need for Halo immobilization or skull distraction and helps begin functional exercise dirigation earlier.

Adult↗
PubMed2002

Lumbar spinal stenosis: surgical considerations.

Spinal stenosis is an acquired or congenital narrowing of the spinal or nerve-root canals. Surgical treatment is often effective. Acquired spinal stenosis most commonly occurs in those with degenerative disk disease and arthritic facets. If the degenerative process stabilizes and there is adequate room to accommodate the neural contents, symptomatic patients become asymptomatic. Residual stability after decompression must be assessed in patients having multilevel decompression. Fusion maybe indicated. In women with osteoporosis coexisting with degenerative scoliosis and spinal stenosis, decompression for concave nerve-root compression and fusion are necessary. Spinal fusion is not indicated in patients with lumbar spinal stenosis having unilateral decompression for lateral stenosis. Patients with central-mixed stenosis may not need fusion. Patients with spinal stenosis after laminectomies and diskectomies had better results when arthrodesis was done in conjunction with repeated decompression. Arthrodesis with instrumentation and decompression is recommended for patients with degenerative spondylolisthesis.

Bone Transplantation↗
PubMed2003

Results of lumbar disk prosthesis after a follow-up period of 48 months.

BACKGROUND: Damage to the intervertebral disk is usually corrected by means of a prosthesis. OBJECTIVES: To report the outcome of the artificial lumbar disk replacement with the Charité SB III disk prosthesis in 20 patients after a 48 month follow-up. METHODS: The 20 patients were evaluated clinically and radiographically during this period. Preoperative diagnosis included degenerative diskopathy in 17 patients and failed posterior conventional diskectomy in 3. The prosthesis was implanted at one level in 17 patients and bi-level implantation was performed in the other 3 patients. RESULTS: Eighty percent of patients reported satisfactory to very good results. Poor results were reported by four patients, one of whom underwent posterolateral fusion and another is waiting for the same operation. There were two dislocations of the prosthesis followed by immediate revision surgery. CONCLUSIONS: Contraindications for surgery appear to be the principal cause of failure rather than the prosthesis itself.

Adult↗
PubMed2002

Expression of proteoglycan mRNA in human temporomandibular joint disks in temporomandibualr disorders.

The purpose of this study was to investigate the expression of PG mRNA in human temporomandibular joint (TMJ ) disks from patients with temporomandibular disorders (TMD). Total RNA was isolated from the TMJ disks. All patients had undergone diskectomy under general anethesia. RT-PCR was performed using primers for the proteoglycans, aggrecan and decorin. On electrophoresis of a lysate of human TMJ disks, decorin was recognized in each sample. In the calcified part of the disk which we recognized visually, aggrecan was also recognized. These results suggest that TMJ disks contain decorin, and are fibrous tissue. If the disk was subjected to excessive compression in addition to tension, cells similar to chondrocytes and expression of aggrecan was induced. Calcification would be initiated in the part of the disk experiencing the increased compression.

Adult↗