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At least 307 records · Page 17Linked to original sources
PubMed2003

Are 2 cages needed with instrumented PLIF? A comparison of 1 versus 2 interbody cages in a military population.

Bovine biomechanical data have demonstrated adequate stability of a single threaded interbody cage when combined with a unilateral facet screw during posterior lumbar disc excision and interbody fusion (PLIF). Instrumented PLIF surgery using 1 versus 2 interbody cages was studied in 35 military men with disc disease and chronic low back pain. All patients underwent instrumented PLIF with bilateral diskectomy and partial facetectomy, pedicle screws, autogenous iliac crest bone graft, 1 or 2 interbody cages, and posterior lateral fusion. After an average of 15 months' follow-up, the 2-cage group had a higher rate of dural tear, but rates of other complications, hospital stay, fusion rates, pain levels, functional outcomes, and patient satisfaction were good and did not differ between groups. Costs were higher for the 2-cage group by 1728 dollars per patient.

Adult↗
PubMed1992

Postoperative posterior spinal wound infections.

The incidence of postoperative spinal infections increases with the complexity of the procedure. Diskectomy is associated with less than a 1% risk of infection; spinal fusion without instrumentation is associated with a 1%-5% risk; and fusion with instrumentation may be associated with a risk of 6% or more. Twenty-two postoperative posterior spinal infections that occurred during a three-year period were reviewed for this report. Staphylococcus aureus was the most frequent organism cultured (more than 50% of the cases). Other recurring organisms were Staphylococcus epidermis, Peptococcus, Enterobacter cloacae, and Bacteroides. Many patients had multiple organisms. Risk factors appeared to include advanced age, prolonged hospital bed rest, obesity, diabetes, immunosuppression, and infection at remote sites. Operative factors included prolonged surgery (greater than five hours), high volume of personnel moving through the operating room, and instrumentation. Postoperative contamination may occur and may be related to prolonged postoperative bed rest, skin maceration (thoracolumbosacral orthoses), and drainage tubes exiting distally from lumbar wounds (toward the rectum). Effective treatment includes early diagnosis, surgical debridement and irrigation, and parenteral antibiotics. Superficial infections were treated successfully with wound closure over outflow tubes, and deep infections with inflow-outflow systems. Maintaining the instrumentation in place was possible in most cases. Parenteral antibiotics were maintained for six weeks in every case.

Anti-Bacterial Agents↗
PubMed2003

Injuries during a massive tug-of-war game.

"Tug-of-war" may cause a variety of sports injuries, which has rarely been reported previously. This report described an uncommon case of a previously fit 64-year-old male who presented with abrupt onset of loss of consciousness after falling down in a game of massive tug of war including 1,500 participants as the rope snapped apart. Computed tomography (CT) scan of his abdomen revealed liver and spleen rupture. Spinal cord injury due to traumatic herniation of intervertebral disc at C5-6 level and bilateral brachial plexus injury were also noted after exploratory laparotomy with primary repair of liver and spleen. He then received diskectomy over C5-6 and C6-7 and neurolysis for the right brachial plexus. Multiple neurological complications including paraplegia, severe neuralgia over bilateral C5 dermatome and spasticity over bilateral lower extremities developed. After two-year comprehensive rehabilitation programs, the patient recovered to ambulate with assistive device, and resumed partially dependent daily living activities.

Athletic Injuries↗
PubMed1992

[Locked rotational dislocation of the cervical spine].

There is no generally accepted treatment protocol for dislocations of single articular processes of the cervical spine. However, the data in our own series and a survey of the literature show that in this type of injury the primary diagnosis rate is low (around 50%), that closed reduction maneuvers can be neurologically hazardous, and that operative fusion prevents certain complications. Among the 20 patients treated at the authors' institution the injury was located in the lower cervical spine in all but one patients and it was caused by a high-speed traffic accident in 14 patients. Four patients had no therapy at all; the others were fused by an anterior approach in 8, a dorsal approach in 6, and a combined method in 2 patients. There was one death due to intimal tearing of a vertebral artery. Closed reduction caused a transient neurological lesion in 2 patients. In 6 patients whose dislocation was neither reduced nor fused, 3 developed chronic instability. In our new treatment protocol dislocation of a single articular process is only reduced after a diskectomy to prevent extrusion of the disc. If reduction from the anterior approach fails or if it cannot be achieved due delayed treatment, the entrapped nerve root is decompressed. Fusion of the injured segments is carried out by bone blocks and plates or hooks.

Adolescent↗
PubMedDate not supplied

Surgical treatment of Scheuermann's adult kyphosis: case report.

A 39-year-old woman with severe Scheuermann's kyphosis complaining of back pain was treated surgically. The following operations were performed in stages to correct a fixed kyphosis: (1) total diskectomy through an anterior approach; (2) application of the halo pelvic distraction apparatus; (3) anterior spine fusion following correction by spinal distraction. She was relieved of her complaints and deformity at a 3 year follow-up examination.

Adult↗
PubMed1992

Thoracic disk herniation.

Symptomatic thoracic disk herniation is unlikely to be encountered with significant frequency in clinical practice. Subtle manifestations required a high index of suspicion if the work-up is to be efficient. In the appropriate candidate, magnetic resonance imaging is the best screening tool, and it may be the only diagnostic study required. In the symptomatic patient with neurologic dysfunction or persistent pain refractory to nonsurgical therapy, surgical diskectomy is a safe and effective treatment with limited morbidity.

Adult↗
PubMed1979

The Burns' test in low back pain: correlation with the hysterical personality.

Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination which included the Burns' Bench Test. In this test the patient is asked to kneel on a bench with knees and hips flexed and place his fingers on the floor. The kneeling position relieves stress on the low back and tension on the siatic nerve, so that patients with organic causes of low back pain are able to perform the test. Conversely, inability to perform the test is indicative of functional symptoms as in hysteria. All patients were males and the average age was 54. The average interval from surgery was 2 1/2 years. Sixty-seven per cent of those patients unable to perform the Burns' test were classified as hysterical on the basis of the MMPI, while 73% of patients classified as hysterical using the MMPI criteria failed to perform the Burns' test. The correlation between the Burns' test and hysteria as determined by the MMPI was 0.48. In terms of sensitivity and specificity, the sensitivity of the Burn's test in distinguishing patients with an hysterical MMPI was 73%. The specificity for normal subjects was 71%. The Burns' test is a useful clinical test for differentiating between organic and non-organic causes of low back pain. However, the test by itself should not be construed as an unequivocal measure of hysteria as defined psychologically by the MMPI. Failure to perform the test indicates a need for further psychological study.

Adult↗
PubMed1992

Adult scoliosis: evaluation and nonsurgical treatment.

Adult spine deformities may result from idiopathic and degenerative etiologies. These two entities may have superimposed on them an iatrogenic component from diskectomies or laminectomies done to relieve localized stenosis or disk herniations. The cumulative effect on the spine may result in painful and even crippling spine deformities. These are common, and their incidence in the adult population ranges from 3% to 30%, depending on the age group. Spine deformities are commonly painful and can be disabling, but they are rarely fatal. It is incumbent on the surgeon to understand the pathology involved in painful spine disorders and to have a reasonable understanding of the prognosis before attempting invasive therapy. An understanding of the risk/benefit ratio to the patient is also necessary. The decision to proceed with surgical treatment is justified in many cases, but it must be based on a thorough understanding of the anticipated benefits from surgical treatment and the risk of serious complications leading to multiple surgeries and results that can be less desirable than the original condition.

Adolescent↗
PubMed2005

Anterior surgery in the thoracic and lumbar spine: endoscopic techniques in children.

Therapeutic modalities for disorders of the pediatric spine must include video-assisted thoracoscopy. The endoscopic approach to the spine has involved an evolutionary approach. What began as an isolated drainage of a vertebral abscess has continued as a method of single diskectomy, release of the anulus fibrosus with or without ligation of segmental vessels, rib resection for costoplasty, rib harvesting for intervertebral fusion and, most recently, insertion of correctional implants with or without spinal fusion. Video-assisted thoracoscopic surgery offers the potential to decrease surgical morbidity associated with traditional open procedures. The ability of video-assisted thoracoscopic surgery to achieve spinal release and the results of early outcomes and cost are comparable to those of open thoracotomy. The improvement in video technology with multichip cameras has significantly improved and enhanced the ability to identify structures in the chest through small incisions (portals). This technology allows spine surgeons to perform surgical intervention comparable to thoracotomy. Instead of using a 9- to 12-inch incision, four to five portals of approximately 2 cm are used; thus, the cosmetic efects of the scoliosis surgery are enhanced. The potential benefits of this procedure include diminished postoperative pain, decreased length of hospitalization, increased wound care, and early return to prehospital activities.

Adolescent↗
PubMed1992

Indications for lumbar spine fusion in the adult.

More than 20,000 lumbar spine fusions are performed annually in the United States. Results of surgery unfortunately are inconsistent and may reflect unsatisfactory patient selection. Indications for lumbar arthrodesis may arise in degenerative disk disease, deformity, distal extension of previous arthrodesis, trauma, spondylolisthesis, and spinal stenosis (in association with diskectomy or decompression). There are several techniques in the assessment of potential candidates for low lumbar arthrodesis.

Age Factors↗
PubMedDate not supplied

The predictive utility of the orthopedic examination in identifying the low back pain patient with hysterical personality features.

Physical examination of the patient with low back pain routinely includes a number of tests which are useful clinically to the orthopedist as suggestive of the presence of hysteria or malingering. These include tests of light touch differences medially and laterally in the same foot or leg, vibratory sensation in the lower extremities, forward flexion, straight-leg raising differences between the supine and sitting positions, and the Burns' bench test. The present study examined the specific predictive utility of these tests individually and as a composite battery in identifying low back pain patients with hysterical personality features. Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination. Silight to moderate correlations were found for each of the subtests with a Composite Hysteria Index derived from the MMPI. The predictability was improved by the use of a weighted combination of the individual tests obtained by multiple regression analysis. The results lend empirical support to: the predictive value of these clinical tests in definitively identifying 60% of those low back pain patients with hysterical personality features; decision rules for use in clinical practice were also developed.

Adult↗
PubMed1992

Surgical management of cervical radiculopathy. Indication, techniques, and results.

Cervical radiculopathy can be surgically approached either posteriorly or anteriorly and the anterior approach has been described with or without fusion. The choice of approach and technique must be based upon anatomic, pathophysiologic, and biomechanical principles in addition to the familiarity of the surgeon with the procedures. The authors discuss the use of the posterior approach for lateral soft-disk disease because it minimizes disruption of soft and bony tissues and does not markedly disrupt the biomechanics of the cervical spine. The anterior approach is preferred for radiculopathy involving osteophytic hard-disk disease, and when properly and carefully performed, the addition of an interbody fusion holds significant advantages over diskectomy without fusion.

Cervical Vertebrae↗
PubMed1992

Types of anterior cervical grafts.

Anterior cervical diskectomy and fusion provide satisfactory results in most instances of cervical disk herniation and cervical spondylosis. A variety of interpositioned grafts have been described for such problems at one or two levels. Multiple level anterior decompression and fusion for patients with spondylotic myelopathy produce satisfactory results in most instances and are particularly effective when a degenerative kyphosis is present. Appropriate patient selection and attention to technical aspects of exposure, neural decompression, and graft procurement and placement directly influence the surgical outcome.

Bone Transplantation↗
PubMedDate not supplied

[Analysis of the results of endoscopic surgical treatment for hernias of the lumbosacral disks].

The paper provides a comparative analysis of the results of treatment in the patients with disk hernia at the lumbosacral levels, who have been endoscopically operated on by a modified procedure described by J. Destandau and by the routine procedure. In the study group, 58 patients (31 males and 27 females) were operated on. The results of treatment were assessed, by using the MacNab spinal endoscopic intervention scale: there were good results in 88% of cases, fair results in 8.6%, and poor ones in 3.4% (2 patients). In the control group, these were 77.4, 17.8, and 4.8%, respectively. The procedure proposed by the authors for fenestration of the intervertebral disk may extend indications for endoscopic diskectomy and its capacities in ossified disk hernias. Two-stage traction of the root may minimize its injury, particularly in herniated median and paramedian disks.

Adult↗
PubMed1991

Extraforaminal lumbar disk herniation. Clinical features and computerized tomography.

Disk herniation lateral to the intervertebral foramen is defined as extraforaminal. Its particular anatomical site makes its clinical and neurologic features completely different from those of posteromedial and posterolateral disk herniations. Prior to the advent of computerized tomography, only diskography was capable of preoperatively identifying this rare disease. We present 5 cases of extraforaminal disk herniation, the clinical and tomographic diagnosis of which was confirmed at surgery. All patients had severe motor deficit and reported sciatica as prevalent over low back pain. The herniated disk was L4-5 in 2 cases and L5-S1 in 3 cases. The CT scan suggested disk protrusion in 2 cases, extrusion in 2 cases, and sequestration in 1 case. Four of these findings were confirmed intraoperatively. Diskectomy was done after hemilaminectomy and partial or total facetectomy. The clinical result was excellent in 2 cases and good in 3 cases after an average follow-up of 10 months. The use of CT scan as part of the routine diagnostic procedure in patients with radicular pain has lowered the number of cases which the surgical findings were inexplicably negative for disk herniation without having to resort to more complex and invasive diagnostic techniques such as myelo-CT and disk-CT. Moreover, preliminary tomographic localization of the extraforaminal disk herniation makes it possible to operate on the affected level using more conservative techniques. In any case, thorough clinical examination is essential for both correct interpretation of the CT scan and appropriate choice of treatment.

Adult↗
PubMed1991

Low back pain: epidemiology, etiology, diagnostic evaluation, and therapy.

During the past year, investigations involving the etiology, diagnostic evaluation, and therapy of low back pain have reported interesting new data. The natural history of degenerative intervertebral disk disease may be explained by peripheral annular fiber injury that results in damage to the nucleus pulposus. Diurnal changes in patient clinical symptoms and signs may have a correlate in alteration of spinal mechanics that occurs during the course of a day. The diagnostic evaluation of low back pain continues to be revolutionized by magnetic resonance imaging. Although magnetic resonance imaging is able to detect specific lesions with greater sensitivity than other radiographic techniques, correlation between clinical symptoms and signs and anatomic abnormalities is essential for correct diagnosis. Therapeutic controversies continue concerning the efficacy of chiropractic intervention and transcutaneous electric nerve stimulation for low back pain patients. Microsurgical techniques for disk removal may prove to be associated with less morbidity than diskectomy with laminectomy, but require additional study.

Back Pain↗
PubMed1991

[Polymorphism of neurologic manifestations of lumbar osteochondrosis and their dynamics after surgical treatment].

In the article is analyzed the spectrum of neurologic disturbances in 107 patients with lumbar intervertebral osteochondrosis that were subjected to the subtotal diskectomy and anterior spondylodesis. The authors describe the dynamics of pre-- and post-operative neurologic status. The significance and value of separate signs, pain syndrome, disturbances of sensitivity and changes of reflexes have been established. The results of the operative treatment of the degenerative spine instability have been evaluated in the clinical conditions.

Back Pain↗
PubMed1991

Preoperative and postoperative neuroradiologic evaluation of lumbar disk herniation.

Three hundred and forty patients with signs and symptoms of lumbar disk disease were evaluated preoperatively by conventional X-rays, computed tomography, and 2.0 Tesla magnetic resonance imaging (MRI). High-resolution T2 weighted MRI provided a truly noninvasive myelogram. The operative findings were predicted by and correlated with the neuroradiologic studies. High-resolution MRI with intravenous gadolinium-DTPA (Magnevist, Berlex) has been particularly useful in evaluating patients with a history of prior disk surgery and patients who were not relieved of pain by lumbar diskectomy.

Adult↗