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At least 595 records · Page 33Linked to original sources
PubMed2003

Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation.

Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiffness seen with pedicle screw instrumentation, and we concluded that cages should not be used posteriorly without other forms of fixation. On the other hand, placement of two cages using a posterior approach does have the disadvantage of risk to the bilateral nerve roots. We therefore performed a prospective study to determine whether PLIF can be accomplished by utilizing a single diagonal fusion cage with the application of supplemental transpedicular screw/rod instrumentation. Twenty-seven patients underwent a PLIF using one single fusion cage (BAK, Sulzer Spine-Tech, Minneapolis, MN, USA) inserted posterolaterally and oriented anteromedially on the symptomatic side with unilateral facetectomy and at the same level supplemental fixation with a transpedicular screw/rod system. The internal fixation systems included 12 SOCON spinal systems (Aesculap AG, Germany) and 15 TSRH spinal systems (Medtronic Sofamor Danek, USA). The inclusion criteria were grade 1 to 2 lumbar isthmic spondylolisthesis, lumbar degenerative spondylolisthesis, and recurrent lumbar disc herniations with instability. Patients had at least 1 year of low back pain and/or unilateral sciatica and a severely restricted functional ability in individuals aged 28-55 years. Patients with more than grade 2 spondylolisthesis or adjacent-level degeneration were excluded from the study. Patients were clinically assessed prior to surgery by an independent assessor; they were then reassessed at 1, 3, 6, 12, 18, and 24 months postoperatively by the same assessor and put into four categories: excellent, good, fair, and poor. Operative time, blood loss, hospital expense, and complications were also recorded. All patients achieved successful radiographic fusion at 2 years, and this was achieved at 1 year in 25 out of 27 patients. At 2 years, clinical results were excellent in 15 patients, good in 10, fair in 1, and poor in 1. Regarding complications, one patient had a postoperative motor and sensory deficit of the nerve root. Reoperation was required in one patient due to migration of pedicle screws. No implant fractures or deformities occurred in any of the patients. PLIF using diagonal insertion of a single threaded cage with supplemental transpedicular screw/rod instrumentation enables sufficient decompression and solid interbody fusion to be achieved with minimal invasion of the posterior spinal elements. It is a clinically safer, easier, and more economical means of accomplishing PLIF.

Adult↗
PubMed1989

Magnetic resonance imaging in the CNS.

This article, aimed toward the nonneurologist specialist, presents current indications for MRI in the CNS. Primary and metastatic brain tumors, white matter disease, stroke and hemorrhage, hydrocephalus, and spinal disease are discussed. Emphasis is placed on the contribution of MRI to the evaluation of these major classes of disease. Because of its improved sensitivity and noninvasiveness, in most instances MRI is the initial imaging procedure of choice in the CNS.

Adolescent↗
PubMed2004

Gene therapy and cell transplantation for Alzheimer's disease and spinal cord injury.

The targeted delivery of genes and the transplantation of suitable cell types into the adult nervous system have received considerable interest over the last years. The development of improved vector systems for in vivo gene delivery and the discovery of neural stem cells in the adult nervous system have opened new venues for potential therapeutic intervention in progressive neurodegenerative disease and nervous system injury. Thus, strategies have evolved for the delivery of potentially neuroprotective molecules, such as neurotrophic factors, and the replacement of cells and tissue lost due to CNS injury and degeneration.

Alzheimer Disease↗
PubMed2000

Spinal symptoms in aviators and their relationship to G-exposure and aircraft seating angle.

BACKGROUND: Aviator spinal symptoms related to G-exposure such as neck pain may limit flying performance and result in an increase in acute and chronic spinal disease. METHODS: An anonymous survey was conducted to better establish the nature and degree of G-related spinal symptoms. HP (high-performance) aviators were compared with a control group of non-high-performance (NHP) aviators. RESULTS: Of 161 surveys distributed, 79 were returned for a return rate of 49%. No greater incidence of chronic spinal symptoms or disease in the neck or lower back were reported in the HP group as compared with the NHP group. However, a majority of HP aviators (54%) did report acute spinal symptoms, especially neck pain, temporally associated with pulling Gz, occurring either during or shortly after sorties. Some 20% of the total number of HP aviators responding reported that neck symptoms limited their flying performance, including pulling Gz, checking 6, and air combat maneuvers. Despite the increased seat angle slant in the F-16 as compared with the F-15, no significant difference in neck symptoms or performance limitations were reported as a result. Both HP and NHP aviators were noted in general to have good exercise habits with minimal use of tobacco. However, moderate use of alcohol was noted in both groups. CONCLUSIONS: Spinal symptoms, especially neck pain, are a common problem associated with HP flying and frequently limit flying performance though do not appear to result in any increase in long-term morbidity in this relatively young, predominantly male, group of aviators. (Survey form included as an appendix for reference and future research.) KEYWORDS: aerospace medicine, aircraft, aviation, health surveys, military personnel, questionnaires, risk factors, spinal diseases.

Adult↗
PubMed1984

A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients.

In order to study the type and number of CAT scan abnormalities of the lumbar spine that occur in asymptomatic people, 52 studies from a control population with no history of back trouble were mixed randomly with six scans from patients with surgically proven spinal disease, and all were interpreted by three neuroradiologists in a blinded fashion. Irrespective of age, 35.4% (26.6%, 51.0%, and 31.3%) were found to be abnormal. Spinal disease was identified in an average of 19.5% (23.8%, 22.7%, and 12.5%) of the under 40-year-olds, and it was a herniated nucleus pulposus in every instance. In the over 40-year-old age group, there was an average of 50% (29.2%, 81.5%, and 48.1%) abnormal findings, with diagnoses of herniated disc, facet degeneration, and stenosis occurring most frequently.

Adult↗
PubMed2005

Traumatic central cord syndrome: analysis of factors affecting the outcome.

BACKGROUND: The indications and timing of treatment, as well as the best treatment method for traumatic central cord syndrome (CCS), remain controversial. The aims of this study are to determine the prognostic factors of traumatic CCS and to determine appropriate surgical indications. METHODS: We reviewed the clinical and radiological data of 47 patients with this syndrome. The data collected included age, neurological status as measured on a scale defined by the Japanese Orthopaedic Association (JOA), anteroposterior (AP) diameter of the spinal canal on computed tomography, signal intensity change of the spinal cord on T2-weighted magnetic resonance imaging (MRI), associated spinal diseases, and the type of treatment received. The correspondence between the clinical and radiological findings and the neurological outcome was investigated. RESULTS: The patient's age, JOA score on admission, signal intensity change of the spinal cord on MRI, and associated spinal diseases were not significant in predicting the patient's recovery. On the other hand, the AP diameter of the spinal canal (P = .0402) and the interval between injury and surgery (P < .0001) were factors predictive of excellent recovery. In the surgical treatment group, timely surgery was found to improve the outcome, while conservative treatment did not improve the outcome of patients with a low JOA score, a relatively small AP diameter of the spinal canal, or a positive signal intensity change of the spinal cord on T2-weighted MRI. CONCLUSION: The AP canal diameter of the spinal canal and the interval between injury and surgery may be reliable predictors of excellent recovery in patients with CCS. We recommend timely surgery, preferably within 2 weeks of injury, to achieve a better functional outcome in selected patients.

Central Cord Syndrome↗
PubMed1984

[Roentgenologic studies of the spine in small domestic animals. 1. Routine studies].

The technique and interpretation of plain spinal radiography in the dog and cat are reviewed in the present paper. Technical aspects are briefly discussed. More emphasis is placed on the systematic approach of interpretation based on the recognition of specific X-ray signs that are characteristic of spinal disease. Radiographic illustrations of all important matters are included.

Animals↗
PubMed2002

Botulinum a toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease.

OBJECTIVE: To compare the efficacy and tolerance of botulinum A toxin (BTx) versus lidocaine (L), applied in the external urethral sphincter with a single transperineal injection in order to treat detrusor sphincter dyssynergia (DSD) in spinal cord injured patients. METHODS: Thirteen patients (1F, 12 M) suffering from chronic urinary retention due to DSD were randomised to receive one transperineal injection of 100 IU BTx Botox degrees in 4 ml of 9% saline (botulinum group, (BG)) or 4 ml of 0.5% L (lidocaine group, (LG)). The main criteria of efficacy was post-voiding residual urine volume (PRUV), assessed three times daily on day one (D1), D7 and D30 after each injection. Other criteria were micturition diary, satisfaction score (SS), maximal urethral pressure (MUP), maximum detrusor pressure (DP) and type of DSD, recorded on D0 and D30. RESULTS: In the BG, there was a significant decrease in PRUV (D7: -141.4 ml (p<0.03); D30: -159.4 ml (p<0.01)), in MUP (D30: -32 cm H(2)O, p<0.04) whereas no significant improvement was shown in the LG. SS was higher in BG than LG (p<0.02). DSD improved in BG whereas it remained unchanged in LG. All LG patients also received one injection of BTx on D30. They still presented improvement in PRUV and MUP 1 month later (D30'). Tolerance appeared satisfactory in both groups. CONCLUSIONS: The preliminary results of this initial randomised double-blind study clearly demonstrated the superiority of BTx compared to L in improving clinical symptoms and urethral hypertonia associated with DSD in spinal cord injured patients.

Adult↗
PubMed2005

Improved detectability of experimental allergic encephalomyelitis in excised swine spinal cords by high b-value q-space DWI.

Experimental allergic encephalomyelitis (EAE) is the primary experimental model of multiple sclerosis (MS), which involves both inflammation and demyelination and is known to be species-dependent. Spinal cord abnormalities were found in more than 80% of postmortem specimens of MS patients. In the present study, T1, T2 and high b-value q-space diffusion-weighted magnetic resonance imaging (MRI) were used, for the first time, to characterize the EAE model in excised swine spinal cords. The MR images were compared with histological staining and clinical scoring. Although all spinal cords were excised from swine with severe or very severe (clinical score between 3 to 5 on a scale of 5) motor impairments, T1- and T2-weighted MRI revealed white matter (WM) abnormalities in only five of the ten EAE diseased spinal cords studied, while high b-value q-space diffusion weighted MRI (q-space DWI) detected WM abnormalities in all diseased spinal cords studied. Interestingly, high b-value q-space DWI was able to detect abnormalities in the normal appearing white matter (NAWM) even in spinal cords where no plaques were identified by the T1- and T2-weighted MR images. Good anatomical correlation was observed between the high b-value q-space MR images and histology. The extent of DWI abnormalities paralleled the clinical scoring and correlated with histology. In addition, areas classified as NAWM by the T1- and T2-weighted MR images that showed abnormalities in the q-space DWI were also found to have abnormal histology. This improved detection level of the EAE model by high b-value q-space DWI over conventional T1-, and T2-weighted MRI is briefly discussed.

Animals↗
PubMed1993

Heparin sulfate-like immunoreactivity in the spinal cord in motor neuron disease.

The spinal cords from eight autopsy cases of sporadic motor neuron disease (MND) and two control cases were immunohistochemically examined using antibodies directed to neurofilament proteins (anti-Nf) and to heparan sulfate (HepSS-1). Variable numbers of spheroids were observed in the anterior horns in the MND cases. In one case of MND, one third to half of the remaining anterior horn cells contained conglomerate inclusions in their perikarya. These pathological structures were not encountered in the control cases. The immunohistochemical study revealed that both anti-Nf and HepSS-1 intensely labelled all spheroids and conglomerate inclusions in the MND cases. The colocalization of heparan sulfate with neurofilamentous accumulation suggests that heparan sulfate is required for the aggregation of neurofilaments, resulting in the formation of spheroids and conglomerate inclusions in MND.

Aged↗
PubMed2003

Bone morphogenetic proteins and spinal surgery.

STUDY DESIGN: A review of the literature concerning the use of recombinant human bone morphogenetic proteins 2 (rhBMP-2) and 7 (rhBMP-7) in spinal fusion. PURPOSE: To summarize the pertinent preclinical experiments that enabled regulated human clinical trials of recombinant bone morphogenetic proteins for spinal fusion and to update clinicians on the results of those trials. BACKGROUND: More than three decades of research involving thousands of scientists and academicians throughout the world have led to the clinical use of recombinant bone morphogenetic proteins for the treatment of spinal disease. METHODS: The published and presented scientific literature and the author's personal experience were examined. RESULTS AND CONCLUSIONS: Recent clinical data support the assertion that recombinant bone morphogenetic proteins can be used as complete bone graft substitutes in spinal fusion surgery. In some circumstances, the efficacy of these factors for inducing successful fusion is superior to that of autogenous bone graft. RhBMP-2 is shown to be efficacious in several fusion applications, including intervertebral and lumbar posterolateral. Similar efficacy for rhBMP-7 has not yet been demonstrated, although relevant clinical studies are currently under way. The availability of these biologic agents will improve our ability to predictably treat spinal disease and may facilitate the further development of less invasive surgical innovations.

Animals↗