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PubMed2000

[The North American Spine Society Lumbar Spine Outcome Assessment Instrument: translation and psychometric analysis of the German version in rehabilitation patients with chronic back pain].

The "Lumbar Spine Outcome Assessment Instrument", developed by the North American Spine Society (NASS), was translated into German. Its psychometric properties were tested in a group of rehabilitation patients with chronic, unspecific back pain, and in a comparison group of patients in cardiologic rehabilitation. With a Cronbach's alpha of 0.92, internal consistency was high. Principal component analysis revealed that the German version of the NASS instrument surveys the factors "back pain", "neurologic symptoms", and "impairments". A strong correlation with other measures of functional impairment (FFbH-R, IRES) indicates a high concurrent validity of the NASS instrument. After three weeks of inpatient rehabilitation, sensitivity to change could be demonstrated for the summary score of the instrument. This significant change was primarily due to moderate effects in the factor "back pain". In our study population, the factor "impairments" did not show a significant change. On the basis of these results, the German version of "The North American Spine Society Lumbar Spine Outcome Assessment Instrument" can be described as a reliable and valid instrument for measuring back pain, related neurologic symptoms, and back pain-induced impairments in rehabilitation patients. Because the factor "impairments" is not sensitive to change within three weeks of rehabilitation, the instrument is only partly suitable for measuring short-term outcome in rehabilitation patients. Further research is needed to determine if the instrument is useful for middle- and long-term outcome measurement in rehabilitation.

Back Pain↗
PubMed1979

Postsynaptic membrane and spine apparatus: proximity in dendritic spines.

We have reported previously that at dendritic spine synapses, the spine apparatus is associated with the synaptic spinule. In this report this association is shown, in serial thin sections, to involve intimate physical proximity between the postsynaptic density and membranous structures that are part of, or extend from, the spine apparatus itself. Because of the variegated shapes of synaptic spinules, the spine apparatus-postsynaptic density relation suggests participation in membrane distribution or synaptic remodeling phenomena.

Animals↗
PubMed1990

CT of the spine: are plain spine radiographs necessary?

This study was designed to determine whether plain radiographs added any information of clinical significance to the information provided by CT (computed tomography) and its standard digital radiographs in 100 patients presenting for CT of the lumbar spine and 46 patients presenting for cervical spine CT. In only three (3%) of the lumbar studies and two (4.3%) of the cervical studies did the plain radiographs add diagnostic information. The added diagnostic information did not affect patient management in all cases with indications other than trauma. Good quality oblique cervical spine digital radiographs were obtained in 10 cases simply by moving the tube and detectors to the 45 degrees and 135 degrees azimuths. The evidence from this study suggests that when a CT examination of lumbar or cervical spines is planned on a high resolution CT scanner for indications other than trauma, a conventional plain radiographic examination can be omitted in the first instance.

Cervical Vertebrae↗
PubMed1996

Symptoms of the cervical spine in temporomandibular and cervical spine disorders.

This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.

Adult↗
PubMed2000

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation.

STUDY OBJECTIVE: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury. METHODS: A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05. RESULTS: Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades. CONCLUSION: Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear.

Cadaver↗
PubMed1981

Multiple thoracic spine fractures complicating ankylosing hyperostosis of the spine.

Ankylosing hyperostosis of the spine is a distinct clinical entity that merits diagnosis and recognition of its structural limitations. The case of multiple thoracic spine fractures presented here emphasizes the potentially increased susceptibility of involved spines to trauma and also suggests the need to caution diagnosed patients from placing their spines at undue risk.

Bone Diseases↗
PubMed2005

Initial radiographic evaluation of the spine after trauma: when, what, where, and how to image the acutely traumatized spine.

BACKGROUND: Radiographic evaluation of the spine after an acute traumatic event is an integral part of the initial assessment of the patient. Despite this, an imaging protocol that includes detailed recommendations of the views, modalities, and techniques of radiographic work-up is lacking in the peer-reviewed literature. STUDY PURPOSE: The goal of the current review was to suggest a uniform protocol for initial imaging in the traumatized patient and provide a rationale and guidelines to assist in deciding which studies are indicated and at what time they are best obtained. METHODS: The authors' reviewed the available modern, published, English literature, including both peer-reviewed articles and commonly used textbooks, for recommendations concerning which imaging studies are most effective and cost-efficient in detecting spinal injuries in the acute trauma setting. A list of radiologic studies was compiled. A panel of spine surgeon members of the Spine Trauma Study Group, all of whom were highly experienced in trauma management, evaluated the utility and necessity of these imaging studies. CONCLUSIONS: Surgeons agreed that the mainstay of initial radiographic evaluation of the spine after acute trauma remains plain radiographs. CT scanning remains the best mode of delineating the bony details of a spinal injury and should be used to characterize all bony injuries identified on plain radiographs. As CT technology continues to improve, it is likely to play an even greater role as an initial screening tool. The role for MRI continues to expand, particularly in detecting the soft tissue components of injuries.

Diagnosis, Differential↗
PubMed2005

Limitations of the cervical porcine spine in evaluating spinal implants in comparison with human cervical spinal segments: a biomechanical in vitro comparison of porcine and human cervical spine specimens with different instrumentation techniques.

STUDY DESIGN: Porcine and human cervical spine specimens were in vitro biomechanically compared with different instrumentation techniques. OBJECTIVES: To evaluate whether subaxial porcine cervical spines are a valid model for implant testing in a single level corpectomy. SUMMARY OF BACKGROUND DATA: Biomechanical in vitro tests are widely used for implant tests, mainly with human spine specimens. The availability of human cadavers is limited and the properties of the specimen regarding age, bone mineral density, and grade of degenerative changes is inhomogeneous. METHODS: Six porcine and six human cervical specimens were loaded nondestructively with pure moments: 1) in an intact state; 2) after a corpectomy of C5 and substitution by a cage with integrated force sensor; 3) after additional instrumentation with a posterior screw and rod system with: a) lateral mass and b) pedicle screws; 4) after instrumentation with an anterior plate; and 5) with a circumferential instrumentation. The unconstrained motion and the axial loads occurring in the corpectomy gap were measured, as well as the bone mineral density of the specimen before testing. RESULTS: The range of motion in the intact state, as well as for the different instrumentations, was comparable for flexion-extension. In lateral bending and axial rotation, marked differences in the intact state as well as for pedicle screw instrumentations occurred. CONCLUSIONS: The subaxial porcine cervical spine is a potential model in flexion-extension because of its biomechanical similarity. For lateral bending and axial rotation, the marked differences severly restrict the comparability.

Aged↗
PubMed2007

Is it safer to place pedicle screws in the lower thoracic spine than in the upper lumbar spine?

STUDY DESIGN: An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine and the upper lumbar spine using magnetic resonance imaging. OBJECTIVES: To compare the lower thoracic pedicles and upper lumbar pedicles in nondeformity patients as a surrogate measure of safety of pedicle screw use. SUMMARY OF BACKGROUND DATA: Pedicle isthmic width is the significant limiting factor in the safety and proper placement of transpedicular screws. The presumption in the past has been that the lumbar pedicles are larger than the thoracic pedicles. Few publications in the English-language literature specifically evaluate the association between the pedicle isthmic widths of the lower thoracic and upper lumbar. METHODS: The study evaluates 100 patients, without coronal spinal deformities. MRIs were obtained of the pedicles from T10 to L2 and subsequently measured using the axial T2-weighted views. Lower thoracic and upper lumbar pedicle isthmus, the narrowest section of pedicle, was investigated and compared. The "medial pedicle to medial rib corridor" at T10-T12 was defined and measured as part of the methodology of the study. Statistical analysis included one-way analysis of variance with post hoc least significant difference pairwise comparisons. RESULTS: The smallest pedicle isthmic width was at L1 (mean +/- SD, 6.0 +/- 1.6 mm), while T12 (mean +/- SD, 7.6 +/- 1.5 mm) had the largest pedicle width. Although smaller in diameter than T12, both T10 (mean +/- SD, 6.2 +/- 1.2 mm) and T11 (mean +/- SD, 7.5 +/- 1.6 mm) had larger pedicle width than L1 (P < 0.01). Pedicle widths were larger in males compared with females (P < 0.05). CONCLUSIONS: The results show that the lower thoracic pedicles are larger than the upper lumbar pedicles. This may make it safer to place screws in the lower thoracic spine than in the upper lumbar spine. Upper lumbar may be so small (<5 mm) to preclude safe conventional screw placement.

Adolescent↗
PubMed1998

How often does lateral spine DXA detect low bone mass in patients with both normal PA spine and hip?

The clinical utility of lateral bone mineral density (BMD) measurement for the diagnosis of osteoporosis remains controversial. Since both posterior-anterior (PA) spine and hip scans are universally performed, the true clinical utility of lateral dual-energy X-ray absorptiometry (DXA) should lie in its ability to detect low bone mass independent of both PA spine and hip. We examined lateral, PA and hip BMDs in 2134 referred Caucasian females aged 25-89 using the Hologic 2000. Compared only to PA scans, the additional percentages of women with very low BMD (T-score below -2.5 utilizing the National Health and Nutrition Examination Survey [NHANES] III normative database) on lateral were 7.3, 16.4, 28.2, 33.7, and 26.2% for age groups 25-49, 50-59, 60-69, 70-79, and 80-89, respectively. When the results from both PA and total hip measurements were combined, lower but still significant percentages were found: 5.4, 14.9, 24.4, 26.6, and 17.8% for age groups 25-49, 50-59, 60-69, 70-79, and 80-89, respectively. Utilizing the original Hologic normative database, the additional yield in women with a nonosteoporotic PA spine and femoral neck was quite low: 4.6, 8.5, 13.3, 10.0, and 2.5% for women age 25-49, 50-59, 60-69, 70-79, and 80-89, respectively. Thus, the lateral scans now add more additional patients into the very low BMD category. Whether the relationship to future fracture risk of low BMD and T-scores on lateral is similar to that of PA spine remains to be established.

Journal Article↗
PubMed1997

Differential localization of delta glutamate receptors in the rat cerebellum: coexpression with AMPA receptors in parallel fiber-spine synapses and absence from climbing fiber-spine synapses.

The delta 2 glutamate receptors are prominently expressed in Purkinje cells and are thought to play a key role in the induction of cerebellar long-term depression. The synaptic and subsynaptic localization of delta receptors in rat cerebellar cortex was investigated with sensitive and high-resolution immunogold procedures. After postembedding incubation with an antibody raised to a C-terminal peptide of delta 2, high gold particle densities occurred in all parallel fiber synapses with Purkinje cell dendritic spines, whereas other synapses were consistently devoid of labeling. Among the types of immunonegative synapse were climbing fiber synapses with spines and parallel fiber synapses with dendritic stems of interneurons. At the parallel fiber-spine synapse, gold particles signaling delta receptors were restricted to the postsynaptic specialization. By the use of double labeling with two different gold particle sizes, it was shown that delta and AMPA GluR2/3 receptors were colocalized along the entire extent of the postsynaptic specialization without forming separate domains. The distribution of gold particles representing delta receptors was consistent with a cytoplasmic localization of the C terminus and an absence of a significant presynaptic pool of receptor molecules. The present data suggest that the delta 2 receptors are targeted selectively to a subset of Purkinje cell spines and that they are coexpressed with ionotropic receptors in the postsynaptic specialization. This arrangement could allow for a direct interaction between the two classes of receptor.

Animals↗
PubMed1997

Cervical spine fusion: not protective of cervical spine injury and tetraplegia.

The occurrence of tetraplegic spinal cord injuries in two patients who had preexisting cervical spine fusions highlights the vulnerable nature of such patients. One patient sustained a C5-6 fracture-dislocation after a motor vehicle accident, despite a spontaneously fused cervical spine as a consequence of his juvenile rheumatoid arthritis. A second patient sustained a C3-4 distraction injury in a sporting injury 2 years after he had undergone a posterior cervical spine fusion because of an aneurysmal bone cyst. Prior to their spinal cord injuries, both patients had no apparent neurologic deficits, were relatively active, and followed no specific precautions for their spines.

Adolescent↗
PubMed1992

Imaging of the normal spine, developmental anomalies, and trauma of the spine and extremities.

Many significant papers in the current literature have considered the spectrum of developmental and traumatic alterations in the spine. The increasing role of MR and CT imaging is stressed as well as the continued importance of conventional radiography. The distinguishing features and pathology of developmental anomalies and traumatic injuries and the importance of accurate and complete diagnosis are discussed. This review includes articles that emphasize imaging of the normal spine, congenital anomalies, and trauma of the spine and extremities.

Extremities↗
PubMed1987

The value of retropharyngeal soft tissue measurements in trauma of the adult cervical spine. Cervical spine soft tissue measurements.

Widening of the retropharyngeal soft tissue space (RSTS) has been interpreted as a sign of cervical spine trauma. Widely differing measurements are reported in the literature. However it is clear that, using the currently acceptable limits of normal, a large number of patients without spinal injury are subjected to further tests. The RSTS on lateral cervical spine radiographs of 318 patients with a history of cervical spine trauma were measured at the C2-C4 level. The values for patients found to be normal or with fractures/dislocations were evaluated. Statistical analysis of the results demonstrates a considerable overlap in the RSTS of normal and abnormal patients. Therefore we suggest that RSTS measurements are of limited diagnostic value. Using the statistical probability of abnormality, guidelines that indicate which patients may require additional study are suggested.

Adult↗
PubMed2004

The current treatment--a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon's perspective.

For the spine surgeon the problems of the osteoporotic spine can be a painful simple compression fracture, the persisting instability after a fracture, the silent loss of posture due to progressive collapse of multiple vertebrae, and neurological complications related to an osteoporotic fracture. The use of polymethylmethacrylate (PMMA) for the reinforcement of osteoporotic vertebral bodies has turned out to be extremely efficient. Although the natural course of pain due to vertebral fractures decreases within the first weeks in the majority of patients, there remains a number of them with persistent pain and/or ongoing vertebral collapse. With percutaneous cement injection one can achieve fast and lasting pain reduction in 80% to 93% of patients. With multilevel injections it is possible to address the severe osteoporotic spine as a whole where we can halt the ongoing collapse and preserve posture efficiently. Rectification of lordosis can be achieved in fresh fractures with the kyphoplasty technique and, even more efficiently, with the lordoplasty procedure. Kyphosis correction ranges from 8.5 degrees to 14 degrees , and restoration of vertebral body (VB) height goes up to 90%. When surgical stabilization is required, the combination of PMMA reinforcement and fixation with screws appears the only alternative in order to anchor the implants in the severely osteoporotic bone.

Acute Disease↗
PubMed1999

Dynamic neutralisation of the lumbar spine confirmed on a new lumbar spine simulator in vitro.

A new dynamic neutralisation system for lumbar spine segments has been developed and tested on four cadaveric lumbar spines. Segments L4/5 (3 cases) and L3/4 (1 case) were tested on a new lumbar spine simulator which allowed the simultaneous application of bending moments, compressive and shear loads. The average applied loads were 18.3 Nm flexion moment, 2296 N compressive and 458 N anterior shear load for flexion, and 12.5 Nm extension moment, 667 N compressive and 74 N posterior shear load for extension. The relative motion of the upper vertebra in respect to the lower vertebra was measured with the three-dimensional FASTRAK system, using an advanced computer software. The endplate centres as well as the centre of the screw heads were taken as reference points, identified by orthogonally taken radiographs. The dynamic neutralisation system described reduces bending angles and horizontal translations, but it expands vertical translations. The bulging of the posterior annulus is also reduced.

Adult↗
PubMed2005

SSE Spine Tango--content, workflow, set-up. www.eurospine.org-Spine Tango.

The Spine Tango registry is now accessible via the SSE webpage under www.eurospine.org-Spine Tango. Links to the Swiss/International, German and Austrian modules are provided as well as information about the philosophy, methodology and content. Following the links, the users are taken to the respective national modules for registration or log-in and data entry. The Swiss/International module, also accessible under www.spinetango.com, is used by all Swiss and international users, who do not have a separate national module. The physician administered forms for surgery, staged surgery and follow-up can be downloaded as PDFs.The officially recommended Spine Tango patient forms are also available. All forms were implemented in an online version and as scannable optical mark reader forms which can be ordered from the corresponding author.

Databases as Topic↗
PubMed1991

Immunohistochemical localization of raf protein kinase in dendritic spines and spine apparatuses of the rat cerebral cortex.

The ultrastructural localization of raf protein (product of the raf protooncogene) in the neocortex, pyriform cortex and hippocampus of the rat has been investigated by means of pre-embedding immunohistochemistry. Specificity of the antiserum was tested with Western blotting. Besides the immunoreactivity of the dendrites, remarkably strong immunostaining of the dendritic spines and spine apparatuses was noted in each of the investigated areas. The postsynaptic densities were also stained. Since raf proteins are serine/threonine-specific protein kinases, our findings could be important steps toward the understanding of dendritic spine plasticity.

Animals↗