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At least 109 records · Page 6Linked to original sources
PubMed2002

Is the predictive power of previous fractures for new spine and non-spine fractures associated with biochemical evidence of altered bone remodelling? The EPOS study. European Prospective Osteoporosis Study.

BACKGROUND: In the European Prospective Osteoporosis Study (EPOS), a past spine fracture increased risk of an incident fracture 3.6 - 12-fold even after adjusting for BMD. We examined the possibility that biochemical marker levels were associated with this unexplained BMD-independent element of fracture risk. METHODS: Each of 182 cases in EPOS of spine or non-spine fracture that occurred in 3.8 years of follow-up was matched by age, sex and study centre with two randomly assigned never-fractured controls and one case of past fracture. Analytes measured blind were: osteocalcin, bone-specific alkaline phosphatase, total alkaline phosphatase, serum creatinine, calcium, phosphate and albumin, together with the collagen cross-links degradation products serum CTS and urine CTX. Most subjects also had bone density measured by DXA. RESULTS: Cases who had recent fractures did not differ in marker levels from cases who had their last fracture more than 3 years previously. No statistically significant effect of recent fracture was found for any marker except osteocalcin, which was 17.6% lower in recent peripheral cases compared to unfractured controls (p<0.05) and this was independent of BMD. CONCLUSION: Past fracture as a risk indicator for future fracture is not strongly mediated through increased bone turnover.

Aged↗
PubMed1991

Transoral crossbow injury to the cervical spine: an unusual case of penetrating cervical spine injury.

The complexity of missile injuries to the cervical spine has increased as the technology that causes these injuries has become more sophisticated. Management requires adaptation of conventional neurosurgical approaches to the cervical spine in an effort to limit neurological deficit and establish stability. We report an unusual case of a 19-year-old man who suffered transoral penetration of the cervical spine by an arrow released by a crossbow at close range.

Adult↗
PubMed1992

Effect of cervical spine motion on the neuroforaminal dimensions of human cervical spine.

A nerve root impingement within a stenotic neuroforamen is a common sequela of cervical degenerative arthritis and herniated nucleus pulposus. Understanding of the effects of cervical position on foraminal size is important in the assessment of pathology and injury, for selection of a provocative maneuver to elicit symptoms and in selecting a position of immobilization for the management of nerve root impingement syndrome. This biomechanical study of human cadaver cervical spines reports the measured variations in the sizes of neuroforamina as a function of cervical positioning. Five fresh frozen adult human cadaver cervical spines (C2-T1) were tested with combinations of flexion-extension and rotational position. Ten pounds of axial load was applied to simulate a normal loading of a cervical spine. The foramina of C5, C6, and C7 were directly measured using a set of finely graded circular probes. Compared to the foraminal diameter at the neutral position, there were statistically significant reductions in the foramen diameter of 10% and 13%, at 20 degrees and 30 degrees of extension respectively (P < 0.01). Conversely, in flexion, there were statistically significant increase of 8% and 10% at 20 degrees and 30 degrees of flexion respectively (P < 0.01). Though there was a reduction in the foraminal size with ipsilateral 20 degrees rotation, and an increase with contralateral 20 degrees rotation, these changes were not significantly different from the mean of the control. Combinations of flexion or extension position with axial rotation did not significantly change the foraminal size compared to the respective sagittal position with no axial rotation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine.

STUDY DESIGN: Measurements from lateral cervical radiographs of randomly selected patients are compared with two proposed ideal models. OBJECTIVES: To evaluate lordotic cervical curvatures from a large population base, to provide a geometric sagittal cervical spine model, and to test the validity of the model to predict measured angles and distances. Averages of ranges and normal values for cervical lordosis under conditions of static equilibrium are sought. SUMMARY OF BACKGROUND DATA: Seven angles and three distances were taken from 400 randomly selected lateral cervical radiographs of patients at a private clinic. METHODS: The radiographic measurements are compared with predicted values from our geometric sagittal cervical spine model and the Delmas ideal cervical model. RESULTS: Values were predicted successfully by the geometric model with an average error of 5% compared with the radiographic measurements. The range of lordosis, measured at the posterior of C2 and C7, was 16.5-66 degrees, with a mean of 34 degrees. The average height-to-length ratio for the cervical spine was 0.97. CONCLUSIONS: Predicted values from the geometric model were comparable with the measurements of the relative rotation angles at each vertebral interspace, absolute rotation angles from C2 to C7, and height-to-length ratios. A cervical lordosis of 34 degrees and a height-to-length ratio of 0.97 are suggested for clinical and theoretical outcomes.

Adult↗
PubMed2002

Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation.

STUDY DESIGN: A retrospective review of 64 medicolegal records describing cerebrovascular ischemia after cervical spine manipulation was conducted. OBJECTIVES: To describe 64 cases of cerebrovascular accidents temporally associated with cervical spine manipulation therapy in terms of patient characteristics, potential risk factors, nature of complication, and neurologic sequelae. SUMMARY OF BACKGROUND DATA: Approximately 117 cases of postmanipulation cerebrovascular ischemia have been reported in the English language literature. Proposed risk factors include age, gender, migraine headaches, hypertension, diabetes, birth control pills, cervical spondylosis, and smoking. It is often assumed that these complications may be avoided by clinically screening patients and by premanipulation positioning of the head and neck to evaluate the patency of the vertebral arteries. METHODS: Three researchers using a uniform data abstraction instrument performed an independent review of 64 previously unpublished medicolegal records describing cerebrovascular ischemia after cervical spine manipulation. These cases were referred to a single physician for review over a 16-year period from across the United States and Canada. Descriptive statistics were calculated for characteristics of the patients and the complications. Means and standard deviations were computed for continuous variables. Frequencies and proportions were calculated for categorical variables. RESULTS: This study was unable to identify factors from the clinical history and physical examination of the patient that would assist a physician attempting to isolate the patient at risk of cerebral ischemia after cervical manipulation. CONCLUSION: Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.

Adult↗
PubMed2004

Lumbar spine fracture in a 34,100-year-old skeleton: the oldest known prehistoric spine fracture.

WE EXAMINED SPECIAL pathological changes of the lumbar spine from skeleton remains referred to as "Stetten 1," one of the earliest specimens of modern humans dating from the Early Stone Age (Upper Paleolithic). The skeleton was discovered during archaeological excavations under Riek in 1931 in the Vogelherd Cave near Stetten, close to the Lone Valley of southwestern Germany. The archaeological context is the so-called Aurignacian period (40,000-30,000 yr ago), representing the earliest cultural step of modern humans in Europe. Accelerator mass spectrometry with (14)C measurement yields a calibrated age of these remains averaging 34,100 years before the present. The L3-L4 vertebrae exhibit marginal bone fusion on the right side with a smooth surface. They show 20- to 30-degree kyphosis secondary to wedge impaction of the L4 vertebral body. The facet joints and vertebral bodies reveal small marginal osteophytes with even joint surfaces, indicating low degenerative changes. Stetten 1 is characterized by the presence of a healed lumbar spine fracture. It documents the earliest known case thus far of spine fracture among modern humans.

Adult↗
PubMed1994

[Bone mineral density of the lumbar spine and its relation to biological and lifestyle factors in middle-aged and aged Japanese women (Part 1). Relationship of age and menopause to bone mineral density of the lumbar spine measured by dual-energy X-ray absorptiometry].

Bone mineral density (BMD) of the lumbar spine in 198 community-dwelling Japanese women aged 35 years and over was measured by dual-energy X-ray absorptiometry to investigate the effects of aging and menopause on BMD. A highly significant negative correlation between age and BMD was observed in postmenopausal women as widely accepted. We found a weak but statistically significant negative correlation between age and BMD in even premenopausal women, suggesting that their bone loss had commenced before menopause. Marked decrement in BMD was seen during the first ten years after menopause. Menopause clearly accelerated bone loss in the lumbar spine. Two-way analysis of variance of BMD on age and menopausal status showed that these explanatory variables had a significantly decreasing effect on BMD independently of each other. Menopausal status had a greater sum of squares than age, which suggested that menopause played a greater role in bone loss than did aging. Early menopause has been implied as one of the risk factors for bone loss. The women aged 50 to 59 having encountered menopause before 49 years old exhibited significantly lower BMD than those of similar age who experienced menopause at age 49 and older. This difference in BMD was not observed in the women aged 60 and over. Early menopause was no more likely to be a risk factor for bone loss in the elderly women. We conclude that bone loss in the lumbar spine begins before menopause and is accelerated markedly by menopause for about ten years, and that menopause has a greater decreasing effect on the bone mass than does chronological age while each of them has an independent effect on the bone mass decrement.

Absorptiometry, Photon↗
PubMed2005

A computer touch-screen version of the North American Spine Society outcome assessment instrument for the lumbar spine.

We validated the North American Spine Society (NASS) outcome-assessment instrument for the lumbar spine in a computerised touch-screen format and assessed patients' acceptance, taking into account previous computer experience, age and gender. Fifty consecutive patients with symptomatic and radiologically-proven degenerative disease of the lumbar spine completed both the hard copy (paper) and the computerised versions of the NASS questionnaire. Statistical analysis showed high agreement between the paper and the touch-screen computer format for both subscales (intraclass correlation coefficient 0.94, 95% confidence interval (0.90 to 0.97)) independent of computer experience, age and gender. In total, 55% of patients stated that the computer format was easier to use and 66% preferred it to the paper version (p < 0.0001 among subjects expressing a preference). Our data indicate that the touch-screen format is comparable to the paper form. It may improve follow-up in clinical practice and research by meeting patients' preferences and minimising administrative work.

Adolescent↗
PubMed2004

Cervical magnetic resonance imaging abnormalities not predictive of cervical spine instability in traumatically injured patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

OBJECT: Identifying instability of the cervical spine can be difficult in traumatically injured patients. The goal of this study was to determine whether cervical abnormalities demonstrated on magnetic resonance (MR) imaging are predictive of spinal instability. METHODS: Data in all patients admitted through the Level I trauma service at the authors' institution who had undergone cervical MR imaging were retrospectively reviewed. The reasons for MR imaging screening were neurological deficit, fracture, neck pain, and indeterminate clinical examination (for example, coma). Abnormal soft-tissue (prevertebral or paraspinal) findings on MR imaging were correlated with those revealed on computerized tomography (CT) scanning and plain and dynamic radiography to determine the presence/absence of cervical instability. Of 6328 patients admitted through the trauma service, 314 underwent MR imaging of the cervical spine. Of 166 patients in whom CT scanning or radiography demonstrated normal findings, 70 had undergone MR imaging that revealed abnormal findings. Of these 70 patients, 23 underwent dynamic imaging, the findings of which were normal. In each case of cervical instability (65 patients) CT, radiographic, and MR imaging studies demonstrated abnormalities. Furthermore, there were 143 patients with abnormal CT or radiographic study findings, in 13 of whom MR imaging revealed normal findings. Six of the latter underwent dynamic testing, which demonstrated normal results. CONCLUSIONS: Magnetic resonance imaging is sensitive to soft-tissue injuries of the cervical spine. When CT scanning and radiography detect no fractures or signs of instability, MR imaging does not help in determining cervical stability and may lead to unnecessary testing when not otherwise indicated.

Adult↗
PubMed2004

Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

OBJECT: Patients with metastatic spine tumors often have multicolumn involvement and high-grade epidural compression, requiring circumferential decompression and instrumentation. Secondary medical and oncological issues add morbidity to combined approaches. The authors present their experience in using the single-stage posterolateral transpedicular approach (PTA) to decompress the spine circumferentially and to place instrumentation. METHODS: From September 1997 to February 2004, 140 patients with spine metastases underwent the PTA. Magnetic resonance imaging revealed high-grade spinal cord compression in 120 patients (86%) and lytic vertebral body destruction in all patients. Preoperatively 84 patients (60%) received radiotherapy directed to the involved level and 42 (30%) underwent tumor embolization. Following circumferential decompression, all patients underwent anterior reconstruction with polymethylmethacrylate and Steinmann pins, and posterior segmental fixation. The median operative time was 5.1 hours, the median blood loss was 1500 ml, and the median hospital stay was 9 days. Ninety-six percent of the patients experienced postoperative pain improvement and improvement in or stabilization of neurological status. In 51 nonambulatory patients with poor Eastern Cooperative Oncology Group grades, 75% regained the ability to walk. One month postoperatively 90% of patients achieved good-to-excellent performance scores. The overall median patient survival time was 7.7 months. Patients with colon and lung carcinomas had significantly shorter survival times. Major operative complications occurred in 20 patients (14.3%). Wound complications occurred in 16 patients (11.4%), but this was not correlated with preoperative radiation treatment. CONCLUSIONS: The PTA allows circumferential epidural tumor decompression and the placement of anterior and posterior spinal column instrumention. Immediate spinal stability is achieved without the use of brace therapy. This technique achieved a high success rate for pain palliation, neurological preservation, and functional improvement, while avoiding the morbidity associated with combined approaches.

Adult↗
PubMed1999

[Movement efficiency of the cervical spine in pain syndrome associated with instability of the cervical segment of the spine].

The goal of this work is to attempt to evaluate the motor efficiency of the cervical spine by taking into account the range of active movements and the strength of muscle groups in pain syndrome associated with instability of the cervical segment of the spine (CSPS), to point out possible dependencies between the tested parameters of motor efficiency, and to indicate the suitability of motor efficiency examination in assessing the effectiveness of rehabilitation. The results from tests performed on 71 patients indicate that persons suffering from CSPS, in comparison to healthy subjects, ae characterized by very low motor efficiency of the cervical spine. The greatest limitation on the range of active movements occurred in vertical inclination and rotation, while the greatest deficit of strength appeared in the muscle groups of lateral flexors. Moreover, these parameters of motor efficiency showed a high degree of dependency in the examinations. The results from the preliminary examination and the high dynamics of change in the control examinations suggest that motor efficiency examinations are useful in assessing the effectiveness of rehabilitation procedures in patients with CSPS.

Adult↗
PubMed1999

The USS pedicle hook system: a morphometric analysis of its safety in the thoracic spine. Universal Spine System.

The Universal Spine System (USS) pedicle hook design includes a fixation screw that passes obliquely in the anterocranial direction in the pedicle. The addition of the fixation screw was to address concerns with rotation of the hook and hook disengagement. This study was designed to evaluate the safety of the USS screw locked pedicle hook. Eleven cadaveric thoracic spines were instrumented posteriorly with USS pedicle hooks from T1 to T12. Spinal instrumentation was performed by a spinal surgeon experienced with the USS system. Spinal deformity was created prior to instrumentation, ranging from 0 to 55 degrees in the horizontal plane (rotation) and from 0 to 50 degrees in the frontal plane (scoliosis). Radiographs, computed tomography (CT), and segmental dissection were used for data acquisition. Morphometric CT analysis before instrumentation demonstrated that the transverse pedicular diameter was the smallest at T5 with a mean of 3.7 mm. The transverse pedicular angle (TPA) was found to always point toward the midline. The largest TPA was observed at T1 with a mean TPA of 28.4 degrees. The pedicle with the least angular deviation from the midline was T11 with a mean TPA of 7 degrees. Postinstrumentation CT analysis and segmental dissection revealed perforations of the pedicle cortex by the fixation screw in 15% of instrumented pedicles (26/172). There were 6 medial and 20 lateral perforations. Medial perforations occurred exclusively in the three most proximal spinal segments, whereas the lateral perforations occurred throughout the thoracic spine. The mean encroachment of the fixation screw was 1.67 mm medially and 1.95 mm laterally. This study demonstrates the variation in caliber and direction of the thoracic pedicles. Medial and lateral perforations of the pedicle can occur with the USS pedicle hook instrumented system.

Aged↗
PubMed2005

Thoracoscopic spine surgery for decompression and stabilization of the anterolateral thoracolumbar spine.

The anterior thoracolumbar spine can be exposed via a variety of approaches. Historically, open anterolateral or posterolateral approaches have been used to gain access to the anterior thoracolumbar spinal column. Although the exposure is excellent, open approaches are associated with significant pain and respiratory problems, substantial blood loss, poor cosmesis, and prolonged hospitalization. With the increasing use of the endoscope in surgical procedures and recent advances in video-assisted thoracoscopic surgery, minimally invasive thoracoscopic spine surgery has been developed to decrease the morbidity associated with open thoracotomy. The purpose of this article is to illustrate the surgical technique of a minimally invasive thoracoscopic approach to the anterolateral thoracolumbar spine and to discuss its potential indications and contraindications in patients with diseases involving the anterior thoracic and lumbar regions.

Aged↗
PubMed2006

[Clinical character and treatment of coexistence of cervical spine disease and lumbar spine degenerative disease].

OBJECTIVE: To investigate the clinical character and surgical management in coexistence of cervical and lumbar spine disease. METHODS: 53 cases with coexistence of cervical and lumbar spine disease were analyzed for clinical character and follow-up outcomes. 19 single cervical operation cases, 16 single lumbar operation cases and 7 combined cervical lumbar operation cases, all patients were recorded with JOA score. RESULTS: The cases with cervical and lumbar intervertebral disc showed at least 2 segments. After 6 months follow-up, 35/44 cases symptom were relieved obviously, of which 24/35 cases were single operation, relief rate is 75.9%, satisfactory rate is 80.0%; of which 11/35 cases were continuous cervical lumbar operation, relief rate is 78.4%, satisfactory rate is 78.5%. 6/44 cases' symptom with only cervical or only lumbar operation were relieved incompletely, 3/44 cases' symptom with second operation relieved incompletely. 5 cases missed diagnosis on the first operation. 29 cases with responsible focus, of which 25 cases were followed up, relieved obviously, relief rate is 76.5%, satisfactory rate is 96.0%. CONCLUSION: The cases with cervical and lumbar intervertebral disc showed at least 2 segments, the same basis of the spinal canal stenosis and disc herniation is degeneration of spine. certain responsible focus and correct surgical management can get good treatment results.

Adult↗
PubMedDate not supplied

Congenital absence of the lumbar spine and sacrum: one-stage reconstruction with subsequent two-stage spine lengthening.

This is a case report of a child born with severe, type IV lumbosacral agenesis. At age 6 years, she had surgical reconstruction of her absent spine and thoracic-pelvic instability with Harrington rods and autogenous bone obtained from simultaneous bilateral knee disarticulations. This arthrodesis healed solidly, and at the age of 10 years 6 months and again at age 12 years 6 months, she underwent spine lengthening by osteotomy and distraction instrumentation, the first time with Moe rods and the second time with Cotrel-Dubousset rods. Both lengthening osteotomies healed without difficulty. The spine lengthening achieved was 5.0 cm.

Bone Lengthening↗
PubMed1986

Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar and thoracolumbar spine.

A new segmental spine plate fixation system, utilizing a posterior approach and screw fixation, has been developed for disorders of the lower thoracic or lumbar spine. The indications are significant instability and severe pain relieved by immobilization. This new system uses multiple segmental fixation points through the pedicle "force nucleus" of the vertebral body. The spine plates can be contoured for anatomic positioning, reduction, and rigid stabilization to enhance graft consolidation and fusion. The surgical fixation technique is demonstrated in five case presentations illustrating the application and versatility of the method.

Adult↗
PubMed1985

Surgical stabilization of the cervical spine. A comparative analysis of anterior and posterior spine fusions.

Two hundred twenty-two cervical spine stabilization procedures in 212 patients are reviewed. In 114 posterior cervical fusions, 88 anterior fusions, and ten combined procedures, no deaths occurred. Surgical complication rates were similar, but more severe complications were noted with anterior cervical fusions, including tracheoesophageal problems and transient neurologic loss. Six cases of graft dislodgement requiring reoperation also occurred. In long-term follow-up evaluations, 36 anterior fusion patients developed progressive kyphotic deformity averaging 22 degrees between surgery and the time solid fusion was obtained. Degenerative changes above and below the fusion mass were detected in 36 of 59 patients treated by anterior surgery. Posterior cervical fusion patients were noted to have no significant late change in alignment, and degenerative changes were infrequent. However, 73 of 98 patients had significant extension of fusion mass beyond the originally intended levels of stabilization. Because anterior cervical spine fusion was associated with significant complications of graft dislodgement and tracheoesophageal trauma, as well as postsurgical progressive deformity, the authors recommend posterior wiring and fusion as the procedure of choice to treat cervical spine instability and permit halo-free postsurgical rehabilitation. When anterior neural decompression and fusion is necessary, concomitant posterior wiring and fusion or halo vest immobilization may be necessary to maintain reduction and prevent kyphotic angulation, because posterior ligamentous disruption is not always grossly evident on radiographic examination.

Adolescent↗
PubMed1978

Double fractures of the spine--an indication for routine radiographic examination of the entire spine after injury.

Routine radiographic examination of the entire spine in 103 patients with traumatic spinal cord injuries has demonstrated double fractures of the spine in 5 patients. The incidence, clinical significance and mechanism of injury are discussed. The danger of overlooking the presence of a second spinal fracture in the paralysed patient and thus putting the patient at risk of increased spinal cored injury is stressed. A simple system of radiographic examination is described and routine radiographic examination of the entire spine in all patients who have sustained spinal cord injury is advocated.

Accidents, Traffic↗