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PubMed2003

Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36.

STUDY DESIGN: Analysis of longitudinal data collected prospectively from patients seen in 27 National Spine Network member centers across the United States. OBJECTIVE: To evaluate the responsiveness of the Oswestry Disability Index, MODEMS scales, and all scales and summary scales of the MOS Short-Form 36 (SF-36) for patients with low back pain/leg symptoms. SUMMARY OF BACKGROUND DATA: The responsiveness of general and condition-specific health status instruments is a key concept for clinicians and scientists. Various authors have explored responsiveness in common surveys used to assess spine patients. Although it is generally believed that condition-specific measures are more responsive to change in the condition under study, in the case of low back pain, most authors agree that further exploration is necessary. METHODS: Patients with diagnoses of herniated disc, spinal stenosis, and spondylosis from the National Spine Network database who completed baseline and 3-month follow-up surveys were analyzed. Patient-provider consensus regarding improvement, worsening, or no change in the condition was selected as the external criterion. Responsiveness was evaluated using ROC curve analysis and effect size calculations. RESULTS: Nine hundred and seventy patients had complete data at baseline and 3 months. At follow-up, 68% of the patients had consensus improvement. Based on ROC analysis, scales assessing pain were significantly more responsive than scales assessing function. There were no significant differences between the condition-specific scales and their equivalent general-health counterpart. The scales with the highest probabilities of correctly identifying patient's improvement were: the condition-specific pain scale from MODEMS (PAIN, ROC = 0.758); the combined pain and function scale from MODEMS (MPDL, ROC = 0.755); the general pain scale from the SF-36 (BP, ROC = 0.753); the combined pain and function scale from the SF-36 (PCS, ROC = 0.745); the condition-specific function measure from the Oswestry (ODI, ROC = 0.723); and the physical function measure from the SF-36 (PF, ROC = 0.721). A similar rank order was typically maintained with effect size calculations. Results were nearly identical in patients with multiple non-spine-related comorbidities and in patients with high degrees of perceived disability. The BP scale was most responsive to worsening of symptoms. CONCLUSION: For studies of patients with low back problems, the general SF-36 may be a sufficient measure of health status and patient function, without the need for additional condition-specific instruments. Pain scales appear to be the most responsive measures in patients with low back pain.

Cohort Studies↗
PubMed2003

Impact of neck and arm pain on overall health status.

STUDY DESIGN: A prospective, multicenter, cross-sectional analysis of data from the National Spine Network database. OBJECTIVES: To compare the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey, and to compare the impact of these symptoms among patients of varying age and symptom duration. BACKGROUND: Degenerative disorders of the cervical spine can cause debilitating symptoms of neck and arm pain. Physicians generally treat radiculopathy more aggressively than axial neck pain alone, although it has never been shown that the presence of radiculopathy leads to a greater impairment of physical and mental function. MATERIALS AND METHODS: SF-36 Health Survey data were collected from all consenting patients seen within the National Spine Network. Patients with symptoms referable to the cervical spine (as per their physician) were included (n = 1,809). SF-36 scores for all eight scales (bodily pain (BP), vitality (VT), general health (GH), mental health (MH), physical function (PF), role physical (RP), role emotional (RE), and social function (SF), and two summary scales (Physical Component Summary [PCS] and Mental Component Summary [MCS]) were calculated. Age/gender normative scores were subtracted from the scale scores to produce a negative "impact" score, which reflected how far below normal health status these patients were. Patients were grouped according to location of symptoms (axial only, radicular only, or axial and radicular), age (younger than 40, 40 to 60, and older than 60 years), and symptom duration (acute: <6 wk; subacute: 6 wk-6 mo; and chronic: >6 mo). SF-36 scores were compared between all groups using analysis of variance and multiple comparisons with Bonferroni adjustment. RESULTS: Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales (P < 0.05- P < 0.0001). Scores for patients with only axial pain were significantly lower than for patients with only radicular pain for VT (P < 0.04) and GH (P < 0.004). Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales (P < 0.01). PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain. CONCLUSIONS: Combined neck and arm pain were much more disabling than either symptom alone. Younger patients (younger than 40 or 40-60) were more affected by these symptoms than patients older than 60 years. In addition, as symptom duration increased, a negative impact on mental health was observed, although chronic symptoms did not affect physical health. This study suggests that patients with a significant component of axial pain in conjunction with cervical radiculopathy should be considered the most affected of all patients with cervical spondylosis. Given the evidence that the treatment methods at the disposal of physicians are effective, this study suggests that prompt treatment of these patients may help avoid the harmful effects of chronic symptoms on mental functioning, especially among younger patients who were found to be more impacted by the symptoms.

Adult↗
PubMed2005

Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion.

STUDY DESIGN: A retrospective study was conducted. OBJECTIVE: To compare the long-term outcomes after laminoplasty and anterior spinal fusion (ASF) for cervical myelopathy secondary to disc herniation. SUMMARY OF BACKGROUND DATA: There have been no reports of long-term comparative studies of laminoplasty and ASF for cervical myelopathy due to disc herniation. METHODS: Of 21 patients who underwent ASF only between 1984 and 1987, 15 were followed up. Of 22 patients who underwent laminoplasty only between 1987 and 1994, 18 were followed up. There were no significant differences in preoperative prognostic factors between the 2 groups. Average follow-up was 15 years in the ASF group and 10 years in the laminoplasty group. Neurologic and radiologic results were examined. RESULTS: Laminoplasty and ASF provided equal neurologic improvement. In the ASF group, additional surgery was required for bone graft complications in 2 patients and for adjacent spondylosis in 1. In the laminoplasty group, one patient had C5 palsy, and intractable axial pain developed in 5 patients after surgery, but no patients needed additional surgery. CONCLUSIONS: Because the 2 procedures provided the same neurologic improvement, the risks of bone graft complication with ASF must be weighed against the risks of chronic neck pain associated with laminoplasty for determining the best technique. Therefore, because our present surgical strategy for cervical myelopathy due to disc herniation, laminoplasty is the procedure of choice except for a patient with single level disc herniation without developmental canal stenosis, who is considered to be a good candidate for ASF.

Bone Transplantation↗
PubMed2005

Symptomatic hematoma of cervical ligamentum flavum: case report.

STUDY DESIGN: A case of symptomatic hematoma of cervical ligamentum flavum. OBJECTIVE: To report the first ligamentum flavum hematoma in the cervical spine and review the reported cases. SUMMARY OF BACKGROUND DATA: A herniated nucleus pulposis, spondylosis, epidural hematoma or abscess, neoplasm, or some pathology of the ligamentum flavum, such as hypertrophy, ossification, or calcification, are the most common causes of spinal cord and nerve root compression. A ligamentum flavum hematoma has also been reported as a cause of compression of the cauda equina and lumbar nerve roots but has never been found in the cervical spine. METHODS: A 72-year-old man presented with left upper arm pain and left hemiparesis following traditional massage therapy. Admission magnetic resonance images showed a posterior oval-shaped mass that was continuous with the ligamentum flavum at C3-C4 level. RESULTS: A C3-C4 laminectomy for decompression and resection of the lesion was performed. One year after surgery, the patient remained neurologically intact and symptom-free. CONCLUSIONS: Hematoma of the ligamentum flavum occurring in the cervical spine has never been reported previously. Repeated trivial injury on a degenerative ligamentum flavum might be the leading predisposing factor. Spine surgeons should be aware of a hematoma in the ligamentum flavum as a possible cause of spinal cord or root compression, especially in the mobile cervical and lumbar spine.

Aged↗
PubMed2005

Indications for surgical fusion of the cervical and lumbar motion segment.

STUDY DESIGN: A literature review and the authors' clinical experience for the indication of fusion in the degenerative lumbar and cervical spine is provided. OBJECTIVE: To establish absolute and relative criteria for the indication for fusion in the degenerative cervical and lumbar spine. SUMMARY OF BACKGROUND DATA: Fusion in the cervical and lumbar degenerative spine is indicated under certain strict criteria. However, fusion in circumstances not meeting these criteria is controversial. METHOD: A review of the literature and the authors' experience concerning indication and criteria of fusion in degenerative, lumbar, and cervical spine is provided. RESULTS: Fusion for the unstable spine related to trauma, infection, and tumors is relatively accepted. However, indications for fusion for degenerative, cervical, and lumbar spine are more controversial. CONCLUSION: Lumbar and cervical fusion in the degenerative spine is frequently performed. Certain criteria have been established when a fusion should be considered. However, even these are not universally accepted. Strict prospective studies are needed to determine when a fusion of the degenerative, cervical, and lumbar spine is indicated. Patients with severe radicular pain may be considered for surgery after a comprehensive trial of conservative management. Fusion is usually necessary after a cervical discectomy, especially when spondylosis or osteophytic compression is present. Lumbar fusion is rarely indicated for routine discectomy. In patients with mechanical back or neck pain, surgery should only be considered after conservative measures have been exhausted and a radiographic abnormality is present at the symptomatic level, perhaps with pain concordant with discographic findings. Careful patient selection is the key to obtaining favorable surgical outcomes. In many cases, the goal may be a return to functionality rather than achieving a completely asymptomatic state.

Cervical Vertebrae↗
PubMed2005

Finger motion analysis of the patients with cervical myelopathy.

STUDY DESIGN: Pinch motion between the thumb and the index finger in myelopathy hand was analyzed using micro-reflective markers and the VICON system. OBJECTIVE: To clarify the disturbance in small finger motions of the myelopathy hand. SUMMARY OF BACKGROUND DATA: Specificity of hand dysfunction of the patients with cervical myelopathy was recently recognized as the myelopathy hand. The author established the video-based finger motion analysis system and have been applied it to some disease with abnormal pattern in finger movement. METHODS: The subjects included 11 normal persons (normal group; mean age, 30.2 years) and 9 patients with cervical myelopathy caused by spondylosis, ossification of the posterior longitudinal ligament, or disc herniation (myelopathy group; mean age, 56.0 years). All patients exhibited myelopathy hand, which was defined by two specific signs: the finger escape sign and the inability to grip and release rapidly with the fingers. Fourteen 3-mm micro-reflective markers were placed on the dorsal surface of the thumb and the index finger, and on the dorsal hand. Repeated pinching of a small ball, coin, and small rod was recorded by four infrared video cameras with the movement of each marker tracked in three dimensions. The flexion angle of the thumb IP and MCP joints, and the DIP, PIP, and MCP joints of the index finger were calculated as the angle between the vector joining the markers. RESULTS: When pinching the ball, the mean maximum flexion angle and arc of motion of the index DIP and PIP joints were significantly larger in the myelopathy group than in the normal group, while there was no difference in the MCP joint. In the thumb, the maximum flexion angle and the arc of motion of the thumb MCP joint were significantly larger in the myelopathy group than in the normal group. In addition, the arc of motion of the thumb IP joint was larger in the myelopathy group than in the normal group. Similar results were obtained when pinching the coin and small bar. CONCLUSION: Overall, the patients with myelopathy hand exhibited a larger flexion angle in the two distal finger joints when pinching small objects.

Adult↗
PubMed2006

Dynamic intervertebral foramen narrowing during simulated rear impact.

STUDY DESIGN: A biomechanical study of intervertebral foraminal narrowing during simulated automotive rear impacts. OBJECTIVES: To quantify foraminal width, height, and area narrowing during simulated rear impact, and evaluate the potential for nerve root and ganglion impingement in individuals with and without foraminal spondylosis. SUMMARY OF BACKGROUND DATA: Muscle weakness and paresthesias, documented in whiplash patients, have been associated with neural compression within the cervical intervertebral foramen. To our knowledge, no studies have comprehensively examined dynamic changes in foramen dimensions. METHODS: There were 6 whole cervical spine specimens (average age 70.8 years) with muscle force replication and surrogate head that underwent simulated rear impact at 3.5, 5, 6.5, and 8 g, following noninjurious baseline 2 g acceleration. Peak dynamic narrowing of foraminal width, height, and area were determined during each impact and statistically compared to baseline narrowing. RESULTS: Significant increases (P < 0.05) in average peak foraminal width narrowing above baseline were observed at C5-C6 beginning with 3.5 g impact. No significant increases in average peak foraminal height narrowing were observed, while average peak foraminal areas were significantly narrower than baseline at C4-C5 at 3.5, 5, and 6.5 g. CONCLUSIONS: Extrapolation of the present results indicated that the highest potential for ganglia compression injury was at the lower cervical spine, C5-C6 and C6-C7. Acute ganglia compression may produce a sensitized neural response to repeat compression, leading to chronic radiculopathy following rear impact.

Accidents, Traffic↗
PubMed2006

Influence of rhBMP-2 on the healing patterns associated with allograft interbody constructs in comparison with autograft.

STUDY DESIGN: A prospective, nonblinded, multicenter study. OBJECTIVE: To determine the patterns of allograft incorporation and new bone formation after ALIF using stand-alone threaded cortical allograft dowels with either autograft or rhBMP-2. SUMMARY OF BACKGROUND DATA: Accelerated healing patterns of allograft dowels have been reported in an animal study and a small human study of ALIF with rhBMP-2 and bone dowels. METHODS: We enrolled and randomly assigned 131 patients with lumbar spondylosis who were undergoing single-level ALIF with allograft dowels to either the investigational group who received rhBMP-2 (79 patients) or the control group who received autologous bone graft (52 patients). Independent radiologists used plain radiographs and computed tomography scans to evaluate fusion. Allograft incorporation was assessed using a modified Bridwell-Lenke scale, and changes in bone density within the adjacent vertebral bodies were monitored. RESULTS: At 12 months, all investigational patients had radiographic evidence of new bone formation and incorporation of the allografts into the adjacent vertebral endplates; there were no changes in fusion status at 24 months. Fusions were documented in 89% of patients in the control group at 12 months. The percentage declined to 81.5% at 24 months with 10% of the patients in the autograft group showing incomplete healing and 11% having no healing of the allograft dowels. On CT scans, 14 of the investigational patients (14 of 79; 18%) developed a transient, localized area of bone remodeling within the vertebral body adjacent to the allograft dowel. All were healed by 24 months. The transient appearance of these zones had no effect on clinical outcomes. No patient in the control group developed bone remodeling zones. CONCLUSION: We think that the use of rhBMP-2 is a promising method of facilitating allograft dowel incorporation and new bone formation in patients undergoing ALIF with allograft dowels.

Adult↗
PubMed2006

Lumbar total disc arthroplasty utilizing the ProDisc prosthesis in smokers versus nonsmokers: a prospective study with 2-year minimum follow-up.

STUDY DESIGN: Prospective nonrandomized clinical series. OBJECTIVES: To evaluate the efficacy of ProDisc lumbar artificial disc replacement (ADR) in smokers versus nonsmokers. SUMMARY OF BACKGROUND DATA: Smoking is a negative predictor in fusion surgery. To date, a prospective study of the treatment of incapacitating discogenic low back pain using ADR in smokers versus nonsmokers has not been described. METHODS: A prospective analysis was performed on 104 patients with disabling discogenic low back pain treated with single-level lumbar ProDisc total disc arthroplasty. Smokers and nonsmokers were assessed before surgery and after surgery using patient satisfaction, Oswestry, and Visual Analog Scores. Additionally, preoperative and postoperative neurologic, radiographic, and pain medication assessments were performed at similar postoperative intervals. RESULTS: Oswestry, Visual Analog Scores, and patient satisfaction scores revealed statistical improvement beginning 3 months after surgery and were maintained at minimum 2-year follow-up. Patient satisfaction scores were higher in smokers (94%) than in nonsmokers (87%) at 2-year follow-up (P = 0.07). Radiographic analysis revealed an affected disc height increase from 4 mm to 13 mm (P < 0.05) and an affected disc motion from 3 degrees to 7 degrees (P < 0.05). No cases of loosening, dislodgment, mechanical failure, infection, or fusion of the affected segment occurred. CONCLUSIONS: The results of our study indicate that smokers do equally well compared with nonsmokers when ProDisc ADR is used in the treatment of debilitating lumbar spondylosis. Patient outcome and radiographic scores showed significant improvement compared with preoperative levels. Although not evident in our series, additional surveillance for intraoperative and postoperative vascular spasm and occlusion may be warranted in smokers.

Adolescent↗
PubMed2006

The extremes of spinal motion: a kinematic study of a contortionist in an open-configuration magnetic resonance scanner: case report.

STUDY DESIGN: Observational case study on a female contortionist. OBJECTIVE: To investigate how the human spine of a young athlete aligns during extreme body contortions. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no data available in the literature on the spinal kinematics under extreme body contortions. METHODS: Conventional and kinematic magnetic resonance imaging was used to study a 22-year-old female Chinese contortionist. The images were analyzed with regard to abnormal segmental motion and degenerative alterations. RESULTS: No abnormal segmental motion was observed. The patient had a normal spine beside a mild anterior displacement of L1 relative to L2, with mild disc degeneration and small anterior spondylosis. In addition, a mild disc degeneration was observed at T4/5. No other abnormal findings were diagnosed. CONCLUSIONS: The kinematic magnetic resonance investigation of the presented case did not reveal any evidence for abnormal segmental motion or subluxation in extreme body contortions and indicates that this excessive motion results from extreme spinal flexibility.

Adult↗
PubMed2006

Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature.

STUDY DESIGN: Case description. OBJECTIVES: To report 2 cases of vertebral artery injury (VAI) during anterior cervical decompression surgery and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA: The incidence of VAI during an anterior surgical approach to the cervical spine is rare but potentially lethal. The spine surgeon should be aware of the detailed surgical anatomy and be prepared to manage an inadvertent injury to the vertebral artery. METHODS: In the first case presented, infection was the cause of VAI. During aggressive irrigation and pus drainage, massive bleeding was encountered. For the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. Intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. RESULTS: Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm in the first case. In the second case, a pseudoaneurysm was detected by angiography, obtained 4 days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurologic sequelae. CONCLUSIONS: In case of bleeding control by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm. Postoperative vertebral angiography is helpful to avoid life-threatening complications. Endovascular treatment can be a good alternative in the treatment of VAI.

Aneurysm, False↗
PubMed2004

Cervical angina caused by atlantoaxial instability.

Cervical angina is defined as a paroxysmal precordialgia that resembles true cardiac angina caused by cervical spondylosis. Cervical angina most commonly results from compression of the C7 ventral root. We present here a case of cervical angina caused by atlantoaxial instability. This case had marked atlantoaxial instability but no flexibility of the middle to lower levels of the cervical spine. Although there was mild C7 root compression on the radiologic findings, the chest pain was induced by neck motion, and the precordialgia disappeared after posterior atlantoaxial fusion without C7 root decompression. Therefore, we diagnosed this case as cervical angina caused by spinal cord compression at the C1-C2 level. It was speculated that a perturbation of the sympathetic nervous system or a hypofunction of the pain suppression pathway in the posterior horn of the spinal cord caused the pectoralgia. Although cervical angina is a rare disease, physicians should be aware of it; if there are no abnormal findings on cardiac examinations for angina pectoris, they should examine the cervical spine. Cervical angina due to atlantoaxial instability is one of the differential diagnoses of precordialgia.

Afferent Pathways↗
PubMed2004

Synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation.

Synovial cysts of the cervical spine causing myelopathy are rare. The pathogenesis of these cysts is often attributed to degenerative changes of the facet joints or microtrauma. The authors report a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation without a congenital anomaly or inflammatory conditions. A 72-year-old man presented with a progressive right-sided myelopathy attributed to a C1-C2 synovial cyst accompanied by atlantoaxial subluxation and C3-C6 spondylosis. Magnetic resonance imaging of the cervical spine showed a large cystic mass compressing the spinal cord located at the C1-C2 junction. A C1 hemilaminectomy, complete evacuation of the cyst contents, and posterior atlantoaxial fusion were performed, and a double-door laminoplasty was also done at C3-C6. The patient showed significant improvement of paresthesia and motor weakness of the right upper and lower extremities immediately after the operation. Synovial cysts should be considered in the differential diagnosis of an extradural mass of the upper cervical spine. Posterior fusion combined with direct excision of the cyst may be the optimum treatment of a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation.

Aged↗
PubMed2005

Surgical treatment of cervical myeloradiculopathy associated with movement disorders: indications, technique, and clinical outcome.

OBJECTIVE: Movement disorders may be associated with advanced cervical myeloradiculopathy, which represents a major management challenge. We report on eight patients with movement disorders causing progressive cervical myeloradiculopathy who were treated successfully by cervical decompression and reconstruction. RESULTS: The mean age of our patients was 44 years with a male/female ratio of 3:1. The average duration of symptoms prior to presentation was 10 months. The most common levels decompressed and reconstructed were C3-C4 and C4-C5. Six cases showed improvement, and two cases showed stabilization of neurologic status at a mean follow-up of 21 months. Our management strategy and results are interpreted in the context of a systematic review of the literature in which 78 cases are reported. CONCLUSIONS: Movement disorders cause premature cervical spondylosis most commonly involving the C3-C4 and C4-C5 levels. Ventral pathology with kyphotic angulation requires corpectomy or discectomy with or without posterior decompression and reconstruction. Decompression should always be combined with segmental internal fixation. Perioperative use of botulinum toxin and halo vest immobilization can increase the rate of clinical success but requires vigilance to minimize complications. Laminectomy with lateral mass fixation may be used successfully in the absence of kyphotic deformity.

Adult↗
PubMed2006

Investigation of motor dominant C5 paralysis after laminoplasty from the results of evoked spinal cord responses.

BACKGROUND: Postoperative motor dominant C5 paralysis was known as one of several complications after laminoplasty. Several theories have been proposed for postoperative segmental paralysis after laminoplasty, but its etiology remains unclear. OBJECTIVE: To investigate the possible mechanism for postoperative motor dominant C5 paralysis from intraoperative electrophysiological studies using evoked spinal cord potentials (ESCPs). METHODS: A total of 66 patients who had undergone laminoplasty due to compressive cervical myelopathy were studied retrospectively. In all patients, the symptomatic intervertebral levels of cervical myelopathy were identified by several types of the ESCPs. Motor dominant C5 paralysis was determined as at least 1 level down compared with pre-operative shoulder abduction according to the manual muscle testing. RESULTS: Five patients (7.6%) showed postoperative motor dominant C5 paralysis. C5 paralysis occurred from 1 to 3 days after surgery and compromised unilaterally in all 5 patients. The causes of cervical myelopathy were cervical spondylosis in 3 patients and ossification of the posterior longitudinal ligament in 2 patients. One patient with severe impairment (2 in manual muscle-testing [MMT] scale) did not show clinical recovery. The other 4 patients recovered to 4 or 5 on the MMT score from 3 to 6 months after the onset. Based on the findings of ESCPs, the C4-5 level was affected by cervical myelopathy in all 5 patients with postoperative motor dominant C5 paralysis (C4-5 level in 3 patients, both C4-5 and C5-6 levels in 2 patients). A high signal intensity area on T2-weighted magnetic resonance imaging (MRI) was observed in all patients who showed apparent motor dominant C5 paralysis in this study. CONCLUSIONS: Cervical myelopathy at the C4-5 level is a potential risk for motor dominant C5 paralysis. Although it is merely a speculation, when C5 radiculopathy occurs after laminoplasty, C5 paralysis becomes clinically apparent because the deltoid muscle gets predominantly innervated by C5 root due to intramedullary spinal cord damage on the C6 segment in C4-5 myelopathy before surgery. It may represent the high signal intensity area on T2-weighted MRI at the C4-5 level.

Aged↗
PubMed2006

Complications and long-term follow-up results in titanium mesh cage reconstruction after cervical corpectomy.

OBJECTIVE: The incidence of the complications and long-term outcome with a minimum 2-year follow-up of anterior cervical reconstruction using titanium mesh cage is evaluated. Relevant literature was also reviewed to discuss the potential risk factors of the complications of this procedure. METHODS: From 1999 to 2003, 26 patients with cervical spine disorders, (12 patients with OPLL, 7 with cervical spondylosis, 3 with vertebral tumors, 2 with osteomyelitis, and 2 with traumatic lesions) were operated on by this procedure. The series included 14 males and 12 females with a mean age of 60.9 years. Corpectomy was performed on 1 (14 cases), 2 (12 cases). Autologous bone fragments were taken from the excised vertebra. RESULTS: The average improvement rate as scored on the neurosurgical cervical spine scale was 67.4%. The average follow-up period was 54.3 months (range, 24 to 72 months) in 21 who were followed up, and bone union was observed in all cases (22/22 cases) that could be followed up for more than 6 months postoperatively. The average time required for fusion was 6.7 months. Postoperative complications included dyspnea (1 case) and cerebrospinal fluid leakage (2 cases), which was treated by lumbar drainage, without any additional repair operation. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. CONCLUSIONS: This reconstruction technique yielded good clinical results and helped to avoid complications associated with harvesting bone from the iliac crest donor site. However, risk factors related to the method should be carefully considered.

Adult↗
PubMed2004

Evidence-based soft tissue rheumatology: III: trochanteric bursitis.

Trochanteric bursitis is a term used to name a syndrome that features pain and tenderness over the greater trochanter. Present evidence suggests that in the majority of cases, symptoms result from pathology of the gluteus medius or minimus muscles rather than a bursa. Lower limb length discrepancy, iliotibial band contracture, hip osteoarthritis and lumbar spondylosis are often mentioned, but no proved as predisposing factors. After a lumbar spine or hip and other local pathology have been considered and clinically excluded, the clinical features of the syndrome, ie lateral location of pain plus characteristic trochanteric tenderness are usually sufficient to reach a diagnosis. Most patients with trochanteric bursitis can be successfully treated with a NSAID, physiotherapy plus a local corticosteroid injection. The few refractory cases are often treated surgically. Disappointingly, none of the therapeutic interventions used in trochanteric bursitis have been validly assessed.

Journal Article↗
PubMed2006

Risk factors for water sports-related cervical spine injuries.

BACKGROUND: To examine risk factors associated with water sports-related cervical spine injuries (WSCSI). METHODS: A retrospective analysis of all patients admitted for WSCSI from 1993 to 1997 was performed. The severity of cervical spine injury was assessed by review of medical records and imaging studies. Mechanisms of injury and activities at the time of injury were noted to determine risk factors for cervical spine injuries caused by wave forced impacts (WFI) from activities such as bodysurfing and body boarding. These risks were compared with injuries incurred by shallow water dives (SWD). RESULTS: One hundred patients were analyzed (mean age, 36 years old); 89% were male, 62% were nonresidents of Hawaii, and 75% had a large build. Patients without radiographic evidence of fractures, subluxations, and/or dislocations (n = 26) were significantly older (48 versus 32 years old, p < 0.0001) with a higher rate of pre-existing cervical spine abnormalities (65% versus 15%, p < 0.0001) compared with the remainder of patients (n = 74). Seventy-seven percent of WFI involved nonresidents. The mean age of WFI patients was significantly older than patients involved in SWD (42 versus 25 years). Ninety-six percent of wave-related accidents occurred at moderately to severely rated shorebreak beaches. CONCLUSIONS: Wave forced impacts of the head with the ocean bottom typically occurred at moderate to severe shorebreaks, and involved inexperienced, large-build males in their 40s. Spinal stenosis and degenerative spondylosis may increase the risk of cervical spine injury associated with WFI due to the increased risk of neck hyperextension and hyperflexion impacts inherent to this activity.

Adolescent↗