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At least 145 records · Page 8Linked to original sources
PubMed1998

The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans.

STUDY DESIGN: An experimental study on patients undergoing posterior lumbar spine surgery. OBJECTIVES: To study the relation between external compression and muscle strain induced by spinal retractors and intramuscular pressure in the dorsolumbar compartment during posterior spinal surgery. SUMMARY OF BACKGROUND DATA: Pressures were studied as a function of the distance between the retractor blades during surgery. METHODS: Intramuscular pressure was measured bilaterally in the erector spinae muscle with intermittent microcapillary infusion technique in 12 patients undergoing posterior lumbar spine surgery during 271 (range 90-420) minutes. Three self-retaining retractors were tested; the McCulloch, the Viking, and the Richard retractors. RESULTS: Intramuscular pressure was 7.7 mm Hg before surgery. It varied between 35 mm Hg and 69 mm Hg during surgical exposure of the laminas and facet joints. Intramuscular pressure varied between 61 mm Hg and 158 mm Hg depending on which retractor was used and on the distance between the retractor blades. Intramuscular pressure never exceeded 30 mm Hg at rest after the operation. CONCLUSIONS: External compression and muscle strain from retractor blades during surgery increased intramuscular pressure in the paravertebral muscles to levels that, according to other studies, induce ischemia in the muscles.

Adult↗
PubMed1998

Anterior vertebral body screw pullout testing. A comparison of Zeilke, Kaneda, Universal Spine System, and Universal Spine System with pullout-resistant nut.

STUDY DESIGN: A biomechanical study of pullout of anteriorly implanted screws in cadaveric vertebral bodies. OBJECTIVES: To investigate and compare the pullout strength of the Zielke, Kaneda, Universal Spine System (USS) pedicle screw, and USS pedicle screw with a new pullout-resistant nut. SUMMARY OF BACKGROUND DATA: A common problem with anterior purchase regardless of the implant system is screw pullout at the proximal and distal ends of multilevel constructs. There is limited information on a solution to this problem. METHODS: The L1 to L4 vertebral bodies from four cadavers had one each of Zielke and Kaneda pedicle screws (Acromed Corp., Cleveland, OH), USS pedicle screw (Synthes Spine, Paoli, PA), and USS pedicle screw with pullout-resistant nut implanted transversely across the center of the vertebral body with bicortical purchase in a similar fashion as would be used clinically. The screws were extracted using a servohydraulic material testing system. The maximum axial forces were recorded. RESULTS: The Zielke and Kaneda screws had no significant difference in mean pullout strength (P = 0.542). The USS screw alone was less strong (P = 0.009). The USS screw and pullout-resistant nut increased the pullout strength by twofold (P = 0.00006). In the screw pullout tests, the mode of failure was at the screw thread's interface. The USS screw and pullout-resistant nut failed by imploding the body around the nut. With the USS screw and pullout-resistant nut, the pullout strength was determined by the compressive strength of the bone. CONCLUSIONS: The addition of a pullout-resistant nut to an anterior vertebral body screw improves the pullout strength by twofold and changes the mode of failure to rely ultimately on the inherent vertebral body strength rather than the screw's characteristics. The addition of a pullout-resistant nut may be applicable to multilevel implant constructs to prevent screw pullout at the top and bottom.

Biomechanical Phenomena↗
PubMed1999

Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion.

STUDY DESIGN: Two hundred-forty consecutive patients underwent laparoscopic instrumented interbody fusion using custom-designed instrumentation and BAK (Sulzer Spine Tech, Minneapolis, MN) fusion cages. The surgeries were performed at eight spine centers during U.S. Food and Drug Administration investigational device evaluation clinical trials. This cohort was compared with 591 consecutive patients undergoing open anterior fusion with the same device. OBJECTIVES: To investigate the feasibility and safety of the laparoscopic approach compared with that of open procedures. SUMMARY OF BACKGROUND DATA: In other areas of medicine, advances in laparoscopic surgical procedures have resulted in reduced morbidity, expense, and pain when compared with results of the open counterpart. METHODS: The open anterior procedure was performed using a retroperitoneal approach. The laparoscopic procedure was performed transperitoneally with carbon dioxide insufflation to provide visualization using a 10-mm endoscope. Two hollow, titanium, threaded interbody implants packed with autologous bone were inserted into the diseased interspace. RESULTS: The laparoscopy group had a shorter hospital stay and reduced blood loss but had increased operative time. Operative time improved in the laparoscopy group as surgeons' experience increased. Operative complications were comparable in both groups, with an occurrence of 4.2% in the open approach and 4.9% in the laparoscopic approach. Overall, the device-related reoperation rate was higher in the laparoscopy group (4.7% vs. 2.3%), primarily as a result of intraoperative disc herniation. Conversion to open procedure in the laparoscopy group was 10%, with most cases predictable and preventable. CONCLUSIONS: The laparoscopic procedure is associated with a learning curve, but once mastered, it is effective and safe when compared with open techniques of fusion.

Adult↗
PubMed1993

Bone marrow trephine biopsy: anterior superior iliac spine versus posterior superior iliac spine.

Bone marrow biopsy (BMB) is generally performed either on the anterior superior iliac spine (ASIS) or the posterior superior iliac spine (PSIS), the choice between these two sites depending largely upon practice at individual centres. No previous study has attempted to ascertain which of these two sites is preferable for needle BMB. We studied 72 biopsies, of which 36 were of the PSIS and 36 of the ASIS, measuring the length of the cylinder and the area of the histologic section. We asked those patients who had undergone BMB at both sites which had been the less painful. The cylinders obtained from the PSIS were found to have a significantly greater length and area than those obtained from the ASIS (P < 0.00001). Of the 13 patients who underwent BMB at both sites, 11 reported the PSIS biopsy to have been distinctly less painful (P = 0.012). We conclude that needle BMB of the PSIS provides samples of greater length and area, and is less painful, than that of the ASIS.

Biopsy, Needle↗
PubMed1996

Three familial cases presenting with an immobile spine. Rigid spine or Emery-Dreifuss syndrome?

A father and his two sons presented with slowly progressive muscular weakness, contractures of the spine, elbows and ankles, and cardiac conduction disturbances in the father. Clinical and histological findings are discussed in relation to the hitherto reported cases of autosomal dominant variant of the Emery-Dreifuss syndrome and the distinction from the rigid spine syndrome.

Adolescent↗
PubMed1975

Transverse axial tomography of the spine. Part 1: axial anatomy of the normal lumbar spine.

The authors describe the technique of transverse axial tomography of the spine and give a detailed description of the axial anatomy of the normal lumbar spine from L-4 to the sacrum. They demonstrate a specific repetitive pattern of intraosseous and articular segments, and stress the importance of the articular processes in shaping the vertebral canal and the intervertebral foramina. The authors believe axial tomography to be a simple, noninvasive radiological technique that allows cross-sectional visualization of the vertebral canal and articular processes in the living patient.

Humans↗
PubMedDate not supplied

[Epidural anesthesia in surgical interventions on the spine and spinal cord. I. Comparative analysis of the effectiveness of anesthesiological protection under conditions of epidural anesthesia and neuroleptanalgesia in surgery of the spine and and spinal cord].

The study was carried out in 22 patients operated on for vertebral disk hernias and spinal tumors at lumbosacral level. The patients were divided in 2 groups depending on the type of anesthesia (epidural or neuroleptanalgesia-EA and NLA). In the test group all patients were operated under EA with local anesthetics combined with intravenous sedative drugs (diprivan + relanium) under conditions of spontaneous respiration and O2 inhalation through a mask. In the control group combined total intravenous anesthesia by myorelaxants and tracheal intubation were carried out (relanium + diprivan: induction dose 1.95 +/- 0.5 mg/kg, maintenance dose 5.3 +/- 0.4 mg/kg/h, and phentanyl). The purpose of the study was to compare the efficiency of anesthesiological protection under EA and traditional NLA in interventions on the spine, when surgical injury is inflicted in the immediate vicinity to the central structures responsible for pain impulsation. Only EA ensured adequate protection of the patients from surgical stress, as was seen from hemodynamic (arterial pressure and heart rate) and endocrine metabolic parameters (glucose, epinephrine, norepinephrine, hydrocortisone, and prolactin levels). Hence, EA fully demonstrated its protective properties during operations on the spine, and therefore can be regarded as a method of choice in this patient population.

Adjuvants, Anesthesia↗
PubMed2001

[The USS (Universal Spine System) in the treatment of thoraco-lumbar spine fractures].

The paper present the results of surgical treatment of 15 patients (11 males and 4 females--average age 35.3 years) with thoraco-lumbar spine fractures. Pre-op neurological disorders were found in 4 patients with narrowing of the spinal canal, including 1 case of paraplegia. The decrease of vertebrae height was on average 45%. All patients underwent surgical treatment with transpedicular fixation by means of USS (Universal Spine System). In 7 patients 4 vertebrae were instrumented, the rest of the patients had only 3 vertebrae instrumented. In this latter case arthrodesis was not performed. Post-op, the neurological symptoms receded completely in 3 patients and partially in the case with paraplegia. In 76% of the cases vertebra height was restored completely. Patients were allowed to stand on the 3-4 day post-op. Follow-up was 22 months, and the neurological status of the patients was stabile. No decrease in vertebra height was noticed.

Adolescent↗
PubMed2003

[Advance of lower cervical spine pedicle screw fixation in treatment of lower cervical spine instability].

OBJECTIVE: To review the anatomic character of lower cervical pedicle, the placement and the biomechanical stability of the cervical pedicle screw fixation, the clinical application and the complication caused by fixation. METHODS: The literature concerned the cervical pedicle screw fixation in recent years were extensively reviewed. RESULTS: The cervical pedicle screw fixation can be widely used in the lower cervical spine instability according to the anatomic character of lower cervical pedicle, and the good biomechanical stability of the cervical pedicle screw fixation, and the complication can be controlled. CONCLUSION: The cervical pedicle screw fixation is an effective internal fixation for the lower cervical spine instability.

Biomechanical Phenomena↗
PubMedDate not supplied

Proceedings of the State-of-the-Art Symposium on Diagnostic and Interventional Radiology of the Spine, Antwerp, September 7, 2002 (Part two). Upright, weight-bearing, dynamic-kinetic MRI of the spine: pMRI/kMRI.

PURPOSE: To review the general clinical utility of the first dedicated magnetic resonance imaging (MRI) unit enabling upright, weight-bearing positional evaluation of the spinal column (pMRI) during various dynamic-kinetic maneuvers (kMRI) in patients with degenerative conditions of the spine. MATERIALS & METHODS: This study consisted of a prospective non-statistical analysis of cervical or lumbar imaging examinations. All studies were performed on a recently introduced whole body MRI system (Stand-Up MRI, Fonar Corp, Melville, NY). The system operates at 0.6T using an electromagnet with a horizontal field, transverse to the longitudinal axis of the patient's body. Depending upon spinal level, all examinations were acquired with either a cervical or lumbar solenoidal radiofrequency receiver coil. This unit was configured with a top-front open design, incorporating a patient-scanning table with tilt, translation and elevation functions. The unique motorized patient handling system developed for the scanner allowed for vertical (upright, weight bearing) and horizontal (recumbent) positioning of all patients. The top-open construction also allowed dynamic-kinetic flexion and extension maneuvers of the spine. Patterns of bony and soft tissue change occurring among recumbent (rMRI) and upright neutral positions (pMRI), and dynamic-kinetic acquisitions (kMRI) were sought. RESULTS: Depending on the specific underlying pathologic degenerative condition, significant alterations observed on pMRI and kMRI that were either more or less pronounced than on rMRI included: fluctuating anterior and posterior disc herniations, hypermobile spinal instability, central spinal canal and spinal neural foramen stenosis and general sagittal spinal contour changes. No patient suffered from feelings of claustrophobia that resulted in termination of the examination. CONCLUSION: To conclude, the potential relative beneficial aspects of upright, weight-bearing (pMRI), dynamic-kinetic (kMRI) spinal imaging on this system over that of recumbent MRI (rMRI) include: the revelation of occult disease dependent on true axial loading, the unmasking of kinetic-dependent disease, and the ability to scan the patient in the position of clinically relevant signs and symptoms. This imaging unit also demonstrated low claustrophobic potential and yielded relatively high-resolution images with little motion/chemical shift artifact.

Cervical Vertebrae↗
PubMed2005

Occult ligamentous injury of the cervical spine associated with cervical spine fracture.

We report the case of a 20-year-old patient with a C5 cervical spine fracture and an undetected ligamentous lesion between C1 and C2. Cervical spine lesion protocols and the rates of lesions that are not diagnosed with standard evaluation protocols are reviewed, with particular emphasis on comatose patients. Dynamic studies during the surgical procedure for fixation of the fracture are recommended to increase the detection of ligamentous lesions.

Accidents, Traffic↗
PubMed1991

[Dorsal fixation of the thoracic and lumbar spine with grooved plates in combination with the Universal Spine Instrumentation System. A short stretch, angle-stable alternative].

In the Department of Surgery in the University Hospital "Bergmannsheil" in Bochum, 67 patients with unstable injuries of the thoracic and lumbar spine were analyzed in a retrospective study. The sagittal correction loss was greatest about 6 months after dorsal stabilization--6 degrees on the average--after stabilization with a plate alone. The correction loss after stabilization with plates combined with the Universal Spine Instrumentation System (USIS), which was developed for ventral derotational spondylodesis or after implantation of an internal fixation device, however, amounted to 3 degrees on the average. The clinical results show that by combining the plate and USIS the injuries can be stabilized for short stretches and without correction loss. The main advantage of this combination over internal fixation is the smaller amount of metal used, which means the soft tissue in loss compromised and there is a possibility of fitting the implant more directly. In 10 patients (15%) the implants broke at the place of maximum shear stress between 4 and 8 months postoperatively after consolidation of the fracture and without spoiling the result. This occurred equally often with all types of implants. Efficient use of the three systems is discussed with regard to the different pathomechanical modes of injury. A causative scheme of treatment is presented.

Adolescent↗
PubMed1995

[Retinoic acid-induced hyperostosis in the murine spine, particularly in the cervical spine].

In order to investigate the role of retinoic acid in inducing spinal hyperostosis, the murine spine was radiologically and histologically examined after a 24-week peroral administration of synthetic retinoic acid (etretinate). In the cervical spine, osteophytes on the ventral rims of the vertebral bodies were more developed after etretinate administration than in controls. Histologically, chondrocytes after etretinate administration proliferated in the anterior longitudinal ligaments at the junction of the ventro-caudal rim and the epiphyseal region of the C2 and C3 vertebral bodies. Endochondral ossification was a characteristic feature and immature chondrocytes and mesenchymal cells were found in the region. After etretinate administration, the incidence of proliferative changes was 67.6% at the C2 ventro-caudal rim, and 79.4% and 70.6%, respectively in the C2 and C3 ventral epiphyseal regions. These percentages were highly significant compared with controls, but they were not dosage-dependent. These findings suggested that retinoic acid was involved in the differentiation and proliferation of chondrocytes in ligaments.

Animals↗
PubMed2001

Functional MRI of the spine: different patterns of positions of the forward flexed lumbar spine in healthy subjects.

Since the introduction of the technique of vertical open-configuration systems, efforts have been made to obtain functional lumbar spinal magnetic resonance (MR) images. The purpose of this study was to determine the relation between facet joint orientation and flexion patterns in the lower lumbar spine. Thirty-four normal subjects (18 women, 16 men) were examined in a vertical open 0.5-T MR scanner with T1-weighted gradient echo (GE) sequences. Flexion angles were digitally measured in the sagittal plane and facet joint orientation in the axial plane. The population showed three different functional flexion patterns: 17.6% (n=6) had kyphotic angles in all three lower lumbar levels during forward flexion (type 1), 50% (n= 17) had a lordotic angle at L5/S1 but kyphotic angles at L4/L5 and L3/L4 (type 2), and 32.4% (n=11) showed lordotic angles at L5/S1 and L4/L5 but a kyphotic angle at L3/L4 (type 3). There were statistically significant differences between flexion patterns and mean facet joint orientation: at 4/15 33.3 degrees for type 1, 33.5 degrees for type 2 and 46.2 degrees for type 3; at L5/S1 27.2 degrees for type 1, 46.4 degrees for type 2 and 48.1 degrees for type 3. There were no significant differences between the three groups at L3/L4. The three different flexion patterns in normal subjects and their relation to facet joint orientation have not been described previously. Knowledge of these patterns may lead to a better understanding of physiological spinal movement as a base for future investigations in low back pain patients.

Adult↗
PubMed2005

Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial.

OBJECTIVES: To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. DESIGN: Multicentre randomised controlled trial. SETTING: 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. PARTICIPANTS: 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for spinal fusion. INTERVENTION: Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy. MAIN OUTCOME MEASURE: The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure. RESULTS: 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was -4.1 (95% confidence interval -8.1 to -0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures. CONCLUSIONS: Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.

Adolescent↗
PubMed2005

Percutaneous Harlow Wood needle biopsy of the spine: a retrospective analysis of 238 spine lesions.

This retrospective study assessed the diagnostic accuracy and clinical usefulness of the Harlow Wood needle biopsy for spinal lesions. The medical records of 238 patients (138 men and 100 women) who underwent closed spine biopsy from 1987 through 1997 were reviewed. Patient age ranged from 21 to 83 years. Lesions involved the thoracic vertebrae in 127 patients, the lumbar vertebrae in 99 patients, and the sacrum in 12 patients. Cultures of the biopsy specimens were examined histopathologically and cytologically. One hundred twenty-four patients were diagnosed with a spinal infection, and 68 patients were diagnosed with a tumor. In the remaining 46 patients, the biopsy specimens were negative for infection or neoplasia in 20 patients and not diagnostic in 26 (10.9%) patients. There were no major complications. The Harlow Wood needle biopsy is a simple, repeatable procedure with satisfactory diagnostic accuracy (89.1%) and can be performed on an outpatient basis.

Adult↗
PubMed1995

Lateral spine dual-energy X-ray absorptiometry bone mineral measurement with fan-beam design: effect of osteophytic calcifications on lateral and anteroposterior spine BMD.

Recently, fan beam (FB) designs have been made available by several manufacturers (Aloka, Hologic Lunar and Sophar) to measure lumbar spine bone mineral area density (BMD) in both an anteroposterior (AP) and a lateral projection. The present study was performed to evaluate some characteristics of a new dual energy X-ray absorptiometry (DXA) system for supine lateral scans in normals and to study possible advantages for patients with osteophytic calcifications (OC). The precision errors of in vitro and in vivo measurements were estimated by an anthropomorphic phantom and in healthy volunteers. To study the effect of osteoarthritic changes on AP and lateral DXA measurements, BMC (bone mineral content) and BMD were measured in age-matched women (n = 150) with and without OC. Precision errors for lateral BMD in vitro over 1 and 6 months were 0.58/0.67% (slow/fast scan modes) and 0.67/0.77% (slow/fast scan modes), respectively. The short- and mid-term reproducibility of BMD values were 2% and 3.5%, respectively, using the compare function (3.5% and 7.5%, respectively, without the compare facility). The analysis of women with and without OC (n = 150) demonstrated higher mean values for AP BMD (0.892 +/- 0.145 g/cm2) in patients with OC (n = 75) than in normals (0.836 +/- 0.135 g/cm2, n = 75, difference 6.3%). For lateral scans, BMD differed to a minor degree (3.1%) in patients with OC (0.629 +/- 0.133 g/cm2) compared with normals (0.610 +/- 0.117 g/cm2). Corresponding results were obtained in fast FB mode. Furthermore, we found significant (P < 0.0001) correlations between BMD in lateral and AP scans in patients without OC (r = 0.63) and in patients with OC (r = 0.57). Although the FB design facilitated fast AP and lateral scans, the higher precision errors of lateral scans could limit its application in longitudinal studies. The use of compare function should be recommended. However, BMD of lateral scans was less influenced by OC.

Absorptiometry, Photon↗
PubMed2006

Contrast-enhanced MR imaging of the spine: when, why and how? How to optimize contrast protocols in MR imaging of the spine.

The optimal protocols and the role of contrast agents in spinal MR imaging are controversial. Although the diagnosis of many common spinal diseases can be reliably achieved by means of unenhanced images, contrast use is often necessary to improve lesion detection and differential diagnosis. The heterogeneity of the different spinal compartments and the wide variety of spinal pathology require tailored imaging strategies. Thus, the rules to achieve optimization of contrast protocols for MR imaging of the spine are frequently very different to those for brain imaging, and depend on the location and site of origin of the lesions in a specific spinal compartment, on the findings of unenhanced imaging, and on the concomitant use of fat-suppression techniques. Furthermore, in most cases, the small size of the examined structures requires a meticulous technique, and the administration of a contrast agent with high relaxivity, such as MultiHance, is advisable to enable the detection of tiny areas of contrast enhancement. The applications and clinical utility of post-contrast MR imaging are discussed with regard to different spinal diseases.

Contrast Media↗