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At least 163 records · Page 9Linked to original sources
PubMed2003

The aging spine: new technologies and therapeutics for the osteoporotic spine.

Osteoporosis results in low-energy fractures of the spine. The load necessary to cause a vertebral fracture is determined by the characteristics related to the vertebral body structure, mineral content, and quality of bone. Radiographic techniques centered on dual X-ray absorptiometry (DXA) permit a determination of bone mass and fracture risk. Current medical therapies principally using bisphosphonate and pulsatile PTH profoundly decrease the risk of fracture (50+%). Fall prevention strategies can further decrease the possibility of fracture. A comprehensive approach to osteoporosis can favorably alter the disease.

Absorptiometry, Photon↗
PubMed1986

A controlled trial of six-month and nine-month regimens of chemotherapy in patients undergoing radical surgery for tuberculosis of the spine in Hong Kong. Tenth report of the Medical Research Council Working Party on Tuberculosis of the Spine.

Sixty patients in Hong Kong with a diagnosis of tuberculosis of the thoracic, thoraco-lumbar or lumbar spine were allocated at random to either a 6-month (6M) or a 9-month (9M) regimen of daily isoniazid plus rifampicin, supplemented in all patients by streptomycin twice a week for the first 6 months. All patients had the modified 'Hong Kong' operation of radical resection of the lesion and insertion of autologous bone grafts. After exclusions, the main analyses of this report concern observations for 3 years on 51 patients (25 6M, 26 9M). The clinical and radiographic condition of the two series on admission was broadly similar. At 18 months, 19 of the 25 6M and 22 of the 26 9M patients had a favourable status, achieved on the allocated regimen that is, they had no clinical evidence of active disease, in particular no sinus or clinically evident abscess and no central nervous system lesions; they were capable of full physical activity and radiographically the lesion was quiescent. At 3 years, 24 patients in each series had a favourable status. Of the remaining three patients, one (9M) was clinically favourable but his spinal lesion was reported not yet quiescent at radiographic assessment. The other two patients (one in each series) had a favourable status in every respect except that they had required modifications of the allocated regimen; both had had a sinus at the site of the operation scar requiring surgical excision, with additional chemotherapy in one (9M). These modifications apart, all 25 6M and 25 of the 26 9M patients had a favourable status at three years. A sinus or clinically evident abscess was present on admission in seven patients (5 6M, 2 9M) and had resolved by 3 months in all seven, although one patient (6M) developed a sinus at the operation site subsequently. A further four patients (1 6M, 3 9M) developed an abscess or sinus for the first time after the start of treatment, but all resolved within 6 months. Two patients (one 6M, one 9M) had a mild paraparesis and one (9M) a cauda equina lesion on admission; all had resolved by 9 months. Radiographic evidence of bony fusion of the affected vertebral bodies had occurred in 36% of 25 6M and 42% of 26 9M patients at 6 months, in 44% and 77% respectively at 9 months (P = 0.03), 68% and 88% respectively at 18 months and 100% in both series at 36 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

Quantitative anatomy of cervical spine ligaments. Part II. Middle and lower cervical spine.

The quantitative anatomy of the ligaments of the middle and lower cervical spine was determined from six human cadaveric specimens using stereophotogrammetry. For each of the ligaments--anterior longitudinal, posterior longitudinal, capsular, ligamentum flavum, interspinous, and supraspinous--the origins, lengths, and orientations were defined three-dimensionally. The anterior and posterior longitudinal ligaments were approximately 7.5 mm wide and 12 mm long at levels C3 through T1, whereas only 3.8 mm wide but 23 mm long and 31 mm long at C1-C2, respectively. The capsular ligaments were fairly constant at all levels, oriented posteriorly at approximately 45 degrees to the transverse plane. The ligamentum flavum were relatively constant in width (5 mm), whereas their lengths increased from 5.2 mm at C2-C3 to 8.7 mm at C7-T1. The interspinous ligament was tilted anteriorly 30-40 degrees and was shortest at levels C2-C3 and C3-C4. The supraspinous ligament was more vertically oriented than the interspinous ligament by 15-20 degrees.

Adult↗
PubMed1984

Safety of anterior cement fixation in the cervical spine: in vivo study of dog spine.

There is increased use of methylmethacrylate in the treatment of neoplastic lesions of the spine. The advantage of this treatment is immediate stabilization, thus avoiding prolonged immobilization. In vivo study using a dog model showed that anterior fixation with cement, with or without Gelfoam as insulation material, produced no spinal cord injury.

Animals↗
PubMed1991

Cervical spine strength after facet injury and spine plate application.

Although metallic plates are used for cervical spine stabilization, few biomechanical studies have been done to evaluate their efficiency. A previous study indicated that one half of the facet joint may be destroyed before compromise in strength occurs. Isolated motion segments in which one half of the facet joint was resected bilaterally were used. A two-hole Roy-Camille plate was attached bilaterally with 3.5-mm-diameter, 16-mm-long screws and the construct loaded in shear. Failure occurred at 415.6 N by fracture through the screw holes of the damaged joint, compared to a failure load of 699.6 N in specimens without screws and plates but in which 75% of the joint had been destroyed. Results were significant at the 95% confidence level. A second group of specimens using C2-3-4 and C5-6-7 was tested after 50% facet resection and application of a three-segment plate. Failure again occurred by fracture through the screw hole at the damaged joint. We conclude that, if significant facet destruction is present, screw holes for plate application further weakens the bone. The desired biomechanical stability may not be present.

Bone Plates↗
PubMed1993

Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion.

Ninety of 110 consecutive patients with rheumatoid deformities of the cervical spine surgically treated had associated neurologic deficits. Fifty-five patients had atlantoaxial subluxation. In this group, there were 16 Ranawat Class I patients (normal), 21 Class II (weakness, hyperreflexia, dysesthesia), 13 Class IIIA (paresis and long-tract findings but can ambulate), and five Class IIIB (quadriparesis and inability to ambulate). After C1-C2 stabilization, 94.8% improved at least one class. Twenty-two patients had AAS-SMO (atlanto-axial subluxation and superior migration of the odontoid) only one before surgery was Class I, five Class II, eight Class IIIA, and eight Class IIIB. Seventy-six percent improved at least one class after surgery. Nineteen had isolated subaxial subluxation (SAS). Three were Class I, two Class II, nine Class IIIA, and five were Class IIIB. After surgery, 94% improved at least one class, and all were ambulating. Fourteen had combined AAS-SMO-SAS deformities. There were no Class I patients, only four Class II, four Class IIIA, and six Class IIIB. After surgery, 71% improved. The four deaths that occurred in the immediate postoperative period were Class IIIB. Fifteen patients had worsening or recurrence of their symptoms. Thirteen of these were related to the later development of subaxial subluxation. Neurologic symptoms and recovery were related to severity of the deformity. Those with SMO had greater neurologic deficits and worse results. In general, neurologic recovery is encouraging even in the IIIB patient. Earlier surgery should be done, however, particularly before SMO develops, if possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Spine update. Administrative databases in spine research.

The use of administrative health care databases for the storage and retrieval of information is increasing. The data collection, entry, and collation follows a predictable process for hospital admissions. Many conclusions have been drawn from research performed using administrative databases. These conclusions can have significant and important implications for patients, providers, and society at large, to the extent that such data inform participants in the current health care policy debate. In an effort to better understand the significance of conclusions drawn from studies that rely on electronic administrative databases as their source of information, the present report addresses the process, strengths, weaknesses, and future plans for the use of administrative databases in spine research.

Databases, Factual↗
PubMed2003

Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine.

STUDY DESIGN: An in vitro biomechanical study of several reconstructive techniques after a two-level cervical corpectomy. OBJECTIVES: To evaluate, compare, and quantitate the stability of several reconstructive strategies (anterior, posterior, or anterior/posterior with or without instrumentation) after a multilevel cervical corpectomy. SUMMARY OF BACKGROUND DATA: Several clinical and biomechanical studies have questioned the stability of stand-alone long-segment anterior plate fixation after a multilevel (>or=2) corpectomy. The large cantilever forces generated within the stabilized construct, particularly at the caudal screw-bone interface, have led to plate and screw dislodgement and the need for further surgical intervention. The addition of posterior segmental instrumentation has been shown to improve overall stability and decrease local stresses on the anterior fusion construct (graft and plate). MATERIALS AND METHODS: Seven fresh-frozen cadaveric human cervical spines (C1-T1) were harvested. The C1-C2 and C7-T1 vertebral bodies were embedded in poly-methylmethacrylate (PMMA). Three VICON cameras tracked three-dimensional segmental motions at the ends of the fusion construct after a two-level corpectomy and placement of a strut graft with or without instrumentation. Pure moments (flexion/extension, lateral bending, and axial rotation) were applied to the C1 level of each specimen. The motion segments were loaded to a maximum of 2 Nm using dead weights. Testing was first performed on the intact specimens. Then, a two-level corpectomy at the C4 and C5 levels was performed. A PMMA strut graft was then placed into the corpectomy site. Biomechanical testing was then repeated among three different reconstruction techniques: 1) anterior cervical locking plate (PEAK; Depuy-Acromed, Raynham, MA) with dual unicortical screw fixation at C3 and C6; 2) posterior cervical instrumentation (Summit; Depuy-Acromed) using a 3.0-mm rod with segmental lateral mass screw fixation from C3 to C6; and 3) a combined anterior-posterior instrumentation using the anterior PEAK plate and posterior Summit rod system. RESULTS: In all pure moments tested (flexion/extension/lateral bending/axial rotation) the combined anterior-posterior instrumentation reconstruction model and the posterior-only instrumentation model were significantly more rigid than the anterior-only instrumentation model (P < 0.05). Interestingly, no statistically significant difference was noted between the combined anterior plate/posterior instrumentation model and the posterior instrumentation-only model. CONCLUSION: The biomechanical results obtained suggest that posterior segmental instrumentation confers significant stability to a multilevel cervical corpectomy regardless of the presence or absence of anterior instrumentation. In cases in which the stability of a multilevel reconstruction procedure is tenuous, the surgeon should strongly consider the placement of segmental posterior instrumentation to significantly improve the overall stability of the fusion construct.

Biomechanical Phenomena↗
PubMed1987

Functional recovery after decompressive spine operation for cervical spine fractures.

Ninety-nine patients with cervical spine fractures from C-4 through C-7 were operated upon from 1975 to 1981. Operation was performed to restore normal relationships between the spinal cord and roots and the spinal canal and foramina and to maintain these relationships by fusion when necessary. Neurological function was recorded pre- and postoperatively using a functional scale. Satisfactory fusion without adverse change in vertebral alignment was achieved in each patient. The average interval between injury and operation was 29 days. When neurological recovery was observed, it began promptly after operation, suggesting a cause and effect relationship.

Cervical Vertebrae↗
PubMed1976

A five-year assessment of controlled trials of in-patient and out-patient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Fifth report of the Medical Research Council Working Party on tuberculosis of the spine.

In two centres in Korea 350 patients with a diagnosis of tuberculosis of the thoracic and/or lumbar spine were allocated at random: in Masan to in-patient rest in bed (IP) for six months followed by out-patient treatment or to ambulatory out-patient treatment (OP) from the start; in Pusan to out-patient treatment with a plaster-of-Paris jacket (J) for nine months or to ambulatory treatment without any support (No J). All patients recieved chemotherapy with PAS with isoniazid for eighteen months, either supplemented with streptomycin for the first three months (SPH) or without this supplement (PH), by random allocation. The main analysis of this report concerns 299 patients (eighty-three IP, eighty-three OP, sixty-three J, seventy No J; 143 SPH, 156 PH). Pre-treatment factors were similar in both centres except that the patients in Pusan had, on average, less extensive lesions although in a greater proportion the disease was radiographically active. One patient (J/SPH) died with active spinal disease and three (all No J/SPH) with paraplegia. A fifth patient (IP/PH) who died from cardio respiratory failure also had pulmonary tuberculosis. Twenty-three patients required operation and/or additional chemotherapy for the spinal lesion. A sinus or clinically evident abscess was either present initially or developed during treatment in 41 per cent of patients. Residual lesions persisted in ten patients (four IP, two OP, one J, three No J; six SPH, four PH) at five years. Thirty-two patients had paraparesis on admission or developing later. Complete resolution occurred in twenty on the allocated regimen and in eight after operation or additional chemotherapy or both. Of the remaining four atients, all of whom had operation and additional chemotherapy, three died and one still had paraparesis at five years. Of 295 patients assessed at five years 89 per cent had a favourable status. The proportions of the patients responding favourably were similar in the IP (91 per cent) and OP (89 per cent) series, in the J (90 per cent) and No J (84 per cent) series and in the SPH (86 per cent) and PH (92 per cent) series.

Abscess↗
PubMed1982

A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. Eighth Report of the Medical Research Council Working Party on Tuberculosis of the Spine.

One hundred and fifty patients in Hong Kong with a diagnosis of tuberculosis of the thoracic, thoracolumbar or lumbar spine were allocated a random to the "Hong Kong" radical resection of the lesion and the insertion of autologous bone grafts (Rad. series) or to debridement of the spinal focus without bone grafting (Deb. series). All patients received daily chemotherapy with para-aminosalicylic acid (PAS) plus isoniazid for 18 months, with streptomycin for the first three months. After exclusions, the main analyses of this report concern 119 patients (58 Rad., 61 Deb.) followed up for 10 years. During the first five years the allocated regimen was modified because of the spinal lesion in 14 patients, but there were no further modifications between five and 10 years. No patient developed a sinus or clinically evident abscess or a neurological abnormality between five and 10 years. Bony fusion occurred earlier and in a higher proportion of patients in the Rad, series but at five and 10 years there was vary little difference between the series. Over the period of 10 years there was a mean increase in vertebral loss of 0.05 of a vertebral body in the Rad. series and 0.23 in the Deb. series. In both series most of this loss occurred in the first 18 months, with very little subsequent change in the next eight and a half years. Over the 10 years there was a mean reduction in the angle of kyphosis in the Rad. series of 1.4 degrees for patients with thoracic and thoracolumbar lesions and 0.5 degrees for those with lumbar lesions. By contrast, in the Deb. series there were mean increases in the angle of 9.8 degrees and 7.6 degrees respectively. In both series most of the changes had occurred early, and persisted subsequently. At 10 years 57 of 58 Rad. and all 61 Deb. patients had a favourable status, 50 (86 per cent) and 54 (89 per cent) respectively on the allocated regimen without modification.

Adolescent↗
PubMed1985

A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine.

Two hundred and eighty-three patients with tuberculosis of the thoracic and/or lumbar spine have been followed for 10 years from the start of treatment. All patients received PAS plus isoniazid daily for 18 months, either with streptomycin for the first three months (SPH) or no streptomycin (PH), by random allocation. There was also a second random allocation for all patients: in Masan to inpatient rest in bed (IP) for six months followed by outpatient treatment or to ambulatory outpatient treatment from the start (OP), and in Pusan to outpatient treatment with a plaster-of-Paris jacket (J) for nine months or to ambulatory treatment without any support (No J). A favourable status was achieved on their allocated regimen by 88% of patients at 10 years. Some of the remaining patients also attained a favourable status after additional chemotherapy and/or operation, and if these are included the proportion achieving such a status increases to 96%. There were five patients whose deaths were attributed to their spinal disease. A sinus or clinically evident abscess was present on at least one occasion in the 10-year period in 42% of the patients. Residual sinuses persisted at 10 years in two patients, at death at seven years in a third and at default in the seventh year in a fourth. Thirty-five patients had paraparesis at some time during the 10-year period, including two who died with paraplegia before five years. Complete resolution occurred in 26 patients (in six after additional chemotherapy and/or surgery). At 10 years two patients had severe paraplegia and one a moderate paraparesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine.

The final results up to 15 years are reported of clinical trials of the management of tuberculosis of the spine in Korea and Hong Kong. In Korea, 350 patients with active spinal tuberculosis were randomised to ambulatory chemotherapy or bed rest in hospital (in Masan) or a plaster-of-Paris jacket for nine months (in Pusan). Patients in both centres were also randomised to either PAS plus isoniazid for 18 months or to the same drugs plus streptomycin for the first three months. In Hong Kong, all 150 patients were treated with the three-drug regime and randomised to either radical excision of the spinal lesion with bone graft or open debridement. On average, the disease was more extensive in Korea, but at 15 years (or 13 or 14 years in a proportion of the patients in Korea) the great majority of patients in both countries achieved a favourable status, no evidence of CNS involvement, no radiological evidence of disease, no sinus or clinically evident abscess, and no restriction of normal physical activity. Most patients had already achieved a favourable status much earlier. The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset paraplegia. The results of chemotherapy on an outpatient basis were not improved by bed rest or a plaster jacket and the only advantage of the radical operation was less late deformity compared with debridement. A second series of studies has shown that short-course regimes based on isoniazid and rifampicin are as effective as the 18-month regimes: ambulatory chemotherapy with these regimes should now be the main management of uncomplicated spinal tuberculosis.

Adolescent↗
PubMed2004

Evaluation and treatment of congenital and developmental anomalies of the cervical spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

Congenital and developmental osseous abnormalities of the cervical spine can result in neural compression ranging from the medulla oblongata to the cervicothoracic spinal cord junction. These may present in infancy as scoliosis and even limb weakness. A high index of suspicion is essential. Neurodiagnostic imaging relies on high-resolution computerized tomography (CT) scanning and three-dimensional CT reconstructions as well as magnetic resonance imaging and angiography. The anatomical/physiological CT factors considered when developing a surgical approach are: 1) the stability and reducibility of the lesions; 2) direction and manner of encroachment of the lesion on the neural structures; 3) neural and vascular abnormalities; and 4) growth potential of the affected area. Primary stabilization is required for reducible lesions, whereas irreducible lesions are decompressed in the manner in which encroachment has occurred. Instability, whether present before or after operative intervention, required spinal stabilization. Illustrative examples of this approach are presented.

Adolescent↗
PubMed1975

Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. A long-term study.

Two hundred and forty-one consecutive anterior spine fusions for tuberculosis were reviewed to determine how often late progressive kyphosis occurred because of disproportionate growth of the posterior and anterior elements. Three of thirty-one patients with objective roentgenographic evidence of solid anterior fusion had an increase in kyphosis. Two of these had findings suggestive of growth retardation of the anterior ring epiphysis above the fusion mass. Posterior-element overgrowth in the third patient could not be excluded as a cause.

Child↗
PubMed1991

Quantitative anatomy of cervical spine ligaments. Part I. Upper cervical spine.

The quantitative anatomy of the ligaments of the upper cervical spine was determined from six human cadaveric specimens. For the apical, transverse, and alar ligaments, the origins, lengths, and orientations were determined in three-dimensional space. The apical ligament was 23.5 (3.8) mm long with a 20 degrees anterior tilt from the frontal plane. The transverse ligament was 21.9 (3.7) mm long, whereas the alar ligaments averaged 10.3 (2.0) mm in length. The alar ligaments were oriented 70 degrees from the sagittal plane with much variation in its angle with both the frontal and transverse planes.

Adult↗