RESUMEN
Fifty patients with arachnoiditis were studied, and long-term follow-up ranging from 10 to 21 years was obtained on 36 (72%). Prior to developing arachnoiditis, 90% originally had intervertebral disc disease, Pantopaque (Alcon Surgical, Ft. Worth, Texas) myelography, and subsequent lumbar spine surgery. Pain and functional disability tended to remain the same as at the time of diagnosis, although severity of symptoms fluctuated. Increased neurologic deficits were more frequently due to surgical intervention than to the natural course of the disease. Urinary symptoms characterized by urgency, frequency, and occasional incontinence, with no other apparent cause, developed late in 23%. Although the majority were able to walk and drive a car without limitation, ability to return to previous full-time occupations was markedly limited. The majority depended on daily narcotic analgesics; a few admitted to alcohol abuse. There were two deaths by suicide. Although other deaths were not directly related to arachnoiditis, the average lifespan was shortened by 12 years. Treatment results were disappointing. Arachnoiditis may be disabling; however, longterm follow-up indicates that progression of symptoms and functional impairment are not the natural course of the disease.
Asunto(s)
Aracnoiditis/fisiopatología , Adulto , Anciano , Aracnoiditis/diagnóstico por imagen , Aracnoiditis/terapia , Evaluación de la Discapacidad , Electromiografía , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Laminectomía/efectos adversos , Masculino , Persona de Mediana Edad , Mielografía/efectos adversos , Dolor , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Vejiga Urinaria/fisiopatología , Trastornos Urinarios/etiologíaRESUMEN
Eight adults who had back pain and sciatica that was caused by Grade-III or IV isthmic spondylolisthesis of the fifth lumbar vertebra on the sacrum were treated consecutively by in situ arthrodesis without decompression. The anterior displacement of the fifth lumbar vertebra averaged 82 per cent (range, 66 to 118 per cent). The length of follow-up averaged 5.5 years (range, two to fourteen years). All of the arthrodeses resulted in a solid fusion and excellent relief of both the back pain and the sciatica. All of the preoperative neurological deficits resolved, with the exception of a decreased or absent Achilles-tendon reflex in two patients. There were no complications, and all of the patients returned to their preoperative occupations.
Asunto(s)
Ciática/cirugía , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Radiografía , Ciática/etiología , Espondilolistesis/clasificación , Espondilolistesis/complicacionesRESUMEN
This article illustrates the application of the Wiltse pedicle screw fixation system and the general principles of pedicle screw insertion. The system is designed for stabilization of the lumbosacral spine. Indications complications, and personal results are reviewed.
Asunto(s)
Tornillos Óseos , Vértebras Lumbares/cirugía , Dispositivos de Fijación Ortopédica , Enfermedades de la Columna Vertebral/cirugía , Diseño de Equipo , Humanos , Radiografía , Sacro/cirugía , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Acero InoxidableRESUMEN
For comparison purposes, seven different internal fixation systems were applied sequentially to each of six fresh-frozen cadaver spines at the lumbosacral junction. The spines were loaded to a maximum flexion bending moment of 12 Newton meters and an extension moment of 6 Nm. Resultant angular motion was recorded with an electrogoniometer. The Synthes and Kaneda devices provided the most rigid fixation in flexion and extension testing. The Luque internal fixation system was as effective as the Kaneda and Synthes systems at limiting extension but was slightly less successful at limiting flexion. The Knodt system was effective at limiting extension but less effective in limiting flexion. The interfacet screws were effective at limiting flexion but less effective at limiting extension. Harrington rods to the sacral alae were the least effective system in both directions. Sublaminar wires did little to improve their performance.