RESUMEN
AIM OF THE STUDY: The purpose of the present investigation was to determine the significance of the technique of nucleotomy for the biomechanical properties of the intervertebral disc. METHODS: From 29 human cadavers the lumbar-vertebral segment L2/3 was taken. The laminae were removed and the segment was tested by an mechanical testing device. Measurements were taken under physiological loads in flexion/extension, lateral bending and rotation direction. There after nucleotomy was simulated by four different procedures: perforation of the anulus with a diameter of 3 mm, rectangular excision (1 x 1 cm) of the anulus, discotomy with 3 g and 6 g nucleus pulposus. In each step the measurement was repeated. RESULTS: The size of the defect in the anulus fibrosus did not have significant influence on the stiffness of the disc. There was a significant relation between quantity of removed disc material and flexibility of the motion segment. CONCLUSION: The quantity of removed nucleus pulposus plays a crucial role in the segmental mobility whereas the size of the approach in the anulus fibrosus, f.e. endoscopic with a hole diameter of 3 mm or conventionally with a rectangular defect of 1 x 1 cm, did not influence mobility.
Asunto(s)
Discectomía/métodos , Disco Intervertebral/fisiopatología , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/fisiopatología , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Humanos , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de SaludRESUMEN
QUESTION: Investigation of the predictive value of the Catterall- as compared to the Herring-classification in patients with Perthes disease. METHOD: A radiological follow-up study including 53 patients with a total of 59 affected hips was carried out. In the initial diagnosis the Catterall-, Waldenström- and Herring-stages were assessed. The epiphyseal ratio, the head-neck ratio and the lateral subluxation were measured and compared at the time of diagnosis, fragmentation stage and in a follow-up examination, which was carried out 4, 9 years after diagnosis on the average. The results of the follow-up examination were assessed using the Mose-classification and compared as well. In addition the two classifications were compared as to the necessity of an upgrading. RESULTS: Both classifications yielded similar descriptions of the radiomorphometric course. There was a good correlation between the results of Herring A and Catterall I, Herring B and Catterall II and III and Herring C and Catterall IV. Upgradings were necessary in the Herring- and the Catterall-classification in 21 cases, and 18 cases, respectively. CONCLUSION: The predictive values of both classifications are comparable.
Asunto(s)
Enfermedad de Legg-Calve-Perthes/clasificación , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Enfermedad de Legg-Calve-Perthes/cirugía , Masculino , Osteotomía , Complicaciones Posoperatorias/diagnóstico por imagen , Pronóstico , Radiografía , Resultado del TratamientoRESUMEN
Translaminar screw fixation of the lumbar spine represents a simple and effective technique for short segment fusion in the degenerative spine. Clinical experience with 173 patients who underwent translaminar screw fixation revealed a fusion rate of 94%. The indications for translaminar screw fixation as a primary fixation procedure are: segmental dysfunction, lumbar spinal stenosis with painful degenerative changes, segmental revision surgery after dissectomies, and painful disc-related syndromes such as internal disc disruption and lumbar disc herniation with concomitant degenerative changes. As an additional stabilization procedure, translaminar screws can be used to augment anterior fusion or reinforce pedicle systems. Translaminar screw fixation achieves as high fusion rate provided the biomechanical principles of the lumbar spine with an intact anterior column are respected and a meticulous operative technique is employed to enhance bony ingrowth of the graft.
Asunto(s)
Tornillos Óseos , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Reoperación , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/cirugía , Factores de TiempoRESUMEN
STUDY DESIGN: In a retrospective study, the long-term results of translaminar facet screw fixation of the lumbar and lumbosacral spine are reviewed. OBJECTIVES: To evaluate the clinical results, fusion rates and complications of this posterior fusion technique in various conditions of the lumbar spine. SUMMARY OF BACKGROUND DATA: Posterior fusion of the lumbar and lumbosacral spine is one of the possible methods to relieve pain and eliminate instability in degenerative conditions. Data in the literature support the use of internal fixation to optimize the rate of fusion. METHODS: Posterior lumbar and lumbosacral fixation with translaminar screws and fusion in 173 patients with degenerative changes with or without compressive syndromes including failed back syndromes, monosegmental hypermobilities, and posttraumatic conditions were investigated. Fixation and fusion with translaminar screws was performed in 57% monosegmentally, in 40% across two segments and in 2% over three segments. Decompressive surgery was performed in addition in 52% and nucleotomy in 30% of the cases. Clinical and radiologic assessment with flexion/extension x-rays was performed in 145 (83%) patients by two independent orthopedic surgeons. After an average follow-up of 68 months (range, 52-83). RESULTS: Ninety-four percent of the patients showed solid bony fusion in the radiologic follow-up. Loosening of the screws was noted in 3%, and two screws were broken without apparent motion on the functional x-rays. Pain scores decreased from 7.6 before surgery to 2.9 after surgery on a 10-point pain scale. The results were further analyzed according to Stauffer and Coventry with 99 good results, 70 satisfactory results, and 4 bad results. CONCLUSIONS: Translaminar screw fixation offers an immediate postoperative stability of the lumbar and lumbosacral spine and enhances fusion. In the present series no neurologic complications were noted. It represents a useful and inexpensive technique for short segment fusion of the nontraumatic lumbar and lumbosacral spine.
Asunto(s)
Tornillos Óseos , Fijadores Internos , Vértebras Lumbares/cirugía , Sacro/cirugía , Fusión Vertebral/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Seudoartrosis/cirugía , Reoperación , Estudios Retrospectivos , Sacro/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Pathogenically the erosive intervertebral osteochondrosis is the destructive form of the intervertebral osteochondrosis. This paper aims to define this acute variant by means of diagnostic criteria. In differential diagnosis a spondylodiscitis, an ankylosing spondylitis, a destructive spondylo-arthropathy and a morbus Scheuermann must be considered. Fifteen patients with erosive osteochondrosis were treated at the Department of Orthopaedic Surgery of the University of Mainz between 1990 and 1994. The diagnosis on admission into hospital was incorrect in all cases. Plain X-rays showed a decrease in height in the affected intervertebral room and bony erosions of the adjacent vertebral endplates. Distinction to spondylodiscitis was possible in MRT. In contrast to erosive osteochondrosis in spondylodiscitis edema cannot only be seen in the adjoining vertebrae but also in the affected disc. In later paravertebral inflammatory abscess often can be found. After conservative treatment four patients were free of complaints. 11 patients were operated on due to neurologic symptoms or increasing kyphosis of the lumbar spine. At average follow-up of 16 months intervertebral fusion was found in all operated patients. Lack of publicity and severance to spondylodiscitis seem to be major problems in diagnosing erosive osteochondrosis.
Asunto(s)
Osteocondritis/diagnóstico por imagen , Osteocondritis/cirugía , Adulto , Anciano , Diagnóstico Diferencial , Diagnóstico por Imagen , Discitis/diagnóstico , Femenino , Humanos , Fijadores Internos , Disco Intervertebral , Masculino , Persona de Mediana Edad , Radiografía , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral , Espondilitis/diagnósticoRESUMEN
STUDY DESIGN: The amount of motion allowed by various cervical orthoses was compared with the amount of unrestricted neck motion in vivo. OBJECTIVES: To determine how much mechanical stability commonly used cervical orthoses provide to the wearer. SUMMARY OF BACKGROUND DATA: Few studies have compared quantitatively the restriction of motion from cervical orthoses that are commonly prescribed for patients. No studies have used methods allowing measurement of all three rotations throughout the range of motion in passive and active tests. Previous studies may have overstated the amount of restriction provided resulting from the methods used. METHODS: Five subjects were tested for cervical range of motion in flexion-extension, axial, rotation, and lateral bending. Each was tested with no collar, with soft collar, with Philadelphia collar, with Philadelphia collar with thoracic extension, and with sterno-occipital mandibular immobilizer brace. Each test was conducted passively and actively. Measurements were taken with the CA-6000 Spine Motion Analyzer, a highly accurate and precise computerized linkage system that simultaneously records all three rotations in real time. RESULTS: All orthoses restricted motion to some extent. Generally, the collars ranked (from least restrictive to most restrictive): soft, Philadelphia, Philadelphia with extension, and sterno-occipital mandibular immobilizer brace. However, the differences were not usually large, and the collars did not restrict motion as much as previously reported. No collar restricted the motion of any of the subjects to less than 19 degrees of flexion-extension, 46 degrees of axial rotation, or 45 degrees of lateral bending, and most subjects demonstrated significantly more motion. CONCLUSIONS: Although cervical orthoses can be helpful for other reasons, they do not provide a high level of mechanical restriction of motion. Additionally, the restriction they do provide can vary widely between people. Prescribing physicians should consider the relative merits of the various orthoses before deciding whether they will meet a patient's needs. The differences between the collars tested may not be enough to justify one of the more expensive or less comfortable collars.
Asunto(s)
Vértebras Cervicales/fisiopatología , Traumatismos Craneocerebrales/rehabilitación , Inestabilidad de la Articulación/rehabilitación , Cuello , Aparatos Ortopédicos , Adulto , Femenino , Humanos , Masculino , Movimiento/fisiología , Cuello/cirugía , Traumatismos del Cuello , Calidad de Vida , Rango del Movimiento Articular/fisiología , Rotación , Resultado del TratamientoRESUMEN
The width of the foramen in the lumbar spine is directly related to the position of the vertebrae. In an MRI study the measurements of the cross-sectional area of the neuroforamen of L4/5 and L5/S1 in neutral position, segmental distraction and compression were calculated. Nine cadaver specimens were investigated and the foraminal width of L4/5 and L5/S1 was measured. In both segments of all specimens the foraminal space significantly enlarged under distraction and decreased under compression. In the L4/5 segment the average relative difference between distraction and compression was 27%.
Asunto(s)
Vértebras Lumbares/patología , Sacro/patología , Fracturas de la Columna Vertebral/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vértebras Lumbares/lesiones , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Sacro/lesionesRESUMEN
In inveterate cases of grade 2-3 spondylolisthesis (degenerative or spondylolytic), segmental mobility may be reduced by radiologically confirmed disc resorption. Fusion may be indicated in patients with persistent pain. A simple technique for fusion without reduction of the spondylolisthesis is presented. Fixation of the segment is achieved by two cancellous bone screws inserted bilaterally through the pedicles of the lower vertebra into the body of the upper slipped, vertebra. The cases of 16 patients with an average follow-up of 31 months (range 24-27 months) treated with this direct pediculo-body fixation are presented. Clinical evaluation showed significant decrease in pain and, in patients with concomitant spinal stenosis, walking distance without pain improved from between 500 and 1000 m to more than 3000 m. Radiologically, fusion was observed in all cases. The presented technique of internal fixation of a slipped segment in the degenerative lumbar spine represents a simple minimally traumatic procedure with successful clinical and radiological outcome. Additional procedures, such as decompression of the spinal canal, may be performed.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Tornillos Óseos , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Masculino , Persona de Mediana Edad , Espondilolistesis/complicaciones , Factores de Tiempo , Resultado del TratamientoRESUMEN
We prospectively evaluated the results of decompression of the spine, with and without arthrodesis, for the treatment of lumbar spinal stenosis without instability in forty-five patients (twenty-one men and twenty-four women) who had been managed between November 1989 and November 1990. The average age at the time of the operation was sixty-seven years (range, forty-eight to eighty-seven years). The patients were randomly assigned to one of three treatment groups (fifteen patients in each group) according to when they were admitted to the hospital. Group I was treated with decompression with laminotomy and medial facetectomy; Group II, with decompression and arthrodesis of the most stenotic segment; and Group III, with decompression and arthrodesis of all of the decompressed vertebral segments. All of the operations were performed by the same surgeon. The average duration of follow-up was twenty-eight months (range, twenty-four to thirty-two months). All three groups had a significant improvement in the distance that the patients were able to walk at the time of the latest follow-up examination compared with before the operation (p < 0.001 for Group I, p < 0.002 for Group II, and p < 0.005 for Group III). With the numbers available, there were no significant differences in the results among the three groups with regard to the relief of pain (p = 0.25 for Group I compared with Group II, p = 0.36 for Group II compared with Group III, and p = 0.92 for Group I compared with Group III).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Artrodesis , Estenosis Espinal/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Between 1968 and 1977, 72 patients with idiopathic scoliosis underwent Harrington Instrumentation (HI). Between 1985 and 1988, 21 patients with idiopathic scoliosis had posterior spinal fusion with Cotrel-Dubousset instrumentation (CDI). All patients were operated by the same orthopedic surgeon. None of the CDI patients had postoperative brace or cast protection, the HI group had on average 6 months' postoperative brace treatment. The two groups of patients were comparable in age, sex, and type of curves. The HI group and CDI group were reexamined with clinical and radiological assessment after mean periods of 148 months and 60 months respectively. The average preoperative Cobb angle in the CDI group was 59.9 degrees (HI group 67.8 degrees), which improved to 20.8 degrees (HI group 33 degrees) postoperatively--a correction of 66.3% (HI group 51.3%). The loss of correction on reassessment amounted to 5% in the CDI group and 20.7% in the HI group. In both groups, the mean rib hump height was reduced to 2.2 cm. In 40% of the Harrington patients, a flat back was found, but this was not related to clinical back pain. The rate of complications and reintervention was 9.5% in the CDI group and 8.3% in the HI group. There were no neurological complications. Subjectively, 86% of the Harrington patients and 95.2% of the CDI patients rated the results of their operation as "good" or "very good." The CDI group showed better results in correction of the Cobb angle and loss of correction, while saving one mobile lumbar segment. The correction of the rib hump showed the same results for both techniques. Blood loss and operation time was much lower in the HI group. However, the rate of complications was similar in both groups.
Asunto(s)
Escoliosis/cirugía , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
In cases of suspected painful instability of a cervical segment, temporary external fixation by means of external fixator was applied. The segmental immobilization caused immediate relief of pain. The pain reoccurred after removal of the immobilization. The effect of immobilization by external fixation was investigated in biomechanical tests using fresh cadaveric C4-7 specimens. Multidirectional flexibility was measured before and after application of the fixator at C4/C5, C5/C6 and C4-6. We measured the reduction in motion between the different segments. In every situation the neutral zone decreased more than the range of motion. The findings are helpful to understand the clinical instability of the spine and support the hypothesis that the neutral zone is more closely associated with clinical instability than range of motion. The combination of clinical application and biomechanical investigation allowed us to establish a direct correlation between instability and pain.
Asunto(s)
Vértebras Cervicales/lesiones , Lesiones por Latigazo Cervical/cirugía , Accidentes de Tránsito , Adolescente , Adulto , Fenómenos Biomecánicos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Fijadores Externos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Lesiones por Latigazo Cervical/diagnóstico por imagenRESUMEN
In a prospective study 45 patients with clinically relevant spinal stenosis of the lumbar spine were randomized in three groups. Group 1 underwent isolated decompression without fusion, group 2 had decompression and selected fusion, and group 3 underwent fusion of all decompressed segments. Patients with previous surgery of the lumbar spine or obvious instability, such as spondylolisthesis, were excluded from the study. The results were dominated by the relevant clinical improvement in the symptoms of spinal stenosis in all three groups. There were no statistical significant differences in the clinical results between the patients with and without fusion. We conclude that in the absence of obvious segmental instability, no fusion is required for decompressive surgery in degenerative lumbar spinal stenosis.