Lumbo-sacral fusion with spring fixation.
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A method of posterior lumbo-sacral fusion is described in which springs are used to fix the grafts and to maintain immobilisation. Fifty patients with lumbar disc degeneration or spondylolisthesis have been reviewed. The results have been assessed clinically by grading the symptoms before and after operation. Stay in hospital has been short and return to work rapid. There has been a high proportion of good results. (+info)
Idiopathic hypertrophic spinal pachymeningitis: a case report.
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Idiopathic hypertrophic pachymeningitis (IHP) is a rare, chronic nonspecific and granulomatous inflammatory disorder of the dura with unknown etiology. The diagnosis can be established by open biopsy and exclusion of all other specific granulomatous and infectious diseases. We report a typical case of spinal IHP occurring in a long segment of cervical and thoracic dura from C6 to T8. The patient was 56-yr-old female, who had been suffered from pain on her upper back and both arms for 3 months and recent onset motor weakness of both legs. During the 9 months of follow-up period, she experienced the improvement of her neurologic symptoms with combined therapy of partial excision and corticosteroid medication. Since early surgical intervention and subsequent pulse steroid therapy are mandatory for this disease to avoid irreversible damage of nervous system, the identification of this unique disease entity is essential on frozen diagnosis. A few cases have been reported in Korean literature. (+info)
Paget's disease of the spine and its management.
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A review of the literature was conducted to study the pathomechanics by which Paget's Disease of bone (PD) alters the spinal structures that result in distinct spinal pathologic entities such as pagetic spinal arthritis, spinal stenosis, and other pathologies, and to assess the best treatment options and available drugs. The spine is the second most commonly affected site with PD. About one-third of patients with spinal involvement exhibit symptoms of clinical stenosis. In only 12-24% of patients with PD of the spine is back pain attributed solely to PD, while in the majority of patients back pain is either arthritic in nature or a combination of a pagetic process and coexisting arthritis. Neural element dysfunction may be attributed to compressive myelopathy by pagetic bone overgrowth, pagetic intraspinal soft tissue overgrowth, ossification of epidural fat, platybasia, spontaneous bleeding, sarcomatous degeneration and vertebral fracture or subluxation. Neural dysfunction can also result from spinal ischemia, when blood is diverted by the so-called "arterial steal syndrome". Because the effectiveness of pharmacologic treatment for pagetic spinal stenosis has been clearly demonstrated, surgical decompression should only be instituted after failure of antipagetic medical treatment. Surgery is indicated as a primary treatment when neural compression is secondary to pathologic fractures, dislocations, spontaneous epidural hematoma, syringomyelia, platybasia, or sarcomatous transformation. Since, in the majority of cases with pagetic spinal involvement, there are also coexisting osteoarthritic changes, antipagetic medical treatment alone may be disappointing. Therefore, one must be careful before attributing low back pain to PD alone. Five classes of drugs are available for the treatment of PD: bisphosphonates, calcitonins, mithramycin (plicamycin), gallium nitrate, and ipriflavone. Bisphosphonates are the most popular, and several forms have been investigated, but only the following forms have been approved for clinical use: disodium etidronate, clodronate, aledronate, risedronate, neridronate, pamidronate, tiludronate, ibadronate, aminohydroxylbutylidene bisphosphonate, olpadronate, and zoledronate. Several of these forms are still under investigation. (+info)
Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion.
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The authors report on 32 consecutive patients with instability at the craniocervical, cervical and cervicothoracic regions suffering from various pathologies, who were treated with posterior instrumentation and fusion using the posterior hooks-rods-plate cervical compact Cotrel-Dubousset (CCD) instrumentation alone or, in three patients, in combination with anterior operation. The patients were observed postoperatively for an average of 31 months (range 25-44 months) and evaluated both clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, complications and status of arthrodesis. All patients but one (who died) achieved a solid arthrodesis based on plain and flexion/extension roentgenograms. Cervical lordosis (skull-C7) and cervicothoracic kyphosis (C7-T2) was improved by instrumentation towards a physiological lateral curve by an average of 33% (P<0.05) and 28% (P<0.05) respectively. Anterior vertebral olisthesis was reduced in the craniocervical and cervicothoracic region, by 73% and 90% respectively. At final follow-up there was an improvement of the neurologic Frankel status by an average of 1.2 grades and of myelopathy in 75% of the operated patients. Good to excellent functional results were seen in 77% of the operated patients, while acute and chronic pain was reduced by an average of 2.4 grades, on a scale of 0-3, in operated patients. No neurovascular or pulmonary complications arose from surgery. There was no significant change in lateral spine profile and olisthesis at the latest follow-up evaluation. There were no instrument-related failures. One patient requested hardware removal in the hope of reducing postoperative pain in the cervicothoracic region. The poor and fair results were related to the lack of improvement of neurologic impairment and myelopathy. The results of this study demonstrate that cervical CCD instrumentation applied in the region of the skull to the upper thoracic region for various disorders is a simple and safe instrumentation that restores lateral spine alignment, improves the potential for a solid fusion and offers sufficient functional results in the vast majority of the operated patients. However, the use of hooks in spinal stenosis is contraindicated. (+info)
A square to indicate the unstable zone in severe spondylolisthesis.
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The reduction and stabilisation of high-grade dysplastic developmental spondylolisthesis by means of modern internal fixators can correct slip, but can leave the sagittal alignment unbalanced, causing instability, e.g. in the adjacent, non-fused lumbar segments. Through analysis of the modifications of imbalance in the spine and pelvic ring due to surgical correction, this study defines the unstable zone of high-grade dysplastic developmental spondylolisthesis and proposes a simple radiographic method to identify it. (+info)
The relationship between cartilage end-plate calcification and disc degeneration: an experimental study.
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OBJECTIVE: To study the relationship between cartilage end-plate calcification and intervertebral disc degeneration. METHODS: An experimental model of cervical disc degeneration in rabbits was established by resection of the cervical supraspinous and interspinous ligaments and detachment of the posterior paravertebral muscles from the cervical vertebrae. Mechanical instability in the cervical spine elicited by this surgical intervention accelerated the process of intervertebral disc degeneration. The extent of intervertebral disc degeneration was graded in morphologically, and the thicknesses of the calcified layer and the uncalcified layer of the cartilage end-plate were measured in each degenerated cervical disc. RESULTS: In less severely degenerative cervical discs, the morphology of the cartilage end-plate showed nearly normal construction, and the tidemark was clear. In severely degenerative discs, the matrix and cells showed fibrosis, the tidemark advanced, and the calcified cartilage thickened. There exists a positive correlation between the thickness of the calcified layer of the cartilage end-plate and the degree of cervical disc degeneration. CONCLUSION: The calcification of the cartilage end-plate is the key factor that initiates and promotes cervical disc degeneration. (+info)
BACKGROUND: Spinal dural arteriovenous fistulae comprise the majority of spinal vascular malformations. The most common clinical presentation is that of progressive myeloradiculopathy, probably related to venous hypertension, which may lead to permanent disability and even death. OBJECTIVE: To report our clinical experience with spinal dural arteriovenous fistulae. METHODS: Nine patients with spinal dural AVF were managed at our center during a one year period (1998-1999). The patients, eight men and one woman ranging in age from 46 to 75 years, presented with initially fluctuating and eventually permanent and progressive paraparesis, sensory disturbances and sphincter dysfunction. The neurological signs generally began symmetrically and progressed from the distal to proximal limb regions. The duration of symptoms before diagnosis ranged from 6 to 36 months during which the patients underwent an extensive but fruitless work-up and even unnecessary operations due to misdiagnosis. All patients finally underwent magnetic resonance imaging and spinal angiography, which demonstrated the pathological vascular fistula. Interruption of the AVF was achieved by embolization or by surgical resection. RESULTS: Following treatment, six patients experienced improvement of gait and sphincter control, and the severe neurological deficits stabilized in the other three patients with long duration of illness. There was no further deterioration in any of the treated patients. CONCLUSIONS: The history, neurological findings and radiological changes on MRI scan should alert clinicians to the possibility of spinal dural AVF, leading to diagnostic spinal angiography. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality. (+info)
Open access neuroimaging for general practitioners--diagnostic yield and influence on patient management.
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This study assessed the first year of a regional general practitioner (GP) open-access neuroimaging service, to determine diagnostic yield and influence on patient management. Overall, 48.1% of examinations demonstrated a radiologically significant abnormality with 64.1% of spinal imaging examinations demonstrating significant findings. Utilised appropriately, a regional open-access neuroimaging service has good diagnostic yield and may influence the management of most referred patients. (+info)