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Showing papers in "Spine in 1976"


Journal ArticleDOI
01 Mar 1976-Spine
TL;DR: For 98% of patients, the present knowledge of the psychologic, social, and mechanical stress factors should be utilized for proper counseling, together with attempts at correction with any type of noninvasive modality according to the preference of the individual physician.
Abstract: The low-back pain problem reviewed in this paper represents a great challenge to orthopaedic surgeons around the world Although in most instances a rather undramatic problem, low-back pain is, in patients aged 30 to 60 years, the most expensive ailment from a socio-economic viewpoint The intervert

473 citations


Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: The pain drawing of a patient with low-back pain predicted a high or low hypochondriasis or hysteria scale on the Minnesota Multiphasic Personality Inventory in 97 of 109 patients studied.
Abstract: A study was undertaken to evaluate the possibility of using the pain drawing of a patient with low-back pain as a screening test to determine whether further psychologic evaluation was necessary. Using the analysis described, the pain drawing predicted a high or low hypochondriasis or hysteria scale

309 citations


Journal ArticleDOI
01 Mar 1976-Spine
TL;DR: A definition of the term clinical instability and a systematic method for identifying it based on an analytic review of the literature is presented.
Abstract: In an effort to facilitate the diagnosis and treatment of instability of the lower cervical spine, a definition of the term clinical instability and a systematic method for identifying it based on an analytic review of the literature is presented.

173 citations


Journal ArticleDOI
01 Dec 1976-Spine
TL;DR: A surgical procedure is proposed in which the ligamentum flavum is retained to protect against adhesions and is proposed to play only a passive role in neural entrapment problems.
Abstract: Studies of the form and function of the ligamentum flavum have been made directly, by investigating the structure and indirectly, by appraising properties of analogous elastic tissue structures. The flavum is noted to retain its elastic content with age and to demonstrate shortening and thickening a

96 citations


Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: The distance between the weight and the body was found to influence the stress on the back much more than the method used to lift.
Abstract: The intervertebral disc pressure in the third lumbar disc, the intraabdominal pressure, and the myoelectric activity of several muscles of the back were recorded simultaneously in 4 healthy subjects. The studies comprised static pulling against a fixed resistance with the back either straight or flexed, dynamic lifting, and holding of a weight at various distances to the body. The distance between the weight and the body was found to influence the stress on the back much more than the method used to lift.

88 citations


Journal ArticleDOI
01 Mar 1976-Spine
TL;DR: Segments of fibula have been used to secure stability and arthrodesis in the management of 26 patients with disease or injury of the cervical spine.
Abstract: The procedures for operative treatment of cervical spinal disease and injury have proven to be technically simple and to have a low incidence of postoperative morbidity. There are occasional technical difficulties, however, which have been encountered during these procedures, one of the most common

80 citations


Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: An appraisal of the attempted denervation of the zygapophyseal joint with radio-frequency coagulation techniques as applied to 149 patients selected from a population of 234 individuals with intractable spinal pain.
Abstract: Attempted denervation of the zygapophyseal joint with radio-frequency coagulation techniques has been proposed as a method for treatment of pain of spinal origin. This study reports an appraisal of the method as applied to 149 patients selected from a population of 234 individuals with intractable s

79 citations


Journal ArticleDOI
01 Jan 1976-Spine
TL;DR: Twenty patients underwent bilateral-lateral column fusion for symptomatic spondylolisthesis which had failed to respond to conservative measures and received good-to-excellent results and have returned to full unrestricted activity.
Abstract: Twenty patients underwent bilateral-lateral column fusion for symptomatic spondylolisthesis which had failed to respond to conservative measures. The average age was 14.5 years and the followup has been 4.3 years. The majority were Grade III or IV. All developed a solid roentgenographic appearance of the fusion within the first year. Nineteen of the 20 obtained good-to-excellent results and have returned to full unrestricted activity. Forty percent of the surgically treated patients had congenital lumbosacral subluxation (Newman Type I) versus 12% of the nonoperative group. In addition, children with Grades III and IV spondylolisthesis were likely to require surgery.

66 citations


Journal ArticleDOI
01 Dec 1976-Spine
TL;DR: Uncertainties in the present nomenclature of the various forms of stenosis of the lumbar vertebral canal are discussed, and proposals for a more precise definition of the stenotic conditions are given.
Abstract: The fallacies of the term stenosis are discussed. Propositions for a more precise definition of the stenotic conditions are given, based on the distinction between transport stenosis and compressive stenosis and their different properties. Uncertainties in the present nomenclature of the various for

56 citations


Journal ArticleDOI
01 Jan 1976-Spine
TL;DR: A significant decrease in the index with aging was found in both sexes; however, male discs were significantly less permeable than female discs in all ages tested.
Abstract: A method for determining the permeability of the rabbit intervertebral disc to fluorescein and formation of a suitable index are presented. A significant decrease in the index with aging was found in both sexes; however, male discs were significantly less permeable than female discs in all ages test

52 citations


Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: Proposed management should include both posterior stabilization of the spine and anterior decompression of the cord, all accomplished, ideally, under one anesthetic.
Abstract: Certain injuries of the thoracolumbar junction disrupt spinal stability by interrupting both the anterior and posterior supporting columns of the spine. Spinal cord injury occurs in these injuries as a result of insult from an anterior direction. Proposed management should include both posterior stabilization of the spine and anterior decompression of the cord, all accomplished, ideally, under one anesthetic. Five illustrative cases demonstrate the principles and outcomes of this approach.

Journal ArticleDOI
01 Mar 1976-Spine
TL;DR: It is postulated that some of the small nerve filaments might represent proprioceptive receptors which participate in a proposed connection between the nerves in the nuchal ligament and the posterior cervical musculature by way of the spinal cord, and may have neurophysiologic significance and assist in head position and control.
Abstract: A study was conducted to attempt to elucidate the significance of the nuchal ligament in the human body. In this investigation, the nuchal ligament of man and the domesticated ox were compared anatomically, functionally, and biomechanically. Significant findings include the demonstration of the entry and arborization of nerve fibers into the substance of both human and bovine nuchal ligaments. It is postulated that some of the small nerve filaments might represent proprioceptive receptors which participate in a proposed connection between the nerves in the nuchal ligament and the posterior cervical musculature by way of the spinal cord. Hence the nuchal ligament may have neurophysiologic significance and assist in head position and control. The bovine nuchal ligament possesses elastic properties which may be shared by human ligamentum flava.

Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: A surgical approach to the upper thoracic spine is described in which dissection from the cervical region is extended caudally to develop an interval between the trachea and esophagus medially and the innominate vessels inferolaterally.
Abstract: A surgical approach to the upper thoracic spine is described in which dissection from the cervical region is extended caudally to develop an interval between the trachea and esophagus medially and the innominate vessels inferolaterally. The upper four thoracic vertebral bodies and their intervening

Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: An investigation of the role of protein-polysaccharide complexes of the nucleus pulposus in intervertebral disc prolapse and degeneration is presented and a visual representation is provided of the hypothesis that there is a chemical basis for disc degeneration and prolapse, and that the process may be a cyclic one.
Abstract: An investigation of the role of protein-polysaccharide complexes of the nucleus pulposus in intervertebral disc prolapse and degeneration is presented. Investigative techniques include roentgenographic crystallography, infrared spectroscopy, polarizing and electronmicroscopy, direct biochemical inve

Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: The authors note that the Milwaukee brace can delay surgery in certain congenital curves, but its use cannot serve as the definitive nonoperative treatment for congenital scoliosis in most cases.
Abstract: Sixty-three patients with well-documented congenital scoliosis were studied to determine their response to the use of the Milwaukee brace for nonoperative treatment. The results in 2 patients were classified as “very good,” 33 were classified as “good,” 8 as “fair,” and 20 as “poor.” The specific limits of these categories are defined. The authors observed that there were three types of curves, which responded to brace management: 1) the longer and flexible curves, 2) those demonstrating correctability, either in traction or on side bending, and 3) those in which there was a mixture of anomalous and nonanomalous vertebrae. Short, sharp, and rigid curves did not respond to brace treatment. The authors note that the Milwaukee brace can delay surgery in certain congenital curves, but its use cannot serve as the definitive nonoperative treatment for congenital scoliosis in most cases.

Journal ArticleDOI
01 Mar 1976-Spine
TL;DR: The authors propose that hydromyelia and syringomyelia are the cause of developmental scoliosis in myelodysplasia and suggest methods of investigating and treating patients with these conditions.
Abstract: Fourteen of 15 myelodysplastic patients evaluated for developmental scoliosis were found to have communicating hydrosyringomyelia, a manifestation of spontaneously arrested hydrocephalus. Eight of these patients had progressive extremity paralysis in addition to the scoliosis. Treatment by ventricular decompression was associated with short term stabilization in 6 early cases of scoliosis. However, more advanced scoliosis in 2 patients continued to progress. Neurologic deficits were improved even in advanced cases by ventricular shunting. The authors propose that hydromyelia and syringomyelia are the cause of developmental scoliosis in myelodysplasia and suggest methods of investigating and treating patients with these conditions.

Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: An experimental model is described, which has been used for evaluating effects of clinically used concentrations of chymopapain on peripheral nerve tissue, and results are discussed in relation to the clinical use of chylomicine in the treatment of intervertebral disc disease.
Abstract: An experimental model is described, which has been used for evaluating effects of clinically used concentrations of chymopapain on peripheral nerve tissue. Chymopapain does not acutely block impulse conduction or axonal transport of proteins. However, chymopapain induces impairment of the barrier function of the perineurial sheath and increases permeability of the intraneural microvessels resulting in intraneural edema formation. The long-term consequences are degeneration of nerve fibers and formation of intraneural fibrosis, requiring an increased threshold voltage for eliciting action potentials. The results are discussed in relation to the clinical use of chymopapain in the treatment of intervertebral disc disease.

Journal ArticleDOI
01 Mar 1976-Spine

Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: Those aspects of scoliosis—lateral curvature of the spine—that lend themselves to examination from the viewpoint of biomechanics are reviewed.
Abstract: This article reviews those aspects of scoliosis—lateral curvature of the spine—that lend themselves to examination from the viewpoint of biomechanics. The initiation, progression, and treatment of scoliosis involve mechanical changes. Biomechanical studies have already contributed to an understanding of some features of the disease, and this article suggests several other studies that still need to be made. The need for better descriptions of scoliotic morphologies is a recurrent theme.

Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: The clinical syndrome of calcified cervical intervertebral discs in children is reviewed and 2 new cases are presented, stressing the importance of conservative treatment.
Abstract: The clinical syndrome of calcified cervical intervertebral discs in children is reviewed and 2 new cases are herein presented. A brief discussion of the etiology, clinical course, and treatment is given, stressing the importance of conservative treatment.

Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: Observations were made while the author was developing personal experience with a method for intradiscal injections in the lumbar spine using chymopapain, in preparation for participation in a subsequent double-blind study.
Abstract: This report details observations made while the author was developing personal experience with a method for intradiscal injections in the lumbar spine using chymopapain, in preparation for participation in a subsequent double-blind study. Thirty patients were injected with the enzyme according to a standardized protocol, which included discography. All patients were candidates for surgery for disc displacement. The overall rate of satisfactory symptomatic relief was 70% at an average follow-up time of 11 months, and 21 of 30 patients returned to their previous employment.

Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: Compression of the spinal cord and nerve roots by disc herniation, contusion, and/or edema from hyperextension and flexion injuries in the patients with sexual dysfunction was the most probable cause of damage to the intermediolateral column of cells in the lateral horn.
Abstract: Loss of sexual desire and impairment of sexual function in patients with symptoms of cervical spinal cord involvement without paralysis were found in 85 patients of both sexes in a series of 2076 consecutive patients seen during a 13-year period. History of trauma was given by 79 patients. Compression of the spinal cord and nerve roots by disc herniation, contusion, and/or edema from hyperextension and flexion injuries in the patients with sexual dysfunction was the most probable cause of damage to the intermediolateral column of cells in the lateral horn. In another study, sections of the spinal cords of 11 patients, who had been subjected to lower cervical cordotomies, showed destruction of the lateral horn of the spinal cord in 3 patients who had experienced sexual dysfunction. Sexual function improved in 77% of patients with surgically treated cervical spinal cord injuries and in 26% of conservatively treated patients.

Journal ArticleDOI
01 Dec 1976-Spine
TL;DR: Paravertebral infection occurred following 3 of the first 100 Dwyer spinal instrumentations performed in Hong Kong, and the implant had to be removed in every case to eradicate the infection.
Abstract: Paravertebral infection occurred following 3 of the first 100 Dwyer spinal instrumentations performed in Hong Kong. The implant had to be removed in every case to eradicate the infection. Further deformity occurred with the exception of 1 patient who underwent posterior spinal fusion and Harrington rod instrumentation.

Journal ArticleDOI
01 Sep 1976-Spine
TL;DR: Three patients with flexion-distraction injuries of the thoracolumbar spine are used to illustrate the pathomechanics of this injury and appropriate treatment for selected patients.
Abstract: Three patients with flexion-distraction injuries of the thoracolumbar spine are used to illustrate the pathomechanics of this injury and appropriate treatment for selected patients. This injury is particularly associated with the use of seat belts in automobile accidents. The variable nature of joint disruption, fracture, and ligamentous injury is illustrated and redefined from previous studies in the literature. Associated injuries are common and must be taken into consideration. The indications for surgical treatment and specific details about type of fixation are suggested.


Journal ArticleDOI
01 Mar 1976-Spine
TL;DR: Meglumine iocarmate (Dimeray, Dimer-X) is considered to be a relatively safe contrast material with gives improved radiographic definition in the lumbosacral spinal canal when compared with iodophenylundelic acid (Pantopaque).
Abstract: The efficacy of meglumine iocarmate (Dimeray, Dimer-X) as a myelographic agent was evaluated by comparing myelographic findings in 67 patients with data obtained from discography in 62 patients and from surgery in 5. Myelography demonstrated the presence of defects at the same level at which they we

Journal ArticleDOI
01 Jun 1976-Spine
TL;DR: Cells in fibroblast cultures from patients with idiopathic scoliosis were compared with cells from a control group without idiopathy scolia regarding the presence of metachromasia, and possible interpretation of these findings is discussed.
Abstract: Cells in fibroblast cultures from patients with idiopathic scoliosis were compared with cells from a control group without idiopathic scoliosis regarding the presence of metachromasia. Seventy percent of the cultures from patients with Idiopathic scoliosis demonstrated this characteristic, as compared with 30% of the control group (P < 0.005). Possible interpretation of these findings is discussed.

Journal ArticleDOI
01 Dec 1976-Spine
TL;DR: The histopathologic findings in a human spinal cord in which there was an attempt at myelorrhaphy are presented and there was no evidence of regeneration of long tract fibers across or in the vicinity of the myelorsaphy.
Abstract: The histopathologic findings in a human spinal cord in which there was an attempt at myelorrhaphy are presented. There was no evidence of regeneration of long tract fibers across or in the vicinity of the myelorrhaphy

Journal ArticleDOI
01 Dec 1976-Spine
TL;DR: A 21-year-old male with a complete paraplegia secondary to a .38 caliber, self-inflicted gunshot wound underwent a myelorrhaphy 15 months following injury and expired 14 months later without realizing neurologic improvement.
Abstract: A 21-year-old male with a complete paraplegia secondary to a .38 caliber, self-inflicted gunshot wound underwent a myelorrhaphy 15 months following injury. The patient expired 14 months later without realizing neurologic improvement.

Journal ArticleDOI
01 Dec 1976-Spine
TL;DR: Six cases are presented of patients who have had surgical procedures for cervical or lumbar disc protrusions or spondylosis and myelograms of these patients are shown to demonstrate that, following removal of a compressive spinal lesion, the myelogram may improve or become normal.
Abstract: Six cases are presented of patients who have had surgical procedures for cervical or lumbar disc protrusions or spondylosis. Myelograms of these patients are shown to demonstrate that, following removal of a compressive spinal lesion, the myelogram may improve or become normal. This is potentially important in the evaluation of the postoperative patient who develops persistence or recurrence of symptoms since the myelogram may indicate a specific lesion amenable to surgical relief rather than the poorly defined “postoperative changes.”