Showing papers in "Spine in 1977"
TL;DR: Five patients with severe cervical spondylotic myelopathy were followed clinically until their deaths, and their neurologic deficits were repeatedly documented.
Abstract: Five patients with severe cervical spondylotic myelopathy were followed clinically until their deaths, and their neurologic deficits were repeatedly documented. In the terminal phase, these patients exhibited abnormal postures, severe muscle wasting, and the inability to stand and walk. Sensory loss
148 citations
TL;DR: The clinical features of 166 patients with ossification of the posterior longitudinal ligament and ankylosing spinal hypertosis are reported and the histologic features of the spine and spinal cord are described.
Abstract: The clinical features of 166 patients with ossification of the posterior longitudinal ligament are reported. Symptoms of cervical myelopathy develop and include difficulty walking and sensory and motor disturbances. Roentgenograms disclose dense ossification posterior to the vertebral bodies, and symtoms are most often observed when the ossification occupies more than 60% of the saggital diameter of the cervical canal. Posterior decompression is the most effective surgical treatment. Two patients with ossification of the posterior longitudinal ligament and ankylosing spinal hypertosis expired and necropsy was performed. The histologic features of the spine and spinal cord are described.
131 citations
TL;DR: Of the 17 patients with cervical spondylosis and myelopathy treated with Robinson anterior cervical discectomy and fusion, 15 became ambulatory without aid, 1 ambulated with a walker, and 1 was unimproved.
Abstract: Seventeen patients with cervical spondylosis and myelopathy were treated with Robinson anterior cervical discectomy and fusion at one or more levels. The average age was 64 years and the followup has been 2 years. All patients were unable to ambulate without aid prior to surgery. Of the 17 patients, 15 became ambulatory without aid, 1 ambulated with a walker, and 1 was unimproved. None of the patients was made worse by the procedure or deteriorated later.
119 citations
TL;DR: Analysis and interpretation of high-speed motion films indicated that whenever the vertebral body is loaded in compression it deforms, and the deformation applies pressure on the marrow contents, which may be a contributory factor to the observed nonlinear increase in strength as strain rate increases.
Abstract: Isolated human thoracic vertebral bodies were systematically subjected to compressive loads at three different strain rates over four orders of magnitude. Each vertebra was crushed to 50% of its original length. High-speed motion picture films were taken of each test event. Static, quasistatic, and dynamic material property data were collected and included ultimate load, deformation to ultimate load, stiffness, and energy to ultimate load. Analysis and interpretation of high-speed motion films indicated that whenever the vertebral body is loaded in compression it deforms, and the deformation applies pressure on the marrow contents. This internal hydraulic effect may be a contributory factor to the observed nonlinear increase in strength as strain rate increases. The response of the marrow with respect to the deformation of the vertebral centrum is described. When the compressive load was removed, all vertebrae began a recovery process. The general features of this restoration process are described. The mechanism or mechanisms by which recovery takes place are not fully understood.
112 citations
TL;DR: A trend of improvement in disability after anterior interbody fusion and a tendency to late worsening in disability following cervical laminectomy were significant and occurred as long as 8 to 12 years after improvement and plateau.
Abstract: Fifty-five patients with progressive, worsening cervical spondylotic myelopathy were surgically treated and followed from 2 to 20.5 years (mean 7 years). The biomechanical factors impinging on the spinal cord were clarified mainly by air myelography. Twenty-six patients underwent anterior interbody fusion by the Cloward technique which was used for removal of large midline masses, kyphosis angulation, single-level and double-level osteophytes or rarely for unstable subluxations. Twenty-nine patients underwent cervical laminectomy at C3 through C7; the majority were also treated with a dural graft to enlarge the dural tube in instances of vertebral retrolisthesis, osteophytes at three or more levels, pathological lordosis, or advanced vertebral body ankylosis. Ultimate success or failure of the surgical procedure could not be predicted by the preoperative presence or absence of most numerous complaints or findings. However, presence of sphincter disturbance and excessive lower extremity weakness was associated with a postoperative worsened result. A trend of improvement in disability after anterior interbody fusion and a tendency to late worsening in disability following cervical laminectomy were significant. In some instances, late worsening occurred as long as 8 to 12 years after improvement and plateau.
92 citations
TL;DR: A wide variation In IVD was found in 132 patients who had previously undergone surgical procedures for nerve root compression from herniated discs at the L4–5 and L5–S1 levels 10 or more years before.
Abstract: Six methods of measuring intervertebral disc space height (IVD) were evaluated in experiments using isolated vertebral pairs, intact human cadavers, and living subjects. Accurate measurements of IVD required methods that corrected for radiographic magnification and carefully controlled the source–target-film relationships. Axial rotation beyond 40° and lateral bend beyond 20° prevented accurate measurements. A wide variation In IVD was found in 132 patients who had previously undergone surgical procedures for nerve root compression from herniated discs at the L4–5 and L5–S1 levels 10 or more years before. Disc space narrowing was significantly greater at operated than nonoperated levels (P=0.01), but did not correlate with clinical results. The clinical and research applications of these methods are critically assessed.
90 citations
TL;DR: The findings support the following conclusions: unstable thoracic spine fractures may be managed successfully by Harrington instrumentation and spine fusion; stable fractures may been made unstable by laminectomy; complete paraplegia is unaltered by type of treatment.
Abstract: Thirty patients having T1 through T11 fractures stabilized by fusion or Harrington instrumentation were followed from 1964 through 1975. They were studied to determine the results in achieving spine stabilization in injury treatment early as well as late; the neurologic course before and after treatment; and the effect of treatment on the course of the spine deformity and the neurologic deficit. The findings support the following conclusions: unstable thoracic spine fractures may be managed successfully by Harrington instrumentation and spine fusion; stable fractures may be made unstable by laminectomy; complete paraplegia is unaltered by type of treatment; incomplete cord lesions carry a favorable prognosis; adequate decompression may be furnished by fracture alignment.
87 citations
TL;DR: It is the view that adolescent idiopathic scoliosis should be regarded as a multifactorial disease and a possible model for the pathogenesis of the disease is outlined.
Abstract: The etiology of idiopathic scoliosis is still unsolved, despite extensive research. This paper analyzes the different factors of relevance. Recent investigations have convincingly demonstrated the hereditary traits of idiopathic scoliosis. In the adolescent group a specific growth pattern has also been demonstrated, while muscular factors and biochemical changes of connective tissues are somewhat more uncertain. A significant number of patients demonstrate asymmetries in the vestibular apparatus and electroencephalographic abnormalities. Because of the essential role of the vestibular and central nervous systems in the postural equilibrium, functional asymmetries or minor pathologic changes in these structures might also be factors of importance. It is our view that adolescent idiopathic scoliosis should be regarded as a multifactorial disease. Combining the findings in recent investigations, a possible model for the pathogenesis of the disease is outlined.
82 citations
TL;DR: Results are presented which indicate that a spondylolytic type fracture can be initiated by fatigue loading, and the mechanics of spONDylolysis andSpondylolisthesis are shown to be related through the shearing properties of the intervertebral disc.
Abstract: The forces acting across the pars interarticularis of the fifth lumbar vertebra while in the fully flexed and partially flexed postures are calculated. These values are compared with the strength of the neural arch obtained experimentally. This comparison shows the neural arch to be a relatively strong structure. However, results are presented which indicate that a spondylolytic type fracture can be initiated by fatigue loading. The mechanics of spondylolysis and spondylolisthesis are shown to be related through the shearing properties of the intervertebral disc.
69 citations
TL;DR: Although initial stabilization was achieved in all cases, there were four instances of late instability and 5 patients died from widespread metastatic disease during the first month after surgery.
Abstract: Methyl methacrylate was used for the stabilization or replacement of portions of the cervical spine in 24 patients who had instability or neurologic deficit secondary to unresectable primary or metastatic tumors. Vertebral body replacement was performed after anterior decompression in 10 patients. Posterior stabilization, with or without a decompressive laminectomy, was carried out in 14 patients. Seventeen of the 24 patients were symptomatically improved; none was made worse neurologically, and all but 4 were able to be mobilized by the third postoperative day. During the first month after surgery, 5 patients died from widespread metastatic disease. Although initial stabilization was achieved in all cases, there were four instances of late instability. There were no infections and no unusual tissue reactions to the methyl methacrylate.
68 citations
TL;DR: In a clinical and electromyographic study of 113 patients, all of whom underwent posterior lumbar spinal surgery, it was shown that some measure of denervation of the paravertebral muscles occurred in 96% of cases and it was concluded that diagnostic electromyography of theParaspinal muscles in a postsurgical patient is of no value.
Abstract: The posterior paravertebral muscles of the lumbar spine are supplied segmentally by the posterior primary rami of the lumbar and sacral nerves. Electromyographic examination of these muscles is used to seek evidence of specific lumbar and sacral nerve root compromise. An anatomic study of the posterior rami and their branches has demonstrated that these nerves are very liable to be damaged during a routine posterior surgical approach to the lumbar spine. In a clinical and electromyographic study of 113 patients, all of whom underwent posterior lumbar spinal surgery, it was shown that some measure of denervation of the paravertebral muscles occurred in 96% of cases. Denervation was shown to persist for many years following surgery, and reservation was only partial. It was concluded that diagnostic electromyography of the paraspinal muscles in a postsurgical patient is of no value.
TL;DR: Data obtained from electromyographic studies of the musculature of the trunk are reviewed to define the role of individual trunk muscle groups in the functional anatomy of the lumbar spine in various positions, motions, and conditions.
Abstract: This report reviews data obtained from electromyographic studies of the musculature of the trunk and considers their physiologic and methodologic bases. Current knowledge regarding the relation between electrical and mechanical output of muscle is incomplete and conflicting, but supports interpreting electromyographic information based on a principle of monotonicity, in which changes in electrical output parallel changes in force. Electromyographic information is utilized to define the role of individual trunk muscle groups in the functional anatomy of the lumbar spine in various positions, motions, and conditions.
TL;DR: Tomography was performed on 136 patients following trauma to the cervical spine and demonstrated abnormalities not identified on the plain cervical spine radiographs: eg, odontoid fractures, facet fractures and dislocations, congenital lesions, multiple fractures, and other unsuspected lesions.
Abstract: Tomography was performed on 136 patients following trauma to the cervical spine. In approximately 25% of the patients tomograms demonstrated abnormalities not identified on the plain cervical spine radiographs: eg, odontoid fractures, facet fractures and dislocations, congenital lesions, multiple fractures, and other unsuspected lesions. In an additional 25% of patients, the tomograms disproved the suspected plain film findings. In 12.5% of the cases examined, the tomographic examination dramatically altered the management of the patient. In an additional 25%, the patient's management was significantly modified by the information obtained at tomography.
TL;DR: A one-stage decompression-stabilization procedure has been developed for the treatment of thoracolumbar fracture-dislocation with neurologic deficit that gives more satisfactory decompression, but also allows early mobilization and rehabilitation.
Abstract: A one-stage decompression-stabilization procedure has been developed for the treatment of thoracolumbar fracture-dislocation with neurologic deficit. A modified costotransversectomy decompression followed by Harrington rod stabilization was employed. This approach not only gives more satisfactory decompression, but also allows early mobilization and rehabilitation.
TL;DR: The data suggest that a clinical similarity exists between bone tumors and protruded lumbar intervertebral discs; intractable, progressive pain accentuated by the supine position favors the diagnosis of bone tumor.
Abstract: Of the more than 1000 patients seen at the Mayo Clinic with surgically proven bone tumor involving the vertebral column, thoracic cage, pelvis, or lower extremities, 38 had the preoperative diagnosis of protruded lumbar intervertebral disc. Of these 38 patients, 18 underwent myelography and laminect
TL;DR: It is concluded that compression and ischemia of the spinal cord are additive causes of myelopathy in man.
Abstract: The fundamental cause of cervical spondylotic myelopathy is discussed in terms of anatomic, pathologic, clinical, and experimental evidence. The authors conclude that compression and ischemia of the spinal cord are additive causes of myelopathy in man. Neurologic and microangiographic data from 38 dogs with experimental cervical myelopathy are presented to substantiate the concept of additive etiologic factors.
TL;DR: This report details the electromyographic findings of 109 patients who underwent facet rhizotomy and finds that eighty percent of patients demonstrating bilateral denervation of the posterior primary ramus muscles report good–to–excellent relief of pain.
Abstract: This report details the electromyographic findings of 109 patients who underwent facet rhizotomy. All patients had mechanical lowback and extremity pain. Relief of such pain with this technique is dependent on bilateral denervation of the structures supplied by the posterior primary ramus. Eighty percent of patients demonstrating bilateral denervation of the posterior primary ramus muscles report good–to–excellent relief of pain.
TL;DR: Using biplanar roentgenography, the three–dimensional spatial locations of various bony landmarks on the human lumbar vertebrae were calculated, and their positions compared with anatomically determined values via sectional technique were compared.
Abstract: Using biplanar roentgenography, the three–dimensional spatial locations of various bony landmarks on the human lumbar vertebrae were calculated, and their positions compared with anatomically determined values via sectional technique. A previously described method was found to be accurate for localizing bony landmarks in space when the vertebral end–plates or superior pedicles could be seen on anteroposterior and lateral films. The experimental technique simulated in vivo conditions, suggesting that biplanar roentgenography is a useful method for study of vertebral orientation and motion in living subjects.
TL;DR: In 1 case of progressive deformity and neurologic loss which required surgery, somatosensory–evoked responses, which correlated well with clinical findings, were used to monitor spinal cord function.
Abstract: Two cases graphically demonstrate the well–established but often forgotten fact that not all compression fractures of the thoracic spine are stable. Adequate diagnosis depends on good roentgenograms and, if necessary, laminograms, to show whether the vertebral body is impacted or comminuted. Vertebr
TL;DR: A thesis is developed regarding its etiology and proposes that the symptoms and signs of the disease result from the interaction of critically large chondro-osseous spurs in an abnormally small cervical spine canal with motion.
Abstract: Cervical spondylotic myelopathy is a disease entity which occurs as a complication of chronic degenerative changes in the cervical spine. A thesis is developed regarding its etiology and proposes that the symptoms and signs of the disease result from the interaction of critically large chondro-osseo
TL;DR: An 18-month followup of 38 patients indicated that the graduated spinal block test was predictive of patients' eventual return to work, while MMPI scales reflecting passivity and the use of repression were strongly related to subsequent functional activity level and perceived pain.
Abstract: Responses to the graduated spinal block test and Minnesota Multiphasic Personality Inventory (MMPI) were examined in 55 patients with chronic low-back pain. The two tests agreed only 54.5% of the time in classifying patients as having either functional or organic origins of pain. Patients diagnosed as functional on the spinal block test had significantly higher scores on MMPI scales measuring hypochondriasis and repression, but otherwise were strikingly similar to patients diagnosed as organic by this procedure. The study does not strongly support the use of the graduated spinal block test as a diagnostic aid in recognizing the emotional component of chronic back pain. In a second part of the study, an 18-month followup of 38 patients indicated that the graduated spinal block test was predictive of patients' eventual return to work, while MMPI scales reflecting passivity and the use of repression were strongly related to subsequent functional activity level and perceived pain.
TL;DR: A pathologic compression fracture of T11 caused paraparesis and disturbed vesical and anorectal function in a 33-year-old woman and the lesion proved to be a benign giant-cell tumor.
Abstract: A pathologic compression fracture of T11 caused paraparesis and disturbed vesical and anorectal function in a 33-year-old woman. Laminectomy was performed and the lesion proved to be a benign giant-cell tumor. The whole affected vertebra was removed and the spine was reconstructed by inserting iliac bone autografts between T10 and T12. After incorporation of the grafts the patient regained very good function.
TL;DR: Results indicate that a) the immediate fixation provided by wire–methylmethacrylate was adequate, b) the weakest points of the construct were the end fixations, and c) the mode of failure was the wires pulling out of the spinous processes.
Abstract: This paper reports a biomechanical study of a surgical specimen consisting of a spine segment from C2 to T4 with fracture at C6–7, stabilized by wires and methylmethacrylate. Biomechanical testing involved rigidly fixing the specimen atT3–4 and applying increasing flexion load at C2. During testing several lateral roentgenograms and photographs were taken. Results indicate that a) the immediate fixation provided by wire–methylmethacrylate was adequate, b) the weakest points of the construct were the end fixations, and c) the mode of failure was the wires pulling out of the spinous processes.
TL;DR: Early definitive diagnostic studies are considered indicated in patients with major neurologic deficit following cervical trauma, since the incidence of spinal cord compression from a damaged disc appears significant.
Abstract: A study was done to evaluate the frequency and importance of disc protrusion in cervical trauma that resulted in major neurologic deficit, and this paper is a preliminary report of the results. Twenty consecutive patients underwent contrast studies shortly after injury, and 8 were judged to have significant disc herniations impinging on the spinal cord. All underwent early surgery with excision of the lesion. Four patients exhibited marked improvement in the immediate postoperative period. On the basis of these findings, early definitive diagnostic studies are considered indicated in patients with major neurologic deficit following cervical trauma, since the incidence of spinal cord compression from a damaged disc appears significant. Surgical excision of the disc resulted in rapid neurologic improvement in half of the cases.
TL;DR: It is concluded that the diagnosis of cauda equina compression can be made on clinical grounds only and a myelographic deformity, no matter how marked, is not diagnostic proof of this syndrome.
Abstract: Intermittent cauda equina compression remains a diagnostic challenge. The authors have reviewed 30 operative cases and the literature, and conclude that the diagnosis can be made on clinical grounds only. A myelographic deformity, no matter how marked, is not diagnostic proof of this syndrome, nor is the absence of neurologic deficit. Decompression by laminectomy and medial face-tectomy brings about a gratifying result in most instances.
TL;DR: Electron microscopic study was made on two back muscles of 12 adolescent patients with idiopathic scoliosis who had a vertebral angle range from 48–75°, indicating that various changes occur in these muscles irrespective of their relation to the curvature of the spine.
Abstract: Electron microscopic study was made on two back muscles, the intertransversus and the erector spinae muscles, of 12 (11 girls and 1 boy) adolescent patients with idiopathic scoliosis who had a vertebral angle range from 48–75°. Control muscle biopsies were taken from 3 patients who underwent operation for other aliments. The results indicate that various changes occur in these muscles irrespective of their relation to the curvature of the spine. In general, the myofibrils of the affected fibers are smaller in size and surrounded by a greater amount of myoplasm. There is also a general increase in glycogen and lipid content of the fibers. Various forms of derangement of myofilaments and Z bands are found. The sarcoplasmic reticulum in some of the affected muscles becomes dilated and vesiculated. The triads, like those of the normal fibers, are located at the A-l junction. The terminal cisternae, however, are enlarged in most cases. In 1 patient with spina bifida, the intertransversus muscle showed, in addition, extremely dilated T-tubules. Similar features were not found in the erector spinae muscle from the same patient. It is concluded from this study that various forms of structural changes occur in the back muscles of idiopathic scoliosis.
TL;DR: During the past 11 years, 6 cases of symptomatic thoracic and thoracolumbar disc lesions have been treated by an anterior surgical procedure, and the extrapleural approach to the thorACic vertebrae has been preferable because of simplified postoperative care with easier prevention of postoperative respiratory complications.
Abstract: During the past 11 years, 6 cases of symptomatic thoracic and thoracolumbar disc lesions have been treated by an anterior surgical procedure. This procedure has consisted of total discectomy of the involved intervertebral disc, followed by intervertebral body fusion using autogenous iliac bone throu
TL;DR: There was a significantly lower bleeding rate after treatment with MCH or with G–T than after manual compression with dry sponges, and a low level increase in the anti-bovine serum albumin IgM and IgE antibody titers in the MCH-treated patients.
Abstract: The effectiveness of topically applied microfibrillar collagen hemostat (MCH) in controlling bleeding from human iliac crest bone graft donor sites is compared with that of sponge compression and Gelfoam– thrombin (G–T) packs. Measurements were made by elution of hemoglobin from sampling sponges applied to the donor bed to yield base line bleeding rate and rates at intervals after treatment. There was a significantly lower bleeding rate after treatment with MCH or with G–T than after manual compression with dry sponges. No significant difference was detected between the MCH and G–T groups. There was a low level increase in the anti-bovine serum albumin IgM and IgE antibody titers in the MCH-treated patients. No clinically apparent immunologic responses were detected.
TL;DR: In this analysis of discography, a positive discogram was considered to be one showing the pattern of herniation, and both the normal roentgenographic pattern and the patterns of degeneration were classified as negative discograms.
Abstract: In this analysis of discography, a positive discogram was considered to be one showing the pattern of herniation, and both the normal roentgenographic pattern and the pattern of degeneration were classified as negative discograms. Application of these criteria to a review of the literature disclosed incidences of about 17% false negative and 22% false positive lumbar discograms. The data were subjected to predictive value analysis to demonstrate the accuracy of lumbar discography in individual patients. Whether positive or negative, the results have a predictive value of 75 to 85% accuracy.
TL;DR: Thirty-four patients with spondylotic myelopathy underwent anterior cervical decompression and fusion with the Smith-Robinson technique, with results that indicated patients with vascular complaints were especially improved after surgery.
Abstract: Thirty-four patients with spondylotic myelopathy underwent anterior cervical decompression and fusion with the Smith-Robinson technique. Followup was conducted at 6 months for all patients and at 18 months for 17 patients. No deteriorations occurred, and only 2 patients failed to improve. Progress reached a plateau after 4 months postoperative. Patients with vascular complaints were especially improved after surgery. Additional posterior decompression was required in 6 patients. No patient returned fully to normal. There are five indications for anterior surgery in myelopathy: vascular symptoms, instability, combined radiculopathy and myelopathy, minor spondylosis, and stress protrusion following anterior fusion.