Showing papers in "Spine in 1978"
TL;DR: Lesions such as major trauma, spondylolisthesis, those following spinal fusion, Paget's disease, and fluorosis, on occasion act directly to produce central or lateral stenosis.
Abstract: Study of autopsy specimens of the lumbar spine makes it possible to construct a spectrum of pathologic change. Progressive degenerative changes in the posterior joints lead to marked destruction and instability. Similar changes in the disc result in herniation, internal disruption, and resorption. Combined changes in posterior joint and disc sometimes produce entrapment of a spinal nerve in the lateral recess, central stenosis at one level, or both of these conditions. Changes at one level often lead, over a period of years, to multilevel spondylosis and/or stenosis. Developmental stenosis is an enhancing factor in the presence of a small herniation or moderate degenerative stenosis. Lesions such as major trauma, spondylolisthesis, those following spinal fusion, Paget's disease, and fluorosis, on occasion act directly to produce central or lateral stenosis.
538 citations
TL;DR: The biomechanic terms essential for a comprehensive description of spinal kinematics are defined, described, and exemplified to provide a perspective for present knowledge and future research.
Abstract: Spinal kinematics concerns the kinds and amounts of motion the human spine undergoes during its normal physiologic movements. This paper is a review of the research in this area and provides information about past and current knowledge. The biomechanic terms essential for the precise and accurate description of spinal kinematics are defined, described, and exemplified. Requirements for a comprehensive description of spinal kinematics are presented to provide a perspective for present knowledge and future research. Finally, the current status of spinal kinematic research is described, and information about the ranges of motion of the human spine for various vertebral levels and for motion in different directions is provided.
407 citations
TL;DR: Microlumbar discectomy is an extremely conservative microsurgical procedure for the treatment of the virgin herniated lumbar disc that features no laminectomy or curettement of the disc space.
Abstract: Microlumbar discectomy is an extremely conservative microsurgical procedure for the treatment of the virgin herniated lumbar disc. The technique has been utilized in 530 patients over a 5 1/2-year period, and features no laminectomy or curettement of the disc space. Preservation of extradural fat and blunt perforation of the annulus fibrosus, rather than scalpel incision, appear to minimize reherniations and adhesion reactions. Operating time has averaged 37 minutes and postoperative stay 3.1 days during the past 36 months (46% of these were compensation cases). In this series, a satisfactory result is defined as those patients who remain economically productive and physically comfortable at the time of followup. Satisfactory results were achieved in 91% of patients after one procedure.
369 citations
TL;DR: A detailed description is given of the principles and surgical technique for extensive resection of the sacrum, including an adjacent part of each ilium, for radical removal of tumor.
Abstract: A detailed description is given of the principles and surgical technique for extensive resection of the sacrum, including an adjacent part of each ilium, for radical removal of tumor. Two levels of sacral amputation are discussed: between S1 and S2 (through the canals of the S1 nerves) and through S
214 citations
TL;DR: It is confirmed that midline spinal fusion offers few benefits in the management of lumbar disc disease and that persistent symptoms and functional impairment were equally as common among patients who underwent fusion as among those who did not.
Abstract: Seventy-nine percent of 312 patients who underwent lumbar disc surgery were evaluated at least 10 years postoperatively (mean equal to 13.7 years). Residual back and nerve root symptoms and functional impairment were equally as common among the 143 patients who underwent fusion as they were among the 64 patients who did not. Thirty percent of the patients whose spines were fused and 37.7% of those patients whose spines were not fused were considered long-term failures because of persistent symptoms or the need for reoperation. Thirty-seven percent of the fusion patients had persistent graft donor site symptoms. Examined patients showed a high percentage of residual neurologic defects. An unexplained positive Trendelenburg sign was present in 14.8% of the fusion patients and in 18.2% of the patients whose spines were not fused. Although retrospective studies often have problems of accuracy, this analysis confirms other observations that midline spinal fusion offers few benefits in the management of lumbar disc disease.
177 citations
TL;DR: In patients with recurrent sciatica, perineural fibrosis and recurrent herniation were the most common problems; those patients with the latter pathologic condition responded most favorably to repeat surgery.
Abstract: Sixty patients requiring repeat surgery after lumbar disc excision are reviewed. Thirty-one had had their initial surgery performed by the authors and represent a 5.9% frequency of repeat surgery after initial laminectomy for sciatica. Of the 60 patients, 49 suffered recurrent radicular pain, 20 suffered from back pain, and 8 had other problems (infection, extradural cysts, etc.). In patients with recurrent sciatica, perineural fibrosis and recurrent herniation were the most common problems; those patients with the latter pathologic condition responded most favorably to repeat surgery. Of 520 patients who had undergone disc excision, only 9 required secondary fusion.
124 citations
TL;DR: Flexion-extension motion and compression-distraction forces across the cervical spine were evaluated in patients in halo vests and in 1 patient in a halo cast.
Abstract: Flexion-extension motion and compression-distraction forces across the cervical spine were evaluated in 6 patients in halo vests and in 1 patient in a halo cast. Motion in the vest was evaluated in supine and upright positions and averaged 31% of normal motion at the levels tested. Compression-distraction forces showed great individual variation and frequent compression. The average distraction force varied in different positions by nearly 20 pounds in the vest and over 30 pounds in the cast. Methods of improving cervical spine stability in halo orthoses are discussed.
100 citations
TL;DR: Computerized axial tomography and anglography were performed in 1 case and were extremely helpful, and surgical resection of the lesion is the only currently effective method of treatment, but long-term survival figures are not good.
Abstract: Involvement of the spine by chondrosarcoma is rare. Three recent cases involving the cervical with or without extension to the thoracic spine are reported. Detailed radiologic investigations to evaluate the extent of the disease are essential to management. Computerized axial tomography and angiography were performed in 1 case and were extremely helpful. Surgical resection of the lesion is the only currently effective method of treatment, but long-term survival figures are not good.
96 citations
TL;DR: It is suggested that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.
Abstract: Forty-five patients who had lumbar disc surgery 10 or more years previously, and had required a second operative procedure, have been evaluated. Failures occurred up to 16 years after the first operation, and were most commonly due to pseudoarthrosis in the patients who underwent spinal fusion initially, and to recurrent disc lesions at the same level as previous surgery in the patients who did not have fusion. The clinical and functional results in the second group of patients who required a second procedure were comparable to those of patients who required only a single procedure. In contrast, patients who had undergone spinal fusion who required a second procedure had significantly worse clinical and functional results, both in comparison to the patients who did not undergo fusion as well as to patients who had had fusion as a single procedure. The only predictable, demonstrable source of failure was acquired spondylolysis. Frequently, repair of pseudoarthrosis did not lead to symptomatic relief. These data suggest that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.
90 citations
TL;DR: The mechanics of the muscle-ligament system for a weight lift in man is described and the efficiency of this mechanism in the human is compared with other primates showing the vast superiority of man in this aspect over his nearest relatives.
Abstract: The mechanics of the muscle-ligament system for a weight lift in man is described. The adaptations of the human spine and the hip to this mechanism are indicated. The efficiency of this mechanism in the human is compared with other primates showing the vast superiority of man in this aspect over his nearest relatives.
85 citations
TL;DR: The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented and there was microscopic evidence of arachmoiditis ossificans in 3 patients and arachNoiditis calcificans in 1 patient.
Abstract: The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented. Lumbar spine surgery and the injection of contrast materials prior to the diagnosis of this condition are considered the most important factors in its genesis. In this series, there was microscopic evidence of arachnoiditis ossificans in 3 patients and arachnoiditis calcificans in 1 patient.
TL;DR: In a followup study of 147 patients operated on over a 2¼-year period, the surgical cure rate was 96%, and the postoperative hospital stay was reduced to less than 3 days.
Abstract: Microlumbar discectomy is a new surgical technique for the treatment of herniated lumbar disc. The operating microscope and special instruments enable the surgeon to remove the herniated portion of the disc without laminectomy through a 1-inch skin incision. A transfusion was never necessary. In a followup study of 147 patients operated on over a 2 1/4-year period, the surgical cure rate was 96%, and the postoperative hospital stay was reduced to less than 3 days. One year after surgery, all noncompensation cases were working as were 80% of the compensation cases. Microlumbar discectomy is safe, effective, and economic for the patient.
TL;DR: Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression, and probably dense adhesions between the dura and the posterior longitudinal ligament.
Abstract: A case of intradural rupture of a lumbar intervertebral disc is reported, and the literature is reviewed. The majority of intradural disc herniations occur at the L4--5 level. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The myelographic picture varies from an irregularly marginated intradural lesion overlying the disc space to a complete block. The common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament, preventing the more common lateral extradural disc herniation. Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression.
TL;DR: A lumbar disc surgery predictive score card or questionnaire has been developed to assess potential candidates for excision of a herniated lumbare disc who have not previously undergone lumbAR spine surgery.
Abstract: A lumbar disc surgery predictive score card or questionnaire has been developed to assess potential candidates for excision of a herniated lumbar disc who have not previously undergone lumbar spine surgery. It is not designed to encompass patients who are being considered for other types of lumbar s
TL;DR: The purpose of this presentation is to give an overall review of the various etiologies of kyphosis and the current status of management of these various problems.
Abstract: Kyphosis has become an increasingly important problem to the surgeon interested in the management of significant spinal deformity. As scoliosis has become better understood, the more difficult problems have become apparent and one of the most difficult of these is kyphosis. Kyphosis is the deformity which can produce paraplegia if it progresses to a significant degree and remains untreated. Contrary to scoliosis, in which bracing and posterior fusion alone are usually quite sufficient, kyphosis sometimes responds to bracing and other times it does not. If surgical treatment is necessary it quite often requires an anterior fusion. The purpose of this presentation is to give an overall review of the various etiologies of kyphosis and the current status of management of these various problems.
TL;DR: Analysis of previous operative procedures, cerebrospinal fluid studies, and myelographic patterns did not disclose any consistent correlation with the clinical presentation, and the combination of oil myelography and spinal surgery was the probable cause of arachnoiditis in almost all cases.
Abstract: The diagnostic and therapeutic courses of 68 patients with the discharge diagnosis of spinal arachnoiditis were reviewed. The combination of oil myelography and spinal surgery was the probable cause of arachnoiditis in almost all cases. The clinical presentation featured leg pain (90%), low-back pain (80%), and sphincter disturbance (25%). Motor, sensory, and reflex changes were present in two thirds of the cases, with a majority having defects attributable to bilateral or multiple root level involvement. Specific analysis of previous operative procedures cerebrospinal fluid (CSF) studies, and myelographic patterns did not disclose any consistent correlation with the clinical presentation. Results are interpreted in light of prior clinical and experimental studies on the reaction of the meninges to trauma and myelography.
TL;DR: Twenty-four patients with acute fracture dislocations of the dorsal-lumbar spine underwent stabilization with Harrington instrumentation and were followed for an average of 16 months, and functional results were comparable to or exceeded the results of other series.
Abstract: Twenty-four patients (of whom 17 were paraplegic) with acute fracture dislocations of the dorsal-lumbar spine underwent stabilization with Harrington instrumentation and were followed for an average of 16 months. Immediate postoperative ambulation was achieved in 16 patients. There was little difference between compression and distraction with respect to reduction and maintenance of correction. Compression rods resulted in solid union in 15 of 16 patients, while distraction rods were successful in 6 of 8 instances. In contrast to reported series in which operative intervention has been avoided, at least a 50% reduction in total hospitalization stay and costs has been achieved. Functional results were comparable to or exceeded the results of other series, and complication rates were similar with the exception of postoperative pain in 2 patients.
TL;DR: Some other subtle signs related to the phenomenon of denervation supersensitivity which is well known to physiologists and clinicians involved in peripheral nerve disease, yet its related signs have not been applied to low-back pain are described.
Abstract: The authors have previously reported myalgic hyperalgesia as a useful localizing sign in "low-back sprain" patients with no physical findings. This paper describes some other subtle signs related to the phenomenon of denervation supersensitivity which is well known to physiologists and clinicians involved in peripheral nerve disease, yet its related signs have not been applied to low-back pain. Following denervation of some neurons, muscle and peripheral receptors become supersensitive to transmitter substances and to different forms of stimuli. Since the peripheral nerve is a mixed nerve, findings are multiphasic and include autonomic dysfunction, trophic changes, cutaneous and myalgic hyperalgesia, and increased muscle tone. One or more of these signs occurred in 30 patients with secondary low-back pain but less often in 30 patients with primary or mechanical low-back pain; their presence, though slight, in asymptomatic controls may identify those individuals with a vulnerable back.
Journal Article•
TL;DR: In this article, the etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis were presented, and the injection of contrast materials prior to the diagnosis of this condition were considered the most important factors in its genesis.
Abstract: The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented. Lumbar spine surgery and the injection of contrast materials prior to the diagnosis of this condition are considered the most important factors in its genesis. In this series, there was microscopic
TL;DR: Five hundred consecutive idiopathic scoliosis patients in whom routine oblique roentgenograms of the lumbosacral area were obtained, plus 39 patients with a presenting problem of spondylolisthesis, were reviewed in an attempt to answer questions concerning the best therapeutic approaches in patients having coincidentScoliosis and pars defects.
Abstract: Five hundred consecutive idiopathic scoliosis patients in whom routine oblique roentgenograms of the lumbosacral area were obtained, plus 39 patients with a presenting problem of spondylolisthesis, were reviewed in an attempt to answer questions concerning the best therapeutic approaches in patients having coincident scoliosis and pars defects. The incidence of pars defects in patients with idiopathic scoliosis was found to be 6.2%, slightly higher than in the white female population at large. The indications for a surgical approach to the pars defect and/or the spinal curvature parallel the indications for each problem arising independently.
TL;DR: The authors urge others to look for scoliosis in their patients with arthrogryposis and to anticipate its progression.
Abstract: Fourteen of 50 patients studied with arthrogryposis also had scoliosis, an incidence of 28%. Eight patients developed a severe curve associated with functional disability and poor health. Three patients were unable to walk independently, and 2 died in childhood. Seven patients had congenital scoliosis; 4 had long "C" neuromuscular curves, and 3 had scoliosis associated with pelvic obliquity caused by unilateral hip dislocation or contracture. The natural history of congenital and neuromuscular curves was progression to an extreme and rigid scoliosis. The authors urge others to look for scoliosis in their patients with arthrogryposis and to anticipate its progression.
TL;DR: The purpose of this presentation is to outline the extent of surgical resection necessary for complete decompression of the neural elements in spinal stenosis and to introduce a system for the evaluation of disability in patients with spinal stenotic.
Abstract: The purpose of this presentation is to outline the extent of surgical resection necessary for complete decompression of the neural elements in spinal stenosis and to introduce a system for the evaluation of disability in patients with spinal stenosis. Sixteen patients with the confirmed diagnosis of lumbar spinal stenosis were evaluated by the system. Ten cases were treated surgically. Indications for operative treatment were 1) intolerable pain in average daily living, 2) progressively worsening or significant degree of motor weakness, and 3) sphincter dysfunction. Satisfactory results from operative treatment were expected only after adequate and thorough decompression. The extent of surgical decompression was determined by clinical evaluation, myelographic examination, and by the type of disease process exhibited. The most common cause of unsatisfactory results was inadequate decompression of spinal contents. The extent of adequate decompression is described according to three different variations of pathologic anatomy of spinal stenosis: a) concentric contraction of the spinal canal, b) sagittal flattening of the spinal canal, and c) stenosis caused by anomalous articular process(es). No excellent results were obtained even after thorough and adequate decompression of spinal contents.
TL;DR: Posterior wedge resection with local fusion with Harrington instrumentation may be the only method of affording sac closure, or providing continuity of the ulcerated integument.
Abstract: The deforming mechanisms in the congenital lumbar kyphosis of myelomeningocele are situated anteriorly. Posterior wedge resection with local fusion therefore will not prevent progression of the deformity. Nonetheless, this procedure may be the only method of affording sac closure, or providing continuity of the ulcerated integument. Definitive corrective surgery will be required later and must combat the anterior deforming forces. Resection of the apical vertebral body followed by posterior fusion with Harrington instrumentation provides a solid straight spine.
TL;DR: The properties of Amipaque provide excellent possibilities for detailed studies of all parts of the spinal subarachnoid space, and the medium constitutes a new and interesting aid for these investigations.
Abstract: In lumbar myelography, early side effects occur in about half the patients examined with modern water-soluble contrast media. At myelography with Amipaque (metrizamide) these reactions are usually minor, and serious adverse reactions are rare. In our own series of 650 consecutive lumbar myelographie
TL;DR: Eosinophilic granuloma of the cervical spine in children is a rare lesion which presents both diagnostic and theraputic problems and is not advised unless a second stage fusion is planned.
Abstract: Eosinophilic granuloma of the cervical spine in children is a rare lesion which presents both diagnostic and therapeutic problems. The report describes three additional cases. Open biopsy is recommended instead of attempted needle aspiration in children. Laminectomy is likely to result in spinal deformity, and is not advised unless a second stage fusion is planned. Radiotherapy is effective in controlling the lesion. The ultimate outcome is usually good.
TL;DR: Surgical attack on arachnoiditis is a straightforward surgical exercise that produces no further neurologic deficits and some short-term improvement but there does not appear to be a method for preventing the reaccumulation of the scar tissue and subsequent recurrence of the symptoms.
Abstract: The results of a long-term study of 28 patients operated on for adhesive lumbar arachnoiditis are presented. The technique involved was microscopic lysis of adhesions. The first case of surgery was performed in 1966 and the last, in 1970, with followup through 1976. Numerous observations are made regarding the clinical picture and the appearance of arachnoiditis at the time of surgery. Some conclusions are drawn regarding the causes of this condition with some emphasis on the role of Pantopaque, multiple surgeries, and other trauma. The conclusion is that surgical attack on arachnoiditis is a straightforward surgical exercise that, when carried out with appropriate caution, produces no further neurologic deficits and some short-term improvement. However, the authors feel that this procedure should not be performed at the present time because there does not appear to be a method for preventing the reaccumulation of the scar tissue and subsequent recurrence of the symptoms.
TL;DR: It is suggested that a calcium-related neuromuscular defect could be an important factor in the genesis of idiopathic scoliosis.
Abstract: X-ray fluorescence spectrometry was used to determine calcium, copper, and zinc concentrations in paraspinal and gluteal muscles obtained during spinal surgery from patients with scoliosis. Samples of 1-3 mg were sufficient to demonstrate that calcium was higher in idiopathic than in other forms of scoliosis or in normal control muscles. It is suggested that a calcium-related neuromuscular defect could be an important factor in the genesis of idiopathic scoliosis.
TL;DR: Using the recommended dose of 10 ml with an iodine concentration of 170 mg/ml for this examination, adhesive arachnoiditis is unlikely to occur and this is considered the contrast medium of choice for lumbar myelography.
Abstract: Late sequelae (adhesive arachnoiditis) have been reported following myelography with the oily contrast medium (Pantopaque) and with the ionic water-soluble contrast media methiodal sodium (Abrodil, Conturex, Kontrast U) meglumine iothalamate (Conray Meglumine) and meglumine iocarmate (Bis-Conray, Dimer-X). Adhesive arachnoiditis has not yet been reported after the use of the nonionic water-soluble contrast medium metrizamide (Amipaque). Thus, this is considered the contrast medium of choice for lumbar myelography. Using the recommended dose of 10 ml with an iodine concentration of 170 mg/ml for this examination, adhesive arachnoiditis is unlikely to occur. Increased osmolality of spinal fluid after injection of contrast medium is related to increased frequency of arachnoiditis.
TL;DR: Cervical spine injuries associated with three-point fixation lap-sash seat belts result from Impact against the sash, and may produce serious deficits with grave injuries.
Abstract: Cervical spine injuries associated with three-point fixation lap-sash seat belts result from impact against the sash. While such injuries are infrequent and often without serious neurologic sequelae, they may produce serious deficits with grave injuries. Flexion-extension fractures of the lower cervical vertebrae, fractures of the transverse and spinous processes of the lower cervical and uppermost thoracic vertebrae, discal disruptions, and brachial plexus avulsions may occur. Of the 3 patients reported here, 2 escaped serious damage.
TL;DR: A case of arachnoiditis ossificans about the cauda equina occurring after septic complications following laminectomy and surgical excision of the ossIFIC tissue resulted in clinical improvement is added.
Abstract: Arachnoiditis ossificans is uncommon and has been reported to occur in areas surrounding the brain stem, the spinal cord, and the cauda equina. Predisposing etiologic factors include vascular anomalies, spinal anesthetics, and meningitis. This report adds a case of arachnoiditis ossificans about the cauda equina occurring after septic complications following laminectomy. Surgical excision of the ossific tissue resulted in clinical improvement.