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Showing papers in "Spine in 1979"


Journal ArticleDOI
01 Jan 1979-Spine
TL;DR: The authors find that the mean behaviors of the different segment classes sometimes differ, but these differences are seldom pronounced and scatter in the behavior of individual motion segments very often overshadows any class differences.
Abstract: The influences of age, sex, disc level, and degree of degenration on the mechanical behavior of 42 fresh cadaver lumbar motion segments are reported. The motions and intradiscal pressure changes that result from the application of flexion, extension, lateral bending, and torsional moments; compression; and anterior, posterior, and lateral shears are described. The authors find that the mean behaviors of the different segment classes sometimes differ, but these differences are seldom pronounced. Scatter in the behavior of individual motion segments is pronounced, and very often overshadows any class differences.

323 citations


Journal ArticleDOI
01 Sep 1979-Spine
TL;DR: It is shown that the pericapsular and intrafacetal pain referral areas are similar and that the upper lumbar spine is more sensitive than the lower.
Abstract: Patterns of pain referral, induced from the posterior elements, have been studied in normal volunteer subjects. A series of intracapsular and pericapsular injections were performed at the L1-2 and L4-5 levels. The areas of pain referral indicate overlap between the upper and lower lumbar spine. It is also shown that the pericapsular and intrafacetal pain referral areas are similar and that the upper lumbar spine is more sensitive than the lower.

275 citations


Journal ArticleDOI
01 Sep 1979-Spine
TL;DR: Although complex radiographic changes follow lumbar disc surgery, with or without failure, it is concluded that the plane radiograph is of little aid in determining the source of postoperative pain.
Abstract: Ninety-six patients who had undergone disc excision and midline spinal fusion and 36 patients who had had simple disc excision had spinal radiographs made 10 or more years postoperatively. Claw spurs were found most commonly at the L2-3 and L3-4 levels in fusion patients, particularly male laborers. Traction spurs with segmental hypermobility were found more commonly at the L4-5 level in patients whose spines were not fused, particularly women. Total lumbar flexion-extension was greater in nonfusion than in fusion patients, but the L1-3 mobility was greater in those who had undergone fusion, suggesting a compensatory increase in the range of lumbar motion. Segmental mobility at levels of surgery in nonfusion patients was similar in those with good and those with poor clinical results. Disc space narrowing was common at levels of operation, but did not correspond to the clinical result. Pseudarthrosis was demonstrated in 26% of fusion patients, but was of no clinical significance. Although complex radiographic changes follow lumbar disc surgery, with or without failure, it is concluded that the plane radiograph is of little aid in determining the source of postoperative pain. The sole exception is that of acquired spondylolysis, which was found in 2.5% of this group of fusion patients, and was clearly associated with a poor clinical outcome. Symptomatic degenerative disc disease at levels above lumbar spinal fusions appears to be an uncommon clinical problem.

242 citations


Journal ArticleDOI
01 Jan 1979-Spine
TL;DR: The influence of backrest inclination and lumbar support on the shape of the lumbars spine in sitting positions has been studied radiographically on 38 healthy subjects: the lordosis increased with increasing support and the location of theLumbar Support with respect to the level of the spine did not significantly influence the measured angles.
Abstract: The influence of backrest inclination and lumbar support on the shape of the lumbar spine in sitting positions has been studied radiographically on 38 healthy subjects. Four angles of backrest inclination and four different sizes of lumbar support were studied. In addition, the lumbar support was placed at three different lumbar levels. When sitting down from a standing position, the pelvis rotates and the lumbar lordosis decreases. Increases in the backrest-seat angle had only minor effect on the lumbar lordosis. A lumbar support, on the other hand, had a significant influence: the lordosis increased with increasing support. The location of the lumbar support with respect to the level of the spine did not significantly influence the measured angles.

223 citations


Journal ArticleDOI
01 May 1979-Spine
TL;DR: It is concluded that uncontrolled hip rotation reduces the value of the SLR test, that medial hip rotation near the limit of painfree SLR is a useful qualifying test for increased root tension, and that the diagnostic value and repeatability of SLR would be improved by adopting a standardized protocol.
Abstract: Studies of the sacral plexus have been made in six cadavers to demonstrate the increased tension due to medial hip rotation. A standard protocol was adopted for the straight-leg-raising test (SLR) and three qualifying tests--dorsiflexion of the ankle, medial hip rotation, and cervical flexion--when examining 442 patients. Positive signs on medial hip rotation were frequently associated with evidence of increased tension and neurologic dysfunction of lumbosacral roots. It is concluded that uncontrolled hip rotation reduces the value of the SLR is a useful qualifying test for increased root tension, and that the diagnostic value and repeatability of SLR would be improved by adopting a standardized protocol.

151 citations


Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: Five common syndromes productive of low-back and leg pain are presented as the basis for clinical investigation to arrive at an early and definite diagnosis in low- back pain problems.
Abstract: Five common syndromes productive of low-back and leg pain are presented as the basis for clinical investigation to arrive at an early and definite diagnosis in low-back pain problems. The five are posterior facet syndromes, sacroiliac-piriformis syndrome, herniated nucleus pulposus, central spinal stenosis, and nerve entrapment in the lateral recess. All may present with a common symptom complex of low-back, buttock, trochanteric, and posterior thigh pain. Specific details from history, physical, and radiographic examination may allow separation of these entities, but proof of diagnosis requires data from response to treatment, facet and nerve injection, myelography, discography, and computerized tomography (CT) scan.

125 citations


Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: In those instances of potentially increased postoperative instability or persistent mechanical back complaints, consideration should be given to augmenting decompressive procedures with Harrington instrumentation and fusion for these painful collapsing lumbar spines.
Abstract: Recent work on degenerative lumbar curves has focused on stable deformities with entrapment syndrome secondary to spondylotic compression. A review of our local experience with degenerative lumbar curves shows that approximately half of the 14 cases have had a less typical radiographic presentation of short reciprocating lumbar curves thought to be on the basis of asymmetric intervertebral osteochondrosis. In these latter cases, marked spondylotic ridging and intervertebral buttressing were absent; therefore, major decompressive surgery on the residual posterior elements may increase instability and hasten further collapse. Although most patients have had good relief of radicular leg complaints with decompressive procedures, several patients had persistent low-back pain that appeared to have a mechanical basis. In those instances of potentially increased postoperative instability or persistent mechanical back complaints, consideration should be given to augmenting decompressive procedures with Harrington instrumentation and fusion for these painful collapsing lumbar spines.

107 citations


Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: Starting in February 1975, laminotomies in 107 dogs in an attempt to study the possibility of prevention of scar tissue formation about the dural sac and nerve roots were performed, it was found that pedicle grafts of fat gave more complete Prevention of scar.
Abstract: The formation of scar tissue always follows lumbar disc surgery and usually causes no difficulty. Reoperation may be necessary because of disc reherniation or because of the scar tissue itself. Reoperation is tedious and dangerous because of the presence of scar formation. Beginning in February 1975, the authors performed laminotomies in 107 dogs in an attempt to study the possibility of prevention of scar tissue formation about the dural sac and nerve roots. Gelfoam and Gelfilm were found to increase scar formation. Micropore tape and plastics such as polyethylene, mylar, and woven and smooth silastic were tried without complete success. Free fat grafts gave better protection than other substances, but it was found that pedicle grafts of fat gave more complete prevention of scar. The living pedicle fat grafts also prevented the usual closure of the laminotomy. The technique of pedicle fat grafts has also been used with success in 36 human patients to date.

103 citations


Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: Lumbar scoliosis with degenerative changes in the elderly presents with spondylosis, variable apophyseal joint arthrosis, laminar hypertrophy, and marginal osteophytosis most prominent within the scoliotic apex.
Abstract: Lumbar scoliosis with degenerative changes in the elderly presents with spondylosis, variable apophyseal joint arthrosis, laminar hypertrophy, and marginal osteophytos most prominent within the scoliotic apex. Resultant lumbar stenosis, alone or with ventral spurs and herniated discs as isolated or associated lesions, can produce disabling low-back and lower extremity pain, weakness, and neurogenic claudication relievable by appropriate decompressive surgery. Myelography is essential as a preoperative measure. Whether such scoliosis is superimposed on adolescent thoracolumbar scoliosis or arises anew in later life remains an open question.

97 citations


Journal ArticleDOI
01 Sep 1979-Spine
TL;DR: Preliminary results suggest that this is a valid technique for obtaining satisfactory reduction of the deformity and stabilization in severe cases of spondylolisthesis.
Abstract: A technique for combined posterior and anterior reduction of spondylolisthesis is presented. Preliminary results suggest that this is a valid technique for obtaining satisfactory reduction of the deformity and stabilization in severe cases of spondylolisthesis (greater than 50%). The indications for this approach and possible complications are described in detail.

83 citations


Journal ArticleDOI
01 Jan 1979-Spine
TL;DR: The findings suggest that there is a generalized specific neuromuscular disorder causing idiopathic scoliosis, and both spinal and peripheral muscles showed frequent abnormalities when examined morphologically and histometrically by light and electron microscopy.
Abstract: This report describes part of a wider study on muscles from patients with adolescent idiopathic scoliosis. The aim of the study was to clarify if there exists a side-related pathology in the spinal musculature and if extraspinal muscles are abnormal in scoliosis patients. In scoliotic patients, both spinal and peripheral muscles showed frequent abnormalities when examined morphologically and histometrically by light and electron microscopy. Idiopathic scoliosis patients differed from the others. Morphologic pathology seemed worse on the concave side. A mild Type I fiber atrophy occurred in spinal muscles on the concave side and in the deltoids. A generalized tendency towards small myofibers was also noted. The findings suggest that there is a generalized specific neuromuscular disorder causing idiopathic scoliosis.

Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: This objective preoperative evaluation method reduced negative disc explorations and improved early surgical results, and is recommended for patients being considered for elective lumbar discectomy.
Abstract: A reproducible method is presented for selecting patients with low-back pain and sciatica for lumbar discectomy based on specific objective criteria in four categories: neurologic signs, sciatic tension signs, personality factors (MMPI scores), and lumbar myelography. Operative findings for 50 consecutive cases selected using this method revealed complete nucleus pulposus herniation in 43 cases. This contrasts with complete herniation in only 5 of 26 patients undergoing lumbar discectomy before the method was employed. This objective preoperative evaluation method reduced negative disc explorations and improved early surgical results. We recommend its use for patients being considered for elective lumbar discectomy.

Journal ArticleDOI
01 Jul 1979-Spine
TL;DR: Standardized measurements of the midsagittal diameters at the cephalad and caudad borders of the laminas of the vertebral canal are proposed as a means of furthering both surgical and comparative studies.
Abstract: Computerized axial tomography (CAT) in cases of stenosis of the lumbar bony vertebral canal may demonstrate features of diagnostic significance in the shape of the canal and the bony structures surrounding it. The distinguishing features are the measurements. Standardized measurements of the midsagittal diameters at the cephalad and caudad borders of the laminas of the vertebral canal are proposed as a means of furthering both surgical and comparative studies. Identification of these borders in CAT scans is described, as is the procedure for taking measurements. One or two interlaminar, transarticular CAT scans are also made. In these scans, the midsagittal diameters cannot be measured because the ligamentum flavum forms the posterior wall in the midline. The scans may, however, demonstrate narrow lateral recesses and deformities of the articular processes and joint spaces. Errors in measurement of midsagittal diameters result from the inability of CT body scanners to show the angle between axial sections and the anterior vertebral canal wall, and from the partial volume phenomenon. The diameters are then too large. Errors in the angle of axial sections also lead to distortion in reconstructions of sagittal sections of the vertebral canal from the soft material obtained from axial sections. New precision designs are described. The principal indication for the intrathecal injection of water-soluble contrast media in CAT scanning is the determination of the thickness of the ligamentum flavum. Apart from its value in distinguishing various forms of stenosis, CAT scanning may also reveal inadequacies in surgical decompression.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: Prophylactic surgery to prevent future back pain in young patients who have lumbar curves is not justified because scoliosis surgery in the adult carries a high risk and long-term efficacy is unproved, and all types of conservative measures must be tried.
Abstract: From available long-term follow-up studies of untreated scoliosis, there seems to be minimal risk of disabling back pain in adult patients who have lumbar curves. A review of all Swedish patients who in 1971 received disability pension because of scoliosis showed very few who had lumbar curves, significantly fewer and with curves of lesser degrees than patients who had thoracolumbar and thoracic curves. Those exhibiting lumbar curves were mostly 60 years of age or older and had curves around 25 degrees only, of the type that can arise as a result of osteoporosis and disc degeneration. Whether severe low-back pain occurs more often in adults who have lumbar curves than in those whose spines are straight is open to question, since calculations presented show approximately the same incidence of surgery performed for back pain in scoliotic patients and in those whose spines are straight. Because scoliosis surgery in the adult carries a high risk and long-term efficacy is unproved, all types of conservative measures must be tried before discussing an operation. Prophylactic surgery to prevent future back pain in young patients who have lumbar curves is not justified.

Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: The data obtained from the history and examination of patients with low-back pain and sciatica have been subjected to an observer variation analysis and redesign of the proformata resulted in a reduction of the observer error.
Abstract: The data obtained from the history and examination of patients with low-back pain and sciatica have been subjected to an observer variation analysis. Redesign of the proformata resulted in a reduction of the observer error from 33% to 18% for the history, but no improvement in the finding of a 30% observer error in the examination. The clinician has a simple choice: if he wishes to obtain a large amount of detailed information he must realize that much of it will be unreliable; if he is prepared to limit the information then he will increase its reliability.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: The somatosensory evoked potential (SEP) has been employed as an intraoperative spinal cord monitor to see if decompression results in any rapid changes in spinal cord conductivity and to correlate these findings with the patient's subsequent clinical course.
Abstract: As part of a study to determine if decompressive surgery benefits patients who have incomplete lesions of the spinal cord, the somatosensory evoked potential (SEP) has been employed as an intraoperative spinal cord monitor. This procedure was used to see if decompression results in any rapid changes in spinal cord conductivity and to correlate these findings with the patient's subsequent clinical course. In addition to trauma, however, other factors also affect the SEP, and these must be recognized if intraoperative monitoring is to be successful. Frequency of stimulation, wakefulness, and anesthetic agents alter the wave-form and amplitude of the SEP. Using nitrous oxide, oxygen, meperidine (or morphine), and a muscle relaxant for anesthesia, and stimulating at frequencies of 1 or 2 per second, 11 patients with cervical or upper thoracic lesions have been monitored. There was no loss or diminution of an SEP and no patient was neurologically poorer afterwards. In 4 patients, the SEP "improved" soon after decompression. Clinical outcome, however, was not related to whether the SEP changed or remained the same. In total, 8 patients subsequently improved functionally and 3 did not.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: A new recording method for continuous spinal cord monitoring has been developed at Rancho Los Amigos Hospital using peripheral nerve stimulation, spinal evoked potentials (SEPs) are recorded from cancellous bone of spinous processes, providing a highly reproducible and consistent signal.
Abstract: A new recording method for continuous spinal cord monitoring has been developed at Rancho Los Amigo Hospital. Using peripheral nerve stimulation, spinal evoked potentials (SEPs) are recorded from cancellous bone of spinous processes. This neurologically noninvasive technique provides a highly reproducible and consistent signal, unaffected by biologic noise and surgical handling of the spinal column. Moreover, the evoked response is extremely sensitive to changes in functional integrity of the spinal cord. In experimental spinal cord injuries, produced by localized distraction of the spine, changes of the evoked responses were well correlated with the change in spinal cord function.

Journal ArticleDOI
01 Jan 1979-Spine
TL;DR: The failure to find a potent prediction scheme for the Minnesota Multiphasic Personality Inventory confirms that MMPI information must be used with considerable caution in treatment planning and only as an adjunct to other clinical and psychological data.
Abstract: Between 1965 and 1975, 103 low-back patients were rated preoperatively for general level of functioning, and each completed a Minnesota Multiphasic Personality Inventory (MMPI) test. Following surgery, patients were rated in terms of treatment effectiveness at 6 months and 1 year. The MMPI hypochondriasis and hysteria scales were moderately related to surgical success, as were the severity of initial restriction in the level of functioning and the number of operations performed during the study. However, the MMPI profiles were strikingly similar for all patients. Factors which were not predictive of surgical outcome included age, sex, duration of symptoms, number of back surgeries prior to entering this clinic, and the degree of pathologic condition discovered at operation. The failure to find a potent prediction scheme confirms that MMPI information must be used with considerable caution in treatment planning and only as an adjunct to other clinical and psychological data.

Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: Eight patients, all with continued posterior hip pain following total hip arthroplasty, were seen during a 15-month period, and pain and other disabling symptoms were traced to a degenerated, stenotic lumbar spine.
Abstract: Eight patients, all with continued posterior hip pain following total hip arthroplasty, were seen during a 15-month period. In each patient, that pain and other disabling symptoms were traced to a degenerated, stenotic lumbar spine. The relationship of lumbar stenosis to degenerative hip disease is presented. Myelography was used to diagnose the stenosis in all patients, and findings were confirmed at laminectomy. Wide decompressive laminectomy and partial facetectomy was followed by complete relief of pain and other disabling symptoms in the 6 patients who were able to undergo it.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: Spinal cord monitoring, as currently practiced, requires a source of sensory stimulus, transmitted through filters and amplifiers, to result in an enhanced signal, which is recorded and studied.
Abstract: Spinal cord monitoring, as currently practiced, requires a source of sensory stimulus, transmitted through filters and amplifiers, to result in an enhanced signal, which is recorded and studied. Three techniques are under investigation. In one, the stimulation and responses are recorded directly from the dura. In another, the stimulus is applied to a peripheral nerve and the response is gathered from vertebral bone. The third utilizes responses in the form of cortical evoked potentials, with the stimulus applied to peripheral nerves.

Journal ArticleDOI
01 May 1979-Spine
TL;DR: An investigation to determine whether or not human spine configurations can be categorized into types by which one could predict the possibility of disablement at one specific level more than another found that high intercrestal line and long transverse process probably act as antitorsional devices protecting the L5-S1 disc; hence the likelihood of degeneration at L4–5 is increased.
Abstract: This paper reports an investigation to determine whether or not human spine configurations can be categorized into types by which one could predict the possibility of disablement at one specific level more than another. Configurations of the lumbar spine, the shape of the lower two lumbar discs, the anterior and posterior heights of discs, the sizes of the transverse processes of L4-5, the presence or absence of rudimentery ribs, and the presence of transitional vertebrae were studied in roentgenograms of 554 subjects. They concluded that the probable criteria for development of L4-5 degeneration were 1) high intercrestal line passing through the upper half of L4, 2) long transverse process on L5, 3) rudimentary rib, and 4) transitional vertebra. Criteria for development of L5-S1 degeneration were 1) intercrestal line passing through the body of L5, 2) short transverse process on L5, 3) no rudimentary rib, 4) no transitional vertebrae. A high intercrestal line and long transverse process probably act as antitorsional devices protecting the L5-S1 disc; hence the likelihood of degeneration at L4-5 is increased.

Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: Because of the dynamic and ever-changing status of the lumbar spine with the passage of time, patient selectivity seems to be less critical after 5 years.
Abstract: This report assessed the relationship between patient selection and the outcome of lumbar disc surgery. Patient selecting is assessed by means of a predictive scoring technique previously reported. Because of the dynamic and ever-changing status of the lumbar spine with the passage of time, patient selectivity seems to be less critical after 5 years. For the first 5 years, however, the outcome of lumbar disc surgery seems to be directly related to patient selectivity.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: Discography was helpful in assessing complex pain problems, and its use led to improved results of surgery because of more comprehensive preoperative definition of the problem.
Abstract: This report analyzes a series of 350 adult patients whose spinal deformity was treated surgically. Indications included pain, curve progression, cosmesis, structural disabilities, neurologic complications, cardiorespiratory problems, and failed previous surgery. Discography was helpful in assessing complex pain problems, and its use led to improved results of surgery because of more comprehensive preoperative definition of the problem. Pain relief occurred in 70% of patients. Traction, either the halo-femoral or the halo-pelvic type, was used in 62 patients. Complex surgery, including anterior and posterior approaches, is required in curves of large magnitude, especially when curves are rigid. Overall curve correction in this series was 40%.

Journal ArticleDOI
01 Mar 1979-Spine
TL;DR: The authors review an additional 199 cases, finding that decision making was influenced by discography in 155 cases and a positive discogram was surgically confirmed in 111 patients, although most patients with positive myelograms did not have discography.
Abstract: Lumbar discography has been performed in over 1500 patients at St. Luke's Episcopal Hospital, and a report concerning 683 cases has been previously published. The authors review an additional 199 cases, finding that decision making was influenced by discography in 155 cases (78%). A positive discogram was surgically confirmed in 111 patients (56%). In 14(7%) the disc was found to be normal at surgery. One hundred six patients (53%) had positive discograms with negative or equivocal myelogram. In 36 patients with a positive myelogram, the discogram was corroborative, although most patients with positive myelograms did not have discography. Sixty-nine patients (35%) did not have surgery.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: Root entrapments in the sciatic distribution were most common and arose on the side opposite the major curve, coming from the concavity of compensatory lumbosacral curves; Mechanisms of root entrapment vary, but foraminal compression and pedicular kinking were mostCommon.
Abstract: From 1969 through 1978, 30 adults presented with painful idiopathic scoliosis and associated radicular symptoms. Fifteen had major thoracolumbar curves and 15 had major lumbar curves. Ten (33%) had physical findings of the nerve root entrapment, 4 having two roots entrapped. Root entrapments in the sciatic distribution were most common and arose on the side opposite the major curve, coming from the concavity of compensatory lumbosacral curves (7 of 9 patients). Root entrapment in a femoral nerve distribution came from the concavity of the major curve (1 patient). Whether in a major or compensatory curve, entrapments usually arise in the concavity (8 of 10 patients). Mechanisms of root entrapment vary, but foraminal compression and pedicular kinking were most common. When major deforming curves are corrected fairly completely, most nerve root entrapments are relieved; sciatic entrapments are decompressed by spontaneous straightening of the lumbosacral curve. Dwyer instrumentation and fusion has been the most effective method of surgical management in carefully selected cases.

Journal ArticleDOI
01 Jan 1979-Spine
TL;DR: The final results of fusion were both subjectively and objectively satisfactory and spastic cerebral palsy and increased length of fusion predisposed to nonunion, while severity of olisthesis and ambulatory treatment postoperatively could not be implicated.
Abstract: Eighty-one patients under the age of 20 years who underwent fusion for symptomatic spondylolysis and spondylolisthesis were evaluated. Sex distribution was equal. Initial symptoms included back pain in 90% of patients, radicular pain radiating to an L5 or S1 nerve root distribution in 57%, and back deformity in 46%. Physical findings included diffuse lumbosacral tenderness in 70% of patients, increased lumbar lordosis in 63%, and neurologic deficit of an L5 or S1 nerve root in 16%. Roentgenograms demonstrated lytic pars interarticularis defects in 9% of patients without olisthesis, while 35% had slips of greater than one-half the width of the sacrum. Radiographic nonunion after fusion was diagnosed in 15% of patients. Spastic cerebral palsy and increased length of fusion predisposed to nonunion, while severity of olisthesis and ambulatory treatment postoperatively could not be implicated. The final results of fusion were both subjectively and objectively satisfactory. Eighty-one percent of patients had no or very mild pain which did not interfere with activity, while 16% required occasional salicylates and only 2%, stronger analgesics. Ninety-one percent participated in athletics, and 73% of patients were employed at work which involved prolonged standing or sitting. Physical examination 5 years postoperatively in 27 patients demonstrated no evidence of hamstring spasm, supple spines, and only mild incisional tenderness. Neurologic examination was normal in all but 1 patient who remained unchanged following fusion 9 years previously.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: The experience with adult lumbarScoliosis among patients at a scoliosis center is detailed, showing some curves are shown to progress in the adult, while others appear de novo.
Abstract: This report details the expierience with adult lumbar scoliosis among patients at a scoliosis center. Some curves are shown to progress in the adult, while others appear de novo. Pain arising in adult scoliosis may reflect root compression or segmental degeneration. Once pain arises in an adult lumbar curve, it is likely to be progressive and often requires surgical treatment.

Journal ArticleDOI
01 Nov 1979-Spine
TL;DR: Four patients underwent transoral resection of the odontoid with utilization of microsurgical technique and spinal cord monitoring of somatosensory cortical evoked responses and all patients improved following surgery, and no operative morbidity or mortality was encountered.
Abstract: Four patients underwent transoral resection of the odontoid with utilization of microsurgical technique and spinal cord monitoring of somatosensory cortical evoked responses. All patients improved following surgery, and no operative morbidity or mortality was encountered. Spinal cord monitoring enhances the safety of the procedure and, reapplied at a later date, detects information of prognostic value.

Journal ArticleDOI
01 Jan 1979-Spine
TL;DR: Six patients were treated by the transthoracic anterolateral approach, and improvement occurred in all, and most of the 7 patients discussed had an early diagnosis made.
Abstract: Thoracic disc herniation is difficult to recognize. Diagnosis is easily made when the patient has a paraparesis, but at this point the disc herniation is usually large, and the result of the disc removal is less certain. Most of the 7 patients discussed had an early diagnosis made. Six patients were treated by the transthoracic anterolateral approach, and improvement occurred in all.