scispace - formally typeset
Search or ask a question

Showing papers in "Spine in 1985"


Journal ArticleDOI
01 Jul 1985-Spine
TL;DR: In this article, the authors used objective functional capacity measurement techniques to guide a treatment program for a group of 66 chronic back pain patients and found that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients.
Abstract: Objective functional capacity measurement techniques were used to guide a treatment program for a group of 66 chronic back pain patients. These patients were compared with a group of 38 chronic patients who were not administered the treatment program. Outcome data were collected by telephone survey at an average 1 year follow-up. In addition, functional capacity measures were collected for treatment group patients on admission and follow-up evaluations. Results demonstrated that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients. These changes were also accompanied by positive changes in psychologic measures. In addition, at 1 year follow-up, the treatment group had approximately twice the rate of patients who returned to work, relative to the comparison group. Additional surgery rates were comparable for both groups (6% in the treatment and 7% in the comparison group), but the frequency of additional health-care professional visits was substantially higher in the comparison group. The findings suggest that quantitative functional capacity measures can give objective evidence of patient physical abilities and degree of effort and can significantly guide the clinician in administering an effective treatment program.

404 citations


Journal ArticleDOI
01 Apr 1985-Spine
TL;DR: Radiographic study with dynamic views obtained in the frontal and lateral planes identify unstable states in the clinical environment and indicates that a certain mechanical threshold has been reached or transgressed.
Abstract: A lumbar motion segment is considered to be unstable when it exhibits abnormal movement. This movement can be abnormal in quality (abnormal coupling patterns) or in quantity (abnormal increased motion). This instability can be symptomatic or asymptomatic, depending on the demands made on the motion

351 citations


Journal ArticleDOI
01 Nov 1985-Spine
TL;DR: Fracture of the upper sacrum results from falls from a height and is usually associated with suicidal attempts by jumping, and awareness of the possibility of such injury, especially in the presence of perineal neurologic deficit should result in securing good quality radiographic study, including tomograms.
Abstract: Thirteen patients with transverse fractures of the upper sacrum were studied to determine fracture anatomy, clinical presentation, and therapeutic approaches. The injury results from falls from a height and is usually associated with suicidal attempts by jumping. The position of the lumbar spine in lordosis or kyphosis at the time of impact determines which of three types of morbid anatomy will result. Because of associated polytrauma, fracture of the upper sacrum is often not recognized in the acute stage, and awareness of the possibility of such injury, especially in the presence of perineal neurologic deficit should result in securing good quality radiographic study, including tomograms. Surgical treatment is often required.

342 citations


Journal ArticleDOI
01 Jul 1985-Spine
TL;DR: Tests on ten older discs with pre-existing ruptures showed that such discs are stable and do not leak nuclear pulp, and six discs developed a gradual prolapse during the testing period.
Abstract: Fifty-two cadaveric lumbar motion segments were subjected to fatigue loading in compression and bending to determine if the intervertebral discs could prolapse in a gradual manner. Prior to testing, the nucleus pulposus of each disc was stained with a small quantity of blue dye and radiopaque solution. This enabled the progress of any gradual prolapse to be monitored by direct observation and by discogram. Six discs developed a gradual prolapse during the testing period. The injury starts with the lamellae of the annulus being distorted to form radial fissures and then nuclear pulp is extruded from the disc and leaks into the spinal canal. Discs most commonly affected were from the lower lumbar spine of young cadavers. Tests on ten older discs with pre-existing ruptures showed that such discs are stable and do not leak nuclear pulp.

317 citations


Journal ArticleDOI
01 Oct 1985-Spine
TL;DR: It is demonstrated that strength deficits are a major factor in the deconditioning syndrome associated with chronic low-back pain.
Abstract: A prototype sagittal plane trunk strength tester was used to measure trunk strength in 286 chronic low-back pain patients. Initial data for this patient group are compared with data acquired previously from a group of controls, adjusted for age, sex, and body weight. Distinct patterns characterize the patient sample as opposed to the controls: Patient values for both flexors and extensors were markedly decreased, with greater variability; Extensor strength was affected more significantly than flexor strength; Discrepancies between patients and controls were greater for females than for males; High-speed dropoff ratios were much lower for patients, both in flexion and extension. These results demonstrate that strength deficits are a major factor in the deconditioning syndrome associated with chronic low-back pain.

314 citations


Journal ArticleDOI
01 Oct 1985-Spine
TL;DR: The laminoplasty reported in Spine 1982 by the author (H.T.) was modified by a technical improvement to obtain a more reliable enlargement of the cervical spinal canal to treat patients with severe cervical myelopathy.
Abstract: The laminoplasty reported in Spine 1982 by the author (H.T.) was modified by a technical improvement to obtain a more reliable enlargement of the cervical spinal canal. The technical improvements and results are described in detail. The osteotomized laminae that floated en bloc like a hinged door must be stabilized by bone blocks with wire ligatures. Thirty patients with severe cervical myelopathy due to multisegmental spondylosis or ossification of posterior longitudinal ligament underwent surgery. The extent of the enlargement of the canal was 4.1 mm on the average in the anteroposterior diameter, and in no case was a significant reduction in the diameter of the canal noted during the follow-up period. A stable and thorough decompression of the spinal canal was noted on the postoperative computed tomograms with satisfactory surgical results.

291 citations


Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: This study considers some of the criteria for normal posture in the group of spondylolysis patients, especially as they are related to the lumbar spine and pelvis.
Abstract: On theoretic grounds it can be assumed that aberrations of posture may play a role in the generation of low-back pain by creating concentrations of stress. However, this assumption remains speculative because of the absence of criteria for normal posture. This study considers some of these criteria, especially as they are related to the lumbar spine and pelvis. The relations between the angle of declivity of the sacrum and radius and inclination of the lordotic curvature of the lumbar spine show good correlation. Mean values of postural parameters in the group of spondylolysis patients differ significantly from those in the group of healthy volunteers.

287 citations


Journal ArticleDOI
01 Mar 1985-Spine
TL;DR: Using a method comparable with that of Eklund and Corlett (1984) stature was measured with an accuracy of 1 mm in eight young adults, and Rest in Fowler's position gave more rapid regains in stature than post-exercise recovery in standing positions.
Abstract: Using a method comparable with that of Eklund and Corlett (1984) stature was measured with an accuracy of I mm in eight young adults. The mean circadian variation was 19.3 mm (1.1% of stature). Fifty-four percent of the diurnal loss in stature occurred in the first hour after rising. Approximately 70% was regained during the first half of the night. With static shoulder loads (2.5-40 kg), increases in the rate of shrinkage with increasing weight were nonlinear. Repetitive lifting led to greater shrinkage than with equivalent static loading. Rest in Fowler's position gave more rapid regains in stature than post-exercise recovery in standing positions. The technique is therefore suitable for assessment of the effects of manual work with both occupational and therapeutic applications.

251 citations


Journal ArticleDOI
01 Nov 1985-Spine
TL;DR: This study examines different morphologic measurements in the evaluation of patients with lumbar spinal stenosis and introduces a new measurement, the transverse area of the dural sac, which was excellent in relation to cross-sectional area and anteroposterior diameter.
Abstract: This study examines different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT scans from 24 patients who underwent surgery for central lumbar stenosis were analyzed. No correlation was observed between the size of the bony spinal canal and the size of the dural sac. A new measurement, the transverse area of the dural sac, is introduced. Normal values are provided. Correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent.

231 citations


Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: Breast, lung, and prostate neoplasms were the most frequent tumors of origin in the 55% of patients who had vertebral lesions and Hypernephroma was the most common cancer to present as a neurologic deficit secondary to an undetected primary malignancy.
Abstract: Metastatic bone disease in 322 patients was analyzed to assess the frequency and behavior of disseminated carcinoma to the vertebral column. Breast, lung, and prostate neoplasms were the most frequent tumors of origin in the 55% of patients who had vertebral lesions. The lumbar spine was the site of the greatest number of metastases. Back pain did not occur in 36% of the 179 patients with spinal disease. Cord compression occurred in 20% of the patients with vertebral involvement, and prostate tumors were the most frequent neoplasm to cause epidural spinal cord impingement. Hypernephroma was the most common cancer to present as a neurologic deficit secondary to an undetected primary malignancy.

217 citations


Journal ArticleDOI
01 Oct 1985-Spine
TL;DR: It was concluded that spondylosis up to three disc levels should be treated by subtotal spondylectomy and fusion regardless of the canal diameter, when involvement extended four or more levels, extensive laminectomy was recommended.
Abstract: Three surgical procedures for multisegmental cervical spondylotic myelopathy were evaluated on the basis of a follow-up study (12-157 months) of 95 patients. Twenty-four patients were treated by extensive laminectomy, 50 by anterior interbody fusion by the Cloward and/or Smith-Robinson techniques, and 21 by subtotal spondylectomy and fusion. Results of subtotal spondylectomy were significantly (P less than 0.01) better when compared with those of the other two procedures. It was concluded that spondylosis up to three disc levels should be treated by subtotal spondylectomy and fusion regardless of the canal diameter. When involvement extended four or more levels, extensive laminectomy was recommended.

Journal ArticleDOI
01 Nov 1985-Spine
TL;DR: This study is a retrospective review of 221 patients with untreated idiopathic thoracic and thoracolumbar scoliosis that were observed from the first months of life until maturity.
Abstract: This study is a retrospective review of 221 patients with untreated idiopathic thoracic and thoracolumbar scoliosis that were observed from the first months of life until maturity. There are three stages in the evolution of these curves: a single main period of progression, a secondary period of progression, and a stable period. The chronology of these different periods varies. In "infantile scoliosis," the main period of accelerated increase of the curve occurs prior to 6 years of age. In "juvenile-puberal scoliosis," it occurs from 6 years of age to the first stages of puberty, and in "puberal scoliosis," the main increase occurs during puberty or adolescence. The prognosis of the scoliosis can be established at any age based on different parameters, such as the specific angle of rotation from birth to 6 years of age, the torsion angle from 6 years of age to P2, and the Cobb angle after puberty.

Journal ArticleDOI
01 Apr 1985-Spine
TL;DR: In the spine, stability is affected by restraining structures that, if damaged or lax, will lend to altered equilibrium and thus instability.
Abstract: Instability is a mechanical entity, and an unstable structure is one that is not in a optimal state of equilibrium. In the spine, stability is affected by restraining structures that, if damaged or lax, will lend to altered equilibrium and thus instability. Instability is defined as loss of stiffness.

Journal ArticleDOI
01 Apr 1985-Spine
TL;DR: Application of specific fusion techniques in those patients who fail to respond to conservative treatment and require carefully selected approaches based on the overall pathology may improve the currently unacceptable low rate of success from such operations.
Abstract: Segmental instability, secondary to spinal degeneration, is a controversial topic. Based on current clinical, radiographic, and biomechanical considerations, this condition is classified as axial rotational, translational, retrolisthetic, and postsurgical instability syndromes. Each of these conditions would be expected, if untreated, to progress to a fixed deformity in which the clinical symptoms of spinal stenosis would predominate. The classification of these four types of instability suggests a need for specifically tailored fusion techniques in those patients who fail to respond to conservative treatment. Antitorsion facet fusion is suggested for axial rotatory instabilities; anterior (or posterior) interbody fusion for translational instabilities; and fusion in flexion (Knodt rods or facet fusion) for retrolisthetic instabilities. Post-surgical instability syndromes require carefully selected approaches based on the overall pathology. Application of specific fusion techniques, in carefully selected patients, may improve the currently unacceptable low rate of success from such operations.

Journal ArticleDOI
01 Dec 1985-Spine
TL;DR: Age, delay in treatment, spina bifida, and bone scan result did not correlate with the ultimate clinical result.
Abstract: Sixty-seven persons with symptomatic spondylolysis or grade 1 spondylolisthesis were treated with the modified Boston brace. The average age was 16.0 years, and the average follow-up was 2.5 years. Following treatment, 52 persons (78%) had either an excellent or good result with no pain and returned to full activities. Nine (13%) continued to have mild symptoms, and six (9%) subsequently required fusion in situ. Twelve of the patients showed radiographic evidence of healing of their pars defect(s). This group and those with the best overall results tended to be men with spondylolysis and relatively acute onset of symptoms. Age, delay in treatment, spina bifida, and bone scan result did not correlate with the ultimate clinical result.

Journal Article
01 Oct 1985-Spine
TL;DR: A prototype sagittal plane trunk strength tester was used to measure trunk strength in 286 chronic low-back pain patients, and distinct patterns characterize this patient group.
Abstract: A prototype sagittal plane trunk strength tester was used to measure trunk strength in 286 chronic low-back pain patients. Initial data for this patient group are compared with data acquired previously from a group of controls, adjusted for age, sex, and body weight. Distinct patterns characterize t

Journal ArticleDOI
01 Jul 1985-Spine
TL;DR: Subtotal discectomy induced significantly less motion at the injury site than total disceCTomy, in all loading modes, and the clinical relevance of these findings are discussed.
Abstract: The biomechanical effects of discectomy on the motion behavior of whole lumbar spine are investigated using a Selspot II system. Fresh human ligamentous specimens were potted at the sacrum and clinically relevant loads (flexion/extension, right/left lateral bending, and right/left axial torsion moments) applied through a loading frame attached rigidly to the topmost vertebra of the specimen. The resulting three-dimensional motions of each vertebra for the intact specimen were recorded. The specimen was injured sequentially on the right side of the L4-5 level: partial laminectomy, partial facetectomy, subtotal discectomy, and total discectomy. The motion behavior of the specimen after each injury was recorded. The results of the injured tests were normalized with respect to the corresponding intact results. The normalized data for eight specimens were pooled for statistical analysis. Subtotal discectomy induced significantly less motion at the injury site than total discectomy, in all loading modes. At L3-4, the motion segment above the injury level, anteroposterior translation in flexion and lateral translation in left lateral bending show significant increases irrespective of the amount of nucleus excised. The clinical relevance of these findings are discussed.

Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: It is considered that prophylactic stabilization of the spine is analogous to prophially nailing of a femur with a pathologic lesion, both the femur and spine are weight-bearing structures and the advent of segmental instrumentation makes this a feasible accomplishment with minimal morbidity.
Abstract: Metastatic tumors of the spine often cause severe pain and paralysis because of deformity and neural encroachment. As oncology now extends the life expectancies of these patients, spinal decompression and stabilization is necessary. We consider that prophylactic stabilization of the spine is analogous to prophylactic nailing of a femur with a pathologic lesion. Both the femur and spine are weight-bearing structures. The advent of segmental instrumentation makes this a feasible accomplishment with minimal morbidity. Seventeen patients with metastatic disease of the spine at Rush-Presbyterian-St. Luke's Medical Center, Chicago, were reviewed. All maintained spinal stability postoperatively. Eleven of the 17 had significant pain relief for 3 months or more. Five of 11 paralyzed patients had significant neural recovery. A classification for treatment purposes regardless of tissue type was developed. Once classified, the surgical goals for these patients were to decrease pain, to preserve or to improve neurologic function and to mobilize the patient without external orthosis.

Journal ArticleDOI
01 Oct 1985-Spine
TL;DR: The goals of this study were to measure isometric and isokinetic strength of trunk flexors, extensors and rotators, and explore relationships among these muscle groups; and compare a torque to body weight adjustment measure versus lean body weight.
Abstract: The goals of this study were to: (1) evaluate the repeatability of a method of measuring trunk strength; (2) measure isometric and isokinetic strength of trunk flexors, extensors and rotators; (3) explore relationships among these muscle groups; and (4) compare a torque to body weight adjustment mea

Journal ArticleDOI
01 Nov 1985-Spine
TL;DR: The conclusion is that a posterior decompression with preservation of the articular processes plus a transverse process fusion at the involved level is the preferred method of treatment for degenerative spondylolisthesis without regard to age.
Abstract: The purpose of this article is to evaluate three surgical approaches to the treatment of degenerative spondylolisthesis. A review of 107 surgically treated cases were used to select a group of patients who met the following criteria: No previous spine surgery, no involvement in litigation, and no significant lesions at other levels of the spine. Adequate follow-up. The selected group of 47 surgically treated cases of degenerative spondylolisthesis had follow-up of 2-7 years. Three surgical approaches to the treatment of degenerative spondylolisthesis were analyzed. A relatively small patient group with a wide posterior decompression, at the level of the slip, sacrificing the articular processes had good to excellent results in only 33% of the cases. A second group with a midline posterior decompression with preservation of the articular processes had 80% good to excellent results after 2 years. The third group with a midline decompression and preservation of the articular processes had an added intertransverse process fusion between the olisthetic levels. This group had 90% good to excellent results. The conclusion is that a posterior decompression with preservation of the articular processes plus a transverse process fusion at the involved level is the preferred method of treatment for degenerative spondylolisthesis without regard to age.

Journal ArticleDOI
01 Mar 1985-Spine
TL;DR: Biplanar radiography, although capable of differentiating between the groups was not able to provide clinically useful information concerning individual patients with this type of back pain.
Abstract: Back pain patients have restricted spinal movements, and the pattern of disturbance from normal movements may indicate the pathology and the functioning of the lumbar spine. Biplanar radiography was used to measure the three-dimensional intervertebral movements of patients with back pain alone and with back pain plus nerve tension signs demonstrated by restricted straight leg raise. Statistically significant decreases in flexion/extension compared with a normal control group were demonstrated for both groups. Accompanying coupled movements were increased only in those patients without nerve tension signs indicating asymmetrical muscle action, while those with tension signs had symmetric splinting particularly of the lower levels. Conservative treatments had no effect either clinically or on the movements. Caudal epidural injections produced clinical improvement and increased movements demonstrating relaxation of muscle splinting. Biplanar radiography, although capable of differentiating between the groups was not able to provide clinically useful information concerning individual patients with this type of back pain.

Journal ArticleDOI
01 Sep 1985-Spine
TL;DR: A multivariate correlation matrix demonstrated no typical pattern of associated abnormalities except a diminished spinal range of motion in one plane was associated with the anticipated diminishment in all other planes of motion, and often with greater restrictions of straight leg raising tests.
Abstract: Three hundred twenty-one males, ages 18-55, had standardized tests to determine height, weight, Davenport Index, leg length inequality, determination of flexion and extension torques, flexion/extension balance, range of motion, straight leg raising, and lumbar lordosis. A total of 106 (33.0%) had never experienced low-back symptoms; 144 (44.9%) had or were having moderate low-back pain (LBP); and 71 (22.1%) had or were having severe low-back symptoms. These three subgroups showed no significant differences in height, weight, Davenport Index, lumbar lordosis, or leg length inequalities. LBP patients had less flexor and extensor strength and were flexor overpowered, had diminished range of motion for spinal extension and axial rotation (P = 0.003, P = 0.0005), and diminished straight leg raising capacity (P = 0.04). A multivariate correlation matrix demonstrated no typical pattern of associated abnormalities except a diminished spinal range of motion in one plane was associated with the anticipated diminishment in all other planes of motion, and often with greater restrictions of straight leg raising tests.

Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: It is proposed that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits in idiopathic Scoliosis.
Abstract: An etiologic concept linking an impaired axial motor control system to the structural deformity of idiopathic scoliosis (ISc) is proposed. Postural studies reveal that during quiet stance, adaptation is marked in conditions associated with visual control of sway, particularly of lateral sway; during imposed perturbations of the body, destabilized postural reactions are pronounced in tests requiring visual-vestibular coupling. Observations of visual and/or vestibular generated eye movements indicate ocular instability among a high proportion of the ISc. Previously, the authors argued that a direct relationship exists between visual and/or vestibular functioning and a disordered axial motor system. This was attributed to an aberrant brain stem mechanism. In this presentation, however, we propose that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits. Among the wide range of visual-vestibular variables studied, those representing processing of vestibular signals within the CNS yield the highest degree of correlation with the magnitude of the curve. Moreover, differences in vestibular processing between two subsets of ISc, namely ISc with (70%) and without (30%) normal academic achievement are significant. Variables referable to both vestibular and visual processing correctly classify 87% of the ISc with normal academic achievement and 100% of the ISc with a history of academic problems. The association between learning deficits, altered processing of vestibular information, and ISc suggest a unique syndrome complex, and an important role of cortical structures in the etiology of this disorder. The presence of a visuo-spatial perceptual impairment may be the common feature of ISc. In an attempt to restore perceptual dysfunction (by rearrangement), the ISc adopts a new axial and vestibular motor control strategy based upon recalibration or reinterpretation of proprioceptive signals arising from the axial musculature.

Journal ArticleDOI
01 Apr 1985-Spine
TL;DR: Moiré fringes were used to determine centrode patterns in cadaveric spines with degenerative disc disease and the most complex loci noted were those discs that showed minimal radiographic evidence of degeneration, that Is, the minor and mild groups.
Abstract: Moire fringes were used to determine centrode patterns in cadaveric spines with degenerative disc disease. The normal centrodes were compared with those with minor, mild, moderate, and severe degenerative disc disease. The most complex loci noted were those discs that showed minimal radiographic evidence of degeneration, that is, the minor and mild groups. The loci lengthened significantly (P less than 0.001) when compared with normal controls. The position of the centrode shifted downward into the body of L5 in the moderate group.

Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: The higher concentration of electrolytes in the disc after a long period of loading increases its osmotic absorption force and enables the disc to hold back the remaining water, even against a considerable pressure.
Abstract: The human intervertebral disc acts as an osmotic system. Water, salt, and other low-molecular substances penetrate the cartilage plates and annulus fibrosus. The content of water, sodium, potassium, and ashes in different regions of 69 human lumbar intervertebral discs was examined before and after being loaded with certain weights. Under load, the disc loses water (annulus 11%, nucleus 8%) and gains sodium and potassium. The higher concentration of electrolytes in the disc after a long period of loading increases its osmotic absorption force and enables the disc to hold back the remaining water, even against a considerable pressure. After reduction of the pressure, water is quickly reabsorbed and the disc gains height and volume. The pumping mechanism maintains the nutrition and biomechanical function of the intervertebral disc.

Journal ArticleDOI
01 May 1985-Spine
TL;DR: Simulations show that the lumbodorsal fascia under control of the abdominal muscles contributes to reduce the stress at the intervertebral joint.
Abstract: The abdominal mechanism, utilizing intraabdominal pressure, has been described and numericized. Simulations show that the lumbodorsal fascia under control of the abdominal muscles contributes to reduce the stress at the intervertebral joint. The musculature of the lumbar spine is of primary importance in the control of the efficiency of the spinal mechanism. The system of loading, which results in observable physiologic response, maintains the compressive load at virtually 90 degrees at the bisector of the disc for all weights and all angles of forward flexion.

Journal ArticleDOI
01 Nov 1985-Spine
TL;DR: Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review of lumbar complaints and there was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed.
Abstract: Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review. The majority of the films were taken because of lumbar complaints. The mean lumbosacral (LS) angle (L2-Sacrum) was 45.05 degrees +/- .85 degrees. The mean lumbolumbar (LL) angle (L2-L5) was 29.96 degrees +/- .74 degrees. Only minor differences were found between a standardized (prospective) and a nonstandardized (retrospective) group. There was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed. A "routine" supine lateral lumbar spine roentgenogram is a very accurate means of measuring lordotic angles. A lordotic angle of less than 23 degrees defines hypolordosis and more than 68 degrees, hyperlordosis.

Journal ArticleDOI
01 Jan 1985-Spine
TL;DR: Identification of clinical findings of the fifth lumbar root involvement gave a level diagnostic accuracy comparable with myelography, while pain projection into the first sacral distribution was less reliable especially in cases with signs of two roots.
Abstract: Neurologic symptoms and signs in patients with sciatica were prospectively studied and compared with myelographic and operative findings in 403 cases with lumbar disc herniation as the cause of sciatica with special reference to accuracy of the clinical level diagnosis. Fifty-six percent of the herniations at L4-5. However, pain projection into the first sacral distribution was most common. Neurologic symptoms and signs of involvement of a single root were present in 239 cases and of two roots in 154 cases in L4-5 and L5S1 herniations. Pain projection into the fifth lumbar distribution was a very important symptom for identification of clinical findings of the fifth lumbar root involvement gave a level diagnostic accuracy comparable with myelography, while pain projection into the first sacral distribution was less reliable especially in cases with signs of two roots. The neurologic picture of high herniations was completely unreliable. Lumbar myelography or computer tomography is recommended as a routine preoperative study.

Journal ArticleDOI
01 Jul 1985-Spine
TL;DR: The observations made in this study strongly support the concept that spinal nerve roots in general and the human lumbosacral spinal nerve Roots in particular are structurally, vascularly, and metabolically unique regions of the nervous system.
Abstract: The observations made in this study strongly support the concept that spinal nerve roots in general and the human lumbosacral spinal nerve roots in particular are structurally, vascularly, and metabolically unique regions of the nervous system. Peculiarities of their intrinsic vasculature and supporting connective tissue may account for suspected "neuroischemic" responses to pathologic mechanical stresses and inflammatory conditions associated with degenerative disease of the lower spine. It is hoped that the newly described features of the radicular vasa nervorum (to avoid confusion with the dissimilar blood supply of peripheral nerves, the term "vasa radiculorum" might be more accurate) may advance the understanding of certain aspects of lower spine symptomatology and provide some basis for much needed future research.

Journal ArticleDOI
01 Apr 1985-Spine
TL;DR: Two groups of surgically treated patients with degenerative spondylolisthesis were compared and those who had decompression accompanied by fusion had more favorable outcomes than those treated with decompression alone.
Abstract: Two groups of surgically treated patients with degenerative spondylolisthesis were compared. Those who had decompression accompanied by fusion had more favorable outcomes than those treated with decompression alone.