Showing papers in "Spine in 1990"
TL;DR: The accuracy of pedicular screw placement was assessed in 40 consecutive patients treated with the AO “Fixateur Interne” with improvement in accuracy noted in the latter 25% of screw insertions, reflecting the learning curve associated with this technique.
Abstract: The accuracy of pedicular screw placement was assessed in 40 consecutive patients treated with the AO “Fixateur Interne.” Postoperative CT scans were used to measure canal encroachment from the medial border of the pedicle, the angle of insertion and the point of entry. Eighty-one percent of the scr
1,048 citations
TL;DR: A five-category grading scheme for assessing the gross morphology of midsagittal sections of the human lumbar intervertebral disc was developed and the ability of three observers to categorize a series of 68 discs with a wide spectrum of morphologies established the comprehensiveness of the classification.
Abstract: A five-category grading scheme for assessing the gross morphology of midsagittal sections of the human lumbar intervertebral disc was developed. The ability of three observers to categorize a series of 68 discs with a wide spectrum of morphologies established the comprehensiveness of the classificat
850 citations
TL;DR: An excisional operation should be performed on those cases who scored above 9 points, while a palliative operation is indicated for those who scored under 5 points, and the prognosis could not be predicted from a single parameter.
Abstract: An assessment system for the prognosis of metastatic spine tumors was evaluated for 64 cases who had undergone surgery. Six parameters were employed in the assessment system: 1) the general condition, 2) the number of extraspinal bone metastases, 3) the number of metastases in the vertebral body, 4) metastases to the major internal organs (lungs, liver, kidneys, and brain), 5) the primary site of the cancer, and 6) the severity of spinal cord palsy. Each parameter ranged from 0 to 2 points. The total score obtained for each patient can be correlated with the prognosis, while being valuable in predicting it. However, the prognosis could not be predicted from a single parameter. In conclusion, an excisional operation should be performed on those cases who scored above 9 points, while a palliative operation is indicated for those who scored under 5 points.
635 citations
TL;DR: The structure of the lumbar disc anulus fibrosus was investigated using a layer-by-layer peeling technique and microscopic examination of various cut surfaces to identify mechanisms of layer interruption at local laminate irregularities.
Abstract: The structure of the lumbar disc anulus fibrosus was investigated using a layer-by-layer peeling technique and microscopic examination of various cut surfaces. Anulus specimens from spines of two different age groups and from two levels, L2–3 and L4–5, were examined. The vertebra-disc-vertebra units
546 citations
TL;DR: Data establish biochemical evidence of inflammation at the site of lumbar disc herniations, as the enzyme responsible for the liberation of arachidonic acid from cell membranes is the rate-limiting step in the production of prostaglandins and leukotrienes.
Abstract: Inflammation of neural elements is frequently mentioned clinically in association with lumbar radiculopathy. Mechanical embarrassment of neural elements by definable structural abnormalities is inadequate as a sole explanation of nerve injury in this condition. The purpose of this study was to demonstrate whether an enzymatic marker for inflammation (phospholipase A2) could be identified in human disc samples removed at surgery for radiculopathy due to lumbar disc disease. Samples were assayed for phospholipase A2 activity. The level of activity in the disc samples was compared with values obtained from other human tissues using the same assay. Specific activity (percent hydrolysis radiolabelled substrate) ranged from 238 to 1,014.5 nmol/min/mg. Mean activity for the human disc material was 568.7 nmol/min/mg, compared with 0.006 nmol/min/mg for human PMN, and 12.1 nmol/min/mg for inflammatory human synovial effusion. The pH and cation-related activity were identical to those demonstrated for phospholipase A2 inflammatory conditions. Human lumbar disc phospholipase A2 activity is from 20- to 100,000-fold more active than any other phospholipase A2 that has been described. As the enzyme responsible for the liberation of arachidonic acid from cell membranes, phospholipase A2 is the rate-limiting step in the production of prostaglandins and leukotrienes. These data establish biochemical evidence of inflammation at the site of lumbar disc herniations.
531 citations
TL;DR: Spines from 832 deceased patients with a terminal diagnosis of malignant neoplasm were examined grossly, microscopically and radiographically for evidence of tumor and occult lesions not visible radiographically occur.
Abstract: Spines from 832 deceased patients with a terminal diagnosis of malignant neoplasm were examined grossly, microscopically and radiographically for evidence of tumor. Gross tumor and bone destruction or sclerosis were reliable signs of obvious metastases. Occult lesions visualized on gross sagittal sections but not detectable radiographically occurred in 26% of spines with confirmed metastatic deposits. Vertebral collapse was not a reliable indicator of metastases. Collapse was not caused by neoplasm in 22% of cases. Overall, metastases were found in 36% of patients dying from neoplastic disease. Although most metastases are obvious, occult lesions not visible radiographically occur. Collapsed vertebra may be impostors simulating metastatic disease.
516 citations
TL;DR: Each joint produced a clinically distinguishable, characteristic pattern of pain, which enabled the construction of pain charts that putatively could be of value in determining the segmental location of symptomatic joints in patients presenting with cervical zygapophyseal pain.
Abstract: The pain patterns evoked by stimulation of normal cervical zygapophyseal joints were determined in five volunteers. Under fluoroscopic control, joints at segments C2-3 to C6-7 were stimulated by distending the joint capsule with injections of contrast medium. Each joint produced a clinically distinguishable, characteristic pattern of pain, which enabled the construction of pain charts that putatively could be of value in determining the segmental location of symptomatic joints in patients presenting with cervical zygapophyseal pain.
469 citations
TL;DR: It is suggested that medial facetectomy does not affect lumbar spinal stability, and conversely, total facetectomy, even created unilaterally, makes the lumbr spine unstable.
Abstract: In an in vitro experiment using fresh human lumbar functional spinal units, the effects of the division of the posterior ligaments (consisting of the supraspinous/ interspinous ligaments) and graded facetectomies were investigated. The graded facetectomies consisted of unilateral and bilateral media
466 citations
TL;DR: Progressive failure of the inner anulus was seen in all sheep and occurred in the majority of discs between 4 and 12 months after the operation, suggesting that discrete tears of the outer anulus may have a role in the formation of concentric clefts and in accelerating the development of radiating clefts.
Abstract: An animal model was developed to test the hypothesis that discrete peripheral tears within the anulus lead to secondary degenerative changes in other disc components In 21 adult sheep, a cut was made in the left anterolateral anulus of three randomly selected lumbar discs The cut was parallel and adjacent to the inferior end-plate, and had a controlled depth of 5 mm This left the inner third of the anulus and the nucleus pulposus intact and closely reproduced the rim Lear lesion described by Schmorl Animals were randomly allocated to different groups in relation to the length of time interval between operation and death, varying from 1 to 18 months At death, the lumbar spine was cut into individual joint units and each disc sectioned into six parasagittal slabs After observation of the slabs under the dissecting microscope, two of the six slabs, the one containing the anulus lesion and a contralateral, were processed for histology The results of this study suggest that, despite the great care taken at operation to ensure that the inner anulus was left intact, progressive failure of the inner anulus was seen in all sheep and occurred in the majority of discs between 4 and 12 months after the operation Although the outermost anulus showed the ability to heal, the defect induced by the cut led initially to deformation and bulging of the collagen bundles, and eventually to inner extension of the tear and complete failure These findings suggest that discrete tears of the outer anulus may have a role in the formation of concentric clefts and in accelerating the development of radiating clefts Peripheral tears of the anulus fibrosus therefore may play an important role in the degeneration of the intervertebral joint complex
396 citations
TL;DR: It is concluded that disc degeneration occurs before facet joint osteoarthritis, which may be secondary to mechanical changes in the loading of the facet joints.
Abstract: The purpose of this study was to determine the relationship between facet joint osteoarthritis and disc degeneration in subjects in whom both MRI and CT scans had been obtained. The MRI scans were used to determine disc degeneration, the CT scans to determine facet joint osteoarthritis. It was hypot
375 citations
TL;DR: No patients had perithecal or perineural fibrosis, 1 patient had a progression of stenosis, and all patients had disc desiccation at the level of disc herniation with contiguous levels being normally hydrated, as well as a decrease in neural impingement.
Abstract: The purpose of this study was to evaluate the natural history of morphologic changes within the lumbar spine in patients who sustained lumbar disc extrusions. All patients in this study were treated nonoperatively for radicular pain and neurologic loss. The following questions were addressed: 1) Does perithecal or perineural fibrosis result when extrusions are not removed surgically, and 2) Do disc extrusions spontaneously resolve, and, if so, how rapidly? The study population consisted of 11 patients with extrusions and radiculopathy. All patients were successfully treated nonoperatively. All had a primary complaint of leg pain and all had positive straight leg raising reproducing their leg pain at less than or equal to 60 degrees. Additionally, 87% had muscle weakness on a neurologic basis in a root level distribution corresponding to the site of disc pathology. Computed tomographic (CT) examinations were obtained on all patients at the inception of treatment. These studies were compared with follow-up MRI studies. The initial CT scans were evaluated for the following criteria: disc size and position, thecal sac effacement, nerve root enlargement or displacement, and evidence of central or intervertebral canal stenosis. In addition to the pathomorphology evaluated on the CT scans, follow-up MRI studies also evaluated disc hydration at the herniated and contiguous levels, and the presence of perithecal or perineural fibrosis. The following grading system was used to evaluate change in fragment size on the follow-up studies: Grade 1-0 to 50% decrease in size; Grade 2-50 to 75% decrease in size; Grade 3-75 to 100% decrease in size.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Cumulative compression and shear were significantly higher in institutional aides with pain compared with those without pain (P < 0.01), and the pain group was similar to the no-pain group in age, weight, and height.
Abstract: The association between cumulative load (biomechanic load and exposure time integral over the entire work experience) and back pain was investigated in a group of institutional aides with physically stressful jobs. A questionnaire/interview was conducted with 161 of these institutional aides. The point prevalence of back pain in this sample was 62%. Men had worked a mean duration of 14.3 years and women 11.6 years at the time of the onset of the first pain episode. Every job performed was analyzed by the use of a two-dimensional static mathematical model. The compression and shear at the thoracolumbar and lumbosacral discs were computed by the use of a biomechanic model. Cumulative compression and shear were significantly higher in institutional aides with pain compared with those without pain (P less than 0.05-0.01). The pain group was similar to the no-pain group in age, weight, and height.
TL;DR: The increased resistance to failure from posteriorly directed forces and independence from variations in bone mineral density may indicate that laminar hooks are superior to spinous process wires and pedicle screws for spinal fixation in patients with decreased bone mineraldensity due to osteoporosis, osteomalacia, or other forms of metabolic bone disease.
Abstract: Posteriorly directed load to failure testing of four different types of spinal implants was performed in individual T5 to S1 vertebra harvested from seven fresh-frozen human cadaveric spines. The implants tested were: 1) Drummond spinous process wires, 2) Harrington laminar hooks, 3) Cotrel-Dubousset transpedicular screws, and 4) Steffee VSP transpedicular screws. The ultimate failure of each implant was compared with the bone mineral density of each vertebra to determine which implants, if any, were particularly advantageous in osteoporotic vertebrae. Before biomechanical testing, the spines were analyzed in vitro by dual photon absorptiometry to determine the bone mineral densities (gm/cm2) of each vertebra. The mean tensile loads to failure for each of the implants tested were as follows: Cotrel-Dubousset transpedicular screws: 345 Newtons; spinous process wire/button: 382 Newtons; Steffee transpedicular screws: 430 Newtons; and laminar hooks: 646 Newtons. The difference between the loads to failure for laminar hooks and the other implants was significant (P less than 0.05) using one-way analysis of variance. The overall correlation coefficient for bone mineral density with ultimate load to failure was 0.30 (P less than 0.001). The correlation coefficients were 0.47 (P less than 0.001) for spinous process wires alone; 0.096 (not significant) for laminar hooks alone; 0.37 (P less than 0.001) for Cotrel-Dubousset pedicle screws; and 0.48 (P less than 0.001) for Steffee pedicle screws. Of the four different implants tested, laminar hooks were most resistant to failure from posteriorly directed forces.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: This study supports the hypothesis that posterior distraction instrumentation can effectively decompress the canal and correct kyphosis in patients sustaining burst-type injuries and results in a more complete and reliable decompression of the canal.
Abstract: The authors instituted a prospective, randomized study of patients presenting with acute burst fractures of the thoracolumbar and lumbar spine. Patients were alternately treated by posterior distraction using pedicle instrumentation (AO fixateur interne) or anterior decompression and instrumentation (Kostuik-Harrington device). Forty patients are presented with a mean follow-up of 20 months. Preoperatively, there was significant canal compromise in 39 patients. This measured 44.5% in those patients undergoing posterior surgery and 58% in those patients undergoing anterior surgery. Postoperatively, this was reduced to 16.5% and 4%, respectively. There is a statistically significant difference between these two groups (P less than 0.0001). The mean preoperative kyphotic deformity was 18.7 degrees in those patients treated by anterior surgery and 18.2 degrees in the group treated by posterior surgery. At last follow-up, the mean improvement in kyphotic deformity was 9.3 degrees in the anterior group and 11.3 degrees in the posterior group. There is no statistically significant difference between these two groups. There were two implant failures of the anterior Kostuik-Harrington construct and two implant failures of the AO fixateur interne. Blood loss was significantly higher in the patients undergoing anterior surgery, but there were no complications from thoracotomy and anterior decompression of the dural sac. This study supports the hypothesis that posterior distraction instrumentation can effectively decompress the canal and correct kyphosis in patients sustaining burst-type injuries. Anterior surgery, however, results in a more complete and reliable decompression of the canal.
TL;DR: It appears that the ability of MRI to aid in examination of the condition of the spinal cord will offer a means of predicting neurologic recovery following acute spinal cord injury.
Abstract: Magnetic resonance imaging (MRI) was performed on 37 patients with acute spinal injury using T1- and T2-weighted images. Three different types of MRI signal patterns were detected in association with these spinal cord injuries. A classification was developed using these three patterns. Type I, seen in ten (27.0%) of the patients, demonstrated a decreased signal intensity consistent with acute intraspinal hemorrhage. Type II, seen in 16 (43.2%) of the patients, demonstrated a bright signal intensity consistent with acute cord edema. Type III, seen in three (8.1%) of the patients, demonstrated a mixed signal of hypointensity centrally and hyperintensity peripherally consistent with contusion. The remaining eight patients had normal cords by MRI. All 37 patients had an admitting neurologic assessment and classification of their spinal injury according to the Frankel classification and the Trauma Motor Index (TMI). At an average of 12.1 months postinjury, their neurologic function was reassessed. Patients with Type I patterns showed no improvement in their Frankel classification and minimal improvement in their TMI, 32.1 to 42.4. In comparison, all of the Type II and III patterns improved at least one Frankel classification. The Type II TMI increased from 70.8 to 91.9 and Type III from 37.3 to 75.7. This preliminary report indicates a distinct correlation between the pattern of spinal cord injury as identified by MRI and neurologic recovery. It appears that the ability of MRI to aid in examination of the condition of the spinal cord will offer a means of predicting neurologic recovery following acute spinal cord injury.
TL;DR: A retrospective review of 94 patients who have undergone anterior cervical discectomy and fusion was performed to analyze the result in patients who had a diagnosis of posterolateral spondylosis, disc herniation, or both, finding that there was an 88% good or excellent result when no additional spONDylosis was present.
Abstract: A retrospective review of 94 patients who had undergone anterior cervical discectomy and fusion was performed to analyze the result in patients who had a diagnosis of posterolateral spondylosis, disc herniation, or both. Although in 23 of 94 patients additional adjacent asymptomatic levels of spondylosis were noted, only the symptomatic levels were addressed in the 94 cases. Postoperatively two cases of dysphagia were noted, as well as a 4% pseudarthrosis rate. There was an 88% good or excellent result when no additional spondylosis was present, but only a 60% good or excellent result when just the symptomatic levels were addressed, leaving unoperated adjacent levels of spondylosis.
TL;DR: To test the predictive value of segmental pain charts for predicting the segmental location of symptomatic joints in patients with cervical joint pain, ten patients with suspected cervical zygapophyseal pain were studied.
Abstract: To test the predictive value of segmental pain charts, ten patients with suspected cervical zygapophyseal pain were studied Their pain distribution was recorded on a body diagram, and using pain charts derived from studies on normal volunteers, predictions were made by two observers of the segmental location of the symptomatic joint Correct predictions were made in all nine patients who were shown to have symptomatic joints on the basis of diagnostic joint blocks The results vindicate the accuracy of pain charts for predicting the segmental location of symptomatic joints in patients with cervical joint pain
TL;DR: Results show that although both anterior fusion and cervical laminotomy-foraminotomy provide satisfactory results in the surgical management of anterolateral soft disc herniation, anterior fusion provides better long-term improvement; and anterior cervical fusion provides safe and effective results for the management of central discHerniation.
Abstract: Anterior cervical fusion was initially described in the 1950s for cervical spondylotic radiculopathy. The indications for this procedure in the management of soft disc herniation have not been clearly defined. In addition, controversy exists as to whether a cervical soft herniation should be managed by an anterior approach or a posterior cervical laminotomy-foraminotomy. The authors report the results of a prospective study comparing anterior discectomy and fusion to posterior laminotomy-foraminotomy for the management of soft cervical disc herniation. Twenty-eight patients underwent anterior discectomy and fusion (Robinson horseshoe graft) while 16 patients underwent posterior laminotomy-foraminotomy. The disc herniations were classified into two types. Type I were single level anterolateral herniations (33 patients) while type II were central soft disc herniations (11 patients). Clinically, patients with type I herniations manifested signs and symptoms of radiculopathy while patients with type II herniations manifested signs of myelopathy or neck pain and bilateral upper extremity paresthesias in 4 patients. Confirmatory studies were myelography in 12 patients, myelography combined with computed tomography (CT) in 26 patients, and magnetic resonance imaging (MRI) in 6 patients. For type I herniations, 17 patients underwent anterior fusion while 16 patients had a posterior laminotomy-foraminotomy. The 11 patients classified as type II herniation all underwent anterior discectomy and fusion. There were 27 men and 17 women. The age range was 21 to 52 years (mean, 41 years). The follow-up was 1.6 to 8.2 years (mean, 4.2 years).(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Observations on sectioned and opened preparations of human sacroiliac joints show the presence of cartilage-covered ridges and depressions, which are complementary on the auricular surfaces, and this type of roughening is viewed as a nonpathologic adaptation to the forces exerted at the SI joints, leading to increased stability.
Abstract: Observations on sectioned and opened preparations of human sacroiliac joints (SI joints) show the presence of cartilage-covered ridges and depressions, which are complementary on the auricular surfaces. These macroscopically visible features of the joints, which become visible relatively early in life, are more pronounced in men than in women. This type of roughening, as well as that by increased coarseness of the auricular surface, is viewed as a nonpathologic adaptation to the forces exerted at the SI joints, leading to increased stability. Differences between men and women may be attributed to childbearing and to a difference in the center of gravity. It is emphasized that intra-articular ridges and depressions can be misinterpreted roentgenologically as osteophytes.
TL;DR: The results indicate that the least pathology stemmed from moderate or mixed physical loading, but the least back pain was associated with sedentary work.
Abstract: The occurrence of symmetric disc degeneration, anular ruptures, end-plate defects, vertebral body osteophytosis, and facet joint osteoarthrosis was examined radiographically and osteologically in 86 male cadavers for whom occupational, physical loading, and back pain histories were obtained from the men's families History of back pain and the parameters of spinal pathology were related to the highest and lowest degrees of physical loading In multivariate analyses, history of back injury was related to the occurrence of symmetric disc degeneration, anular ruptures, and vertebral osteophytosis Symmetric disc degeneration was associated with sedentary work, and vertebral osteophytosis was related to heavy work History of back pain was related to occupational physical loading after control for the effects of the other covariates The results indicate that the least pathology stemmed from moderate or mixed physical loading, but the least back pain was associated with sedentary work
TL;DR: Calculation of dynamic vertebral translation provided a more accurate assessment of vertebral motion than measurement of static displacement on a flexion or extension view alone, and suggested that the previously reported large range of motion and frequency of overlap between symptomatic and asymptomatic patients may be significantly decreased by calculating dynamic motion, rather than static vertebral positions.
Abstract: The utility or futility of flexion-extension radiographs in the diagnosis of lumbar spine segmental instability is a controversial issue. Previous investigations have reported a large range of normal motion and a significant overlap of symptomatic and asymptomatic motion patterns. The authors' goal was to define normal lumbosacral motion in vivo using ordinary weight-bearing lateral flexion-extension radiographs from 40 volunteers without the use of computers or special X-ray equipment. Calculation of dynamic vertebral translation, defined as the change in relative position from flexion to extension, provided a more accurate assessment of vertebral motion than measurement of static displacement on a flexion or extension view alone. Normal lumbar vertebral levels should have less than 3.0 mm of dynamic anteroposterior (AP) translation (less than 8% of vertebral body width). Although 42% of the normal subjects had at least one level with a static olisthesis greater than 3.0 mm in either flexion or extension, only 5% had a dynamic AP translation greater than 3.0 mm. These data have suggested that the previously reported large range of motion and frequency of overlap between symptomatic and asymptomatic patients may be significantly decreased (eightfold) by calculating dynamic motion, rather than static vertebral positions. The authors believe these data will provide the basis for reassessment of flexion-extension radiography in the diagnosis of lumbar spine instability.
TL;DR: The results suggest that SI is a useful criteria to assess deformity and predict progression of segmental kyphosis.
Abstract: In an effort to quantify the risk for late progression in burst fractures, the sagittal index (SI) was defined to help to assess the segmental deformity at the level of the fracture. The SI is a measurement of the kyphotic segmental deformity corrected for the normal sagittal contour at the level of the deformed segment. A prospective study was devised in 1986 for burst fracture treatment. Complete data were available on 35 patients (22 males, 13 females), with an average follow-up of 27 months. SI was greater than 15 degrees in the first group, the members of which were treated surgically. The technique is described. SI was less than 15 degrees in the third group, the members of which were treated conservatively. The second control group included patients with SI greater than 15 degrees but who were not treated according to the authors protocol for independent reasons. The results suggest that SI is a useful criteria to assess deformity and predict progression of segmental kyphosis.
TL;DR: The results indicate that the least pathology stemmed from moderate or mixed physical loading, but the least back pain was associated with sedentary work.
Abstract: The occurrence of symmetric disc degeneration, anular ruptures, end-plate defects, vertebral body osteophytosis, and facet joint osteoarthrosis was examined radiographically and osteologically in 86 male cadavers for whom occupational, physical loading, and back pain histories were obtained from the men's families. History of back pain and the parameters of spinal pathology were related to the highest and lowest degrees of physical loading. In multivariate analyses, history of back injury was related to the occurrence of symmetric disc degeneration, anular ruptures, and vertebral osteophytosis. Symmetric disc degeneration was associated with sedentary work, and vertebral osteophytosis was related to heavy work. History of back pain was related to occupational physical loading after control for the effects of the other covariates. The results indicate that the least pathology stemmed from moderate or mixed physical loading, but the least back pain was associated with sedentary work.
TL;DR: Results show that articular surfaces with both coarse texture and ridges and depressions have high friction coefficients, compatible with the view that roughening of the SI joint concerns a physiologic process.
Abstract: The amount of friction between the articular surfaces of sacroiliac (SI) joints was determined and related to the degree of macroscopic roughening. Results show that articular surfaces with both coarse texture and ridges and depressions have high friction coefficients. The influence of ridges and de
TL;DR: The mechanism and progression of disk slippage were studied clinically and radiographically in 40 patients and it was suggested that the mechanisms of spinal restabilization prevent progression of the disease.
Abstract: To clarify the natural course of degenerative spondylolisthesis, the mechanism and progression of disk slippage were studied clinically and radiographically in 40 patients. Progressive slippage was observed in 12 patients (30%). No progression of slippage was noted in patients who showed narrowing of the intervertebral disk, spur formation, subcartilaginous sclerosis, or ossification of ligaments. These suggest that the mechanisms of spinal restabilization prevent progression of the disease. General joint laxity was observed in many patients (65%), and this was believed to be involved in the pathogenic mechanism of this disease. There was no correlation between the clinical symptoms and progression of slippage. These findings suggest that careful consideration of the natural mechanisms of spinal restabilization as well as the natural course of the disease is important.
TL;DR: Male gymnasts had significantly increased incidence and severity of back pain as compared to the rest of the athletes, and athletes with great demands on the back are subjected to an increased risk of symptomatic damage of the spine.
Abstract: Back pain and radiological changes of the thoraco-lumbar spine were investigated in 142 top athletes, representing wrestling, gymnastics, soccer and tennis (age range 14-25 years). All groups of athletes reported back pain at high frequencies (50-85%). Male gymnasts had significantly increased incidence and severity of back pain as compared to the rest of the athletes. Radiological abnormalities occurred in 36-55% of the athletes. Reduced disc height, Schmorl's nodes and change of configuration of vertebral bodies correlated with back pain (P less than 0.05, P less than 0.01 and P less than 0.05). Significant covariation between these types of abnormalities was found. Athletes with great demands on the back are thus subjected to an increased risk of symptomatic damage of the spine.
TL;DR: In patients with low-back and radiating leg pain, a clinical phenomenon has been described known as "centralization", which occurs during a mechanical evaluation protocol described by McKenzie as mentioned in this paper.
Abstract: In patients with low-back and radiating leg pain, a clinical phenomenon has been described known as "centralization," which occurs during a mechanical evaluation protocol described by McKenzie. Relocation of the most distal pain in a proximal or central direction characterizes the pain behavior when patients are assessed in this fashion. Centralization typically occurs rapidly and can be maintained. In a review of 87 such patients, centralization occurred in 76 (87%). Its occurrence during initial mechanical evaluation is a very accurate predictor of successful treatment outcome and reliably determines the appropriate direction of treatment exercise. Nonoccurrence of centralization accurately predicts poor treatment outcome and was a helpful early predictor of the need for surgical treatment.
TL;DR: The effectiveness of bone graft stimulation with the device is established and a randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed.
Abstract: A randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed on 195 subjects. There were 98 subjects in the active group and 97 subjects in the placebo group. A brace containing equipment to induce an electromagnetic field was applied to patients undergoing interbody fusion in the active group, and a sham brace was used in the control group. In the active group there was a 92% success rate, while the control group had a 65% success rate (P greater than 0.005). The effectiveness of bone graft stimulation with the device is thus established.
TL;DR: Patients with low back pain and sciatica of various causes were reviewed with reference to problems associated with pedicle plate fixation of the lumbar spine and it was recommended that screw and plate materials be improved to prevent screw breakage.
Abstract: Fifty-seven patients with low back pain and sciatica of various causes were reviewed with reference to problems associated with pedicle plate fixation of the lumbar spine. Eleven percent of patients had neurologic problems postoperatively and 3.5% (two patients) had severe sensory impairments. All patients had this complication in the early phases of the study. Of 297 screws, 17 broke, ie, 5.7%. These breakages occurred in 12 of 57 patients (21%). In patients with spondylolisthesis, the degree of slip correction averaged 53% postoperatively, which decreased to 35% at the 1-year follow-up. Slip angle was maintained after correction. Pedicle screw plate fixation is an effective form of immobilization of the lumbar spine used in achieving arthrodesis. The surgeon must be fully trained in methodology. It is recommended that screw and plate materials be improved to prevent screw breakage.
TL;DR: The most reliable test results showed that the IM LB EXT strength curves were linear and descending from flexion to extension and ranged from 235.8 ± 85.2 to 464.9 ± 150.7 N · m for men and from 134.6 ± 53.9 N. m for women.
Abstract: The purpose of this study was to evaluate the reliability and variability of repeated measurements of isometric (IM) lumbar extension (LB EXT) strength made at different joint angles. Fifty-six men (age, 29.4 +/- 10.7 years) and 80 women (age, 24.3 +/- 9.1 years) completed IM LB EXT strength tests on 3 separate days (D1, D2, and D3). On D1 and D2, subjects completed two tests (T1 and T2) separated by a 20- to 30-minute rest interval. For each test, IM LB EXT strength was measured at 72, 60, 48, 36, 24, 12, and 0 degrees of lumbar extension. Mean IM strength values, within-day reliability coefficients, and test variability over the seven angles improved from D1 to D2 (D1: mean, 160.0 to 304.1 N.m, r = 0.78 to 0.96, SEE = 37.6 to 46.9 N.m; D2: mean, 176.3 to 329.1 N.m, r = 0.94 to 0.98, SEE = 29.0 to 34.4 N.m). Mean strength values leveled off by D3 (174.5 to 317.0 N.m). The most reliable test results showed that the IM LB EXT strength curves were linear and descending from flexion to extension and ranged from 235.8 +/- 85.2 to 464.9 +/- 150.7 N.m for men (extension to flexion) and from 134.6 +/- 53.2 to 237.3 +/- 71.9 N.m for women. Lumbar extension strength was clearly greatest in full flexion, which is in contrast to previously reported results. One practice test was required to attain the most accurate and reliable results. These data indicate that repeated measures of IM LB EXT strength are highly reliable and can be used for the quantification of IM LB EXT strength through a range of motion.