Spine
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Twenty-one cases of chordoma arising in the mobile spine were retrospectively reviewed. ⋯ En bloc excision--even if marginal--is the treatment of choice of chordomas of the spine. Early diagnosis and careful surgical staging and planning are necessary. Megavoltage radiation can be administered as an adjuvant.
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Sixty radiographs were measured on two separate occasions by three physicians using four different techniques to evaluate the reliability and reproducibility of the measurement of lumbar lordosis. ⋯ The measurement of lumbar lordosis is reproducible and reliable if the technique is specified and one accepts 10 degrees as acceptable variation. Factors that affect the reproducibility of measurement include end vertebra selection (especially with transitional segments) and vertebral endplate architecture.
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The cervical spine of an 86-year-old man known to have a fracture of the odontoid process was removed at autopsy and dissected. ⋯ Both the fatal outcome and the pathologic examination showed that established management concepts, particularly screw fixation of a fractured odontoid process, should be reconsidered in light of the potential occurrence of transdental posterior rotary subluxation. Because the incidence of capsular, ligamentous, and vascular injuries associated with fractures of the odontoid process is still poorly understood, more autopsies would be needed. The case also raises the question of whether, in an elderly patient like ours, a fracture of the odontoid process should prompt immediate surgical stabilization.
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Intraoperative recording of somatosensory-evoked potentials is useful for monitoring spinal cord tolerance during spinal fusion with instrumentation. Volatile anesthetic agents are known to have prominent suppressive effects on somatosensory-evoked potentials. This study evaluates the effect of intrathecal administration of opioid, consisting of morphine sulfate and sufentanil, on somatosensory-evoked potential monitoring. ⋯ Somatosensory-evoked potential monitoring was possible in all patients undergoing extensive spinal surgery. Intrathecal opioid anesthesia with low concentrations of isoflurane in air and oxygen seems to have no effects on somatosensory-evoked potentials.
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Biography Historical Article
The rise and fall of Erichsen's disease (railroad spine).
The railroad represented one of the major technologic achievements of the 19th century. Sadly, railroad collisions, which resulted in major injuries and loss of life, began to tarnish the image of this popular mode of transportation. Public alarm about rail travel intensified in 1866, when noted British surgeon John Eric Erichsen described a peculiar progressive spinal disorder, similar to spinal concussion, that was a sequela to railroad accident or injury. The history of this disorder, which came to be known as "railroad spine" or "Erichsen's disease", represents a little known yet important chapter in the evolution of the modern comprehension of functional illness that can complicate or even replace an initial substrate of organic disease.