Spine
-
Comparative Study
Morphometric comparison of the pedicle rib unit to pedicles in the thoracic spine.
A radiographic study of the pedicle rib unit morphology as compared with measurements of the pedicle in cadaveric thoracic spines. ⋯ This study confirms the marked difference in size of the pedicle rib unit as compared with the pediclein both transverse width and chord length. This allows for a space that accommodates much larger major screw diameters, longer screw lengths, and because of the nature of screw placement, a greater screw convergence. Thus, there is anatomic potential for extrapedicular vertebral body fixation in the thoracic spine. However, care must be taken in placement of screws following precisely our previously described method of extrapedicular screw insertion. Penetration of surrounding structures, most notably the aorta on the left, is a potential risk when deviating from the method. Biomechanical evaluations are presently being conducted to evaluate the use of extrapedicular thoracic screw fixation.
-
Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord in the cervical or thoracic region. Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. In particular, cervical disc herniation has been rarely reported as a cause of this syndrome, and including the first article of Stookey in 1928, 9 only 22 cases have been reported. ⋯ A critical review of the pertinent literature is proposed, and the neuroradiologic, therapeutic, and prognostic implications are discussed. Brown-Sequard syndrome produced by a cervical disc herniation is presumably often underdiagnosed, and early surgical intervention is always recommended.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device.
A prospective, randomized, controlled clinical trial comparing a cylindrical threaded titanium cage to a femoral ring allograft control for anterior lumbar interbody fusion. ⋯ Cylindrical threaded titanium cages have a higher fusion rate, comparable improvements in clinical outcome (Oswestry, Low Back Pain Questionnaire, SF-36), and fewer secondary supplemental fixation procedures compared to the femoral ring allograft control.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Characterization of acute whiplash-associated disorders.
An experimental study of motor and sensory function and psychological distress in subjects with acute whiplash injury. ⋯ Acute whiplash subjects with higher levels of pain and disability were distinguished by sensory hypersensitivity to a variety of stimuli, suggestive of central nervous system sensitization occurring soon after injury. These responses occurred independently of psychological distress. These findings may be important for the differential diagnosis of acute whiplash injury and could be one reason why those with higher initial pain and disability demonstrate a poorer outcome.
-
A retrospective outcomes study. ⋯ Two-level discectomy is an effective treatment with clinical outcome comparable with single-level discectomy. Patients with posterolateral disc herniations and definitive radiculopathy without osseous degenerative changes at the same levels have better clinical outcome and quality of life scores compared with those patients having concomitant degenerative arthritis at the same levels. Patients having two-level discectomy may be at increased risk of requiring subsequent lumbar fusion compared with those with single-level discectomy.