Spine
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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.
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This article is the second in a series examining the employment practices of Sears, Roebuck and Co. in light of its compliance with the Americans with Disabilities Act of 1990. Sears employs approximately 20,000 persons with disabilities, nearly 7000 individuals with orthopedic disabilities. The article describes findings from two major areas of inquiry relevant for spine professionals: 1) the costs and benefits of workplace accommodations, and 2) the ways in which Sears and other companies informally and formally resolve Americans with Disabilities Act Title I disputes.
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The authors studied the vascular anatomy of the thoracic and lumbar spine in cadavers related to the clinical use of total en bloc spondylectomy in malignant vertebral tumors. ⋯ Total en bloc spondylectomy conducted posteriorly is less likely to damage the thoracic aorta from T1 to T4 but, distal to T5, the aorta must be carefully retracted anteriorly before manipulation of the affected vertebra(e). For a malignant tumor involving L1 or L2, the medial and, occasionally, the intermediate crura of the diaphragm and the first two lumbar arteries must be treated carefully before spondylectomy. Malignant tumors involving the L3 and L4 vertebral bodies can be approached with a total en bloc spondylectomy technique only when the inferior vena cava has been safely retracted anteriorly.
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This study retrospectively analyzed the outcome of unilateral vertebral artery ligation during cervical spine surgery. ⋯ A vertebral artery could be ligated uneventfully when the diameter of the vertebral artery was not larger than the one not involved. Where vertebral artery ligation could not be avoided, it should be confirmed by preoperative angiogram that the other vertebral artery is large enough and that simultaneous occlusion testing of the involved vertebral artery is uneventful.