Spine
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Retrospective review of all patients who underwent surgical treatment of cervical spondylitic myelopathy and were monitored by somatosensory evoked potentials. ⋯ 1) Multilevel anterior cervical decompression and fusion produced a significant improvement in the motor function of patients with cervical spondylitic myelopathy. 2) Patients with intraoperative increase in amplitude or shortening of latency had a more rapid clinical improvement than patients with stable recordings. 3) Long-term reassessment did not show any difference between patients with intraoperative somatosensory evoked potential improvement and those with stable somatosensory evoked potential recordings. Therefore, somatosensory evoked potential improvements cannot be used to determine prognosis at the present time. 4) A greater number of patients should be studied using more objective methods for quantifying gait patterns and motor function.
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Comparative Study
Validation of the American Spinal Injury Association (ASIA) motor score and the National Acute Spinal Cord Injury Study (NASCIS) motor score.
In this study the motor scores of 62 consecutive acute spinal cord-injured patients were retrospectively reviewed. ⋯ The American Spinal Injury Association and National Acute Spinal Cord Injury Study motor scores can both be used for the neurological quantification of motor deficit and motor recovery.
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This study analyzed anteroposterior, lateral, inlet, and outlet radiographic representations of different iliosacral screw orientations and evaluated anatomic features of the superior aspects of the sacral alae. ⋯ The inlet view shows the orientation of screws relative to the coronal plane and extraosseus screws extending anterior to the ala, whereas the outlet view elucidates the placement of screws relative to the transverse plane and extraosseus screw tips extending into the sacral foramina or superior to the ala. Evaluation of preoperative pelvic computed tomography scans may be helpful in understanding the unique morphology of each individual patient and enhancing the safety of iliosacral screw placement.
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In embalmed human bodies the tension of the long dorsal sacroiliac ligament was measured during incremental loading of anatomical structures that are biomechanically relevant. ⋯ The long dorsal sacroiliac ligament has close anatomical relations with the erector spinae muscle, the posterior layer of the thoracolumbar fascia, and a specific part of the sacrotuberous ligament (tuberoiliac ligament). Functionally, it is an important link between legs, spine, and arms. The ligament is tensed when the sacroiliac joints are counternutated and slackened when nutated. The reverse holds for the sacrotuberous ligament. Slackening of the long dorsal sacroiliac ligament can be counterbalanced by both the sacrotuberous ligament and the erector muscle. Pain localized within the boundaries of the long ligament could indicate among other things a spinal condition with sustained counternutation of the sacroiliac joints. In diagnosing patients with aspecific low back pain or peripartum pelvic pain, the long dorsal sacroiliac ligament should not be neglected. Even in cases of arthrodesis of the sacroiliac joints, tension in the long ligament can still be altered by different structures.
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Segmental mobility and intradiscal pressure were measured and the data compared in six cadaveric lumbar spine specimens before and after in vitro simulated single level L4-5 and double level L4-5-S1 anterior interbody fusions. ⋯ There is no evidence that the neighboring unfused segments are loaded beyond their physiological limits due to the fusion. However, the neighboring unfused segments have to work more frequently toward the extremes of their functional ranges of motion after fusion and these effects will be more marked after a double level L4-5-S1 fusion.