Spine
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The benefits of achieving rigid internal fixation and eliminating the need for postoperative external orthotic support with L-rod spinal instrumentation made it desirable for use in the surgical treatment of neuromuscular scoliosis. From May 1981 to May 1985, 31 severely involved cerebral palsy patients with progressive spinal deformity underwent posterior fusion and L-rod instrumentation. All patients except one were nonambulatory. ⋯ Six Group II patients were not fused into the sacrum. Scoliosis and pelvic obliquity were corrected in both groups. Torso decompensation improved to 2.7 cm in the Galveston group, but increased to 5.6 cm at follow-up in the patients not fused into the sacrum.(ABSTRACT TRUNCATED AT 250 WORDS)
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The influence of low-back trouble on lumbar sagittal mobility was explored in 958 individuals aged 10 to 84 years. Experience of low-back trouble was determined by questionnaire, and categorized as none, a previous history, or a current spell. Maximal mobility was estimated from flexicurve records of back surface curvature. ⋯ Similarly hypomobility was found in nonsufferers as well as in those with back trouble. The data indicated that young adults (notably males) with previous low-back trouble may not recover their previous mobility on symptomatic resolution. The finding of hypermobility in current sufferers indicates that mobilization therapy may not be appropriate for such patients.
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This paper analyzes the initial effect of the Zielke VDS operation on S-shaped idiopathic spinal curves in 17 patients with particular reference to the thoracic spine. The curves are evaluated by conventional methods (Cobb angle, apical vertebral rotation, kyphosis, and lordosis) and by a new method using end vertebra angles (EVAs). Three new surgical correction indices are used. ⋯ The thoracic apical vertebral rotation shows variable changes. The findings show that the correction of the upper curve occurs mainly in the thoracolumbar spinal segment. It is suggested that this junctional segment of the spine is of importance in determining the limits of both instrumentation and fusion for idiopathic scoliosis.
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The Dallas Pain Questionnaire (DPQ) was developed to assess the amount of chronic spinal pain that affects four aspects (daily and work-leisure activities, anxiety-depression, and social interest) of the patients' lives. Results of the DPQ's statistical properties suggest that the DPQ is an externally reliable instrument as well as internally consistent. Two factors emerged from factor structure analysis. ⋯ A t test demonstrated that chronic pain patients have significantly higher DPQ scores than normals. Because these findings support its statistical properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.
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In order to define the indications for spinal fusion in patients undergoing decompression for lumbar spinal stenosis, 114 patients surgically treated were reviewed. Follow-up was 24 to 108 months. Patients were grouped into four categories: 15 with lateral recess stenosis, 45 with central-mixed stenosis, 43 with stenosis following prior lumbar surgery(s), and 11 with scoliosis and spinal stenosis. ⋯ In those with stenosis following prior lumbar surgeries, although not statistically significant, those who had concomitant decompression and arthrodesis had a better outcome than those in whom decompression only was done. Patients with scoliosis and stenosis had decompression for significant motor and reflex deficits and fusion over the length of their major curves. Patients having decompression for lumbar stenosis with degenerative spondylolisthesis, isolated disc resorption with degenerative facet joints, intervertebral disc disease with instability, and those with scoliosis with multidirectional instabilities benefit from concomitant spinal fusion.