Spine
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Comparative Study
Posterior fixation of thoracic and lumbar spine fractures using DC plates and pedicle screws.
A prospective investigation of internal fixation of acute thoracic and lumbar spine fractures using pedicle screws and dynamic compression plates was performed. This article details the results of 23 patients who were followed for an average of 20 months. The indications for the procedure were an unstable fracture--dislocation below the eighth thoracic vertebra or low lumbar fractures that would be difficult to treat with conventional spinal implants. ⋯ There was no increase in neurologic deficit. One patient developed an asymptomatic pseudarthrosis demonstrated by breakage of both plates through unfilled screw holes at the motion segment. Other complications included one wound infection, one case of arachnoiditis after an intradural bone fragment was excised, and one dural tear created by a Kirschner wire, which did not result in a neurologic deficit or a cerebrospinal fluid leak.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Hypotensive anesthesia for scoliosis surgery in Jehovah's Witnesses.
Hypotensive anesthesia has been advocated in spinal surgery for the purpose of diminishing operative blood loss. This study evaluated its effectiveness in 12 Jehovah's Witnesses undergoing Harrington instrumentation and fusion who refused transfusion. Previous series from this institute did not use deliberate hypotension because of routinely low blood loss. ⋯ The majority of blood losses in spinal instrumentation with fusion occurs with decortication. This rapid bleeding occurs at venous pressures which are unaffected by arterial blood pressure manipulation. The authors conclude that spinal surgery is possible in Jehovah's Witnesses without transfusion and that operative technique is the single most important determinant of blood loss.
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The hypothesis for the mechanism of production of scoliosis, advanced on the basis of morphometric and morphologic studies in human thoracic skeleton, finds further support in the results of an experimental study in rabbits described herein. The removal of transverse processes alone resulted in the production of scoliosis and lordosis. When both transverse processes and facet joints were removed, scoliosis developed rapidly and was considerable. ⋯ The convexity of the curve was always toward the operated side, and the apex was almost always at the lowest operated segment. Lordosis was limited to within the operated area. The results of the experiment indicate that scoliosis resulted because of the asymmetry in load transmission through the ribs to the vertebral column in rabbits.
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A longitudinal, prospective study was conducted on 3,020 aircraft employees to identify risk factors for reporting acute back pain at work. The premorbid data included individual physical, psychosocial, and workplace factors. During slightly more than 4 years of follow-up, 279 subjects reported back problems. ⋯ The quintile of subjects scoring highest on Scale-3 (Hy) of the MMPI were 2.0 times more likely to report a back injury (P = 0.0001) than subjects with the lowest scores. The multivariate model, including job task enjoyment, MMPI Scale-3, and history of back treatment, revealed that subjects in the highest risk group had 3.3 times the number of reports in the lowest risk group. These findings emphasize the importance of adopting a broader approach to the multifaceted problem of back complaints in industry and help explain why past prevention efforts focusing on purely physical factors have been unsuccessful.