European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60 +/- 11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. ⋯ The risk of late neurological deterioration is substantial. As the condition is very rare and the treatment is demanding and associated with a very high risk of complications, the treatment of these patients should be centralised in special spinal trauma units. A combined approach that stabilises the spine from both sides is probably beneficial.
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Failed back surgery syndrome (FBSS) is the presence of persistent, disabling pain in the hip, thigh, leg, or lower back of a patient who has undergone a laminectomy or discectomy. Some degree of FBSS is found in approximately 15% of such patients. There may be a direct relationship between the extent of pathology found during the initial surgical procedure and the probability that FBSS will develop. ⋯ In an attempt to inhibit peridural fibrosis, methylprednisolone, polyethylene films, and fat grafts have been applied to the dura after discectomy. These experimental treatments have had limited success. Development of a therapy that reliably prevents peridural adhesive fibrosis will reduce the incidence of FBSS.
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Comparative Study
Correction of idiopathic scoliosis using the H-frame system.
To determine the effectiveness of posterior H-frame instrumentation for the surgical treatment of idiopathic scoliosis, 36 patients were studied. The patients underwent surgery between 1989 and 1993 and were evaluated for curve correction, hump correction, vertebral rotation, fusion level and complications. Average age at surgery was 19 years. ⋯ Major neurological problems did not occur. Pseudoarthrosis developed in one patient and imbalance in two patients. The H-frame system satisfactorily achieves curve and rib hump correction with little correction loss.
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Eighty adult patients, 33 men and 47 women, mean age 46 years (SD 11.8, range 19-74 years), were evaluated 5 years after low-back surgery. The mean duration of symptoms before operation was 8.7 (SD 7.1) years. The purpose was to evaluate the 5-year outcome of low-back surgery, to find the best predictors for the outcome, and to find out if a correlation exists between the patient's sense of coherence and the outcome of low-back surgery. ⋯ In all patients, the Oswestry total index before the index operation is suggested to be a predictor of the final outcome. In multiple regression analysis, the number of previous operations and the preoperatively recorded Oswestry total index appeared to be the best predictors for outcome of low-back surgery. We also found that the SOC scale correlated significantly with the Oswestry total index and seems to provide a possible explanation of ability to cope with the disability and pain associated with low-back disorders.
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Previous experimental studies have shown the effects of acute compression of the spinal cord and peripheral nerve roots. Recently, however, a few studies of chronic compression of the cauda equina in animal models have been reported. The purpose of this study was to determine the long-term electrophysiologic changes resulting from chronic compression of the cauda equina in dogs. ⋯ Dogs in which motor and sensory evoked potentials recovered also showed gradual disappearance of neurologic symptoms and signs. Recovery of motor evoked potentials in particular was associated with complete disappearance of neurologic symptoms and signs. For accurate prognosis in cases of chronic cauda equina compression, a combined diagnostic study of sensory and motor evoked potentials is recommended.