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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Review
Is there a rational basis for post-surgical lifting restrictions? 2. Possible scientific approach.
Lifting restrictions postoperatively are quite common but there appears to be little scientific basis for them. Lifting restricitions are inhibitory in terms of return to work and may be a factor in chronicity. The mean changes in functional spinal motion unit (FSU) stiffness with in vitro or computer-simulated discectomies, facetectomies and laminectomies were reviewed from the literature. ⋯ The adjusted NIOSH guidelines provide a reasonable way to estimate weight restrictions and accomodations such as lifting aids. Such resitrictions should be as liberal as possible so as to facilitate, not prevent, return to work. Patients need more advice regarding lifting activities and clinicians should be more knowledgeable about the working conditions and constraints of a given workplace to effectively match the solution to the patient's condition.
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Although the structural changes occurring in the scoliotic spine have been reported as early as the 19th century, the descriptions and biomechanical explanations have not always been complete and consistent. In this study, three-dimensionally rendered CT images of two human skeletons with a scoliotic deformity and two patients with serious scoliosis were used to describe the intrinsic vertebral and rib deformities. The pattern of structural deformities was found to be consistent. ⋯ The rib deformities at the convex side of the scoliotic curve showed an increased angulation of the rib at the posterior angle, whereas the rib curve on the concave side was flattened. The observed vertebral deformities suggest that these are caused by bone remodelling processes due to forces in the anterior spinal column, which drive the apical vertebral body out of the midline, whereas forces of the musculo-ligamentous structures at the posterior side of the spinal column attempt to minimize the deviations and rotations of the vertebrae. The demonstrated rib deformities suggest an adaptation to forces imposed by the scoliotic spine.
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One of the most common complications of lumbar spine surgery is peridural fibrosis, a fibroblastic invasion of the nerve roots and the peridural sac exposed at operation. Peridural fibrosis may produce symptoms similar to those the patient experienced preoperatively and, if another spinal operation is necessary, may increase the risk of injury at reexposure. In a controlled study in dogs, we assessed the use of expanded polytetrafluoroethylene (ePTFE) as a barrier to postoperative invasion of fibrous tissue into the laminectomy defect. ⋯ No foreign-body reactions to the membrane or membrane-related infections occurred. We conclude that the ePTFE spinal membrane, when properly implanted, is an effective barrier to postsurgical fibrous invasion of the vertebral canal. Clinical studies of use of this material in spinal surgery are warranted.
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Review Case Reports
Hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine.
Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2-3. ⋯ The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified.