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
-
Some patients with scoliosis have a relatively short vertebral canal. This poses the question of whether a short spinal cord may sometimes cause scoliosis. The present paper presents two observations that may support this concept. ⋯ The study confirms that the vertebral canal and the intervertebral foraminae retain their original orientation. The spinal cord is eccentric in the canal towards the concavity of the curve; the major component of rotation occurs anterior to the vertebral canal and the axis of this rotation seems to be at the site of the spinal cord. These observations do not establish that a short spinal cord will result in scoliosis, but the results are compatible with this hypothesis, and that impairment of spinal cord growth factors may sometimes be responsible for scoliosis.
-
Whiplash, a common injury following motor vehicle crashes, is associated with high costs and a prognosis that is variable and difficult to predict. We studied the profile of recovery from whiplash and assessed whether presenting signs and symptoms directly after the crash were predictive of whiplash prognosis. We formed a population-based incident cohort of all 2627 individuals who sustained a whiplash injury resulting from a motor vehicle crash in the province of Québec, Canada, in 1987, and followed these patients for up to 7 years. ⋯ In contrast, using a classification of injury severity previously proposed by the Québec Whiplash Associated Disorders Task Force, the median recovery time varied from 17 to only 123 days. We conclude that whiplash patients presenting with several specific musculoskeletal and neurological signs and symptoms will have a longer recovery period. These patients can easily be identified and closely monitored and targeted for the evaluation of early intervention programmes aimed at managing whiplash patients with a poor prognosis.
-
The present study investigates the diagnostic value of rotatory computed tomography (CT) examinations in normal subjects and patients with whiplash associated disorders (WAD), with the aim of reproducing earlier findings of rotatory CT studies. Forty-seven WAD patients with persistent complaints after a rear-end collision (non-cranial contact acceleration/deceleration trauma) were enrolled in this study. To guarantee a maximally homogeneous study population, only WAD patients with a marked passive cervical retroflexion restriction were included. ⋯ Excessive RR values were only found at C0/C1. A traumatic lesion of the ligaments at C0/C1, which prevent vertical translation of the skull with regard to the atlas, is hypothesised. The results of the discriminant analysis of the RR values make this method applicable for the individual WAD patient in daily practice.
-
Forty-six patients with lumbar spondylolysis and mild isthmic spondylolisthesis were managed with direct repair of the defect with or without facet joint fusion in the affected segment. There were 24 males and 22 females, ranging in age from 15 to 56 years (average, 38.2 years). These patients had experienced clinical symptoms due to spondylolysis for between 4 months and 20 years (average, 5.3 years). ⋯ There was no significant difference in outcome between the spondylolytic/spondylolisthetic patients with non-degenerative disc, who were treated with direct repair of defect only, and those with degenerative disc, who additionally underwent a fusion procedure (P > 0.05). The present series demonstrates a satisfactory result and a high rate of bony healing of the pars defect by this operative procedure in patients with lumbar spondylolysis and mild isthmic spondylolisthesis. Preoperative assessment of the disc degeneration with MRI is of great assistance in making the protocol choice of whether to opt for fusion.
-
Giant cell tumours involving vertebral bodies are still difficult to treat, though results are gradually improving. The object of this study was to assess the results of "complete excision", both of previously untreated giant cell tumours and of recurrences, and to consider the possible effects of any tumour contamination during operation. Nine consecutive patients with giant cell tumours of the thoracic and lumbar spine were treated surgically between 1986 and 1995. ⋯ Where an intralesional component is unavoidable, total removal of the (pseudo)capsule should be ensured by preliminary extralesional dissection. Any tumour spill should be meticulously removed. The use of frozen sections to check resection margins is advisable.