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-three patients with low back pain underwent spinal fusion following a positively predicting external fixation test. Thirty-two spinal fusions and one sacroiliac joint fusion were performed. ⋯ Multiple variables affect the results of spinal fusion. We feel that the external fixator test in low back pain management is very invasive, and its use cannot be justified.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study.
This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. ⋯ With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed some-what better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.
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A 17-year-old young man presented with a highly unstable fracture dislocation of the third and fourth thoracic vertebrae with neurological deficit, in which the fractured spine had perforated the thoracic esophagus. Open reduction and internal fixation of the spinal fractures in combination with aggressive treatment of the mediastinitis caused by esophageal perforation, consisting of two re-thoracotomies, was performed. Two years after the accident, the patient had recovered well. The neurological deficit had recovered, and there were no difficulties with swallowing.
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We report a unique complication caused by the rod of a Harrington instrumentation device, which resulted in spinal stenosis and myelopathy. A literature review revealed no previous causes of direct spinal cord impingement caused by the rod of a Harrington device. In this case, years after the initial operation, the rod penetrated the lamina at the junction between a thoracic and a lumbar curve, causing spinal stenosis and myelopathy. We conclude that regular control of the position of the device and awareness of possible late neurological complications are necessary to identify such complications as early as possible.
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The purpose of this prospective study was to determine the overall incidence and distribution of lumbo-sacral degenerative changes (i.e. disc protrusion or extrusion, facet degeneration, disc degeneration, nerve root canal stenosis and spinal stenosis) in patients with and without a lumbo-sacral transitional vertebra (LSTV). The study population consisted of 350 sequential patients with low back pain and/or sciatica, referred for medical imaging. In all cases CT scans of the lumbo-sacral region were obtained. ⋯ This was also the case for disc degeneration (52.8% vs 28%), facet degeneration (60.4% vs 42.6%) and nerve root canal stenosis (52.8% vs 27.9%). For spinal canal stenosis there was no statistically significant difference between the two categories. In conclusion, our findings indicate that an LSTV does not in itself constitute a risk factor for degenerative spine changes, but when degeneration occurs, it is more likely to be found at the disc level above the LSTV.