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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The pathogenesis of neurogenic claudication is thought to lie in relative ischemia of cauda equina roots during exercise. In this study we will evaluate the effect of the transient ischemia brought on by exercise on motor conduction in patients suffering from lumbar spinal stenosis (LSS). We will also evaluate the sensitivity of motor evoked potentials (MEPs) in detecting motor conduction abnormalities before and after the onset of neurogenic claudication. ⋯ There was a significant difference between the MEPLT and the PMCT values measured before and after exercise in the patients with signs of neurological deficit. This difference was not found to be significant in patients without neurological deficits (t-test P < 0. 05). It may be concluded that exercise increases the sensitivity of MEPs in detecting the roots under functional compression in LSS.
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In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. ⋯ Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 c.c. at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis.
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This study retrospectively reviews 20 sequential patients with thoracolumbar burst fractures without neurologic deficit. All patients were treated by indirect reduction, bisegmental posterior transpedicular instrumentation and monosegmental fusion. Clinical and radiological outcome was analyzed after an average follow-up of 6.4 years. ⋯ Therefore, posterolateral fusion alone does not prevent disc space collapse. Nevertheless, clinical long-term results are favorable. However, if disc space collapse has to prevented, an interbody disc clearance and fusion is recommended.
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This series comprises ten patients treated with transpedicular screw fixation, who suffered early postoperative problems such as radicular pain or motor weakness. Besides plain radiographs, all patients were also evaluated with MR imaging. ⋯ MR images, especially T1-weighted ones, were very helpful for visualizing the problem and verifying the positions of the screws. In cases of wide areas of signal void around the screws, the neighboring axial MR images at either side, which have fewer artifacts, gave more information about the screws and the vertebrae.
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The purpose of this study was to determine prognostic criteria for return to work 9-12 years after standard nucleotomy for herniated nucleus pulposus confirmed by CT. From 1985 until 1988, 182 patients (102 male, 80 female, mean age 45 years) with a single-level herniated nucleus pulposus were operated on for the first time. In summer 1997, an average of 10.2 years after the operation, 101 of 182 patients (55.5%) returned a standardised questionnaire. ⋯ Group II contained 57 patients, of whom 18 worked only part of the time, 9 had changed to a lighter full-time job, 23 had taken early retirement, and 7 were receiving a pension. Patients in group I were significantly younger (38 vs. 51 years), had a smaller proportion of patients with more than 20% overweight (27% vs. 44%), had a smaller proportion of severe, grade 0 and 1, motor dysfunction (0% vs. 16.3%), had been operated sooner (within 3 days: 52.3% vs. 19.3%), had undergone fewer re-operations for recurrence of the herniation (4.5% vs. 21.1%), and had worked less frequently in physically demanding jobs (6.7% vs. 22.8%). We concluded that when there is a relative indication for herniated nucleus pulposus surgery, it should be limited to patients aged below 40 years, with slight motor dysfunction, who work in physically undemanding jobs, so as to make a satisfactory long-term result more likely.