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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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.
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Chronic low back pain patients chosen for lumbar fusion surgery were entered into a prospective study with the aim of evaluating whether pre-operative pharmacological pain classification correlated with the outcome of surgical treatment. Twenty consecutive patients (mean age 39 years, range 29-50 years) with a mean pain duration of 4.6 years (range 1-8 years) participated. The patients' pain, disability and work situation were evaluated pre- and post-operatively. ⋯ In the group with non-responding pain surgical outcome was significantly poorer (P < 0.01), and was ranked as excellent/good in only one out of seven patients. There was a significant improvement (P < 0.05) concerning both pain and disability in the nociceptive group, but not in the non-responding group. Pre-operative pharmacological pain testing may be useful as a predictor of surgical outcome and we suggest that it can be employed as a means to identify patients with non-responding pain and poor surgical prognosis.
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This prospective study with independent clinical review was set up to monitor the clinical outcome of patients when using serial periradicular/epidural corticosteroid injection techniques in managing cervical radiculopathy. Over a 10 year period, between 1986 and 1995, a consecutive series of 68 secondary referral patients presenting with cervical radiculopathy were entered into the study. There were 57 men (84%) and 11 women (16%) of average age 47 years (range 31-65 years). ⋯ Despite the fact that all 68 patients were potential surgical candidates, they all made a satisfactory recovery without the need for surgical intervention. Forty-eight patients (76%) did not experience any arm pain, and of the 15 patients (24%) who did, this improved from 10 to an average of 2 (range 1-4) on a 10-point pain scale. Thus, patients with cervical radiculopathy make a satisfactory recovery with serial periradicular/epidural corticosteroid injections without the need for surgical intervention.