The spine journal : official journal of the North American Spine Society
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Cervical myelopathy is a group of closely related disorders usually caused by spondylosis or by ossification of the posterior longitudinal ligament and is characterized by compression of the cervical spinal cord or nerve roots by varying degrees and number of levels. The decrease in diameter of the vertebral canal secondary to disc degeneration and osteophytic spurs compresses the spinal cord and nerve roots at one or several levels, producing direct damage and often secondary ischemic changes. ⋯ This review summarizes some of the significant pathophysiological processes involved in cervical myelopathy.
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Comparative Study Clinical Trial
Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion.
The surgical treatment for low-grade isthmic spondylolisthesis in adults with intractable lumbar pain is usually spinal fusion. It has been postulated that anterior column reconstruction may be relatively advantageous in those patients with unstable slips. ⋯ Outcomes up to 2 years were superior by clinically important differences after a combined anterior-posterior operation compared with posterior-alone surgery for unstable spondylolisthesis; however, between-group differences attenuated appreciably after 6 months. The apparent clinical and occupational benefits of combined fusion should be considered along with possible increases in minor complications and procedure-related costs.
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Comparative Study
Two in vivo surgical approaches for lumbar corpectomy using allograft and a metallic implant: a controlled clinical and biomechanical study.
Both bone graft and metallic implants have been used in combination with the necessary anterior rod or plate instrumentation to fill the voids left by vertebral body removal, with the ultimate goal of restoring stability. One type of device that has recently been introduced is an expandable titanium telescoping cage that is designed to be used as a strut implant to fill corpectomy defects. The use of these devices has met varying success. Acceptance by surgeons and spine biomechanicians has been limited by clinical failure with subsequent loss of reduction and increase in kyphosis. In order to further improve patient care, it is critical to evaluate the use of these implants through biomechanical as well as other modes of testing. ⋯ The use of allograft bone for corpectomy defect repair in the lumbar spine appears to contribute to a stiffer and perhaps more stable spine segment compared with using the expandable cage device for such a repair after a 4-month healing period in this in vivo calf model. These findings thus far are based upon the biomechanical data gathered.
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Magnetic resonance (MR) imaging is frequently used to evaluate first-time episodes of serious low back pain (LBP). Common degenerative findings are often interpreted as recent developments and the probable anatomic cause of the new symptoms. To date no prospective study has established a baseline MR status of the lumbar spine in subjects without significant LBP problems and prospectively surveyed these subjects for acute changes shortly after new and serious LBP episodes. This method can identify new versus old MR findings possibly associated with the acute symptomatic episode. ⋯ Findings on MR imaging within 12 weeks of serious LBP inception are highly unlikely to represent any new structural change. Most new changes (loss of disc signal, facet arthrosis, and end plate signal changes) represent progressive age changes not associated with acute events. Primary radicular syndromes may have new root compression findings associated with root irritation.
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The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes.
Imbalanced patterns of erector spinae activity and reduced trunk extension strength have been observed among patients with low back pain (LBP). The association between LBP and neuromuscular imbalance still remains unclear. ⋯ A direct relationship between LBP and neuromuscular imbalance was documented in athletes with LBP. Maximum isometric trunk extension strength had no relationship to the presence of LBP or the occurrence of neuromuscular imbalance of erector spinae. Common clinical testing of spinal mobility and muscular flexibility had only limited correlation to LBP and neuromuscular imbalance.