The spine journal : official journal of the North American Spine Society
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The existing evidence suggests that, although older spinal cord injury (SCI) patients experience a similar degree of neurologic recovery to younger patients, older patients experience diminished functional outcomes at follow-up. However, all studies have assumed that the impact of age on functional outcome is the same across the spectrum of injury severity. ⋯ Overall, advanced age is associated with worse functional outcome after SCI; however, this effect varies across the spectrum of injury severity. These results will help to facilitate enhanced clinical communication as well as potentially aid in the development of customized treatment and rehabilitation protocols.
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Several methods for C1-C2 stabilization have been described in the literature. These include C1-C2 transarticular and C1 lateral mass screws. In patients with aberrant anatomy such as a high-riding vertebral artery (VA) or the presence of an arcuate foramen at C1, there exists a higher risk of VA injury. This may lead to excessive bleeding, stroke, and possibly death. There have been several studies determining the incidence of arcuate foramen and high-riding VA occurring individually in the general population, but none have determined their occurrence simultaneously. ⋯ The arcuate foramen and high-riding VA are common anomalies that are often not recognized. Although ipsilateral high-riding VA and arcuate foramen rarely occur in the general population, proper identification of these anomalies on preoperative CT scan facilitates planning the safest technique for C1-C2 instrumentation.
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Decompressive procedures such as laminectomy, facetectomy, and costotransversectomy are routinely performed for various pathologies in the thoracic spine. The thoracic spine is unique, in part, because of the sternocostovertebral articulations that provide additional strength to the region relative to the cervical and lumbar spines. During decompressive surgeries, stability is compromised at a presently unknown point. ⋯ Thoracic spine stability was not significantly affected by sequential decompressive procedures in thoracic segments at the level of the true ribs in all three planes of motion in intact thoracic specimens. Age appeared to negatively correlate with ROM of the specimen. Our study suggests that thoracic spinal stability is maintained immediately after unilateral decompression at the level of the true ribs. These preliminary observations, however, do not depict the long-term sequelae of such procedures and warrant further investigation.
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Anterior cervical discectomy and interbody fusion was a classical treatment for cervical degenerative disc disease (CDDD). However, the rigid fusion also leads to a reduction in normal cervical spine motion and to increased biomechanical stress at adjacent levels, which in turn accelerates degenerative changes of the discs at these levels. Cervical disc replacement (CDR) is a new technology with the aim of addressing the limitations of fusion procession and preserving motion at the treated level. Discover prosthesis (DePuy Spine, Raynham, MA, USA) is a new type artificial disc and there are few reports about it. ⋯ The use of Discover prostheses in our study resulted in satisfactory clinical and radiographic outcomes. The prostheses can restore and maintain interbody height, while preserve the motion of the treated segment. Although the results of this study demonstrate initial safety and effectiveness in a Chinese population, we need further studies to know more about the impact of CDR with Discover prosthesis, especially on HO and adjacent segment degeneration.
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Abnormal pretreatment flexion-relaxation in chronic disabling occupational lumbar spinal disorder patients has been shown to improve with functional restoration rehabilitation. Little is known about the effects of prior lumbar surgeries on flexion-relaxation and its responsiveness to treatment. ⋯ Despite the fact that the patients with prior surgery demonstrated greater pretreatment SEMG and ROM deficits, functional restoration treatment, combined with SEMG-assisted stretching training, was successful in improving all these measures by post-treatment. After treatment, both groups demonstrated ROM within anticipated limits, and the majority of patients in all three groups successfully achieved flexion-relaxation. In a chronic disabling occupational lumbar spinal disorder cohort, surgery patients were nearly equal to nonoperated patients in responding to interdisciplinary functional restoration rehabilitation on measures investigated in this study, achieving close to normal performance measures associated with pain-free controls. The responsiveness and final scores shown in this study suggests that flexion-relaxation may be a useful, objective diagnostic tool to measure changes in physical capacity for chronic disabling occupational lumbar spinal disorder patients.