Spine
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It has been suggested that the muscles of the anterolateral abdominal wall increase the stability of the lumbar region of the vertebral column by tensing the thoracolumbar fascia and by raising intra-abdominal pressure. In this report these new mechanisms are reviewed and their contribution to vertebral stability assessed. The thoracolumbar fascia consists of two principal layers of dense fibrous tissue that attach the abdominal muscles to the vertebral column. ⋯ Abdominal muscle contraction was simulated in whole cadavers in both the flexed and lateral bending positions to compare the stabilizing effect of the thoracolumbar fascia and intra-abdominal pressure mechanisms. These definitive experiments showed that the resistance to bending in the sagittal plane offered by the abdominal muscles acting through fascial tension was of a similar magnitude to that offered by a raised intra-abdominal pressure, both being relatively small in the fully flexed position. The stabilizing influence of the middle layer of the thoracolumbar fascia in lateral bending was clearly demonstrated and warrants further study in vivo.
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Between 1976 and 1984, twenty-one patients with ankylosing spondylitis were treated surgically. Eight patients with rigid thoracic kyphosis underwent a two-stage combined procedure. The average correction was 36 degrees. ⋯ Both showed improvement in neurologic function. At follow-up, all but one patient had improvement in pain and spinal alignment. There have been no deaths or persistent neurologic problems from these procedures.
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The CT/discographic findings from 225 discs in 91 low-back pain patients were compared to the pain provocation during the injection of contrast into the disc. The radiographic appearance of disc deterioration demonstrating disc degeneration and annular disruption of each disc was classified separately using a fourpoint scale: normal, slight, moderate, or severe. ⋯ The CT/discogram presents an axial view of the disc that allows a subgrouping of disc deterioration that can discriminate between peripheral deterioration (degeneration) and internal deterioration (disruption). The disruption supposedly occurs earlier and is more likely to be the source of exact pain reproduction.
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Nineteen upper cervical spine specimens were dissected to examine the macroscopic and functional anatomy of alar ligaments. They are on both sides, symmetrically placed, approximately 10-13 mm long and elliptical in cross-section 3 X 6 mm in diameter. The fiber orientation is dependent on the height of dens axis, mostly in the cranial caudal direction. ⋯ The ligaments limit the axial rotation in the occipito-atlanto-axial complex (to the right by left alar and vice versa) as well as in side bending. The ligament is most stretched, and consequently most vulnerable, when the head is rotated and in addition flexed. This mechanism, common in whiplash injuries, could lead to irreversible overstretching or rupture of the ligaments especially as the ligaments consist of mainly collagen fibers.
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Comparative Study Clinical Trial Controlled Clinical Trial
Chemonucleolysis versus surgery in lumbar disc herniations: correlation of the results to preoperative clinical pattern and size of the herniation.
A prospective study was carried out on the results of chemonucleolysis or surgery in 156 patients who had lumbar disc herniations. All patients were considered as potentially good candidates for chemonucleolysis. Seventy-two received a chymopapain injection and 84 underwent surgery. ⋯ The results of chemonucleolysis in patients who had large herniations were significantly inferior to those of surgery: at final follow-up the results were satisfactory in 50% of patients in the chemonucleolysis group and 89% of those in the surgery series. Chemonucleolysis appears to be the treatment of choice in most patients with small disc herniations and an effective alternative to surgery in most patients with medium-size herniations when the preoperative clinical pattern indicates a slight or moderate nerve root compression. In all large herniations and in small- or medium-size herniations causing a severe nerve root impingement, surgery should be preferred to chemonucleolysis.