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Biomedical subjects

A Nordwall

Publications and source records attributed to A Nordwall.

At least 37 records · Page 2Linked to original sources
PubMed1992

Influence of surgical treatment of scoliosis in children with spina bifida on ambulation and motoric skills.

The influence on motoric skills of surgical treatment of scoliosis in 14 children with myelomeningocele was studied. Fifty percent of the children had increased flexion contractures of the hips at follow-up, and all but one patient had impaired motor ability. There was no influence on activities of daily life, but 57% of children had lost some of their ambulation capacity. Postoperative physiotherapy is highly advisable. Intensive attempts to treat these children conservatively to prevent scoliosis progression is suggested.

Activities of Daily Living↗
PubMed1991

Thoracotomy and scoliosis.

The incidence of thoracic scoliosis after completion of growth was studied in a group of patients operated on in childhood with a lateral thoracotomy for esophageal atresia and cardiac and pulmonary disorders. Twenty of 61 patients had a thoracic scoliosis exceeding 10 degrees. The curves were mostly convex toward the operated side except in patients treated surgically for esophageal atresia, in which they were concave toward the operated side. None of the curves exceeded 25 degrees, and no therapy was needed. Thoracic scoliosis should, however, be remembered as a possible complication after lateral thoracotomy in childhood.

Adult↗
PubMed1990

Ultimate strength of the lumbar spine in flexion--an in vitro study.

The ultimate strength in flexion of 16 lumbar functional spinal units (FSU) was determined. The specimens were exposed to a combined static load of bending and shearing in the sagittal plane until overt rupture occurred (simulated flexion-distraction injuries). The biomechanical response of the FSU was measured with a force and moment platform. Mechanical displacement gauges were used to measure vertical displacements (flexion angulation) of the specimens. Photographs were taken after each loading step for determination of horizontal displacements and the centre of rotation. The lumbar FSU could resist a combination of bending moment and shear force of 156 Nm and 620 N respectively, before complete disruption occurred. The tension force acting on the posterior structures was 2.8 kN. The flexion angulation just before failure was 20 degrees and the anterior horizontal displacement between the upper and lower vertebrae was 9 mm. The centre of rotation was located in the posterior part of the lower vertebral body. The bone mineral content in the vertebrae appeared to be a good predictor of ultimate strength of the lumbar FSU. Knowledge of the biomechanical response of the lumbar spine under different static traumatic loads is a first step to better understand the injury mechanisms of the spine in traffic accidents.

Biomechanical Phenomena↗
PubMed1989

Normal range of motion of the cervical spine.

To evaluate the normal range of motion of the cervical spine, 70 healthy subjects were studied using radiography and clinical examination. An equal number of men and women were studied; age ranged from 12 to 79 years. Radiographs were taken in the lateral projection during maximal flexion and extension. In the frontal projection, radiographs were taken during maximal bending to the left and right. The radiographs were analyzed on a digitizing tablet linked to a computer, using preset points to indicate the motion between the vertebrae. The intraobserver error of measurement was +/- 1.8 degrees. The range of axial rotation was measured with the aid of a compass placed on the subject's head. The intraobserver error of measurement with this technique was +/- 6 degrees. The largest intersegmental flexion-extension motion occurred between C4/C5 and C5/C6. A linear decrease of motion in all directions, except in flexion, was found with age. There was no statistically significant difference in motion for men and women. The reliability of methods is discussed.

Adolescent↗
PubMed1988

Forces and motions across the neck in patients treated with halo-vest.

A prospective study of the sagittal plane motion of the cervical spine, stabilized with a halo-vest was performed in 31 consecutive patients with unstable cervical spine injuries. Motion was measured in lateral radiograms taken with the patient in different positions and while performing various exercises. The extreme angle in extension and flexion in each motion segment, in any of the exercises, was measured and the sum of this maximal motion in each segment, between occiput and C6, was noted (maximal cervical motion). Distraction-compression forces across the neck were studied simultaneously with the motion study in the last 20 patients of the series. Strain gauges were mounted on the two vertical rods of the halo-vest and the forces were correlated to the motion of the spine. We found a mean maximal cervical motion of 51 degrees (about 70% of the normal motion). The halo-vest restricted the motion the most below C2 and the least above C2. In the supine position, all patients had a distraction force across the neck (mean: 51 N) that decreased in some exercises (eg, sitting, standing) and increased in others (eg, arm lifting, shoulder shrugging). Both the motion and the force varied widely between different types of exercises. There was a maximal variation of 175 N between the exercises. A positive correlation was found (r = 0.8) between the distraction force in the supine position and the maximal cervical motion. No significant differences of motion in the cervical spine were found between the rehabilitation exercises and common activities of daily living.

Adolescent↗
PubMed1988

Halo-vest treatment of unstable traumatic cervical spine injuries.

Eighty-three patients with unstable cervical spine injuries were treated with halo-vest stabilization in a prospective consecutive series during a 10 year period. At the follow-up 2-7 years after the trauma, six patients had died and eight patients had been surgically stabilized. Sixty-seven of the remaining 69 patients (97%) were subjected to the follow-up performed with validated protocols. All patients but three were reexamined clinically and radiographically. Flexion-extension motion and sidebending of the neck was measured radiographically. Rotation was measured with the aid of a compass placed on top of the head of the patient. Forty-four patients (53%) had initial neurological deficit, 26 with tetraparesis. The age range was 13-89 years and the male/female ratio was 2/1. The halo-vest treatment period was 10-12 weeks. The 1 year healing rate was 90%. Seven nonunions occurred, all in fracture types known to be prone to nonunion. Complications during the treatment were usually minor, with pin problems being the most frequent (pin loosening 60%). At the follow-up, approximately 80% of all patients had complaints of local neck symptoms. Pain at the extremes of neck motion and stiffness was the most frequent. The symptoms were mild and did not usually have any major impact on return to work or leisure activities. Seventy-five percent of patients with incomplete cord lesions and useless muscle function improved to useful function. The patients had a statistically significant decrease of rotation (18%) and sidebending (18%) of the neck but normal flexion-extension motion when compared to the normal.

Adult↗
PubMed1987

Odontoid fractures treated with halo-vest.

In a consecutive series of 75 patients with unstable cervical spine injuries treated with halo-vest, 1976-1984, a total of 14 patients (comprising 18.7%) had odontoid fractures. Of the patients with odontoid fractures, 1 patient had an incomplete tetraparesis. All patients except 1 were treated within the first day after the trauma. A total of 50% were injured in motor vehicle accidents. The odontoid fracture was reduced by skull traction and then stabilized with a halo-vest for 12 weeks. One patient died within the first 2 weeks after the injury. There were no other serious complications during the treatment. The initial dislocation and reduction was studied. Ten patients were followed-up after 2 years. Another 2 patients died of other causes during that time. One had an Anderson-d'Alonzo Type II fracture that failed to unite. Different prognostic factors were analyzed. Fracture gap and fracture type may have contributed to nonunion. Only 1 patient was totally free from symptoms after 2 years. The halo-vest was well tolerated in all patients and assured a high percentage of healing.

Adult↗
PubMed1987

Influence of halo vest treatment on vital capacity.

Respiratory function (vital capacity) was studied in 20 consecutive patients with unstable cervical spine injuries treated with a halo vest. Eight patients were neurologically intact. Twelve patients had incomplete spinal cord injuries that were classified on a neurologic function scale (Sunny-brook) immediately and 3 months after injury. Spirometric tests were done within 1 week of halo vest fixation, after 3 months of treatment, and 1 week after dismounting of the halo vest. The results showed that initial vital capacity was smaller than predicted normal in all patients and 30% less in neurologically impaired patients. Both groups improved during the treatment and somewhat more after removal of the halo vest. In neurologically intact patients, the halo vest caused a respiratory restriction of 10%, which was fully regained after removal of the halo vest. The difference between the groups remained throughout the study. There was no evidence that the halo vest itself affects the vital capacity more in patients with incomplete cord lesions than in neurologically intact patients. All of the cervical spine injuries healed uneventfully.

Adolescent↗
PubMed1986

A new instrument. The Harrington rod director.

To reduce flexion deformity in spine fractures operated with Harrington distraction rods, these rods have to be bent into lordosis. A "rod director" was constructed to facilitate the insertion of the lower, square end of the bent rod into the square-holed hook. This instrument makes it possible to reduce and stabilize the spine more efficiently.

Equipment Design↗
PubMed1985

Unstable thoracolumbar fractures. A comparative clinical study of conservative treatment and Harrington instrumentation.

Fifty patients (14-55 years of age) with unstable thoracolumbar fractures were studied: 24 patients treated conservatively 1971-1977 and 26 patients treated surgically with Harrington instrumentation 1977-1981. The treatment groups were comparable in all respects. Radiologic evaluation showed that Harrington distraction rods restored the fractured vertebra almost to its original shape, and the gibbus and scoliosis were significantly reduced. However, at the follow-up examination at least 2 years after the injury, the gibbus angle had recurred almost to the value at admission in patients with the rods removed. The conservatively treated patients showed a continuous increase of the gibbus angle and of the anterior and central vertebral compression. At the follow-up evaluation, all fractures in both treatment groups were healed. There was no difference between the treatment groups regarding neurologic improvement. Thirteen of 14 patients with severe or moderate paraparesis considerably improved their neurological status. A rehabilitation index with special reference to paraparetic patients showed no difference between the treatment groups already three months after the injury. Thoracolumbar fatigue, thoracolumbar pain and stiffness, skin problems, and pain at direct pressure at the fracture site occurred equally in the conservative and Harrington groups. The overall complications were few. The aseptic intermittent catheterization method introduced in 1977 considerably diminished the frequency of upper urinary tract infections. The treatment with open reduction, fusion, and stabilization with Harrington rods considerably reduced the immobilization and hospitalization times. The average immobilization time was reduced from 67 to 18 days. The hospitalization time in neurologically intact patients was reduced from 80 to 30 days.

Adolescent↗
PubMed1985

Changes in histochemical profile of muscle after long-term electrical stimulation in patients with idiopathic scoliosis.

Adolescent patients with idiopathic scoliosis were treated with long-term electrical stimulation (30 Hz) at the posterior axillary line on the convex side of the curvature in order to correct the spinal deformity. The patients were also followed with muscle biopsies from the latissimus dorsi of the stimulated side taken before, after 3 and 6 months of electrical stimulation. There was a tendency for an increase in the percentage of type I and especially the type II C (undifferentiated) fibers after stimulation. The mean muscle fiber area and the fiber areas of the various fiber types did not change significantly. Histopathological findings were generally rare before as well as after 3 months of electrical stimulation, the only noticeable finding being a somewhat increased frequency of atrophic fibers in groups after 6 months of stimulation. In all studied patients the enzymatic activity of citrate synthase increased after 3 months and further in three studied patients after 6 months of stimulation. The present study gives some evidence of an adaptive process caused by electrical stimulation towards a more fatigue-resistant muscle.

Adenylate Kinase↗
PubMed1984

Unstable thoracolumbar fractures. A study by CT and conventional roentgenology of the reduction effect of Harrington instrumentation.

Fourteen patients with unstable thoracolumbar fractures were examined with conventional roentgenologic technique and CT before and after operation with Harrington instrumentation. CT was superior in evaluating posterior elements, bone fragments in the spinal canal, and degree of narrowing of the spinal canal. Harrington rods restored the general spinal alignment. However, even after surgery, the midsagittal diameter, as well as the cross-sectional area of the spinal canal were still diminished by 26%. The reduction of the spinal canal improved significantly by early surgical intervention. Open reduction and stabilization with Harrington rods and fusion within three days after injury is recommended.

Adolescent↗
PubMed1984

The thoracolumbar crush fracture. An experimental study on instant axial dynamic loading: the resulting fracture type and its stability.

Seven vertebral preparations of L1, with surrounding discs, facet joints, and ligaments were exposed to an instant axial dynamic force in order to produce a burst or crush fracture. The resulting fractures were similar to fractures observed clinically and showed a comminuted vertebral body with fractured vertebral end-plates, dislocated disc nucleus, bone fragments severely encroaching upon the spinal canal, and facet joint laxity. The flexion-extension range was increased considerably. This implies that this fracture type should be regarded as unstable with a risk of progressive flexion deformity, neurologic deterioration and pain. The fracture could be reduced by an axial distraction force of 400 N simulating the effect of Harrington distraction rods. However, the distraction resulted in an "empty" vertebral body with small areas of spongious bone mixed with fragments of the disc nucleus and fragments of the vertebral end-plate.

Biomechanical Phenomena↗
PubMed1983

A locking hook-spinal rod: current status of development.

A locking hook spinal rod previously demonstrated to be sufficiently stable and strong in cadaver experiments has been employed in 30 unstable thoraco-lumbar spinal injuries with results superior to Harrington instrumentation.

Humans↗
PubMed1983

The crush-cleavage fracture. A "new" thoracolumbar unstable fracture.

Among 14 patients with unstable thoracolumbar fractures examined by both conventional radiography and CT, we found seven patients with a "new" common fracture pattern. This fracture pattern consisted of (1) superior disc injury, (2) crush fracture of the upper half of the vertebral body, (3) sagittal fracture (cleavage fracture) of the lower half of the vertebral body, (4) bone fragments in the spinal canal, and (5) laminar fracture. Five of the seven patients had sustained their injuries in vertical falls; all five had primary neurological deficit symptoms. We consider this fracture to be unstable.

Adolescent↗
PubMed1983

Paraplegia in unstable thoracolumbar injuries. A study of conservative and operative treatment regarding neurological improvement and rehabilitation.

Thirty-seven patients with unstable thoracolumbar fractures and paraplegia were studied: 11 patients were given exclusively conservative treatment, 14 patients were treated conservatively after laminectomy with or without fusion, and 12 patients were treated with Harrington instrumentation. None of the 12 cases with complete paraparesis at admission to the hospital improved their neurological status. In patients with moderate and severe but not complete paraparesis one month after injury, the neurological improvement continued for several years and in many the neurological restitution was complete. There was no difference between the three treatment groups regarding the neurological improvement. A new Rehabilitation Index was constructed with special reference to paraplegic patients. One month after the injury the Rehabilitation Score in the Harrington group was considerably higher than in the other groups. After three months the score was equalized in the conservatively treated group and the Harrington group whereas the score of the laminectomy-fusion group remained lower as long as two years after injury. Thirty-two patients were followed-up two years after the injury. Irrespective of the treatment, 30 of 32 patients had reached their maximal ADL scores at the follow-up. In 19 patients the bladder function was satisfactory. Eleven patients could walk independently. Twelve patients used wheel-chairs. Twenty-eight patients managed outdoor transportation without help. Twenty-four patients (75 per cent) had returned to work. Complaints about back deformity, skin problems and pain at direct pressure over the fracture site were significantly more frequent in the conservative and laminectomy-fusion groups. The treatment with open reduction, fusion and stabilization with Harrington rods considerably reduced the immobilization and hospitalization time. The complications were few. - The Harrington operation resulted in an early rehabilitation, which is of great psychological importance for the patient. - Our study confirms the disadvantages of laminectomy followed by conservative treatment reported by other authors.

Adolescent↗
PubMed1981

The changing pattern of scoliosis treatment due to effective screening.

We evaluated the effects over a ten-year period of a program for early detection and treatment of idiopathic scoliosis in a stable population of 1.5 million people. Seven hundred and twenty-five patients with a scoliosis of more than 20 degrees (as measured with Cobb's method) and who were twenty years old or younger were followed during this period. Although treatment principles remained essentially the same, the percentage of patients who required an operation each year decreased. The magnitude of the ten most severe curves detected each year decreased from an average of 64 degrees to 44 degrees. Efforts to detect scoliosis early have resulted in a threefold increase in the number of patients treated for scoliosis.

Adolescent↗