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Biomedical subjects

F J Eismont

Publications and source records attributed to F J Eismont.

At least 19 recordsLinked to original sources
PubMed1992

Anterior decompression, structural bone grafting, and Caspar plate stabilization for unstable cervical spine fractures and/or dislocations.

Fourteen patients who sustained acute cervical spine fractures and/or dislocations with associated posterior ligamentous disruption had anterior decompressions, structural bone grafting, and anterior Caspar plate stabilization. With an average 30-month follow-up, no patient has had loss of fixation. Despite criticism raised from biomechanical testing, the Caspar anterior plate system (Aesculape, Tuttlingen, Germany) may be added to structural bone grafting of unstable cervical fractures and/or dislocations, yielding an in vivo solid construct, which obviates the need for simultaneous posterior stabilization.

Adult↗
PubMed1992

Myokymic discharges: prompt cessation following nerve root decompression during spine surgery.

In surgical cases during which spine nerve roots are at risk, we have found it useful to monitor EMG from the muscles supplied by those roots. Mechanical irritation of a root results in muscle activity, whose amplified signals can be broadcast over a loudspeaker, providing immediate feedback to the surgeon that the root is being irritated. We report here on a patient undergoing spinal canal decompression and fusion following a burst fracture of the L5 vertebral body sustained five days previously. EMG was continuously monitored from the tibialis anterior (TA) and medial gastrocnemius (MG) muscle groups bilaterally. During the period leading up to decompression, myokymic discharges from the left TA muscle were observed, whereas the other 3 muscles monitored did not show such activity. These semi-rhythmic and repetitive discharges from the left TA ceased immediately following surgical removal of a bone fragment compressing the left L5 nerve root. This indicates that the site of axonal irritation was the nerve root, and that myokymic discharges secondary to acute axonal compression can cease immediately upon nerve root decompression.

Action Potentials↗
PubMed1991

Diagnosis and treatment of cervical radiculopathy and myelopathy.

Cervical spine disorders frequently require evaluation by an orthopaedic surgeon. With sufficient understanding of the pathophysiology, natural history, differential diagnosis, presenting signs and symptoms, and roentgenographic appearance, as well as the nonoperative and operative treatment options of radiculopathy and myelopathy, the treating surgeon can guide the majority of patients to an early return to functional activities. This paper briefly reviews the aforementioned requisites for successful management of cervical degenerative disorders.

Cervical Vertebrae↗
PubMed1991

Traumatic occipitoatlantal dislocation.

Four patients with traumatic occipitoatlantal dislocation are presented. The dislocations were the result of rapid deceleration motor vehicle accidents. The mechanism of injury was by hyperextension-rotation combined with a distraction force. Three patients sustained multiple injuries. Neurologic findings were variable. One patient with complete cord transection and closed head trauma died 4 days after the injury. In the three surviving patients, the occipitoatlantal dislocation was not diagnosed by the initial examiner. Prompt recognition and stabilization are essential to avoid further neurologic injury. Care must be taken not to increase the dislocation. A halo applied before operation facilitates reduction and allows posterior occipitoatlantal fusion to be performed under optimum conditions.

Accidents, Traffic↗
PubMed1989

Dural laceration occurring with burst fractures and associated laminar fractures.

The cases of sixty patients in whom a burst fracture of a thoracic or lumbar vertebral body had been treated with posterior instrumentation and arthrodesis less than two weeks after the injury were retrospectively reviewed. Thirty of the patients had an associated laminar fracture. Eleven of the thirty, all of whom had a lumbar fracture and a preoperative neurological deficit, were noted at operation to have dural laceration. In four of the patients who had dural laceration, neural elements were entrapped between the fragments from the laminar fracture. None of the remaining thirty patients who did not have a laminar fracture had dural laceration (p = 0.0002). Univariate and multivariate statistical analysis revealed no significant association of the dural laceration with the patients' age or sex, or with the radiographic characteristics of the spine. There was a significant association between dural laceration and neurological deficit (p = 0.0001). In our series, the presence of a preoperative neurological deficit in a patient who had a burst fracture and an associated laminar fracture was a sensitive (100 per cent) and specific (74 per cent) predictor of dural laceration. The presence of this fracture pattern and an associated neurological deficit also predicted a risk of dural laceration with entrapped neural elements. This information may influence decisions as to whether an anterior or a posterior surgical approach should be used in such patients.

Adolescent↗
PubMed1989

Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine.

A retrospective review was conducted to assess the effectiveness and safety of a temporary subarachnoid shunt to treat patients who have a leak of cerebrospinal fluid after a spinal operation. The shunt is percutaneously inserted in the lumbar spine and is removed after four days. This technique was used in nineteen patients over a ten-year period. Of the seventeen patients who had the shunt in place for the full four days, fourteen had resolution of the drainage of cerebrospinal fluid from the wound. One of two patients whose shunt was removed early also had a successful result. Eleven of the fifteen patients who were successfully treated were available for follow-up, and none had any adverse effects related to the original cerebrospinal-fluid leak or its treatment. The four patients who had a persistent leak were successfully treated with reoperation and direct repair of the dura. Eleven (58 per cent) of the nineteen patients had transient complaints of nausea and vomiting while being treated with subarachnoid drainage. Two of the nineteen patients had evidence of an intradural infection after placement of the catheter; the infection resolved in both patients after removal of the catheter and treatment with appropriate antibiotics. Closed subarachnoid drainage, when properly performed and monitored, is a reasonably effective and safe method for treating dural-cutaneous cerebrospinal-fluid leaks after a spinal operation. It may be considered as a non-operative alternative to the standard procedure of reoperation and direct repair of the dura. A good result is still possible in patients in whom this technique fails and who eventually need surgical management.

Cerebrospinal Fluid↗
PubMed1988

Spinal infection: evaluation with MR imaging and intraoperative US.

Magnetic resonance (MR) images of the spine and/or intraoperative spinal ultrasound (US) in 24 patients with spinal infections were reviewed and correlated with clinical and pathologic data to determine their diagnostic value. In disk space infection with osteomyelitis and in retrospinal abscess, MR images showed characteristic findings, whereas in myelitis, MR images demonstrated nonspecific abnormalities. The appearance on MR images of epidural abscesses ranged from clearly identifiable extradural masses with high-intensity signal on spin-echo T2-weighted images to extensive inhomogeneous collections of mixed signal intensities, difficult to distinguish from adjacent meningitis. Myelography with high-resolution computed tomography (CT) and intraoperative spinal US was superior to MR imaging in demonstrating epidural abscesses when there was concomitant meningitis. With intraoperative spinal US, epidural abscesses could be located and their decompression monitored. MR imaging is recommended as the initial screening procedure in spinal infection; in those few patients with nondiagnostic MR images, myelography with high-resolution CT should be the supplementary study. If surgery is planned, intraoperative spinal US should be used.

Abscess↗
PubMed1987

Antibiotic penetration into rabbit nucleus pulposus.

A rabbit model was used to determine the penetration of four commonly used antibiotics (clindamycin, tobramycin, cephalothin, and oxacillin) into the nucleus pulposus after receiving an 8-hour course of intramuscular antibiotic injections. Clindamycin and tobramycin achieved therapeutic levels in the nucleus pulposus and both were present in greater than 50% of serum levels. Cephalothin was not detected in the nucleus pulposus and penetrated at less than 4% of serum levels at 1 hour after injection. The data were inconclusive regarding oxacillin penetration.

Animals↗
PubMed1987

Spinal cord injury--a systems approach: prevention, emergency medical services, and emergency room management.

Spinal cord injury is considered a catastrophic disease because of the significant morbidity, mortality, and costs not only in fiscal terms but in social terms. There are approximately ten thousand new spinal cord injuries per year with the national prevalence estimated at between three and five hundred thousand Americans. These authors advocate a systems approach for the comprehensive management of these devastating injuries. In all phases of care for the spinal-cord-injured person, the key is a team approach and a commitment to an optimal patient care program that can result in minimizing patient morbidity, mortality, and the cost of care as well as making neurologic function maximal.

Accident Prevention↗
PubMed1986

MRI of the chronically injured cervical spinal cord.

Thirteen patients with prior cervical spinal cord injury resulting in quadriplegia were evaluated with magnetic resonance imaging (MRI) long after their initial injury, either because of the relatively recent onset of new and worsening neurologic symptoms or to rule our residual compression on the spinal cord or nerve roots. The results of MRI were compared with delayed metrizamide computed tomography (CT) in 10 cases, and in five of those the results were also compared with intraoperative spinal sonography. It was found that MRI more accurately demonstrated the intramedullary abnormalities in the injured spinal cord than did delayed metrizamide CT because the former could separate myelomalacia from a posttraumatic spinal cord cyst, a differentiation that was frequently difficult with delayed metrizamide CT. T2-weighted spin-echo pulsing sequences with long echo times were particularly useful in evaluating these patients.

Adolescent↗
PubMed1986

Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases.

Twenty-four patients who had a major complication after attempted stabilization of the spine with methylmethacrylate were referred for treatment. The initial instability that necessitated stabilization was caused by a traumatic condition in fifteen of these patients and by a metastatic tumor in nine. The average length of time before failure of fixation was 208.3 days for the patients who had a traumatic condition and 193.7 days for those who had a neoplasm. In eleven patients a progressive neural deficit developed postoperatively, and in six others the recovery of neural function was possibly hindered by the cement. A deep wound infection developed in six patients, and in five of them treatment by removal of the methylmethacrylate and metal, followed by a prolonged period of cervical traction, was required. Loosening and failure of fixation was the most common complication--it occurred in twelve of the fifteen patients who had a traumatic lesion and in eight of the nine who had a neoplasm. Salvage operations that included removal of the cement and conventional bone-grafting procedures were performed in eleven of the twelve patients who had loosening associated with a traumatic lesion and in six of the eight who had loosening and a tumor. Stability was restored in every patient. Improved long-term results can be achieved by using grafts of iliac bone and triple-wire stabilization methods (a midline wiring between the spinous processes and two iliac-crest grafts, one on each side, wired to the posterior elements) instead of methacrylate in the primary treatment of traumatic injuries. The treatment of choice for instability caused by neoplastic destruction of two or more vertebral bodies includes a construct of methylmethacrylate anteriorly. However, if cement is used, early augmentation with posterior fusion of the spine and stabilization should be considered. As a rule, combined anterior and posterior stabilization is recommended for the reconstruction of a spine that is unstable due to neoplastic destruction. In general, whenever methylmethacrylate is used for spinal stabilization, it should be augmented with grafts of iliac bone to provide long-term stability.

Adult↗
PubMed1985

Symptomatic spinal cord deformity secondary to a redundant intramedullary shunt catheter. Clinical and radiographic features.

Right arm pain, motor and sensory loss in the right arm and right facial numbness recurred in a 27 year old quadraplegic shortly after a posttraumatic spinal cord cyst (PTSCC) was shunted via a catheter into the adjacent subarachnoid space. Although shunt malfunction was clinically suspected, metrizamide computed tomography (MCT) suggested that redundancy of the catheter had caused deformity of the spinal cord. This hypothesis was confirmed at surgery when intraoperative spinal sonography (IOSS) showed that the spinal cord deformity at C1-C2 disappeared when the catheter was withdrawn. This case shows that new or recurrent spinal cord symptoms may be due to a mechanical deformity of the cord rather than shunt malfunction, that restricting the length of the shunt catheter which is used to decompress PTSCCs is important, and that IOSS is an indispensable tool for visualizing the changes in spinal cord morphology during shunting procedures.

Adult↗
PubMed1985

Impalement injuries.

Impalement injuries are unusual, complex surgical problems. We present a case of impalement through the spine and abdomen, describe a two-team approach to operative extraction utilizing simultaneous laminectomy and laparotomy incisions, and outline the management of an infectious complication caused by unusual bacterial and fungal pathogens. General principles of management include: the impaling object must be stabilized and manipulation avoided during extrication and transport. Operative removal requires careful preplanning, and should be tailored to the specific presenting injuries, with early multispecialty involvement as necessary. Extensive exposure is mandatory and may be achieved through a variety of standard or unconventional incisions so as to permit extraction of the impaled object under direct vision. Meticulous care of the traumatic wound is necessary, and careful followup is required for recognition and early management of infectious complications.

Abdominal Injuries↗