Biomedical subjects

Gregory R Trost

Publications and source records attributed to Gregory R Trost.

6 recordsLinked to original sources

PubMed2007

Use of ventral plates for cervical arthrodesis.

OBJECTIVE: Ventral cervical plates are used to increase the immediate postoperative rigidity of the spine after decompressive and reconstructive procedures. The evidence supporting this practice is reviewed. METHODS: A computerized literature search of the database of the National Library of Medicine was conducted using PubMed. All relevant articles were reviewed and a critique was performed to explore the utility of ventral cervical plating. RESULTS: Several randomized controlled trials of ventral cervical discectomy versus ventral cervical discectomy and fusion were identified. Three randomized controlled trials that included a differentiation between anterior cervical decompression and fusion, with and without plating, were identified. Many retrospective series, technical reports, and topical reviews were also identified. CONCLUSION: There is little support in the literature for the medical usefulness of ventral cervical plates after single-level cervical fusion. There may, however, be a cost-benefit advantage to the use of such devices. In multilevel procedures and in the setting of traumatic instability, there seems to be an advantage to the use of cervical plates.

Arthrodesis↗

PubMed2007

Cervical spondylosis: ventral or dorsal surgery.

Cervical spondylosis is a result of degenerative changes of the cervical spine. Neurological symptoms of myelopathy result from the narrowing of the spinal canal, causing spinal cord compression. Surgical management of cervical stenosis requires an understanding of the interplay between multiple pathological and biomechanical factors contributing to this disease process. Surgical decompression can be addressed from a ventral, dorsal, or combined approach. The authors discuss the technical aspects of the surgical decision making process regarding the decision to approach the spine from a ventral or dorsal orientation.

Cervical Vertebrae↗

PubMed2004

Anterior cervical plates: a historical perspective.

The development of anterior cervical plates (ACPs) represents a rapidly changing aspect of spine surgery. This paper focuses on a historical overview of ACPs. The authors discuss the disadvantages of earlier generations of plates and demonstrate how current plates have been designed to overcome the presumed shortcomings of their predecessors. This historical review begins with the earliest plates--unrestricted backout plates--and moves on to newer plates--restricted backout plates and their different subcategories. Virtually all modern ACPs work equally well in cervical stabilization; however, there are differences in design that warrant future studies to understand the long-term performances of different plates.

Bone Plates↗

PubMed2003

Recurrent lumbar disc herniation.

Recurrent lumbar disc herniation is a common disease process. It has been noted to occur in 5 to 15% of cases surgically treated for primary lumbar disc herniation. Outcomes in one series approached those after the initial operations, although this is not the case in the experience of most surgeons. The removal of recurrent lumbar disc herniations requires meticulous surgical technique. Great care is taken to identify the osseous margins of the previous surgical site. Identification and dissection of scar from the dura mater is greatly aided with the use of a microscope.

Cicatrix↗

PubMed2002

Unilateral calf hypertrophy seen in lumbosacral stenosis: case report and review of the literature.

STUDY DESIGN: A case report of a patient with neurogenic unilateral calf hypertrophy and review of the literature are reported. OBJECTIVES: To provide further evidence that S1 radiculopathy is predisposed to develop neurogenic muscle hypertrophy. SUMMARY OF BACKGROUND DATA: Calf hypertrophy, specifically hypertrophy of the gastrocnemius muscle, is a rare but recognized presentation of S1 and less commonly L5 radiculopathies. The pathophysiology of this is incompletely understood. METHODS: We present a 59-year-old patient with painless progressive distal right leg weakness and calf enlargement. Electrodiagnostic studies and MAGNETIC RESONANCE IMAGING scanning were performed to evaluate the extent and cause of radicular damage as the etiology for unilateral calf hypertrophy. RESULTS: Examination and electrodiagnostic studies revealed right L5, right S1, and left L5 radiculopathies. Imaging studies demonstrated lumbar stenosis at L3-L4, L4-L5, and L5-S1 vertebral levels as well as L4-L5 and L5-S1 foraminal stenosis. After decompressive surgery the progressive nature of the patient's symptomatology halted, and he had partial resolution of his deficits. CONCLUSION: Although the patient had bilateral L5 radiculopathies, he only had hypertrophy in the distribution of his right S1 radiculopathy. This supports the hypothesis that dysfunction of the S1 nerve root or its distribution is a predisposing factor to develop neurogenic muscle hypertrophy. Furthermore, patients presenting with unilateral calf hypertrophy need a careful diagnostic evaluation for S1 radiculopathy as well as to exclude asymmetric presentation of systemic neuromuscular conditions.

Electrodiagnosis↗

PubMed2002

Anatomic suitability of the C1-C2 complex for pedicle screw fixation.

STUDY DESIGN AND OBJECTIVES: A computed tomography (CT) study of 60 consecutive patients (120 sides) was performed to assess suitability for either transarticular or pedicle screw fixation. SUMMARY OF BACKGROUND DATA: A C1 lateral mass and C2 pedicle screw fixation with a rigid cantilever beam system has been described. The anatomic constraints relevant for this technique have not. METHODS: Fifty consecutive patients underwent standard CT of the cervical spine. Pedicle and transarticular screw trajectories were plotted, and the maximum safe diameter for screw placement was determined for each trajectory. Also, trajectories were plotted in 10 additional patients with known craniocervical junction abnormalities using three-dimensional (3-D) imaging and computer-aided navigation tools. Screw placement was considered feasible if a 4-mm diameter trajectory could be plotted without impingement on neural or vascular structures. RESULTS: Four-millimeter diameter pedicle screws could be placed in 91 of 100 C2 pedicles in the CT studies and in 20 of 20 pedicles in the 3-D studies. Four-millimeter diameter C1-C2 transarticular screws could be placed in 94 of 100 sides in the CT study and in 19 of 20 sides in the 3-D study. Four sides could tolerate a C2 pedicle screw and not a transarticular screw; the opposite situation existed in five sides. Placement of screws into C1 was not an issue in any patient. The mean maximum diameter of potential transarticular screws was 6.5 mm, and the mean maximum diameter of the pedicle screws was 5.3 mm (P < 0.01). CONCLUSIONS: C1-C2 pedicle screw fixation is a technique that appears to be widely applicable and may represent an alternative fixation technique in selected patients.

Bone Screws↗