Biomedical subjects

J N Abramovitz

Publications and source records attributed to J N Abramovitz.

5 recordsLinked to original sources

PubMed1993

Complications of surgery for discogenic disease of the spine.

Disc disease is benign and not life threatening. Its long-term prognosis is uncertain, and spontaneous recoveries are common. The decision to perform surgery thus carries with it a heavy responsibility to provide safe treatment. "Good safe surgical technique" is essential, but it is much more than a well-rehearsed routine procedure. From preoperative evaluation to surgery to postoperative care, the surgeon must look ahead to problems that might arise. Where anticipated risks cannot be avoided, they should be minimized, and when adverse events occur, active recognition will lead to early and accurate management.

Cervical Vertebrae↗

PubMed1991

Lumbar disc surgery: results of the Prospective Lumbar Discectomy Study of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

The Prospective Lumbar Discectomy Study enrolled 740 patients in a multiphysician, multicenter, consecutive patient protocol to evaluate the indications and efficacy of lumbar discectomy. Five hundred and thirteen patients could be evaluated at 3 months after surgery. Stepwise logistic regression showed that the factors of fraction of pain referred to the back, work-related injury, absence of back pain on straight leg-raise examination, correspondence of leg pain to typical radicular patterns, leg pain on straight leg-raise examination, and reflex asymmetry were independently predictive of good outcome from surgery. Univariate analysis of the case with different numbers of predictive factors present showed that use of the operating microscope, sensory deficit, central disc bulge, and free disc fragment were correlated with outcome only in subgroups. An analysis of unsatisfactory outcomes showed two patterns: one of failure as a result of mechanical back pain and one of failure as a result of radiculopathy. Factors predictive of outcome did not influence the type of failure. In a stepwise logistic regression analysis, facetectomy and preoperative sensory deficit were associated with increased likelihood of mechanical back pain failure, while preoperative motor deficit was associated with an increased likelihood of radicular failure. The results support several intuitively derived and commonly believed principles of lumbar disc surgery.

Follow-Up Studies↗

PubMed1986

Vertebral osteomyelitis. The surgical management of neurologic complications.

Twelve patients with neurologic complications of vertebral osteomyelitis are reported. Initial symptoms were due to diffuse intraspinal abscesses (epidural or subdural) in six patients and to kyphotic deformities in three. A localized anterior subligamentous abscess was found in one patient and a similar abscess with kyphosis in one. Kyphosis and diffuse epidural abscess were found in one patient. Operations were designed to relieve cord compression and maintain or improve spinal stability. Outcome was good in eight patients and poor in two; two patients died. Delayed neurologic deterioration after laminectomy occurred in two patients who presented with epidural abscess and minimal signs of osteomyelitis due to subsequent development of anterior abscess and spinal deformity. Therapy of this problem is discussed, with emphasis on choice of technique for neural decompression. Adequate decompression with attention to stability will yield a good result in the majority of cases.

Abscess↗

PubMed1983

Sclerosing orbital pseudotumor.

We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our case, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.

Adult↗

PubMed1982

Recurrent central cord injury: a case report.

A case of multiple episodes of central cord injury after minor trauma is reported. Cervical films showed a canal diameter of 11 mm at C-3, C-4 and minor instability with a canal diameter of 9 mm in extension. Anterior cervical fusion resulted in a stable spine and the prevention of further symptoms. The mechanism of central cord injury is reviewed, and it is suggested that in some cases careful evaluation will reveal remediable cord compression. Operative treatment may be indicated in central cord injury.

Cervical Vertebrae↗