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Biomedical subjects

Jeff S Silber

Publications and source records attributed to Jeff S Silber.

14 recordsLinked to original sources
PubMed2005

Resolution of pronounced painless weakness arising from radiculopathy and disk extrusion.

In this retrospective, consecutive case series, we report the nonsurgical and rehabilitation outcomes of consecutive patients who presented with pronounced painless weakness arising from disk extrusion. Seven consecutive patients who chose physiatric care were followed clinically, and strength return was monitored. Each presented with predominantly painless radiculopathy, functionally significant strength loss, and radiographic evidence of disk extrusion or sequestration. Each patient participated in a targeted strengthening program, and in some cases, transforaminal injection therapy was employed. Each patient demonstrated an eventual full functional recovery. In most cases, electrodiagnostic studies were performed and included a needle examination of the affected limb and compound muscle action potentials from the most clinically relevant and weakened limb muscle. The electrodiagnostic findings and, in particular, the quantitative compound muscle action potential data seemed to correlate with the timing of motor recovery. Patients with predominantly painless and significant weakness arising from disk extrusion can demonstrate successful rehabilitation outcomes. Despite a relative absence of pain, such patients can present with a more rapidly reversible neurapraxic type of weakness. The more quantitative compound muscle action potential data obtained through electrodiagnostic studies may offer the treating physician an additional means of characterizing the type of neuronal injury at play and the likelihood and timing of strength return.

Action Potentials↗
PubMed2005

Whiplash: fact or fiction?

Cervical sprain/strain or whiplash injuries are a common cause of acute and chronic musculoskeletal impairments and are ubiquitous after rear-end automobile collisions. The diagnosis is largely subjective and the ideal treatment controversial. Unfortunately, the majority of compensated litigation claims are associated with whiplash-type injuries secondary to motor vehicle accidents. Fortunately, many recent advances have led to better understanding of the collision and injury biomechanics and to development of a prognostic classification system, objective diagnostic tests, an array of treatment modalities, and, most important, safer automobiles. These advances will undoubtedly lead to decreased incidence, a more accurate diagnosis, and a tailored management regimen resulting in improved outcomes and ultimately fewer legal proceedings.

Accidents, Traffic↗
PubMed2005

Complications of halo fixation of the cervical spine.

Halo fixators play an integral role in stabilizing the cervical spine. They are most widely used after upper cervical to midcervical spine fractures and dislocations and as a supplement to various surgical fixation techniques. Compared with supine cervical traction techniques, halo fixators allow early patient mobilization and shorten hospital stays. The incidence of halo-fixator complications remains high. Minor complications include pin loosening, localized infection, periorbital edema, superficial pressure sores, and unsightly scars. Major complications include pin penetration, osteomyelitis, subdural abscess, nerve palsies, fracture overdistraction, and persistent instability. Many of these potential complications can be avoided with proper pin placement and meticulous pin care.

Bone Nails↗
PubMed2004

Measurement variability in the assessment of sagittal alignment of the cervical spine: a comparison of the gore and cobb methods.

BACKGROUND: Reconstructive procedures of the cervical spine are being performed with increasing frequency. Maintenance of physiologic sagittal alignment is an essential component of reconstructive procedures of the spine. Two methods exist for measuring sagittal alignment in the cervical spine: the Gore and Cobb methods. An experimental study comparing Gore and Cobb measurement techniques for nonspondylotic and spondylotic cervical spines was conducted. The objectives were to assess the intra- and interobserver variability of both the Gore and the Cobb methods of measurement to determine the most reproducible technique for assessing sagittal alignment of the cervical spine. METHODS: With use of C3 and C7 as the end vertebrae, lateral radiographs of 20 nonspondylotic (group 1) and 20 spondylotic (group 2) cervical spines were measured by the Gore and Cobb methods on three different occasions by three orthopaedic surgeons with different levels of experience. RESULTS: For group 1, there was less intra- and interobserver variability for the Gore method than for the Cobb method (P < 0.05). Group 2 measurements were also less variable for the Gore method, although this was not statistically significant. Pooling all three observers, 95% confidence limits for intra- and inter-observer variability for the Gore method were 3 degrees and 6 degrees for group 1 and 4 degrees and 7 degrees for group 2, respectively. For the Cobb method, corresponding values were 4 degrees and 9 degrees for group 1 and 5 degrees and 9 degrees for group 2. Overall, intraobserver measurements were less variable than interobserver measurements (P < 0.01). There were no significant differences in variability based on experience level. CONCLUSION: Measurements of cervical spine sagittal alignment by the Gore method are more reproducible than by the Cobb method.

Arthrography↗
PubMed2004

Infections of the spine: what the orthopedist needs to know.

Infections of the spine usually present with back pain in the absence of constitutional symptoms. Diagnosis requires a high index of suspicion and appropriate radiological and laboratory studies. Most infections can be managed conservatively with organism-specific antibiotics and bracing with good success. Surgery may be indicated to isolate the offending organism and to manage neurological and structural complications.

Epidural Abscess↗
PubMed2004

Atypical proximal limb pain of suspected high lumbar stenotic origin arising from severe aortoiliac disease--Leriche's syndrome.

We present the cases of two middle aged women who were referred to our physiatric spine center with chronic and proximal lower extremity pain complaints of suspected upper lumbar and stenotic origin. Their histories, physical examinations, and imaging studies were not convincing for a primary radicular pain generator. Non-invasive arterial Doppler studies demonstrated a significant brachial to high thigh pressure discrepancy without a focal segmental drop affecting the more distal lower extremity vasculature. Computed tomography (CT) angiograms confirmed advanced aorto-iliac atherosclerotic disease in each case. Spine practitioners are often consulted by the medical community to direct care in patients with suspected lumbar stenosis. These atypical cases of patients with isolated proximal lower extremity pain remind us of the symptomatic overlap between neurogenic and vascular claudication and emphasize the importance of a detailed history, physical examination, and appropriate imaging studies in identifying patients with primary arterial insufficiency.

Journal Article↗
PubMed2003

Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion.

STUDY DESIGN: This retrospective, questionnaire-based investigation evaluated iliac crest bone graft (ICBG) site morbidity in patients having undergone a single-level anterior cervical discectomy and fusion (ACDF) procedure performed by a single surgeon (T.J.A.). OBJECTIVE: To evaluate acute and chronic problems associated with anterior ICBG donation, particularly long-term functional outcomes and impairments caused by graft donation. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion procedures frequently use autologous anterior ICBG to facilitate osseous union. Although autologous ICBG offers several advantages over alternative grafting materials, donor site morbidity can be significant. Acute and chronic complications of donor sites have been reported, yet there are currently no reports of long-term functional outcomes after autologous anterior ICBG donation after single-level ACDF. METHODS: A questionnaire was mailed to 187 consecutive patients who were retrospectively identified to have undergone autologous anterior ICBG harvest for single-level ACDF between 1994 and 1998. The questionnaire divided items into symptomatic (acute and chronic) and functional assessments. Patients answered yes, no, or not applicable; pain was assessed with a Visual Analogue Scale (VAS). RESULTS: Surveys were completed either by mail or follow-up telephone interview by 134 patients (71.6%). Average follow-up was 48 months (range, 24-72 months). Acute symptoms were reported at the following rates: ambulation difficulty, 50.7%; extended antibiotic usage, 7.5%; persistent drainage, 3.7%; wound dehiscence, 2.2%; and incision and drainage, 1.5%. The chronic symptom questionnaire demonstrated a high degree of satisfaction with the cosmetic result (92.5%). Pain at the donor site was reported by 26.1% of patients with a mean VAS score of 3.8 in 10, and 11.2% chronically use pain medication. Twenty-one patients (15.7%) reported abnormal sensations at the donor site, but only 5.2% reported discomfort with clothing. A unique functional assessment revealed current impairments at the following rates: ambulation, 12.7%; recreational activities, 11.9%; work activities, 9.7%; activities of daily living, 8.2%; sexual activity, 7.5%; and household chores, 6.7%. CONCLUSIONS: A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.

Activities of Daily Living↗
PubMed2003

Etiology, treatment, and prevention of athletic "stingers".

Stingers or burners are common in athletes, especially football players. They represent a traction, compression, or direct blow to the upper roots of the brachial plexus. They are usually transient and resolve quickly. Cervical canal stenosis with concurrent degenerative disc disease may predispose an athlete to this injury. Return-to-play criteria are largely based on the number of previous episodes and the duration of symptoms. These criteria also require appropriate consideration of any underlying pathological conditions. Appropriate counseling, including modification of tackling and addition of protective gear, in conjunction with complete rehabilitation, may be effective in preventing this condition or decreasing the rate of recurrence. The athlete, family, and coaches need to understand that recurrence remains unpredictable.

Athletic Injuries↗
PubMed2002

Advances in surgical management of lumbar degenerative disease.

The past several years have seen many advances in spine technology. Some of these advances have improved the quality of life of patients suffering from disabling low back pain from degenerative disk disease. Traditional fusion procedures are trending toward less invasive approaches with less iatrogenic soft-tissue morbidity. The diversity of bone graft substitutes is increasing with the potential for significant improvements in fusion success with the future introduction of several well tested bone morphogenic proteins to the spinal market. Biologic solutions to modify the natural history of disk degeneration are being investigated. Recently, electrothermal modulation of the posterior annulus fibrosis has been published as a semi-invasive technique to relieve low back pain generated by fissures in the outer annulus and ingrowing nociceptors (intradiskal electrothermal therapy, and intradiskal electrothermal annuloplasty). Initial results are promising, however, prospective randomized studies comparing this technique with conservative therapy are still lacking. The same is true for artificial nucleus pulposus replacement using hydrogel cushions implanted in the intervertebral space after removal of the nucleus pulposus posterior or through an anterior approach. Intervertebral disk prostheses are presently being studied in small prospective patient cohorts. As with all new developments, careful prospective, long-term trials are needed to fully define the role of these technologies in the management of symptomatic lumbar degenerative disk disease.

Biomechanical Phenomena↗
PubMedDate not supplied

Analysis of patient variables affecting neurologic outcome after traumatic cervical facet dislocation.

BACKGROUND CONTEXT: Traumatic cervical facet dislocation accounts for a disproportionate rate of neurologic disability. The relative importance of patient and management variables, including the timing of spinal reduction, in ultimate neurologic outcome has not been well defined. PURPOSE: To analyze data from a cohort of patients sustaining traumatic cervical facet dislocation to determine the relative importance of several patient and management variables in neurologic recovery after injury. STUDY DESIGN/SETTING: A retrospective study was conducted at a major referral center for spinal-cord-injured patients. PATIENT SAMPLE: Forty-five patients sustaining traumatic cervical facet dislocation. OUTCOME MEASURES: Using improvement in American Spinal Injury Association (ASIA) motor score as the primary outcome measure, patient data were used to construct a statistical model allowing the analysis of several clinically relevant variables. METHODS: The records of patients sustaining a traumatic cervical facet dislocation over a 5-year period were reviewed. Clinical data were collected for all patients with adequate follow-up. The data were used to construct a statistical model designed to analyze the contribution of the variables age, gender, time to reduction of the spine and initial motor score to neurologic improvement (the outcome measure). In addition, the effect of variable interaction was studied. RESULTS: Most patients demonstrated neurologic improvement over the course of follow-up after cervical facet dislocation. For this data set, the variables age and initial motor score were significantly associated with neurologic improvement. However, time to reduction of the spine did not demonstrate a significant independent relationship to neurologic outcome. No significant interaction was found between patient age or gender and the time to reduction with regard to predicting neurologic recovery. CONCLUSION: The present study uses a statistical model to determine the relative importance of clinically relevant variables for a population of patients after traumatic cervical facet dislocation. This model confirms the clinical impression that younger patients with lesser degrees of neurologic injury tend to achieve the best neurologic recovery after a traumatic facet dislocation. Although a strong benefit from earlier spinal column reduction did not emerge from the present data set, additional study is needed to define those patients who would benefit from immediate reduction of the spinal column.

Adult↗
PubMedDate not supplied

Management of postprocedural discitis.

BACKGROUND CONTEXT: Fortunately, the incidence of postprocedural discitis is relatively uncommon. The paucity of physical examination findings behooves the spine care practitioner to have a high index of suspicion in any patient presenting with increasing back pain after an invasive spinal procedure. The diagnosis can often be established in a timely fashion based on the history, physical examination, laboratory studies (erythrocyte sedimentation rate, C-reactive protein and blood cultures) and imaging studies (plain radiographs, magnetic resonance imaging, computed tomography and radionuclide scanning). PURPOSE: To review the English literature on the subject of postprocedural discitis. The incidence, pathophysiology, laboratory markers and imaging findings are discussed. Recommendations on treatment strategies are presented along with long-term clinical outcomes of this postprocedure complication. METHODS: A contemporary English literature search of MEDLINE and PubMed on the topic of postoperative discitis was performed. RESULTS: The incidence of postprocedural discitis is approximately 0.2%. The most common etiologic agent is Staphylococcus aureus. The C-reactive protein is the most sensitive clinical laboratory marker to assess the presence of infection and effectiveness of treatment response. Magnetic resonance imaging is the imaging modality of choice in the diagnosis of spinal infection. The majority of patients are managed adequately with organism-specific antibiotics and spinal immobilization with good long-term outcomes. Operative intervention (open biopsy followed by antibiotic treatment and spinal immobilization or debridement and reconstruction) in patients who fail to respond to nonoperative treatment or in the presence of neurologic worsening has been demonstrated. CONCLUSION: Postprocedural discitis is a rare complication after any invasive spinal procedure. It is imperative for the treating surgeon to maintain a high index of suspicion. Appropriate laboratory and imaging studies are invaluable in establishing a timely diagnosis. In the majority of patients, antibiotic treatment along with spinal immobilization has been shown to produce good long-term outcomes. Operative intervention is rarely necessary in patients failing conservative treatment.

Anti-Bacterial Agents↗
PubMedDate not supplied

Changing patterns of pediatric pelvic fractures with skeletal maturation: implications for classification and management.

Orthopaedic traumatologists have recognized the unique fracture patterns and injury constellations of pediatric pelvic fractures. However, an understanding of the effect of advancing skeletal maturation is needed to avoid applying adult classifications and management. The authors determined how pelvic fracture patterns and management change with advancing skeletal maturity. At their pediatric trauma center, they identified 166 consecutive pelvic fractures. Eighty percent of patients had plain radiographs adequate to evaluate the triradiate cartilage. Physes were scored as open, narrowed, or closed. The Risser sign, fracture pattern, survival after injury, and need for open reduction and internal fixation were recorded. Ninety-seven patients (mean age 5.7 years) had an open triradiate or an "immature pelvis." Thirty-two patients (mean age 14 years) had a closed triradiate cartilage or a "mature pelvis." The immature group had a higher propensity for isolated pubic rami and iliac wing fractures. The mature group had a higher predilection for acetabular fractures and pubic or sacroiliac diastasis. All patients requiring open reduction and internal fixation had a mature pelvis. The incidences of specific pelvic fracture patterns between the two groups were statistically different. Management of fractures to the immature pelvis should focus on associated injuries. Once the triradiate cartilage has closed, adult pelvic fracture classifications and management principles should be used.

Adolescent↗