Biomedical subjects
Publications and source records attributed to L Aulisa.
A case of cervical spine (atlas) osteoblastoma in a 14-year-old patient is reported. Osteoblastoma is a rare primary bone tumour and in young patients it mainly occurs in the spine. Occurrence in the cervical tract is uncommon and in the atlas it is very rare. Only two other cases were found in our literature review.
The authors screened blind children from a special school to determine whether there is any correlation between idiopathic scoliosis and changes in the postural control system induced by blindness. Children with disabilities in addition to blindness, and children under the age of 8 years were excluded. They selected a homogeneous sample of 46 children of whom 39 were congenitally blind and 7 had become blind after birth. The results in the congenitally blind group were highly significant both quantitatively (59% exhibited structural deviations of the spine) and qualitatively. Apart from 2 cases they all exhibited multiple short scoliotic curves with unique characteristics rarely seen in sighted subjects. Despite this, the authors feel unable to make any categorical assertions regarding the possible role played by functional changes in the exterosensory and proprioceptive organs in the pathogenesis of idiopathic scoliosis. They suggest that the development of such multiple small curves in congenital blindness is simply the response of a congenitally deprived mechanism of body development to achieve stable equilibrium in the spine.
We have investigated the affect of removal of Harrington rods in 36 patients who had undergone successful spinal fusion for idiopathic scoliosis. In the curves in which further deterioration had taken place even though fusion had been achieved, there was a small improvement in both major and minor curves in the first six months after removal of the rod, followed by complete stabilisation of the curve. A similar tendency to stabilisation was noticed in the curves which had not shown deterioration. We conclude that regression of a curve which has fused following Harrington rod instrumentation occurs when the rod has not been placed according to optimum biomechanical principles. Removal of the rod then relieves the deforming stresses and allows the spine to stabilise.
Corrosion and histopathological modifications in tissues surrounding the rod in a stainless steel Harrington's system, are reported. These phenomena occur soon after implantation and are very evident. Therefore in contrast to Harrington's thesis, the authors are convinced that it is necessary to remove the system after the consolidation of bone grafts.
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A 15-year-old girl was referred to us because of foot drop. The motor deficit was characterized by a peculiar fluctuating course related to sporting activity: improvement of symptoms during no-sport periods and worsening during sport training. Neurophysiological examination revealed marked global impairment of muscles innervated by the peroneal nerve. Ultrasound and MRI showed a mass in close proximity to the neck of the fibula extending in a tubular fashion. At operation an intraneural lesion was found and was totally removed. Histology revealed that it was an intraneural cyst. A hypothesis on the pathogenesis was drawn up. One year after the operation a clinical and neurophysiological follow-up was performed.
Instability is one of the pathologic conditions of the spine for which surgical treatment is increasingly indicated, even if to-date the definition of instability is controversial. Some aspects of the biomechanics of the spine with particular reference to the viscoelastic characteristics of its elements and the involved loads, are reported. The elasticity of the spine is analyzed with an in-depth consideration of the concept of stability and instability from the biomechanical, clinical and radiographic viewpoint.
The surgical management of clinical spinal instability is for many aspects controversial since the lack of a precise clinical and instrumental definition of instability complicates the implementation of a therapeutic protocol. Both the indications and the surgical procedure are not always well defined. Some of the most common surgical techniques used in the most frequent causes of instability of the lumbar spine: fractures, degenerative disease and spondylolisthesis, are described.
With the advances in diagnostic and surgical procedures, for degenerative disease of the lumbar spine an aggressive therapeutic approach is more frequently indicated. The available surgical procedures are numerous and in continuing evolution. Most common surgical procedures used in major degenerative disease of the lumbar spine as disk herniation and stenosis are described. Indications, results and complications associated to these procedures are also illustrated.
The differentiation between normal sequelae and complications of any surgical treatment of the lumbar spine is of the utmost importance. Clinical and radiological diagnosis is often difficult. Certainly the introduction of computed tomography (CT) and magnetic resonance imaging (MRI) has improved and refined the diagnostic possibilities, however not all problems have been resolved. For example, the frequent resort in vertebral surgery to metal implants which may limit or even prevent the interpretation of CT or MR images, should be kept in mind. The main types of surgical procedures involving the lumbar spine are briefly reviewed, focusing on CT and MRI appearance of normal sequelae of early or late complications and the recurrence of the lesion that necessitated the first procedure.