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Biomedical subjects

L Keppler

Publications and source records attributed to L Keppler.

12 recordsLinked to original sources
PubMed1999

MR imaging of the thrower's shoulder. Internal impingement, latissimus dorsi/subscapularis strains, and related injuries.

In conclusion, internal impingement apparently occurs in nearly all patients and is demonstrable on MR imaging. Pathologic changes associated with internal impingement seem to develop with repetitive placement of the arm into a position of extreme external rotation and abduction. Findings may include lesions of the posterior superior labrum, undersurface irritation, or tearing of the supraspinatus-infraspinatus junction near the attachment site and cystic changes of the posterior superior glenoid and posterior lateral greater tuberosity. There is no evidence for a particular sequence of pathologic changes. Instability may be associated with but does not appear to be a prerequisite for the development of the pathologic lesions of internal impingement.

Adult↗
PubMed1995

Seven-year follow-up of vertebral excision and reconstruction for malignant hemangioendothelioma of bone.

STUDY DESIGN: This study reports the 7-year follow-up of an L5 vertebral hemangioendothelioma treated with tumor excision and allograft reconstruction stabilized with transpedicular fixation. OBJECTIVES: A review of vertebral hemangioendotheliomas is provided to outline the rationale for surgical excision in such cases. SUMMARY OF BACKGROUND DATA: Radiation therapy has been the mainstay of therapy in surgically inaccessible lesions of the spine. The long-term follow-up of radical spinal tumor excision and reconstruction in previously surgically inaccessible areas has not been reported for vertebral hemangioendothelioma. METHODS: After embolizations, anterior L5 corpectomy and allograft femoral reconstruction was performed. Second-stage (same day) posterior element excision was followed by VSP stabilization of L4-S1 with artificial pedicles anchored into the femoral allograft at L5. Radiation therapy followed. RESULTS: Satisfactory long-term (7-year) segmental reconstruction using allograft and VSP was realized, even in the face of postoperative radiation therapy. CONCLUSION: Contemporary spinal reconstructive techniques have been developed that continue to limit the number of surgically inaccessible tumors in the spine. The present report shows these techniques to be durable and apparently effective in vertebral hemangioendothelioma.

Bone Transplantation↗
PubMed1994

Posterior transvertebral osteotomy for adult thoracolumbar kyphosis.

STUDY DESIGN: A retrospective case study was performed on the single-stage posterior transvertebral closing-wedge osteotomy for treatment of adult thoracolumbar kyphosis. SUMMARY OF BACKGROUND DATA: Forty-one consecutive cases in 38 patients available for follow-up, averaging 33 months (range 4-87 months), are included. All patients had severe pain and/or deformity; 51% of cases had previous fractures, and 49% had postlaminectomy failed back syndromes with kyphosis. A preoperative neurologic deficit was present in 34% of the cases including two with cauda equina syndrome. METHODS: Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed independently. Complications, risks, benefits, results, and biomechanical considerations were evaluated and discussed as compared with other techniques. RESULTS: All cases had solid union at follow-up; 93% maintained correction averaging 35 degrees with three requiring revision for failure. Postoperatively, 19.5% of the cases had new neurologic deficits with five (12.2%) temporary or minor and three (7.3%) major, including one with unimproved paraplegia at follow-up. Eight of the 14 preoperative neurologic deficit cases improved postoperatively; 26 additional surgeries were performed on 18 patients most commonly for pain (x 11) and additional trauma (x 4). The subjective questionnaire results indicated significant patient satisfaction, with 76% stating they would repeat the surgery and 90% recommending it to another. CONCLUSION: This technically demanding high-risk procedure provides an effective and mechanically superior correction for acute angle thoracolumbar kyphosis in selected adult patients, with high subjective satisfaction.

Female↗
PubMed1993

Artificial disc replacement. Preliminary report with a 3-year minimum follow-up.

Artificial disc replacement was performed in six patients with an average age of 55 years and average follow-up of 3.4 years. Four of the six patients had juxtafusion degeneration, one had multilevel disc degeneration, and one patient had isolated disc resorption. The Acroflex disc (Acromed Corporation, Cleveland, OH), which was used in the replacement, is composed of a rubber core vulcanized to two titanium end plates. The latter have superior posts to provide for initial mechanical fixation and porous in-growth surfaces for long-term fixation. Satisfactory results occurred in four of six patients. Poor results occurred in the presence of deformity that resulted in prosthetic failure and isolated disc resorption. There was an average 8 degrees angular and 2.3-mm translational movement and satisfactory in-growth at all interfaces. Design objectives of endurance, biocompatibility, geometry, kinematics, constraint, dynamics, stability, and fail-safe were met; however, this study is preliminary in nature.

Biocompatible Materials↗
PubMed1991

Clinical correlation between degenerative spine disease and dermatomal somatosensory-evoked potentials in humans.

The relationship between clinical status and preoperative and intraoperative dermatomal somatosensory-evoked potentials was investigated as a function of test site. Results indicated that the specificity and sensitivity of dermatomal somatosensory-evoked potentials varied with level of involvement: L5 demonstrated greatest agreement with equal correlation at L3, L4, and S1. Variables that influenced correlation included history of previous surgeries, type of anesthetic used, interpretation criteria, and whether the patient was awake or asleep. It was concluded that dermatomal somatosensory-evoked potentials can provide the surgeon with diagnostic and intraoperative information regarding the functional integrity of single nerve root function.

Evoked Potentials, Somatosensory↗
PubMed1991

Reduction of high-grade slips (grades III-V) with VSP instrumentation. Report of a series of 41 cases.

Records of 41 patients were reviewed for early complications resulting from reduction of high-grade spondylolisthesis. Blood loss averaged 1,427 ml. There were no cases of infection, dural tears, or bladder or bowel dysfunction. Two cases of transient foot drop and one case of permanent foot drop developed. A lumbar plexus stretch palsy occurred in one patient. Long-term results were evaluated in 20 patients followed up 2 or more years after surgery. Three of the 20 did not have interbody fusions and lost their reductions. All 20 patients went on to fuse with no pseudoarthrosis. One case of broken plate and two cases of broken screws occurred. Patient satisfaction ranged from good to excellent. Results suggest that reduction of high-grade slips with interbody fusion is a safe and effective procedure.

Blood Loss, Surgical↗
PubMedDate not supplied

Neurological complications resulting from supracondylar fractures of the humerus in children.

One hundred thirty-eight children with supracondylar fractures of the humerus were reviewed. Seventeen (12%) exhibited neurological deficits. Nine median, four ulnar, and four radial neuropathies were encountered. The neurological deficit was treated expectantly. The osseous injury was treated by a variety of methods. All patients except two recovered spontaneously in an average of 9 weeks. One patient was still improving at 9 months' follow-up. Another patient with radial neuropathy underwent exploration 6 months after injury and was found to have a transected radial nerve. This study demonstrates that neurological deficits from supracondylar humeral fractures remain common, involve all three major nerves of forearm, and, with rare exception, recover with conservative therapy.

Child↗