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Biomedical subjects

L L Wiltse

Publications and source records attributed to L L Wiltse.

17 recordsLinked to original sources
PubMed1991

Unilateral lumbar fusion.

Unilateral fusion of the lumbar spine is rarely necessary or indicated. However, in patients with a "far-out syndrome" requiring decompression or in cases where unilateral posterior element resection is necessary for any reason, it may be both necessary and indicated. This unilateral destabilization effectively removes one leg of the tripod, rendering that intervertebral joint potentially unstable. The charts and radiographs of 13 patients (seven men, six women) with an average age of 60 years (range, 25 to 76) who underwent unilateral fusion were retrospectively reviewed. Follow-up time ranged from 12 1/2 to 2 years with a median follow-up of 8 years. Eleven of the fusions were at one level, and two were at two levels. Seven patients had a far-out syndrome secondary to degenerative scoliosis; four were secondary to spondylolisthesis. Two patients had an osteoid osteoma involving a pedicle. A paraspinal approach was used in the majority of patients. Autologous bone graft was used in all patients. Unilateral pedicle screw fixation was used in the last patient in the series. The fusion rate was 85% (11/13). Three patients were smokers, two of whom developed pseudarthrosis. Disc space height did not appear to affect fusion rate. There was no progression of slip noted in any of the patients. One complication was noted in this group: a moderate postoperative infection, which cleared spontaneously.

Female↗
PubMed1976

Treatment of spondylolisthesis and spondylolysis in children.

There are 2 fairly common types of spondylolisthesis in children - dysplastic and isthmic. The dysplastic type is secondary to congenital defects at the lumbosacral joint. The isthmic is usually due to a fatigue fracture of the pars interarticularis but there is also an hereditary element in this type. Most children with spondylolisthesis never develop significant symptoms and even of those who do, the vast majority can be treated without surgery. If symptoms persist or if further olisthesis is occurring, a one-level spinal fusion done through a paraspinal approach is recommended. It is most important not to allow olisthesis to develop to the point that the child shows the cosmetically undesirable stigmata characteristic of the condition. Solid fusion can be obtained in every case and will stop further slip.

Adolescent↗
PubMed1976

Spondylolysis in the female gymnast.

In a roentgenographic analysis of the lumbar spine of 100 young female gymnasts engaged in high-level competition, the incidence of pars interarticular defects was 11 per cent; 6 per cent had spondylolisthesis. This is 4 times higher than their non-athletic female peers. It appears that the female athlete may have the same incidence of pars interarticularis defects as the male performing similar activities. Pars defects developing in association with athletic activities may be distinct from those developing in early childhood. A negative lumbosacral roentgenographic series does not completely rule out a developing pars defect. Bone scintography offers an additional tool for evaluating early stress reaction in the pars, and suggests that if the athlete restricts vigorous activity, some will heal without progressing to roentgenographically detectable defects. Low back pain in the young gymnast should be a warning sign. Close scrutiny of pars interarticularis in these young athletes will reveal a high incidence of developing defects.

Adolescent↗
PubMed1975

Chymopapain chemonucleolysis in lumbar disk disease.

Experience with chymopapain chemonucleolysis in 1,200 cases of lumbar disk disease indicates that it is an effective method of relieving pain resulting from an abnormal intervertebral disk. Complications were few; anaphylaxis occurring immediately after injection was by far the most serious. With the use of a corticosteroid and an antihistamine in preoperative preparation, the incidence of anaphylaxis had dropped, although it still occurs. On long-term follow-up, chemonucleolysis appears to be as good as laminectomy in properly selected cases.

Anaphylaxis↗
PubMed1975

Fatigue fracture: the basic lesion is inthmic spondylolisthesis.

The defect in the pars interarticularis in spondylolysis and spondylolisthesis is most often the result of repeated trauma, stress, and factors other than acute fracture. These fatigue fractures develop early in life, may have a strong hereditary basis, and most often represent incidental roentgenographic findings. Attention should be given to the youngster or adolescent with low-back pain and paraspinal muscle spasm. If these patients are followed closely, the incidence of pars interarticularis defect is higher than appreciated. The lesion in some of these individuals may progress to significant vertebral slipping. If the developing defect is recognized early, treatment can be quite satisfactory.

Adolescent↗
PubMed1975

Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low-back syndrome.

Pre-injection psychological test scores, surgeon ratings, and patient biographical data were evaluated as predictors of success of chymopapain injection therapy in 130 patients who would otherwise have been treated by laminectomy. Three psychological tests were administered to each patient: the Minnesota Multiphasic Personality Inventory, the Cornell Medical Index, and the Quick Test (a measure of mental ability). In addition, the surgeons rated their patients on a five-point scale immediately after injection relative to their suitability for injection therapy and at one year relative to the objective and symptomatic results. The MMPI hysteria and hypochondriasis scales and the surgeon's rating of the psychogenic component of the patient's pain were predictive of the result of chemonucleolysis. The patient's biographical data which consisted of age, sex, marital status, occupation, and education were not related to postoperative outcome.

Adult↗
PubMedDate not supplied

Surgery for intervertebral disk disease of the lumbar spine.

There is little doubt that surgical treatment of lumbar spine pain is often unsatisfactory. It is likely that we are using a cannon when a peashooter properly aimed would do a better job. Various injection techniques, especially injection of the disk itself would seem to be a rational approach. Scarring around the spinal nerves and dura is an unsolved problem. The search for an interposition membrane goes on. Fat grafts are being advocated, but it is too early to evaluate their efficacy. The problem of how to adequately decompress the nerves in spinal stenosis without jeopardizing spinal stability is still unsolved. Interbody fusion still carries a high failure rate as far as fusion is concerned, but what is worse, failure to relieve the pain for which it was done remains frequent. Spine pain programs concentrating upon training in exercises, training in the proper way to perform the activities of daily living and especially psychological counseling and operant conditioning probably represent the greatest single recent advance in the rehabilitation of the low back sufferer. Finally, there is an unfulfilled need for more accurate reporting of our subjective clinical results if advances are to be made in this area, where pain is the principal problem.

Arthrodesis↗
PubMedDate not supplied

Multiplanar computerized tomography in the normal spine and in the diagnosis of spinal stenosis. A gross anatomic-computerized tomographic correlation.

The limitations of current diagnostic tools, including myelography, in localizing the anatomic lesion in spinal stenosis are well recognized. The purpose of this study is to investigate whether computerized tomography can more effectively define the normal and abnormal osseous structures compromising the boundaries of the spinal canal, nerve root canal, and intervertebral foramen. This study is a pathologic-radiographic correlation between CT scans and sections of spine specimens that were so scanned. The tomographic images investigated were multiplanar, that is, simultaneously presenting transverse, coronal, and sagittal images. Spine specimens were chosen to show how the technique applies to the normal spine, as wel as to selected specimens with spinal stenosis. The role of the discs and apophyseal joints in shaping the intervertebral foramina and lateral recesses is emphasized in both normal and abnormal specimens. This study shows that computerized tomography can precisely localize anatomic lesions and, by comparison of the image to the gross anatomic specimen, that it is a reliable portrayal of the anatomic fact.

Humans↗
PubMedDate not supplied

The treatment of spinal stenosis.

Decompression usually relieves leg pain and enables the patient to walk normal distances. Some back pain may remain. This is often helped by a light elastic support. If there was loss of sensation and motor power before operation, return may be considerable. The operation is only a small part of the total treatment of spinal stenosis. By relieving the pressure on nerves and blood vessels, it paves the way for the postoperative measures previously outlined. These are aimed at rebuilding atrophied muscles and restoring movement to stiff joints. We emphasize the importance of dealing not only with central stenosis involving the central canal, but also of making certain that there is no compression of the spinal nerves in their canals as they pass out through the foramina.

Adult↗