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Biomedical subjects

M N Hadley

Publications and source records attributed to M N Hadley.

At least 55 records · Page 3Linked to original sources
PubMed1997

Prospective assessment of continuous intrathecal infusion of baclofen for spasticity caused by acquired brain injury: a preliminary report.

Twelve consecutive patients with severe spasticity and hypertonia following acquired brain injury were treated with continuous intrathecal infusion of baclofen via an implanted, programmable infusion pump-catheter system for a minimum of 3 months. In every case intrathecal baclofen therapy resulted in a statistically significant reduction in upper- and lower-extremity tone, spasm frequency, and reflexes, contributing to improved functional abilities. There were no untoward side effects or complications associated with treatment. This preliminary assessment indicates that intrathecal administration of baclofen is effective in treating the disabling spasticity caused by acquired brain injury in selected patients.

Adolescent↗
PubMed1996

Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis.

The authors conducted a prospective study of 132 patients requiring interbody fusion without instrumentation following anterior cervical discectomy to compare the efficacy of tricortical iliac crest allograft versus autograft fusion substrates. The objectives of the study were to assess the potential differences in interspace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. The impact of habitual cigarette smoking on fusion rates was also examined. Autograft tricortical iliac crest bone was found to be superior to allograft bone as an interbody fusion substrate after both single- and multiple-level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation, and radiographic and clinical fusion success rates. Cigarette consumption had a significant adverse effect on successful anterior cervical interbody fusion for both autograft and allograft substrate, an effect that was most pronounced among smokers treated with allograft bone (p = 0.004).

Adult↗
PubMed1994

Dialysis-associated spondylarthropathy. Report of 10 cases.

Ten patients undergoing long-term renal dialysis for end-stage renal failure developed a destructive, non-infectious spondylarthropathy. All 10 patients had biopsy-proven dialysis-associated spondylarthropathy and subsequent spinal instability secondary to beta 2-microglobulin deposition in the vertebrae, intervertebral disc spaces, and support structures of the spine. Nine patients had cervical spinal instability and one had thoracolumbar spinal instability, with resultant neural compression. In at least one patient, the spinal instability was rapidly progressive. All had received renal dialysis for 34 months or longer (mean 109 months, range 34 to 154 months). Each patient required spinal stabilization (external in seven patients, internal in three). Nine of the 10 patients underwent neural decompression and spinal stabilization and fusion procedures. One patient's neurological condition was worse following surgery due to a postoperative cervical epidural hematoma; in the other nine patients, the presenting symptoms and signs improved. Three of these chronically ill patients did not survive their hospitalization, for a perioperative mortality rate of 30%. Death was due to cardiopulmonary arrest in two patients on Day 5 and 9 postoperatively and to sepsis in the third on Day 14. Of the seven early survivors, two additional patients died: one on Day 59 due to congestive heart failure and the other on Day 273 due to a cerebrovascular accident. Four of five patients who were followed for 8 months or longer (mean 14 months, range 8 to 20 months) had successful neural decompression and spinal stabilization procedures with evidence of stable bone fusion, indicating that these chronically ill, difficult-to-manage patients can be successfully treated. Clinicians who treat patients with renal disease and neurosurgeons who treat spinal disorders should be aware of dialysis-associated spondylarthropathy as a potential cause of degenerative vertebral column instability.

Adult↗
PubMed1993

Lumbar microdiscectomy with medial facetectomy. Techniques and analysis of results.

Lumbar microdiscectomy and medial facetectomy are safe and effective operative options in the treatment of symptomatic herniated lumbar discs in selected patients. We use this approach for patients with a lateralized intracanalicular disc herniation (rather than a broad-based disc rupture) without significant degenerative stenosis or a prior operation. The procedures can usually be performed easily and quickly with excellent illumination and visualization. The medial facetectomy component of the procedure allows early identification of the compressed nerve root and affords excellent exposure to the disc space without significant nerve root or thecal sac retraction. The results with microsurgical discectomy are good and the complications few. The limited incision and surgical dissection appear to minimize postoperative patient morbidity and may reduce the duration of the postoperative hospital stay. It is important that we not lose sight of the fact that the goal of lumbar disc surgery is to restore an individual's functional abilities and allow an expeditious return to daily activities as well as to work. Among carefully chosen patients, a skilled surgeon probably can achieve this goal using either standard or microsurgical techniques.

Adolescent↗
PubMed1993

Cervical disc herniations. The anterior approach to symptomatic interspace pathology.

The anterior operative approach to the cervical spine is an excellent and safe operative route for the treatment of symptomatic cervical disc herniations. The authors describe their surgical techniques and clinical results with this approach and discuss the issue of fusion following anterior cervical discectomy for spinal cord and cervical nerve root decompression.

Cervical Vertebrae↗
PubMed1992

Facet fracture-dislocation injuries of the cervical spine.

Sixty-eight patients with acute traumatic cervical facet fracture-dislocation injuries are presented. These patients represented 6.7% of all cervical spine fractures identified over a 12-year period. Thirty-one patients had unilateral facet injuries and 37 had bilateral facet injuries. Neurological morbidity was 90% and was most severe among bilateral facet injury patients (84% complete injuries). Spinal shock was identified in 13 patients and was a poor prognostic indicator for the subsequent recovery of associated neurological deficits. Closed reduction was attempted in 66 of 68 patients and was successful in 58% of the patients. Seven patients deteriorated. Open reduction-internal fixation was successful in 83% of 24 patients with a 4% morbidity. Seventy-eight percent of patients improved with rapid closed reduction, and 60% improved with open reduction-internal fixation; however, only 10 patients of the entire 68 made significant neurological recoveries. In these 10 patients, the timing of decompression-realignment appeared to be more important than the means of reduction.

Adolescent↗
PubMed1991

Pediatric spinal cord injury without radiographic abnormalities: report of 26 cases and review of the literature.

Spinal cord injury without radiographic abnormality (SCIWORA) occurs primarily in the pediatric population but is less common than other forms of spinal injury among children. Between 1972 and 1990, 159 pediatric patients were admitted to the Barrow Neurological Institute with acute traumatic spinal cord or vertebral column injuries. Of these, 26 children (16%) sustained SCIWORA. The mechanism of injury, its severity, and the prognosis for recovery were related to the patient's age. In young children, SCIWORA accounted for 32% of all spinal injuries and tended to be severe; 70% were complete injuries. In older children, SCIWORA accounted for only 12% of the spinal injuries, was rarely associated with a complete injury, and had an excellent prognosis for complete recovery of neurologic function. As with other types of spinal cord injuries, the severity of neurological injury was the most important predictor of outcome. Patients with complete neurological deficits from SCIWORA had a poor prognosis for recovery of neurological function.

Adolescent↗
PubMed1991

Management of athletic injuries of the cervical spine and spinal cord.

Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral column and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty-five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The interspinous method of posterior atlantoaxial arthrodesis.

Thirty-six patients underwent C1-2 posterior wiring and fusion procedures over a 5-year period for unstable C-2 fractures (eight cases), unstable atlas-axis combination fractures (six cases), rheumatoid C1-2 instability (14 cases), os odontoideum (four cases), traumatic C1-2 ligamentous instability (three cases), or instability secondary to a C-2 tumor (one case). In each case, the atlantoaxial arthrodesis utilized sublaminar wire at C-1 and incorporated an iliac-crest strut-graft positioned between the posterior arches of C-1 and C-2, held in place by securing wire around the base of the spinous process of the axis. Follow-up examination was performed in all patients after a mean postoperative duration of 33.7 months. The technical aspects and clinical merits of this fusion procedure, which led to a 97% union rate (one nonunion) and minimal morbidity and mortality rates, are presented.

Adult↗
PubMed1991

Cavernous malformations and capillary telangiectasia: a spectrum within a single pathological entity.

Cerebral vascular malformations have traditionally been divided into four categories: arteriovenous, venous, cavernous, and capillary telangiectases. A controversy exists about separating the latter two lesions into separate entities. Critics claim the distinction is arbitrary but have been unable to present convincing evidence linking the two types of lesions. We have reviewed the histories of 20 patients with cavernous malformations and have analyzed the clinical, radiographic, and surgical-autopsy data associated with these lesions. In some patients, multiple lesions, including cavernous malformations, capillary telangiectases, and transitional forms between the two, were identified. Based on this analysis, we conclude that capillary telangiectasia and cavernous malformations represent two pathological extremes within the same vascular malformation category and propose grouping them as a single cerebral entity called cerebral capillary malformations.

Capillaries↗
PubMed1990

Management morbidity and mortality of poor-grade aneurysm patients.

Preliminary experience with the occasional good survival of patients in Hunt and Hess Grade IV or V with aneurysmal subarachnoid hemorrhage (SAH) led to a prospective management protocol employed during a 2 1/2-year period. The protocol utilized computerized tomography (CT) scanning to diagnose SAH and to obtain evidence for irreversible brain destruction, consisting of massive cerebral infarction with midline shift or dominant basal ganglia or brain-stem hematoma. These patients, along with those who exhibited poor or absent intracranial filling on CT or angiography, were excluded from active treatment and given supportive care only. All other patients had immediate ventriculostomy placement and, if intracranial pressure (ICP) was controllable (less than or equal to 30 cm H2O without an intracranial clot or less than or equal to 50 cm H2O in the presence of a clot), went on to have craniotomy for aneurysm clipping. Aggressive postoperative hypertensive, hypervolemic, hemodilutional therapy was subsequently employed. Of 54 patients with poor-grade aneurysms, ventriculostomy was placed in 47 (87.0%) and yielded high ICP's in the overwhelming majority, with the mean ICP being 40.2 cm H2O. Nineteen poor-grade aneurysm patients received no surgical treatment and survived a mean of 31.8 hours with 100% mortality. Thirty-five patients underwent placement of a ventriculostomy, craniotomy for aneurysm clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemic, hemodilutional therapy. The outcome at 3 months of the 35 patients who were selected for active treatment was good in 19 (54.3%), fair in four (11.4%), poor in four (11.4%), and death in eight (22.9%). It is concluded that poor-grade aneurysm patients usually present with intracranial hypertension, even those without an intracranial clot. Based on radiographic rather than neurological criteria, a portion of these patients can be selected for active and successful treatment. Increased ICP can be present without ventriculomegaly, and immediate ventriculostomy should be performed. As long as ICP is controllable, craniotomy and postoperative intensive care can effect a favorable outcome in a significant percentage of these patients.

Cerebral Hemorrhage↗
PubMed1990

Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction.

Fourteen patients with superior cervical spinal cord injuries and the clinical signs and symptoms of cruciate paralysis are presented. This rare injury pattern is characterized by weakness of the upper extremities with little or no compromise of lower-extremity function following trauma to the superior spinal cord. Anatomically, cruciate paralysis is thought to represent selective injury to descending corticospinal tracts as they decussate at the cervicomedullary junction. The clinical and radiographic findings of each patient are outlined and the incidence and natural history of the injury syndrome, including a review of the literature, are presented.

Adolescent↗
PubMed1990

Surgical approaches to the thoracolumbar spine.

Pathology affecting the spinal cord structures and/or vertebral segments at the TLJ is not uncommon. Trauma is the most frequent cause of dysfunction-compression at these levels and may result in permanent neurological disability and vertebral column instability. Patients with TLJ pathology must be evaluated carefully and thoroughly with serial neurological examinations and diagnostic radiographic studies as outlined. The treatment of patients who are documented to harbor TLJ pathology must be individualized and is determined by the type, extent, and level of the lesion, the presence of dislocation and/or instability, and the degree of neurological compromise. Surgical decompression is the treatment of choice for patients with tumor or herniated disk. Many of the TLJ trauma patients may be managed nonoperatively, but surgical decompression and stabilization will be required in selected patients to maximize their long-term functional recovery. There are several viable surgical options and approaches available for the treatment of TLJ lesions, depending on individual patient pathology and the experience and expertise of the surgical team. In general, ventral compressive lesions, depending on individual patient pathology and the experience and expertise of the surgical team. In general, ventral compressive lesions must be approached via a ventral or ventrolateral exposure allowing decompression without injury to neural structures. In our experience, the "modified" costotransversectomy approach is an efficacious approach for treatment of TLJ pathology and incorporates both a decompression procedure and a stabilization-fusion procedure (when required) into the same operative setting.

Humans↗