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Biomedical subjects

R S Brower

Publications and source records attributed to R S Brower.

6 recordsLinked to original sources
PubMed1999

Microdecompression for lumbar spinal canal stenosis.

STUDY DESIGN: A description of the technique for lumbar microdecompression and a prospective study of the outcomes. OBJECTIVE: To describe and analyze a technique that affords an excellent decompression while minimizing damage to surrounding tissues. SUMMARY OF BACKGROUND DATA: Commonly used techniques of lumbar decompression that include bilateral takedown of paraspinal musculature and aggressive bony resection can result in significant iatrogenic sequelae. A less destructive alternative is needed. METHODS: Unilateral limited takedown of multifidus was undertaken, and ipsilateral decompression performed. The contralateral side then was addressed under the midline structures with microscopic visualization--thereby preserving the supra-/interspinous ligament complex and the contralateral musculature. Thirty consecutive patients undergoing the procedure were analyzed prospectively and after a follow-up period by independent observers using a modified validated functional outcome score and patient satisfaction measures. RESULTS: The technique affords an excellent decompression while minimizing destruction to tissues not directly involved in the pathologic process. Functional outcome scores doubled, and 87% of patients reported high satisfaction rates. CONCLUSIONS: Lumbar microdecompression is a minimally invasive technique that appears to provide excellent functional outcomes.

Adult↗
PubMed1997

Traumatic vertical atlantoaxial instability in a case of atlanto-occipital coalition.

STUDY DESIGN: This is a report of a woman with an atlanto-occipital coalition who experienced a traumatic vertical atlantoaxial facet dislocation and severe associated neurologic injury. OBJECTIVE: To describe the radiographic and pathoanatomic characteristics of the injury process. SUMMARY OF BACKGROUND DATA: Severe injuries of the occipito-atlantoaxial complex are uncommon and only rarely are associated with patient survival. This is the first report of this particular injury. METHODS: Plain radiography and tomography demonstrated the facet dislocation and instability of the injury. Surgical exploration for repair of the torn dura mater and bony arthrodesis demonstrated the gross pathoanatomy. RESULTS: The patient's vertical atlantoaxial instability was stabilized, her dura mater reconstructed, and her necrologic status has improved to allow mobilization with a cane. CONCLUSION: Vertical atlantoaxial instability has not been described previously. From the somewhat subtle radiographic findings, one might underestimate the severity of the neurologic damage. Aggressive work-up and management of this injury is suggested to avoid potential further necrologic sequelae.

Accidents, Traffic↗
PubMed1994

Anular incision technique on the strength and multidirectional flexibility of the healing intervertebral disc.

STUDY DESIGN: This study used a sheep model to biomechanically analyze the healing strength of the anulus fibrosus after two types of anular incisions. OBJECTIVE: This study evaluated whether the type of anular incision made at the time of lumbar discectomy plays a role in the subsequent healing strength of the anulus and the biomechanical flexibility of the corresponding motion segment. METHODS: Two types of anular incision, a full thickness removal of a box or window of anulus and a full thickness straight transverse slit through the anulus, were made in the intervertebral discs of 18 adult sheep. After healing times of 2, 4, and 6 weeks, the intervertebral discs were tested versus control levels for strength of anular healing and biomechanical flexibility of the corresponding motion segment. RESULTS: The box incised discs showed a significantly greater loss in strength during the early healing phase (2 to 4 weeks) and a longer response before recovering anular strength when compared with the slit-incised discs. The type of incision also affected the multidirectional flexibility of the motion segments in a differentiated manner. Larger amounts of motion were seen with the box incision when compared with the slit incision at all time periods and in all pure moments. CONCLUSION: The technique of anular incision plays a definite role in the timing and strength of subsequent anular healing. The box incision through the anulus led to significantly weaker healing than did the slit incision in the early healing phase (2-4 weeks). Also, larger amounts of motion were seen in the vertebral motion segments of those discs undergoing box incision when compared with slit or control levels.

Animals↗
PubMed1992

Cervical spondylotic myelopathy. Clinical syndrome and natural history.

A wide-based spastic gait is the classical presentation of the patient with cervical spondylotic myelopathy. A complete neurologic evaluation is needed to determine the degree of involvement and to classify the clinical syndrome. The natural history seems to be one of static neurologic deficit or episodic progression.

Cervical Vertebrae↗
PubMedDate not supplied

In vitro comparison of over-the-top and through-the-condyle anterior cruciate ligament reconstructions.

Knee kinematics, during standard knee examination maneuvers, were measured on 15 fresh cadaveric knees in their normal state and after isolated sectioning of the anterior cruciate ligament using a six degree of freedom electrogoniometer. Proximal iliotibial band autografts were used to perform two anterior cruciate ligament reconstructions on the cadaveric knees: an over-the-top reconstruction and a through-the-condyle procedure. Both of these reconstructions reduced the abnormal anterior translation of the anterior cruciate ligament-deficient knee seen in Lachman testing. However, neither reconstruction restored the normal anterior translation. In addition, other motions remained uncorrected: 1) the internal rotation due to internal torque at full extension; 2) coupled anterior translation during internal rotation at full extension; and 3) coupled medial translation with anterior translation in Lachman testing. There were no statistical differences noted in the joint kinematics created by either reconstruction.

Aged↗