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Biomedical subjects

S D Gertzbein

Publications and source records attributed to S D Gertzbein.

At least 19 recordsLinked to original sources
PubMed1998

Pseudarthrosis of the lumbar spine. Outcome after circumferential fusion.

STUDY DESIGN: Twenty-five patients with a pseudarthrosis after previous spinal fusion surgery were reviewed after a circumferential fusion was performed. OBJECTIVES: To determine the fusion rate and its relation to outcome, i.e., pain reduction and return to work, and associated complications. SUMMARY OF BACKGROUND DATA: Circumferential fusion has become a common procedure with more patients undergoing multiple operations. This operation is thought to improve the fusion rate with a low complication rate. However, the procedure has not been evaluated specifically for the management of pseudarthrosis. METHODS: Twenty-five patients were reviewed regarding age, gender, smoking status, previous back surgeries, extent of leg and back pain, occupation, levels of surgery, type of instrumentation, blood loss, and complications. A minimum follow-up period of 2 years included evaluation of radiographs, pain levels, medication, and return to work. RESULTS: Twenty percent of patients were heavy smokers. An average of 2.2 previous procedures had been performed, and the average follow-up period was 2.7 years. Eighty percent of patients underwent multiple-level fusions. A solid fusion was achieved in 100%. Complications included two painful instrumentation devices requiring removal, one retroperitoneal hematoma, one anterior abdominal wall dehiscence, and one case of pneumonia. Pain scores improved from 7.4 to 4.7 for back pain, and 5.4 to 2.8 for leg pain, respectively. Both improvements were statistically significant (P < 0.01 and 0.003, respectively). However, only 52% of patients reduced their pain by a full category. Forty-one percent were still taking narcotics intermittently or consistently, and 53% returned to work or were actively seeking employment. DISCUSSION: A fusion rate of 100% was noted in the face of factors often placing patients at high risk for developing a pseudarthrosis, namely multiple levels of previous spinal surgery, including previous pseudarthrosis, and a habit of heavy smoking. Complications were few. However, the satisfactory outcome rate was only somewhat better than 50%, based on a lack of substantial pain improvement and return to work.

Bone Screws↗
PubMed1998

Traumatic pneumomyelography. A marker of spinal column injury in the face of innocuous spine fractures: two case reports.

STUDY DESIGN: A report of two cases of spinal column injury. OBJECT: To document the presence of air within the spinal canal following spinal fractures. SUMMARY OF BACKGROUND DATA: Only two previous cases of air in the spinal canal have been reported in the English literature. This report emphasizes that even with innocuous-appearing fractures of the thoracic spine, a similar phenomenon can occur. METHODS: The author reports on the medical records and radiographic investigations related to these two cases. RESULTS: Air within the cervical, thoracic, and lumbar spine was identified in what appeared to be minor spinal fractures of the thoracic spine. CONCLUSIONS: In cases of relatively undisplaced fractures of the thoracic spine associated with air in the spinal canal, one should be alert to the possibility of more unstable injuries that may have undergone significant displacement at the time of the fracture.

Adult↗
PubMed1998

An unusual cause of lumbar discitis.

STUDY DESIGN: Case report. OBJECTIVE: To identify an unusual cause of lumbar discitis. SUMMARY OF BACKGROUND DATA: Discitis resulting from a foreign body has not been reported in the English-language literature. METHOD: A case report is reviewed identifying the presence of this foreign object (titanium), erroneously implanted into the disc space at L5-S1. Imaging studies identify the location and surrounding reaction. RESULTS: The surgical exploration of this disc revealed an inflammatory response surrounding the disc with degeneration within the disc space. CONCLUSION: If this gynecologic procedure is performed using bone anchors, care must be take to ensure that the sacrum is identified before insertion.

Discitis↗
PubMed1996

Semirigid instrumentation in the management of lumbar spinal conditions combined with circumferential fusion. A multicenter study.

STUDY DESIGN: Patients with the diagnosis of degenerative disc conditions or spondylolisthesis undergoing circumferential fusion with posterior pedicle screw fixation using a semirigid rod were reviewed. OBJECTIVES: To determine the effectiveness of this approach in achieving a spinal fusion and satisfactory clinical outcome, and to determine the complications associated with the procedure. SUMMARY OF BACKGROUND DATA: The use of instrumentation to stabilize the lumbar motion segments and thereby enhance the fusion rate has been proposed in a number of studies. Semirigid fixation was believed to be effective in achieving these objectives without concern for stress-shielding, which was suggested by some authors using rigid fixation systems. METHODS: Patients who required spinal fusion with anterior and posterior approaches because of specific lumbar pathology or previous surgeries were selected. The surgery consisted of an anterior interbody fusion using allograft, followed by a posterolateral fusion and pedicle screw fixation. Fusion was determined by continuity of trabecular bridging, and outcomes were determined by pain reduction and return to previous levels of activity. Fusion was considered solid if the two posterolateral areas were fused (Zones one and two), if the anterior interbody area was fused (Zone three), or if all three zones were fused. Complications were documented during and after surgery. RESULTS: Sixty-two percent of patients had previous surgery with 25% of these patients having a diagnosis of pseudarthrosis. Fifty-five percent of patients had two or more levels fused, and 43% were heavy smokers. Ninety-seven percent of patients had successful fusions. Pain was significantly reduced on a pain analogue scale from 7.1 to 2.1 in the back and from 5.8 to 1.5 in the leg (p < 0.006 and 0.0001, respectively). Fifty-nine percent of patients returned to their previous level of activity, and 18% returned to lighter work or job retraining, for a total of 77% returning to the same or lighter levels of activity. Complications included metal failure, 4.9%; neurologic deficit, 1.2%; deep infection, 1.2%; deep venous thrombosis, 4.9%; and vascular injury, 2.4%. Fatal pulmonary embolus occurred in one patient. CONCLUSION: This technique produces a satisfactory fusion rate (97%) and a good clinical outcome based on pain reduction and return to a satisfactory level of activity (77%). It is associated with few, but significant, complications that compare well with other reported series in a difficult group of patients. This procedure should be reserved for patients who are considered to be at high risk for not achieving spinal fusion.

Adolescent↗
PubMed1994

Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.

STUDY DESIGN: Thirty-five patients with spinal fractures in a series of 1019 patients deteriorated neurologically while in the hospital. Thirty-two were available for review. OBJECTIVES: To determine whether there was a preponderance of a fracture type associated with early neurologic deterioration. METHODS: Patients were evaluated by means of plain radiographs and computed tomography scans according to the classification of Denis for the fracture types. This was compared with a newer classification. Neurologic assessment was according to the Frankel grading system and the motor score index. RESULTS: Ten patients deteriorated by one Frankel grade and two deteriorated by three Frankel grades; the remaining deteriorated, but within the same grade. The motor score index dropped from 33.5 to 26.8. In the Denis classification, the most common injury was a burst fracture, including a significant number of rotational bursts. In the newer classification, those fractures that contained a component of rotation were the most commonly seen. CONCLUSION: When a torsional mechanism has been identified, additional care should be taken in managing patients with spinal fractures because of the risk of further neurologic injury.

Hospitalization↗
PubMed1994

A comprehensive classification of thoracic and lumbar injuries.

In view of the current level of knowledge and the numerous treatment possibilities, none of the existing classification systems of thoracic and lumbar injuries is completely satisfactory. As a result of more than a decade of consideration of the subject matter and a review of 1445 consecutive thoracolumbar injuries, a comprehensive classification of thoracic and lumbar injuries is proposed. The classification is primarily based on pathomorphological criteria. Categories are established according to the main mechanism of injury, pathomorphological uniformity, and in consideration of prognostic aspects regarding healing potential. The classification reflects a progressive scale of morphological damage by which the degree of instability is determined. The severity of the injury in terms of instability is expressed by its ranking within the classification system. A simple grid, the 3-3-3 scheme of the AO fracture classification, was used in grouping the injuries. This grid consists of three types: A, B, and C. Every type has three groups, each of which contains three subgroups with specifications. The types have a fundamental injury pattern which is determined by the three most important mechanisms acting on the spine: compression, distraction, and axial torque. Type A (vertebral body compression) focuses on injury patterns of the vertebral body. Type B injuries (anterior and posterior element injuries with distraction) are characterized by transverse disruption either anteriorly or posteriorly. Type C lesions (anterior and posterior element injuries with rotation) describe injury patterns resulting from axial torque. The latter are most often superimposed on either type A or type B lesions. Morphological criteria are predominantly used for further subdivision of the injuries. Severity progresses from type A through type C as well as within the types, groups, and further subdivisions. The 1445 cases were analyzed with regard to the level of the main injury, the frequency of types and groups, and the incidence of neurological deficit. Most injuries occurred around the thoracolumbar junction. The upper and lower end of the thoracolumbar spine and the T10 level were most infrequently injured. Type A fractures were found in 66.1%, type B in 14.5%, and type C in 19.4% of the cases. Stable type A1 fractures accounted for 34.7% of the total. Some injury patterns are typical for certain sections of the thoracolumbar spine and others for age groups. The neurological deficit, ranging from complete paraplegia to a single root lesion, was evaluated in 1212 cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1994

Iliac crest reconstruction after tricortical graft harvesting.

Twenty-eight patients underwent anterior iliac crest reconstruction after the harvesting of autogenous tricortical graft. The anterior iliac crest was reconstructed using the resected rib from the thoracoabdominal approach. The authors evaluated graft site pain and residual deformity, radiographic evidence of rib incorporation, and the incidence of lateral femoral cutaneous nerve injury. There were no reports of graft site pain greater than "acceptable" levels, requiring nonnarcotic analgesics on an intermittent basis and not interfering with activities of daily living. Four lateral femoral cutaneous nerve neuropraxias were recorded, none of clinical significance. The authors advocate the use of autogenous tricortical anterior iliac crest bone graft when performing reconstructive spinal surgery, followed by reconstruction of the iliac crest with the resected rib from the surgical approach.

Adolescent↗
PubMed1992

Scoliosis Research Society. Multicenter spine fracture study.

This study consisted of 1,019 spinal fracture patients followed prospectively for 2 years. Sixty-four physicians from 12 countries participated. The purpose of the study was to determine: 1) the relationship between neurologic deficit and fracture type, level, and spinal canal compromise; 2) the neurologic outcome comparing surgical versus nonsurgical treatment and anterior versus posterior surgery; and 3) the relationship of pain to both kyphotic deformity and to surgical and nonsurgical treatment. The main findings of this study are as follows: 1) seat belts reduced the incidence of severe neurologic injury; 2) there was a higher incidence of neurologic deficit with fracture-dislocations and a higher incidence of neurologically intact patients with compression and flexion-distraction injuries; 3) there was a greater incidence of complete neurologic deficits caused by fractures at the spinal cord level, and a diminished incidence at the cauda equina level; 4) for burst fractures there was a weakly positive relationship between canal compromise and neurologic deficit, including bladder function; 5) surgical intervention led to a greater percentage of improved neurologic function than nonoperative treatment, but the rate of improvement was not statistically different; 6) anterior surgery was not more effective than posterior surgery in improving the neurologic function when function was assessed using the Frankel or Motor Index scales, but it was statistically significant when compared to the Manabe scale; 7) in patients who deteriorated before surgery and underwent surgery, there was a greater improvement neurologically, particularly for anterior surgery, compared to those patients treated nonoperatively or to the overall surgically treated group; 8) There was a statistically significant relationship between bladder function and fracture type, with an increased incidence of absent function seen with fracture-dislocations, of impaired function with burst fractures, and of intact bladder function with compression and flexion-distraction injuries; 9) anterior surgery was more beneficial in improving complete bladder impairment to partial impairment compared to posterior surgery; 10) a kyphotic deformity of greater than 30 degrees at 2-year follow-up was associated with an increased incidence of significant back pain; 11) patients who had surgery complained less of severe pain than those who were treated without surgery.

Accidents↗
PubMed1992

Canal clearance in burst fractures using the AO internal fixator.

The purpose of this study was to evaluate the ability of posterior distraction delivered by the AO internal fixator to effect a satisfactory reduction of the intraspinal fragments in burst fractures. The overall decompression achieved was from an initial compromise of 54% to a residual encroachment of 40%. Canal clearance proved most effective when carried out in the first 4 days, with an initial canal compromise of between 34 and 66%. The extent of improvement, even in this group, was not dramatic, with an average of 31% encroachment still remaining, with some cases as high as 50%. Therefore, we recommend that when canal clearance is essential, anterior decompression is the treatment of choice.

Fracture Fixation, Internal↗
PubMed1990

Accuracy of pedicular screw placement in vivo.

The accuracy of pedicular screw placement was assessed in 40 consecutive patients treated with the AO "Fixateur Interne." Postoperative CT scans were used to measure canal encroachment from the medial border of the pedicle, the angle of insertion and the point of entry. Eighty-one percent of the screws were placed within 2 mm of the medial border of the pedicle and 6% had 4-8 mm of canal encroachment with two patients developing minor neurological complications that spontaneously resolved. Four percent were inserted lateral to the pedicle. The parameters linked to satisfactory screw placement include entry point, angle of insertion and pedicular isthmus widths. Improvement in accuracy was noted in the latter 25% of screw insertions, reflecting the learning curve associated with this technique.

Bone Screws↗
PubMed1990

Results of a locking-hook spinal rod for fractures of the thoracic and lumbar spine.

The results of a consecutive series of 110 patients treated with the locking-hook spinal rod are presented. A prospective protocol was completed in 95 patients. Pain was absent or mild in 93%. In those patients with a partial neurologic deficit, there was recovery of at least one Frankel grade in 84%. The overall kyphotic deformity was reduced from 21 to 17 degrees. In those patients in whom no anterior surgery was performed, the deformity improved from 21 to 13 degrees. No rod fractures occurred, and the overall instrument complication rate was 13.7%, of which one was due to infection and four secondary to uncrimped nuts, for a true complication rate of 8.4%. The locking-hook spinal rod has proven to be a satisfactory internal fixation device in the treatment of unstable thoracolumbar fractures.

Adult↗
PubMed1990

Analysis of sagittal plane instability of the lumbar spine in vivo.

Segmental instability secondary to degenerative disc disease may result in chronic low-back pain. In the sagittal plane, segmental instability can be characterized during lumbar motion from full extension to full flexion. The authors studied this movement using a translational method for the kinematic analysis, implementing a new concept known as the instability factor. Both translational and angular components of motion are evaluated. By computing the incremental motion parameters at different stages of spinal bending, the total amount of translation and angulation is obtained and combined in a ratio termed the instability factor. This factor increases with linear instability and decreases with rotational instability. The authors reviewed 12 control subjects and 36 patients with chronic low-back pain. The diagnoses of patients were categorized into three groups: idiopathic low-back pain, lumbar disc prolapse, and degenerative disc disease. Lateral radiographs of each subject's spine at the L4-5 level were obtained using low dose radiography and were performed serially as the subjects moved from full extension to full flexion. It was found that the group of patients with degenerative disc disease had an average age-corrected instability factor of 37.3 (mm/radian), which was significantly larger than that of normal subjects 25.5 (mm/radian), (P = 0.0065). No significant difference was seen in the instability factor of patients with idiopathic low-back pain or lumbar disc prolapse.

Adult↗
PubMed1989

Rationale for the management of flexion-distraction injuries of the thoracolumbar spine based on a new classification.

A new classification of flexion-distraction injuries of the spine is described based on the bony and soft tissue injuries to the posterior complex and the anterior column. In addition, the classification includes the status of the vertebral body, that is, the association of a wedge-compression fracture or a burst injury. The soft tissue component provides a rationale for surgical intervention. Most injuries were treated by compression instrumentation, but it is recommended that those injuries associated with a burst component require distraction instrumentation.

Adolescent↗