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S L Papastefanou

Publications and source records attributed to S L Papastefanou.

5 recordsLinked to original sources
PubMed2002

3D back shape in normal young adults.

In today's climate of evidence based medicine, there is an increasing emphasis on objective assessment to monitor treatment effectiveness. Although spinal posture and back shape are commonly assessed by clinicians, current practice is based on subjective findings and unreliable objective tools. Numerous management protocols aim to improve both posture and shape, however data related to normal back shape is quite scarce. The aim of this study was to investigate normal back shape in young adults, in order to produce normative values against which deformity could be defined. The Integrated Shape Imaging System (ISIS) was used to measure the three-dimensional back shape. A convenience sample of 48 normal adults, aged 18-28 volunteered to participate in this study. A small minority of individuals showed no curve (8%), 55% showed a single curve and the rest showed a double one. Right spinal asymmetry was more frequent than the left (77% to 52%). Mean values and 95% confidence intervals were 14.1 degrees (11.7 degrees-16.5 degrees) for upper Lateral asymmetry, 5.6 degrees (3.3 degrees - 7.9 degrees) for lower lateral asymmetry, 24.9mm (20.6mm -29.2mm) for thoracic kyphosis and 14.9mm (12.5mm -17.2mm) for lumbar lordosis. Increasing upper lateral asymmetry correlated with decreasing thoracic kyphosis (p=0.01). Maximum skin surface angle correlated positively with only upper lateral asymmetry (p<0.0001). Similar topographical interrelationships have been demonstrated in scoliosis. It is important that clinicians in relevant disciplines objectively assess all three dimensions of back shape, as our research shows that changes in one plane are associated with changes in the other two planes.

Adolescent↗
PubMed2002

3-D measurement of posture and back shape using a low cost, portable system--a reliability study.

The reliability and accuracy in the measurement of landmark points using a 3-D digitizer on a static back phantom are reported. The results show the systems clinical reliability as a low cost, portable and flexible method for recording back posture. Consistent results are demonstrated for a single measurer and good agreement was found between two measurers. Few intrinsic errors were found in the devices performance.

Back↗
PubMed2000

Surface electrode somatosensory-evoked potentials in spinal surgery: implications for indications and practice.

STUDY DESIGN: A retrospective study of 442 major spinal operations with spinal cord monitoring performed in a University Hospital between 1982 and 1992 was performed. OBJECTIVES: To assess the reliability of the authors' method for monitoring by somatosensory-evoked potential recording, to determine criteria for intraoperative corrective action, and to redefine the need for the wake-up test. SUMMARY OF BACKGROUND DATA: The routine use of somatosensory-evoked potential monitoring in spinal surgery remains controversial. In Nottingham, the authors have used a method of recording from either scalp or high cervical electrodes. METHODS: The recordings and outcomes of all monitored spinal operations between the years 1982 and 1992 were reviewed. RESULTS: In 442 procedures, 23 technical failures (no reliable monitoring) occurred. Most technical failures were in patients with severe preoperative neurology, identifiable by somatosensory-evoked potential recording before operation. In the remaining 419 procedures, a significant intraoperative change in response occurred in 70 procedures (16.7%). Using the definitions of the American EEG Society, the authors identified 10 true-positives and 60 false-positives. There were no false-negatives. A wake-up test was performed if an amplitude drop greater than 50% from baseline value persisted after attempts to correct any possible identifiable intraoperative cause. This occurred in only 21 patients (5%). In the true-positive group, somatosensory-evoked potential recordings remained persistently abnormal despite an apparently normal subsequent wake-up test. The sensitivity of the method according to current definitions was 100% and the specificity 85.33%. CONCLUSIONS: Modified guidelines are needed for routine intraoperative use of somatosensory-evoked potential monitoring in spinal surgery. Such guidelines should avoid the term "false-positive" as currently defined and concentrate on the causative analysis of abnormal responses that warn of critical spinal cord dysfunction before that becomes irreversible and allow for appropriate action. Information from this monitoring method alerted the surgeon to the possible need for corrective action in an additional 9.78% of the reported patients, who traditionally would have been regarded as false-positives. A wake-up test still is indicated in patients with persistent suppression of their somatosensory-evoked potential despite correction of any identifiable cause and in cases of technical failure. The current method proved flexible, versatile, and reliable for future use.

Adolescent↗
PubMed1994

Femoral nerve palsy. An unusual complication of anterior lumbar interbody fusion.

SUMMARY OF BACKGROUND DATA: Compression neuropathy of the femoral nerve has been reported as an uncommon complication of bleeding into the iliopsoas muscle. OBJECTIVE: The authors detected anatomic reasons of direct injury to the femoral nerve at the lower lumbar level. METHODS: Keeping the hip in extension during the course of carrying out anterior fusion on a previously failed posterior fusion was considered another causative factor of femoral nerve injury. Anatomical dissection confirmed the likelihood of this injury being produced in this situation. RESULTS: Femoral nerve traction and compression can occur after prolonged compression of the nerve within the psoas muscle stretched between an immobile lower lumbar spine and the lesser trochanter when the hip is kept in extension. In the patients described no other reasons for direct or indirect injury were identified. CONCLUSION: Although uncommon, the complication should be kept in mind. It can be avoided by intraoperative hip flexion.

Cadaver↗