Biomedical subjects

S M Lehmer

Publications and source records attributed to S M Lehmer.

3 recordsLinked to original sources

PubMed1994

Posterior transvertebral osteotomy for adult thoracolumbar kyphosis.

STUDY DESIGN: A retrospective case study was performed on the single-stage posterior transvertebral closing-wedge osteotomy for treatment of adult thoracolumbar kyphosis. SUMMARY OF BACKGROUND DATA: Forty-one consecutive cases in 38 patients available for follow-up, averaging 33 months (range 4-87 months), are included. All patients had severe pain and/or deformity; 51% of cases had previous fractures, and 49% had postlaminectomy failed back syndromes with kyphosis. A preoperative neurologic deficit was present in 34% of the cases including two with cauda equina syndrome. METHODS: Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed independently. Complications, risks, benefits, results, and biomechanical considerations were evaluated and discussed as compared with other techniques. RESULTS: All cases had solid union at follow-up; 93% maintained correction averaging 35 degrees with three requiring revision for failure. Postoperatively, 19.5% of the cases had new neurologic deficits with five (12.2%) temporary or minor and three (7.3%) major, including one with unimproved paraplegia at follow-up. Eight of the 14 preoperative neurologic deficit cases improved postoperatively; 26 additional surgeries were performed on 18 patients most commonly for pain (x 11) and additional trauma (x 4). The subjective questionnaire results indicated significant patient satisfaction, with 76% stating they would repeat the surgery and 90% recommending it to another. CONCLUSION: This technically demanding high-risk procedure provides an effective and mechanically superior correction for acute angle thoracolumbar kyphosis in selected adult patients, with high subjective satisfaction.

Female↗

PubMed1994

Treatment of L5-S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1 (Gaines procedure).

STUDY DESIGN AND OBJECTIVES: A retrospective study was performed on the two-stage Gaines procedure for the treatment of spondyloptosis, evaluating indications, techniques, results, and patient satisfaction. SUMMARY OF BACKGROUND DATA: Sixteen consecutive patients from two institutions were included. Their average age was 24 years. Average follow-up was 3.9 years, with 11 patients included in follow-up 2 or more years. Ten patients (63%) had a preoperative neurologic deficit--three with cauda equina syndrome, one with foot drop. All patients had severe back or radicular symptoms and significant disability or severe deformity. METHODS: Patient examinations, interviews, chart review, and radiographic measurements all were performed independently. A subjective questionnaire was administered to each patient comparing preoperative with postoperative changes in pain, function, and appearance, as well as their overall outcome assessment. RESULTS: Postoperatively, 12 patients (75%) had early neurologic deficits, with seven of these having had a preoperative deficit. Four of these seven had a persistent deficit at follow-up, one with a permanent foot drop and three with documented weakness that was still improving at follow-up. The patient with preoperative foot drop remained unchanged, and the remaining seven patients with early deficit all recovered within 1 year. All three patients with preoperative cauda equina syndrome recovered postoperatively. The subjective questionnaire results revealed extremely high patient satisfaction. They reported significant improvement in pain, function, and appearance. CONCLUSIONS: Despite the relatively high complication rate, with appropriate patient selection, planning, and surgical technique, this procedure appears to be a sound method for treating severe cases of spondyloptosis, yielding very high patient satisfaction.

Adult↗

PubMed1994

Delayed pain response after lumbar discography.

The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients, five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete or discrete annular tears that are not filled at the time of injection. Later (2-12 h in this study), dye leakage occurs through these lesions, thereby precipitating the discogenic pain. This phenomenon may be missed and is probably more common than previously believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic information following this study.

Adult↗