Biomedical subjects

Scott D Daffner

Publications and source records attributed to Scott D Daffner.

7 recordsLinked to original sources

PubMed2003

Impact of neck and arm pain on overall health status.

STUDY DESIGN: A prospective, multicenter, cross-sectional analysis of data from the National Spine Network database. OBJECTIVES: To compare the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey, and to compare the impact of these symptoms among patients of varying age and symptom duration. BACKGROUND: Degenerative disorders of the cervical spine can cause debilitating symptoms of neck and arm pain. Physicians generally treat radiculopathy more aggressively than axial neck pain alone, although it has never been shown that the presence of radiculopathy leads to a greater impairment of physical and mental function. MATERIALS AND METHODS: SF-36 Health Survey data were collected from all consenting patients seen within the National Spine Network. Patients with symptoms referable to the cervical spine (as per their physician) were included (n = 1,809). SF-36 scores for all eight scales (bodily pain (BP), vitality (VT), general health (GH), mental health (MH), physical function (PF), role physical (RP), role emotional (RE), and social function (SF), and two summary scales (Physical Component Summary [PCS] and Mental Component Summary [MCS]) were calculated. Age/gender normative scores were subtracted from the scale scores to produce a negative "impact" score, which reflected how far below normal health status these patients were. Patients were grouped according to location of symptoms (axial only, radicular only, or axial and radicular), age (younger than 40, 40 to 60, and older than 60 years), and symptom duration (acute: <6 wk; subacute: 6 wk-6 mo; and chronic: >6 mo). SF-36 scores were compared between all groups using analysis of variance and multiple comparisons with Bonferroni adjustment. RESULTS: Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales (P < 0.05- P < 0.0001). Scores for patients with only axial pain were significantly lower than for patients with only radicular pain for VT (P < 0.04) and GH (P < 0.004). Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales (P < 0.01). PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain. CONCLUSIONS: Combined neck and arm pain were much more disabling than either symptom alone. Younger patients (younger than 40 or 40-60) were more affected by these symptoms than patients older than 60 years. In addition, as symptom duration increased, a negative impact on mental health was observed, although chronic symptoms did not affect physical health. This study suggests that patients with a significant component of axial pain in conjunction with cervical radiculopathy should be considered the most affected of all patients with cervical spondylosis. Given the evidence that the treatment methods at the disposal of physicians are effective, this study suggests that prompt treatment of these patients may help avoid the harmful effects of chronic symptoms on mental functioning, especially among younger patients who were found to be more impacted by the symptoms.

Adult↗

PubMed2003

Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion.

STUDY DESIGN: This retrospective, questionnaire-based investigation evaluated iliac crest bone graft (ICBG) site morbidity in patients having undergone a single-level anterior cervical discectomy and fusion (ACDF) procedure performed by a single surgeon (T.J.A.). OBJECTIVE: To evaluate acute and chronic problems associated with anterior ICBG donation, particularly long-term functional outcomes and impairments caused by graft donation. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion procedures frequently use autologous anterior ICBG to facilitate osseous union. Although autologous ICBG offers several advantages over alternative grafting materials, donor site morbidity can be significant. Acute and chronic complications of donor sites have been reported, yet there are currently no reports of long-term functional outcomes after autologous anterior ICBG donation after single-level ACDF. METHODS: A questionnaire was mailed to 187 consecutive patients who were retrospectively identified to have undergone autologous anterior ICBG harvest for single-level ACDF between 1994 and 1998. The questionnaire divided items into symptomatic (acute and chronic) and functional assessments. Patients answered yes, no, or not applicable; pain was assessed with a Visual Analogue Scale (VAS). RESULTS: Surveys were completed either by mail or follow-up telephone interview by 134 patients (71.6%). Average follow-up was 48 months (range, 24-72 months). Acute symptoms were reported at the following rates: ambulation difficulty, 50.7%; extended antibiotic usage, 7.5%; persistent drainage, 3.7%; wound dehiscence, 2.2%; and incision and drainage, 1.5%. The chronic symptom questionnaire demonstrated a high degree of satisfaction with the cosmetic result (92.5%). Pain at the donor site was reported by 26.1% of patients with a mean VAS score of 3.8 in 10, and 11.2% chronically use pain medication. Twenty-one patients (15.7%) reported abnormal sensations at the donor site, but only 5.2% reported discomfort with clothing. A unique functional assessment revealed current impairments at the following rates: ambulation, 12.7%; recreational activities, 11.9%; work activities, 9.7%; activities of daily living, 8.2%; sexual activity, 7.5%; and household chores, 6.7%. CONCLUSIONS: A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.

Activities of Daily Living↗

PubMed2003

Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis.

The radiographs of 35 consecutive adult patients with isthmic spondylolisthesis who underwent a transforaminal lumbar interbody fusion (TLIF) with one or two Brantigan carbon fiber cages and pedicle screw instrumentation were evaluated. Anterolisthesis, disk space height, and slip angle were measured in preoperative and postoperative standing neutral radiographs. Anterolisthesis was reduced and disk space height was increased with the TLIF procedure. Average slip angle, however, was not significantly altered. The restoration of lordosis across the listhetic disk space correlated with a more anterior placement of the interbody cage within the disk space. The TLIF technique, performed with the Brantigan cage and pedicle screw instrumentation, appears to be able to restore disk height and reduce forward translation in patients with isthmic spondylolisthesis, but improvement in sagittal alignment is dependent upon anterior placement of the interbody device.

Adult↗

PubMed2003

Adult degenerative lumbar scoliosis.

Degenerative scoliosis of the lumbar spine affects a significant number of adults. Although the etiology of this condition is not clear, the most commonly implicated causes include osteoporosis and degenerative disc disease. Clinically, patients with this condition most commonly complain of axial low back pain, but they may also present with radicular complaints. This pain may be generated directly by the facet joints or may be due to nerve root impingement or traction. Imaging of this spinal deformity should include both plain radiographs and computed tomographic myelography. Nonoperative therapy is ideal, but surgery is indicated for severe radicular symptoms refractory to conservative management or for progression of the curve. Ideally, surgical treatment should consist of decompression and fusion with segmental instrumentation.

Adult↗

PubMed2002

Vertebral injuries: detection and implications.

Vertebral injuries occur in a predictable and reproducible manner that is dependent upon the mechanism of injury. Each mechanism of injury leaves distinct imaging 'fingerprints' regardless of the location in the spine. This chapter will discuss four areas: the mechanisms of injury and their imaging 'fingerprints'; abnormalities of alignment and anatomy, bony integrity, cartilage or joint space, and soft tissues-the ABCS of injury; the imaging features that will indicate stability of the spine following injury; and the classification of spine injuries into two categories-'major' or 'minor'. The imaging features described in this chapter apply to both radiography as well as to computed tomography (CT). Although helical CT is being used more commonly for the evaluation of suspected cervical injuries, radiography of the entire spine remains the standard.

Cartilage, Articular↗

PubMed2002

Computed tomography diagnosis of facet dislocations: the "hamburger bun" and "reverse hamburger bun" signs.

Unilateral or bilateral facet dislocations are difficult to diagnose. Computed tomography (CT) is being used more extensively to screen patients with suspected cervical vertebral injury. We describe two new signs, the "hamburger bun" sign of normal facet joints and the "reverse hamburger bun" sign that should be useful in establishing a diagnosis of facet dislocation. Normal facet joints are oriented on a CT examination so that they resemble the sides of a hamburger bun. Facet dislocations upset this relationship and reverse the orientation of the "bun" halves to each other.

Biomechanical Phenomena↗

PubMed2002

Managing disorders of the cervicothoracic junction.

A wide range of pathologic conditions occur at the cervicothoracic junction. These conditions are usually the result of trauma, neoplastic processes, infection, prior surgery, or degenerative changes. Instability in this region of the spine is difficult to manage, particularly because of the complex biomechanics involved and the challenging surgical approaches required for treatment. Traditional radiologic evaluation of the cervicothoracic junction is often inadequate; as a result, the standard 3-view cervical spine series should be augmented with swimmer's or oblique views. Surgical treatment, designed to increase stability and allow early mobilization and rehabilitation, often requires internal fixation devices; lateral-mass or pedicle screws are increasingly being used to avoid complications associated with devices occupying the spinal canal. Although posterior surgical approaches to the cervicothoracic junction are relatively straightforward, anterior approaches require mastery in traversing the various bony and soft-tissue structures.

Cervical Vertebrae↗