Biomedical subjects

Y Mirovsky

Publications and source records attributed to Y Mirovsky.

At least 19 recordsLinked to original sources

PubMed2002

Good results of circumferential spine fusion in smokers, using autograft and allograft.

We have examined the rates of anterior interbody fusion of lumbar spine segments following fusion with a fresh frozen femoral head allograft in 25 heavy smoking patients. They were all stabilized both anteriorly and posteriorly. The indications for surgery were: degenerative disc disease, degenerative spondylolisthesis and nonunion following previous posterolateral fusion of lumbar spine segments. Only patients who had fusion of one or two lumbar segments were included. They all were stabilized posteriorly with pedicle screws and autogenic iliac bone graft. The fusion was assessed at least one year after surgery according to plan X-rays as "Solid", "Questionable" or "Failure". One patient was found at follow up not fused, in another one the fusion was "questionable" and all the other 23 patients had an anterior solid fusion. Clinically, 84% of the patients had the same or improved work status as before surgery and 68% acknowledged that they were satisfied with the surgical results. No major complications were recorded and the average length of hospitalization was 10.3 days.

Journal Article↗

PubMed2000

Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest.

STUDY DESIGN: A prospective study in two groups of patients selected randomly. OBJECTIVES: To determine whether keeping the outer and inner cortices of the ilium intact, while obtaining bone graft, would result in reduced postoperative bleeding and less postoperative pain. SUMMARY OF BACKGROUND DATA: Donor site complications after harvesting bone from the iliac crest are frequent. They comprise pain and bleeding related to the large bone exposed, injuries to the cluneal nerve, and sacroiliac instability. METHOD: Sixty patients who were admitted for elective fusion of lumbar segments were included in the study. In half of them, the iliac bone graft was taken in the outer Table method (group A), which included the outer cortex and the cancellous bone beneath, and in the remaining 30 patients only the cancellous bone from between the cortices was collected (group B). The amount of bone harvested, and the time taken to obtain it, were measured, as was the blood volume in the drains. At fixed intervals after surgery and up to 2 years thereafter, the patients were asked to grade the severity of pain in their back and at the donor site. RESULTS: Two years after surgery, 22% of the patients in group A and 17% of the patients in group B reported to have significant pain at the donor site. This difference was not found to be statistically significant, nor was the postoperative bleeding. The average amount of bone harvested in group A was 36 grams compared with 25.7 grams in group B, taking 14 minutes and 20.3 minutes, respectively, to harvest it. These differences were found to be statistically significant. CONCLUSIONS: Preserving the iliac cortices, while obtaining bone graft, does not reduce the postoperative bleeding or the severity of pain at the donor site. In the intraosseous method, less bone is harvested and longer duration of surgery is required, compared with that of the outer Table method.

Adult↗

PubMed2000

Injuries to the lateral femoral cutaneous nerve during spine surgery.

STUDY DESIGN: A prospective study to locate patients with injured lateral femoral cutaneous nerve after elective spine surgery. OBJECTIVES: To assess the prevalence of injury of the lateral femoral cutaneous nerve and to identify the cause of injury according to the position of the patients at surgery and the surgical approach. SUMMARY OF BACKGROUND DATA: Injuries to the lateral femoral cutaneous nerve, also known as meralgia paresthetica, may cause pain and therefore result in restriction of activity. Compression of the nerve by disc hernia, retroperitoneal tumors, and external pressure around the anterior superior iliac spine are among the more common causes. METHODS: One hundred five patients admitted for elective spine procedures were grouped according to position on the operating table and surgical approach. All patients were examined before and after surgery for signs of injury to the lateral femoral cutaneous nerve, and those found injured were followed up for 1 year after surgery. RESULTS: Injury to the lateral femoral cutaneous nerve was found in 21 (20%) patients. In 6 of them, all of whom underwent surgery on the Hall-Relton frame, the injury was bilateral. In 7 patients the injury was not associated with discomfort. In addition to injury by external pressure at the anterior superior iliac spine from the Hall-Relton frame, the nerve was also injured at the retroperitoneum by hematoma or traction and at the anterior iliac crest when bone was harvested. In 89% of the patients, the nerve completely recovered within 3 months of surgery. Two patients still had pain 1 year after surgery and hypoesthesia of the anterolateral thigh. CONCLUSION: Injuries to the lateral femoral cutaneous nerve during spine surgery are frequent, and patients should be informed of the possible risk. It usually has a benign course, but some preventive steps should be taken: keep posterior to the anterior superior iliac spine and minimize retraction when harvesting a bone graft, pad the posts of the Hall-Relton frame over the anterior superior iliac crest, and avoid traction on the psoas muscle during the retroperitoneal dissection.

Age Distribution↗

PubMed2000

Eccentric compression of the spinal canal causing dominantly contralateral-side symptoms.

In this retrospective study, five patients are described in whom the dural sac at the thoracic and lumbar spine was compressed by a herniated disk or stenosis, located eccentrically in the spinal canal. In all of them, the symptoms or neurologic findings were dominantly in the limb contralateral to the side of compression. All five patients were operated on and the compressing disk or lamina was removed, resulting in immediate improvement of symptoms. In only one of the patients was the compression at the common level of L4-L5. In the remaining four patients, compression was at the low thoracic or upper lumbar spine. With the exception of one patient, the area of canal compression was greater than 50%.

Adult↗

PubMed1999

[Spinal and extra-spinal tumors mimicking discal herniation].

Low back pain radiating to a limb is usually caused by lumbar disc herniation. Tumors of the spinal cord or near the sciatic or femoral plexus can cause neural compression and clinical signs similar to those of disc herniation. Such tumors are usually misdiagnosed as discal herniation and appropriate treatment is delayed. We present 4 men who had tumors causing low back pain radiating to the leg: a 70-year-old with metastatic squamous cell carcinoma of the lung, a 20-year-old with aneurysmal bone cyst of the vertebral column, a 52-year-old with retroperitoneal sarcoma and a 32-year-old who also had retroperitoneal sarcoma. Diagnosis and treatment were delayed because the clinical symptoms were ascribed to lumbar disc herniation. The latter 2 patients had CT-scans showing lumbar disc herniation, but similar findings are common among asymptomatic individuals. The differential diagnosis of low back pain radiating to the leg should include tumor when there is a history of cancer, pain not relieved by conservative treatment nor by lying down, pain is increased at night, pain accompanied by weight loss, and when physical examination demonstrates injury to more than 1 nerve root. In these circumstances work-up should include EMG, radioisotope scan and CT of the pelvis.

Adenocarcinoma↗

PubMed1999

[Epidural spinal abscess].

A 42-year-old man was admitted for fever and severe low back pain radiating to both legs. On MRI, an epidural spinal abscess from S1 to D10 was seen. Treatment included laminectomy, drainage of the abscess and antibiotics. Recovery was complete without neurological damage. Increased awareness of this disease may lead to diagnosis and treatment.

Adult↗

PubMed1999

Hartshill spinal fixation in vertebral metastasis.

Spinal fusion by Hartshill rectangle frame was used in 10 patients with spinal cord compression secondary to vertebral metastasis in the thoracic and lumbar spine, occupying mainly the posterior elements. All patients presented with pain, bone collapse, and neurologic deficit. The procedure is built on a system of sublaminar wires passed under two to three lamina above and below the decompressed area and tightened to a prebent metal frame. This procedure was relatively simple, and the immediate stabilization achieved in our patients was good. All patients experienced immediate pain relief. While only two patients were able to walk before surgery, seven were able to do so at follow-up. During a follow-up period of at least 2 years in two patients, or until death in the other eight patients, one patient had a broken wire that did not affect the correction achieved at surgery. Partial loss of correction in the sagittal plane was found in two patients who had metastasis in the lumbar spine and in another patient who had metastasis in the ninth thoracic vertebra.

Adenocarcinoma↗

PubMed1998

Changes in proteoglycans of intervertebral disc in diabetic patients. A possible cause of increased back pain.

STUDY DESIGN: Characterization of the analytic profile of proteoglycans in the intervertebral discs at L4-L5 of nondiabetic (n = 5) and diabetic (n = 5) age-matched subjects. The discs used were discarded material from operations. OBJECTIVES: To clarify the reason for the higher risk of disc prolapse in diabetic patients. SUMMARY OF BACKGROUND DATA: The pathogenesis of diabetes results from a combination of neurologic dysfunctions and a yet undefined metabolic failure, which leads to an abnormal proteoglycan profile. METHODS: The following methods were used to determine the proteoglycan profile: the measurement of 35S-sulfate uptake per gram wet tissue into sulfated glycosaminoglycan using fresh tissue explants; extraction of proteoglycans by 4 M guanidinium chloride containing protease inhibitors, with further purification by ultracentrifugation on cesium chloride buoyant density gradient under dissociative conditions; total uronic acid and protein contents in the various gradient fractions; assessing the length of sugar side chains of isolated 35Sulfate-glycosaminoglycan molecules by separation of the glycosaminoglycan molecules on a Sepharose 6B-CL column; and paper chromatography of the final digest products of glycosaminoglycan molecules obtained by chondroitinase ABC, a glycosaminoglycan-degrading enzyme. RESULTS: The findings show that discs from normal nondiabetic subjects have 15 times the rate of 35Sulfate incorporation into glycosaminoglycan molecules than do discs of diabetic patients. The proteoglycans of diabetic patients are banded at a lower buoyant density, indicating a lowered glycosylation rate and a lower number of sugar side chains per core protein. In discs of diabetic patients, there is a slight increase in the chain length of chondroitin sulfate. Further analysis of the glycosaminoglycan chains showed a decreased amount of keratan sulfate, compared with that in nondiabetic subjects. However, the total uronic acid content of the disc tissues and the ratio of uronic acid to protein of each fraction were unchanged in diabetic patients versus that in control subjects. CONCLUSIONS: Discs in patients with diabetes have proteoglycans with lower buoyant density and substantially undersulfated glycosaminoglycan, which with the specific neurologic damage in these patients, might lead to increased susceptibility to disc prolapse.

Aged↗

PubMed1998

Neurosurgical intervention for cervical disk disease in dystonic cerebral palsy.

We report five young patients with athetoid-spastic cerebral palsy who had deteriorated neurologically. Magnetic resonance imaging (MRI) was used to investigate suspected compressive cervical spine lesion. Cervical spondylosis with disk protrusions was found in all patients. Four patients underwent surgery by an anterior approach with insertion of a bone graft resulting in substantial clinical improvement. The other patient, diagnosed 8 years after onset of symptoms, was treated conservatively. The availability of MRI makes early recognition of cervical cord compression possible, allowing effective surgical intervention in this special group of patients.

Adult↗

PubMed1997

Eosinophilic granuloma of the spine.

Twenty patients treated for eosinophilic granuloma of the spine were studied. Only 40% demonstrated the classical radiographic picture of vertebra plana. In 60% a lytic lesion of the vertebral body or the posterior elements was found. Seven patients underwent surgery; the indications were neurological involvement or failure of the biopsy to disclose the diagnosis. At an average follow-up period of 7 years, 17 patients are well and alive with no residual spinal pain, neurological compromise, recurrent disease, or extraskeletal involvement. Vertebral body collapse underwent some regeneration but did not regain full body height. In several patients this resulted in a local deformity. In patients with unifocal spinal eosinophilic granuloma, watchful observation with no treatment other than spinal support is warranted. In patients with neural involvement or multifocal lesions, a more active treatment, including surgery, may be indicated.

Adolescent↗

PubMed1995

[Ciprofloxacin-associated bilateral acute achilles tendinitis].

Bilateral achilles tendinitis developed in a 40-year-old man following treatment with Ciprofloxacin, 500 mg twice a day, for prostatis. The signs of tendinitis resolved 6 weeks after cessation of the drug. In recent years very few cases of this rare complication have been reported. In some cases it results in a torn achilles tendon. If diagnosed early, complete recovery usually follows about 6 weeks after cessation of the drug.

Achilles Tendon↗

PubMed1995

Novel synergistic treatment of ethanol withdrawal seizures in rats with dopamine and serotonin agonists.

A recent observation in this laboratory of a simultaneous increase in striatal dopamine and a decrease in serotonin in ethanol-dependent rats during ethanol withdrawal prompted studies with combined dopaminergic + serotoninergic agonists to stop withdrawal seizures. Amphetamine (2 mg/kg) + fenfluramine (8 mg/kg) given jointly, but not separately, prevented ethanol withdrawal seizures as effectively as benzodiazepines (chlordiazepoxide), the current drugs of choice. The combination of amphetamine and fenfluramine, unlike chlordiazepoxide, significantly reduced intake of ethanol during and immediately following ethanol withdrawal.

Alcohol Withdrawal Delirium↗

PubMed1995

Cotrel Dubousset and Wisconsin segmental spine instrumentation: comparison of results in adolescents with idiopathic scoliosis King Type II.

When introduced, the Wisconsin segmental spine instrumentation (WSSI) and the Cotrel Dubousset instrumentation (CDI) were promoted as technical advances for the correction of spinal deformities. Both systems provide acceptable correction and greatly reduce the need for postoperative immobilization. A retrospective study of a homogeneous group of 53 adolescent patients with idiopathic scoliosis with King Type II curves who had reached skeletal maturity at follow-up was conducted to compare and analyze the results of these two systems. Thirty-six of these patients had been operated on using WSSI and 17 had been operated on using CDI. CDI and WSSI were found to be equally effective in treating King Type II curves. No difference was found between the two groups in the fusion rates, spinal balance, time required for surgery, or amount of curve correction. The answer to the question of which system is "better" depends on the surgeon's experience and familiarity with the equipment.

Adolescent↗

PubMed1995

Fracture of the iliac crest following bone grafting: a case report and literature review.

Fracture of the anterior iliac crest following bone grafting is an extremely rare occurrence. Five cases have been reported in the literature, none of which were internally stabilized. We are reporting a sixth case. Of the six cases, our harvest site is the furthest posterior from the anterior superior iliac spine. The fracture resulted in a large displaced anterior fragment that required open reduction and internal fixation with plates and screws. Osteoporosis increases the risk of anterior iliac crest fractures following bone grafting, but preventive procedures can be performed.

Bone Transplantation↗

PubMed1994

Thrombotic occlusion of the left common iliac artery after an anterior retroperitoneal approach to the lumbar spine.

Thrombotic occlusion of the left common iliac artery occurred in a 59-year-old man after an anterior and posterior spinal fusion. Preoperatively, the patient was known to have peripheral vascular disease. Symptoms of an L4-5 radiculopathy were noted postoperatively. After an iliac-iliac bypass, the symptoms completely resolved. Retraction of the vessels during the anterior retroperitoneal approach was the presumed cause. To the authors' knowledge, this is the first report of a thrombotic occlusion developing in a patient after an anterior retroperitoneal approach to the lumbar spine. It is their hope that through an increased awareness similar complication will be prevented.

Arteriosclerosis↗

PubMed1994

Automated percutaneous discectomy for reherniations of lumbar discs.

Ten patients with lumbar disc reherniation at the same level as the one previously openly operated on were treated by automated percutaneous discectomy (APD). The results after follow-up for 2.5 years, on the average, showed 70% with complete or significant pain relief, 60% with motor deficit improvement, and 22% with improvement of sensory deficit. Included among the patients who had pain relief were two of three in whom discography had produced only a small amount of pain, but only one of two in whom the contrast material showed contained epidural leak. To reduce the unsuccessful results, patients with segmental instability or spinal stenosis after open surgery should not be treated by APD.

Adult↗

PubMed1988

Anterior interosseous nerve palsy following closed fracture of the proximal ulna. A case report and review of the literature.

Complete paralysis of the anterior interosseous nerve was seen in 32-year-old army officer 5 weeks after he sustained a minimally displaced fracture of the proximal ulna. The fracture was immobilized in an arm cast. Thirteen weeks after injury, the cast was removed following evidence of bone union. Complete recovery of the flexor pollicis longus was noted 17 weeks after the injury, while recovery of the flexor profundus to the index finger to grade four lasted 10 months. To the best of our knowledge, this is the first case reported in the English language literature in which anterior interosseous nerve palsy follows isolated fracture of the proximal ulna.

Adult↗

PubMed1988

Traumatic anterior dislocation of the hip joint with fracture of the acetabulum: a case report.

A 67-year-old woman sustained a pubic-type anterior dislocation of the hip associated with a comminuted fracture of the anterosuperior part of the acetabulum and the anteroinferior iliac spine following a fall on the knee. Because of interposition of the iliopsoas tendon, closed reduction followed by skeletal traction failed to achieve reduction of the acetabular fragment. An abnormally high degree of anteversion of the femoral neck is suggested as a possible predisposing factor in this injury.

Acetabulum↗