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At least 793 records · Page 44Linked to original sources

PubMed2005

Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come.

BACKGROUND: Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a stand-alone diagnostic modality in the evaluation of SF. METHODS: Retrospective review of all blunt trauma patients over a two year period (1/01-12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 codes. RESULTS: There were 3,537 blunt trauma patients evaluated, with 236 (7%) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19%) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment. CONCLUSIONS: SCT of the spine identified 99.3% of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.

Adolescent↗

PubMed2006

Surgical correction of spinal deformities after solid organ transplantation in childhood.

A review of the current literature reveals no systematic analyses of the results of surgical correction of spinal deformity after pediatric organ transplantation. We therefore evaluated clinical and radiographic outcomes of spinal deformity correction after solid organ transplantation in childhood and adolescence. All 211 cases of heart, liver, and kidney transplantations performed in children in our country were reviewed. Six patients had undergone surgical correction of spinal deformity at a mean age 14.6 (range 12-17) years. Clinical data of the patients were evaluated. Radiographs of the whole spine were taken preoperatively, immediately after, at 2-year, and final follow-up visits. The Scoliosis Research Society (SRS) questionnaire was completed and a physical examination was performed at the final follow-up visit. The mean follow-up after spinal surgery was 4.9 years (range 2-7.6 years). Four patients developed scoliosis after organ transplantation without any evidence of scoliosis prior to organ transplantation. One patient with congenital scoliosis was operated on after kidney transplantation. One boy had osteoporosis and severe local kyphosis due to vertebral compression fractures. Four patients underwent anterior and posterior surgery, two posterior only. The mean preoperative Cobb angle of the thoracic curve was 54 degrees (range 42-69 degrees) in the patients with scoliosis. The postoperative values were 30 degrees (26-38 degrees) immediately after instrumentation and 39 degrees (34-42 degrees) at the final follow-up visit. The patient with vertebral compression fractures and progressive kyphosis had 70 degrees curve before surgery, 23 degrees immediately after the operation, and 60 degrees at the final check up. The mean total score on the SRS questionnaire was 95.5 (range 90-101). There is a relatively high incidence (2.8%) of spinal deformities needing operative treatment after solid organ transplantation. Possible etiologies for spinal deformities are growth disturbance and muscle weakness due to the basic disease. The other important factors are related to immunosuppressive medication, especially glucocorticoids needed after transplantation. Primary correction of these deformities was satisfactory, but during follow-up, a certain amount of recurrence of the curves was evident. Poor bone quality may explain some of the loss of correction.

Adolescent↗

PubMed2005

Initial experience of percutaneous vertebroplasty using single-plane C-arm fluoroscopy for guidance.

PURPOSE: The purpose of this study was to evaluate the feasibility and safety of percutaneous vertebroplasty (PVP) using single-plane C-arm fluoroscopy. MATERIALS AND METHODS: Lesions in the present study all comprised compression fractures with intact pedicles. A polymethylmethacrylate (PMMA) mixture was injected by the transpedicular approach under C-arm fluoroscopy using a lateral projection. Before and after PVP, the pain score was determined using visual analog scale methods. RESULTS: Between June 2002 and May 2004, we performed 31 PVPs in 17 patients during 22 treatment sessions. Underlying pathology comprised neoplasm-related compression fracture (n=9) and fractures attributed to osteoporosis (n=8). Mean pain score was 8.0 (range, 4.5-10) immediately before PVP, and 1.9 (range, 0-7) at 24 h after PVP. Mean time needed to perform PVP was 59 min. Mean time to approach a pedicle was 36 min (range, 20 min for 1 pedicle to 110 min for 3 pedicles). No complications requiring surgical intervention or exacerbating conditions beyond pre-treatment levels were noted. CONCLUSION: PVP using single-plane C-arm fluoroscopy for guidance is feasible, safe, and quick.

Adult↗

PubMed2001

Vertebroplasty.

Vertebroplasty is the percutaneous placement of polymethylmethacrylate (PMMA) into vertebral compression fractures for relief of pain. Polymethylmethacrylate is the cement used by orthopedic surgeons for rapid stable fixation of prosthetics in living bone. While the exact mechanism of pain relief is unknown, it is believed that the delivery of the PMMA into the fracture stabilizes the vertebral body, obtaining an analgesic effect. Vertebroplasty is an outpatient procedure that is performed with the aid of fluoroscopy. It has a high benefit/risk ratio with high success rates in comparison to extremely low complication rates. These patients consist of elderly osteoporotic patients that often times have underlying medical conditions or younger patients suffering from steroid or metastatic induced compression fractures. These patients are considered to be poor surgical candidates. In the past, this patient population has been relegated to epidural steroid injections, epidural catheters, or time contingent narcotics to control the pain. These conservative measures often lead to a patient with decreased activities of daily living and uncontrolled pain. Vertebroplasty provides a safe procedure that allows for long-term pain relief, decreased use of medication, and increased activities of daily living. This article is a review of the history, indications, contraindications, and key outcome studies. The technique is described along with complications, preprocedural care, and postprocedural care.

Journal Article↗

PubMed2003

Percutaneous vertebroplasty: rationale, clinical outcomes, and future directions.

Percutaneous transpediculate vertebroplasty is an innovative and successful treatment of painful osteoporotic and pathologic compression fractures that are refractory to medical therapy. Large-scale clinical series have shown that vertebroplasty can provide significant pain relief with very low complication rates. Expectations of positive results of the ongoing randomized trials are high. With the accumulation of scientific data, technological advancements, and acceptance by the general community, vertebroplasty may be become the standard of care for treatment of painful vertebral body compression fractures.

Fracture Fixation↗

PubMed1976

Body composition and skeletal metabolism following pituitary irradiation in acromegaly.

The change in body composition in acromegaly that resulted from pituitary irradiation was examined using the technic of total body neutron activation analysis. Before treatment, increased ratios of total body P:Ca, P:K and Na:K were noted. After pituitary irradiation, the total body levels of P, Na and K were reduced in a proportion that indicated restoration of body composition towards normal. Skeletal mass (total body calcium) decreased into the range observed in osteoporosis in several patients. Trabecular bone mass, as reflected by the Singh Index, was consistently reduced, and two patients had vertebral compression fractures. Local bone mass as determined by photon absorptiometry was reduced when the values were normalized for age, sex and body size. It is postulated that in untreated acromegaly there is differential bone remodelling with an increase in cortical bone accompanied by a reduced trabecular bone mass. When reduction of hGH levels is accomplished with treatment, cortical apposition may decrease. Since the increased cortical bone mass probably aids in preventing vertebral compression fractures, the treated acromegalic patient may incur an increased risk of fractures. This risk may be increased further by the hypogonadism which may arise secondary to pituitary irradiation or surgery. It would be prudent to ensure that the hypogonadal acromegalic patient receives an adequate calcium intake and sex hormone replacement therapy.

Acromegaly↗

PubMed2004

Treatment of pain from osteoporotic vertebral collapse by percutaneous PMMA vertebroplasty.

BACKGROUND: Vertebral compression fractures are common complications in advanced osteoporosis. In general, this disease of the elderly patient is characterized by severe local back pain. Pathophysiologically, bony instability triggers local pain during body movement. Serious pain immobilizes the patients and forces them to bed rest. As a result, complications like thrombosis or pneumonia occur. Invasive treatment with surgical instrumentation for vertebral stabilization is not indicated in elderly patients especially with additional diseases. The purpose of this study was to test the hypothesis that percutaneous polymethylmethacrylate (PMMA) vertebroplasty significantly reduces pain due to vertebral collapse in osteoporotic patients and improves quality of life. METHODS: A total of 38 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were treated by PMMA vertebroplasty. After admission, before discharge from the hospital, six weeks, half a year and one year later patients answered the Oswestry Low Back Pain Disability (OLBPD) Questionnaire for assessment of treatment related change in disability. In all patients percutaneous vertebroplasty was performed under local anesthesia. FINDINGS: A total of 92% of patients reported a significant pain reduction immediately after treatment. Also one year after vertebroplasty pain remained significantly reduced. Vertebroplasty was highly beneficial for patients with pain related to local instability of the spine. Extravasation of PMMA beyond the vertebral margins was observed in 26% of the cases. No treatment related clinical or neurological complications were noticed. INTERPRETATION: PMMA vertebroplasty is a useful and safe method of pain relief which rapidly regains quality of life for patients with osteoporotic vertebral compression.

Administration, Cutaneous↗

PubMedDate not supplied

Percutaneous vertebral augmentation.

BACKGROUND CONTEXT: With the aging of the population, painful osteoporotic compression fractures are becoming more common. PURPOSE: To review the physiologic implications of these injuries as well as treatment options and outcomes, especially with reference to newer, percutaneous "augmentation" procedures, that is, vertebroplasty and kyphoplasty. STUDY DESIGN/SETTING: A literature review. METHODS: No direct, randomized studies comparing vertebroplasty, kyphoplasty and standard, nonoperative care are available. RESULTS: The growing literature suggests a role for kyphoplasty and vertebroplasty in the management of patients with intractable pain or progressive vertebral collapse after vertebral compression fracture. Both procedures likely offer similar rates of pain relief. Kyphoplasty, although more expensive, may allow fracture reduction. The void created with the balloon tamp allows a more viscous cement to be applied, thereby decreasing the risk of extravasation. CONCLUSIONS: More study is required to understand the ideal role of these new techniques in the management of spinal osteoporosis and associated fractures. However, for carefully selected cases, current data suggest that the complication rates are low and pain relief can be profound.

Aged↗

PubMed2000

Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints.

OBJECTIVE: To review the value of magnetic resonance imaging (MRI) in diagnosis and evaluation of rheumatic diseases of the spine and sacroiliac joints. METHODS: A review of the literature on MRI of the spine and sacroiliac joints in rheumatoid arthritis (RA), ankylosing spondylitis (AS), infectious spondylodiscitis, infection of the sacroiliac joint (SIJ), gout, calcium pyrophosphate deposition disease, nontraumatic vertebral compression fractures, insufficiency fracture of the sacrum, avascular necrosis of the vertebral body, sarcoidosis, and Paget's disease was performed. The reports were obtained from a Medline search. RESULTS: In RA, AS, and crystal deposition disease, synovial tissue, atlantoaxial and subaxial subluxations, crystal deposition, and neurologic compromise can be adequately diagnosed with MRI of the cervical spine. Studies on MRI of SIJs in AS indicate that MRI enables early diagnosis of sacroiliitis. In most cases of infectious spondylodiscitis, avascular necrosis of the vertebral body, nontraumatic vertebral compression fractures, and insufficiency fractures of the sacrum characteristic findings on MRI suggest the correct diagnosis. Moreover, soft tissue abnormalities and neurologic compromise can be visualized. In infection of the SIJ, MRI shows findings suggesting an inflammatory process. In Paget's disease, MRI does not provide additional information as compared with plain radiography (PR) or computed tomography (CT). CONCLUSION: In evaluation of spinal and SIJ abnormalities in many rheumatic diseases, MRI, in addition to PR, can replace conventional tomography, CT, and myelography. Moreover, MRI can visualize soft tissue abnormalities and neurologic compromise without use of intrathecal contrast.

Humans↗

PubMed2006

The influence of montmorillonite clay reinforcement on the performance of a glass ionomer restorative.

OBJECTIVES: A pristine calcium montmorillonite (Ca-MMT) and an organically modified 12-amino-dodecanoicacid treated montmorillonite (ADA-MMT) clay were evaluated to determine the reinforcement effect on the performance of a glass ionomer (GI) restorative ChemFil Superior (Dentsply DeTrey, Kanstanz, Germany) to assess the potential as a posterior filling material. METHODS: Mean compressive fracture strengths and standard deviations were determined for groups of 30 cylindrical specimens with 0.5-2.5 wt.% Ca-MMT and ADA-MMT additions to either the powder or the liquid elements of the GI. Working characteristics were assessed using an oscillating rheometer, the interlayer d-spacings (d(001)) of each MMT clay was determined using X-ray diffraction (XRD) and the set cement structure was determined by scanning electron microscopy (SEM). RESULTS: The addition of up to 1.0 wt.% ADA-MMT resulted in a significant increase in the mean compressive fracture strength of the GI utilising the one-way ANOVA and Tukey test comparisons at P<0.05. When Ca-MMT clay was added to the GI a significant reduction in mean strength was recorded (P<0.05). MMT clay addition to the powder and liquid element of the GI in excess of 1.0 wt.% resulted in no significant differences in working characteristics although increases in setting times were evident for MMT addition up to 1.0 wt.%. XRD patterns identified the d(001) peaks for Ca- and ADA-MMT at 2 theta angles of 8.44 degrees and 5.07 degrees and d(001) spacings of 1.04 and 1.74 nm, respectively. CONCLUSIONS: The increased interlayer d-spacings recorded for ADA-MMT clay demonstrates that the clay had expanded layers which may have provided an increased opportunity for the polyacrylic acid chains of the GI restorative to diffuse into the MMT galleries. It is postulated that the increased interlayer d-spacings for the ADA-MMT clay had a positive reinforcing effect on the GI compared with the Ca-MMT clay where no increased performance was identified. The study has highlighted the potential for increasing the performance of GI restoratives when using an organically modified clay as a reinforcement which could increase the potential of GIs as posterior filling materials.

Aluminum Silicates↗

PubMed2004

A syringe compressor for vertebroplasty: technical note.

OBJECTIVE: Percutaneous vertebroplasty (VP) has become a popular technique to treat osteoporotic vertebral compression fractures and spinal column neoplasms. The consistency of the bone cement mixture during the procedure would appear to be increasing with time, but the physician experiences injection difficulty, and there are also concerns with the limited injection time available for such a procedure. METHODS: We describe a special-design screw-syringe compressor to be used with the ordinary 10 mL Luer-Lok syringe and a short connecting tube for the injection of bone cement during VP. RESULTS: The syringe compressor could yield maximum 2,772 psi compression pressure and could finely control the cement delivery rate to 0.2 mL/ a turn. We have used this technique to treat 296 consecutive patients with 384 vertebral compression fractures who were suffering from disabling back pain refractory to analgesic therapy. Using this technique, the injection time can be prolonged to 12 min and the delivery volume can be better controlled. CONCLUSION: With the aid of the syringe compressor, the cementing material can be accurately and steadily injected as desired by the physician. Bone-cement injection can be better controlled with this syringe compressor. Furthermore, this delivery system would reduce per treatment cost.

Decompression, Surgical↗

PubMed2003

Line scan diffusion imaging of the spine.

BACKGROUND AND PURPOSE: Recent findings suggest that diffusion-weighted imaging might be an important adjunct to the diagnostic workup of disease processes in the spine, but physiological motion and the challenging magnetic environment make it difficult to perform reliable quantitative diffusion measurements. Multi-section line scan diffusion imaging of the spine was implemented and evaluated to provide quantitative diffusion measurements of vertebral bodies and intervertebral disks. METHODS: Line scan diffusion imaging of 12 healthy study participants and three patients with benign vertebral compression fractures was performed to assess the potential of line scan diffusion imaging of the spinal column. In a subgroup of six participants, multiple b-value (5-3005 s/mm(2)) images were obtained to test for multi-exponential signal decay. RESULTS: All images were diagnostic and of high quality. Mean diffusion values were (230 +/- 83) x 10(-6) mm(2)/s in the vertebral bodies, (1645 +/- 213) x 10(-6) mm(2)/s in the nuclei pulposi, (837 +/- 318) x 10(-6) mm(2)/s in the annuli fibrosi and ranged from 1019 x 10(-6) mm(2)/s to 1972 x 10(-6) mm(2)/s in benign compression fractures. The mean relative intra-participant variation of mean diffusivity among different vertebral segments (T10-L5) was 2.97%, whereas the relative difference in mean diffusivity among participants was 7.41% (P <.0001). The estimated measurement precision was <2%. A bi-exponential diffusion attenuation was found only in vertebral bodies. CONCLUSION: Line scan diffusion imaging is a robust and reliable method for imaging the spinal column. It does not suffer as strongly from susceptibility artifacts as does echo-planar imaging and is less susceptible to patient motion than are other multi-shot techniques. The different contributions from the water and fat fractions need to be considered in diffusion-weighted imaging of the vertebral bodies.

Adult↗

PubMed1999

Percutaneous vertebroplasty in vertebral osteonecrosis (Kummell's spondylitis).

The authors report the clinical symptoms and response to therapy of a series of patients who presented with subacute or chronic back pain due to vertebral osteonecrosis (Kummell's spondylitis) and who underwent percutaneous vertebroplasty. The authors performed a retrospective chart review of a series of 95 patients in whom 149 painful, nonneoplastic compression fractures were demonstrated and who were treated with percutaneous transpediculate polymethylmethacrylate (PMMA) vertebroplasty. In six of these patients there was evidence of vertebral osteonecrosis, as evidenced by the presence of an intravertebral vacuum cleft on radiography or by intravertebral fluid on magnetic resonance (MR) imaging. Clinical and radiological findings on presentation were noted. Technical aspects of the vertebroplasty technique were compiled. Response to therapy, defined as qualitative change in pain severity and change in level of activity, was noted immediately following the procedure and at various periods on follow-up reviews. One man and five women, who ranged in age from 72 to 90 years (mean 81 years), were treated. Each patient had one compression fracture. The fractures were at T-11 (one patient), L-1 (two patients), L-3 (two patients), and L-4 (one patient). The pain pattern was described as severe and localized to the affected vertebra, and sometimes radiated along either flank. Pain duration ranged from 2 to 12 weeks, and the pain was refractory to conservative therapy that consisted of bedrest, analgesics, and external bracing. At the time of treatment, all patients were bedridden because of severe back pain. In all patients either plain radiographic or computerized tomography evidence of intravertebral vacuum cleft or MR imaging evidence of vertebral fluid collection consistent with avascular necrosis of the vertebral body was demonstrated. Four patients underwent bilateral transpediculate vertebroplasty, and two patients underwent unilateral transpediculate vertebroplasty. The fracture cavities were specifically targeted for PMMA injection. Additional fortification of the osteoporotic vertebral body trabeculae was also performed when feasible. "Cavitygrams" or intraosseous venograms with gentle contrast injection were obtained prior to application of cement mixture. In all patients subjective improvement in pain and increased mobility were demonstrated posttreatment. The follow-up period ranged from 4 to 24 hours after treatment. Two patients made additional office visits at 1 and 3 months, respectively. Patients presenting with vertebral osteonecrosis (Kummell's spondylitis) often suffer from local paraspinous or referred pain. When performing vertebroplasty on these patients, confirmation of entry into the fracture cavities with contrast-enhanced "cavitygrams" should be performed prior to injection of PMMA cement. The response to vertebroplasty with regard to amelioration of pain and improved mobility is encouraging.

Journal Article↗

PubMed2002

Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation.

STUDY DESIGN: Review and analysis of seven cases of syringomyelia treated surgically. OBJECTIVE: To demonstrate the beneficial role of decompressive surgery for the altered cerebrospinal fluid (CSF) flow dynamics in syringomyelia not associated with Chiari I malformation. A comparison between the pre- and post-operative syrinx size and CSF flow in the subarachnoid space was made using cine-mode magnetic resonance imaging (cine-MRI) and then correlated with clinical improvement. SETTING: University Hospital, Seoul, Korea. METHODS: Conventional spinal MRI and cine-MRI were performed in the region of CSF flow obstruction preoperatively in seven patients with syringomyelia not associated with Chiari I malformation. The group consisted of one case of syrinx with post-traumatic compression fracture, one case of post-traumatic arachnoiditis, two cases of holocord syrinx associated with hydrocephalus without Chiari malformation, one case of syrinx with post-traumatic pseudomeningeal cyst, one case of post-laminectomy kyphosis-associated syringomyelia and one case of post-tuberculous arachnoiditis syringomyelia. Based on the preoperative cine-MRI, the types of surgery appropriate to correct the CSF flow obstruction were chosen: decompressive laminectomy-adhesiolysis and augmentation duraplasty in arachnoiditis cases, ventriculoperitoneal shunt for hydrocephalus, cyst extirpation in pseudomeningeal cyst and both anterior and posterior decompression-fusion in the case of post-laminectomy kyphosis. A syrinx-draining shunt operation was performed in three cases; where the syringomyelia was associated with post-traumatic compression fracture refractory to a previous decompression, where hydrocephalus was present in which the decompression by ventriculoperitoneal shunt was insufficient and where post-traumatic arachnoiditis was present in which the decompression was impossible due to diffuse adhesion. Change in syrinx size was evaluated with post-operative MRI in all seven cases and restoration of flow dynamics was evaluated with cine-MRI in three of the cases, two patients with clinical improvement and one patient with no change of clinical status, respectively. RESULTS: Four out of seven patients showed symptomatic improvement after each decompressive operation. In the remaining three cases, reconstruction of the spinal subarachnoid space was not possible due to diffuse adhesion or was not the main problem as in the patient with syrinx associated with hydrocephalus who had to undergo a shunt operation. One of these three patients showed clinical improvement after undergoing syringosubarachnoid shunt. A decrease of syrinx size was observed in only two out of the five patients who showed clinical improvement after treatment. Of these five patients, two patients underwent post-operative cine-MRI and the restoration of normal CSF flow dynamics was noted in both patients. Of the remaining two patients, one underwent post-operative cine-MRI and there was no change in the CSF flow dynamics evident. CONCLUSION: These results suggest that the restoration of CSF flow dynamics between the syrinx and the subarachnoid space by decompressive operation is more effective than simple drainage of the syrinx cavity itself in the treatment of syringomyelia without Chiari malformation.

Adolescent↗

PubMed1992

[Aspects and role of spinal MRI in the assessment of solitary plasmacytoma and multiple myeloma. Apropos of 11 cases].

Spinal MRI was performed in 9 multiple myeloma and 2 solitary plasmacytoma, using sagittal, T 1-weighted (TR: 350-550 ms/TE: 15-26 ms) and T 2-weighted (TR: 2,000-2,500 ms/TE: 60-120 ms) sequences, with additional gadolinium injection in 3 cases. MRI features were the following: 1) round, patchy lesions with low T 1 signal highlighted by gadolinium and bright T 2 signal were present in 10 of the 11 patients: all osteolytic lesions seen on plain X-rays corresponded to such lesions and biopsy performed in 4 cases showed massive marrow replacement by plasma cells. 2) overall marrow signal was dramatically decreased in 3 patients (2 of whom had a high tumoral mass). 3) extra-dural compression was present in 4 cases. 4) 25 vertebral compression fractures (10 of whom with a "benign" appearance) and focal fat deposition were seen. 5) postradiation treatment examination seemed predictive of the outcome in the 2 solitary plasmacytomas. MRI proved to be more sensitive than plain X-rays or bone scintigraphy. Number and size of focal tumor-like lesions did not correlate with the low marrow signal appearance. Both correlated poorly with overall tumoral mass but diffuse abnormalities were associated with rapidly fatal outcome in three cases. These features might reflect qualitative rather than quantitative patterns of the disease (nodular or diffuse macroscopic marrow replacement). These findings are in agreement with those of the few previous studies. MRI is valuable for spinal cord damage assessment. It appears less accurate in benign versus malignant vertebral compression fracture determination than it does in bone metastasis. Its prognostic value is still questionable.

Aged↗

PubMed1994

[Results of therapeutic management of vesico-urethral and anorectal disorders in 20 patients with cauda equina syndrome].

Twenty patients (7 females and 13 males) with cauda equina lesions (12 herniated lumbar disks, 4 tumours, and 4 compression fractures of the lumbar spine), were treated according to a standardized management of their urinary and digestive symptoms, after surgery. The bladder emptying inability was managed by Crédé manoeuver facilitated by appropriate drugs completed by self intermittent catheterization. The constipation was treated by non irritant osmotic laxatives, and defecation obtained by abdominal straining, was facilitated by a suppository. All the patients recovered a sphincteric autonomy, without invalidating incontinence. Within 3 to 6 months, eleven patients improved enough bladder emptying to stop drugs and self-catheterization. None presented urinary incontinence. Within the same time, 14 had a stool daily, but medical treatment of the constipation had to be carried on in all of the 20 patients. None of the patients had incontinence for the solid stools, but only the patients who improved (spontaneously or after biofeedback therapy) the voluntary anal sphincter contraction were continent for the gaz, and liquid stools. The intermittent self-catheterization release (a complete emptying of the bladder being achieved) was more frequent after tumor treatment than after herniated disk, or compressive fracture treatment; the same release happened in case of immediate management if compared with delayed management of the urinary symptoms. Adversely, the digestive recovering was not influenced by either the etiology of the cauda equina lesions or the therapeutic management delay. Defecography demonstrated anatomical disturbances of the rectoanal apparatus such as perineal descent and/or mucosal prolapse, which could be secondary to the abdominal straining necessary to complete bladder and rectum emptying.

Adult↗

PubMed1994

A comparison of lateral versus anterior-posterior spine dual energy x-ray absorptiometry for the diagnosis of osteopenia.

Because bone mineral density (BMD) measurements at various sites differ in the relative amounts of cortical and trabecular bone that they assess, they also differ in their sensitivity for detecting osteopenia. Lateral spine dual energy x-ray absorptiometry (DXA) allows measurement of BMD of the vertebral bodies, which contain mainly trabecular bone, without contribution from the posterior vertebral elements, which are rich in cortical bone. Thus, we hypothesized that lateral spine DXA would detect osteopenia more frequently than anterior-posterior (AP) spine DXA. To assess the ability of DXA to estimate trabecular bone mass, we compared AP and lateral DXA spine measurements with trabecular bone measurements by quantitative computed tomography (QCT) in 58 patients. We then compared AP vs. lateral spine DXA measurements in 1) 300 women referred for routine bone densitometry, 2) 30 glucocorticoid-treated women, and 3) 44 women with vertebral compression fractures. To compare short term reproducibility, we performed repeat AP and lateral DXA scans in 50 women. The association between QCT and DXA measurements was stronger when DXA measurements were made in the lateral (r = 0.784) or midlateral (r = 0.823) projection than in the AP (r = 0.571) projection. The association of BMD with age was stronger when DXA measurements were made in the lateral (r = 0.536) or midlateral (r = 0.536) projection than in the AP (r = 0.382) projection. The declines in BMD with age for AP, lateral, and midlateral DXA measurements were 0.48%, 0.60%, and 0.88%/yr, respectively. In the women referred for routine densitometry, lateral DXA measurements were significantly (P < 0.05) more abnormal than AP measurements compared with those in young women. This was also true in the women treated with glucocorticoids and women with vertebral compression fractures. Lateral DXA often detected osteopenia in patients whose AP DXA was normal. The 95% confidence limits for changes in BMD attributable to measurement error for AP, lateral, and midlateral DXA were 0.027, 0.038, and 0.057 g/cm2, respectively. These results indicate that lateral DXA measurements identify patients with osteopenia more often than AP DXA measurements, probably because lateral DXA more accurately estimates trabecular bone mass. Short term reproducibility of lateral DXA is nearly as good as that for AP DXA.

Absorptiometry, Photon↗

PubMed1998

Shen instrumentation for the management of unstable thoracolumbar fractures.

STUDY DESIGN: A retrospective study was carried out using Shen instrumentation, which is a modified pedicle rod sleeve spinal system, to perform reduction and fusion in patients with unstable thoracolumbar fracture. OBJECTIVES: To demonstrate that the simple, locally made pedicle rod sleeve instrumentation is as effective as conventional systems in the management of thoracolumbar fractures. The current results are also compared with those reported in the literature. SUMMARY OF THE BACKGROUND DATA: Many instrumentations, such as Harrington, Luque, and Dick, have been used for the management of thoracolumbar fracture in the past 2 decades. Every device has its advantages and disadvantages based on clinical practice and the biomechanical mechanism of reduction. METHODS: Between January 1991 and December 1995, 96 consecutive patients who had experienced unstable thoracolumbar fractures were treated surgically with Shen instrumentation, which consists of four components: superior pedicle screws, distraction rods, sleeves, and inferior laminar hooks. Of these 96 patients, 76 were male and 20 were female (age range, 16-68 years; mean, 37 years). Thirty patients had partial paraplegia and 38 patients had complete paraplegia, according to the Frankel classification. Injury categories were as follows: 43 burst fractures, 26 flexion-compression fractures, 22 fracture-dislocation injuries, and 5 flexion-distraction injuries. RESULTS: The average follow-up was 39 months (range, 24-60 months). Kyphotic deformity was corrected from 27.1 degrees before surgery to 4.2 degrees after surgery, translation was reduced from 30.7% to 0%, height of compressed vertebral bodies was restored from 52.3% to 96.5% of the normal height. Computed tomographic evaluation showed that the cross-canal area was restored from 48.1% before to 70.9% after surgery. Improvement of neurologic function of more than one Frankel grade occurred in 90% of patients. CONCLUSION: Based on the understanding of biomechanics and the present clinical results, Shen instrumentation is as efficacious as conventional devices available today and may serve as a cost-effective option for thoracolumbar injuries, especially in a developing country.

Adolescent↗