Journal of spinal disorders & techniques
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J Spinal Disord Tech · Feb 2005
Structures at risk following anterior instrumented spinal fusion for thoracic adolescent idiopathic scoliosis.
With the increasing popularity of anterior instrumented spinal fusion for adolescent idiopathic scoliosis, there has also been a rising concern over the proximity of the descending aorta to the screw tips and the possibility of vessel wall erosion over time. This computed tomography (CT) study attempts to define the relative position of the thoracic aorta and other vital structures to the spine (preoperatively) and to the projected instrumentation (postoperatively) by level and curve magnitude in deformity patients. ⋯ The course of the thoracic aorta may vary in individuals; however, in deformity patients, it generally moves from a relatively anterolateral position proximally to a posteromedial position at the apex. Distally, it moves more anteriorly. Consequently, the aorta moves closer to the screw tips both at the apex and distally, whereas the distal screws are more frequently juxtaposed to the descending aorta (P < 0.05).
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J Spinal Disord Tech · Feb 2005
Comparative StudyA cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury.
Symptom expectation for whiplash injury has been shown to be low in countries with low rates of chronic whiplash when compared with countries like Canada, where chronic whiplash is common. The objective of the current study is to compare the frequency and nature of expected "whiplash" symptoms in Germany with that in Canada. ⋯ In Germany, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. The current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Germany may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.
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J Spinal Disord Tech · Feb 2005
Case ReportsReversal of anterior cervical fusion with a cervical arthroplasty prosthesis.
This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level. ⋯ The old fusion was removed at the C5-C6 level and remobilized, and an arthroplasty was performed. At discharge, the patient's neck pain and hand symptoms had improved, and he had motion demonstrable on radiologic imaging at C5-C6. This is the first reported case of reversal of a cervical fusion with re-establishment of motion and represents an alternate acceptable management of pseudoarthrosis or recent spinal fusion.
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J Spinal Disord Tech · Dec 2004
Comparative Study Clinical Trial Controlled Clinical TrialClinical presentation and anatomic position of L3-L4 disc herniation: a prospective and comparative study.
A prospective, controlled cohort study was conducted to assess the anatomic transverse location and clinical presentation of L3-L4 disc herniation compared with lower lumbar levels. ⋯ The incidence of foraminal and far lateral disc herniation is significantly higher at the L3-L4 level compared with lower lumbar levels. When examining an older patient complaining of thigh pain, special attention should be given to the quadriceps strength, patellar reflex, and femoral stretch test. The L3-L4 foraminal and extraforaminal area should be assessed carefully.