Journal of spinal disorders & techniques
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J Spinal Disord Tech · Dec 2002
The biomechanical effects of multilevel posterior foraminotomy and foraminotomy with double-door laminoplasty.
The aim of this study is to evaluate the biomechanical effects of multilevel foraminotomy and foraminotomy with double-door laminoplasty compared with foraminotomy with laminectomy. Using fresh human cadaveric specimens (C2-T1), sequential injuries were created in the following order: intact, bilateral foraminotomies (C3-C4, C4-C5, C5-C6), laminoplasty (C3-C6) using hydroxyapatite spacer, removal of the spacers, and laminectomy. Changes in the rotations of each vertebra in each injury status were measured in six loading modes: flexion, extension, right and left lateral bending, and right and left axial rotation. ⋯ After removal of the spacers and following laminectomy, the motion increased significantly in flexion and axial rotation. The ranges of initial slack showed similar trends when compared with the results at maximum load. Clinical implications of these observations are presented.
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J Spinal Disord Tech · Dec 2002
Lumbar disc herniation regression after successful epidural steroid injection.
In some lumbar disc herniation patients, noninvasive measures fail, necessitating more aggressive treatment, such as epidural steroid injections or surgery. This study sought to determine whether improvement in patients who receive epidural steroid injections is related to regression of herniated nucleus pulposus or whether such patients' symptoms decrease because of the steroid effect in the presence of continued herniated nucleus pulposus. Two nonoperatively treated patient cohorts were followed who had follow-up MRI. ⋯ The epidural steroid injection group had fewer sequestered or extruded herniations that resorbed, and most were of lower hydration. In conclusion, epidural steroid injections do not alter ultimate herniated nucleus pulposus regression. Patients in whom the disc herniation has less hydration may have prolonged symptoms, but many improve with epidural steroid injections.
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J Spinal Disord Tech · Oct 2002
Comparative StudyCorrelative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain.
This prospective comparative study was designed to investigate the possible link between SF-36 functional status and lateral roentgenographic variables of the standing lumbar spine in patients with low back pain (LBP) versus asymptomatic volunteers. To the authors' knowledge, no previous studies have correlated SF-36 scores and sagittal roentgenographic variables in patients with LBP versus asymptomatic individuals. A total of 100 male volunteers, used as controls, and an equal number of age-, height-, and weight-comparable patients of the same ethnicity with chronic LBP were compared on the basis of roentgenographic and SF-36 data. ⋯ For the patients with LBP this study showed that General health, Physical Functioning, Role-Emotional, Social Functioning, and Bodily Pain were significantly correlated with age, height, L1-L2 inclination, distal lordosis, L2-L5 index, and L4-L5 and L5-S1 disc index. This comparative study showed that the functional status of hard-working patients with chronic LBP is associated with degenerative changes on the lateral radiographs of the lumbosacral spine. Spine surgeons should take into consideration the results of this study in reconstruction of painful degenerative lumbosacral spine.
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J Spinal Disord Tech · Oct 2002
Case ReportsCyclic sciatica related to an extrapelvic endometriosis of the sciatic nerve: new concepts in surgical therapy.
Sciatic pain caused by endometriosis of the sciatic nerve is an uncommon clinical finding and seems to have been verified histologically in only a few cases. Patients complain of typical signs and symptoms of common sciatica that are cyclic in nature. ⋯ However, conservative surgery with excision of the endometriosis from the nerve can be successful in selected patients who wish to preserve reproductive function. We report a case of sciatic nerve involvement explored by magnetic resonance imaging, with endometriosis in contact with the nerve in the right sciatic trunk.
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J Spinal Disord Tech · Oct 2002
Comparative StudySingle-level lumbar spine fusion: a comparison of anterior and posterior approaches.
This study is a retrospective review of 122 patients who underwent single-level lumbar spine fusion. The objectives were to directly compare perioperative morbidity and early results of single-level anterior interbody posterolateral intertransverse process lumbar spine fusion and to provide objective findings that may be useful in selecting surgical method. Lumbar spinal fusion is a well-recognized surgical treatment of intractable low back pain resulting from DDD or spondylolisthesis. ⋯ This may in turn affect surgical outcome and hospital cost. However, both approaches to single-level lumbar fusion produce similar early fusion rates and clinical results. Revision fusions had poor early results regardless of approach.