The Journal of bone and joint surgery. American volume
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Fifty-five patients who had loss of lumbar lordosis after spinal fusion and subsequently had corrective osteotomies were studied. When they were first seen, fifty-two patients (95 per cent) were unable to stand erect and forty-nine (89 per cent) had back pain. The previous use of distraction instrumentation with a hook placed at the level of the lower lumbar spine or the sacrum was the factor that was most frequently identified as leading to the development of the flatback syndrome. ⋯ Anterior spinal fusion combined with posterior osteotomy resulted in greater maintenance of correction. The prevention of flatback syndrome is important, since its treatment is difficult. When a spinal fusion must be extended to the level of the lower lumbar spine or the sacrum, the use of distraction instrumentation should be avoided in order to prevent this deformity.
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Thirty-eight (49 per cent) of seventy-seven paraplegic patients whose level of injury was at or caudad to the second thoracic vertebra were found to have signs and symptoms of carpal tunnel syndrome. The prevalence of carpal tunnel syndrome was found to increase with the length of time after the injury. In the eighteen patients in whom manometric studies were done, the carpal tunnel pressures when the wrist was in the neutral position were higher than those that have been reported in non-paraplegic patients who did not have carpal tunnel syndrome but were lower than the values in non-paraplegic patients who did have the syndrome. ⋯ However, in the paraplegic patients, regardless of whether or not they had carpal tunnel syndrome, the pressures that developed when the wrist was in extension were significantly higher than those in non-paraplegic patients, regardless of whether or not they had carpal tunnel syndrome. Most of the activities of daily living of paraplegic patients, including the maneuver to relieve ischial pressure that consists of arising from the seated position using the extended arms, are performed with the wrists locked in maximum extension. The pressure that develops in the carpal canal during this forced extension of the wrist, probably combined with the repetitive trauma to the volar aspect of the extended wrist while propelling a wheelchair, contributes to the high frequency with which carpal tunnel syndrome is found in paraplegic patients.