Spine
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Based on the experimental and clinical results in the literatures and the author's experience, a working hypothesis for the pathomechanism of radicular pain is proposed. When the nerve root is involved, mechanical and circulatory changes are produced. ⋯ Disturbed or enhanced synthesis and transport of neuropeptides can also be elicited. These multifactorial changes may finally result in sensitization of both the central and peripheral nervous systems, causing radicular pain.
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The morphologic changes and signal intensity of the spinal cord on preoperative magnetic resonance images were correlated with postoperative outcomes in 74 patients undergoing decompressive cervical surgery for compressive myelopathy. The transverse area of the spinal cord on T1-weighted images at the level of maximum compression was closely correlated with the severity of myelopathy, duration of disease, and recovery rate as determined by the Japanese Orthopaedic Association score. In patients with ossification of the posterior longitudinal ligament or cervical spondylotic myelopathy, the increased intramedullary T2-weighted magnetic resonance imaging signal at the site of maximal cord compression and duration of disease significantly influenced the rate of recovery. A multiple regression equation was then developed with these three variables to predict surgical outcomes.
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Airway management in patients with an unstable cervical spine remains a challenge. A video fluoroscopic technique that transfers the image to a floppy disk for direct measurement is described. This technique enabled standardized, direct measurement of the cervical spine during airway maneuvers before and after a C5-6 posterior instability was surgically created in five cadaveric specimens. Unsupported direct oral techniques often can cause more motion than do indirect nasal techniques, and chin lift/jaw thrust and cricoid pressure can cause as much motion as do some of the intubation techniques.
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Two cases are described in which displaced sternal fractures were associated with thoracic spine fractures of minimal, initial displacement. Nonoperative, expectant treatment led to significant kyphotic deformity. It is postulated that the sternum and ribs represent a fourth column of structural thoracic spine support. An overriding, displaced sternal fracture is a marker for a severe flexion-distraction unstable thoracic spine injury with a propensity for deformity.