Spine
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Limitation of movement of the back, pelvis, chest wall, and other joints are the consequences of ankylosing spondylitis. The most serious problem is severe kyphosis leading to disturbance of the activities of daily living and failure of the respiratory system. Transpedicular decancellation closing wedge vertebral osteotomy, using the posterior approach followed by segmental spinal instrumentation, is a safe and easy technique for correction of the deformity. ⋯ Only one case in this report had dura tear due to adhesion between the dura and the ossified ligamentum flavum, which required exploration and repairing with myofascial graft. No case had any neurologic complication. At an average of 24 months' follow-up, all cases had improvement of their general appearance, posture, respiratory and gastrointestinal functions, and had good bony union.
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The geometric changes of acute thoracolumbar burst fractures under extension and traction loadings were analyzed using functional radiographs. The injuries were produced in an in vitro high-speed impact model. The changes in nine geometric parameters (three angular and six linear) were analyzed from neutral posture to extension and traction positions. ⋯ In the traction position, all nine geometric parameters changed significantly from the neutral posture, whereas only the vertebral diameter remained significantly different from its intact value. These findings demonstrated the treatment advantages of applying traction force to acute burst fractures in contrast to extension moments. Further, changes in the angular parameters due to motion from neutral to extension posture demonstrated that the acute flexibility of the three-vertebrae segment was contributed almost equally by the upper disc (35%), lower disc (27%), and fractured vertebra (38%).
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This prospective study investigated the relationship between behavioral sign scores (from Waddell) and the return to work status of chronic low-back pain patients who completed a work-oriented physical rehabilitation program without formal facility-related psychologic or social services. Further, the authors monitored the effect of this program on changing these scores. The program consisted of physical reconditioning through resistive exercises, flexibility and aerobic training, posture and body mechanics education, and progressive work simulation tasks and activities of daily living. ⋯ There was no significant reduction in scores for patients who did not return to work. The results suggest these signs may predict the effectiveness of treating chronic low-back pain patients in a return-to-work physical rehabilitation program. Conversely, screening for behavioral signs may identify low-back pain patients who would benefit from intensive behavioral and psychiatric testing and intervention efforts.
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Over the past 10 years, 231 insufficiency fractures of the sacrum have been reported in the literature. These fractures, which are due to osteopenia, form a distinct subgroup of pathologic fractures. ⋯ Frequency, age, sex, diagnosis, underlying diseases, and associated fractures of the 20 cases of insufficiency fractures of the sacrum are described and compared with those previously reported. Insufficiency sacral fracture as a cause of low-back pain in women older than 55 years of age is concluded to be a clinical entity.
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Sacral insufficiency fractures are an often unsuspected cause of low-back pain in elderly women with osteopenia who have sustained unknown or only minimal trauma. The authors describe 10 cases of spontaneous sacral insufficiency fractures, confirmed by computed tomography, characterized by the onset of acute low-back pain. Differential clinical and radiographic diagnosis of these fractures is often difficult. ⋯ The fractures extend vertically in the sacral alae, parallel to the sacroiliac joints. They are located just lateral to the margins of the lumbar spine. This distribution suggests that such fractures could be partially caused by weight-bearing transmitted through the spine.