Spine
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A retrospective comparison of postoperative continuous epidural analgesia and patient-controlled analgesia following surgical treatment for adolescent idiopathic scoliosis. ⋯ Although both continuous epidural analgesia and patient-controlled analgesia provide effective pain control following surgery for adolescent idiopathic scoliosis, patients with continuous epidural analgesia had significantly better pain scores for all time periods, less fluctuations in pain, and lower maximum pain levels during the postoperative period.
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Case Reports
Lumbar chance fracture in an adult snowboarder: unusual mechanism of a chance fracture.
A case of a Chance fracture in an adult snowboarder following a fall is presented. The mechanism of this fracture is reported. ⋯ Chance fractures are horizontal splitting fractures of the posterior elements of the vertebrae, and the mechanism of the injury is that of a hyperflexion of the spine over a fulcrum. A Chance-type fracture can be seen in an adult snowboarder, when acute hyperflexion of the spine occurs following a fall backward.
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Intervertebral disc degeneration was evaluated by morphologic appearance, magnetic resonance imaging, and by biochemical matrix composition. Caliber and distribution of openings of the adjacent vertebral osseous endplates were measured. ⋯ A high indirect correlation between the density of openings in the osseous endplate (particularly of the size of the capillary buds) and the morphologic degeneration grade of the disc support the hypothesis that occlusion of these openings may deprive the cells of nutrients, leading to insufficient maintenance of the extracellular matrix and disc degeneration.
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Graded endplate injuries were performed in porcine lumbar discs. The effects of such injuries were compared to control animals in which a sham operation was performed. ⋯ Injuries of vertebral endplates in porcine discs were found to cause degenerative changes in the disc tissue on MRI, histologic, and biochemical investigations. The severity of such degenerative changes was related to the severity of endplate injuries. Injuries of vertebral endplate may be one of the pathomechanisms leading to early changes in the disc matrix and eventually to abnormal biomechanical behavior of the whole disc. The present animal model seems to be a suitable experimental model for disc degeneration.