Spine
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Since 1973, 50 of 54 children have been treated by the author with a combined anterior and posterior fusion. Twenty males and 34 females, ranging in age from 1 to 16 years, have been followed for a mean period of 5.5 years. Sixteen patients with a kyphosis averaging 113 degrees (range, 77 to 170 degrees) had correction of deformity to a mean of 35 degrees. ⋯ These required repair and were successfully treated by supplemental posterior fusion resulting in an overall pseudarthrosis rate of 5.7%. Anterior fusion of the dysraphic spine allows greater correction of both spinal deformity and pelvic obliquity in addition to contributing significant strength to the fusion mass. Segmental spinal instrumentation with sublaminar and pedicular wiring to custom-contoured Luque rods provides excellent correction and immediate postoperative stability.
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Two hundred fifty patients with low-back pain who underwent lumbar discography followed by computed tomography (CT) are the subject of this prospective study. In 93% of the patients, these combined imaging techniques provided additional useful diagnostic information that affected patient management and the selection of treatment alternatives. Lumbar discography followed by CT proved valuable in determining the significance of equivocal or multiple level abnormalities, determining the type of disc herniation, defining surgical options, and evaluating the previously operated spine. ⋯ The radiographic morphology of the normal herniated and degenerative lumbar discs shown by CT-discography gives unique insight into the pathogenesis of disc degeneration. The complications that followed the 750 discograms were one case of urticaria and one disc space infection. Even with the availability of high resolution CT and MRI, lumbar discography remains the only pain provocation challenge to the lumbar disc.
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The structure of the lumbar disc anulus fibrosus was investigated using a layer-by-layer peeling technique and microscopic examination of various cut surfaces. Anulus specimens from spines of two different age groups and from two levels, L2-3 and L4-5, were examined. ⋯ The variations of the anulus structure with circumferential and radial locations were studied. The following principal structural features were quantified: 1) the anulus, excluding the transition zone, consists of 15 to 25 distinct layers, depending on the circumferential location, the spine level, and the specimen age; 2) in any 20 degrees circumferential sector, nearly half of the layers terminate or originate, thereby causing local laminate irregularities; 3) there are two identifiable mechanisms of layer interruption at these irregularities; 4) the thickness of individual layers varies both circumferentially and radially and increases markedly with age; and 5) the number of fiber bundles over the total height of the disc varies from 20 to 62, with an average interbundle spacing of 0.22 mm.
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An attempt was made to determine the effect of pregnancy on the abdominal muscles and to correlate changes in abdominal muscles strength with low-back pain during pregnancy. The study included 328 women. Group A consisted of 164 pregnant women; group B consisted of 164 non-pregnant women. ⋯ Whereas all non-pregnant women could perform a sit-up, 16.6% of pregnant women could not perform a single sit-up. There was no statistically significant correlation between the sit-up performance and backache. It may be concluded that during pregnancy the abdominal muscles become insufficient.