Spine
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The author reports on 223 patients who underwent lumbar percutaneous facet rhizotomy for chronic low-back or chronic back and leg pain. The overall success rate was 69%. The procedure is very safe and can offer relief for many patients in whom organic pathology, most commonly a herniated lumbar disc, has been eliminated. The procedure, screening and results are discussed.
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Intraoperative spinal ultrasonography (IOSU) was performed during anterior spinal operations in 124 patients. The IOSU proved very useful in ascertaining whether the bone-removing width was sufficient for the spinal transverse diameter. ⋯ When the insufficient width of bone removal or remaining compression factor was found, an additional technique could be performed immediately, and the IOSU was helpful for prevention of cervical reoperation and improvement of surgical results. The degree of spinal pulsations observed in IOSU was of great value in the prediction of the prognosis for spinal cord postoperatively.
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The second cervical vertebra (C2) is in a pivotal position for the alignment and stability of the cervical vertebrae as a whole. Since its spinal canal is wider at the cranial and narrower at the caudal end, a dome-like excision of the inner side of the spinal canal from the caudal toward the cranial end results in the decompression of the lesion, preserving the dorsal part of the C2. ⋯ The result was satisfactory in terms of the decompression and stability of the cervical vertebrae: even 5 years after the operation, no osteogenesis was noted in the expanded spinal canal to induce compression again. It thus may be concluded that this method is good enough to replace conventional laminectomy.
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In 1969 the authors started their prospective study to determine the natural history of atlanto-axial subluxation in patients suffering from rheumatoid arthritis. Between January 1969 and July 1971 they accumulated 41 cases of atlanto-axial subluxation. These patients were studied clinically and radiologically, and the initial findings were published in the Journal of Bone and Joint Surgery, Volume 55B, August 1973. ⋯ The remaining 10 patients have died from unrelated causes. Only 3 patients underwent surgical stabilization. This study concluded that the atlanto-axial subluxation is compatible with life, but some patients require surgical intervention.
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To clarify the pathophysiology of intermittent claudication in 37 patients with lumbar spinal stenosis, neural function was evaluated by examining somatosensory evoked potentials (stress-SEPs), and nerve action potentials (stress-NAPs) before and after walking stress. It was shown preoperatively that the stress-SEPs became abnormal immediately after walking in 31 of 37 patients. ⋯ The present method is noninvasive, simple in technique, painless, and safe, a procedure therefore that is useful as the initial step in the diagnosis and treatment of patients with lumbar canal stenosis. It also may help to differentiate neurogenic from vascular intermittent claudication.