Spine
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It has been suggested that the pattern of development and attrition of blood vessels and notochord remnants leaves congenitally weak points in the cartilage disc plates. There is strong presumptive evidence that nuclear prolapse can take place through these weak spots in the cartilage plates to form Schmorl's nodes. It has been postulated that the development of Schmorl's nodes may also lead to anomalies of the vasculature in the end-plates, which may lead to further end-plate lesions. ⋯ The specimens examined were from individuals ranging in age from 17 to 90 years. The specimens were sectioned at 150 microns, stained, and the percentage of the bone cartilage interface occupied by marrow spaces was measured using a microscope with an ocular micrometer. The specimens with Schmorl's nodes had a significantly greater proportion of disc marrow contacts than did the normal vertebrae.
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Recent advances in spinal instrumentation have brought about a new emphasis on the three-dimensional spinal deformity of scoliosis and especially on the restoration of normal sagittal plane contours. Normal alignment in the coronal and transverse planes is easily defined; however, normal sagittal plane alignment is not so simple. This retrospective study was undertaken to increase the understanding of the normal alignment of the spine in the sagittal plane, with a special emphasis on the thoracolumbar junction. ⋯ When using composite measurements of the combined frontal and sagittal plane deformity of scoliosis, this wide range of sagittal variance should be taken into consideration. Using norms established here for segmental alignment, areas of hypokyphosis and hypolordosis commonly seen in scoliosis can be more objectively evaluated. The thoracolumbar junction is for all practical purposes straight; lumbar lordosis usually starts at L1-2 and gradually increases at each level caudally to the sacrum.
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The benefits of achieving rigid internal fixation and eliminating the need for postoperative external orthotic support with L-rod spinal instrumentation made it desirable for use in the surgical treatment of neuromuscular scoliosis. From May 1981 to May 1985, 31 severely involved cerebral palsy patients with progressive spinal deformity underwent posterior fusion and L-rod instrumentation. All patients except one were nonambulatory. ⋯ Six Group II patients were not fused into the sacrum. Scoliosis and pelvic obliquity were corrected in both groups. Torso decompensation improved to 2.7 cm in the Galveston group, but increased to 5.6 cm at follow-up in the patients not fused into the sacrum.(ABSTRACT TRUNCATED AT 250 WORDS)
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The influence of low-back trouble on lumbar sagittal mobility was explored in 958 individuals aged 10 to 84 years. Experience of low-back trouble was determined by questionnaire, and categorized as none, a previous history, or a current spell. Maximal mobility was estimated from flexicurve records of back surface curvature. ⋯ Similarly hypomobility was found in nonsufferers as well as in those with back trouble. The data indicated that young adults (notably males) with previous low-back trouble may not recover their previous mobility on symptomatic resolution. The finding of hypermobility in current sufferers indicates that mobilization therapy may not be appropriate for such patients.