Spine
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This paper analyzes the initial effect of the Zielke VDS operation on S-shaped idiopathic spinal curves in 17 patients with particular reference to the thoracic spine. The curves are evaluated by conventional methods (Cobb angle, apical vertebral rotation, kyphosis, and lordosis) and by a new method using end vertebra angles (EVAs). Three new surgical correction indices are used. ⋯ The thoracic apical vertebral rotation shows variable changes. The findings show that the correction of the upper curve occurs mainly in the thoracolumbar spinal segment. It is suggested that this junctional segment of the spine is of importance in determining the limits of both instrumentation and fusion for idiopathic scoliosis.
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The Dallas Pain Questionnaire (DPQ) was developed to assess the amount of chronic spinal pain that affects four aspects (daily and work-leisure activities, anxiety-depression, and social interest) of the patients' lives. Results of the DPQ's statistical properties suggest that the DPQ is an externally reliable instrument as well as internally consistent. Two factors emerged from factor structure analysis. ⋯ A t test demonstrated that chronic pain patients have significantly higher DPQ scores than normals. Because these findings support its statistical properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.
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Unintended incidental durotomy is not an infrequent complication of spinal surgery (incidence, 0.3-13% reported). Although prompt repair is advocated, little has been written regarding any consequences of primarily repaired durotomies on long-term patient outcome. ⋯ No differences of statistical significance could be identified in comparing the outcomes of the two groups. Incidental durotomy, when recognized and repaired intraoperatively, does not increase perioperative morbidity or compromise final result.
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In order to define the indications for spinal fusion in patients undergoing decompression for lumbar spinal stenosis, 114 patients surgically treated were reviewed. Follow-up was 24 to 108 months. Patients were grouped into four categories: 15 with lateral recess stenosis, 45 with central-mixed stenosis, 43 with stenosis following prior lumbar surgery(s), and 11 with scoliosis and spinal stenosis. ⋯ In those with stenosis following prior lumbar surgeries, although not statistically significant, those who had concomitant decompression and arthrodesis had a better outcome than those in whom decompression only was done. Patients with scoliosis and stenosis had decompression for significant motor and reflex deficits and fusion over the length of their major curves. Patients having decompression for lumbar stenosis with degenerative spondylolisthesis, isolated disc resorption with degenerative facet joints, intervertebral disc disease with instability, and those with scoliosis with multidirectional instabilities benefit from concomitant spinal fusion.
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Comparative Study
A comparison of actual and apparent lumbar lordosis in black and white adult females.
The purposes of this study were to investigate differences in lumbar lordosis in black and white adult females and to explain the clinical impression that blacks have a greater lordosis than whites. An actual lumbosacral lordosis angle (ALS) was measured from a standing right lateral lumbosacral radiograph using the angle formed from the intersection of lines drawn across the top of the second lumbar vertebral body (L2) and across the top of the sacrum. An actual lumbo-lumbar angle (ALL) was measured in the same manner, except the second line was drawn across the bottom of the fifth vertebral body (L5). ⋯ Significant differences were found between black and white APL, with blacks demonstrating a larger APL than whites (P less than 0.01). A high correlation was noted between ALS and ALL in both blacks (0.70, P less than 0.01) and whites (0.77, P less than 0.01). The investigators therefore contend that the clinician's assumption that blacks have a greater lordosis than whites is based on an apparent increased lordosis due to more prominent buttocks (APL).