Spine
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Review Case Reports
Central retinal artery occlusion after scoliosis surgery with a horseshoe headrest. Case report and literature review.
Central retinal artery occlusion is a well-documented entity that occurs after trauma and embolic, thrombotic, or spasmodic episodes in both children and adults. Its occurrence as a complication of elective surgery is very rare but quite tragic. This report describes a case of central retinal artery occlusion occurring in a child after scoliosis surgery in which a horseshoe headrest was used. Recommendations are given on how to avoid this serious complication.
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Our surveys have shown lifetime prevalence of L. BP. over 30% among schoolchildren. The purpose of this study was to evaluate the relationship between back and isokinetic trunk strength, anthropometric parameters, and sports activities. ⋯ Lifetime prevalence of back pain was 44.5% and point prevalence was 13%. In this cross-sectional study, anthropometric and strength profiles were significantly related to age and gender. Non specific low back pain was not correlated to trunk muscle strength and/or sports activities.
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Controversy centers on the determination of surgical fusion in lumbar spinal patients. What method best determines the nature of surgical arthrodesis remains unanswered. Numerous studies have investigated the accuracy of different radiologic tests. ⋯ This finding agrees with the authors' knowledge of osteoid and mineralized bone. The premineralized osteoid may be functionally fused, but appear radiolucent on radiographic film. Once solid trabecular bony bridging occurs radiographic identification of fusion is easier to determine.
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Somatosensory evoked potentials (SEPs) were recorded at the lumbar spine following stimulation of the tibial nerve (mixed-nerve SEP; MSEP), the sural nerve (specific nerve SEP; SSEP), and the skin corresponding to the L6 and S1 dermatomes (dermatomal field SEP; DSEP-L and DSEP-S) in the hog. To determine the sensitivity of these three SEPs to the single nerve root (S1 root) function, the effects of nerve roots lesioning were investigated. Cutting S1 nerve root reduced the peak-to-peak amplitude of MSEP by only 28% in comparison with baseline values. ⋯ When S1 nerve root was left intact and L5, L6, and S2 nerve roots were cut, the relative amplitudes of MSEP, SSEP, DSEP-L, and DSEP-S were decreased to 68%, 73%, 31%, and 74%, respectively. These results indicate that DSEP-S is as sensitive to the function of S1 nerve root as SSEP but the sensitivities of DSEP-S and SSEP are low in the hog. MSEP is shown unsuitable to monitor the single nerve root dysfunction.
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There continues to be considerable controversy regarding the management of thoracolumbar burst fractures. Most feel that failure of the middle osteoligamentous complex, particularly with retropulsion of fragments into the spinal canal, is an indication for operative management. Others advocate postural reduction and prolonged bedrest for such injuries. ⋯ On average, nearly two-thirds of the fragment occluding the canal resorbed, with most remodeling complete within one year. For patients with burst fractures presenting neurologically intact, we obtained the following findings: 1) nonoperative management yields acceptable results; 2) following nonoperative management, bony deformity (i.e., kyphosis and body collapse) progresses marginally relative to the rate of canal area remodeling; 3) incidence of subsequent neurologic deficits is quite low; and 4) initial radiographic severity of injury or residual deformity following closed management does not correlate with symptoms at follow-up. This pattern of results suggests nonoperative management as the preferred treatment in these circumstances.