Spine
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Case Reports Comparative Study
The application of pelvic pins in halo-pelvic distraction. An anatomic study.
The application of the pelvic hoop for halo-pelvic distraction, as described by O'Brien, has led to serious abdominal complications. A study of mature Caucasian pelves as compared to the smaller East Indian pelves has shown that in the larger pelvis, when the gluteal tubercle and posterior superior iliac spine are used as landmarks, as advocated by O'Brien, the pins will invariably pass within the soft tissue elements of the inner pelvis instead of being entirely within the bony ilium, as O'Brien noted in the Chinese pelves. On the basis of pelvic measurements and observations, the authors recommend an open technique for passage of the pins.
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Randomized Controlled Trial Clinical Trial
Chymopapain for the treatment of intervertebral disc herniation. A preliminary report of a double-blind study.
Sixty patients with unilateral sciatica resulting from lumbar intervertebral disc herniation were entered into a double-blind study. All patients had failed to respond to conservative management, and the diagnosis had been confirmed by metrizamide myelography. Following a randomized schedule, 30 patients had intradiscal injections of chymopapain and 30 patients had intradiscal injections of an equivalent volume of normal saline solution. ⋯ Six weeks after the injection, 73% of patients treated with chymopapain and 37% of patients treated with saline solution considered that the treatment was successful. The success rate at six months was 80% for patients treated with chymopapain and 57% for saline-injected patients. From the preliminary results of this study, chymopapain is recommended for the treatment of sciatica from intervertebral disc herniation when conservative measures have failed and before disc fragment excision is considered.
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Ninety of 120 patients with herniated lumbar discs who received an intradiscal injection of chymopapain achieved successful recovery. Sixteen of the 21 patients who underwent subsequent surgery had a good result. Study of the unsuccessful cases showed that disc sequestration and lateral stenosis were the major organic causes of failure. ⋯ They appear to be a contraindication to chemonucleolysis. Psychogenic pain components and the failure of the enzyme to hydrolyse the nuclear proteoglycans in a few cases were the other two causes of poor results. A survey of postchemonucleolysis computed tomographic scans suggested that, although capable of digesting nuclear material in most cases, chymopapain may also work through an "anti-inflammatory" mechanism.
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The effects of Harrington instrumentation on the longitudinal axis rotation of the vertebra, the kyphosis-lordosis, and the rib-cage deformity were investigated by computer tomography in 33 patients. No significant derotation was achieved. ⋯ The rib hump was reduced significantly only with distraction rod instrumentation. The obtained results indicate that despite instrumentation, the spine preserves an almost unchanged peripheral position in the rib cage.
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A follow-up x-ray study of 554 subjects aged between 50 and 84 years has been carried out to determine the appearance, presence, and progression of scoliosis in the elderly and its relationship to osteoporosis and back pain. The subjects were chosen from a population group of 3600 subjects examined 7 to 13 years previously in the same investigators. Some degree of scoliosis was found in 70% of the subjects, and curves of 10 degrees or more in approximately 30%. ⋯ There was no direct relationship between the presence or progression of scoliosis and osteoporosis. There was no direct relationship between scoliosis and back pain or between scoliosis and degenerative changes in the spine. Since scoliosis in the elderly seldom becomes a clinical problem of significance, there would appear to be no valid reason for a more extensive study of the condition at this time.