European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Three separate stages have previously been defined in the progressive degenerative process. The first stage, characterized as temporary dysfunction with early degenerative findings, transforms into a second period of segmental instability evidenced by a resulting deformity. With the deformity the process has reached a late stage of definitive stabilization induced by osteoligamentary repair mechanisms. ⋯ The segmental mobility status cannot be deduced from the radiographic, degenerative disc stage, since the inter-individual differences in mobility are pronounced for the same disc status. A fully stable situation cannot be taken for granted, even when the disc is reduced by more than 50%, considering the fact that some persisting mobility was seen for most patients in category III. A preceding stage of instability, in the clinical situation proven by a resulting deformity, was not verified in this study.
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The anatomic proof of a spinal compartment and the clinical symptoms of compartment syndrome in patients with chronic back pain are inconsistent with the rarely met measuring criteria of intramuscular pressure (IMP). Previous studies assume a dependence of the IMP on spinal alignment (degree of lumbar spine flexion) and the degree of muscle activation. The significance of these disturbance variables in the interpretation of IMP could explain the above discrepancy. ⋯ To sum up, it can be said that IMP was subject to great interindividual variation in all the experiments. This parameter is highly dependent on spinal alignment and muscular activity. Further studies are needed so that the IMP can be interpreted properly when diagnosing a chronic compartment of the erector spinae muscles.
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Experimental data suggest that lumbar torsion contributes to lumbar disc degenerative changes, such as instability, spondylolisthesis and spinal canal stenosis. However, some basic mechanical characteristics of the lumbar spine under torsional loading have not yet been reported in detail. For example, the function of the facet joints under combined mechanical loads such as torsion with superimposed flexion or extension postures is an area of interest about which little biomechanical data have been reported. ⋯ In the transverse plane, the HAM position showed a discrete trend towards the posterior part of the specimens during extension. Kinematic data were visualized using computer animation techniques and CT-based reconstructions of the respective specimens. This information may be used for identifying and characterizing physiologic and pathologic motion and for specifying conservative and surgical treatment concepts and, thus, may find application to identifying indications for spinal fusion or in evaluating the effect of future semi-flexible instrumentation.
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Literature regarding the effect of a spinal fracture and its treatment in terms of resulting spinal range of motion (ROM) is scarce. However, there is need for data regarding sagittal spinal ROM, since many patients who sustain a spinal fracture are concerned about the back mobility they will have after treatment. In addition, the relationship between ROM and impairment is not clear. ⋯ We conclude that patients treated operatively for a thoracolumbar spinal fracture have a lower thoracolumbar ROM than controls. Spinal ROM, however, does not influence impairment. A spinal fracture results in impairment, no matter what therapy is chosen.