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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Persons with recurrent low back pain (LBP) have been observed to have altered proprioceptive postural control. These patients seem to adopt a body and trunk stiffening strategy and rely more on ankle proprioception to control their posture during quiet upright standing. The aim of this study is to determine the effect of changing postural condition (stable and unstable support surface) on postural stability and proprioceptive postural control strategy in persons with recurrent LBP. ⋯ Persons with recurrent LBP showed significantly different postural control strategies favoring ankle muscle proprioceptive control (ratio closer to 1) instead of paraspinal muscle proprioceptive control (ratio closer to 0) for both standing without foam (ratio ankle muscle/paraspinal muscle control = 0.83) (P < 0.0001) and on foam (ratio ankle muscle/paraspinal muscle control = 0.87; P < 0.0001) compared to healthy individuals (0.67 and 0.46, respectively). It is concluded that young persons with recurrent LBP seem to use the same proprioceptive postural control strategy even in conditions when this ankle strategy is not the most appropriate such as standing on an unstable support surface. The adopted proprioceptive postural control strategy might be effective in simple conditions, however, when used in all postural conditions this could be a mechanism to undue spinal loading, pain and recurrences.
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Case Reports
The value of bilateral ipsilateral and contralateral motor evoked potential monitoring in scoliosis surgery.
Intraoperative monitoring (IOM) of the motor pathways is a routine procedure for ensuring integrity of corticospinal tracts during scoliosis surgery. We have previously demonstrated presence of ipsilateral motor evoked potentials (MEPs) during IOM for scoliosis surgery, but its significance was uncertain. In this case series, we show concurrent ipsilateral and contralateral MEP amplitude changes obtained with cortical stimulation are of value in reducing false positive observations during IOM. The use of this easily recordable MEP is thus advocated as a diagnostic adjunct to contralateral MEPs for scoliosis and spinal surgery.
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Vascular injury as a complication of disc surgery was first reported in 1945 by Linton and White. It is a rare but potentially fatal complication. ⋯ Treatment has traditionally been by open vascular surgical repair, however with modern imaging and endovascular techniques, minimally invasive treatment should be considered first line in patients who are stable. We present the case of a 51-year-old woman who sustained common iliac artery injury during lumbar spinal surgery that was treated successfully using a covered stent.
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Chiari I malformations are often associated with congenital craniocervical anomalies such as platybasia, basilar invagination, and retroflexion of the odontoid process. Management of ventral brain stem compression associated with Chiari I malformations remains controversial, but several authors report a significant rate of failure with suboccipital decompression alone in the presence of pronounced ventral brain stem compression (VBSC). Treatment options described in the literature for these patients involve anterior, posterior, or combined decompressions with or without concurrent arthrodesis. ⋯ We describe an alternative surgical treatment for Chiari I patients with significant ventral brain stem compression where a combined anterior and posterior decompression was considered necessary. We report two patients who underwent transoral odontoidectomy with preservation of the anterior arch of the atlas and suboccipital craniectomy with C1 laminectomy followed by C1-C2 arthrodesis. Preservation of the anterior arch of the atlas in conjunction with C1-C2 arthrodesis stabilizes the occipito-atlanto-axial segments while conserving more cervical mobility as compared to an occipitocervical fusion.