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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The rat L5/6 facet joint, from which low-back pain can originate, is multisegmentally innervated from the L1 to L5 dorsal root ganglions (DRGs). Sensory fibers from the L1 and L2 DRGs are reported to non-segmentally innervate the paravertebral sympathetic trunks, whilst those from the L3 to L5 DRGs segmentally innervate the L5/6 facet joint. In the current study, characteristics of sensory DRG neurons innervating the L5/6 facet joint were investigated in rats, using a retrograde neurotransport method, lectin affinity- and immuno-histochemistry. ⋯ Under physiological conditions in rats, DRG neurons transmit several types of sensations, such as proprioception or nociception of the facet joint. Most neurons transmitting pain are CGRP-IR peptide-containing neurons. They may have a more significant role in pain sensation in the facets via peptidergic DRG neurons.
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Bone bruising associated with long bone injury is a defined entity with known radiological, pathologic and clinical features. Vertebral bone bruise (VBB) has been described through magnetic resonance imaging (MRI) of the injured spine, but to date the consequences of this entity are unknown. The objective of this retrospective study was to describe the plain radiographic outcome of MRI-defined VBB associated with thoracic and lumbar spine fracture in adults, and to assess whether VBBs caused abnormalities of the bone-implant interface at instrumented levels. ⋯ A total of 12 out of 30 (40%) bruised levels were instrumented in 13 out of 18 (72%) operated patients. No bone--implant interface failure was observed at these levels. It is concluded that VBB associated with thoracic and lumbar vertebral fracture in adult patients does not appear to cause significant progressive vertebral deformity or bone--implant interface failure.
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Clinical Trial
Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients.
The treatment of neurologically intact patients with thoracolumbar burst fractures is still controversial. This study was designed to evaluate the role of nonoperative treatment for 29 neurologically intact patients with two- or three-column-injured thoracolumbar burst fractures. Neurologically intact patients with types A, B and C burst fractures were treated conservatively and divided into groups GI and GII, according to their column involvement, with two and three injured columns, respectively. ⋯ None of the patients had neurological deterioration. Most of the functional results were satisfactory. As a result, it was concluded that nonoperative treatment could be an alternative method for neurologically intact two- and three-column-injured Denis-types A, B and C thoracolumbar burst fractures.
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The value of range of motion (ROM) as an indicator of impairment associated with spinal problems, and in monitoring changes in response to treatment, is a controversial issue. The aim of this study was to examine the interrelationship between subjective disability (Roland-Morris scores) and objectively measured impairment (ROM), both before and in response to spinal decompression surgery, in an older group of patients with herniated lumbar disc (DH). Seventy-six individuals took part in the study: 33 patients (mean age 57 years, SD 9 years) presenting with DH and for whom decompression surgery was planned, and 43 controls (mean age 57 years, SD 7 years), with no history of back pain requiring medical treatment. ⋯ The patients in the "poor" outcome group ("surgery didn't help"; 9%) had a significantly greater reduction in ROF(lumbar) post-surgery compared with the "good" outcome group ("surgery helped"; 91%) (p=0.04). In stepwise linear regression, the change in ROF(lumbar) was the only variable accounting for the change in self-rated disability pre-surgery to post-surgery (variables not included: pain intensity, psychological factors). The pivotal role of lumbar mobility in explaining disability emphasizes the importance of measuring lumbar and hip ranges of motion separately, as opposed to "global trunk motion." In the patient group examined, the determination of lumbar spinal mobility provides a valid, objective measure of function, that shows differences from normal matched controls, that correlates well with self-rated disability, and the changes in which correlate extremely well with subjective changes in disability following surgery.
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Spinal deformity is the commonest orthopaedic manifestation in neurofibromatosis type-1 and is categorized into dystrophic and non-dystrophic types. Management should be based on a meticulous assessment of the spine with plain radiography and magnetic resonance imaging (MRI) to rule out the presence of dysplastic features that will determine prognosis and surgical planning. MRI of the whole spine should also be routinely obtained to reveal undetected intraspinal lesions that could threaten scheduled surgical interventions. ⋯ Bracing of dystrophic curves has been unsuccessful. Combined anterior/posterior spinal arthrodesis including the entire structural component of the deformity is indicated in most cases, particularly in the presence of associated sagittal imbalance. This should be performed using abundant autologous bone graft and segmental posterior instrumentation to minimize the risk of non-union and recurrence of the deformity.