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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Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. ⋯ Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.
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The pathogenesis of neurogenic claudication is thought to lie in relative ischemia of cauda equina roots during exercise. In this study we will evaluate the effect of the transient ischemia brought on by exercise on motor conduction in patients suffering from lumbar spinal stenosis (LSS). We will also evaluate the sensitivity of motor evoked potentials (MEPs) in detecting motor conduction abnormalities before and after the onset of neurogenic claudication. ⋯ There was a significant difference between the MEPLT and the PMCT values measured before and after exercise in the patients with signs of neurological deficit. This difference was not found to be significant in patients without neurological deficits (t-test P < 0. 05). It may be concluded that exercise increases the sensitivity of MEPs in detecting the roots under functional compression in LSS.
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This series comprises ten patients treated with transpedicular screw fixation, who suffered early postoperative problems such as radicular pain or motor weakness. Besides plain radiographs, all patients were also evaluated with MR imaging. ⋯ MR images, especially T1-weighted ones, were very helpful for visualizing the problem and verifying the positions of the screws. In cases of wide areas of signal void around the screws, the neighboring axial MR images at either side, which have fewer artifacts, gave more information about the screws and the vertebrae.
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Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) motions between the pubic bones measured by X-ray examination when the patient was standing on one leg, alternating left and right. ⋯ Further studies are needed to assess the relationship with clinical parameters, sensitivity, specificity and responsiveness in various categories of patients. In contrast with the opinion of Chamberlain, that a radiographically visualized step between the pubic bones is caused by cranial shift of the pubic bone at the side of the standing leg, it is concluded that the step is caused by caudal shift of the pubic bone at the side of the leg hanging down. The caudal shift is caused by an anterior rotation of the hip bone about a horizontal axis near the sacroiliac joint.
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An international congress about "the back of children and teenagers and the prevention of backache" was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP). ⋯ An immunohistological study seems to confirm the presence of degenerative-type alterations and changes in collagen in the vertebral plates and nucleus of juvenile spine. These data must be confirmed, and their relation to natural history and prognosis of juvenile LBP have to be clarified by longitudinal studies.