Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2001
Lumbar spinal stenosis assessment with computed tomography, magnetic resonance imaging, and myelography.
Degenerative spinal stenosis of the lumbar spine is caused by many factors, some of which include: disc herniation, ligamentum flavum and facet hypertrophy, spondylolisthesis, and compression fracture. Most often the stenosis is caused by a combination of these factors. The imaging modalities in routine use to evaluate these conditions are computed tomography, magnetic resonance imaging and computed tomography-myelogram. ⋯ Magnetic resonance imaging should be the first choice because it does not require ionizing radiation or contrast injection. The aim of the current study is to present the common causes of lumbar stenosis. Where appropriate, each case is shown with images from each modality so that their similarities and differences can be highlighted.
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Clin. Orthop. Relat. Res. · Mar 2001
Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis.
Between 1990 and 1993, 54 consecutive patients were treated with decompression, fusion and instrumentation surgery for complex lumbar spinal stenosis. The mean age of the patients was 60 years. The average followup was 39 months. ⋯ Of the 47 patients who completed the questionnaire, 96% of patients were very satisfied or somewhat satisfied with the operation, 98% were satisfied with relief of pain, 94% were satisfied with their ability to walk, 89% were satisfied with their strength, and 94% were satisfied with balance. Survivorship analysis (failure endpoint was revision surgery) revealed that at the end of 4 years, the patient had a 92% chance of not undergoing revision surgery for any reason (mechanical and infectious), and a 94% chance of not undergoing revision surgery for mechanical reasons. Lumbar decompression, fusion, and instrumentation surgery seems to be efficacious in patients with complex lumbar spinal stenosis (associated previous lumbar spine operations with evidence of radiographic instability, radiographic evidence of junctional stenosis after surgery, radiographic evidence of instability, degenerative spondylolisthesis greater than Grade I with instability, if present, and degenerative scoliosis with a curve greater than 20 degrees).
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Most commonly, sagittal imbalance associated with stenosis is seen with a hypolordotic fusion mass, junctional kyphosis, and junctional stenosis. If the deformity is flexible, it can be treated with anterior and posterior fusion with anterior structural grafting. If it is fixed, which it usually is, then a pedicle subtraction procedure with decompression and extension of the fusion usually is the most suitable operative approach.
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The natural history of degenerative lumbar spinal stenosis is documented poorly. Little is known about the efficacy of nonoperative treatments. ⋯ Efficacy of nonoperative treatment may depend greatly on the nature and severity of the patient's symptomatic and radiographic presentation. Several studies on nonoperative treatment of patients with between 1 and 5 years of followup suggest that variably 15% to 43% of patients will have continued improvement after nonoperative treatment.
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Clin. Orthop. Relat. Res. · Feb 2001
Randomized Controlled Trial Clinical TrialGraduated compression stockings: knee length or thigh length.
The mechanisms by which graduated compression stockings prevent deep venous thrombosis are not completely understood. In the current study the physiologic effect of low-pressure graduated compression stockings on the venous blood flow in the lower limb and the practical aspects of their use were assessed. Patients having elective orthopaedic surgery at a university orthopaedic department were randomized into five groups to wear two different types of graduated compression stockings in thigh and knee lengths. ⋯ All stockings were reported to be difficult to use. Thigh and knee length stockings have a significant effect on decreasing venous stasis of the lower limb. Knee length graduated compression stockings are similarly efficient in decreasing venous stasis, but they are more comfortable to wear, and they wrinkle less.