Journal of spinal disorders
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A severe isolated thoracolumbar and lumbar hyperlordosis spinal deformity occurring in a patient with cerebral palsy is rare and has not been reported before. The authors describe the presentation, operative considerations, and treatment of patients with this unusual hyperlordotic spinal deformity, particularly those with cerebral palsy. A multiple-stage surgical reconstruction was required to correct this complex spinal deformity. ⋯ Finally, a posterior spinal fusion with instrumentation from T2 to the pelvis definitively corrected his deformity. The patient responded well to surgical intervention without complications and continues to have stable correction of his hyperlordosis deformity 2 years after surgery. Severe lordotic sagittal plane spinal deformities can be treated with anterior and posterior spinal fusion and instrumentation with intervening traction in the properly selected and prepared patient who has cerebral palsy.
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The current experiment reexamines this laboratory's frequently cited previous experimental conclusion that a mechanism underlying the beneficial effects of glucocorticoids in the treatment of spinal cord injury may be the enhanced preservation of spinal cord tissue potassium. For the first time, similar methodology also has been applied to study the effects of hypothermia. Canine spinal cords were injured at T13 by use of an epidural balloon and then were treated with local hypothermia or intramuscular dexamethasone or both. ⋯ At either 6 days or 7 weeks, spinal cords T8 through L4 were removed and divided into 10 ordered blocks, which were analyzed for wet and dry weight, potassium concentration, and sodium concentration. Correlations between clinical motor and chemical results were evaluated. The conclusions drawn are as follows: 1) The canine severe rapid compressive injury model, unlike the previously published less severe feline impact injury model, is not associated with widespread early loss of spinal cord tissue potassium content (dry weight). 2) The dog compressive model, unlike the cat impact model, does not provide evidence that one fundamental mechanism of the confirmed beneficial action of steroids entails enhanced early preservation of tissue potassium content. 3) At 6 days, decrease in the percentage of dry weight and increase in sodium concentration, representing edema, occurred at and adjacent to the direct compression site in all lesioned dog groups except those treated with dexamethasone, demonstrating an antiedema effect of dexamethasone that was nullified by concurrent local hypothermia. 4) This antiedema effect of dexamethasone was associated with superior early motor improvement but did not lead to superior long-term function, in comparison with hypothermia. 5) At 7 weeks, decrease in the percentage of dry weight and potassium concentration, and increase in sodium concentration, all restricted to the directly compressed segment, signify necrosis. 6) This new chemical index of necrosis was highly correlated with clinical motor performance.
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A prospective evaluation of patients with lumbar spinal stenosis undergoing operative treatment was performed using treadmill-bicycle functional testing as well as Oswestry and Visual Analog Pain scales for self-assessment. Thirty-two patients undergoing spinal stenosis decompression with and without a concomitant spinal fusion were prospectively evaluated, preoperatively and a minimum of 2 years postoperatively. ⋯ Improvement in patient function demonstrated on the Oswestry questionnaire correlated with decreased pain observed on the Visual Analog Pain scale. The treadmill-bicycle test appears to be a useful tool for the differential diagnosis of neurogenic claudication and may be used as an objective test of postoperative outcome.
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Case Reports
Neck pain secondary to radiculopathy of the fourth cervical root: an analysis of 12 surgically treated patients.
Neck pain can originate from any number of factors. Perhaps the most difficult symptom complex to resolve is axial neck pain arising from upper cervical nerve root compression. The purpose of this study is to report the results of surgical intervention in a series of patients with neck pain from C4 radiculopathy. ⋯ Patients underwent either anterior cervical discectomy and fusion or posterior laminoforaminotomy at the C3-C4 segment. The results show that a good to excellent clinical result can be achieved in most patients (92% in our series). The importance of identifying patients with C4 radiculopathy lies in the fact that surgery can alter the natural history of neck pain secondary to upper cervical root radiculopathy, unlike axial neck pain from degenerative disk disease.
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Clinical Trial Controlled Clinical Trial
Postoperative enteroparesis by patient-controlled analgesia combined with continuous epidural block for patients after posterior lumbar surgery.
This study evaluated postoperative enteroparesis influenced by patient-controlled analgesia combined with continuous epidural block in patients who underwent posterior lumbar surgery. One hundred nine patients were divided into three groups at random (group 1, controls (18 patients); group 2, postoperative patient-controlled analgesia and continuous epidural block (45 patients); group 3, one-shot epidural analgesia, postoperative patient-controlled analgesia, and continuous epidural block (46 patients). ⋯ However, their clinical abdominal findings the morning after surgery were worse than those in control patients. The times when patients could take any nourishment and eat solid food (rice) were delayed by patient-controlled analgesia with continuous epidural block.