scholarly journals Clinical application of the Panjabi neutral zone hypothesis: the Stabilimax NZ posterior lumbar dynamic stabilization system

2007 ◽  
Vol 22 (1) ◽  
pp. 1-3 ◽  
Author(s):  
James J. Yue ◽  
Jens P. Timm ◽  
Manohar M. Panjabi ◽  
Jorge Jaramillo-De La Torre
Keyword(s):  
Spinal Injury ◽  
Spinal Column ◽  
Dynamic Stabilization ◽  
Spinal Instability ◽  
Neutral Zone ◽  
Low Back ◽  
Stability Function ◽  
Intervertebral Motion ◽  
Lumbar Dynamic Stabilization ◽  
Neutral Posture

✓The neutral zone (NZ) is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. The NZ appears to be a clinically important measure of spinal stability function. Its size may increase with injury to the spinal column, which in turn may result in spinal instability or low-back pain. Dynamic stabilization systems are designed to support and stabilize the spine while maintaining range of motion (ROM). The Stabilimax NZ device has been designed to reduce the NZ after spinal injury to treat pain while preserving ROM.

scholarly journals Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy

2014 ◽  
Vol 21 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Jeffrey C. Wang ◽  
Andrew T. Dailey ◽  
Praveen V. Mummaneni ◽  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Lumbar Fusion ◽  
Signs And Symptoms ◽  
Herniated Disc ◽  
Spinal Instability ◽  
Low Back ◽  
Low Level ◽  
Disc Herniations

Patients suffering from a lumbar herniated disc will typically present with signs and symptoms consistent with radiculopathy. They may also have low-back pain, however, and the source of this pain is less certain, as it may be from the degenerative process that led to the herniation. The surgical alternative of choice remains a lumbar discectomy, but fusions have been performed for both primary and recurrent disc herniations. In the original guidelines, the inclusion of a fusion for routine discectomies was not recommended. This recommendation continues to be supported by more recent evidence. Based on low-level evidence, the incorporation of a lumbar fusion may be considered an option when a herniation is associated with evidence of spinal instability, chronic low-back pain, and/or severe degenerative changes, or if the patient participates in heavy manual labor. For recurrent disc herniations, there is low-level evidence to support the inclusion of lumbar fusion for patients with evidence of instability or chronic low-back pain.

Spine Metastasis of Thymic Carcinoma in a Pediatric Patient: A Case Report and Comprehensive Literature Review

2020 ◽  
Vol 55 (5) ◽  
pp. 289-294
Author(s):  
Kadir Oktay ◽  
Ebru Guzel ◽  
Okay Baykara ◽  
Mevlana Akbaba ◽  
Ibrahim Sari ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Thymic Carcinoma ◽  
Tumor Resection ◽  
Treatment Protocol ◽  
Spinal Column ◽  
Spinal Instability ◽  
Pediatric Case ◽  
Case Presentation ◽  
Intrathoracic Tumor ◽  
History Of

<b><i>Introduction:</i></b> Thymic carcinoma metastases of the spinal column are very rare, especially in pediatric patients. To our knowledge, this is the first such pediatric case in the literature. <b><i>Case Presentation:</i></b> We report the case of a 14-year-old male patient with T12 and L1 metastases of thymic carcinoma. He had history of thymectomy and intrathoracic tumor resection 7 months previously. The patient’s neurological condition deteriorated; therefore, tumor resection and decompression of the spinal canal were performed. He underwent instrumentation and fusion procedures to prevent spinal instability. <b><i>Conclusion:</i></b> The main purpose of the treatment is gross total resection of the thymic carcinoma. However, adjuvant methods such as radiotherapy and chemotherapy should be added to the treatment protocol in patients who have higher stage diseases or those in whom total tumor resection cannot be achieved.

scholarly journals Investigator analytic repeatability of two new intervertebral motion biomarkers for chronic, nonspecific low back pain in a cohort of healthy controls

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Daphne To ◽  
Alexander Breen ◽  
Alan Breen ◽  
Silvano Mior ◽  
Samuel J. Howarth
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Image Sequences ◽  
Standard Errors ◽  
Healthy Controls ◽  
Low Back ◽  
Cross Sectional ◽  
Personalized Care ◽  
Intervertebral Motion ◽  
Intraclass Correlations

Abstract Background Understanding the mechanisms underlying chronic, nonspecific low back pain (CNSLBP) is essential to advance personalized care and identify the most appropriate intervention. Recently, two intervertebral motion biomarkers termed “Motion Sharing Inequality” (MSI) and “Motion Sharing Variability” (MSV) have been identified for CNSLBP using quantitative fluoroscopy (QF). The aim of this study was to conduct intra- and inter-investigator analytic repeatability studies to determine the extent to which investigator error affects their measurement in clinical studies. Methods A cross-sectional cohort study was conducted using the image sequences of 30 healthy controls who received QF screening during passive recumbent flexion motion. Two independent investigators analysed the image sequences for MSI and MSV from October to November 2018. Intra and inter- investigator repeatability studies were performed using intraclass correlations (ICC), standard errors of measurement (SEM) and minimal differences (MD). Results Intra-investigator ICCs were 0.90 (0.81,0.95) (SEM 0.029) and 0.78 (0.59,0.89) (SEM 0.020) for MSI and MSV, respectively. Inter-investigator ICCs 0.93 (0.86,0.97) (SEM 0.024) and 0.55 (0.24,0.75) (SEM 0.024). SEMs for MSI and MSV were approximately 10 and 30% of their group means respectively. The MDs for MSI for intra- and inter-investigator repeatability were 0.079 and 0.067, respectively and for MSV 0.055 and 0.067. Conclusions MSI demonstrated substantial intra- and inter-investigator repeatability, suggesting that investigator input has a minimal influence on its measurement. MSV demonstrated moderate intra-investigator reliability and fair inter-investigator repeatability. Confirmation in patients with CNSLBP is now required.

Gunshot Wounds to the Spine in Adolescents

Neurosurgery ◽  
2005 ◽  
Vol 57 (4) ◽  
pp. 748-752 ◽  
Author(s):  
Henry E. Aryan ◽  
Arun P. Amar ◽  
Burak M. Ozgur ◽  
Michael L. Levy
Keyword(s):  
Injury Severity ◽  
Spinal Injury ◽  
Gunshot Wounds ◽  
Dynamic Imaging ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Severity Of Injury ◽  
Bony Involvement ◽  
Cervical Injuries

ABSTRACT OBJECTIVE: The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. METHODS: Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability. RESULTS: Sixty patients were identified with a mean age 15.6 years (± 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (± 22.8 d), and mean rehabilitation stay was 86.3 days (± 48.9 d), for a total hospitalization of 107.4 days (± 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P &lt; 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries. CONCLUSION: After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.

Progressive post-traumatic syringomyelia: a clinical case

2019 ◽  
Vol 21 (4) ◽  
pp. 81-88
Author(s):  
F. A. Bushkov ◽  
M. A. Bzhylyanskiy ◽  
A. Yu. Kordonskiy
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Informed Consent ◽  
Conflict Of Interest ◽  
Clinical Case ◽  
Spinal Injury ◽  
Spinal Column ◽  
Cord Injury ◽  
Post Traumatic ◽  
The Right

The objective of the present article is to describe a rare clinical case of progressive post-traumatic cervical syringomyelia after spinal cord injury with fracture of proximal metaepiphysis of the right humerus. The patient had a progressive neurological loss after spinal cord injury.Materials and methods. The patient underwent surgical treatment: decompression and stabilization of spinal column, surgical technique of spinal cord detethering, cyst shunting.Results. In the postoperative period the patient had increased spasticity in the lower extremities, increased weakness in the muscles of the upper extremities, aggravation of orthostatic hypotension, and inability to flex the first and the fifth fingers of the right hand. Magnetic resonance imaging of the cervical spine revealed progression of syringomyelia.Conclusion. This case demonstrates differentiation between cervical myelopathy and plexus paresis in a patient with combination spinal injury and reveals the mechanisms underlying late progression of neurological deficit.Conflict of interest. The authors declare no conflict of interest.Informed consent. The patient gave written informed consent to the publication of his data.

Upright, Weight-Bearing, Dynamic-Kinetic MRI of the Spine pMRI/kMRI

2002 ◽  
Vol 15 (4) ◽  
pp. 333-357 ◽  
Author(s):  
J.R. Jinkins ◽  
J.S. Dworkin ◽  
C.A. Green ◽  
J.F. Greenhalgh ◽  
M. Gianni ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Spinal Column ◽  
Axial Loading ◽  
Signs And Symptoms ◽  
Longitudinal Axis ◽  
Whole Body ◽  
Spinal Instability ◽  
Receiver Coil ◽  
General Utility ◽  
Chemical Shift Artifact

The purpose of this study was to demonstrate the general utility of the first dedicated magnetic resonance imaging (MRI) unit enabling upright, weight-bearing positional evaluation of the spinal column ( pMRI) during various dynamic- kinetic maneuvers ( kMRI) in patients with degenerative conditions of the spine. This study consisted of a prospective analysis of cervical and lumbar imaging examinations. All studies were performed on a recently introduced whole body MRI system (Stand-Up™ MRI, Fonar Corp, Melville, NY). The system operates at 0.6T using an electromagnet with a horizontal field, transverse to the longitudinal axis of the patient's body. Depending upon spinal level, all examinations were acquired with either a cervical or lumbar solenoidal radiofrequency receiver coil. This unit is configured with a top/front-open design, incorporating a patient-scanning table with tilt, translation and elevation functions. The unique motorized patient handling system developed for the scanner allows for vertical (upright, weight bearing) and horizontal (recumbent) positioning of all patients. The top/front-open construction also allows dynamic-kinetic flexion and extension maneuvers of the spine. Patterns of bony and soft tissue change occurring among recumbent ( rMRI) and upright neutral positions ( pMRI), and dynamic- kinetic acquisitions ( kMRI) were sought. Depending on the specific underlying pathologic degenerative condition, significant alterations observed on pMRI and kMRI that were either more or less pronounced than on rMRI included: fluctuating anterior and posterior disc herniations, hypermobile spinal instability, central spinal canal and spinal neural foramen stenosis and general sagittal spinal contour changes. No patient suffered from feelings of claustrophobia that resulted in termination of the examination. In conclusion, the potential relative beneficial aspects of upright, weight-bearing ( pMRI), dynamic-kinetic ( kMRI) spinal imaging on this system over that of recumbent MRI ( rMRI) include: the revelation of occult disease dependent on true axial loading, the unmasking of kinetic-dependent disease, and the ability to scan the patient in the position of clinically relevant signs and symptoms. This imaging unit also demonstrated low claustrophobic potential and yielded relatively high-resolution images with little motion/chemical-shift artifact.

scholarly journals Pedicle Screw-Based Posterior Dynamic Stabilization: Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Dilip K. Sengupta ◽  
Harry N. Herkowitz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Surgical Treatment ◽  
Pedicle Screw ◽  
Clinical Evidence ◽  
Dynamic Stabilization ◽  
Low Back ◽  
Design Rationale ◽  
Clinical Instability ◽  
Posterior Dynamic Stabilization

Posterior dynamic stabilization (PDS) indicates motion preservation devices that are aimed for surgical treatment of activity related mechanical low back pain. A large number of such devices have been introduced during the last 2 decades, without biomechanical design rationale, or clinical evidence of efficacy to address back pain. Implant failure is the commonest complication, which has resulted in withdrawal of some of the PDS devices from the market. In this paper the authors presented the current understanding of clinical instability of lumbar motions segment, proposed a classification, and described the clinical experience of the pedicle screw-based posterior dynamic stabilization devices.

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