Selection of instrumentation and fusion levels for scoliosis: where to start and where to stop

2004 ◽  
Vol 1 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Keith H. Bridwell
Keyword(s):  
Adult Patient ◽  
Degenerative Changes ◽  
Final Decision ◽  
Adolescent Patient ◽  
Lumbar Curve ◽  
Content Type ◽  
Apical Rotation ◽  
A Minor ◽  
Selection Of ◽  
Fine Print

Object. Although there are several papers in the literature regarding selection of fusion levels in the adolescent patient, fewer articles pertain to this in the adult patient. The author reviewed his experience and the literature and reports on the choice of fusion levels in the adolescent and adult patient. Methods. After a review of available data, the author determined that the proximal and distal extent of the fusion should be based on defining curves as either major or minor in the adolescent patient. It is often possible to exclude minor curves from the fusion. Relative Cobb measurement, apical deviation from the plumb line, and apical rotation are the most useful means of distinguishing a major from a minor curve. Otherwise, the proximal and distal extent of a fusion should be performed in such a way that the proximal and distal vertebrae are both neutral and stable (bisected by the center sacral line) postoperatively. Additional segments may need to be included in the adult patient in whom extensive degenerative changes and subluxations are present. The decision of whether to terminate a long fusion at L-5 or the sacrum in an adult degenerative lumbar curve is complex and many factors have to be considered. Conclusions. Guidelines exist for fusion levels in both adolescent and adult patients. Not all curves require fusion. There are many coronal and sagittal considerations that have to be analyzed when making the final decision.

Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence

2004 ◽  
Vol 100 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Vaijayantee Kulkarni ◽  
Vedantam Rajshekhar ◽  
Lakshminarayan Raghuram
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Imaging Study ◽  
Degenerative Changes ◽  
Adjacent Segment ◽  
Mr Images ◽  
Short Term ◽  
Content Type ◽  
Fine Print

Object. The authors studied whether cervical spine motion segments adjacent to a fused segment exhibit accelerated degenerative changes on short-term follow-up magnetic resonance (MR) imaging. Methods. Preoperative and short-term follow-up (mean duration 17.5 months, range 10–48 months) cervical MR images obtained in 44 patients who had undergone one- or two-level corpectomy for cervical spondylotic myelopathy were evaluated qualitatively and quantitatively. The motion segment adjacent to the fused segment and a segment remote from the fused segment were evaluated for indentation of the thecal sac, disc height, and sagittal functional diameter of the spinal canal on midsagittal T2-weighted MR images. Thecal sac indentations were classifed as mild, moderate, and severe. New indentations of the thecal sac of varying severity (mild in 17 patients [38.6%], moderate in 10 [22.7%], and severe in six [13.6%]) had developed at the adjacent segments in 33 (75%) of 44 patients. The degenerative changes were seen at the superior level in 11 patients, inferior level in 10 patients, and at both levels in 12 patients and resulted from both anterior and posterior element degeneration in the majority (23 [69.6%]) of patients. The remote segments showed mild thecal sac indentations in seven patients and moderate indentations in two patients (nine [20.5%] of 44). Compared with the changes at the remote segment, the canal size was significantly decreased at the superior adjacent segment by 0.9 mm (p = 0.007). No patient sustained a new neurological deficit due to adjacent-segment changes. Conclusions. On short-term follow-up MR imaging, levels adjacent to the fused segment exhibited more pronounced degenerative changes (compared with remote levels) in 75% of patients who had undergone one- or two-level central corpectomy.

Lumbar disc protrusion in children

1981 ◽  
Vol 54 (4) ◽  
pp. 480-483 ◽  
Author(s):  
Robert G. Fisher ◽  
Richard L. Saunders
Keyword(s):  
Differential Diagnosis ◽  
Adult Patient ◽  
Lumbar Disc ◽  
Disc Protrusion ◽  
Content Type ◽  
Sciatic Pain ◽  
Major Complications ◽  
Refractory Case ◽  
Fine Print

✓ Forty-three cases of surgically treated lumbar disc protrusion in patients 21 years or younger are analyzed. The results were generally good. Ten percent of the patients required reoperation within 3 years. No major complications were experienced. Follow-up observation ranged from 4 to 30 years. Disc protrusion should be considered in the differential diagnosis of children with back and sciatic pain, and early myelography should be carried out in the refractory case. The symptoms, signs, myelograms, and surgical findings are usually similar to those of the adult patient with a disc protrusion.

Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens

2005 ◽  
Vol 3 (5) ◽  
pp. 379-385 ◽  
Author(s):  
Stefan A. König ◽  
Axel Goldammer ◽  
Hans-Ekkehart Vitzthum
Keyword(s):  
Articular Cartilage ◽  
Articular Surface ◽  
Craniocervical Junction ◽  
Degenerative Changes ◽  
Content Type ◽  
Articular Surfaces ◽  
Anatomical Data ◽  
Grade Ii ◽  
Grade Iii ◽  
Fine Print

>Object. The goal of this project was to measure vertebral dimensions at the craniocervical junction and to investigate degenerative changes in this region and their correlations with the anatomical data. These studies will assist in an understanding of biomechanical conditions in this region, which are clinically relevant in cases of cervicogenic headaches and vertigo. Methods. The authors examined 30 cadaveric specimens obtained from patients ranging in age from 24 to 88 years at death. Measurements of angles of the vertebrae were conducted using an imprint method. Microsections of osseous endplates and articular cartilage were graded according to their degrees of degeneration by using the Petersson classification (0, no sign of degeneration; I, superficial degeneration with several fragmentations; II, deeper degeneration with cartilaginous disintegration and penetrating ulceration; or III, complete cartilaginous degeneration with the appearance of subchondral bone in > 50% of the articular surface). The authors found Grade I changes in 100% of the occiput specimens. In the superior articular cartilage of C-1 no changes (Grade 0) were found in two specimens, whereas 6% of the specimens exhibited Grade II changes and 89% exhibited Grade I changes. In the inferior articular cartilage of C-1, 57% of the specimens displayed Grade I changes, 14% Grade II, and 20% Grade III changes. In the superior articular cartilage of C-2, 62.5% of the specimens displayed Grade I changes and 25% Grade II changes. At the occiput—C1 level the authors found a higher frequency of degeneration at the upper left articular surface of the atlas (Quadrants 1 and 3), and at the C1–2 level they found a higher frequency of degeneration at the upper left and upper right articular surfaces of the axis (Quadrants 2 and 3, respectively). Using the McNemar test, the authors investigated the frequency of affection of single quadrants in a left—right side comparison (lateral reversal). Significant differences were identified for Quadrant 2 of the upper left articular surface of C-2 and Quadrant 3 of the upper right articular surface of C-2. These results correlate with the analysis of single articular surfaces of the axis, but contradict the results for the atlas, in which no significant difference in the left—right side comparison was found. Conclusions. Severe degeneration in the atlantooccipital joints appears to be a rare condition, with no Grade II or III degeneration found in the occipital condyles and 6% Grade I, 89% Grade II, but no Grade III changes in the superior articular cartilage of the atlas. Degeneration of the inferior articular cartilage of C-1 and the superior articular cartilage of C-2 indicates that the atlantoaxial joint faces more intense mechanical exposure, which is increased at the upper joint surfaces.

Congenital arthrogryposis associated with atlantoaxial subluxation and dysraphic abnormalities

2000 ◽  
Vol 93 (1) ◽  
pp. 130-132
Author(s):  
Wolf O. Luedemann ◽  
Marcos S. Tatagiba ◽  
Sami Hussein ◽  
Madjid Samii
Keyword(s):  
Traffic Accident ◽  
Craniocervical Junction ◽  
Atlantoaxial Subluxation ◽  
Arthrogryposis Multiplex Congenita ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Dorsal Stabilization ◽  
A Minor ◽  
Transoral Decompression ◽  
Fine Print

✓ The authors report the case of a 27-year-old woman with an arthrogryposis multiplex congenita (AMC) associated with atlantoaxial subluxation. To the authors' knowledge, this is the first report of its kind. The authors review the literature with reference to dysraphic abnormalities associated with atlantoaxial subluxation and with AMC. The patient presented with severe tetraparesis following a minor traffic accident. She underwent a procedure in which transoral decompression and dorsal stabilization were performed and, postoperatively, made a good clinical outcome. The authors stress the need for diagnostic neuroimaging of the craniocervical junction in patients with AMC.

Surgical treatment of spontaneous intracerebral hemorrhage

1973 ◽  
Vol 39 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Jean E. Paillas ◽  
Bernard Alliez
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Cerebral Hemorrhage ◽  
Preoperative Diagnosis ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.

Interhemispheric cyst of neuroepithelial origin in association with partial agenesis of the corpus callosum

1980 ◽  
Vol 52 (3) ◽  
pp. 399-403 ◽  
Author(s):  
Lillian C. Solt ◽  
John H. N. Deck ◽  
Roger Scott Baim ◽  
Karl TerBrugge
Keyword(s):  
Corpus Callosum ◽  
Adult Patient ◽  
Choroid Plexus ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cyst Wall ◽  
Choroid Plexus Epithelium ◽  
Content Type ◽  
Interhemispheric Cyst ◽  
Fine Print

✓ The authors report an adult patient with a symptomatic interhemispheric cyst demonstrated by computerized tomography (CT), angiography, and at surgery. Choroid plexus epithelium was identified arising from the inner aspect of the cyst wall. Partial agenesis of the corpus callosum is postulated on the basis of the CT findings and the presence of choroid plexus in the interhemispheric cyst.

The syndrome of carotid occlusion following minor craniocerebral trauma

1970 ◽  
Vol 33 (6) ◽  
pp. 636-639 ◽  
Author(s):  
Richard A. Olafson ◽  
Lee A. Christoferson
Keyword(s):  
Head Injury ◽  
Young Patient ◽  
Head Injuries ◽  
Craniocerebral Trauma ◽  
Carotid Occlusion ◽  
Content Type ◽  
Delayed Onset ◽  
Visual Defects ◽  
A Minor ◽  
Fine Print

✓ A new syndrome of carotid occlusion following a minor head injury not obviously involving the neck is reported in two patients. The characteristic delayed onset of unilateral motor, sensory, and visual defects in the relatively young patient is discussed. The authors have also hypothesized a mechanism for carotid occlusion produced by minor head injuries.

Histopathological changes following removal of the perineurium

1980 ◽  
Vol 53 (2) ◽  
pp. 233-238 ◽  
Author(s):  
John A. Nesbitt ◽  
Robert D. Acland
Keyword(s):  
Transverse Section ◽  
Degenerative Changes ◽  
Histopathological Changes ◽  
Content Type ◽  
Microsurgical Techniques ◽  
Sciatic Nerves ◽  
Fine Print ◽  
Perineurial Sheath

✓ Using microsurgical techniques, the perineurial sheath was stripped off the sciatic nerves of rats over a 0.5 cm length at a point where the nerve consists of a single fascicle. The nerves were excised 0 to 84 days after the injury, and were examined in semi-thin transverse section. A new sheath, closely resembling normal perineurium, became organized during the first 10 days; it appeared uniformly over the length of the injured segment. The new perineurial sheath was probably formed by endoneurial fibroblasts migrating from within the fascicle. In undamaged specimens, the axons immediately beneath the excised perineurium underwent no degenerative changes.

Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion

2005 ◽  
Vol 3 (4) ◽  
pp. 271-275 ◽  
Author(s):  
Chien-Jen Hsu ◽  
Wen-Ying Chou ◽  
Hsiu-Peng Teng ◽  
Wei-Ning Chang ◽  
Yi-Jiun Chou
Keyword(s):  
Bone Graft ◽  
Fusion Rate ◽  
Posterolateral Fusion ◽  
Final Decision ◽  
Graft Material ◽  
Chi Square ◽  
Content Type ◽  
Coralline Hydroxyapatite ◽  
Flexion Extension ◽  
Fine Print

Object. The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF). Methods. This prospective, case—control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis—induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion—extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups. Conclusions. Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.

Stereotaxic surgery for cerebral palsy

1974 ◽  
Vol 40 (5) ◽  
pp. 577-582 ◽  
Author(s):  
V. Balasubramaniam ◽  
T. S. Kanaka ◽  
P. B. Ramanujam
Keyword(s):  
Cerebral Palsy ◽  
Content Type ◽  
Involuntary Movements ◽  
Stereotaxic Surgery ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ An analysis of 94 cases of cerebral palsy treated by stereotaxic surgery is reported. The selection of patients and target areas for surgery are discussed. Hypertonic cases are classified into rigid, rigidospastic, and spastic types on the basis of surface electromyographic studies. For rigidity and rigidospasticity, ventrolateral thalamotomy gives relief, while spastic cases do well with dentatectomy. Centromedian thalamotomy relieves sensory-induced involuntary movements. Involuntary movements unaccompanied by changes in tone are abolished by lesions of the nucleus ventralis intermedius.

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