摘要 :
Obesity has been shown to be a significant factor in the development of musculoskeletal disease. In particular, there has been a recent increase in interest in the role of obesity in lumbar spine disease and surgical outcomes for ...
展开
Obesity has been shown to be a significant factor in the development of musculoskeletal disease. In particular, there has been a recent increase in interest in the role of obesity in lumbar spine disease and surgical outcomes for lumbar spine pathology. Obese individuals are more likely to develop both clinical and radiographic evidence of degenerative lumbar spine disease. Weight loss, whether in the form of diet and exercise regimens or bariatric surgery, may provide some improvement in clinical lumbar spine complaints. In situations in which surgery is necessary to treat degenerative lumbar spine conditions, obese patients experience improvement but less so compared to nonobese patient. Obese patients may be more likely to develop perioperative and postoperative complications.
收起
摘要 :
The study of the biomechanics of the human spine is not yet developed extensively. Recent developments in this field have heightened the need for observing the spine from a comprehensive perspective to understand the complex biome...
展开
The study of the biomechanics of the human spine is not yet developed extensively. Recent developments in this field have heightened the need for observing the spine from a comprehensive perspective to understand the complex biomechanical patterns, which underlie the kinematic and dynamic responses of this multiple-joint column. Within this frame of exigence, a joint study embracing experimental tests and multibody modelling was designed. This study provides novel insights to the segmental contribution profiles in flexion and extension, analysing different forms of sagittal-plane angles. Moreover, the validation of the multibody model contributes to defining the key aspects for a consistent spine modelling as well as it introduces the basis for simulating pathological conditions and post-orthopaedic surgical outcomes.
收起
摘要 :
Background context: The anterior approach to the spine is becoming an increasingly important avenue to treat spine conditions. Most of the literature reporting on the exposure uses an access surgeon assisting the spine surgeon to ...
展开
Background context: The anterior approach to the spine is becoming an increasingly important avenue to treat spine conditions. Most of the literature reporting on the exposure uses an access surgeon assisting the spine surgeon to expose and prepare the spine for implant. Purpose: To compare perioperative parameters and complications in anterior lumbar spine surgery with the exposure performed either by a spine surgeon or a general surgeon. Study design: A retrospective cohort study comparing perioperative parameters and complications of anterior lumbar spine surgery. Methods: A retrospective review was completed on 96 consecutive patients who underwent anterior spine surgery between Levels L3 and S1 from 1995 to 2008. Patient and surgery characteristics including demographics, comorbidities, perioperative parameters, and complications were logged. In the first 56 consecutive patients, a general surgeon completed the exposure, with an additional patient who later had the exposure performed by a general surgeon because of extensive prior abdominal surgeries. In the next 39 patients, the orthopedic surgeon completed the exposure. Results: When the operation was performed solely by a spine surgeon, the estimated blood loss, operative time, and hospital stay was 204 mL, 2.80 hours, and 3.5 days, respectively. In the procedures completed with the aid of a general surgeon, it was found that the same parameters were 420 mL, 3.93 hours, and 4.7 days, respectively, and statistically significantly less in the group without the assistance of the general surgeon (p=.0007, p=.0003, and p=.0006, respectively). Fewer complications also were observed in that group (p<.00001). The most common complication was an ileus. Major complications including retrograde ejaculation, iliac vein bleeding, peritoneal rent requiring repair, dyspareunia, or scrotal/penile swelling were only observed in the group with the assistance of the general surgeon. Conclusions: This study indicated that a spine surgeon can successfully and safely carry out the anterior exposure to the spine without the aid of an access surgeon.
收起
摘要 :
The degenerative spinal lesions are one of the most frequent causes of lumbar pain syndrome. Diagnosing them is difficult due to poor correlation between radiological data and clinical symptoms. Computed tomography is one of the k...
展开
The degenerative spinal lesions are one of the most frequent causes of lumbar pain syndrome. Diagnosing them is difficult due to poor correlation between radiological data and clinical symptoms. Computed tomography is one of the key modalities in the diagnosis of degenerative disc disease.
收起
摘要 :
BACKGROUND: Stadiometry measures total trunk height variations but cannot quantify individual spinal segment height changes. Different methods exist to measure both intervertebral disc and lumbar spine height (LSH) variations but ...
展开
BACKGROUND: Stadiometry measures total trunk height variations but cannot quantify individual spinal segment height changes. Different methods exist to measure both intervertebral disc and lumbar spine height (LSH) variations but they are either limited by radiation exposure or cost. Musculoskeletal ultrasound could be a valuable alternative to measure spinal segmental height changes as a result of intervention.
收起
摘要 :
The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough re...
展开
The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough review of databases from the US National Library of Medicine and the National Institutes of Health was conducted. The complications of ALIF addressed in this paper include pseudarthrosis and subsidence, vascular injury, retrograde ejaculation, ileus, and lymphocele (chyloretroperitoneum). Strategies identified for improving fusion rates included the use of frozen rather than freeze-dried allograft, cage instrumentation, and bone morphogenetic protein. Lower cage heights appear to reduce the risk of subsidence. The most common vascular injury is venous laceration, which occurs less frequently when using nonthreaded interbody grafts such as iliac crest autograft or femoral ring allograft. Left iliac artery thrombosis is the most common arterial injury, and its occurrence can be minimized by intermittent release of retraction intraoperatively. The risk of retrograde ejaculation is significantly higher with laparoscopic approaches, and thus should be avoided in male patients. Despite precautionary measures, complications from ALIF may occur, but treatment options do exist. Bowel obstruction can be treated conservatively with neostigmine or with decompression. In cases of postoperative lymphocele, resolution can be attained by creating a peritoneal window. By recognizing ways to minimize complications, the spine surgeon can safely use ALIF procedures.
收起
摘要 :
Spondylolisthesis is defined as the forward translation of one vertebra on another in the sagittal plane. There are multiple etiologies of Spondylolisthesis, including the degenerative and postsurgical varieties. Degenerative Spon...
展开
Spondylolisthesis is defined as the forward translation of one vertebra on another in the sagittal plane. There are multiple etiologies of Spondylolisthesis, including the degenerative and postsurgical varieties. Degenerative Spondylolisthesis presents in a more elderly population and usually involves the lumbar fourth and fifth vertebrae. The pathogenesis is believed to be secondary to the progressive degeneration of the disc and facets, which results in instability and pathologic segmental motion. Clinically, patients present with low back pain and neurological symptoms consisting of spinal claudication or radiculopathy. A postsurgical Spondylolisthesis is often the inevitable result of decompression with up to 50% of patients developing late instability that requires stabilization. Similar to a degenerative Spondylolisthesis, these patients will present with reoccurrence of radicular pain associated with increasing low back pain. A Spondylolisthesis is identified with plain radiographs, which should include flexion and extension to identify pathologic motion. An MRI is useful for the evaluation of stenosis, while a Myelo/CT with flexion and extension weight-bearing views is superior for the evaluation of dynamic instability. Non-operative treatment consists of bracing, nonsteroidal antiinflammatory medication, epidural blocks, weight reduction, and physical therapy. Surgical indications include severe back pain or neurological symptoms. Following decompression, an arthrodesis is recommended for a degenerative Spondylolisthesis since long-term studies have demonstrated improved outcomes. A postsurgical Spondylolisthesis, by definition, is unstable and requires a concurrent stabilization. Surgical options include posterior pedicular rod and screw fixation, posteriorly placed interbody implants combined with pedicular instrumentation, or combined anterior and posterior procedures. Materials available for fusion include autograft, allograft, or new biologic graft substitutes such as rhBMP-2. This article reviews the etiology and pathogenesis of Spondylolisthesis along with recommended treatment options and surgical techniques to enable clinicians to insure superior patient treatment outcomes.
收起
摘要 :
Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A...
展开
Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A 53-year-old male who had no significant medical history was admitted due to complaints of back pain radiating to the flank for the last 3 months, followed by a progressive motor weakness of both lower limbs. Lumbar magnetic resonance imaging (MRI) demonstrated osteomyelitis and diskitis, suspected to be a pyogenic condition rather than a tuberculosis infection. Despite antibiotic treatment for several weeks, the symptoms worsened, and finally, open surgery was performed. Surgical biopsy revealed an Aspergillus infection and medical treatment with amphotericin B was started. It can be diagnosed early through an MRI; biopsy is very important but difficult, and making the correct differential diagnosis is essential for avoiding unexpected complications. The authors report a case of lumbar Aspergillus osteomyelitis in an immunocompetent adult and reviewed previously described cases of spinal aspergillosis.
收起
原文获取