Aims: To assess the
Purpose: The goal of laminectomy is to relieve spinal stenosis and improve radiculopathy. Back pain related to poor trunk muscular conditioning may negatively affect post-operative outcomes. A better understanding of this relationship is important to improve the selection of appropriate surgical candidates. The purpose of this study was to assess the association between cross-sectional lumbar
Background: Prospective population studies demonstrate that poor
Aims: The purpose was to assess the effect of discec-tomy surgery on postural control, lumbar perception and reßex activation of
Summary Statement.
Summary Statement. Patients with adolescent idiopathic scoliosis show clear signs of abnormal motor coordination between the long superficial
This work was aimed at study the role of
Purpose. Cognitive Muscular Therapy (CMT) is a new treatment for low back pain which integrates psychological techniques for pain management alongside training to improve postural control. Rather than focus on postural alignment or strength, CMT aims to improve the regulation of postural tone (low-level activity which supports the body against gravity). This is achieved by teaching patients an awareness of compensatory paraspinal activation, which can be triggered by overactivity of the abdominal muscles. The aim of this study was to understand whether CMT could reduce symptoms associated with low back pain and improve
The posterior midline approach used in spinal surgery has been associated with a significant rate of wound dehiscence. This study investigates anatomical study of the arterial supply of the cervical and thoracic spinal muscles and overlying skin at each vertebral level. It aimed to provide possible anatomical basis for such wound complications. A dissection and angiographic study was undertaken on 8 cadaveric neck and posterior torso from 6 embalmed and 2 fresh human cadavers. Harvested cadavers were warmed and hydrogen peroxide was injected into the major arteries. Lead oxide contrast mixture was injected in stepwise manner into the subclavian and posterior intercostal arteries of each specimen. Specimens were subsequently cross-sectioned at each vertebral level and bones elevated from the soft tissue. Radiographs were taken at each stage of this process and analysed. The cervical
Introduction: Acute compartment syndrome is most commonly seen in the lower limb. Only four cases have been reported in the
Purpose &
Background: The spinal muscles are increasingly being linked to spinal complaints. However, little is known regarding the corticospinal control of these muscles. Corticospinal pathways can be activated using transcranial magnetic stimulation (TMS) applied over the motor cortex. This study uses TMS to assess corticospinal input to the
Background. Surgical site infection following spine surgery is associated with increased morbidity, mortality and increased cost for the health care system. The reported pooled incidence is 3%. Perioperative antibiotic prophylaxis is a key factor in lowering the risk of acquiring an infection. Previous studies have assessed perioperative cefuroxime concentrations in the anterior column of the cervical spine with an anterior surgical approach. However, the majority of surgeries are performed in the posterior column and often involve the lumbar spine. Accordingly, the objective was to compare the perioperative tissue concentrations of cefuroxime in the anterior and posterior column of the same lumbar vertebra using microdialysis in an experimental porcine model. Method. The lumbar vertebral column was exposed in 8 female pigs. Microdialysis catheters were placed for sampling in the anterior column (vertebral body) and posterior column (posterior arch) within the same vertebra (L5). Cefuroxime (1.5 g) was administered intravenously over 10 min. Microdialysates and plasma samples were continuously obtained over 8 hours. Cefuroxime concentrations were quantified by Ultra High Performance Liquid Chromatography Tandem Mass Spectrometry. Microdialysis is a catheter-based pharmacokinetic tool, that allows dynamic sampling of unbound and pharmacologic active fraction of drugs e.g., cefuroxime. The primary endpoint was the time with cefuroxime above the clinical breakpoint minimal inhibitory concentration (T>MIC) for Staphylococcus aureus of 4 µg/mL as this has been suggested as the best predictor of efficacy for cefuroxime. The secondary endpoint was tissue penetration (AUC. tissue. /AUC. plasma. ). Results. Mean T>MIC 4 µg/mL (95% confidence interval) was 123 min (105–141) in plasma, 97 min (79–115) in the anterior column and 93 min (75–111) in the posterior column. Tissue penetration (95% confidence interval) was incomplete for both the anterior column 0.48 (0.40–0.56) and posterior column 0.40 (0.33–0.48). Conclusions. Open lumbar spine surgery often involves extensive soft tissue dissection, stripping and retraction of the
The requirements for a motion segment fusion for degenerative disc disease are relief from symptoms from a solid union with minimal damage to surrounding tissue. This is possible with the ‘Mini PLIF’ using the B Twin cages and facet screws. This procedure produces reliable relief of symptoms with a solid fusion. The use of facet screws mean that the nerve supply of the
Purpose. Lumbar
Recently a great amount of research has been conducted into fatigability of
Introduction. A new triggered electromyography test for detection of stimulus diffusion to intercostal muscles of the contralateral side during thoracic pedicle screw placement was evaluated. Experimental research was carried out in order to determine if, using this test, neural contact at different aspects of the spinal cord and nerve roots could be discriminated. Methods. Nine industrial pigs (60–75 kg) had 108 pedicle screws placed bilaterally in the thoracic spine (T8–T13). Neural structures were stimulated under direct vision at different anatomic locations from T9 to T12. Recording electrodes were placed over the right and left intercostal muscles. Increasing intensity of the stimulus was applied until muscle response was detected at the contralateral side (diffusion phenomenon). After this first experiment, the thoracic spine was instrumented. Screws were placed in the pedicle in two different positions, the anatomic intrapedicular location and with purposeful contact with the neural elements. Results. Response thresholds to direct stimulation of nerve root at different points were significantly lower than those obtained by stimulation of the dorsal aspect of the spinal cord (0.44±0.22 mA vs 1.38±0.71 mA). However, a 24-fold stimulation intensity (6.50±0.29 mA) was necessary to obtain diffusion of the EMG response to the opposite left side if the right nerve root was stimulated. Only a 2-fold increment (3.17±0.93 mA) was able to elicit diffusion of EMG responses to the contralateral side when stimulation was applied to the dorsal aspect of the spinal cord. Contralateral EMG responses after high increases of stimulation thresholds indicated nerve root contact. Diffusion phenomenon after low threshold increments reflected medullar contact. Electromyography recordings after triggered stimulation of the screws showed that only screws in contact with the spinal cord had significantly lower responses (2.72±1.48 mA). Conclusion. Stimulus-triggered EMG could only discriminate screws with violation of the medial pedicle wall if they were contact with neural tissues. Recording EMG-potentials at the contralateral
Purpose: Low frequency peaks (LFP) commonly observed in EMG spectra of
Bilateral decompression of spinal stenosis may induce instability which compromises outcome. In an attempt to overcome this problem, bilateral decompression can be carried out through a unilateral approach. The ipsilateral side is decompressed by hemi-laminectomy with undercutting partial facetectomy and the contra-lateral side is treated by careful excavation beneath the spinous processes and laminae with preservation of the laminae, posterior ligament complexes and
The Lumbar Spinous Processes (LSP) have an important anatomical and biomechanical function protecting the neural structures in the spinal canal, and as an anchor for the inter and supraspinous ligaments, and the inter-segmental