Introduction. Patients with metastatic spinal cord compression (MSCC) or unstable spinal lesions warrant early surgical consultation. In multiple myeloma, chemotherapy and radiotherapy have the potential to decompress the spinal canal effectively in the presence of epidural lesions. Mechanical stability conferred by bracing may potentiate intraosseous and extraosseous bone formation, thus increasing spinal stability. This study aims to review the role of non-operative management in myeloma patients with a high degree of
Aims. The aim of this study was to assess the reliability of using MRI scans to calculate the
The evaluation of the lumbar spine by CT or MR in supine position provides excellent information about the morphology of the spinal structures (inside and outside the spinal canal) but of course cannot give dynamic information. By Newton’s Third Law we know that every axial vector acting on a functional spine unit corresponds a second vector of equal intensity but of opposite direction that counterbalances the first one and brings all the structures in a dynamic equilibrium. The definition of
Introduction: We hypothesise that disc degeneration is a major cause of segmental instability in elderly spines. Accordingly, we simulated two mechanical features of disc degeneration on cadaveric spines, and measured their effects on spinal movements. Methods: Twenty-one motion segments (T8–9 to L4–5) were obtained from spines aged 48–90yrs. Specimens were loaded rapidly to simulate full spinal bending movements in vivo, while vertebral movements were tracked using an optical MacReflex system. Intradiscal stresses were investigated using “stress profilometry”. Experiments were repeated following compressive creep loading (which reduced disc water content by an amount similar to the aging process) and again following a compressive overload cycle which fractured a vertebral endplate and decompressed the nucleus. MacReflex data were used to quantify the neutral-zone (NZ), the range of motion (ROM), and the range of translational (gliding) movements. Results Creep and endplate fracture both reduced disc height, and generated stress concentrations within the posterior annulus. Both treatments increased NZ, ROM and translational movements in flexion and lateral bending, but not in extension. Endplate fracture markedly increased the “instability index” (NZ/ROM) in flexion. Discussion Disc “degeneration” increased all measures of
Fifty-five patients with severe pain from
The aim of this study was to assess the use of early ambulatory halo-thoracic immobilisation in paediatric patients with
Introduction: Wide laminectomy has been the accepted treatment of choice for stenosis in the lumbar spine. Recently, bilateral laminotomy has been proposed as an alternative decompressive technique for spinal canal stenosis. There have been no biomechanical studies to determine the in vitro difference in stability between these techniques. Objective: To determine the in vitro difference in stability in a functional spinal unit (FSU) following bilateral laminotomy, and compare it to the instability resulting from laminectomy. Methods: Six fresh human cadaver lumbar spines were injured sequentially at the L4-5 level: bilateral laminotomy and laminectomy. The normal and injured spines were subjected to flexion, extension, lateral bending and torsional moments. The three-dimensional motion behaviour of each spine before and after the two injuries was recorded using a magnetic motion sensor. The data from all five spines was pooled for statistical analysis. Results: With flexion and extension loading, bilateral laminotomy induced significantly less sagittal angulation and translation in the FSU than did laminectomy. Significant increases in coronal translation occurred with laminectomy in spines subjected to lateral bending loads. There were no significant differences between the two techniques in coronal plane angulation with lateral bending loads and torsional loads. Discussion: Adequate exposure of the lateral recesses requires limited medial facetectomy with both laminotomy and laminectomy. With laminotomy, the lamina and posterior ligamentous structures are preserved. This is aimed at decreasing the potential late development of
A 22-year-old man was admitted to hospital after being assaulted. He complained of a painful neck and upper limbs, with weakness and numbness of his upper limbs. Initial treatment was skull traction for six weeks, during which the motor power in the upper limbs recovered. CT scan of the cervical spine showed a lytic expanding bone lesion in the atlas. At 10 weeks he was transferred to a Spinal Centre, walking normally, with good bladder and bowel control. He was complaining of intermittent occipital headaches and pain at the cervicothoracic junction. He was wearing a cervical orthosis. His neck movements were guarded and markedly restricted. No neurological deficit was detected. A right-sided brachiocephalic artery angiogram showed no abnormality. MR scan showed definite narrowing of the spinal canal at the C2 vertebral level and stress studies some vertebral instability at the atlanto-axial level. Under general anaesthetic a transoral biopsy, curettage, and bone grafting of the atlas was carried out. The biopsy material comprised white membranous-type material, which had the histological features of hydatid cysts. A posterior spinal fusion with instrumentation was performed over posterior vertebral arches Cl to C3. Postoperatively ultrasound of the abdomen and radiograph of the chest did not reveal any further evidence of hydatid disease. Treatment with albendazole was commenced. The diagnosis was not anticipated preoperatively.
This study examined spinal fractures in patients
admitted to a Major Trauma Centre via two independent pathways,
a major trauma (MT) pathway and a standard unscheduled non-major
trauma (NMT) pathway. A total of 134 patients were admitted with
a spinal fracture over a period of two years; 50% of patients were
MT and the remainder NMT. MT patients were predominantly male, had
a mean age of 48.8 years (13 to 95), commonly underwent surgery
(62.7%), characteristically had fractures in the cervico-thoracic
and thoracic regions and 50% had fractures of more than one vertebrae,
which were radiologically unstable in 70%. By contrast, NMT patients
showed an equal gender distribution, were older (mean 58.1 years;
12 to 94), required fewer operations (56.7%), characteristically
had fractures in the lumbar region and had fewer multiple and unstable
fractures. This level of complexity was reflected in the length
of stay in hospital; MT patients receiving surgery were in hospital
for a mean of three to four days longer than NMT patients. These
results show that MT patients differ from their NMT counterparts
and have an increasing complexity of spinal injury. Cite this article:
Background. It has become increasingly important to conduct studies assessing clinical outcomes, reoperation rates, and revision rates to better define the indications and efficacy of lumbar spinal procedures and its association with symptomatic adjacent segment degeneration (sASD). Adjacent segment degeneration (ASD) is defined as the radiographic change in the intervertebral discs adjacent to the surgically treated spinal level. SASD represents adjacent segment degeneration which causes pain or numbness due to post-operative
Background. Current clinical treatment for
Lumbar diseases have become a major problem affecting human health worldwide. Conservative treatment of lumbar diseases is difficult to achieve ideal results, and surgical treatment of trauma, complications, it is imperative to develop a new treatment method. This study aims to explore the regulatory mechanism of cartilage endplate ossification caused by abnormal stress, and design intervention targets for this mechanism, so as to provide theoretical reference for the prevention and treatment of lumbar degeneration. In vivo, we constructed
Introduction. Spine is a common site for haematological malignancies. Multiple myeloma affects the spine in 70% of cases. New guidelines were published in 2015 to help manage spinal haematological malignancies. Despite neural compression or
Previous studies have shown improved outcome following surgery for spinal cord compression due to metastatic disease. Further papers have shown that many patients with metastatic disease are not referred for orthopaedic opinion. The aims of this paper are to study the survival and morbidity of patients with spinal metastatic disease who receive radiotherapy. Do patients develop instability and progressive neurological compromise? Can we predict which patients will benefit from surgery?. Retrospective review of patients receiving radiotherapy for pain relief or cord compression as a result of metastatic disease. Patients were scored with regards to Tomita and Tokuhashi, survival and for deterioration in neurology or
Previous studies have shown improved outcome following surgery for spinal cord compression due to metastatic disease. Further papers have shown that many patients with metastatic disease are not referred for orthopaedic opinion. The aims of this paper are to study the survival and morbidity of patients with spinal metastatic disease who receive radiotherapy. Do patients develop instability and progressive neurological compromise?. Do patients require surgery or are the majority adequately treated by oncologists?. Review of patients receiving radiotherapy for pain relief or cord compression as a result of metastatic disease. Patients were scored with regards to Tomita and Tokuhashi, survival and for deterioration in neurology or
The progression of post-tubercular kyphosis in 61 children who received ambulatory chemotherapy was studied prospectively. The angles of deformity and kyphosis were measured for each patient at diagnosis, 3, 6, 9, 12 and 18 months later and every year thereafter for 15 years. During the course of the disease signs of instability appeared on the radiographs of some of the children. These were dislocation of the facets, posterior retropulsion of the diseased fragments, lateral translation of the vertebrae in the anteroposterior view and toppling of the superior vertebra. Each sign was allocated one point to create a
National Institute of Clinical Excellence guidelines on Metastatic Spinal Cord Compression recommend urgent consideration of patients with spinal metastases and imaging evidence of structural spinal failure with
Purpose of study:. The question of prolonged bracing following injury in patients diagnosed with SCIWORA remains controversial. Proponents of the ‘Segmental
Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre. A retrospective review was performed of all gram-negative spinal infections (n = 32; median age 71 years; interquartile range 60 to 78), excluding surgical site infections, at a single centre between 2015 to 2020 with two- to six-year follow-up. Information regarding organism identification, antibiotic regime, and treatment outcomes (including clinical, radiological, and biochemical) were collected from clinical notes.Aims
Methods