Lumbar fusion results related to diagnosis.

STUDY DESIGN: Pain outcome and functional outcome after primary lumbar fusion surgery were determined by a self-assessment questionnaire. The responses were correlated with various clinical parameters. OBJECTIVES: To determine the result of fusion surgery among patients in various diagnostic groups using semiquantitative outcome scales. SUMMARY OF BACKGROUND DATA: Most previous studies on the results of primary lumbar fusion have reported the presence of pain, but few have addressed function outcomes. Results of a literature review were inconclusive as to whether a patient's diagnosis is a predictor of improved results. METHODS: During the 3-year period from 1988 to 1990, 165 patients underwent a primary lumbar fusion procedure. They had a chart and radiograph review and were categorized into five major diagnostic groups: 1) pediatric, 2) grade I-II spondylolisthesis (low-slip), 3) grade III-IV spondylolisthesis (high-slip), 4) degenerative disc disease, and 5) postdiscectomy. At a follow-up period of 5 years (mean) after the fusion, patients were mailed a questionnaire in which they described their pain and functional status before and after their lumbar fusion surgery. Questionnaires were returned by 92% of the patients. The questionnaire scores, complications, and revision procedures were grouped by patient diagnosis and analyzed. RESULTS: Patient satisfaction with the results of primary lumbar fusion ranged from 69% (for the postdiscectomy group) to 100% (for the pediatric and high-slip groups). For all diagnostic groups, lumbar fusion resulted in a significant decrease in back pain and leg pain (visual analog scale), which was maintained throughout the follow-up period. For back pain, the pediatric and high-slip groups showed significantly more improvement than the degenerative disc disease or postdiscectomy groups. Leg pain among patients in the pediatric and high-slip groups was significantly more improved than leg pain among patients in the low-slip, degenerative disc disease, or postdiscectomy groups. There was no deterioration of pain scores during the follow-up period. After fusion, all groups had a significant decrease in Oswestry disability scores; patients in the pediatric and high-slip group had significantly more improvement than patients in the degenerative disc disease or postdiscectomy groups. High- and low-slip groups had a significant improvement in their pain drawing score. Medication use was substantially reduced in all groups. After fusion, a lack of improvement in back pain score or disability score was significantly correlated with pseudarthrosis. CONCLUSIONS: The outcome of primary lumbar fusion surgery was decreased pain and increased function for the majority of patients in all five diagnostic categories. The amount of improvement varied by diagnostic group. Patients with developmental conditions showed greater improvement than patients with degenerative conditions.

Tannic acid and chromic chloride-induced binding of protein to red cells: a preliminary study of possible binding sites and reaction mechanisms.

The binding mechanisms and binding sites involved in the tannic acid and chromic chloride-induced binding of protein to red cells were investigated using the binding of IgA paraprotein to red cells as model systems. Inhibition studies of these model systems using amino acid homopolymers and compounds (common as red cell membrane constituents) suggest that the mechanisms involved are similar to those proposed for the conversion of hide or skin collagen to leather, as in commercial tanning. These studies also suggest that tannic acid-induced binding of IgA paraprotein to red cells involves the amino acid residues of L-arginine, L-lysine, L-histidine, and L-proline analogous to tanning with phenolic plant extracts. The amino acid residues of L-aspartate, L-glutamate and L-asparagine are involved in a similar manner in chronic chloride-induced binding of protein to red cells.

Effect of beta-propiolactone on blood group antibody detection.

A panel of 50 blood group antibodies covering a range of blood group antigens has been tested in the presence of 0.25% beta-propiolactone as a possible means of reducing infectivity of high-risk HTLV III/HBsAg samples. 11/50 (22%) antibodies could not be detected by the indirect antiglobulin test, and 6/40 (15%) were undetectable by the two-stage papain technique.

Effect of sodium phosphonoformate on blood group antibody detection.

A panel of 47 blood group antibodies covering a range of blood group antigens has been tested in the presence of 680 mumol concentration sodium phosphonoformate as a putative chemical additive to serum to reduce infectivity of 'high risk' HTLV-III/HBsAg samples. No inhibitory effect could be demonstrated using the indirect antiglobulin test or prepapainized cell test.

An investigation into the effect of reagent volume on the spin indirect antiglobulin test.

Three polyspecific antiglobulin reagents were tested in a spin antiglobulin technique with 51 antibodies of varying blood group specificities in which the volume of antiglobulin reagent used ranged from 1 volume (35 microliters) to 3 volumes (105 microliters). Statistical analysis of results showed that a significant decrease in avidity and agglutination scores occurred as the volume of antiglobulin reagent used was increased ('volume effect'). The volume effect was shown by 33/51 (65%) of antibodies with all three antiglobulin reagents and by 48/51 (94%) of antibodies with at least one antiglobulin reagent. Only 3/51 (6%) failed to show the volume effect with all three antiglobulin reagents.

A protocol for sensitive large-scale screening of blood donors for IgA deficiency.

A protocol for large-scale screening of blood donors for IgA deficiency using a tanned cell passive haemagglutination-inhibition (PHI) technique and enzyme-linked immunosorbent assay (ELISA) is described. Evidence presented suggests that native serum from a case of IgA paraproteinaemia, suitably diluted and heated to 56 degrees C for 60 min, can act as a satisfactory and simple alternative to purified IgA preparations in the PHI test. When PHI and ELISA techniques were used in combination to screen 41,851 random donors, 58 were found to contain less than 200 ng/ml of IgA and were classified as totally IgA-deficient (1:721). This is in close agreement with the data from other workers.

Comparative trial of six methods for the detection of CMV antibody in blood donors.

Six techniques were compared to find the most suitable method for determining the cytomegalovirus (CMV) antibody status of blood donors. Five hundred and ninety-six random sera were tested by immunofluorescence (IF), complement fixation (CFT), two enzyme linked immunosorbent assays (ELISA), a commercial indirect haemagglutination test (IHA)--used as supplied, and a locally devised micromodification of the same IHA test. Five hundred and thirty-five sera shared total agreement of results by all tests. The ELISA tests were the most discordant with other methods (10.5% discordancies both positive and negative). IF and CFT correlated well with other tests (0.8% discordances each) but for different reasons are unsatisfactory for donor screening. The IHA test used as supplied and its micromodification gave the most consistent results (0.8% and 0.5% discordancies respectively). The micromodification is easy to perform and read; it compares very favourably with CFT and IF for material costs and expertise required, and readily lends itself to the testing of large numbers of sera in a reasonable time. Within certain provisos the micro-IHA technique described is recommended as the most suitable test for blood donor screening.