Fracture-dislocation of the dorsal-lumbar spine. Acute operative stabilization by Harrington instrumentation.

Twenty-four patients (of whom 17 were paraplegic) with acute fracture dislocations of the dorsal-lumbar spine underwent stabilization with Harrington instrumentation and were followed for an average of 16 months. Immediate postoperative ambulation was achieved in 16 patients. There was little difference between compression and distraction with respect to reduction and maintenance of correction. Compression rods resulted in solid union in 15 of 16 patients, while distraction rods were successful in 6 of 8 instances. In contrast to reported series in which operative intervention has been avoided, at least a 50% reduction in total hospitalization stay and costs has been achieved. Functional results were comparable to or exceeded the results of other series, and complication rates were similar with the exception of postoperative pain in 2 patients.

Polyarticular disability: a functional assessment.

The purpose of this study was to design and evaluate a system for the functional evaluation of patients with polyarticular disease. A single assessment can be done in approximately 15 minutes. Extensive prior preparation is not required. The evaluation is reproducible and the numerical characterization agrees well with a physician's overall assessment of functional impairment. The subscores can be used independently of the total score to focus on specific areas of disability. Use of the evaluation in other institutions has produced a high degree of reliability. Statistical evaluation has demonstrated areas of weakness that have been eliminated or modified to increase reliability of the system.

Venous thrombosis in acute spinal cord paralysis.

Radiolabeled fibrinogen, impedance phlebography and venogram surveillance were carried out in ten consecutive acute spinal cord paralysis patients. Nine patients had evidence of deep venous thrombosis by radiolabeled fibrinogen technique. Venogram confirmed the presence of venous thrombosis in seven. Impedance phlebography was positive in only four. Eight patients developed a positive radiolabeled fibrinogen test after a surgical procedure. One patient with extensive venous thrombosis had multiple pulmonary emboli.

Cervical accessory respiratory muscle function in a patient with a high cervical cord lesion.

The function of the accessory respiratory muscles (ARM) of the neck were studied in a quadriplegic patient suffering from a C2-3 lesion of the cervical spinal cord. Subtotal expiratory paralysis resulted in an essentially complete loss of expiratory reserve volume such that residual volume and functiona residual capacity were equal (RV=FRC). Tidal volume and vital capacity were severely reduced. Being extrinsic to the chest, the ARM of the neck functioned independently of changes in thoracic gas volume; however, their performance appeared posture-dependent, and was less efficient in the sitting position. Despite the fact that the ARM preferentially expanded the upper part of the ribcage, significant V/Q mismatch did not seem to occur. Voluntary use of glossopharynegeal breathing (GPB) greatly enhanced the patient's ventilatory capability. Flow volume data during GPB documented the efficiency of the glossopharyngeal muscles, which function as a positive pressure pump to force air into the lungs.