Rigid fusion after cloward operation for cervical disc disease using autograft, allograft, or xenograft: a randomized study with radiostereometric and clinical follow-up assessment.

STUDY DESIGN: In this study, 43 patients scheduled for a single-level cervical Cloward procedure for disc disease were randomized prospectively to fusion with autograft, allograft, or xenograft. OBJECTIVE: To outline any differences in fusion over time in terms of final mobility and clinical outcome between the three bone grafts. SUMMARY OF BACKGROUND DATA: Fusion is used to relieve pain from a spinal segment. The bovine xenograft gives a fibrous fusion in contrast to the solid bone fusion obtained with autograft from the iliac crest, but no definite differences in clinical outcome have been shown previously after surgery at a single level. METHODS: By use of radiostereometric analysis, 33 patients were observed after 6, 12, and 24 to 50 (mean, 37) months. All 43 patients underwent clinical examination, which involved pain rating before and after surgery, with a final follow-up assessment by an unbiased observer. RESULTS: Mobility could be demonstrated in 9 patients after 1 year and in 6 patients at the final follow-up assessment, without pain, and with no difference between bone grafts. The patients who received autograft experienced a greater reduction of pain than the patients treated with xenograft. CONCLUSIONS: Most of the patients healed with a rigid fusion no matter which graft was used, but the healing process took longer than expected. The clinical results were not influenced by whether mobility could be demonstrated. There was a tendency toward better clinical results in the patients treated with autograft.

Metabolic and haemodynamic changes in the pathologic hypermobile spine.

The purpose of the study was to evaluate whether pathologic hypermobility of the lumbar spine could produce haemodynamic, metabolic, and histologic changes similar to those found in osteoarthritis. Five adult goats were surgically made hypermobile in the lumbar spine by an extensive laminectomy involving exarticulation of the facet joints of the L4 and L5 levels. Seven months following the operation oxygen partial pressure (pO2), was measured in situ in the nucleus pulposus and in the adjacent lumbar body of the hypermobile segment. A segment three levels more cranially served for control. Mass spectrometry was used for continuous registration of pO2. Intraosseous pressure (IOP) was measured in the lumbar bodies of the same levels. Hypermobility averaged a 60 per cent increase at the operated segment as measured on flexion-extension radiograms preoperatively and 7 months postoperatively. The hypermobile discs had decreased in height as measured by CT scanning and this was confirmed by histologic sections. Significant hypoxia was found in the nucleus pulposus of the hypermobile segment, while increased pO2 and IOP existed in the adjacent lumbar body.

Reduced pain after surgery for cervical disc protrusion/stenosis: a 2 year clinical follow-up.

PURPOSE: To follow the clinical outcome after surgery for cervical radiculopathy caused by degenerative cervical disc disease and to compare it with the outcome after conservative treatment. METHOD: Forty-three patients all awaiting surgery were studied prospectively. A control group of 39 conservatively treated patients were chosen, matched for gender and age. All patients rated their Sickness Impact Profile (SIP) and pain (VAS) and were clinically examined by unbiased observers initially and after 3, 9 and 24 months. RESULTS: Long-lasting pain reduction was noted both in the neck and in the arm for the operated patients, as well as improved sensory function and reduction of reflex disturbances. Their SIP showed a temporary improvement in the overall index, in the psychosocial dimension, in sleep/rest and home management, but only mobility remained improved. Among the operated patients referred directly to us, there was an improvement in SIP at the final follow-up. The control group's SIP indicated only a temporary improvement in sleep/rest. CONCLUSIONS: Surgically treated patients experienced pain reduction which was partially maintained for at least 24 months. A sustained improvement in the health status measured by SIP was observed only among operated patients that were not referred via the social insurance offices.

[Spectrum of sequelae after whiplash injury. Localization and development in relation to the clinical picture]. / Skadepanorama efter pisksnärtstrauma. Lokalisation och utveckling i relation till den kliniska bilden.

Neck sprain, a common sequela of motor vehicle trauma, is characterised by soft tissue lesions in the facet joints (the capsule), cervical discs (the annulus), ligaments, muscles, and sometimes in the nerve roots or the central nervous system. The cardinal manifestation of whiplash injury is neck pain, which may arise from any innervated part of the injured joints or muscles except the disc nucleus, the articular surface of facet joints, or the flaval ligaments. Pain may be referred to the skin or muscles via the respective sensory nerves. The tissue lesions, together with post-traumatic nerve root degeneration or medullary compression, may give rise to the complex neck sprain syndrome. Localisation of the source of symptoms by means of meticulous physical examination, MRI (magnetic resonance imaging), or accurately sited local anaesthetic injections is described in the article, and operative and multimodal rehabilitation procedures are discussed.

Respiratory gas pressures in the spine. Measurements in goats.

Normal values of pO2, pCO2, pH, and intraosseous pressure were measured in situ in the lumbar spine of goats. In the lumbar bodies and discs no difference existed between values found cranially and caudally. pO2 was lower and pCO2 higher in the nucleus pulposus than in the adjacent lumbar bodies. This emphasizes the nutritional route to the disc via the vertebral end plate. Intraosseous pressures in the cranial and caudal levels of the lumbar spine did not differ, and the pressures were the same as otherwise found in cancellous bone. These are the first combined in situ measurements of several basic metabolic parameters in the normal spine using recordings with continuous mass spectrometry. They may constitute a basis for further investigation of metabolism in the structures of the spine.

Lumbo-omental shunt for drainage of cerebrospinal fluid--an experimental study in dogs. I. The transport of cerebrospinal fluid from the lumbar subarachnoid space, studied by 169Yb-DTPA and a gamma camera.

Studies using an experimental cerebrospinal fluid (CSF) shunting procedure are presented. By transposing a pedicle graft of the greater omentum to the lumbar subarachnoid space, the CSF absorption of the omentum can be utilized. Monitoring the absorption of intrathecally administration of 169Yb-DTPA by gamma camera sequential pictures 1 to 17 months after the shunt procedure, a rapid transport of radionuclide from the lumbo-omental shunt to the systemic venous blood was demonstrated.

Lumbo-omental shunt for drainage of cerebrospinal fluid--an experimental radionuclide study in dogs. II. Evaluation of transport routes from lumbar subarachnoid space to venous blood.

In a series of dogs, the transport routes of intrathecally administered 99Tcm-DTPA from an omental graft to the venous blood were studied by scintillation probes placed over the portal and external jugular veins and by blood samples from the inferior vena cava. It was found early in the course of investigation that a rich revascularization frequently occurred between the transplanted omentum and the surrounding muscles. In all dogs, the omental graft was divided, in its muscle tunnel about 5 cm outside the dural sac, 13--19 months after the implantation. Even after this a rapid transport to the venous system of radionuclide could be demonstrated. The revascularization of the graft was also studied morphologically in two dogs means of microangiography.

Atlantoaxial arthrography. A postmortem study.

The atlantoaxial joints of nine cadavers were examined with Amipaque. A lateral percutaneous approach was elaborated. Interarticular communications and pertinent anatomical features were analyzed.

Angiographic findings in subdural hematoma correlated with CT attenuation values.

Twenty-eight subdural hematomas in 24 patients were examined by angiography and computed tomography (CT). The angiographic appearance of the hematomas was classified as either crescentic, lentiform, or transitional. The attenuation value of the hematomas was calculated from the CT scans. The mean attenuation of crescentic hematomas (13.8 EMI units--EU: 500 scale) was considerably lower than those of lentiform (21.7 EU) and transitional (19.8 EU) hematomas. The crescentic and transitional hematomas were either subacute or chronic, the chronic crescentic hematomas having an attenuation value at or around serum level. The lentiform hematomas were all more than 24 days old. The relatively high attenuation in chronic lentiform and transitional hematomas was probably caused by rebleeding, and the shape indicates enlargement of the hematomas after membrane formation has occurred. In the chronic, low attenuation crescentic hematomas, no recent bleed and no enlargement had occurred.

Computer tomography of traumatic intra- and extracerebral lesions.

Computer tomography was performed in 29 patients with intra- or extracerebral lesions and the results evaluated retrospectively and compared with angiography, operation or autopsy findings. Many subdural haematomas were difficult to distinguish and in two cases it was impossible. Angiography proved to be more certain. In all cases the intracerebral heamatoma was considerably more evident at computer tomography than at angiography and for contusions, the information provided is fully comparable with that by angiography.

Size of the intracerebral ventricles as measured with computer tomography, encephalography and echoventriculography.

Ventricular size in a total of 192 patients was determined with computer tomography (CT), encephalography (Enc) and echoventriculography (echo-VG). There was good correlation (greater than or equal to 0.80) between the values for the size of the lateral ventricles obtained with all three methods. Correlation between values for the width of the third ventricle: CT/Enc and CT/echo-VG: poor; Enc/echo-VG: good ( = 0.85). Both at computed tomography and encephalography there was poor correlation between anterior horn index and the width of the third ventricle.

Atlantoaxial instability in Marfan's syndrome. Diagnosis and treatment. A case report.

A case of Marfan's syndrome is described in which progressive neurological signs and symptoms were produced by flexion of the head. Radiological examinations revealed hypermotility between the atlas and axis, as well as compression of the medulla oblongata by the odontoid process on flexion, since low positioned cerebellar tonsils prevented dorsal shift of the oblongata. The signs and symptoms disappeared after occipitocervical internal transfixation.

Bulk flow of cerebrospinal fluid through a lumbo-omental pedicle graft in the dog.

Perfusion tests were performed in dogs with a pedicle graft of the greater omentum implanted in the lumbar subarachnoid space to measure its capacity to drain CSF. The CSF pressure was set at different levels in the range 0--50 mmHg and the outflow from a complete CSF space and then from the isolated dural sac was recorded in the same dog with an electronic drop recorder. It was shown that the omental graft could transport as much as 30% of the CSF normally carried by the physiological pathways. The spinal outflow in the controls was virtually non-existent. It is concluded that a bulk flow of CSF occurs through the graft. The results suggest that a lumbo-omental pedicle graft could possibly be used as a biological shunt in the treatment of hydrocephalus.