1/6. Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy.BACKGROUND: patients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion. methods: Two patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement. RESULTS: Postoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary. CONCLUSIONS: patients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/6. Reversal of anterior cervical fusion with a cervical arthroplasty prosthesis.This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level. Six months after the original surgery, he underwent re-exploration. decompression and arthroplasty were effected at the C6-C7 level. The old fusion was removed at the C5-C6 level and remobilized, and an arthroplasty was performed. At discharge, the patient's neck pain and hand symptoms had improved, and he had motion demonstrable on radiologic imaging at C5-C6. This is the first reported case of reversal of a cervical fusion with re-establishment of motion and represents an alternate acceptable management of pseudoarthrosis or recent spinal fusion.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/6. Bilateral open laminoplasty using ceramic laminas for cervical myelopathy.Evaluation was done of 65 patients with cervical myelopathy treated by bilateral open laminoplasty using artificial laminas, between 1984 and 1988, who had been followed for more than 2 years. The mean recovery rate on the Japanese Orthopaedic association scoring system was 65% in all cases, and 72% in the cases with no other complications. The artificial laminas appeared well adapted to the laminas in computed tomography and dynamic radiographic examinations, and there were no cases of reduction of the enlarged canal. Postoperative restriction of the range of motion of the cervical spine was lessened by the positioning of lateral grooves, more appropriate external fixation, and posterior flexion exercise after operation. This procedure is not technically complicated, it does not involve appreciable blood loss during operation, it prevents grafted free fat from migrating into the spinal canal, and is advantageous for posterolateral bone chip grafting.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/6. Internal decompression for multiple levels of lumbar spinal stenosis: a technical note.In cases of lumbar spinal stenosis, use of the wide decompressive procedure for neural compression without regard for the integrity of facets tends to lead to instability and the chronic pain syndrome. Experience with the posterior lumbar interbody fusion technique indicates that, in cases of multiple levels of spinal canal stenosis, the decompression can be made adequately by inferior and superior marginal laminotomy, mesial facetectomy with an osteotome, and foraminotomy with an angle bone punch and a supersonic curette. Internal thinning of the thickened lamina can be achieved by the shaving action of the supersonic curette done from within the spinal canal. This technique achieves the necessary internal decompression of the multiple levels of spinal stenosis without interruption of the integrity of the motion segment. The spinous processes and the supraspinous ligaments and the lateral half of the facet, with its firm fibrous capsules, are scrupulously preserved. The disc is not removed unless it is overtly extruded.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/6. Nonoperative management of lumbar spinal stenosis.OBJECTIVE: To describe the successful treatment of a patient with lumbar spinal stenosis utilizing nonoperative procedures. CLINICAL FEATURES: A 76-yr-old male with a chief complaint of low back pain and left lower extremity pain demonstrated the following per history and physical examination: 1. A right antalgic shift. 2. Restricted lumbar range of motion with provocation of left lower extremity pain during extension. 3. Generalized lumbar spondylosis as revealed on plain film X rays. 4. MRI confirmed lumbar stenosis. A diagnosis of lumbar spinal stenosis secondary to spondylosis was made. INTERVENTION AND OUTCOME: Twelve treatments of flexion-distraction manipulation, deep tissue massage, ultrasound, therapeutic exercise, heel lift, and modification of activities of daily living. He was discharged from care asymptomatic in 3 wk. Objective improvement was also noted. CONCLUSIONS: Conservative treatment designed to increase lumbar flexion, thus increasing lumbar spinal canal volume, has a positive influence on the diminution of neural ischemia and its resultant neural dysfunction. Additional research is needed to elucidate these concepts.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/6. A nonsurgical treatment approach for patients with lumbar spinal stenosis.The purpose of this case report is to describe a physical therapy approach to the evaluation, treatment, and outcome assessment of two patients diagnosed with lumbar spinal stenosis. Evaluation consisted of assessment of neurological status, spinal range of motion, and lower-extremity muscle force production and flexibility; administration of the Modified Oswestry low back pain Questionnaire and the Roland-Morris Disability Questionnaire; assessment of pain using a visual analog scale; and performance of a two-stage treadmill test. The treatment program was designed to treat the impairments, and harness-supported treadmill ambulation (unloading) was used to address the limitation in ambulation identified by the treadmill test. Outcome assessment included measuring changes in the status of the impairments and assessing responses to the disability questionnaires and performance of the two-stage treadmill test. Improvements were noted on all outcome measures for both patients after 6 weeks of physical therapy and at the 4-week follow-up examination. Larger case series and randomized trials with long-term follow-ups are recommended.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |