Old traumatic lesions of the dorsal and lumbar spine]

The authors present 71 cases of malunion or old traumatic lesions. They result from an unadapted initial surgical or functional treatment. The pain symptoms are in the form of vertebral pain or nerve root pain, often associated with signs of neurological deficit. The authors emphasize the stability or instability of the lesion in order to assess its reducibility. The radiographic exploration (dynamic views, MRI, CT, medullary arteriography) would serve as a guide for the treatment strategy. The authors do not report any case of permanent postoperative neurological aggravation. Three surgical options are analyzed (anterior approach, posterior approach and "three-stage" surgery). An enlarged posterior approach enables treatment and reduction of all malunions, except if a medullary feeder artery is present on the site of the lesion. The pain symptoms improve in 87% of all cases. The authors do not report any permanent postoperative neurological aggravation.     

Cryomicrotomy of the lumbar spine

To investigate the pathogenesis of lumbar canal stenosis, a morphologic study was carried out by cryomicrotomy using 10 fresh lumbar spine specimens from the 3rd lumbar vertebra to the 1st sacral vertebra. The cryomicrotomy findings confirmed that anatomical relations were clearly demonstrated between dura, nerve root, osseous structure, disc and ligamentum flavum in frontal, sagittal, and transverse section. Furthermore, in sagittal section specimens, thickness of ligamentum flavum varies from extension to flexion. These conditions play a dynamic factor in the pathogenesis of spinal canal stenosis.     

Fractures of the lumbar spine

Summary Sixty-six (70 per cent) of 94 patients with fracture of the lumbar spine (L2–L5), treated at the Central Hospital of Tampere in 1968–1975, were seen after an average interval of 5 years and 4 months. The mean age of the patients at the time of injury was 40.4 years. Somewhat less than half the fractures were sustained at home or in leisure hours and one third were due to traffic accidents. Two thirds were anterior wedge fractures. One patient died in the hospital of other injuries sustained in the same accident. Paraplegia was caused in one case, other neurological lesions in six cases. The treatment was mainly conservative and based on the principle of early functional exercises. Surgery was used in 2 cases of fracture-dislocation. The patients were mobilized after an average of 19 days. The mean duration of hospital treatment was 26 days. Seventy-nine per cent were able to return to work after an average of 3.6 months. No noteworthy changes in the neurological state occurred during follow-up. Half the followed-up patients considered the state of their back as at least good. Poor end-results were more frequent in patients over 40 years old than in those under 40. Radiological deformities were more often observed in patients showing neurological symptoms. Increased interspinous distance and flexion or compression deformities had an unfavourable effect on the clinical result.

---

Zusammenfassung Von den im Zentralkrankenhaus Tampere in den Jahren 1968–1975 behandelten 94 Patienten mit Lendenwirbelbrüchen (L2–L5) wurden 66 Patienten (70%) im Durchschnitt nach 5 Jahren und 4 Monaten nachuntersucht. Das Durchschnittsalter der Patienten zur Zeit der Verletzung betrug 40,4 Jahre. Etwas weniger als die Hälfte der Brüche ereignete sich zu Hause oder in der Freizeit und ein Drittel im Straßenverkehr. Zwei Drittel davon waren Vorderkantenbrüche. Ein Patient starb im Krankenhaus an anderen Verletzungen, die er bei demselben Unfall erlitten hatte. In einem Fall entstand eine Paraplegie und in sechs Fällen andere neurologische Symptome. Die Behandlung war in erster Linie konservativ, früzeitig und funktionell. Chirurgische Eingriffe wurden bei zwei Luxationsfrakturen vorgenommen. Die Patienten wurden im Durchschnitt nach 19 Tagen mobilisiert. Die durchschnittliche Dauer der stationären Behandlung betrug 26 Tage. 79% der Patienten konnten nach durchschnittlich 3,6 Monaten ihre Arbeit wieder aufnehmen. Bemerkenswerte Veränderungen im neurologischen Zustand traten während der Beobachtungszeit nicht auf. Die Hälfte der nachuntersuchten Patienten beurteilte den Zustand ihres Rückens als zumindest gut. Die über 40jährigen Patienten wiesen im Vergleich zu den jüngeren bedeutend mehr schlechte Endergebnisse auf. Vergrößerung der interspinalen Abstands- und Flexions- oder Kompressionsveränderungen verschlechterten das klinische Resultat.

     

Impalement injury of the lumbar spine

Impalement is an uncommon injury, which combines aspects of both blunt and penetrating trauma. Particularly, reported cases of impalement injury of the lumbar spine are very rare. We present a case of impalement in which a steel rod penetrated the back into the vertebral body of the lumbar spine as the result of a fall. This injury was treated successfully with irrigation, debridement, and removal of the foreign body in the operating room. Thereafter, a secondary posterolateral interbody fusion (PLIF) procedure was performed due to instability of the lumbar spine. After 1 year, the patient had regained good functional results.     

Percutaneous discectomy of the lumbar spine

Summary Ten patients with clinical and radiological evidence of herniated discs at lower lumbar levels were treated with partial discectomy by a lateral percutaneous approach. Eight patients had complete relief from radicular pain and were discharged within four days. They returned to normal daily activity within one month.

---

Résumé Dix malades présentant des signes cliniques et radiologiques de hernie discale L3–L4 et L4–L5 ont été traités par discectomie partielle, effectuée par voie per-cutanée à l'aide d'un trocart introduit par voie postéro-externe. Huit de ces patients ont été totalement soulagés de leurs douleurs et ont pu quitter l'hôpital au 4e jour. Ils ont repris une activité normale dans un délai d'un mois.

     

Preseason screening of the lumbar spine

The author proposes a step-by-step method of lumbar spine examination which can be incorporated into the large scale preseason athletic participation screening process. This paper lists and describes examination techniques which can be administered quickly and accurately to large numbers of athletes in succession. In addition, the paper delineates two levels of proficiency required to perform the examination, outlines a practical format, and discusses general and specific precautions and contraindications to participation. J Orthop Sports Phys Ther 1981;3(1):6-10.     

Dynamic stabilization of the lumbar spine

This study analyzed the outcome of patients treated with total disk replacement and posterior dynamic stabilization. For pathologies of different origin, dynamic stabilization of the lumbar spine is a novel alternative to fusion surgery. Although a physiological reconstruction of the sagittal profile was not always achieved, improvement was seen in all subscales of the clinical outcome measures in both treatment groups. Posterior dynamic stabilization and total disk replacement are promising alternatives to fusion with acceptable morbidity for strictly defined indications.     

Innervation of the lumbar spine.

Back pain, in spinal stenosis, can arise from many sources. Apart from nerve root involvement any of the structures considered above can be implicated. In degenerative conditions, where discogenic and posterior facet pain are present, excess activity tends to increase these symptoms. In addition there is evidence that impulses reaching the spinal nerve root through the sinu-vertebral nerve and possibly the posterior ramus may potentiate the irritability of that root. Whether such a mechanism contributes to the claudication of degenerative spinal stenosis is not known.