Analysis of medications used in the treatment of cervical disk degeneration.

This review focuses on the scientific design and concepts of drug management of cervical disk disorders. Steroids, nonsteroidal anti-inflammatory medicines, narcotics, antidepressants and muscle relaxants are discussed.

Incidence of cervical spinal stenosis in professional and rookie football players.

Sagittal canal/vertebral body ratios were measured on cervical spine lateral radiographs of 124 professional football players and 100 rookie football players. A total of 894 levels were measured in 224 players. Thirty-two percent (40) of the 124 professional football players, and 34% of the 100 rookies had a ratio of less than 0.80 at one or more levels from C3 to C6. The 0.80 ratio has been considered indicative of cervical spinal stenosis. This is the first time that the incidence of spinal stenosis, as determined by Torg's ratio, has been demonstrated in a population of professional and rookie football players. Because one-third of this population has cervical spinal stenosis as determined by the Torg ratio, other factors should be considered in the evaluation of a player with a transient quadriplegic episode when making continued play decisions.

Lumbar spine injury in the athlete.

In summary, the keys to proper management of lumbar spine problems in athletes include (1) comprehensive diagnosis; (2) aggressive, effective nonoperative care; and (3) pinpointing operations that do as little damage as possible to normal tissue but correct the pathologic lesion.

The role of spinal flexion and extension in changing nerve root compression in disc herniations.

Changes in nerve root compression forces with spinal motion were measured on six freshly frozen adult cadaver spine specimens. A model was devised to represent a herniated disc at the L4-5 level. This was done using an anterior approach placing a compression-measuring device through the disc at the L4-5 level and against the L5 root. An accelerometer was used to monitor the range of motion of the spine. Because the compression device was held in a static position, the only variable was the tautness of the nerve root across the tip of the device. By simultaneously monitoring motion and force delivered at the tip of the compression meter placed at the nerve root, we were able to quantitate nerve root tension forces across the tip of the measuring device in relation to spinal motion. The force was measured with controls as well as in flexion and extension. In addition, the force was measured as traction was applied to the L5 root. The amount of compressive force and tension in the nerve root increased with flexion of the spine and decreased with extension of the spine. In conclusion, flexion of the lumbar spine increased the compressive force on the L5 root and extension decreased the compressive force on the L5 root.

Comparison of disc space heights after anterior lumbar interbody fusion.

Thirty-one consecutive patients underwent anterior interbody fusion of 40 levels of the lumbar spine using autogenous, autologous, or mixed iliac crest graft. Each patient's disc space height was measured preoperatively, immediately postoperatively, and an average of 29 months postoperatively. The immediate postoperative radiograph demonstrated an average increase in disc space height of 89%, or 9.5 mm for each operated level. The late radiographic evaluation, from 7 to 54 months postoperatively, showed an average decrease of 1%, or 0.1 mm for each level. At late follow-up, no correlation could be found between the time from the operation and disc space height. One hundred percent of patients developed disc space height decreases during the postoperative period, with 46% of levels being narrower than their preoperative height at last follow-up. Loss of distraction is a normal postoperative occurrence of the procedure. Disc space distraction is temporary with anterior interbody fusion.

Dynamic EMG analysis of torque transfer in professional baseball pitchers.

Fifteen professional baseball pitchers underwent active pitching motion analysis of the abdominal oblique, rectus abdominis, lumbar paraspinous and gluteus maximus muscles bilaterally via surface electrode evaluation. Baseline resting and isometric maximum values were obtained and active data referenced against these for comparison. The muscle activity then was measured during the pitching sequence and analyzed in each of the five pitching phases. The abdominal oblique, lumbar paraspinous and rectus abdominis contralateral to the pitching arm and the ipsilateral gluteus maximus all had increases in activity level of 75 to 100% during the active pitching motion. Using these data indicating specific muscle group patterns with clinical and performance data, we hope to minimize injuries and maximize pitching performance.

Comparison of MRI to contrast CT in the diagnosis of spinal stenosis.

Retrospectively, the MR (magnetic resonance) and contrast CT (computed tomography examinations of 41 patients (123 segments) were objectively scored to evaluate spinal stenosis and disc degeneration. Five categories to evaluate stenosis included the facet joint, foramina, central canal, disc on sagittal section, and disc on axial section. In addition, the ability to demonstrate spondylolysis was compared. The examinations were interpreted by a single observer blinded to the results. Comparisons show 96.6% agreement between MR and contrast CT in the diagnosis of spinal stenosis. Magnetic resonance showed disc degeneration in 74 of 123 segments, while CT showed disc degeneration disease in 27 of 123 segments. Spondylolysis was recognized at three segments on both MR and CT. In conclusion, MR and contrast CT are comparable in their abilities to demonstrate spinal stenosis, and MR is more sensitive in demonstrating disc degeneration.

Magnetic resonance imaging in the diagnosis of disc degeneration: correlation with discography.

One hundred and one disc levels in 36 patients with low-back pain were studied with magnetic resonance imaging (MRI) (T2-weighted) sagittal images and conventional roentgenographic discography to detect early disc degeneration. Thirty-nine discs also were evaluated after discography with roentgenographic CT MRI findings were compared with discography results. MRI was 99% accurate in predicting normality or abnormality as determined by discography. Changes in disc signal on MRI accurately reflected the presence or absence of degenerative changes seen on discography in patients with low-back pain. Clinically, MRI is a useful technique for detecting early disc degeneration and for assessing the affected disc level and adjacent levels in patients with low-back pain and spondylolithesis.

Cervical radiculopathy. A review.

This paper is a review of current information on cervical radiculopathy. The focus is on the natural history of the process, the accuracy of diagnostic tests to determine etiology, the differential diagnosis involved, and the surgical tactics available. The most important conclusions are the criteria for patient selection for surgery and a statistical demonstration of the adequacy of both the anterior and the posterior approaches for decompression of the cervical nerve root.

Calcaneus deformity in cerebral palsy.

Most but not all calcaneus feet in cerebral palsied patients are iatrogenic. The cause is related to imbalance between plantarflexors and dorsiflexors in most instances. Injudicious heel cord lengthening, inadequate preoperative assessment of anterior tibial power, heel cord lengthening accompanied by gastrocsoleus neurectomy or transposition of peroneal and posterior tibial tendons, anterior to the malleoli, are all potential causes of calcaneus deformity in cerebral palsy.

Cavus, cavovarus, and calcaneocavus. An update.

Cavus, cavovarus, and calcaneocavus deformities are often related to neuromuscular disorders that result in intrinsic and/or extrinsic muscle imbalance in the foot. A careful search for intraspinal causes should be made, particularly in progressive cavus deformity in children. Plantar release is the most common procedure performed for correction of cavus feet and its variants. The choice among available surgical procedures is dictated by the age of the patient, the flexibility and cause of the deformity, an analysis of the deformity, and appropriate standing roentgenograms. Soft tissue procedures, including plantar fasciotomy and tendon transfers, are usually done in younger patients. Bony procedures, including calcaneal, midtarsal, and forefoot osteotomies, are performed in mature feet and are tailored to the apex of the deformity. Triple arthrodesis is a salvage operation for correcting cavus and its variants.