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1.
Eur Spine J ; 13(1): 22-31, 2004 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-14685830

RESUMEN

Patients suffering from neurogenic intermittent claudication secondary to lumbar spinal stenosis have historically been limited to a choice between a decompressive laminectomy with or without fusion or a regimen of non-operative therapies. The X STOP Interspinous Process Distraction System (St. Francis Medical Technologies, Concord, Calif.), a new interspinous implant for patients whose symptoms are exacerbated in extension and relieved in flexion, has been available in Europe since June 2002. This study reports the results from a prospective, randomized trial of the X STOP conducted at nine centers in the U.S. Two hundred patients were enrolled in the study and 191 were treated; 100 received the X STOP and 91 received non-operative therapy (NON OP) as a control. The Zurich Claudication Questionnaire (ZCQ) was the primary outcomes measurement. Validated for lumbar spinal stenosis patients, the ZCQ measures physical function, symptom severity, and patient satisfaction. Patients completed the ZCQ upon enrollment and at follow-up periods of 6 weeks, 6 months, and 1 year. Using the ZCQ criteria, at 6 weeks the success rate was 52% for X STOP patients and 10% for NON OP patients. At 6 months, the success rates were 52 and 9%, respectively, and at 1 year, 59 and 12%. The results of this prospective study indicate that the X STOP offers a significant improvement over non-operative therapies at 1 year with a success rate comparable to published reports for decompressive laminectomy, but with considerably lower morbidity.


Asunto(s)
Vértebras Lumbares/cirugía , Prótesis e Implantes , Estenosis Espinal/cirugía , Anciano , Fenómenos Biomecánicos , Descompresión Quirúrgica , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Laminectomía , Masculino , Estudios Prospectivos , Estenosis Espinal/fisiopatología , Estenosis Espinal/terapia , Resultado del Tratamiento , Caminata
2.
J Orthop Res ; 19(4): 597-604, 2001 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11518268

RESUMEN

An evaluation of the regional variation of certain cellular features in the human intervertebral disc (IVD) could lead to a better understanding of site-specific properties relative to degradation, response to injury, and healing processes. The objective of this study was to determine how cell density, cell morphology, cell grouping, and expression of a specific actin isoform varied with location and degeneration in the human disc. A total of 41 human L4-L5 and L5-S1 discs removed postmortem from 21 individuals were analyzed. The discs were graded for degeneration based on the Thompson scale and processed for evaluation. Microtomed sections from paraffin-embedded specimens were stained with hematoxylin and eosin or a monoclonal antibody to alpha-smooth muscle actin (alpha-SMA), an actin isoform often associated with contraction. A significant regional dependence was found for most of the measured parameters. A fourfold increase in cell density was found in proceeding from the nucleus pulposus (NP) to the outer annulus (OA) of the IVD. Approximately 30% of the cells in the NP were present in groups. Virtually all of the cells in the NP and 40% of those in the OA were round. Moreover, notable percentages (12-15%) of the cells in the NP and inner annulus (IA) contained alpha-SMA. Only pair density was found to be correlated with Thompson grade, with more degenerated specimens having higher values. A greater effect was also observed on the percentage of cells in groups. These findings provide the basis for future work to investigate the importance of cells in groups, the role of alpha-SMA in the disc, and the changes in these cellular characteristics in pathological disc conditions.


Asunto(s)
Actinas/análisis , Disco Intervertebral/química , Disco Intervertebral/patología , Adulto , Anciano , Anciano de 80 o más Años , Recuento de Células , Femenino , Humanos , Disco Intervertebral/lesiones , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Cicatrización de Heridas
3.
Arch Orthop Trauma Surg ; 119(7-8): 478-81, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10613246

RESUMEN

Bilateral vertebral artery injuries in closed cervical spine injuries are uncommon, but early recognition and treatment are important to prevent neurological deterioration. A case of bilateral vertebral injuries in a 35-year-old motor vehicle accident victim is presented, and the current literature is reviewed.


Asunto(s)
Vértebras Cervicales/lesiones , Arteria Vertebral/lesiones , Accidentes de Tránsito , Adulto , Femenino , Humanos , Radiografía , Traumatismos Vertebrales/complicaciones , Arteria Vertebral/diagnóstico por imagen
4.
J Arthroplasty ; 11(7): 797-801, 1996 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-8934319

RESUMEN

Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.


Asunto(s)
Prótesis de la Rodilla , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/cirugía , Trasplante Óseo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/cirugía , Osteonecrosis/cirugía , Ligamento Cruzado Posterior , Complicaciones Posoperatorias , Diseño de Prótesis , Falla de Prótesis , Reoperación , Sinovitis/complicaciones , Factores de Tiempo
5.
Orthop Clin North Am ; 27(1): 87-94, 1996 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-8539056

RESUMEN

The presentation and clinical course for hematogenous vertebral osteomyelitis and postoperative discitis is presented. The treatment is primarily conservative care in the form of immobilization and parenteral antibiotics. The indications for surgery are rare and should be reserved for patients resistant to treatment or with septic course, abscess formation, or neurologic deficits. In these cases, the infectious process has generally involved the adjacent vertebrae or the neural elements. Surgery usually involves an anterior approach. The principles of surgical treatment involve debridement of necrotic tissue, decompression of neural elements, and stabilization of the spine. The outcome of patients with vertebral osteomyelitis and secondary discitis in general is favorable when appropriate treatment is rendered. Extension of the infection to the spinal canal in the form of an epidural abscess is also reviewed.


Asunto(s)
Discitis/terapia , Osteomielitis/terapia , Enfermedades de la Columna Vertebral/terapia , Infección de la Herida Quirúrgica/terapia , Absceso/diagnóstico , Absceso/etiología , Absceso/terapia , Antibacterianos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/etiología , Infecciones Bacterianas/terapia , Discitis/diagnóstico , Discitis/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico , Osteomielitis/etiología , Factores de Riesgo , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/etiología , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología
6.
Biomaterials ; 11: 69-72, 1990 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-2204438

RESUMEN

The tissue around loose total joint replacement prostheses displays a synovial-like lining comprised of cells that produce IL-1 and PGE2, mediators of inflammation that stimulate bone resorption. Particles of titanium alloy, as well as cobalt-chromium alloy and polyethylene, were found to aggravate the histiocytic response and production of IL-1 and PGE2. Tissue with similar histological and biochemical features was produced in a canine model of the aseptic loose cemented femoral stem.


Asunto(s)
Reacción a Cuerpo Extraño/patología , Prótesis de Cadera/efectos adversos , Membrana Sinovial/patología , Animales , Cementos para Huesos , Cromo , Cobalto , Dinoprostona/metabolismo , Perros , Reacción a Cuerpo Extraño/metabolismo , Humanos , Interleucina-1/metabolismo , Polietilenos , Falla de Prótesis , Factores de Riesgo , Membrana Sinovial/metabolismo , Titanio
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