Use of oral creatine as an ergogenic aid for increased sports performance: perceptions of adolescent athletes.

BACKGROUND: Competitive athletes, including adolescents, seek ways to gain advantage over competitors. One ergogenic aid is creatine, a naturally occurring nitrogen compound found primarily in skeletal muscle. Increasing creatine levels may prolong skeletal muscle activity, enhancing work output. METHODS: A questionnaire assessing awareness and use of creatine supplementation was completed by 674 athletes from 11 high schools. Data were statistically analyzed to determine variation among groups. RESULTS: Of those surveyed, 75% had knowledge of creatine supplements, and 16% used creatine to enhance athletic performance. Percentage of use increased with age and grade level. Awareness and use were greater among boys than girls. Adverse effects were reported by 26%. Most athletes consumed creatine using a method inconsistent with scientific recommendations. CONCLUSIONS: Use of creatine by adolescent athletes is significant and inconsistent with optimal dosing. Physicians, athletic trainers, and coaches should disseminate proper information and advise these adolescent athletes.

Predicting factors of successful recovery from lumbar spine surgery among workers' compensation patients.

It is commonly believed that patients who are compensated for a work-related injury have less incentive to return to work. This study evaluated how various factors affected the outcomes of lumbar spine surgery in terms of pain relief, functional status, return to work, and general health. Eighty-seven workers' compensation patients had spinal fusion or microdiskectomy. Subjects were evaluated preoperatively and postoperatively using the Oswestry disability scale and the Visual Analog Scale for Pain. The type of surgery performed significantly affected patient outcomes, while such factors as gender, age, smoking, and litigation were insignificant. Microdiskectomy patients, for example, had greater reduction in pain and disability than did fusion patients (P < .01). Return-to-work status was negatively affected by fusion (P < .01). Overall, 55% of patients did return to work in some capacity, but the rate was 72% for microdiskectomy patients versus 43% for fusion patients. While outcomes significantly improved, postoperative scores remained severe. This did not correlate with return-to-work rates, suggesting that outcomes measures may not be effective.

Rate of injury in minor league baseball by level of play.

Professional baseball players are subjected to high stresses and repetitive motions that can lead to orthopedic injuries. Studies have documented significant differences in range of motion and muscle activity between professional athletes and amateurs. These differences are thought to result from adaptive changes occurring in response to repetitive microtrauma. The purpose of this study was to review rates of orthopedic injury in minor league baseball as a function of competitive level. The incidence and severity of orthopedic injuries from 1985 through 1997 were compiled for 6 minor league teams. Significantly greater injury rates were found at the rookie levels than at the higher minor league levels. Following injury, higher-level athletes were most often out 1 to 3 days, while rookies were more likely out 4 to 20 days. It is likely that some of the injuries in rookies occurred because the athletes attempted to participate in a higher level of competition without adequate conditioning and time for adaptive changes. Professional teams should not assume that amateur athletes have been properly conditioned for the increased demands of professional competition. Rookies should undergo specific conditioning and evaluation prior to competing at the professional level.

Complications of the anterior retropharyngeal approach in cervical spine surgery: a technique and outcomes review.

The retropharyngeal approach is used to avoid the risks and limitations of transmucosal surgery. The standard Smith-Robinson approach does not allow complete exposure of the C3 body/disk in patients requiring instrumentation of C3 or in patients with a short, thick neck. The anterior retropharyngeal approach provides additional exposure to the entire cervical spine in these patients. Our results in 14 cases show the anterior retropharyngeal approach to the upper and lower cervical spine to be an effective surgical technique in cases of upper cervical spine abnormalities and for multilevel abnormalities in patients with a short, thick neck. Although complications occurred as a result of the procedure, no permanent disorders were encountered. Adequate exposure to the entire cervical spine can be achieved without the high incidence of infection associated with the transoral approach.

Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases.

STUDY DESIGN: A retrospective review of 20 patients with incidental durotomy treated without mandatory bed rest. OBJECTIVES: To determine whether patients with incidental durotomy can be treated effectively without multiple days of bed rest. SUMMARY OF BACKGROUND DATA: Incidental durotomy can cause postural headaches, nausea, vomiting, dizziness, photophobia, tinnitus, and vertigo. These symptoms are believed to result from a decrease in cerebrospinal fluid pressure, leading to traction on the supporting structures of the brain. Traditional management includes bed rest for up to 7 days to eliminate traction and reduce hydrostatic pressure during the healing process. METHODS: Twenty incidental durotomies were repaired intraoperatively with dural stitches and fibrin glue. Patients were allowed to ambulate according to the natural course after surgery without mandatory bed rest. Symptoms were monitored closely for 1 week, and long-term follow-up assessments were obtained at a minimum of 10 months. RESULTS: Of the 20 patients in this study, 75% had no symptoms after repair of the incidental durotomy. Each of the dural tears was 1-3 mm in length. Two patients reported headache, two reported nausea, and one reported tinnitus; no patients experienced vomiting. One patient (5%) had stitch loosening requiring revision surgery. There were no additional serious complications. CONCLUSIONS: This study has shown that the majority of patients with incidental durotomy can be treated effectively with dural stitches and fibrin glue. Patients can be permitted to ambulate immediately after surgery but should be cautioned to lay flat if they develop symptoms. This will reduce the costs related to the hospital stay and missed work.

The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations. A modified technique and outcomes analysis of 25 patients.

STUDY DESIGN: A retrospective review of 25 patients who underwent a modified surgical procedure for the treatment of far lateral disc herniation. OBJECTIVES: To describe a modification of previous surgical techniques for the treatment of far lateral disc herniation and to review the outcomes in resolution of pain and improvement of functional status. SUMMARY OF BACKGROUND DATA: Lumbar disc herniations that occur far lateral to the intervertebral facet result in spinal nerve compression at L3-L4 and L4-L5. Previous surgical techniques have resulted in an increased risk of instability or continued postoperative back pain. METHODS: Twenty-five patients with far lateral disc herniation underwent surgery using an extreme lateral approach. There was no medial facetectomy or disruption of the pars interarticularis. The intertransverse ligament was released from the superior portion of the inferior transverse process, and the nerve was located before removal of the disc. Preoperative and postoperative visual analog pain scale and Oswestry functional status evaluation were reviewed along with complications to evaluate the efficacy of the surgery. RESULTS: No serious complications were noted, although transient neuropathic pain was common and was theorized to be caused by manipulation of the dorsal root ganglion during surgery. This pain was usually resolved within 4 to 6 weeks. The mean preoperative and postoperative visual analog scale scores were 7.7 and 4.2, respectively. The mean preoperative and postoperative Oswestry scores were 50.7% and 34.7%, respectively. Both of these improvements were statistically significant (P < 0.01). CONCLUSIONS: This far lateral approach allowed the nerve and far lateral disc herniations to be easily identified. Also, there was less blood loss and no medial facetectomy or disruption of the pars interarticularis. This is a safe, effective technique with no disruption of spinal stability.

Posterior extradural lumbar disk fragment.

We present the unique case of a patient with a sequestered disk fragment posterior to the thecal sac producing symptoms of spinal stenosis with neurogenic claudication. The majority of sequestered disk fragments migrate in either a cranial or caudal direction. In only a few cases have disk fragments been identified posterior to the thecal sac. Our patient had a sudden onset of bilateral groin and anterior thigh pain. Magnetic resonance imaging showed relatively severe stenosis at L4-5 with mild disk bulging. Intraoperatively, a large posteriorly placed encapsulated mass of soft tissue was found compressing the posterior portion of the thecal sac. Patients with acute onset of symptoms of spinal stenosis should have herniated disk included in their differential diagnosis, even in the absence of imaging confirmation.

Reliability of magnetic resonance imaging in predicting disc material posterior to the posterior longitudinal ligament in the cervical spine. A prospective study.

STUDY DESIGN: This was a prospective study to evaluate the accuracy of magnetic resonance imaging in predicting the presence of disc material posterior to the posterior longitudinal ligament (PLL), compared with the accuracy of intraoperative visual and tactile examination of the PLL. OBJECTIVES: To determine the accuracy of magnetic resonance imaging in predicting the presence of disc material posterior to the PLL. SUMMARY OF BACKGROUND DATA: Whether removal of the disc to the PLL is sufficient when performing an anterior cervical discectomy and fusion or it is necessary to explore the spinal canal by taking down the PLL is controversial. METHODS: Fifty-four cervical levels were examined by magnetic resonance imaging before surgery to determine whether there was disc material posterior to the PLL. During surgery, the PLL was examined and probed for disruption. The ligament was taken down, and free fragments were identified and removed. RESULTS: Of 54 levels, 12 were correctly identified by magnetic resonance imaging as having disc material posterior to the PLL, and 26 were correctly identified as not having disc material posterior to the PLL. Surgery confirmed that at 26 levels there was disc material posterior to the PLL. Of these 26, 23 (88.5%) had visual or palpable disruption of the PLL. Magnetic resonance imaging failed to predict disc material posterior to the PLL in 14 of the cases in which its presence was confirmed during surgery. Magnetic resonance imaging had 46.2% sensitivity and 92.9% specificity rates. CONCLUSIONS: Because of low sensitivity, magnetic resonance imaging should be used cautiously for predicting free disc material posterior to the PLL. Visual or palpable examination of the PLL during surgery is more accurate for this prediction.

Low postoperative infection rates with instrumented lumbar fusion.

BACKGROUND: Studies have shown postoperative infection rates increase with the use of internal instrumentation. It is believed that longer operative times, prolonged retraction, instrumentation, and bone grafting lead to a higher risk of infection. METHODS: We retrospectively reviewed 126 consecutive instrumented lumbar fusions. All had bone graft. The infection rate was statistically compared with previously reported values. RESULTS: Our infection rate (0.8%) was lower than the combined data from the literature (2.8%), though not significantly different. No significant differences were noted regarding patient or surgical factors. CONCLUSIONS: This review showed that low rates of postoperative infection can be achieved despite patient or surgical factors. We believe that conforming to strict techniques, including copious irrigation and debridement, and having experienced operating room personnel and short operating times will reduce the incidence of postoperative infections.

The natural history of the cervical foramen in symptomatic and asymptomatic individuals aged 20-60 years as measured by magnetic resonance imaging. A descriptive approach.

STUDY DESIGN: This study was intended to identify normal degenerative morphologic evolution in the bony foramen in asymptomatic subjects by decade in comparison with symptomatic subjects of like decades. OBJECTIVES: To determine normal degenerative changes in the cervical spine caused by the aging process that predispose a person to foraminal stenosis and radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is a common problem caused by degenerative changes as people age. The characteristics of the foramen that result in stenosis are not known. METHODS: Five to six symptomatic and asymptomatic people in each decade volunteered for magnetic resonance imaging. Lordosis, disc heights, and ratio of spinal cord diameter to spinal canal diameter were measured at C4-C5, C5-C6, and C6-C7 from sagittal magnetic resonance images. Foraminal heights, widths, and areas were measured at the isthmus of the same foramen from oblique images. RESULTS: Foraminal heights, widths, and areas were larger in asymptomatic patients than in symptomatic patients. Morphologic analysis showed that inferior facet hypertrophy tended to decrease the width of the foramen in aging people. Disc heights, lordosis, and ratio of spinal cord diameter to spinal canal diameter showed no significant differences. CONCLUSIONS: Foraminal height affects overall foraminal area but tends to change little with age. Width also affects overall area and not only decreases in older people but also significantly affects the available area for the exiting nerve root.