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1
Hammer, Niels, Christian Kühne, Jürgen Meixensberger, Bernd Hänsel, and Dirk Winkler. "Takotsubo cardiomyopathy – an unexpected complication in spine surgery." Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-157944.
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Introduction: Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggeredby stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures. Clinical presentation: A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pumpfunction. Conclusion: Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.
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Segar, Anand Hari. "The effect of obesity upon the lumbar spine." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:0db5f091-0f6f-4686-957e-22c5390232b0.
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Back pain is a massive global public health problem with multiple contributing factors including obesity. Obesity is thought to be linked to back pain through mechanical factors. However, obesity also causes a systemic low-grade inflammatory milieu. This would suggest a possible biochemical link between obesity, intervertebral disc degeneration, and back pain. Furthermore, the relationship between obesity and the clinical presentation of spine patients is unclear. This thesis aims to examine the effect of and relationship between obesity, the intervertebral discs, and back pain from biochemical, clinical, and epidemiological perspectives. In this thesis, an in vitro study assessed the effect of leptin, a fat-specific cytokine, upon the intervertebral disc. The bovine intervertebral disc was used as a model in a cell culture system. An ex vivo study examined leptin and pro-inflammatory cytokines produced by paraspinal adipose tissue taken during routine surgical procedures from spinal patients. Plasma taken from patients presenting with low back pain was analysed by mass spectrometry and multiplex immunoassay to identify possible protein biomarkers. At an epidemiological level, statistical modelling of the Genodisc patient population was conducted. This was a pan-European study of 2636 patients presenting to tertiary spinal units. Analyses were performed to examine relationships between obesity, quantified by body mass index (BMI), and pain, clinical diagnosis, and spinal degeneration identified on magnetic resonance imaging (MRI). Leptin was shown to increase the production of and expression of degradative and pain-generating molecules by disc cells. A pro-inflammatory environment, especially IL-6, potentiated this response. Leptin and pro-inflammatory cytokines produced by paraspinal fat were unrelated to clinical symptoms. However, levels of the pro-inflammatory cytokines, TNF-α and IL-6, were raised in the plasma of patients with greater pain or those with spinal stenosis. Furthermore, clusterin and complement were identified, by mass spectrometry, as potential biomarkers for spine patients. Epidemiological analyses revealed that obesity was associated with greater back pain, although the magnitude of this association was small. Similarly, obesity was associated with a diagnosis of spinal stenosis. Finally, increased BMI was found to be an independent predictor of disc degeneration, spinal stenosis, and disc herniation on MRI. In summary, this thesis has furthered the clinical understanding of lumbar spine pathology and back pain. It will provide clinicians with a better framework to assess spine patients. These results show that obesity is associated with lumbar spine degeneration and pain. Leptin could be a factor mediating this relationship. Further studies should concentrate on clarifying the mechanism of action of leptin upon the intervertebral disc and assessing the longitudinal effect of obesity upon the lumbar spine. In this thesis, an in vitro study assessed the effect of leptin, a fat-specific cytokine, upon the intervertebral disc. The bovine intervertebral disc was used as a model in a cell culture system. An ex vivo study examined leptin and pro-inflammatory cytokines produced by paraspinal adipose tissue taken during routine surgical procedures from spinal patients. Plasma taken from patients presenting with low back pain was analysed by mass spectrometry and multiplex immunoassay to identify possible protein biomarkers. At an epidemiological level, statistical modelling of the Genodisc patient population was conducted. This was a pan-European study of 2636 patients presenting to tertiary spinal units. Analyses were performed to examine relationships between obesity, quantified by body mass index (BMI), and pain, clinical diagnosis, and spinal degeneration identified on magnetic resonance imaging (MRI). Leptin was shown to increase the production of and expression of degradative and pain-generating molecules by disc cells. A pro-inflammatory environment, especially IL-6, potentiated this response. Leptin and pro-inflammatory cytokines produced by paraspinal fat were unrelated to clinical symptoms. However, levels of the pro-inflammatory cytokines, TNF-α and IL-6, were raised in the plasma of patients with greater pain or those with spinal stenosis. Furthermore, clusterin and complement were identified, by mass spectrometry, as potential biomarkers for spine patients. Epidemiological analyses revealed that obesity was associated with greater back pain, although the magnitude of this association was small. Similarly, obesity was associated with a diagnosis of spinal stenosis. Finally, increased BMI was found to be an independent predictor of disc degeneration, spinal stenosis, and disc herniation on MRI. In summary, this thesis has furthered the clinical understanding of lumbar spine pathology and back pain. It will provide clinicians with a better framework to assess spine patients. These results show that obesity is associated with lumbar spine degeneration and pain. Leptin could be a factor mediating this relationship. Further studies should concentrate on clarifying the mechanism of action of leptin upon the intervertebral disc and assessing the longitudinal effect of obesity upon the lumbar spine.
3
Downer, Philip R. "Local bone graft harvest in anterior lumbar spine surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0025/MQ50758.pdf.
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Downer, Philip R. "Local bone graft harvest in anterior lumbar spine surgery." Thesis, McGill University, 1998. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=21543.
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The harvesting of a local bone graft from the lumber vertebral body adjacent to an anterior interbody fusion was suggested, to avoid secondary morbidity associated with iliac bone harvest. Instrumentation using a cannulated core drill was developed and assessed in an anatomic safety study. The biomechanical implications of plug removal were assessed in single vertebra and multisegment models. Plug removal using the tools developed was considered safe. The removal of a cylinder bone plug from the vertebral body affected flexion/compression load significantly. The yield strength of the vertebra could be restored effectively using the filler materials studied.
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Louw, Adriaan. "Preoperative education for patients undergoing lumbar spine surgery for radiculopathy." Thesis, Stellenbosch : University of Stellenbosch, 2006. http://hdl.handle.net/10019.1/1681.
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Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2006.Postoperative rehabilitation programs have shown little efficacy in decreasing pain and disability in short and long term outcomes for lumbar discectomy. Preoperative education in other disciplines of medicine and physiotherapy has shown to decrease pain and disability postoperatively. No studies to date have been published on preoperative education for spinal lumbar surgery patients with radiculopathy. Objective: The objective of this study was to contribute towards further understanding of the preoperative educational requirements of patients undergoing lumbar surgery for lumbar radiculopthy. Method Two surveys were conducted. A new questionnaire was developed for patients to determine their preoperative educational needs regarding spinal surgery due to radiculopathy. These questionnaires were administered at 4-weeks postoperatively to patients from four spinal surgeons in the Greater Kansas City metropolitan area of the US. A second physiotherapist survey was developed and distributed to physiotherapists registered with the Kansas and Missouri State Boards who were actively involved in treating spinal surgery patients in Kansas and Missouri. The data collected from completed questionnaires were analyzed using descriptive and inferential statistical tests....
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Louw, Adriaan. "Preoperative education for patients undergoing lumbar spine surgery for radiculopathy /." Link to online version, 2007. http://hdl.handle.net/10019/437.
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Sandén, Bengt. "Fixation of spinal implants : clinical and experimental studies on the effects of hydroxyapatite coating /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5137-3/.
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Estes, Bradley T. "A biomechanical analysis of the plates and screws implanted in posterior cervical spine plating via the lateral mass." Thesis, Georgia Institute of Technology, 1993. http://hdl.handle.net/1853/19481.
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Gilbert, Stephen Gregory. "Bending fatigue of cancellous bone screws used in anterior spine surgery." Thesis, University of Ottawa (Canada), 1993. http://hdl.handle.net/10393/6491.
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Bending fatigue has been noted in early clinical results of anterior spinal fixation using standard 6.5mm outside diameter (3.2mm inside diameter) cancellous bone screws. Fractography was used to qualify and quantify the failure mode. Fracture mechanics was used to determine the load level from the fractographic findings. These results were used in a test program to reproduce the fatigue failures seen in-vivo. The validity of the experimental model was investigated by varying test coupon parameters, testing the modified specimens and comparing the results to those predicted.
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KATO, FUMIHIKO, NAOKI ISHIGURO, MASAAKI MACHINO, KEIGO ITO, YASUTSUGU YUKAWA, and HIROAKI NAKASHIMA. "COMBINED POSTERIOR-ANTERIOR SURGERY FOR OSTEOPOROTIC DELAYED VERTEBRAL FRACTURE WITH NEUROLOGIC DEFICIT." Nagoya University School of Medicine, 2014. http://hdl.handle.net/2237/20549.
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Patel, Purvi Shantilal. "Screw fixation of implants to the spine." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/849/.
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Bone screws are used to fix various implants to the human spine. Screw fixation can be difficult in osteoporotic bone because of its reduced strength. This research aimed to investigate screw fixation techniques in the spine. A questionnaire study, representing British and Irish spine surgeons, confirmed the potential for a simple screw positioning device and identified the need for an improved screw for osteoporotic bone. Determination of the compressive mechanical properties of 0.32 g.cm\(^{-3}\), 0.16 g.cm\(^{-3}\) and 0.09 g.cm\(^{-3}\) polyurethane foam enabled them to be used as models for normal, osteoporotic and very low density osteoporotic, human cancellous bone, respectively. The screw pullout force from these bone models decreased with polyurethane foam density, implying that the quality of bone principally influences the strength of screw fixation. The angle of screw insertion and thread design was also found to affect screw pullout force, but not a small amount of screw toggling prior to axial pullout. No benefits in pullout strength were found when placing screws at 40° in a normal bone model or when using closely placed multiple screws in an osteoporotic bone model.
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Järvimäki, V. (Voitto). "Lumbar spine surgery, results and factors predicting outcome in working-aged patients." Doctoral thesis, Oulun yliopisto, 2018. http://urn.fi/urn:isbn:9789526218151.
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Abstract The aim of this study was to evaluate the results of lumbar spine surgery and determine which factors modify outcome. A follow-up questionnaire, the Beck Depression Inventory (BDI, the Short Form 36 Health Survey (SF-36) and the Oswestry Low Back Disability Questionnaire (ODI) were sent to working-aged patients who had undergone lumbar spine surgery in the Oulu University Hospital between June, 2005 and May, 2008. Those with a BDI ≥ 10 were further classified into either non-melancholic (NmDS) or melancholic depression (MDS) groups. Potential spinal cord stimulation (SCS) candidates were interviewed via telephone. The postal survey was sent to 814 patients, of which 537 (66%) replied. Of these, 361 had undergone disc surgery, 85 stabilizing surgery and 91 decompression. Pain intensity was milder, the frequency of pain more rare, functional disability minimal and quality of life better after disc surgery compared to stabilizing surgery and decompression, which are technically more demanding operations and the patients’ condition are often more serious. Altogether, 213 patients presented with depressive symptoms (DS) defined as having a BDI ≥ 10, and these were further classified into NmDS (n = 153) and MDS (n = 60) subtypes. ODI differed between DS subtypes: those without DS had minimal, NmDS moderate and MDS severe functional disability. Pain was more frequent and more intense among DS patients. In particular, MDS patients suffered from pain, used more pain medication, but received less benefit from it. Disc surgery patients were divided according to body mass index (BMI): normal, pre-obese and obese. Pre-obese and obese patients gained weight during the follow-up. Obese patients had more DS and a worse functional outcome than normal-weighted or pre-obese patients. Of the entire cohort (n = 814), 21 patients received SCS. Eleven respondents underwent SCS treatment after they had replied. Features predicting SCS treatment were daily or continuous pain, higher pain intensity with predominant radicular pain, more severe pain-related functional disability, more DS and reduced benefit from pain medication. The time between lumbar surgery and implantation of a SCS device was extensive. Based on data from phone interviews, it appears that SCS was not offered to all potential candidates. In conclusion, the outcome of lumbar spine surgery was good after disc surgery but less favourable after more demanding stabilizing surgery or decompression. DS, especially of the MDS subtype, and obesity were more often seen in patients with a poorer surgical outcome. SCS treatment was used late and only for patients with very severe painTiivistelmä Tutkimuksen tarkoitus oli arvioida tuloksia lannerangan kirurgiassa ja kartoittaa tekijöitä, jotka vaikuttavat leikkaustulokseen. Seurantakysely, Beckin depressio¬kysely (BDI), SF-36 elämänlaatukysely ja Oswestryn toiminta¬kyky¬kysely (ODI), lähetettiin työikäisille Oulun yliopistollisessa sairaalassa kesäkuu 2005 - maaliskuu 2008 alaselkäleikatuille potilaille. Beckin depressioasteikko > 10 luokiteltiin ei-melankolisesti masentuneisiin (NmDS) ja melankolisesti masen¬tuneisiin (MDS). Mahdolliset takajuostestimulaatio (TJS) -ehdokkaat haastateltiin puhelimitse. Postikysely lähetettiin 814 potilaalle, joista 537 (66%) vastasi. Näistä 361:lle tehtiin välilevytyräleikkaus, 85:lle stabiloiva leikkaus ja 91:lle juurikanavan avarrusleikkaus. Välilevytyräleikatuilla kipu oli lievempää, harvemmin esiintyvää, toiminnallinen haitta vähäisempää ja elämänlaatu parempaa verrattuna potilaisiin, joille tehtiin vaativampi stabiloiva tai juurikanavan avarrusleikkaus. Kaikkiaan 213 potilaalla oli depressio-oireita (DS, BDI ≥ 10) ja nämä luokiteltiin edelleen NmDS (n = 153) ja MDS (n = 60) alaryhmiin. ODI erottui eri DS alatyyppien välillä: ei-DS-potilailla oli minimaalinen, NmDS-potilailla kohtuullinen ja MDS-potilailla vaikea toiminnallinen haitta. Kipua oli useammin ja voimakkaampana DS-potilailla. Erityisesti MDS-potilaat kärsivät kivuista, käyttivät enemmän kipulääkkeitä ja hyötyivät niistä vähemmän. Välilevytyräleikatut luokiteltiin painoindeksin (BMI) pohjalta normaaleihin, ylipainoisiin ja lihaviin. Ylipainoiset ja lihavat lihoivat seuranta-aikana. Lihavilla potilailla oli enemmän masennusta ja huonompi toiminnallinen tulos verrattuna normaaleihin ja ylipainoisiin. Koko tutkimusryhmässä (n = 814) 21 potilasta oli saanut TJS:n. Yksitoista vastaajaa sai TJS:n kyselytutkimuksen jälkeen. TJS:n saaneilla oli päivittäistä tai jatkuvaa, kovempaa ja pääasiassa jalkaan säteilevää kipua. Kipu aiheutti enemmän toiminnallista haittaa, enemmän masennusta ja nämä saivat vähemmän apua kipulääkityksestä. Aika leikkauksen ja TJS:n asennuksen välillä oli pitkä. Puhelinhaastattelun avulla saatu tieto osoittaa, ettei TJS-hoitoa tarjota kaikille potentiaalisille hyötyjille. Yhteenvetona voidaan todeta, että välilevytyräleikkauksen jälkeen tulos oli hyvä ja vaativampien stabiloivan ja juurikanavan avarrusleikkauksen jälkeen heikompi. DS, etenkin MDS ja lihavuus korostuivat huonommin toipuneissa. TJS-hoitoa käytettiin vain vaikeimmille tapauksille ja odotusajat olivat pitkät
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Davis, Johan H. "Thoracolumbar injuries : short segment posterior instrumentation as standalone treatment - thoracolumbar fractures." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5351.
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Thesis (MMed (Surgical Sciences. Orthopaedic Surgery))--University of Stellenbosch, 2010.Objective: This research paper reports on the radiographic outcome of unstable thoracolumbar injuries with short segment posterior instrumentation as standalone treatment; in order to review rate of instrumentation failure and identify possible contributing factors. Background: Short segment posterior instrumentation is the treatment method of choice for unstable thoracolumbar injuries in the Acute Spinal Cord Injury Unit (Groote Schuur Hospital). It is considered adequate treatment in fracture cases with an intact posterior longitudinal ligament, and Gaines score below 7 (Parker JW 2000); as well as fracture dislocations, and seatbelt-type injuries (without loss of bone column - bearing integrity). The available body of literature often states instrumentation failure rates of up to 50% (Alanay A 2001, Tezeren G 2005). The same high level of catastrophic hardware failure is not evident in the unit researched. Methods: Sixty-five consecutive patients undergoing the aforementioned surgery were studied. Patients were divided into two main cohorts, namely the “Fracture group” (n=40) consisting of unstable burst fractures and unstable compression fractures; and the “Dislocation group” (n=25) consisting of fracture dislocations and seatbelt-type injuries. The groups reflect similar goals in surgical treatment for the grouped injuries, with reduction in loss of sagittal profile and maintenance thereof being the main aim in the fracture group, appropriately treated with Schantz pin constructs; and maintenance in position only, the goal in the dislocation group, managed with pedicle screw constructs. Data was reviewed in terms of complications, correction of deformity, and subsequent loss of correction with associated instrumentation failure. Secondly, factors influencing the aforementioned were sought, and stratified in terms of relevance. Results: Average follow up was 278 days for the fracture group and 177 days for the dislocation group (all patients included were deemed to have achieved radiological fusion – if fusion technique was employed). There was an average correction in kyphotic deformity of 10.25 degrees. Subsequent loss in sagittal profile averaged 2 degrees (injured level) and 5 degrees (thoracolumbar region) in the combined fracture and dislocation group. The only factor showing a superior trend in loss of reduction achieved was the absence of bone graft (when non-fusion technique was employed). Instrumentation complications occurred in two cases (bent connection rods in a Schantz pin construct with exaggerated loss in regional sagittal profile, and bent Schantz pins). These complications represent a 3.07% hardware failure in total. None of the failures were considered catastrophic. Conclusion: Short segment posterior instrumentation is a safe and effective option in the treatment of unstable thoracolumbar fractures as a standalone measure.
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Fleming, Mark Alexander. "How does pre-reduction MRI affect surgeon's behaviour when reducing Distraction-Flexion injuries of the cervical spine?" Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2840.
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Böhme, Tina. "Retrospektive Aufarbeitung der Revisionseingriffe aufgrund „Osteosyntheseversagen“ nach Wirbelsäulenoperationen der Jahre 2003 bis 2009." Doctoral thesis, Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-150152.
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Die demographische Entwicklung mit Zunahme des Anteils der älteren Bevölkerung hat in den vergangenen 20 Jahren zu einem Anstieg operationspflichtiger Wirbelsäulenverletzungen geführt. Neue Operationstechniken wurden entwickelt, um den Herausforderungen, die sich durch den größeren Anteil älterer Patienten ergeben, entgegen zu treten. Neben offen-chirurgischen Verfahren kommen mehr und mehr minimal-invasive Techniken zur Anwendung (Lendemans et al. 2011a). Doch unabhängig von der gewählten Methode birgt jeder operative Eingriff Risiken und die Gefahr intra- und postoperativer Komplikationen. Dazu gehören neben allgemeinen Komplikationen wie Blutungen, Verletzung umliegender Strukturen oder postoperativen neurologischen Ausfällen auch implantatbedingte Komplikationen wie z.B. Lockerung, Dislokation oder Bruch des eingebrachten Materials. Letzt genannte Komplikationsart ist ein gemeinsames Charakteristikum der in dieser Arbeit untersuchten Patienten.
Ziel dieser Arbeit war es, die im Zeitraum vom 01.01.2003 bis 31.12.2009 an der Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie der Universität Leipzig operierten Patienten, bei denen aufgrund von Hardwarekomplikationen Revisionseingriffe durchgeführt werden mussten, zu analysieren. Von insgesamt 57 Patienten (♂/♀=35/22) wurden u.a. Daten zu Unfallart, Lokalisation und Klassifikation der Verletzung, operative Details (Operationsdatum, Operationsdauer, Art der durchgeführten Operation einschließlich Einzelheiten zu den verwendeten Implantaten, Navigationsverfahren), postoperative Komplikationen, Nebendiagnosen (kardiale Nebenerkrankungen, Diabetes mellitus Typ II, Morbus Bechterew, Osteoporose, Nikotinabusus) und BMI ermittelt. Die statistische Auswertung wurde teilweise getrennt für die von uns festgelegten Gruppen (FRAKTUR – CARCINOM – SPONDYLODISZITIS – SPONDYLOLISTHESIS) vorgenommen. Das von uns untersuchte Patientengut kann als inhomogen beschrieben werden. Das Durchschnittsalter betrug 59 Jahre, die Altersspanne reichte von 21 bis 92 Jahre. Die Mehrheit der Patienten konnte der Frakturgruppe zugeordnet werden. Am häufigsten war der Abschnitt der LWS von Verletzungen bzw. den weiteren Krankheitsbildern betroffen. Die operative Stabilisierung erfolgte überwiegend von dorsal. Alle Eingriffe wurden Bildwandler-kontrolliert durchgeführt. In 4 Fällen kam zusätzlich eine CT-Navigation zum Einsatz. Als instrumentierungsbedingte Komplikationen wurden postoperativ am häufigsten Materialdislokation/-lockerung und Pedikelschraubenfehllage beobachtet. Bei 78,9% der Patienten (n=45) war ein einziger Revisionseingriff ausreichend. 12 Patienten (21,1%) mussten mindestens einer weiteren Revisionsoperation unterzogen werden. Als Nebendiagnosen wurden 28-mal (49,1%) kardiale Erkrankungen, 13-mal Osteoporose (22,8%), 11-mal (19,3%) Diabetes mellitus Typ II, und 3-mal (5,3%) Morbus Bechterew gezählt. Fast die Hälfte der Patienten (45,6%) hatte 2 oder mehr Begleiterkrankungen. Als weiterer Risikofaktor wurde bei 26,3% ein Nikotinabusus angegeben. Mit einem Anteil von 57,8% (n=33) waren mehr als die Hälfte der Patienten übergewichtig (BMI ≥ 25). In Zusammenschau mit den Angaben der Literatur können die von uns untersuchten Nebendiagnosen als Risikofaktoren für implantatbedingte Komplikationen angesehen werden. Der Einsatz computerassistierter Navigation, insbesondere bei der Implantation der Pedikelschrauben, kann dazu beitragen, die Komplikationsrate zu minimieren. Das Auftreten von Hardwarekomplikationen scheint multifaktoriell bedingt zu sein. Diverse Nebenerkrankungen, der Habitus des Patienten, das gewählte Operationsverfahren und nicht zuletzt die Erfahrung des Operateurs beeinflussen das postoperative Ergebnis.
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Whittle, Ian Roger. "Clinical applications of somatosensory evoked potentials in pediatric neurosurgery /." Title page, contents and summary only, 1985. http://web4.library.adelaide.edu.au/theses/09MD/09mdw627.pdf.
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Sasidhar, Vadapalli. "Stability imparted by a posterior lumbar interbody fusion cage following surgery : a biomechanical evaluation /." See Full Text at OhioLINK ETD Center (Requires Adobe Acrobat Reader for viewing), 2004. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=toledo1092370385.
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Thesis (M.S.B.)--University of Toledo, 2004.Typescript. "A thesis [submitted] as partial fulfillment of the requirements of the Master of Science degree in Bioengineering." Bibliography: leaves 4-11.
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Steffen, Thomas 1958. "Three-dimensional spine biomechanics : a combined in-vivo and ex-vivo approach." Thesis, McGill University, 1998. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=35502.
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Louw, Adriaan. "Preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy." Thesis, Stellenbosch : Stellenbosch Universit, 2013. http://hdl.handle.net/10019.1/85660.
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Thesis (PhD)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Background: On average one in three patients following lumbar surgery (LS) for radiculopathy experience persistent pain and disability following surgery. No perioperative treatments have shown any ability to decrease this persistent pain and disability. In another challenging low back pain (LBP) population, chronic LBP, pain education focusing on the neurobiology and neurophysiology of pain, has shown an ability to reduce reported pain and disability. The purpose of this research study was to develop and test a preoperative neuroscience education program for LS and determine its effect on pain and disability following LS. Research Design and Methods: After a series of studies, a newly designed preoperative neuroscience educational tool (PNET) was developed. Eligible patients scheduled for LS for radiculopathy participated in a multi-center study where they were randomized to either receive usual care (preoperative education), or a combination of usual care plus one session covering the content of the PNET, as delivered by a physiotherapist in a one-on-one verbal session. Prior to LS, and one, three and six months after LS, 67 patients completed a series of self-report outcome measures consisting of LBP and leg pain rating (Numeric Rating Scale), function (Oswestry Disability Index), fear avoidance (Fear Avoidance Beliefs Questionnaire), pain catastrophization (Pain Catastrophization Scale), pain knowledge (Pain Neurophysiology Questionnaire), various beliefs and experiences related to LS (Likert Scale), and post-operative utilization of healthcare (Utilization of Healthcare Questionnaire). Results: At six month follow up there were no statistical difference (p <0.05) between the experimental and control groups in regards to the primary outcome measures of function (p = 0.296), LBP (p = 0.077) and leg pain (p = 0.074). The experimental group scored significantly better on various questions regarding beliefs and experiences having undergone LS, compared to the control group indicating a more positive surgical experience. Analysis of healthcare utilization showed that patients who received the preoperative neuroscience educational program had dramatically less health care utilization (medical tests and treatments) in the six months following LS (p = 0.001), resulting in a 38% savings in healthcare cost. Conclusion: The addition of a preoperative neuroscience educational program to usual care for LS for radiculopathy resulted in a profound behavioral change leading to a more positive surgical experience, decreased healthcare utilization and resultant savings, despite persistent pain and disability.
AFRIKAANSE OPSOMMING: Agtergrond: Gemiddeld een uit elke drie pasiënte ervaar volgehoue pyn en gestremdheid na lumbale chirurgie (LC) vir radikulopatie. Geen peri-operatiewe behandeling het al getoon dat dit die vermoe het om hierdie volgehoue pyn en gestremdheid te verminder nie. In nog 'n uitdagende lae rug pynbevolking, naamlik chroniese lae rugpyn, het pyn-onderrig, wat fokus op die neurobiologie en neurofisiologie van pyn, getoon dat dit kan lei tot verminderde rapportering van pyn en gestremdheid. Die doel van hierdie navorsingstudie was om 'n preoperatiewe neuro-onderrig program vir lumbale chirurgie te ontwikkel en te toets, en die uitwerking daarvan op pyn en gestremdheid na LC te bepaal. Navorsingsontwerp en Metodiek: Na 'n reeks studies is 'n nuwe preoperatiewe neuroonderrig hulpmiddel (PNET) ontwikkel. Geskikte pasiënte wat geskeduleer was vir LC weens radikulopatie, het deelgeneem aan 'n veelvuldige- sentrum studie. Deelnemers is lukraak in een van twee groepe ingedeel om of gewone sorg (preoperatiewe onderrig), of 'n kombinasie van gewone sorg met een sessie wat die inhoud van die PNET gedek het. Laasgenoemde sessie is aangebied deur 'n fisioterapeut in 'n een-tot-een verbale sessie. Voor die LC, en een, drie en ses maande na LC, het 67 pasiënte 'n reeks van selfverslaggewende uitkoms metings voltooi, wat insluit: Lae Rug- en beenpyn gradering („Numeric Pain Rating Scale‟), Funksie („Oswestry Disability Index‟), Vrees-vermyding („Fear Avoidance Beliefs Questionnaire‟), Pyn-katastrofering („Pain Catastrophization Scale‟), Pynkennis („Pain Neurophysiology Questionnaire‟), verskeie oortuigings en ervarings wat verband hou met LC („Likert Scale‟), en postoperatiewe Gesondheidsorg-benutting („Utilization of Healthcare Questionnaire‟). Resultate: Tydens die ses-maande-opvolg was daar geen statistiese verskil (p <0,05) tussen die eksperimentele- en kontrolegroepe met betrekking tot die primêre uitkoms metings van Funksie (p = 0,296), Lae rug Pyn (p = 0.077) en beenpyn (p = 0,074), nie. Die eksperimentele-groep het betekenisvol beter gevaar met verskeie vrae oor oortuiging en ervarings na afloop van LC. Ontleding van gesondheidsorg benutting, het getoon dat pasiënte wie die preoperatiewe neuro-onderrig program ontvang het, dramaties minder Gesondheidsorg (mediese toetse en behandelings) in die ses maande na LC benodig het, (p = 0,001), wat gelei het tot 'n 38% besparing in gesondheidsorgkoste. Gevolgtrekking: Die byvoeging van 'n preoperatiewe neuro-onderrig program, tot die gewone-sorg vir LC weens radikulopatie, het „n noemenswaardige gedragsverandering veroorsaak wat tot n meer positiewe chirurgiese ervaring, verminderde gesondheidsorg benutting en finansiele besparing gelei het, ten spyte van volgehoue pyn en gestremdheid.
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Lagrange, Bella. "Outcome of Lumbar Spine Surgery in Elite Athletes vs. Untrained : Matched Cohort Study from SWESPINE." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-68280.
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Background: Low back pain may be treated surgically if a mechanical cause can be identified. In elite athletes,certain spinal adaptations have been described, from the diver’s kyphosis to the gymnast’s spondylolysis. Some of these chronic spinal changes have previously been identified to influence the long-term result of spinal surgery of untrained patients. Purpose:The aim of this study is to determine whether elite athletes have a betteror worse outcome of spinal surgery compared tophysicallyinactivepatients.Methods:Data from patients registered in Swedish National Spine Register SWESPINE between 1996-2014 were analyzed. The patient reported outcome measures (PROM: s)preoperatively, after one year, and two yearswere evaluated with the following instruments: Visual Analogue Scale (VAS) for leg-and back pain, Oswestry Disability Index (ODI) and EuroQol five-dimension scale(EQ5D)for health-related quality of life. Results:Surgical treatmentwas associated withimprovements in VAS for leg pain in both groups (-48 for elite athletes vs. -53 for physically inactive patients) with nostatistically significant difference between the two groups (p = 0.203). VAS forback pain improved in both groups (-37 vs. -44) without a statistically significant difference between the two groups (p=0.073). ODI improved in both groups (-32 vs. -37)withouta statistically significant difference between the two groups (p = 0.142). EQ5D improved the first year for both groups (0.15 vs.0.11)with a decline the second year (-0.15 vs. -0.13) for both groups without a statistically significant difference between both groups (p = 0.140). There was no statistically significant difference forAUC VAS leg (p = 0.178) and AUC VAS back (p= 0.99). However, there was a statistically significant difference for ODI (p = 0.017) and EQ5D (p = 0.002). Conclusion:Disability, back-and leg pain decreasedafter spinal surgery. Quality of life increased the first year but decreased the second year. There was only astatistical difference of outcome between elite-active patients and non-active patients of the AUC for ODI and EQ5D.
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González, Álvarez Alba. "Design and development of dynamic orthopaedic implants to improve surgical treatment of the spine." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8388/.
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The work in this thesis presents the development of two novel orthopaedic devices as potential improvements for the surgery of the spine. The preliminary design of a novel device to replace the intervertebral disc of the lumbar spine was investigated. The design was driven by the synergistic application of brainstorming, TRIZ and morphological chart methods. One concept solution was chosen and its preliminary design verification was performed with finite element analysis and additive manufacturing. Furthermore, the mechanical behaviour of various polyurethanes as potential materials for the implant core were analysed with mechanical testing. The main research of this thesis focuses on the development of an orthopaedic device to treat severe spinal deformities in children. A novel implant was designed following the application of additive manufacturing, tolerance analysis, finite element analysis and risk analysis. Five working prototypes were successfully manufactured and were tested to evaluate their mechanical behaviour under simulated spinal compressive loading. Improved fatigue strength was obtained in comparison with a current device on the market. Therefore, with further development, the novel implant has the potential for clinical use.
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Sharif, Bidabadi Shiva. "Human Gait Model Development for Objective Analysis of Pre/Post Gait Characteristics Following Lumbar Spine Surgery." Thesis, Curtin University, 2019. http://hdl.handle.net/20.500.11937/78468.
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Although multiple advanced tools and methods are available for gait analysis, the gait and its related disorders are usually assessed by visual inspection in the clinical environment. This thesis aims to introduce a gait analysis system that provides an objective method for gait evaluation in clinics and overcomes the limitations of the current gait analysis systems. Early identification of foot drop, a common gait disorder, would become possible using the proposed methodology.
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Narotam, Pradeep K. "The Utility of Health Care Performance Indicators in Evaluating Low Back Surgery." Thesis, Walden University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10109127.
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Low back syndrome affects 20% of people, and it is estimated that 30% of patients are unable to return to work after surgery. The monitoring of health care outcomes could improve the delivery of health services. The health performance conceptual framework, derived from the Donabedian model, was used to evaluate the functional outcome, clinical recovery, response to surgery, and physician performance of the surgical management of lumbar spine degeneration. A quantitative study (n=685) was undertaken using an administrative database in a repeated-measures design. The clinical and functional outcome improvements were analyzed using t tests. Surgical complexity on health outcome was examined with ANOVA. Predictors of patient satisfaction was explored using Pearson's correlation and regression analyses. The results demonstrated highly significant improvements in functional (mean change 30%; ODI=16.79 ± SD 19.92) and clinical recovery (mean change 50%; modified-JOA=6.983 ± SD 2.613) with surgery at 3 months; a >50% positive response to surgery; and a > 90% patient satisfaction, sustained over a 2 year period. Complexity of surgery did not impact health performance. Strong correlations between the health performance metrics were detected up to 6-months from surgery. Poor clinical recovery and persistent functional disability were predictive of patient dissatisfaction. The social change implications for health policy are that a constellation of health performance metrics could predict the potential for functional and clinical recovery based on presurgery disability while avoiding medical expenditures for procedures with no health benefit; aid in health quality monitoring, peer comparisons, revision of practice guidelines, and cost benefit analysis by payers.
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Haddad, Sleiman. "Surgical site infections in spinal surgery: from risk factors to surgical outcomes." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665823.
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Durante la última década ha aumentado significativamente el volumen de cirugías de columna, además de la complejidad tanto médica como quirúrgica de los pacientes tratados. Esto ha dado lugar a un aumento de complicaciones asociadas. Los profesionales de la salud son ahora más conscientes del impacto de ciertas complicaciones prevenibles, especialmente la infección de la herida quirúrgica (IHQ), cosa que ha provocado un aumento de los esfuerzos para reducir su incidencia. Se han descrito factores de riesgo generales para las IHQ. No obstante, el rol del estado neurológico y del traumatismo no se han analizado específicamente. Además, el impacto de las IHQ en los resultados clínicos tras la cirugía de deformidad espinal del adulto (DEA) aún no está claro.
El objetivo de esta tesis doctoral es revisar los factores de riesgo de la IHQ en la cirugía del raquis así como su impacto sobre el resultado final. Se centra principalmente en el diagnóstico (traumático vs. degenerativo) y el estado neurológico (Lesión medular LM o mielopatía MP) como predictores de la IHQ. También informa de las morbilidades y los costes asociados y evalúa los resultados quirúrgicos después de una IHQ.
La National Inpatient Survey (NIS) y la base de datos del Thomas Jefferson University Hospital (TJUH) se usaron para analizar la infección en la cirugía cervical primaria. Mediante un análisis multivariante, se analizaron los posibles factores de riesgo incluyendo el trauma y la lesión neurológica. Luego se procedió a un análisis de costes. La base de datos del European Spine Study Group (ESSG) sirvió para evaluar su impacto sobre los resultados funcionales y clínicos en pacientes con fusión posterior para la DEA mediante la comparación de cohortes emparejadas.
Un total de 1.247.281 (NIS) y 5.540 (TJUH) pacientes cumplieron los criterios de inclusión. La incidencia de la IHQ fue de 0.73% (NIS) y 1.75% (TJUH). Aumentó progresivamente desde 0,52% en pacientes sin MP hasta 1,97% en el grupo con LM traumática en la muestra del NIS y desde 0,88% a 5,54% en TJUH. Hubo diferencias significativas en las tasas de IHQ entre muestras. El estado neurológico (Odds Ratio [OR] 1,69, p<.0001) y el trauma (OR 1.30, p=.0003) fueron asociados a IHQ en la muestra del NIS. En la muestra del TJUH, solo el trauma (OR 2.11, p=.03) era significativo cuando se tuvieron en cuenta las otras comorbilidades. Los costes de la infección variaron entre los grupos diagnósticos y alcanzaron $184060 en el grupo LM traumática. Los pacientes con IHQ utilizaron con más frecuencia las instituciones especializadas al alta.
Se identificaron 444 pacientes con DEA tratados quirúrgicamente y con más de 2 años de seguimiento. 20 padecieron una IHQ aguda y fueron emparejados a 60 controles. No se observaron diferencias basales entre grupos tanto en variables radiológicas como calidad de vida. Los pacientes con IHQ tuvieron una estancia hospitalaria más prolongada y más complicaciones mecánicas. La infección se asoció a más complicaciones y revisiones no relacionadas. La corrección de la deformidad se mantuvo indiferentemente de la infección a lo largo del seguimiento. Hubo una muerte relacionada con IHQ. Los pacientes con IHQ presentaban peor calidad de vida al año y tenían menos probabilidades de experimentar mejoría. Sin embargo, no se registraron diferencias significativas a partir del año.
Como conclusión, tanto el diagnóstico primario (trauma vs. degenerativo) como el estado neurológico (MP o LM) son predictores de la IHQ en cirugía cervical. La infección afecta significativamente el primer año después de la cirugía de la DEA, se asocia con más complicaciones, revisiones no relacionadas y peor calidad de vida. Sin embargo, su impacto negativo parece diluirse en el segundo año.Over the last decade there has been a significant increase in volume of spinal surgeries performed as well as in medical and surgical complexity of patients. This was accompanied by an increased overall morbidity and volume of complications. At the same time, health care professionals have become more aware of the impact of specific preventable complications such as surgical site infections (SSI) and huge efforts have been directed to reduce SSI incidence. Although the general risk factors for SSI have been discussed, the relationship of neurologic status and trauma to SSI has not been explicitly explored. In addition, the direct and indirect impact of deep SSI on surgical outcomes especially after adult spinal deformity (ASD) surgery is still unclear. The aim of this doctoral thesis is to review the risk factors for developing a SSI after spine surgery, as well as how SSI affects clinical outcome. It mainly focuses on diagnosis (Traumatic vs. Degenerative) and neurological status (Spinal Cord Injury SCI or Myelopathy MP) as predictors for SSI. It also reports the associated morbidities and costs of SSI and evaluates the surgical outcomes after SSI. The National Inpatient Survey (NIS) and the Thomas Jefferson University Hospital (TJUH) databases were probed to analyse infection in patients with primary cervical surgery. Using a multivariate analysis, all interplaying comorbidities and risk factors have been. A subsequent resource utilization analysis has been done. The European Spine Study Group (ESSG) prospective database was used to study the functional and clinical outcomes of SSI in patients with posterior fusion for Adult Spinal Deformity (ASD) through the comparison of matched cohorts. Readmissions, reoperations, deformity correction and fusion rates were also studied. A total of 1,247,281 and 5,540 patients met inclusion criteria in the NIS and TJUH databases respectively. SSI incidence was 0.73% (NIS) versus 1.75% (TJUH). It increased steadily from 0.52% in patients without MP to 1.97% in the traumatic SCI group in the NIS data and from 0.88% to 5.54% in the TJUH. Differences between diagnostic groups and cohorts reached statistical significance. SSI was predicted significantly by neurological status (odds ratio [OR] 1.69, p<.0001) and trauma (OR 1.30, p=.0003) in the NIS data. Other significant predictors included: approach, number of levels fused, female gender, black race, medium size hospital, rural hospital, large hospital, western US hospital and Medicare coverage. In TJUH, only trauma (OR 2.11, p=.03) reached significance when accounting for comorbidities. Costs of infection varied among diagnostic groups and summed $184060 in the SCI group. Patients with SSI were also more likely to be discharged to specialized institutions. 444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter. As a conclusion, both primary diagnosis (trauma vs. degenerative) and neurologic status (MP or SCI) were found to be strong and independent predictors of SSI in cervical spine surgery. Also, SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it's negative impact seems to be diluted by the second postoperative year.
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Alshamari, Muhammed. "Low-dose computed tomography of the abdomen and lumbar spine." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48242.
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Radiography is a common radiologic investigation despite abundant evidence of its limited diagnostic value. On the other hand, computed tomography (CT) has a high diagnostic value and is widely considered to be among the most important advances in medicine. However, CT exposes patients to a higher radiation dose and it might therefore not be acceptable simply to replace radiography with CT, despite the powerful diagnostic value of this technique. At the expense of reduced CT image quality, which could be adjusted to the diagnostic needs, low-dose CT of abdomen and lumbar spine can be performed at similar dose to radiography. The aim of the current thesis project was to evaluate low-dose CT of the abdomen and lumbar spine and to compare it with radiography. The hypothesis was that CT would give better image quality and diagnostic information compared to radiography at similar dose levels. Firstly, the diagnostic accuracy of low-dose CT of the abdomen was evaluated. Results showed that low-dose CT of abdomen has a high sensitivity and specificity compared to radiography, i.e., it has higher diagnostic accuracy. Similar results were obtained from our systematic review. Secondly, in a phantom study, an ovine phantom was scanned at various CT settings. The image quality was evaluated to obtain a protocol for the optimal settings for low-dose CT of lumbar spine at 1 mSv. This new protocol was then used in a clinical study to assess the image quality of low-dose CT of the lumbar spine and compare it to radiography. Results showed that low-dose CT has significantly better image quality than radiography. Finally, the impact of Iterative reconstruction (IR) on image quality of lumbar spine CT was tested. Iterative reconstruction is a recent CT technique aimed to reduce radiation dose and/or improve image quality. The results showed that the use of medium strength IR levels in the reconstruction of CT image improves image quality compared to filtered back projection. In conclusion, low-dose CT of the abdomen and lumbar spine, at about 1 mSv, has better image quality and gives diagnostic information compared to radiography at similar dose levels and it could therefore replace radiography.
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O'Malley, Jennifer A. "Improving therapeutics for Parkinson's disease." Cincinnati, Ohio : University of Cincinnati, 2009. http://rave.ohiolink.edu/etdc/view.cgi?acc_num=ucin1259079683.
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Thesis (Ph.D.)--University of Cincinnati, 2009.Advisor: Kathy Steece-Collier. Title from electronic thesis title page (viewed Apr. 26, 2010). Keywords: Parkinson; dopamine; dyskinesia; levodopa; dendritic spine; medium spiny neuron. Includes abstract. Includes bibliographical references.
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Almeida, Tiago Ladeiro de [UNESP]. "Estudo comparativo entre as técnicas de video-toracoscopia e toracotomia para fenestração de disco intervertebral em cães." Universidade Estadual Paulista (UNESP), 2007. http://hdl.handle.net/11449/101111.
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A estabilidade da coluna depende de estruturas ósseas e tecidos moles, e traumatismos ou degenerações destes levam a diversas enfermidades medulares. Os discos intervertebrais, por exemplo, quando degenerados podem causar protrusão ou extrusão de seu material para o canal medular, com subseqüente compressão da medula, principalmente na região tóraco-lombar, sendo o tratamento cirúrgico normalmente indicado. Dentre as técnicas descritas na literatura, a fenestração discal apresenta menor porcentagem de recidivas, porém, é extremamente traumática pela necessidade de toracotomia para acesso aos discos. Foi realizado um estudo comparativo entre este procedimento e o vídeo-assistido (VATS), que é uma cirurgia minimamente invasiva, para fenestração discal entre décima primeira e décima terceira vértebras torácicas (T11-T13), em 12 cães (seis por técnica). Após a cirurgia os animais foram submetidos a exames clínicos, neurológicos e radiográficos. Além desta comparação, colunas de 13 cadáveres (cinco operados por acesso padrão, cinco por VATS e três controle), foram avaliadas para comparação das estruturas envolvidas e material discal remanescente. Concluiu-se com base nos resultados obtidos que o procedimento de fenestração de discos intervertebrais por VATS proporciona resultados similares ao tradicional, em segurança e eficácia, porém apresenta vantagens no estágio de convalescença do animal.
Spinal stability is dependant of bone and tissue structures, and traumatisms or degenerations of these can lead to many spinal cord enfermities. Intervertebral discs, for example, when degenerated, can lead to protrusion or extrusion of their material to the medular space, with subsequent compression of this, specialy in the thoraco-lumbar region, being the surgical treatment often indicated. Among the literature described techniques, the discal fenestration has lower porcentual of recurrence, but is extremely traumatic by the necessity of a thoracotomy to access the discs. Comparative study was realized between this procedure and a video-assisted one (VATS), wich is a minimally invasive surgery, being realized discal fenestration of discs between eleventh and thirteenth vertebras (T11-T13), in 12 dogs (six each one). After surgery, these animals were submited to clinical, neurological and radiographic evaluations. Besides this comparation, spines of 13 dog corpses (five operated by tradicional technique, five by VATS and three controls) were avaliated to compare involved structures and remanescent disc material. By these data we can conclude that the disc fenestration by VATS has similar results to the tradicional procedure, in safety and eficacy, with some advantages in the animal's convalescence stage.
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梁漢邦 and Hon-bong Leung. "Consequence of paraspinal muscle after posterior lumbar spinal fusion: the histology and electromyography findingsin a rabbit model." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971179.
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Wheeler, Anthony J. "Procedural Rates, Economic Costs, and Geographic Variation of Primary and Revision Lumbar Total Disc Replacement." DigitalCommons@USU, 2013. https://digitalcommons.usu.edu/etd/1764.
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Lumbar degenerative disc disease is a remarkably common condition among patients presenting with chronic low back pain and physical disability. When a surgical treatment option is warranted, patients now have the option of undergoing lumbar total disc replacement (TDR), a relatively new procedure that is designed to replace lumbar fusion, the traditional surgical intervention for degenerative disc disease. The lumbar TDR procedure has demonstrated clinical efficacy equivalent to that of lumbar fusion, although concern remains about the longevity, safety, and costs related to the procedure. These issues were addressed in three separate observational studies using administrative claims data. The first study estimated the revision burden and economic revision burden of lumbar TDR. The second study examined the lumbar TDR hybrid procedure, where both a lumbar TDR and lumbar fusion are performed simultaneously. No observational data have been reported on the frequency, cost, and diagnostic indications related to the TDR hybrid procedure. The third study mapped the geographic variation of procedural rates of lumbar TDR. Previous research has found substantial geographic variation in lumbar spine surgery rates and a similar analysis of lumbar TDR variation has yet to be reported. The present series of studies found the revision burden and economic revision burden of lumbar TDR to be similar to data reported for this procedure from the mid-2000s, though the overall occurrence of the procedure appears to have declined. The economic revision burden made this a lower-cost procedure than lumbar fusion, with a tradeoff in terms of revision burden being higher for lumbar TDR. The lumbar TDR hybrid procedure was found to make up approximately 16% of the total number of TDR procedures, involving much higher costs than a single-level TDR procedure. Finally, geographic variation of the procedural rate of lumbar TDR varied dramatically across the U.S., surpassing the variation observed in lumbar fusion surgery. Limitations of the observational data used in these studies are described. Recommendations for future observational research are offered as well. Finally, implications for these studies on practice guidelines and reimbursement policies are provided.
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Fairhurst, Helen. "A biomechanical analysis of anterior instrumentation used in the surgical correction of adolescent idiopathic scoliosis." Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/69977/1/Helen_Fairhurst_Thesis.pdf.
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Scoliosis is a deformity of the spine which affects children and adolescents, and remains a challenge to treat. This study measured the forces used during surgery to correct scoliosis and studied changes to spinal mechanics from the implantation of metal rods used to hold the spine straight. The results of this study will help surgeons and engineers understand how to straighten the spine more efficiently to provide patients with better outcomes.
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Cain, Christopher Marden John. "Assessment of spinal cord blood flow and function in sheep following antero-lateral cervical interbody fusion in animals with and without spinal cord injuries /." Title page, table of contents and summary only, 1991. http://web4.library.adelaide.edu.au/theses/09MD/09mdc135.pdf.
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Almeida, Tiago Ladeiro de. "Estudo comparativo entre as técnicas de video-toracoscopia e toracotomia para fenestração de disco intervertebral em cães /." Jaboticabal : [s.n.], 2007. http://hdl.handle.net/11449/101111.
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Orientador: Cintia Lúcia ManiscalcoBanca: Paola Castro Moraes
Banca: Patricia Popak Giordano
Banca: Marileda Bonafim Carvalho
Banca: Márcia Rita Fernandes Machado
Resumo: A estabilidade da coluna depende de estruturas ósseas e tecidos moles, e traumatismos ou degenerações destes levam a diversas enfermidades medulares. Os discos intervertebrais, por exemplo, quando degenerados podem causar protrusão ou extrusão de seu material para o canal medular, com subseqüente compressão da medula, principalmente na região tóraco-lombar, sendo o tratamento cirúrgico normalmente indicado. Dentre as técnicas descritas na literatura, a fenestração discal apresenta menor porcentagem de recidivas, porém, é extremamente traumática pela necessidade de toracotomia para acesso aos discos. Foi realizado um estudo comparativo entre este procedimento e o vídeo-assistido (VATS), que é uma cirurgia minimamente invasiva, para fenestração discal entre décima primeira e décima terceira vértebras torácicas (T11-T13), em 12 cães (seis por técnica). Após a cirurgia os animais foram submetidos a exames clínicos, neurológicos e radiográficos. Além desta comparação, colunas de 13 cadáveres (cinco operados por acesso padrão, cinco por VATS e três controle), foram avaliadas para comparação das estruturas envolvidas e material discal remanescente. Concluiu-se com base nos resultados obtidos que o procedimento de fenestração de discos intervertebrais por VATS proporciona resultados similares ao tradicional, em segurança e eficácia, porém apresenta vantagens no estágio de convalescença do animal.
Abstract: Spinal stability is dependant of bone and tissue structures, and traumatisms or degenerations of these can lead to many spinal cord enfermities. Intervertebral discs, for example, when degenerated, can lead to protrusion or extrusion of their material to the medular space, with subsequent compression of this, specialy in the thoraco-lumbar region, being the surgical treatment often indicated. Among the literature described techniques, the discal fenestration has lower porcentual of recurrence, but is extremely traumatic by the necessity of a thoracotomy to access the discs. Comparative study was realized between this procedure and a video-assisted one (VATS), wich is a minimally invasive surgery, being realized discal fenestration of discs between eleventh and thirteenth vertebras (T11-T13), in 12 dogs (six each one). After surgery, these animals were submited to clinical, neurological and radiographic evaluations. Besides this comparation, spines of 13 dog corpses (five operated by tradicional technique, five by VATS and three controls) were avaliated to compare involved structures and remanescent disc material. By these data we can conclude that the disc fenestration by VATS has similar results to the tradicional procedure, in safety and eficacy, with some advantages in the animal's convalescence stage.
Doutor
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Marcantonio, Graziano. "Development of framework for the manufacture of customized titanium cervical cage implants using additive manufacturing." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86243.
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Thesis (MEng)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Neck pain is a common phenomenon that occurs in a large percentage of the population every day. While many occurrences are not deemed critical such as those from muscle strain which can be treated with rest and pain medication, others due to sports injuries, whiplash from car accidents, bad posture or degeneration of the intervertebral disc can be quite severe. In extreme cases failure of the vertebra(e) or the intervertebral disc requires surgery and possibly the use of cervical implants. Where intervertebral discs fail due to herniation or Degenerative Disc Disease (DDD), Anterior Cervical Discectomy and Fusion (ACDF) is a common surgical method used to remove the a ected disc and replace it with a cervical cage implant. These implants are designed to restore the height between the vertebrae, allowing bone from both vertebrae to grow through them and mineralise. Additive Manufacturing (AM) technologies can produce parts with complex geometries not possible using conventional manufacturing methods. This design freedom, coupled with CT scans of a patient, allow for tailoring an implant to the speci c anatomy of the a ected vertebrae using CAD software. Such an approach must be regulated and shown to be technically and commercially feasible before it can be implemented in industry. This study sought to develop a framework for manufacturing customized cervical cage implants using additive manufacturing. The e cacy of customization to reduce the risk of subsidence was investigated by means of non-destructive and destructive mechanical testing on six cadaver specimens, using readily available PEEK cage implants as a benchmark. The results showed that the customized implant was comparable to the PEEK, with no statistically signi cant di erence between the two. In extreme cases, where PEEK implants cannot be used, customized implants could be a suitable alternative to reduce the risk of subsidence. A manufacturing cost analysis was conducted to determine economic feasibility. The estimated cost and selling price of the customized implants under various utilization scenarios and mark-ups was compared to readily available PEEK implants. The estimated selling prices of the customized implants compared favourably to the PEEK verifying the economic viability of using AM.
AFRIKAANSE OPSOMMING: Nek pyn is 'n algemene verskynsel wat daagliks na tevore kom in die bevolking. Baie gevalle word nie as krities geklasi seer nie soos byvoorbeeld spier pyn wat behandel kan word deur genoegsame rus en pyn medikasie. Pyn wat deur sportbeserings, sweepslag beserings 'whiplash' tydens motor ongelukke, verkeerde postuur, of deur slytasie van 'n intervertebrale skyf veroorsaak is, word dikwels as ernstig geklasi seer. In ekstreme gevalle waar die werwel(s) of die inervertebrale skyf(we) faal, sal chirurgie en servikale inplantate moontlik nodig wees. Waneer intervertebrale skywe faal weens herniatie of Degeneratiewe Skyf Siekte (DDD) kan 'n algemene chirurgiese metode, Anterieure Servikale Discectomie en Fusie (ACDF), gebruik word om die gea ekteerde skyf te verwyder en dit te vervang met 'n servikale samesmelting implantaat. Hierdie implantate herstel die hoogte tussen rugwerwels en is ontwerp sodat die been deur dit kan groei en mineraliseer. Komplekse geometrieë kan vervaardig word deur toevoegingsvervaardiging (AM) tegnologieë. Die ontwerp vryheid, gepaard met CT-skanderings en CAD-sagteware stel mens in staat om die geometrie van die implantaat aan te pas tot die spese eke anatomie van die gea ekteerde vertebra. So 'n benadering moet gereguleer word en eers tegnies en kommersieel uitvoerbaar bewys word voordat dit in die bedryf geïmplementeer kan word. Hierdie studie poog verder om 'n raamwerk vir die vervaardiging van persoonlike servikale implantate deur middel van toevoegingsvervaardiging te ontwikkel. Die doeltre endheid van persoonlike implantate om te verhoed dat die chirurg die eind-plaat beskadig, en sodoende die risiko van insakking te verminder, is ondersoek deur middel van meganiese toetse op ses kadawer monsters. Hierdie toetse is gedoen met behulp van geredelik beskikbaar PEEK servikale implantate as 'n maatstaf. Die resultate het getoon dat die persoonlike- en PEEK implantate vergelykbaar is. In moontlike gevalle waar PEEK implantate nie geskik sou wees nie, kan persoonlike implantate 'n alternatiewe opsie wees om die risiko van insakking te verminder.
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Cachon, Thibaut. "Validation pré-clinique d'un dispositif innovant de correction de la scoliose." Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE1355.
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La scoliose est une déformation en trois dimensions de la colonne vertérbale. Les traitements chirurgicaux actuels sont à l’origine d’une perte de mobilité et de croissance du rachis. Pour palier à ces difficultés, un implant innovant de correction à été développé. Cet implant de type « fusionless » a pour but de préserver la mobilité et la croissance de la colonne vertébrale. Des études morphométriques nous ont permis de connaître la croissance du rachis chez le porc. Cette dernière est maximale entre la 6ème et la 10ème semaine de vie. Les corridors d’insertion des vis pédiculaires ont également pu être décrit. Ensuite, des essais biomécaniques nous ont permis de connaître les contraintes s’exerçant sur le rachis du porc au cours de l’apparition des déformations scoliotiques et de décrire la résistance à l’arrachement des vis pédicualires. Chez le porcs, leur implantation doit etre bicorticale. Enfin, le dispositif a pu être implanté avec succès et a été suivi pendant 2 mois chez 6 porcs charcutiers. Nous avons pu montrer que le dispositif ne semble altérer ni la croissance ni la mobilité rachidienne. Aucune dégénérescence discale n’a été observéeScoliosis is a three-dimensional deformity of the spine. Current surgical treatment are associated with a lost of spine mobility and growth. To avoid those complications, a new fusionless device, preserving spine growth and mobility, has been develloped. Morphometrics studies allow us to evaluated spinal growth in the pigs. This latter one is maximal between the 6th and 10th weeks. Safe corridor of implantation of pedicle screws was also described. During biomechanicals studies, in vivo measurements of forces observed pigs during soliosis deformities induction in a porcine model was performed. Pullout ressitance of pedicle screw in pigs verterbra was also measured in ordre to optimize pedicle screw fixation in the porcine model. In growing pigs, bicortical screw implantation should be used.Finally, the device was implanted during two months in 6 pigs. Spine growth and mobility were not affected and no disc degeneration was observed during the follow up period
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Ransom, Kay Johnson. "Imagery/Mental Practice: A Cognitive Technique for Teaching Adaptive Movement to Postoperative Spinal Patients." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc332028/.
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Postoperative spinal patients were randomly assigned to one of three treatment conditions and were taught five adaptive movements by occupational therapists. The Control group received routine hospital occupational therapy; the Placebo group participated in an imagery relaxation task unrelated to the mental practice task of the Imagery group, which was shown line drawings of the adaptive movements under study, provided movement instructions, and asked to mentally practice each movement in a familiar, daily living situation. Thirty-five patients returned for follow-up, and a measure of outcome was obtained through the use of a quantified movement assessment instrument. Subjective ratings for anxiety, rumination, and imagery were made by the occupational therapists. An occupational motoric-symbolic rating scale was developed to assess the symbolic portion of the patient's job experience. Statistical procedures including chi square, analysis of variance, and Pearson correlation were performed. Results were in the predicted direction although statistical significance was not achieved. Possible explanations for the obtained results were discussed.
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Fazenbaker, Lisa Diane. "An In-Vitro Kinematic Biomechanical Evaluation of Two Surgical Techniques in Adolescent Idiopathic Scoliosis." University of Akron / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=akron1335999724.
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Shillington, Mark Pernell. "Anterior vertebral stapling for the fusionless correction of scoliosis." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/30421/1/Mark_Shillington_Thesis.pdf.
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Fusionless scoliosis surgery is an emerging treatment for idiopathic scoliosis as it offers theoretical advantages over current forms of treatment. Currently the treatment options for idiopathic scoliosis are observation, bracing and fusion. While brace treatment is non-invasive, and preserves the growth, motion, and function of the spine, it does not correct deformity and is only modestly successful in preventing curve progression. In adolescents who fail brace treatment, surgical treatment with an instrumented spinal fusion usually results in better deformity correction but is associated with substantially greater risk. Furthermore in younger patients requiring surgical treatment, fusion procedures are known to adversely effect the future growth of the chest and spine. Fusionless treatments have been developed to allow effective surgical treatment of patients with idiopathic scoliosis who are too young for fusion procedures. Anterior vertebral stapling is one such fusionless treatment which aims to modulate the growth of vertebra to allow correction of scoliosis whilst maintaining normal spinal motion
The Mater Misericordiae Hospital in Brisbane has begun to use anterior vertebral stapling to treat patients with idiopathic scoliosis who are too young for fusion procedures. Currently the only staple approved for clinical use is manufactured by Medtronic Sofamor Danek (Memphis, TN). This thesis explains the biomechanical and anatomical changes that occur following anterior vertebral staple insertion using in vitro experiments performed on an immature bovine model. Currently there is a paucity of published information about anterior vertebral stapling so it is hoped that this project will provide information that will aid in our understanding of the clinical effects of staple insertion.
The aims of this experimental study were threefold. The first phase was designed to determine the changes in the bending stiffness of the spine following staple insertion. The second phase was designed to measure the forces experienced by the staple during spinal movements. The third and final phase of testing was designed to describe the structural changes that occur to a vertebra as a consequence of staple insertion.
The first phase of testing utilised a displacement controlled testing robot to compare the change in stiffness of a single spinal motion segment following staple insertion for the three basic spinal motions of flexion-extension, lateral bending, and axial rotation. For the second phase of testing strain gauges were attached to staples and used to measure staple forces during spinal movement. In the third and final phase the staples were removed and a testing specimen underwent micro-computed tomography (CT) scanning to describe the anatomical changes that occur following staple insertion.
The displacement controlled testing showed that there was a significant decrease in bending stiffness in flexion, extension, lateral bending away from the staple, and axial rotation away from the staple following staple insertion. The strain gauge measurements showed that the greatest staple forces occurred in flexion and the least in extension. In addition, a reduction in the baseline staple compressive force was seen with successive loading cycles. Micro-CT scanning demonstrated that significant damage to the vertebral body and endplate occurred as a consequence of staple insertion.
The clinical implications of this study are significant. Based on the findings of this project it is likely that the clinical effect of the anterior vertebral staple evaluated in this project is a consequence of growth plate damage (also called hemiepiphysiodesis) causing a partial growth arrest of the vertebra rather than simply compression of the growth plate. The surgical creation of a unilateral growth arrest is a well established treatment used in the management of congenital scoliosis but has not previously been considered for use in idiopathic scoliosis.
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Ialynychev, Anna. "Predictors of the Incidence and Charges for Lumbar Spinal Fusion Surgery in Florida Hospitals During 2010." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4820.
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Over the past several decades rates of spine surgeries in the U.S. have increased dramatically. Spinal fusion surgery rates, in particular, have grown exponentially despite being one of the most costly, invasive, and controversial methods for treating patients suffering from back conditions. Furthermore, lumbar fusion surgeries continue to be performed at increasing rates despite a lack of scientific evidence and consensus that they are cost-effective and produce better clinical outcomes than less radical treatment of lower back pain. As a result, large amounts of healthcare dollars continue to be invested in these costly procedures which are potentially dangerous and have questionable efficacy in terms of improving patient outcomes.
Importantly, there is a lack of population studies in the literature on spinal fusion surgeries from a health services research perspective. Therefore, the present research is a population based study using an administrative database and includes patients of all ages and payer types. The data used in the present study come from the Florida Agency for Health Care Administration (AHCA) and include all hospitalizations in Florida in 2010.
The objective of the study is to analyze the incidence of spinal fusion surgeries in Florida hospitals for patients of all ages and payer types by demographic variables to understand who gets these surgeries and for which conditions. The first null hypothesis is that there are no statistically significant predictors of the incidence of lumbar/lumbosacral, dorsal/dorsolumbar spinal fusion surgeries in Florida hospitals. Logistic regression was used to analyze the incidence of fusion surgeries. The binary dependent variable was coded as a "1" for all patients who were a case (i.e. they received one of the five procedure codes being studied in the present research) and a "0" for all patients who were controls (meaning they did not receive any of the five fusion procedure codes). Logistic regression was used to predict the probability of an observation being a "1" given the independent variables included in the model.
Additionally, hospital charges were analyzed to understand the associated hospital charges with these surgeries. The second null hypothesis is that there are no statistically significant predictors of the charges of Lumbar/Lumbosacral, Dorsal/Dorsolumbar spinal fusion surgeries in Florida Hospitals. A mixed effects model was used to test this hypothesis and the fixed effects which were included in the model were gender, age, race, principal payer, and principal procedure. A mixed effects model was chosen due to the fact that cases who had surgeries performed at the same hospital are not independent and therefore the data were clustered on hospitals. A random intercept term was used to address this fact. SAS software was used to complete all of the analyses.
In 2010, there were 16,236 Lumbar/Lumbosacral, Dorsal/Dorsolumbar fusion surgery cases in Florida hospitals that were included in the case population and 21,856 individuals included in the control population for a total of 38,092 included in the study population. An understanding of who is most likely to receive a fusion surgery, at what age, and for which diagnoses, as has been done here, is extremely important. This knowledge can help researchers, policy makers, and physicians alike. Comprehensive physician practice guidelines for performing fusion surgeries still do not exist in the year 2013; therefore, in order to have the greatest impact, the efforts for creating the guidelines should be focused on those individuals who are most likely to receive fusions as shown for the first time by the data analyzed here. Given the high incidence of these surgeries in Florida alone, the need for practice guidelines cannot be overstated.
The total hospital charges in Florida hospitals for the 16,236 cases were $2,095,413,584. Despite having the same principal diagnoses and a similar number of additional diagnoses, patients who received a fusion surgery resulted in approximately three times the charges as those incurred by the controls.
Overall, the high incidence and charges for fusion surgeries shown in this study emphasize the importance of having a better understanding of when these surgeries are justified and for which patients. Without comprehensive practice guidelines established through evidence-based research this is difficult, if not impossible, to accomplish. The diagnoses which are most prevalent and show the most inconsistencies between cases may be a good starting point for such guidelines.
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Von, Forell Gregory Allen. "Biomechanical Implications of Lumbar Spinal Ligament TransectionA Finite Element Study." BYU ScholarsArchive, 2012. https://scholarsarchive.byu.edu/etd/2931.
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The purpose of this work was to determine the possible effects of isolated spinal ligament transection on the biomechanics of the lumbar spine. A finite element model of a lumbar spine was developed and validated against experimental data. The model was tested in the primary modes of spinal motion in the intact condition, followed by comparative analysis of isolated removal of each spinal ligament. Results showed that stress increased in the remaining ligaments once a ligament was removed, potentially leading to ligament damage. Results also showed changes in bone remodeling "stimulus" which could lead to changes in bone density. Isolated ligament transection had little effect on intervertebral disc pressures. All major biomechanical changes occurred at the same spinal level as the transected ligament, with minor changes at adjacent levels. The results of this work demonstrate that iatrogenic damage of spinal ligaments disturbs the load sharing within spinal-ligament complex and may induce significant clinical changes in the spinal motion segment.
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Aurich, Lucas Alves. "Determinação do melhor método para prever o alcance à junção craniovertebral nas cirurgias endoscópicas transnasais utilizando neuronavegação." Universidade Tecnológica Federal do Paraná, 2017. http://repositorio.utfpr.edu.br/jspui/handle/1/2872.
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Espera-se redução das complicações cirúrgicas quando lesões localizadas na junção craniovertebral (JCV) são operadas pelo acesso cirúrgico endoscópico transnasal ao invés do acesso transoral. Entretanto, não se sabe ainda qual seria o maior alcance inferior da abordagem transnasal e também qual seria o melhor método para prever o limite de exposição no planejamento pré-operatório. No presente estudo, o alcance à JCV foi definido no período intraoperatório com neuronavegação em 10 pacientes operados pela via transnasal. O limite anatômico obtido foi comparado com as linhas nasopalatina e palatina. A linha nasopalatina mostrou ser o melhor método para prever o alcance inferior à JCV.It is expected reduction of surgical complications when craniovertebral junction pathologies are operated using the endoscopic transnasal approach instead of the transoral approach. However, it is yet unclear what is the lower extent of the transnasal approach and which method is better to predict this lower limit in preoperative planning. This study evaluates the inferior exposure of craniocervical junction in 10 patients operated through the transnasal approach using neuronavigation. The intraoperative anatomical limit was compared to nasopalatine and palatine lines. The nasopalatine line predicts more accurately the inferior limit of the transnasal approach.
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Bouyer, Benjamin. "Utilisation des bases de données médico-administratives pour la recherche clinique et épidémiologique en orthopédie." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS462.
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Le Système National des Données de Santé comprend des données portant sur l’ensemble des activités de soins en France (soins de ville, séjour hospitalier, prestations sociales en lien avec la maladie), auxquelles doivent être notamment associées des données de mortalité (causes de décès, en cours) et sur le handicap (à terme). De multiples travaux ont déjà montré l’intérêt de l’analyse de ces données à des fins de recherche, dans des domaines variés (études épidémiologiques de pathologies ou de groupes de patients, évaluation de produits de santé ou études médico-économiques). L’application à des fins de recherche en orthopédie est assez récente. Cette discipline chirurgicale présente des spécificités en termes de données que nous avons développées dans la première partie de ce travail, en particulier concernant les dispositifs médicaux utilisés. La connaissance de ces données a permis de réaliser une évaluation du fardeau national engendré par les fractures en France. Plus de 562 000 évènements ont été identifiés en 2016 concernant 1 % de la population adulte et près de 12 000 (2%) étaient suivis de décès précoce. L’analyse détaillée a montré des spécificités par site fracturaire et par sexe avec pour tous les groupes une importante augmentation de l’incidence avec l’âge. La troisième partie de cette thèse est consacrée à l’analyse du risque thrombo-embolique après chirurgie rachidienne. L’analyse de données individuelles détaillées a permis de montrer que le risque (de près 1% en population générale) était largement modulé par des facteurs liés aux patients et aux actes réalisés.Le Système National des Données de Santé offre comme nous le montrons dans cette thèse de vastes opportunités pour la recherche en orthopédie. Des travaux préparatoires, notamment dans le domaine de la fiabilisation des mesures d’efficacité, sont encore nécessaires pour répondre à certaines questionsThe National Health Data System includes data on all health care activities in France (outpatient care, hospital stay and social benefits related to diseases), which should be associated with mortality (causes of deaths, ongoing) and disability data (in the middle term). Many studies have already shown the interest of the analysis of these data for research purposes, in various fields (epidemiological studies of pathologies or groups of patients, evaluation of health products or medico-economic studies). The application for orthopedic research purposes is fairly recent. This surgical discipline has specificities in terms of data that we have exposed in the first part of this work; especially with regard to medical devices. The knowledge of these data made it possible to carry out an assessment of the national burden caused by fractures in France. More than 562,000 events were identified in 2016 for 1% of the adult population and nearly 12,000 (2%) were followed by early deaths. The detailed analysis showed specificities by fracture site and by sex with a significant increase of incidence with age for all groups. The third part of this work is devoted to the analysis of thromboembolic risk after spinal surgery. Analysis of detailed individual data has shown an intermediate risk (close to 1% in the general population) largely modulated by factors related to patients and surgical procedures performed.The National System of Health Data offers as we show in this thesis vast opportunities for research in orthopedics. Preparatory works, particularly in the field of the reliability of measures of efficacity of treatments are still needed to answer certain questions
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Tschöke, Sven Kevin. "Moderne Behandlungstrategien in der chirurgischen Therapie der pyogenen Spondylodiszitis der Lendenwirbelsäule." Doctoral thesis, Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-211061.
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Die pyogene Spondylodiszitis als bakterielle Osteomyelitis der Wirbelsäule ist eine seltene Entität der bakteriell-entzündlichen Pathologien des Stütz- und Bewegungsapparates. Trotz adäquater Behandlungsstrategien, wird auch heute noch eine Mortalitätsrate von 5% bis 20% beschrieben. Vor allem die in dem vorwiegend älteren Patientenkollektiv deutlich erhöhte Prävalenz an metabolischen oder kardiopulmonalen Komorbiditäten fordert moderne Therapiekonzepte, die eine risikoarme, jedoch effektive Eradifizierung des bakteriell-entzündlichen Fokus mit schneller Wiederherstellung der prämorbiden Mobilität ermöglichen.
Ausgehend von zwei grundlagenwissenschaftlichen Studien, wurden in der vorliegenden Habilitationsschrift zunächst die komplexen Zusammenhänge von lokaler Gewebsveränderungen und systemischer Entzündung erörtert. Hierbei zeigten die Analysen humaner degenerativer und traumatischer Bandscheibenzellen, dass die Apoptose, insbesondere die Herabregulation anti-apoptotischer Schlüsselkomponenten wie das Bcl-2, als mögliche Schnittstelle im katabolen Stoffwechsel der extrazellulären Bandscheibenmatrix diskutiert werden kann. In der generalisierten bakteriellen Entzündung (Sepsis), ließ sich durch die gentherapeutisch gewebsständige Überexpression von antiapoptotischen und antiinflammatorischen Interleukin-10 (IL-10), auch im IL-10-defzienten Organismus, eine deutliche Reduktion der systemischen proinflammatorischen Immunantwort mit verbesserter Überlebensrate septischer Tiere erzielen.
Jedoch birgt der substantielle Gewebeschaden bei pyogener Spondylodiszitis nicht selten die Gefahr der konsekutiven Instabilität mit neurologischen Komplikationen und stellt damit eine besondere chirurgische Herausforderung dar. Daher wurden in drei weiteren klinischen Studien unsere, in den letzten 10 Jahren etablierten, lösungsorientierten Strategien erläutert.
Zur Überbrückung größerer knöcherner Defekte gelang mit der Implantation expandierbarer Titancages eine sichere knöcherne Durchbauung mit vollständiger Ausheilung des Infektes. Im Beobachtungszeitraum von mehr als 3 Jahren war bei keinem der Patienten ein Infektrezidiv zu verzeichnen. In komplexen Fällen von monosegmentaler Spondylodiszitis der LWS mit multisegmentaler epiduraler Abszedierung, führte die epidurale Katheterspülung über den dorsalen Zugang für die Spondylodese zu einer folgenlosen Ausheilung. Damit konnte ein zusätzliches, iatrogenes Trauma mit multisegmentalen Lamintomien über die Distanz des epiduralen Abszesses vermieden werden. In einer weiteren Studie mit einem Beobachtungszeitraum von bis zu 5 Jahren, erzielte die Implantation von Poly-Ether-Ether-Keton (PEEK) Cages zur dorsalen intersomatischen Fusion bei pyogener Spondylodiszitis eine sehr gute, stabile knöcherne Durchbauung des infizierten Segmentes, ebenfalls ohne Infektrezidiv. Diese Abweichung vom herkömmlichen Standard mit Titanimplantaten erwies sich somit als sichere Alternative mit den für PEEK charakteristischen, verbesserten Eigenschaften.
Im Vergleich zu herkömmlichen Operationsverfahren, verspricht die Integration dieser Ergebnisse in die Weiterentwicklung minimal-invasiver Techniken, insbesondere im multimorbiden Patientenklientel, mindestens gleichwertig gute Ergebnisse bei deutlich reduziertem Operationstrauma.
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Vendrame, José Roberto Benites. "Ensaios mecânicos e estudo histológico da interface dos implantes vertebrais." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-29062007-142851/.
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A cirurgia da coluna vertebral tem se desenvolvido muito nos últimos anos em decorrência da evolução dos sistemas de fixação. O comportamento da interface do parafuso com o osso continua sendo um aspecto não muito dominado. Como o parafuso é a âncora de sustentação, o trabalho procura investigar as técnicas de introdução do parafuso pedicular. Para atingir esse objetivo desenvolvemos o trabalho por meio de estudo com ensaios mecânicos de arrancamento e estudo histológico. Dois tipos de parafusos pediculares foram utilizados: parafuso pedicular do sistema USIS (Ulrich) e parafuso pedicular do sistema USS (Synthes). Os ensaios de arrancamento foram realizados em corpos de prova de madeira e poliuretano. O estudo histológico foi realizado em vértebras lombares de cadáver humano. No estudo envolvendo o parafuso USIS, foram testados os seguintes parâmetros: orifícios feitos com sonda e orifícios feitos com broca, todos do mesmo diâmetro do diâmetro interno do parafuso. Também foi testado o efeito do macheamento em relação ao não macheamento, nos orifícios feitos com broca. No estudo com os parafusos USS foram testados o efeito do diâmetro do orifício piloto tanto no estudo histológico como no arrancamento. No arrancamento destes parafusos também foi testado o efeito do tipo de orifício feito com sonda e com broca. O trabalho foi dividido em etapas: Primeira etapa foi o estudo de arrancamento do parafuso USIS; segunda etapa, estudo histológico de vértebra instrumentada com parafuso USIS, esta parte do trabalho foi constituída por análise de microscopia de luz e microscopia eletrônica de varredura; terceira etapa foi o arrancamento do parafuso USS; e quarta etapa foi o estudo histológico de vértebra instrumentada com parafuso USS. Os resultados da primeira etapa demonstraram que sonda teve efeito melhor do que broca, porque o resultado dos ensaios de arrancamento nos orifícios feitos com sondas teve maior força de arrancamento do que nos orifícios feitos por brocas. Na segunda etapa, análise histológica, verificou-se que os orifícios feitos por sonda apresentaram-se menores e com menor índice de fragmentação ao redor dos orifícios. Esses feitos tiveram diferença estatística significante, tanto na primeira, quanto na segunda etapa. Com relação ao macheamento não foi constatada diferença entre o não macheamento, em nenhuma das duas etapas. Na terceira etapa foi observado que, quando o orifício piloto ultrapassa o diâmetro interno do parafuso, ocorre tendência de queda na força de arrancamento de modo significativo, enquanto que orifício menor que o orifício piloto não tende a causar muita diferença na força de arrancamento em relação ao orifício correspondente ao diâmetro interno do parafuso. Também foi observado que o orifício feito com sonda oferece melhor força de ancoragem do que orifício feito com broca. Na quarta etapa foi constatado que quanto menor a broca para abrir o orifício piloto, menor o diâmetro do orifício, e não houve diferença significativa quanto ao índice de fragmentação ao redor do orifício entre os diferentes tamanhos de broca. Como conclusão pode-se dizer que sonda é melhor para se fazer o orifício piloto, uma vez que alarga menos o orifício, lesa menos as trabéculas ao redor do orifício e proporciona maior força de ancoragem do que broca. Também se pode concluir que o instrumental de menor diâmetro para abertura do orifício piloto é melhor, e o ponto crítico seria o diâmetro interno do parafuso. Não se deve fazer orifício piloto com instrumento de diâmetro maior que o diâmetro interno do parafuso. Não se constatou vantagem em relação ao fato de realizar ou deixar de realizar o macheamento.Spine surgery has developed a lot in the last years because of the evolution of the fixation system. The behavior of a screw in the bone is still unknown in many ways. Because the screw is the anchor of sustentation, this work tries to find the answers involving the pedicle screw fixation. To reach this objective we developed this work based on mechanical and histological studies. Two kinds of pedicle screws were used: pedicle screw of the USIS (Ulrich) and pedicle screw of the USS system (Synthes). The pullout tests were made in wood and polyurethane. The histological study was done in lumbar vertebra of humans. In the study about the USIS screw, the follow parameters were tested: hole done with probe and hole done with drill, all of the same inner diameter of the screw. The effect of tapping and not tapping the hole done with drill was tested. In the USS screw study, the effect of the diameter pilot hole in the pullout tests and its historical analysis was seen. In the pullout tests of these screws, both kind of holes done with probes and a drill were tested. The work was divided into stages; first stage was the study of the pullout of the USIS screw; second stage was two studies, a light-microscopic one and a sweeping-electronic-microscope one of the slides of the instrumented vertebra with USIS screws; third stage was the study of the USS screws pullout comparing the relationship between the diameter of the holes and the inner diameter of the screw together with the type of hole (drill and probe); fourth stage was light-microscopic histological study of the instrumented vertebras which had had USIS screws. Results of the first stage showed that probes were more efficient than drills because the mechanical tests of pullouts from probe-made-holes showed the need of the use of a stronger force. In the second stage, a light-microscopic analysis showed that probe-made-holes had a lesser minimum diameter and a lower index of fragmentation than drill-made holes. With relation to the tapping, there was no difference between the holes. Under electronic microscope sweeping, it was seen that probes betters compact the bone around the screw. In the third stage, it was seen that when 9 the pilot orifice was greater than the screws internal diameter a significantly lower force was needed for pullout, while when the pilot orifice was smaller it did not significantly increase the force needed. It was also seen that probe-made-holes had a better anchorage than the drill-made-holes. In the fourth stage, the histological analysis of the slides done with light-microscopy showed that the smaller the diameter of the drill the smaller minimum diameter; there was no significant difference between fragmentation indexes. Conclusion: Probes are better than drills to make a pilot hole because they cause less damage to the surrounding bone and give a stronger anchorage for the screw; the smaller the instrument used to make the pilot hole, better will be the strength of the screws anchorage; the critical point which the hole must not exceed is the internal diameter of the screw. Tapping, or not, makes no difference to the anchorage.
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Zirkle, Dexter. "The Development of the Anterior Inferior Iliac Spine: A Comparative Analysis Among Hominids and African Apes." Kent State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1427206046.
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Joffe, Naomi Eve. "Evaluation of a body pillow to aid pediatric spinal fusion recovery." Atlanta, Ga. : Georgia State University, 2009. http://digitalarchive.gsu.edu/psych_theses/61/.
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Thesis (M.A.)--Georgia State University, 2009.Title from title page (Digital Archive@GSU, viewed June 25, 2010) Lindsey L. Cohen, committee chair; Erin Tone, Chris Henrich, committee members. Includes bibliographical references (p. 40-44).
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Berki, Visar. "In Vitro Cadaveric Biomechanical Study on Spinal Deformity Correction." University of Akron / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=akron1374507715.
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Seicean, Andreea. "Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448.
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Schäffler, Christian Aljoscha. "Experimentelle Studie zum Vergleich der Computernavigation mit 2D- und 3D-Bildwandlertechnologie am Beispiel der Pedikelschraubeninsertion im Bereich der LWS." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2006. http://dx.doi.org/10.18452/15405.
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Im Rahmen einer experimentellen Vergleichsstudie zweier bildwandlergestützter Navigationssysteme wurde die 3D-bildwandlergestützte Navigation mit der 2D-bildwandlergestützten Navigation zur Pedikelschraubenplatzierung am Modell getestet. Neben der Präzision der Bohrungen in einem postoperativen CT wurden Bildqualität, Genauigkeit des 3D-Scans, Planbarkeit und Umsetzung der Bohrungen bewertet und verglichen. Mit der 3D- Bildwandler- Navigation wurden 38 der 40 Bohrungen exakt platziert (95%). Eine Planung wurde durch einen Softwarefehler der Alpha-Version auf dem Monitor falsch wiedergegeben. Bei einer weiteren Bohrung wurde der Bohrer verkantet, wodurch Bildschirmdarstellung und Realität voneinander abwichen. Daher kam es in einem Fall zu einer lateralen Perforation der Kortikalis im Bereich des Pedikels, im anderen zu einer kaudalen Perforation. Mit der 2D- Bildwandler- Navigation konnten alle 40 Schrauben ohne Pedikelperforation platziert werden. Zwei dieser Schrauben wurden durch die ventrale Kortikalis gebohrt. Beide Verfahren überzeugten durch hohe Präzision und Zuverlässigkeit. 3 der 4 Fehlplatzierungen waren Anwender einer Software bedingt. Eine optimierte Software und verbesserte Instrumente werden diese Fehlerquote weiter reduzieren. Voraussetzung für die 2D-bildwandlergestützten Navigation sind eine gute Bildqualität sowie normale anatomische Gegebenheiten für standardisierte Projektionen. Die neue 3D-bildwandlergestützter Navigation kombiniert die Vorteile der 2D-bildwandlergestützter Navigation und der CT- basierten Navigation mit einer Verringerung der Strahlenbelastung durch den Wegfall des präoperativen CT`s und somit der Einsatzmöglichkeit im akuten Notfall sowie nach intraoperativen Repositionsmanövern. Da kein Matching erforderlich ist, wird insbesondere bei traumatischer Verletzung oder tumorbedingter Veränderung der dorsalen Wirbelstrukturen ein großer Vorteil zur CT- basierten Navigation erwartet. Aufgrund der universellen Einsatzmöglichkeiten eines Bildwandlers wird für diese neue Technologie ein breites Indikationsspektrum angenommen.An experimental study to compare 2D- and 3D- Computer-Assisted Fluoroscopic Navigation for pedicle screw placement. Each system was evaluated by a post-operative CT and included the comparison of the palpation of the pedicular canal, the image quality and the accuracy of planning and performance. For this purpose 40 screws have been set to 9 models of lumbar spine. Using the 3D-flouroscopy based navigation 38 from 40 (95%) drillings were placed correctly. One mistake was caused by an error of the navigation-software. The second mistake was due to a drilling mistake, the drill was not shown correctly on the monitor because the drill has been canted. Using the 2D-flouroscopy based navigation all screws could be placed correctly at the pedicle, but two times the corpus has been perforated to ventral. Both techniques are precise and reliable. 3 out of 4 mistakes were caused by incorrect handling the instrument. The other mistake happened because of a software-error. If the software and the instruments will be optimised, the amount of mistakes will be reduced in the future. In case of the 2D-flouroscopy based navigation sufficient image quality, normal anatomical structures and defined projections are required. The new 3D-flouroscopy based navigation combines the benefit of 2D-flouroscopy based navigation and CT-based navigation by reducing the radiation exposure and the preoperative planning time. Therefore, this technique is suitable for use in an emergency or intraoperative repositions. Because no matching-procedure is necessary for CT-based navigation, we expect advantages especially in therapy of traumatic injuries or changes at the dorsal structures of spine caused by tumour. Furthermore, the use of fluoroscopic based navigation extends the range of applications/the spectrum of indication for this new technology.
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King, Jason. "Energy Release Management Through Manipulated Geometries of Surgical Devices." University of Akron / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=akron1342730044.
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Mont'Alverne, Francisco José Arruda. "Resultados da vertebroplastia percutânea na doença vertebral cervical." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-13022009-141428/.
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A vertebroplastia percutânea (VP) consiste na injeção de polimetilmetacrilato (PMMA) no corpo vertebral para alívio da dor e estabilização vertebral, porém seu uso na região cervical é restrito. No intuito de avaliar a efetividade e a segurança da VP na região cervical (VPC), foram avaliados 75 pacientes que se submeteram à VPC (n=101) por doença maligna (n=69) ou hemangioma vertebral (n=6) no período de janeiro de 1994 a outubro de 2007. A VPC foi realizada por uma abordagem ântero-lateral guiada por fluoroscopia. A dor foi graduada por uma escala variando de 0 a 10. O seguimento clinico (período médio de 8,8 meses) foi obtido em 57 (76%) pacientes: 48 tiveram a VPC indicada para controle da dor e nove para estabilização vertebral. Os dados foram analisados de forma univariada e multivariada. A efetividade analgésica foi obtida em 37 (77,1%) dos 48 pacientes seguidos, tendo sido associada ao volume de cimento injetado (P=0,011) e ao preenchimento vertebral (P=0,007) na análise multivariada. A estabilidade vertebral foi observada em 55 (96,5%) dos 57 pacientes, não se correlacionando com as variáveis estudadas. A curva de ROC identificou o preenchimento vertebral como preditor da efetividade analgésica (P=0,008), sendo 50% o melhor ponto de corte para discriminar a maior probabilidade de efetividade analgésica (sensibilidade de 78,0% e especificidade de 62,5%). O extravasamento de cimento foi identificado em 83 (82,2%) das 101 vértebras tratadas não se correlacionando com as variáveis estudadas. As complicações clínicas foram detectadas em 13 (17,3 %) pacientes: complicações locais em 10 (13,3%) e sistêmicas em três (4%) pacientes. As complicações clínicas foram estatisticamente relacionadas à ruptura do muro posterior (P=0,026) e ao extravasamento de PMMA no plexo venoso transverso (P=0,023). A taxa de mortalidade e morbidade a longo termo foi de 1,3% (um paciente) e 1,3% (um paciente). Pode se inferir que a VPC é um procedimento efetivo e seguro, sem se negligenciar os riscos potenciais de complicações. O preenchimento vertebral e o volume de cimento foram associados à efetividade analgésica, mas não à estabilidade vertebral. O preenchimento vertebral teve o maior poder discriminatório da efetividade analgésica, tendo sido obtido com o ponto de corte de 50 % o melhor equilíbrio entre sensibilidade e especificidade para se determinar a efetividade analgésicaPercutaneous vertebroplasty (PV) consists of an injection of polymethylmethacrylate (PMMA) into the vertebral body for pain relief and spinal stabilization, however reports of PV in the cervical spine (CPV) are scarce in the literature. To evaluate the effectiveness and security of CPV, we evaluated 75 patients (mean age, 51.3 years) who underwent CPV (n=101) for malignancies (n=69) and vertebral hemangiomas (n=6) between January 1994 and October 2007. CPV was performed via an antero-lateral approach, using fluoroscopic guidance. Pain intensity was scored with a scale ranging from 0 to 10. Follow-up (mean time of 8.8 months) was avaible in 57 (76 %) patients: 48 of them had CPV indicated for pain control and nine for spinal stabilization. Data were analysed by means of univariate and multivariate analysis. Pain improvement was observed in 37 (77.1%) out of 48 followed patients and was correlated in multivariate analysis with cement volume (P=0.011) and with vertebral filling (P=0.007). Spinal stabilization was observed in 55 (96.5%) of 57 followed patients and was related with none of the evaluated variables. The ROC curve identified the vertebral filling as a good predictor of pain improvement (P=0.008). The best cut-off point to discriminate pain improvement was 50% of vertebral filling (78.0% sensitivity and 62.5% specificity). In 83 (82.2%) of the 101 treated vertebral levels, at least one type of PMMA leakage was found. None of the evaluated factors were related significantly to PMMA leakage. Clinical complications were detected in 13 (17.3%) patients: local complications in 10 (13.3%) patients and systemic clinical complications in three (4.0%) patients. Posterior wall disruption (P=0.026) and transverse venous PMMA leakage (P=0.023) were significantly associated with clinical complications. Long-term morbidity and mortality rate was 1.3% (one patient) and 1.3% (one patient). CPV is a safe and efficacious procedure, but the potential for local and systemic complications must be considered. Cement volume and vertebral filling were associated with pain improvement but not with spinal stability. Vertebral filling has a good performance to predict pain improvement and a cut-off of 50% of vertebral filing obtained the best compromise between sensitivity and specificity to discriminate pain improvement