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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fracture of the distraction rod is one of the complications following operative treatment of scoliosis by the device of Harrington. It is reported to occur in about 7% of cases. We found this complication twice in our own number of 41 patients during a follow up period of 1 to 4 years. The rods had broken 18 and 23 months after operation, but we never saw a breakage in the 1st postoperative year during the time of cast fixation. The fracture surfaces of each rod were examined under the scanning electron microscope. In one case a fatigue fracture with two beginnings at the opposite sides of the rod was found in combination with a forced fracture in the middle. The number of alterations of load from the beginning of the fracture to the complete breakage was about 10,000. The X-ray showed a loss of correction in the curve of 20 degrees with a pseudoarthrosis visible in the fusion. In the other case a typical pure fatigue fracture was seen 23 months after the operation with 18,000 alterations of load. The X-ray showed only a slight loss of correction of less than 5 degrees and no pseudoarthrosis was visable, neither in the X-ray nor in the operative exploration of the fusion. The breakage of the distraction rod results not only from a pseudoarthrosis but also from other explained facts of the procedure. Further treatment depends on a proven pseudoarthrosis.
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PMID:Damage analysis of the Harrington rod fracture after scoliosis operation. 52 22

Twenty-six patients with progressive neuromuscular scoliosis underwent anterior/posterior (AP) spinal fusion. Thirteen of the patients underwent a one-stage fusion, and 13 underwent a two-stage fusion. Although one-stage AP spinal fusion provides adequate correction of severe curves and allows a more expeditious recovery without increasing patient morbidity or mortality, current third-party payor reimbursement policies provide little incentive for 1-day operations. In addition, the procedure is mentally and physically demanding and the apparent benefits must be weighed against the potential harm that can result from surgeon fatigue or lack of appropriate planning.
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PMID:Comparison of one-stage versus two-stage anterior/posterior spinal fusion for neuromuscular scoliosis. 151 21

The basic principles for scoliosis surgery learned during the Harrington era are still valid today. Experience has confirmed the need for careful selection of the vertebrae to be instrumented, the value of anterior release for rigid curves in imparting convertibility of the deformity, and the importance of careful fusion techniques. During the last decade, further development has occurred because of an increased knowledge of the biomechanical needs for the internally instrumented spine and a three-dimensional appreciation of the scoliotic curve. Biomechanical advances have centered on an understanding of the load-sharing properties afforded by the multiple spinal purchase sites (segmental spinal instrumentation) and the value of two-rod systems linked by couplers. These advances have provided an increased stiffness of the instrumental spine, a reduction in correction loss, improved fatigue properties of the implant, and fewer pseudarthroses. The most important advance of the last decade is an improved awareness of the three-dimensional approach to the scoliotic deformity with the need to preserve or improve sagittal contours. In particular, the importance of the loss of normal thoracic kyphosis or lumbar lordosis has been emphasized. These conceptual gains have led to the development of many new instrument systems to correct deformity. Each is associated with advantages, problems, and risks that must be understood to make intelligent choices for treatment.
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PMID:A perspective on recent trends for scoliosis correction. 199 56

A questionnaire was sent to 206 consecutive patients who were operated on for idiopathic scoliosis by Dr. Paul R. Harrington between 1961 and 1963. Eighty-three per cent of the patients responded to the questionnaire, which consisted of five sections: demographic data, activities of daily living, back symptoms (pain and fatigue), a history of personal and family health, and a personal assessment of the back. One hundred and eleven patients also sent recent radiographs. A control group, comprising 100 individuals who did not have scoliosis and had been matched for age and sex, was given the same questionnaire. The study group had more pain in the interscapular and thoracolumbar regions compared with the control group, but there was no difference with respect to pain in the lumbosacral area or the low back. Neither pain nor fatigue was related to the type of curve, the preoperative degree of curvature, the degree of curvature as seen on the most recent radiograph, the extent of fusion into the lumbar spine, or the presence of a broken rod. Twenty-one years after the operation, the patients were functioning quite well compared with the control subjects.
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PMID:Harrington instrumentation and arthrodesis for idiopathic scoliosis. A twenty-one-year follow-up. 214 36

This paper focuses on peri-adolescent, mild idiopathic scoliosis. The AA present an noninvasive, non hazardous, and dynamical method for photographically individualizing the subject's back discrepancies which manifest themselves between the first and second photos (interval-15 min). After a few minutes in the erect posture, under the subject's fatigue it may be possible to notice and record significant displacement of certain bone prominences. For measuring purposes, the AA utilize a plumb-line, the superior end being applied to the 7th cervical vertebra prominence and the inferior heavy and the level of the line extending between the two posterior--superior iliac spines as indicate by cutaneous landmarks. The subject adaptation and standardized photographic examination are very simple and not expensive. It deals with many medical requirements of pediatric, preventive, rehabilitative and sport medicine. The case is relevant in its postural distortion and orthopedic and rehabilitation specialists are involved. The entity of postural discrepancies was assessed by the AA by means of the case- studies of peri-adolescent subjects. The first case-study (1st group) represents subjects who were submitted to a regular program based on trunk brace and exercises, the second one (2nd group) who were not. The first group showed a better curvature evolution as the x-ray have confirmed in a 24 months follow up. By means of our dynamical study the subject's back postural discrepancies were considered of relevance being the dislocation of the plumb-line distal end with respect to the PSISs' line besides an arbitrarily chosen threshold value. This value is 1/5 of the distance between the two PSISs. The above described dislocation was assessed both in inferior and lateral direction. A relevant descent of the heavy plumb-line is characteristic of a vertebral axial failure (the spine shortens for increase of its curves both in the frontal and in the antero-posterior planes) with a major back trunk inherent distortion. A relevant tilting of the heavy end of the plumb-line means lateral entire subject imbalance (the spine tilts laterally). Of course, combinations of both unfavorable features were frequently possible. Summarizing, the postural imbalance becomes worse together with the curvature seriousness deterioration, i.e. chiefly in the non-compliant patients. Therefore it is to be noticed the entire spine tilting as relevant both in the 1st group and in the 2nd group of patients (24% versus 25%).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Early diagnosis (non-invasive and dynamic) of postural disequilibria in adolescent scoliosis]. 248 98

Wire breakage is frequently mentioned in Luque rod instrumentation with segmental sublaminar wiring, but breakage of the Luque rod is rare. A case report of a broken Luque rod in a patient following a scoliosis post-corrective operation is presented and a metallurgical analysis is provided to evaluate the mechanism of breakage. In the metallurgical analysis, we find many slots and dimples on the rod surface which were induced by an inappropriate bending apparatus and bending manipulation. These defects resulted in a stress concentration effect and initiated fatigue. As for the stress on the rod, this resulted from the force correcting the scoliotic deformity plus the load resulting from patient's daily activity, which increased the progression of fatigue and then induced the final breakage. So, to avoid Luque rod breakage we suggest that the bending manipulation be done appropriately, with external orthosis given to those patients with severe deformity or who are daily very active.
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PMID:[A case report and metallurgical analysis of broken Luque rod]. 263 19

Fourteen patients with degenerative spondylolisthesis and three patients with degenerative scoliosis, all of whom experienced low-back pain, lumbar radiculopathy, and/or intermittent claudication were treated with posterolateral fusion and correction of deformities using a new instrumentation system. This new spinal fixation system combines the advantages of a rod for scoliotic deformities and a plate for sagittal plane disorders. The combination rod-plates can apply multiple forces to facilitate correction of complex deformities as well as enable indirect neurologic decompression. The system allows segmental rigid fixation via transpedicular screws that is limited only to the abnormal vertebral levels to preserve the maximum number of uninvolved lumbar motion segments. The physiologic lumbar lordotic curvature is also preserved. The minimum follow-up period was 1 year. Satisfactory results were obtained in 15 patients (88%). No intraoperative complications occurred. Screw fatigue occurred in two patients at 1-year follow-up examination with no sequelae. The scoliotic and spondylolisthetic deformities were reduced significantly in all patients. This method appears to assist in reducing pathologic motion and deformities that contribute to low-back pain. Compression on neural structures is relieved by thorough decompression and distraction; spinal canal anatomy is also restored.
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PMID:Degenerative spondylolisthesis and degenerative scoliosis treated with a combination segmental rod-plate and transpedicular screw instrumentation system: a preliminary report. 298 Feb 52

The breathing pattern and mouth occlusion pressure developed in 0.1 seconds (P0.1) were measured at rest in sixteen young scoliotic patients in whom the blood gases were within the normal limits. The patients exhibited rapid and shallow breathing. P0.1 was increased above normal, indicating a compensatory increase of neuromuscular inspiratory drive in the face of a stiffer respiratory system. P0.1 (% predicted) correlated positively with the angle of scoliosis. Both duration of inspiration and inspiratory duty cycle correlated negatively with angle of scoliosis and P0.1 (% predicted). On theoretical grounds we show that these changes in breathing pattern are beneficial, both in terms of reducing the energy cost of breathing and preventing the development of inspiratory muscle fatigue.
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PMID:Breathing pattern and load compensatory responses in young scoliotic patients. 316 12

The mechanical performance of contoured Luque rods in a neuromuscular model of spine deformity was examined to define an upper limit of deformity above which rod stresses would exceed the endurance limit for 316L stainless steel and therefore predict fatigue failure. Bovine constructs varying from 0-120 degrees scoliosis were loaded axially, with strain recordings obtained at the apex of the curve. Relatively low loads produced enough tensile stress to contemplate implant fatigue in all except the nondeformed (0 degrees) construct. Construct stiffness was found to decrease rapidly in spines with greater than 38 degrees deformity. In addition, data on patients who had suffered rod fracture from four different centers were found to compare favorably with experimental observations. We conclude that the vulnerability of Luque rod constructs to implant failure, from a mechanical standpoint, is greater than is generally assumed. Cross-linking of rods was found to increase stiffness. Methods to decrease tensile stresses in the implants and increase stiffness include external immobilization, larger diameter rods, and procedures to enhance correction.
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PMID:Mechanical consequences of rod contouring and residual scoliosis in sublaminar segmental instrumentation. 357 90

A total of 187 random cases of untreated idiopathic scoliosis, seen from a minimum of 15 to a maximum of 47 years after the end of growth, were reviewed. All curves increased after skeletal maturity (average progression: 0.4 degrees per year). Thoracic curves tend to progress more than lumbar, lumbar more than thoracolumbar, and thoracolumbar more than double major curves. Pain was present in 114 cases (61%) and appeared more frequently in women, after pregnancies, and with fatigue. Cardiopulmonary symptoms were present in 42 patients (22%), especially those with thoracic and thoracolumbar curves greater than 40 degrees. Psychologic disturbances were found in 35 cases (19%), mostly female patients with thoracic curves greater than 40 degrees. The cosmetic appearance of these patients at long-term follow-up was better compared with that at the end of growth, even though the curves progressed. Patients with decompensation of the trunk at the end of growth seemed to improve with time. In an unselected group of patients with severe curves a mortality rate of 17% was found, twice as much as in the Italian general population.
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PMID:Natural history of untreated idiopathic scoliosis after skeletal maturity. 381 Feb 93


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