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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ethical concerns have hindered any randomised control blinded studies on the imaging required to assess the cervical spine in an unconscious trauma patient. The issue has been contentious for many years and has resulted in burgeoning but inconclusive guidance. MRI and multislice CT technology have made rapid advances, but the literature is slower to catch up. Never the less there appears to be an emerging consensus for the multiply injured patient. The rapid primary clinical survey should be followed by lateral cervical spine, chest and pelvic radiographs. If a patient is unconscious then CT of the brain and at least down to C3 (and in the USA down to D1) has now become routine. The cranio-cervical scans should be a maximum of 2 mm thickness, and probably less, as undisplaced type II peg fractures, can be invisible even on 1 mm slices with reconstructions. If the lateral cervical radiograph and the CT scan are negative, then MRI is the investigation of choice to exclude instability. Patients with focal neurological signs, evidence of cord or disc injury, and patients whose surgery require pre-operative cord assessment should be imaged by MRI. It is also the investigation of choice for evaluating the complications and late sequela of trauma. If the patient is to have an MRI scan, the MR unit must be able to at least do a sagittal STIR sequence of the entire vertebral column to exclude non-contiguous injuries, which, since the advent of MRI, are now known to be relatively common. Any areas of oedema or collapse then require detailed CT evaluation. It is important that cases are handled by a suitably skilled multidisciplinary team, and avoid repeat imaging due to technical inadequacies. The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques.
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PMID:Cervical spine clearance: a review. 1566 89

We performed curettage followed by autogenous bone grafting in several cases of steroid-related osteonecrosis of the femoral condyle, and reviewed the outcome of this procedure after a mean follow-up of 9.5 years. The number of patients was 4; the mean age at the time of the operation was 30.5 years. The mean Knee Society Objective Score was 52.5 before the operation and had increased to 87.5 at the time of the review. The pre-operative radiographic stages were stage 2 in 2 patients and stage 3 in the other 2 patients. Progression in the disease stage was observed in 3 patients. MRI revealed survival of the grafted bone in only one case, and collapse of the articular surface in all cases. In conclusion, though the clinical results showed improvement, the autogenous bone graft failed to answer the purpose of preventing the progression in disease stage.
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PMID:A long-term follow-up study of four cases who underwent curettage and autogenous bone grafting for steroid-related osteonecrosis of the femoral condyle. 1568 35

Published cases of non-traumatic avascular necrosis of the femoral head associated with pregnancy are rare. We report a case of a 41-year-old woman who suddenly complained of bilateral hip pain 3 weeks after delivery by Caesarean section. For a problem of sterility, she had been treated with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG). Initial radiographs of both hip joints were considered regular. After 4 years' evolution, radiographs of the hip joint showed collapse of both femoral heads. Bilaterally, osteonecrosis of the femoral heads was confirmed by MRI. MRI revealed a band pattern of low signal intensity for both hips on T1- and T2-weighted images. She had no history of steroid therapy or alcohol abuse. Osteonecrosis was related to pretentaine. A bilateral total hip arthroplasty was performed. The literature about avascular necrosis of the femoral head associated with pregnancy in previous cases is reviewed.
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PMID:Bilateral osteonecrosis of the femoral head after pregnancy. 1572 94

Fibrous dysplasia (FD) is an uncommon benign fibro-osseous abnormality of bone, of unknown aetiology and equal sex incidence, which is most commonly restricted to one bone (monostotic FD: MFD, 70%). Less commonly multiple bones are affected (polyostotic FD: PFD, 27%). Vertebral involvement is uncommon (4%), but more common with PFD (7 - 24%) than MFD (1%). Of 20 cases of FD involving the cervical spine, only three have represented MFD. Unlike cases associated with PFD, all cases presented with acute neck pain without significant neurological impairment after minor trauma. We present the case of a 35-year-old male with MFD who developed a pathological fracture of C3 following minor trauma. Radiographs showed collapse and typical 'ground glass' lucency of C3. CT revealed replacement of C3 cancellous bone by hypodense tissue extending into the right lateral mass. The cortex was thinned and fractured, and encroached upon the right foramen transversarium and spinal canal. Magnetic resonance imaging demonstrated hypo-intensity on both T1 and T2, with uniform contrast enhancement. Subtotal excision was achieved via an anterior C3 corpectomy, with residual FD left within the right lateral mass. Stability was achieved utilizing an iliac crest strut autograft, C2-4 plate-and-screws, and mobilization in a halo frame for 3 months. At 18 months, he remained asymptomatic and without deficit. Radiography, CT and MRI confirmed graft fusion without FD invasion, but with residual right lateral mass FD unchanged in size.
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PMID:Fibrous dysplasia of the cervical spine presenting as a pathological fracture. 1657 63

When left untreated, scaphoid fractures follow a downward spiral resulting in carpal collapse and arthritis. The purpose of intervention is to allow a cartilage-wrapped bone to heal and maintain a smooth articular surface. Proposed treatment options for scaphoid nonunions have varied success rates. Using the Mack-Lichtman classification for nonunions, a plan can be formulated for individual patients based on motion loss, degenerative changes, carpal collapse, and fracture instability manifested by bone loss. Stable nonunions may benefit from bone grafting and internal fixation. Unstable nonunions require grafting and fixation. With the development of arthritis, grafting and fixation must be weighed against suitability of a proximal row carpectomy or a four-corner fusion with scaphoid excision. Advanced carpal collapse and arthritis mandates fusion, either limited or complete. CT allows preoperative planning to assess grafting requirements. MRI defines vascular supply fa vascular graft is considered. Vascularized graft options have multiplied as attention has been focused on the impact of improved blood supply on the avascular scaphoid. Patient- and fracture-specific factors are important considerations when determining surgical options; underestimating their importance can compromise surgical results even with a high level of technical skill. Successful treatment of scaphoid nonunions remains a difficult challenge despite improvement in fixation devices and surgical options. By regarding injury status together with patient factors, surgical options can be narrowed and patient expectations managed more realistically.
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PMID:Current perspectives in the management of scaphoid nonunions. 1594 38

Syringo-subarachnoid shunting is a well-established procedure for the treatment of syringomyelia. However, the standard surgical procedure requires a laminectomy and posterior midline myelotomy, which have potential complications. In this study, we describe our clinical experience with a modified technique for syringo-subarachnoid shunt insertion in eight patients between 1998 and 2002. The technique comprises a limited hemilaminectomy, a 2 mm myelotomy at the site of dorsal root entry zone, introduction of a 1.5 mm thick catheter into the syrinx and placement of the distal tip of the catheter in the anterolateral subarachnoid space. Using this technique there was no operative morbidity or mortality. Collapse of the syrinx, in the first post-operative month, was demonstrated by MRI in all cases. There were no relapses in the follow-up period. Although our experience is limited and the results preliminary, this technique is less invasive than commonly used techniques and the results are favorable.
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PMID:A modified technique for syringo-subarachnoid shunt for treatment of syringomyelia. 1611 50

Obstructive sleep apnea (OSA) is a common disease with important neurocognitive and cardiovascular sequelae. Existing therapies are unsatisfactory, leading investigators to seek alternative forms of anatomic manipulation to influence pharyngeal mechanics. We have developed a two-dimensional computational model of the normal human upper airway based on signal averaging of MRI. Using the finite element method, we can perform various anatomic perturbations on the structure in order to assess the impact of these manipulations on pharyngeal mechanics and collapse. By design, the normal sleeping upper airway model collapses at -13 cm H2O. This closing pressure becomes more negative (ie, less collapsible) when we perform mandibular advancement (-21 cm H2O), palatal resection (-18 cm H2O), or palatal stiffening (-17 cm H2O). Where clinical data are available in the literature, the results of our model correspond reasonably well. Furthermore, our model provides information regarding the site of obstruction and provides hypotheses for clinical studies that can be undertaken in the future (eg, combination therapies). We believe that, in the future, finite element modeling will provide a useful tool to help advance our understanding of OSA and its response to various therapies.
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PMID:The impact of anatomic manipulations on pharyngeal collapse: results from a computational model of the normal human upper airway. 1616 25

Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3-6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. All patients were managed with surgical debridement and reconstruction and 12-week fluconazole treatment. The neurological deficits resolved completely. The infection has not recurred clinically or radiologically at 5-6 years follow-up. Although rare, Candida should be suspected as a causative pathogen in cases of spinal osteomyelitis. Without treatment the disease is progressive. As soon as osteomyelitis is suspected, investigations with MRI and percutaneous biopsy should be performed followed by medical therapy. This may prevent the need for surgery. However, if vertebral collapse and spinal cord compression occurs, surgical debridement, fusion and stabilisation combined with antifungal medications can successfully eradicate the infection and resolve the neurological deficits.
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PMID:Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases. 1642 90

Among 168 cases with neurologic findings of cervicothoracic syringomyelia and MRI findings of Chiari 1 malformation and/or underdevelopment of the posterior cranial fossa, 15 patients (9.1 %) had collapsed, flat syrinxes and 14 patients (8.3 %) did not have syrinxes. Both groups of patients had clinical findings of central myelopathy that had been stable for at least 3 years. Magnetic resonance imaging detected atrophy of the cervical spinal cord in both groups and spontaneous communications between the syrinx and the subarachnoid space in 3 patients of the group with collapsed syrinxes. Analysis of these results and review of the literature suggest that patients with clinical signs of syringomyelia and Chiari 1 malformation or underdeveloped posterior fossa, but with small or absent syringomyelitic cavities, have the "postsyrinx" state as a result of spontaneous collapse of distended syrinxes.
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PMID:The post-syrinx syndrome: stable central myelopathy and collapsed or absent syrinx. 1651 36

A fall onto the hand can be followed by ligament ruptures, bone fractures or dislocated fractures of the carpus. The diagnosis is based on history, clinical evaluation, and X-ray examination in two perpendicular planes, followed if necessary by CT scan or MRI scan. Lesions of the scapholunate ligaments cannot be definitely excluded except by arthroscopy. As well as fractures of the carpometacarpal joints, fractures involving the ring structure of the carpus or ligament ruptures between carpal bones are frequently observed, and these lead to significantly impaired biomechanics. The prognosis is poor. The discontinuity of the ring must be repaired by means of osteosynthesis and/or suturing ligaments, with the carpal bones held in place by temporary arthrodesis using K-wires. Dislocation in this region requires rapid realignment, as untreated perilunate dislocation or dislocation of the lunate bone will lead to serious secondary damage, which can only be treated by salvage operations involving loss of function. Inappropriate treatment of an injury to the heel of the hand can lead to carpal collapse.
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PMID:[Injury to the heel of the hand]. 1653 24


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