Mobility in the Lumbosacral Spine After Fusion Studied with the Aid of Roentgen Stereophotogrammetry

Olsson, Tord; Selvik, Göran; Willner, Stig

doi:10.1097/00003086-197711000-00022

Cited by 53 publications

(13 citation statements)

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“…If this understanding is correct, disc excision and interbody fusion should be an appropriate treatment [93]. On the other hand, posterolateral fusion with or without instrumentation may not completely eliminate sagittal motion in the anterior column and back pain may still persist despite solid fusion [76,133,139].…”

Section: Low-back Pain Disordersmentioning

confidence: 99%

Pedicle screw fixation in spinal disorders: A European view

1997

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Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.

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Section: Low-back Pain Disordersmentioning

confidence: 99%

Pedicle screw fixation in spinal disorders: A European view

1997

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“…There are many in vivo s, 7,8,12,15,18,22,23 and in vitro 1,9,10,13,14,16,17,19,2o,24 studies on spine kinetics, but there is no consensus on a single diagnostic examination be disclose all the different components of the Functional Spine Units (FSUs). The consequence is a difficulty in developing a global view of the possible patterns of spine dynamics.…”

Section: Introductionmentioning

confidence: 99%

Functional Evaluation of the Lumbar Spine with Axial Loaded Computed Tomography (AL-CT) and Cine AL-CT

Cartolari

1997

Rivista di Neuroradiologia

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This study reports a personal experience in the functional study of the lumbar spine with original diagnostic techniques called Axial Loaded Computed Tomography (AL-CT) and Cine AL-CT, based on the use of the Axial Loader, a device that develops a variable and reproducible axial load in a supine patient during computed tomography or magnetic resonance investigation 3 • 4 • We built a non ferromagnetic, X-ray transparent bed (the Axial Loader), with double blocking rests for shoulders and feet, that can be used during CT and MR spine studies. The inferior block is a platform that moves continuously in a longitudinal direction, with a micrometric mechanism. A dynamometer placed between the inferior platform and the patient's feet can measure the load applied.We studied 75 patients, with a clinical and diagnostic suspicion of lumbar spine instability. The examinations were performed on a conventional CT unit (GE Sytec 3000, General Electric, Milwaukee) with a "volumetric" approach to the lumbar spine.In conclusion,AL-CT and Cine AL-CT is currently the only diagnostic modality that can give dynamic information on the differents UFSs in all their components in one mildy invasive, easily reproducible diagnostic examination.Studio funzionale della colonna lombo-sacrale con tomografia computerizzata sotto carico assiale (Axial Loaded Computed Tomography: AL-CT) e Cine AL-CT RIASSUNTO -Tutti gli studi funzionali della colonna lombare sia in vivo che in vitro hanno evidenziato l'impossibilita di valutare direttamente, con un unico esame radiologico, tutte le componenti (ossee ed extra-ossee) del rachide lombare, nonche la difficolta di una visione d'insieme del rachide lombare. Il Compressore Assiale permette di produrre un carico assiale variabile e riproducibile in un paziente supino, ed e stato applicato a 75 pazienti (35 maschi, 40 femmine, eta media 46 anni) con sospetto clinico-radiologico di instabilita vertebrate lombare. E stato cos! realizzato un esame TC «volumetrico» del tratto lombo-sacrale (in genere L3-S1) dapprima in posizione di massimo scarico funzionale (paziente supino con lieve flessione delle gambe), quindi sotto carico assiale simulante l'ortostatismo (Axial Loaded-Computed Tomography: AL-CT). Sono stati evidenziati numerosi reperti funzionali a carico di tutte le componenti le diverse Unita Funzionali Spinali (UFS), classificati come Modificazioni Dinamiche Elementari (MDE): 1) modificazioni discali: a) scomparsa di vacuum intradiscale in 15 pazienti (segno del vacuum); b) comparsa di vacuum discale in 3 pazienti (vacuum in verso); c) aumento volumetrico/comparsa di protrusionilernie discali in 18 pazienti. 2) Modificazione dei rapporti intermetamerici: a) comparsa/incremento di listesi (con allargamento della eventuate lisi presente) in 18 pazienti; 569 Functional Evaluation of the Lumbar Spine with AL-CT and Cine AL-CT R. Cartolari b) riduzione di ampiezza, sino alla scomparsa, di uno o piu spazi intersomatici in 40 pazienti; c) incremento di ampiezza dello spazio intersomatico L5-S1 in 16 pazi...

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“…This radiostereophotogrammetric method can provide precise motion measurements, 18,19 but it necessarily involves implantation of metal markers as well as a laborious measurement process. This invasive method is not practical in many routine clinical scenarios.…”

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confidence: 99%