After the performance of a pilot study of 28 W.W. II veterans who had all had lumbar intervertebral fusion at least two years previously, an in-depth retrospective evaluation was performed on one hundred (100) Workmen's Compensation Board patients, all with a similar follow-up period subsequent to lumbar intervertebral fusion. All patient characteristics were evaluated, including historical, social, physical, radiological and psychological parameters. A success index was derived by factor analysis of twenty (20) variables all representing various aspects of the patients current functional status. This was used as a basis to analyze the remaining data by multiple correlations. These correlations were studied and 55 highly "success"-correlated variables were selected for further factor analysis. This factor analysis identified eight (8) factors closely associated with success or failure of the fusion operation. In order of importance they were identified thus: "Normally"-functioning lumbar spine. Mobility of body. Freedom from neuroticism. High pain tolerance. Minimum number of surgical operations. Freedom from persistent nerve root deficit. Optimism, ambition. General health and fitness. These eight orthogonal (totally non-correlating) factors alone independently accounted for approximately 80% of the variance of "success" as determined by the statistical index. It is felt that certain of these factors may be etiological in connection with the low back problem and prospective work is necessary to shed further light on this. The methods used in patient evaluation were examined and it is felt that certain of these measures are inadequately objective and involve measurement of several factors at one time. For example, measures of range of movement as conventionally used in orthopaedics were found to show a very high correlation with certain of the psychological measures of abnormality. Some showed poor correlation with age which is contrary to published data on the range of motion in different planes determined radiologically. It is suggested that alternative methods be used which would provide greater specificity. Increased use of quantitative radiological methods is suggested as this provides an accurate way of comparing patients from a purely structural viewpoint. The psychological profile of the patient is shown to be of great importance as twothirds of the patients showed an elevation of one or more Minnesota Multiphasic Personality Inventory scales over a T-score of 70; in a random population this figure would be approximately 3%. It is suggested that psychological evaluation should be used at all stages of low back pain disease to assist in management of the patient. Pseudarthrosis was determined to exist in the presence of two out of three radiological features: Movement at the fusion site on bending x-rays. Presence of a defect in the bone mass. Persistence of the posterior apophyseal joints. The presence of pseudarthrosis did not correlate significantly with success or failure of the operation. It is stressed that only information obtainable in an accurate way of all patients was used in this study and this prevented the use of operative reports, from the patients time of surgery which was frequently inaccurate and was not uniform in the information they provided. It was decided not to use symptomatic information as remembered by the patient from before his operation as this would be coloured by too many subsequent events and would not be matched by comparable physical, radiological or psychometric results. Similarly, success was not correlated with the individual surgeon as some surgeons were represented by too few cases and some patients would have been seen by several surgeonsaat different stages in their illness. This evaluation of the clinical and statistical methods provides much information of use in the clinical and prospective experimental setting. It does not attempt to provide definitive answers regarding the causes of low back pain: prospective investigation is required for this, and the nature of the required studies for this is outlined. / Surgery, Department of / Medicine, Faculty of / Graduate

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2002. x, 55 leaves / Chiropractic researchers have hypothesized as to how the removal of a cervical dysfunction may affect the nervous system negatively. However, little focus has been placed on possible optimizing effects, such as grip strength. This study attempted to establish that relationship. Therefore, the specific aim of this study was to determine the relative effectiveness of segmental manipulation of the cervical spine on grip strength in patients with mechanical cervical spine dysfunction.

Thesis (MSc. (Clinical Psychology)) -- University of Limpopo (Medunsa Campus), 2012 / Spinal cord injury (SCI) is believed to place the individual at a high risk of psychological turmoil. This study explored the subjective experiences of SCI persons, by exploring the psychological effects of SCI at Dr. George Mukhari Hospital. To achieve this, the primary objectives of the study were to; explore the psychological effects faced by SCI individuals; and explore the impact of these effects in their lives and well-being. Participants included eight SCI persons who were in the rehabilitation programme. A qualitative exploratory enquiry approach was utilised, by conducting semi-structured interviews. Data was analysed using a thematic analysis. Two main themes emerged: the psychological effects of SCI and impact of these effects on the well-being of the person. The psychological effects faced by SCI persons were linked to diminished independence, intrapersonal changes, altered interpersonal relationships and emotional disturbance. The psychological effects seemed to be devastating to the optimal functioning of the participants. The impact of these effects was perceived as life changing. The impact of the psychological effects of SCI was linked to psychological adjustment. Psychological adjustment referred to the variety coping strategies adopted by participants and their perceptions post injury. The coping strategies included effective and ineffective coping strategies. Most participants struggled as they attempted to make sense of the effect of SCI. Life post- injury was perceived with mixed emotions that of being hopeful and on other hand fearful; hopeful that their (participants) condition would change for the better, yet fearful as to what if it does not. As to deal with the devastating impact of SCI, participants engaged in a process of reconstructing the self, coming to terms with disability, and striving for maintaining a positive outlook post-SCI. v In conclusion, understanding how SCI persons view themselves post-injury is a prerequisite to the development of appropriate SCI psychological strategies to facilitate optimal functioning. Thus psychological adjustment remains critical in determining the rehabilitation process post injury.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2002. x, 55 leaves / Chiropractic researchers have hypothesized as to how the removal of a cervical dysfunction may affect the nervous system negatively. However, little focus has been placed on possible optimizing effects, such as grip strength. This study attempted to establish that relationship. Therefore, the specific aim of this study was to determine the relative effectiveness of segmental manipulation of the cervical spine on grip strength in patients with mechanical cervical spine dysfunction.

The South African Professional Board for Emergency Care prehospital Clinical Practice Guideline (CPG) recommends that emergency medical services (EMS) make use of the National Emergency X Radiography Utilization Study (NEXUS) rule and Canadian C-spine Rule (CCSR) when managing traumatic spinal injury. However, the safety and effectiveness of prehospital clinical spinal clearance or spinal motion restriction (SMR) decision support tools within poorly resourced settings are unclear. We conducted a scoping review on clinical spinal clearance and selective SMR decision support tools which aimed at identifying possible barriers to their implementation, safety, and effectiveness when used by EMS personnel. Studies were included if they described the use of clinical spinal clearance or SMR decision tools in first line management of blunt trauma patients by medical practitioners in the Emergency Department (ED) or by EMS personnel working in a prehospital setting. After screening, 42 documents fulfilled the inclusion criteria. Several selective SMR decision support tools have been implemented in the prehospital setting, the most common of which were those based on the NEXUS and the CCSR tools. Only one study evaluated the safety and efficacy of the NEXUS rule when used by EMS personnel. The limited prehospital literature available investigating either the NEXUS rule or CCSR therefore makes it difficult to determine its appropriateness for adoption and implementation by EMS personnel in other prehospital settings such as that of South Africa. Furthermore, commonly found prehospital NEXUS-based decision tools presented with unique challenges related to the subjective nature of some of the individual components of the decision tool. This leaves the decision tool open to interpretation by examiners and is especially relevant in settings, such as South Africa, where there are many different levels in scope of practices. This increases the risk of the patient being either under-triaged or over-triaged. More studies are therefore needed to definitively assess for the safety, efficacy and effectiveness of clinical spine clearance within the prehospital setting. It is believed that a selective SMR decision tool which has more specific instructions for the prehospital practitioner may be able to accommodate such challenges and is an area which needs further investigation.

Original research submitted as partial fulfillment of the requirements for the Masters in Medicine degree in Orthopaedic surgery at the University of Witwatersrand, Johannesburg, April 2014 / Objectives 1. Assessment of radiological parameters of spinal stenosis using Magnetic Resonance imaging. 2. Clinical assessment of patients with Oswestry disability index and Neurogenic claudication outcome score questionnaires. 3. To assess correlation between clinical assessment questionnaires’ scores and radiological parameters. Background. Spinal stenosis is a common presentation in the elderly and a reason for surgical intervention. Diagnostic criteria are still inconclusive. There is poor correlation between clinical and radiological findings. New observations have been described and whether they improve diagnostic criteria remains to be seen. Methods. 30 patients with spinal stenosis were included in the study. The 2 questionnaires were administered and Magnetic Resonance Imaging copies were obtained. Questionnaires and images were analyzed. Osirix programme was used to analyze the images and do the measurements. Data was entered onto an excel sheet and analyzed using Statistica software. Frequencies and correlations were done. Results. The age range was between 41 and 85.There were 22 females and 8 males. L4/L5 was the commonest level involved in 23 patients. Multilevel involvement was 23% and those patients had a higher morphological grade, which was statistically insignificant. The commonest morphological grade was C. Sedimentation was positive in 93% of the patients. The Oswestry disability Index and Neurogenic Claudication Outcome score were negatively correlated, which was statistically significant, p = 0.0004. There was no correlation between clinical and radiological features. Conclusion. Spinal stenosis remains a clinical dilemma. There is variability within the population and lack of correlation between clinical and radiologic features. Radiological features however correlate with each other, but do not help with optimizing patient care.

Interbody fusion cages are increasingly used in the treatment of spinal disease and injury in order to stabilize movement and promote arthrodesis of the vertebral bodies, but the micro-mechanics of the interaction between the cage and the adjacent host bone is not fully understood. This information has bearing on post-surgical therapy protocols, prediction of long-term bone tissue changes, and optimization of cage design. In order to gain insight into this problem, functional microCT imaging was used to directly evaluate implant micromotion and full-field vertebral body strains in an animal model implemented with various configurations of BAK interbody cages. It is believed that variations in cage design will produce variable implant success, functional fusion will be related to the extent of implant fixation, and specific strain fields will be associated with fused and unfused samples. We found that samples ranged from completely unfused (implant motion) to fully fused with organized trabecular bone (no motion). Strains concentrated at the implant interface in unfused samples, while fully fused samples exhibited uniformly distributed strains. / Graduation date: 2004

We utilize a simple instrumental (response-outcome) learning task to measure spinal plasticity in the isolated spinal cord. Peripheral uncontrollable nociceptive input has been shown to disrupt spinal instrumental learning and induce enhance tactile reactivity. In contrast, 1.5mA of continuous shock has been found to induce antinociception and protect spinal plasticity from the detrimental consequences of uncontrollable stimulation. The experiments of this dissertation examined the link between the beneficial effects of continuous stimulation and antinociception. The results replicated previous work examining the protective and antinociceptive effect of 1.5mA of continuous shock (Experiments 1-2). Novel to this research was the inclusion of a lower (0.5mA) intensity continuous stimulation. Results revealed that 0.5mA of continuous shock induced a comparable antinociception to that seen with 1.5mA of continuous shock (Experiment 1). At this lower intensity, however, continuous shock was unable to protect the isolated spinal cord from the detrimental effect of intermittent stimulation (Experiment 2). Further examination revealed that co-administration of intermittent and continuous shock did not affect continuous shockinduced antinociception. This was true at both the higher (1.5mA) and lower (0.5mA) intensities of continuous shock (Experiment 3). When 0.5mA of continuous shock was administered prior to intermittent shock, this intensity of continuous shock was better able to immunize the spinal cord from the induction of the learning deficit than 1.5mA (Experiment 4). Further analysis called into question the link between antinociception and the protective effect of continuous shock, as the beneficial effect of continuous shock outlasted the expression of antinociception (Experiment 5). Moreover, 0.5mA of continuous shock was found to reverse the expression of the learning deficit, when continuous stimulation was given after intermittent shock treatment (Experiment 6). While blocking the induction of antinociception was not sufficient to prevent the immunizing effect of continuous shock, data suggest that the mu opioid receptor is implicated in the beneficial impact of continuous stimulation (Experiments 7 and 8). Endogenous brain derived neurotrophic factor (BDNF) release was also found to play a role (Experiment 9). Moreover, continuous shock was found to down-regulate the expression of early genes implicated in the development of central sensitization, c-fos and c-jun. Finally, we found that while continuous stimulation was detrimental to locomotor recovery after spinal cord injury, the combined treatment of continuous and intermittent shock did not negatively affect recovery (Experiments 11 and 12).

Thesis (M. Phil.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 131-141). Also available in print.

Thesis (Ph.D.)--McMaster University, 2004. / Advisor: Kathleen A. Martin Ginis. Includes bibliographical references. Also available via the World Wide Web.