1. INTRODUCTION Injuries of the lower cervical spine can be among the most devastating injuries of the musculoskeletal system because of the increased risk of the injury to the spinal cord, and also because they so often occur to the younger members of the population (Jones A.A.M. et al., 2003; Sekhon H.S.L. et al., 2001; Ball P.A., 2001). The cervical spine is the most vulnerable spinal segment (Sekhon H.S.L. et al., 2001). The mechanism of cervical spine trauma is defined by the direction and magnitude of the forces that have been applied externally to the head and neck complex resulting in injury (Allen B.L.Jr., 1982). Common injury vectors include flexion, compression, rotation and extension (Allen B.L.Jr., 1982). The pattern of injury is related not only to the external applied force, but also to the initial position or posture of the head and neck at the time of injury (Allen B.L.Jr., 1982). One pattern of these injuries of the lower cervical spine is a facet dislocations (Allen B.L.Jr., 1982). The facet dislocation of the cervical spine result from a hyperflexion injury of the neck (Allen B.L.Jr., 1982). These injuries are characterized radiographically by anterolisthesis of one cervical vertebrae over the other and include the slide anteriorly of the inferior facet of the upper dislocated vertebra over the superior facet of the vertebra below (Allen B.L.Jr., 1982; Razack N. et al., 2000). The facet dislocations of the lower cervical spine represent from 4% to 50% of... [to full text]

Spontaneous vertebral fractures are a large and growing health care problem. Biomechanical factors, specifically, abnormal posture or gait‐related spinal motion may interact with age‐weakened bone to induce altered spinal biomechanics that in turn increase the likelihood of vertebral body fracture. This research takes steps towards the goal of reducing the number of vertebral fractures in two phases: 1) Validation of a noninvasive spinal motion measurement system in cadaver torsos and 2) Application of the measurement system in human subjects. The cadaver study compared vertebral motion at 4 levels (T7,T12,L3,L5) as measured by adhesive skin markers versus motion measured by bone pins implanted into the vertebrae. Cadaver torsos were tested in lateral‐bending, flexion and axialrotation. Mean differences in vertebral body angular motion between skin markers and bone pin markers were <0.5° around the anterior‐posterior and medial‐lateral axes and <0.9° around the superior‐inferior axis. This measurement method was able to accurately quantify vertebral body motion in cadaver torsos thus allowing for application to human subject testing. X‐rays and 3D motion capture were employed to quantify spinal posture and motion parameters during gait in 12 older and 12 younger normal, females. Vertebral motion around 3 axes was measured at 4 levels (T7,T10,T12,L2) using noninvasive retroreflective markers during treadmill gait at 3 speeds (0.5,0.7,0.9m/s). The average angular motion of all gait cycles at each speed was determined for each level. The triplanar ranges of motion and variability of motion were compared as a function of age. Older subjects had 31.7% larger frontal Cobb angles and up to 30.9% and 33.5% smaller ranges of spinal motion in the frontal and sagittal planes. Variability of motion in the sagittal plane was up to 42.9% less in older subjects. Decreased ranges of motion and variability of spinal motion observed in older subjects may imply that vertebral loading in these subjects may not be as uniformly distributed across the vertebrae as in younger subjects. Greater stresses may result from the abnormal motion, thus increasing fracture risk. Confirmation of this hypothesis requires a longitudinal study, but if verified, may lead to the development of inexpensive countermeasures to prevent fractures.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 6 uppsatser.

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on March 25, 2010). Vita. Thesis advisor: Christian Lorson. "July 2009" Includes bibliographical references.

Thesis (M.F.A.)--Rochester Institute of Technology, 1995. / Typescript. Includes bibliographical references (leaves 30-31).

Thesis (Ph.D.)--McMaster University, 2004. / Includes bibliographical references (p. 106-123). Also available via World Wide Web.

Senaste åren har mer evidensbaserad forskning kring immobilisering framträtt. Denna forskning har inriktat sig på att ifrågasätta om spinal immobilisering är den mest gynnsamma behandlingsmetoden vid misstänkt spinal skada. Flera länder har påbörjat spinal rörelsebegränsning istället dock finns det inte så mycket forskning på detta område. Immobilisering kan skapa obehag och smärta för patienter, vilket är onödigt lidande om patienterna inte behöver immobiliseras, utan kan rörelsebegränsas istället. Syftet med denna systematiska och integrativa litteraturöversikt var att sammanställa de olika metodernas risker och nytta, för att kunna se vilken metod som patienten gynnas mest av. Metod som valdes var Whittemore &amp; Knafl (2005) som är gjort för just integrativa litteraturöversikter. Resultatet av litteraturöversikten visade att forskningen inte är överens. Analysen av resultatet bildade fem underkategorier och två huvudkategorier. En av huvudkategorierna var Komplexiteten med immobilisering med underkategorier Risker med immobilisering, Positiv utveckling av immobilisering samt Upplevelser av immobilisering. Den andra huvudkategorin var Rörelsebegränsning som behandlingsmetod med två underkategorier Rörelsebegränsning utan hjälpmedel och Hjälpmedel vid rörelsebegränsning. Tidigare forskning visar att det finns svag evidens för att immobilisera patienter med misstänkt spinala skada. Rörelsebegränsning är i behov av vidare forskning för att kunna jämföra de båda metoderna. Patienternas upplevelse av att bli immobiliserad samt rörelsebegränsad är något som idag saknas inom forskning. För att veta vilken metod som är bäst lämpad, behövs ytterligare forskning kring vilken metod patienterna anser vara till mest nytta och minst risk.

Acute and subacute diseases causing intrinsic spinal cord damage are confusing and poorly defined clinically and pathologically. of this study is: The purpose 1. To analyse the spectrum of conditions responsible for acute and subacute myelopathy in South Africa. 2. To categorise the clinical presentations and prognosis of the illnesses and to correlate these with aetiology. 3. To assess the validity of diagnostic criteria for acute and subacute myelopathy in general and for the different aetiological groups. 4. To review the literature and to correlate previous studies with the present one. Thirty-four patients fulfilling strict criteria nave been identified over a seven-and-a-half-year period using the Groote Schuur Hospital computer retrieval system. Although the study was essentially retrospective, 11 of these patients were seen personally during their acute illnesses. All these patients have suffered from illnesses causing spinal cord dysfunction in the absence of trauma, physical agents or any extrinsic pressure such as might be caused by tumours or spondylosis. Maximum disability was reached in less than 8 weeks. In 17 patients no cause was identified. The clinical features, laboratory findings and courses have been analysed. Among the results, a high percentage of patients with Brown-Sequard Syndromes were found with possible significance for the pathogenesis of the illness. Seven patients with meningovascular syphilis were analysed as well as 2 additional patients with spinal cord syphilis not fulfilling the strict criteria of the study. Although well known before the penicillin era, this entity is not well described in modern neurological literature. Four patients had myelopathy associated with pulmonary tuberculosis in the absence of tuberculous meningitis or spinal disease. Three of these 4 patients also developed optic neuropathy. The association of these conditions has previously been described in only a very few patients. Two patients had Epstein-Barr virus infections and 1 had an infection with Mycoplasma pneumoniae. Two had systemic lupus erythematosus and 1 had an acute cord infarct following an aortic aneurysm repair. The literature is reviewed and the findings of this study correlated with previous ones. Conclusions regarding terminology, criteria for diagnosis, investigations, course and prognosis are discussed.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21452号 / 医博第4419号 / 新制||医||1032(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 髙橋 良輔, 教授 伊佐 正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Three clinical investigations together with a combined editorial and review of the cardiovascular physiology of spinal anaesthesia in normal and preeclamptic pregnancy form the basis of a thesis to be submitted for the degree of Doctor of Medicine at the University of St Andrews. First, the longstanding consensus that spinal anaesthesia could cause severe hypotension in severe preeclampsia was examined using three approaches. The doses of ephedrine required to maintain systolic blood pressure above predetermined limits were first compared in spinal versus epidural anaesthesia. The doses of ephedrine required were then similarly studied during spinal anaesthesia in preeclamptic versus normal control subjects. The principal outcome of these studies, that preeclamptic patients were resistant to hypotension after a spinal anaesthetic, was then further investigated by studying pulse transit time (PTT) changes in normal versus preeclamptic pregnancy. PTT was explored both as beat-to-beat monitor of cardiovascular function and also as an indicator of changes in arterial stiffness. The cardiovascular physiology of obstetric spinal anaesthesia was then reviewed in the light of the three clinical investigations, developments in reproductive vascular biology and the regulation of venous capacitance. It is argued that the theory of a role for vena caval compression as the single cause of spinal anaesthetic induced hypotension in obstetrics should be revised.