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

MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 / The cervical spine is subjected to wear and tear as well as trauma. This increases the occurrence of degeneration of intervertebral discs and facet joints. Degeneration will result in loss of disc height and the formation of osteophytes on adjacent vertebrae. Nerve roots can be irritated or compressed by this pathology and patients can possibly develop neurological signs and symptoms as well as pain. An anterior neck fusion is a surgical procedure that is frequently used to manage cervical pathologies such as degeneration, spinal stenosis, disc herniation, or trauma. Cervical pathologies can become severe and neural compression may develop. Compression of neural components can present with symptoms such as muscle weakness, numbness, tingling or radicular pain. The main aim of the surgery is to decompress the neural structures, permanently stabilize the vertebrae, to maintain a cervical lordosis and to hold an anatomical disc space. Chronic spinal disorders, including cervical and lumbar conditions, are considered the most expensive benign condition to manage. Previous research demonstrated poor functional outcomes especially in the lumbar area. Little evidence is available regarding the functional outcomes of patients after anterior neck fusion surgery. The aim of this study was to investigate the levels of pain and the quality of life experienced by patients who had an anterior neck fusion one year ago. Methods A cross – sectional survey was conducted. Neurosurgeons in the Johannesburg region were contacted telephonically to establish whether they performed anterior neck fusion surgery. Potential subjects were then identified and contacted to establish whether they suited the inclusion criteria for the study. Pain was assessed using the Visual Analogue Scale. The Neck Disability Index, Fear Avoidance Beliefs and Short Form-36 questionnaires were completed to determine the levels of dysfunction, anxiety and depression as well as health related quality of life in subjects who had an anterior neck fusion one year ago. The quality of life of these subjects was then compared to that of a healthy baseline group. Results and Discussion Forty-two (n = 42) subjects were telephonically identified from the neurosurgeons’ records. Thirty-five (n = 35) subjects met the inclusion criteria and participated in the study. Twenty-six subjects were female (n = 26) with an average age of 54 years and nine (n = 9) were male with an average age of 53 years. The demographic questionnaire demonstrated a high prevalence v for the use of pain- and anti-inflammatory medication (81.3%). According to the demographic questionnaire, the subjects received on average six physiotherapy treatments postoperatively. Most of the subjects (n = 22) demonstrated pain over the upper shoulder area as well as posterior regions of the neck on the body chart. At the time of assessment, the subjects indicated their level of pain using a VAS scale and had an average score of 35.48mm (SD ± 24.11) which indicated a low level of pain. Results obtained from the NDI questionnaire indicated that the subjects had moderate disability one year postoperatively. The mean score on the NDI for subjects was 31.10 (SD ± 11.96). Subjects did not demonstrate high scores on the FABQ and had a mean score of 54.09 (SD ± 0.99). There were no significant differences between the male and female groups for the FABQ. On the SF-36, the subjects had a moderate reduction in mental health components of QoL [MCS = 42.19 (SD ± 13.31)] as well as the physical health components of QoL [PCS = 46.78 (9.44)]. QoL of these subjects was compared to a baseline group. Results showed a statistically significant difference between the groups for all eight domains (p- values ranged between 0.0001 and 0.012). The mental health component score (MCS) was not significantly different between the groups but subjects with anterior neck fusion had a significantly lower score on the physical health component (PCS) than the baseline group (p = 0.001). Conclusion This paper concluded that subjects who had an anterior neck fusion 12 months ago still suffered from low levels of pain and moderate dysfunction. They reported low levels of QoL related to physical health one year postoperatively.

Thesis (M.S.B.)--University of Toledo, 2004. / Typescript. "A thesis [submitted] as partial fulfillment of the requirements of the Master of Science degree in Bioengineering." Bibliography: leaves 4-11.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Orthopaedic Surgery Johannesburg, 2017 / Background Unstable Thoracolumbar spinal fractures are conventionally treated by open reduction and internal fixation. This involves extensive mobilization of paraspinal muscles, which in turn leads to long-term disability in the form of chronic backache. One of the reasons fractures are stabilized is to prevent kyphotic deformity. Posterior lumbar stabilization done through a minimally invasive technique can achieve the same result as the open technique at the expense of less mobilization of the paraspinal muscles. Aim of the study The aim of the study was to assess the effectiveness of minimally invasive posterior spinal fixation in unstable Thoraco-lumbar fractures in our setting at Charlotte Maxeke Academic Hospital. Objectives To assess the effectiveness of Minimally Invasive Spine Surgery over a short term of minimum of 12 months regarding: Maintaining the correction of fracture kyphosis, Re-operations and Any serious Adverse Events Methodology This was a prospective interventional pilot study. Fractures were classified according to the AO comprehensive system. AO Comprehensive classification fractures A3, B1, B2, C1 and C2 were considered suitable for this technique. Pre-operative, immediate post-operative and one year follow up Cobb’s angles of fracture kyphosis were measured on plain lateral x-rays. Any Serious Adverse Events (SAE) that may have required re-operations were recorded over the minimum of 12 months follow up. Results Twenty patients met the inclusion criteria for this study. Post-operative follow up ranged between 12 and 22 months. There were 14 males and 6 females. The age ranged between 16 years to 54 years with mean of 33.9 years. L1 was the most commonly fractured vertebra. Eleven out of 20 patients sustained fracture of L1, 6 patients had fracture of L2 whereas 3 patients sustained fracture of T12. The AO classification types included one B1, five B2, seven C1 and seven C2 fractures. The pre-operative Cobb’s angle ranged from 7 degrees to 38 degrees with mean of 21.2 degrees. The immediate post-operative Cobb’s angle ranged between zero degrees to 16 degrees with mean of 8.3 degrees. The last follow up Cobb’s angle ranged between zero degrees to 21 degrees with a mean of 10.7 degrees. The loss of correction of fracture kyphosis ranged between zero degrees to 6 degrees with a mean of 2.4 degrees. The post-operative Cobb’s angle was maintained. There was no deterioration of pre-operative neurological status. There was no serious adverse event requiring a re-operation. Conclusion Minimally Invasive Posterior Spinal stabilization for thoracolumbar fractures had an acceptable outcome in our hands in appropriately selected cases. The average loss of correction of 2.4 degrees was in keeping with that found in open technique as well as MIS at other centers. While the number is less, this procedure can be recommended for well selected patients where skills are available. / MT2017

Thesis (doctoral)--Lund University, 1996. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1996. / Added t.p. with thesis statement inserted.

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

In order to continue development of an ultrasound-guidance system for spinal fusion surgery, simulation and experimental research was conducted to study the effects of bone on ultrasound imaging. Simulation work examined the effect of bone volume and transducer frequency on image quality and accuracy. Experimental work utilized a 3.2MHz prototype ultrasound probe to create ultrasound images of pedicles. The simulation results, based on an idealized anatomical model, provided higher-quality images than the experimental results. It was determined that high bone volume and high transducer frequency have a detrimental effect on image quality. The experimental results suggest that the high variability in pedicle shape results in variability in ultrasound image quality. Overall, the simulation and experimental results suggest that ultrasound imaging of bone is feasible at relatively low frequencies, while highlighting the need for more experiments to take into account the substantial variability in pedicle shape and bone volume.

In order to continue development of an ultrasound-guidance system for spinal fusion surgery, simulation and experimental research was conducted to study the effects of bone on ultrasound imaging. Simulation work examined the effect of bone volume and transducer frequency on image quality and accuracy. Experimental work utilized a 3.2MHz prototype ultrasound probe to create ultrasound images of pedicles. The simulation results, based on an idealized anatomical model, provided higher-quality images than the experimental results. It was determined that high bone volume and high transducer frequency have a detrimental effect on image quality. The experimental results suggest that the high variability in pedicle shape results in variability in ultrasound image quality. Overall, the simulation and experimental results suggest that ultrasound imaging of bone is feasible at relatively low frequencies, while highlighting the need for more experiments to take into account the substantial variability in pedicle shape and bone volume.

Thesis (Ph.D.)--University of Tennessee Health Sciences Center, 2005