Nahshon Rand - Academia.edu (original) (raw)
Papers by Nahshon Rand
PubMed, Nov 1, 1999
Traditional methods of obtaining definitive soft-tissue cover in open wounds after high-energy tr... more Traditional methods of obtaining definitive soft-tissue cover in open wounds after high-energy trauma necessitate repeated surgical procedures and sophisticated soft-tissue reconstructions. A simple one-stage technique to treat skin loss in severe open fractures is described. The "rubber band technique" enables postoperative exposure and drainage of the fracture site. The wound closes gradually by facilitated mobilization of skin in response to continuous tension from the rubber band. This technique may prevent the need for additional procedures. Continuous drainage is achieved. When deep infection is suspected, removal of the elastic rubber band permits sufficient exposure of the deep tissues. The "rubber band technique" has proved to be a safe, simple, and efficient method for treating extensive soft-tissue loss in open fractures and after incisions for open reduction or fasciotomy.
The journal of bone and joint surgery, 1994
We report a prospective study of783 male Israeli recruits aged from 17 to 26 years. The risk of s... more We report a prospective study of783 male Israeli recruits aged from 17 to 26 years. The risk of stress fracture was inversely proportional to age on both univariate and multivariate analysis. Each year of increase of age above 17 years reduced the risk of stress fracture by 28%.
Journal of Biomechanics, 1989
In a prospective study of stress fractures among Israeli infantry recruits, the area moment of in... more In a prospective study of stress fractures among Israeli infantry recruits, the area moment of inertia of the tibia was found to have a statistically significant correlation with the incidence of tibial, femoral and total stress fractures. Recruits with "low" area moments of inertia of the tibia were found to have higher stress fracture morbidity than those with "high" area moments of inertia. The best correlation was obtained when the area moment of inertia was calculated about the AP axis of bending at a cross-sectional level corresponding to the narrowest tibial width on lateral X-rays, a point which is at the distal quarter of the tibia. This finding indicates that bending forces about the approximate AP axis are an important causal factor for tibial and many other stress fractures. The bone's bending strength, or ability to resist bending moments, as measured by the area moment of inertia, helps determine risk to stress fracture.
The journal of bone and joint surgery, Sep 1, 1993
Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndro... more Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise. Extensive surgical drainage and antibiotic treatment led to recovery in all cases.
PubMed, Jun 1, 1988
The biomechanical mechanism of tibial diaphyseal stress fractures was studied prospectively in a ... more The biomechanical mechanism of tibial diaphyseal stress fractures was studied prospectively in a group of 286 Israeli recruits. Before training each recruit had roentgenograms taken of his tibiae. Measurements of total tibial and cortical widths in the anteroposterior (AP) and mediolateral planes were made on these roentgenograms at two levels: at the point of the narrowest tibial width on AP roentgenograms (Level 1) and at the point of the narrowest width on lateral roentgenograms (Level 2). The tibial cross section was idealized as an eccentric ellipse within an ellipse, and on the basis of measurements taken from the roentgenograms, the cross-sectional area (compression strength), area moments of inertia about AP and mediolateral axes of bending (bending strength), and the area polar moment of inertia (torsional strength) were calculated for each cross section. During the course of 14 weeks of training, 20% of the recruits sustained tibial diaphyseal stress fractures, all of which were along the medial cortex. Using stepwise logistic regression analysis the tibia's bending strength along an AP axis of bedding at Level 2 was found to be the most significant factor determining whether or not a recruit would develop a tibial stress fracture.
The Journal of Bone and Joint Surgery. British volume, 1987
A prospective study of 295 infantry recruits has shown that the mediolateral width of the tibia m... more A prospective study of 295 infantry recruits has shown that the mediolateral width of the tibia measured radiographically at each of three different levels in the bone had a statistically significant correlation with the total incidence of stress fractures as well as with those in the tibia alone or the femur alone. A narrow tibial width was shown to be a risk factor, but cortical thickness was not found to be significant.
Spinal Implants: Are We Evaluating Them Appropriately?
... Tel-Aviv 62748, ISRAEL, Adjunct Professor, Dept. of Orthopaedics and Rehabilitation, Vanderbi... more ... Tel-Aviv 62748, ISRAEL, Adjunct Professor, Dept. of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville TN. ... 139^ 5. [11] George, D. C, Krag, MH, Johnson, C. C, Van Hal, ME, Haugh, LD, and Grobler, LJ," Hole preparation techniques for transpedicle screws. ...
Israel journal of medical sciences, 1995
A double-blind, prospective randomized study was performed to compare cefazolin and cefonicid giv... more A double-blind, prospective randomized study was performed to compare cefazolin and cefonicid given for prophylaxis to 102 patients undergoing orthopedic surgery. Risk factors (e.g., age, sex, type of operation performed) among the two groups were similar. All patients had foreign material (prosthesis or other hardware) inserted at operation. There was a total of 6 infections (3 wound and 3 urinary tract) in 6 patients among the 48 receiving cefazolin (12.5%), whereas no infections were observed among the 54 patients who received cefonicid. Cefonicid, given once daily, provides protection against postoperative infection that is not inferior to cefazolin. A larger study is needed to confirm whether cefonicid is indeed superior to cefazolin.
Study Design: The effect of Total Hip Replacement surgery (THR) upon spinal sagittal alignment an... more Study Design: The effect of Total Hip Replacement surgery (THR) upon spinal sagittal alignment and low back pain was assessed in patients with severe hip osteoarthritis.Summary of Background Data: Osteoarthritis in the hip joint is associated with abnormal posture and gait due to hip flexion contracture and hip pain. This in turn may cause abnormal spinal sagittal alignment and secondarily induce low back and leg pain. However, there have been no reports regarding the corrective effect of Total Hip Replacement surgery upon spinal sagittal alignment in patients with osteoarthritis of the hip.Methods: This study prospectively analyzed the results of 25 patients (15 females and 10 males, average age 67.4 years (32–84)) undergoing THR for severe osteoarthritis of the hip. Pre and post-surgical assessment included; sagittal measurement of Sacral Inclination (SI) and total Lumbar Lordosis (L1-S1) on standing lateral radiographs. Functional clinical outcomes for hip as well as low back wer...
Military Medicine, 1994
The increasing incidence of open tibial and femoral fractures causes great suffering by patients ... more The increasing incidence of open tibial and femoral fractures causes great suffering by patients and is an enormous economic burden, necessitating improved treatment. The current treatment of these fractures is reviewed, as well as the evolving role of intramedullary nailing in this treatment. Intramedullary nailing seems to give better results than external fixation in Gustilo type I and II fractures, and is at least as good in type III. The introduction of the non-reamed interlocking intramedullary nail may bring about even better outcomes. Any improvements in treatment should be based on thorough understanding of the biologyand biomechanics of the injury.
Journal of Neurosurgery: Spine, 2019
OBJECTIVEThe authors evaluated the long-term clinical outcome of a total posterior arthroplasty s... more OBJECTIVEThe authors evaluated the long-term clinical outcome of a total posterior arthroplasty system in the surgical treatment of lumbar spinal stenosis with degenerative spondylolisthesis.METHODSBetween June 2006 and July 2007, 10 patients with neurogenic claudication due to spinal stenosis and single-level degenerative spondylolisthesis were enrolled in a nonrandomized prospective clinical study. The patients were evaluated with radiographs and MRI scans, the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the SF-36 health survey preoperatively and at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 7 years, and 11 years postoperatively.RESULTSThe mean VAS score for leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 17 at 11 years after surgery. The mean VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 14 at 11 years after surgery. The mean ODI score decreased from 49.1 preoperatively to 1...
Plastic and Reconstructive Surgery, 2001
On August 17, 1999, an earthquake of 7.4 magnitude struck Turkey, resulting in the destruction of... more On August 17, 1999, an earthquake of 7.4 magnitude struck Turkey, resulting in the destruction of the cities Golcuk, Izmit, Adapazari, and Yalova. Three days later, the Israel Defense Force Field Hospital arrived at Adapazari, serving as a reinforcement hospital until the rehabilitation of the local medical facilities. Surgical services in the field hospital were supplied by general, orthopedic, and plastic surgeons. The authors evaluated all soft-tissue injuries managed at the hospital and assessed the need for plastic surgery services in a crisis intervention field hospital. Information was gathered regarding soft-tissue injuries throughout the activity of the hospital. In addition, patients' charts, operations' reports, and entry and evacuation logs were reviewed for all patients accepted and treated in the field hospital. Interviews of patients, local physicians, and citizens of Adapazari were performed to evaluate the medical situation in the first 3 days after the earthquake. A total of 1205 patients were treated by the field hospital in Adapazari; 138 (11.45 percent) of these patients sought aid for isolated soft-tissue injuries, 105 of which (76.09 percent) were earthquake-related. Twenty (51.28 percent) of the operations performed in the hospital were to treat soft-tissue injuries; 1.49 percent of all patients underwent minor surgical manipulations by the plastic surgeon on staff. Plastic surgery patients occupied 13.6 percent of the hospital beds. In conclusion, the authors find it beneficial to supply plastic surgery services at a field hospital in an earthquake situation.
The Journal of the American Academy of Orthopaedic Surgeons
Degenerative lumbar stenosis is a common cause of disabling back and lower extremity pain among o... more Degenerative lumbar stenosis is a common cause of disabling back and lower extremity pain among older persons. The process usually begins with degeneration of the intervertebral disks and facet joints, resulting in narrowing of the spinal canal and neural foramina. Associated factors may include a developmentally narrow spinal canal and degenerative spinal instability. Nonoperative management includes restriction of aggravating activities, physical therapy, and anti-inflammatory medications. If nonoperative treatment has failed, surgical treatment may be appropriate. Decompression should be performed so as to address all clinically relevant neural elements while maintaining spinal stability. If instability is present, autogenous intertransverse bone grafting is recommended. There may be an advantage to augmenting some of these procedures with internal fixation. Surgical success rates as high as 85% have been reported, but may be compromised by inadequate decompression, inadequate st...
Journal of Clinical Neurophysiology, 2016
Intra-operative Neuro-Monitoring (IONM) is commonly used during cervical spine surgeries. Patient... more Intra-operative Neuro-Monitoring (IONM) is commonly used during cervical spine surgeries. Patient positioning with head extension is associated with risk of neurological damage. This study evaluates the frequency of loss of neurophysiological potentials during head positioning, the usefulness of head repositioning to restore the potentials, and the effect on neurological outcome. We retrospectively reviewed consecutive cervical spine surgeries performed at the Israel Spine Center, Assuta Medical Center, during 2006-2013. Surgeries performed with neuromonitoring (transcranial-electric motor evoked potentials [tcMEP], somatosensory evoked potentials [SSEP], electromyographic recordings [EMG]) were included. Demographic data, medical history, findings at neurological examination and imaging, electrophysiological data recorded during surgery, and neurological outcomes were collected and analyzed. 381 patients met inclusion criteria. Loss of potentials was detected in nine patients during patient positioning and repositioning was undertaken with the aim of restoring electrophysiological signals. In 5/9 patients, repositioning resulted in immediate reappearance of potentials; in 1/5, potentials were affected again during decompression. In 4/9 repositioning did not immediately restore electrophysiological signals; in 1/4 potentials reappeared later during the decompression and in 3/4 potentials had not recovered till the conclusion of surgery. There were new neurological deficits in 2/9, including one patient with loss of potential that was not restored with repositioning and the one in whom potential was restored but lost again during decompression. IONM is an efficient tool to alert the surgical team to potential neurological damage. Head reposition often restores the electrophysiological signals with possible prevention of impending sequelae.
American Journal of Physical Medicine Rehabilitation Association of Academic Physiatrists, Nov 1, 2007
Lumbar epidural varices either primary or secondary to outflow obstruction have been implicated i... more Lumbar epidural varices either primary or secondary to outflow obstruction have been implicated in causing lumbar radiculopathy. We report a case of an adolescent male who presented with lumbar radiculopathy attributable to thrombosed lumbar epidural varix as a result of inferior vena cava thrombosis emanating from factor V Leiden mutation. This rare cause of radiculopathy was diagnosed on contrast-enhanced computerized tomography. All symptoms resolved shortly after initiation of intravenous heparin therapy. The relevant literature is reviewed.
International Journal of Spine Surgery, 2015
Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years... more Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years. To draw attention to a potentially serious complication of incidental durotomy-remote cerebellar hemorrhage. Accidental durotomy is a frequent complication of spinal surgery. In most cases the outcome of incidental durotomy is favorable. A delayed potentially serious complication of CSF loss during and after lumbar surgery is remote cerebellar hemorrhage (RCH). During 2008-2012, 1169 lumbar spine procedures were performed at our spine center. In 210 surgeries incidental or intentional durotomies occurred. All patients with durotomies were managed with suturing of the dural wound followed by deep wound drainage left for 5 days and tight wound closure. Of the 210 patients with CSF loss three patients were identified to suffer from RCH-an incidence of 0.26%. The three patients ages 56, 67 and 75 years developed RCH between 36-192 hours after surgery. All three were managed with supportive treatment and close clinical supervision. A gradual clinical and radiological improvement was noted in all three patients. Severe headache after spinal surgery and or declining mental status should not be attributed only to low CSF pressure secondary to dural tearing. It can also be the result of remote cerebral or cerebellar hemorrhage. Once the diagnosis of RCH is made, close clinical supervision is mandatory. In most cases non-operative supportive treatment may lead to eventual full clinical recovery.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Jan 8, 2015
To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in ... more To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in the surgical management of lumbar degenerative spondylolisthesis and or spinal stenosis. During a 1-year period (June 2006 to July 2007), ten patients were enrolled in a non-randomized prospective clinical study. The primary indication was neurogenic claudication due to spinal stenosis with single-level degenerative spondylolisthesis. Patients were evaluated with X-rays and MRI scans, visual analog scale (VAS) for back and leg pain, the Oswestry disability questionnaire, and the SF-36 health survey preoperatively, at 6 weeks, 3 months and 6 months and at 1, 2, 3 and 7 years postoperatively. The VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 19 at 7 years follow-up. The VAS score for worse leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 8.8 at 7 years follow-up. The ODI dropped from 49.1 preoperatively to 13.5 at 6 weeks and 7.8 at 7 years f...
PubMed, Nov 1, 1999
Traditional methods of obtaining definitive soft-tissue cover in open wounds after high-energy tr... more Traditional methods of obtaining definitive soft-tissue cover in open wounds after high-energy trauma necessitate repeated surgical procedures and sophisticated soft-tissue reconstructions. A simple one-stage technique to treat skin loss in severe open fractures is described. The "rubber band technique" enables postoperative exposure and drainage of the fracture site. The wound closes gradually by facilitated mobilization of skin in response to continuous tension from the rubber band. This technique may prevent the need for additional procedures. Continuous drainage is achieved. When deep infection is suspected, removal of the elastic rubber band permits sufficient exposure of the deep tissues. The "rubber band technique" has proved to be a safe, simple, and efficient method for treating extensive soft-tissue loss in open fractures and after incisions for open reduction or fasciotomy.
The journal of bone and joint surgery, 1994
We report a prospective study of783 male Israeli recruits aged from 17 to 26 years. The risk of s... more We report a prospective study of783 male Israeli recruits aged from 17 to 26 years. The risk of stress fracture was inversely proportional to age on both univariate and multivariate analysis. Each year of increase of age above 17 years reduced the risk of stress fracture by 28%.
Journal of Biomechanics, 1989
In a prospective study of stress fractures among Israeli infantry recruits, the area moment of in... more In a prospective study of stress fractures among Israeli infantry recruits, the area moment of inertia of the tibia was found to have a statistically significant correlation with the incidence of tibial, femoral and total stress fractures. Recruits with "low" area moments of inertia of the tibia were found to have higher stress fracture morbidity than those with "high" area moments of inertia. The best correlation was obtained when the area moment of inertia was calculated about the AP axis of bending at a cross-sectional level corresponding to the narrowest tibial width on lateral X-rays, a point which is at the distal quarter of the tibia. This finding indicates that bending forces about the approximate AP axis are an important causal factor for tibial and many other stress fractures. The bone's bending strength, or ability to resist bending moments, as measured by the area moment of inertia, helps determine risk to stress fracture.
The journal of bone and joint surgery, Sep 1, 1993
Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndro... more Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise. Extensive surgical drainage and antibiotic treatment led to recovery in all cases.
PubMed, Jun 1, 1988
The biomechanical mechanism of tibial diaphyseal stress fractures was studied prospectively in a ... more The biomechanical mechanism of tibial diaphyseal stress fractures was studied prospectively in a group of 286 Israeli recruits. Before training each recruit had roentgenograms taken of his tibiae. Measurements of total tibial and cortical widths in the anteroposterior (AP) and mediolateral planes were made on these roentgenograms at two levels: at the point of the narrowest tibial width on AP roentgenograms (Level 1) and at the point of the narrowest width on lateral roentgenograms (Level 2). The tibial cross section was idealized as an eccentric ellipse within an ellipse, and on the basis of measurements taken from the roentgenograms, the cross-sectional area (compression strength), area moments of inertia about AP and mediolateral axes of bending (bending strength), and the area polar moment of inertia (torsional strength) were calculated for each cross section. During the course of 14 weeks of training, 20% of the recruits sustained tibial diaphyseal stress fractures, all of which were along the medial cortex. Using stepwise logistic regression analysis the tibia's bending strength along an AP axis of bedding at Level 2 was found to be the most significant factor determining whether or not a recruit would develop a tibial stress fracture.
The Journal of Bone and Joint Surgery. British volume, 1987
A prospective study of 295 infantry recruits has shown that the mediolateral width of the tibia m... more A prospective study of 295 infantry recruits has shown that the mediolateral width of the tibia measured radiographically at each of three different levels in the bone had a statistically significant correlation with the total incidence of stress fractures as well as with those in the tibia alone or the femur alone. A narrow tibial width was shown to be a risk factor, but cortical thickness was not found to be significant.
Spinal Implants: Are We Evaluating Them Appropriately?
... Tel-Aviv 62748, ISRAEL, Adjunct Professor, Dept. of Orthopaedics and Rehabilitation, Vanderbi... more ... Tel-Aviv 62748, ISRAEL, Adjunct Professor, Dept. of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville TN. ... 139^ 5. [11] George, D. C, Krag, MH, Johnson, C. C, Van Hal, ME, Haugh, LD, and Grobler, LJ," Hole preparation techniques for transpedicle screws. ...
Israel journal of medical sciences, 1995
A double-blind, prospective randomized study was performed to compare cefazolin and cefonicid giv... more A double-blind, prospective randomized study was performed to compare cefazolin and cefonicid given for prophylaxis to 102 patients undergoing orthopedic surgery. Risk factors (e.g., age, sex, type of operation performed) among the two groups were similar. All patients had foreign material (prosthesis or other hardware) inserted at operation. There was a total of 6 infections (3 wound and 3 urinary tract) in 6 patients among the 48 receiving cefazolin (12.5%), whereas no infections were observed among the 54 patients who received cefonicid. Cefonicid, given once daily, provides protection against postoperative infection that is not inferior to cefazolin. A larger study is needed to confirm whether cefonicid is indeed superior to cefazolin.
Study Design: The effect of Total Hip Replacement surgery (THR) upon spinal sagittal alignment an... more Study Design: The effect of Total Hip Replacement surgery (THR) upon spinal sagittal alignment and low back pain was assessed in patients with severe hip osteoarthritis.Summary of Background Data: Osteoarthritis in the hip joint is associated with abnormal posture and gait due to hip flexion contracture and hip pain. This in turn may cause abnormal spinal sagittal alignment and secondarily induce low back and leg pain. However, there have been no reports regarding the corrective effect of Total Hip Replacement surgery upon spinal sagittal alignment in patients with osteoarthritis of the hip.Methods: This study prospectively analyzed the results of 25 patients (15 females and 10 males, average age 67.4 years (32–84)) undergoing THR for severe osteoarthritis of the hip. Pre and post-surgical assessment included; sagittal measurement of Sacral Inclination (SI) and total Lumbar Lordosis (L1-S1) on standing lateral radiographs. Functional clinical outcomes for hip as well as low back wer...
Military Medicine, 1994
The increasing incidence of open tibial and femoral fractures causes great suffering by patients ... more The increasing incidence of open tibial and femoral fractures causes great suffering by patients and is an enormous economic burden, necessitating improved treatment. The current treatment of these fractures is reviewed, as well as the evolving role of intramedullary nailing in this treatment. Intramedullary nailing seems to give better results than external fixation in Gustilo type I and II fractures, and is at least as good in type III. The introduction of the non-reamed interlocking intramedullary nail may bring about even better outcomes. Any improvements in treatment should be based on thorough understanding of the biologyand biomechanics of the injury.
Journal of Neurosurgery: Spine, 2019
OBJECTIVEThe authors evaluated the long-term clinical outcome of a total posterior arthroplasty s... more OBJECTIVEThe authors evaluated the long-term clinical outcome of a total posterior arthroplasty system in the surgical treatment of lumbar spinal stenosis with degenerative spondylolisthesis.METHODSBetween June 2006 and July 2007, 10 patients with neurogenic claudication due to spinal stenosis and single-level degenerative spondylolisthesis were enrolled in a nonrandomized prospective clinical study. The patients were evaluated with radiographs and MRI scans, the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the SF-36 health survey preoperatively and at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 7 years, and 11 years postoperatively.RESULTSThe mean VAS score for leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 17 at 11 years after surgery. The mean VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 14 at 11 years after surgery. The mean ODI score decreased from 49.1 preoperatively to 1...
Plastic and Reconstructive Surgery, 2001
On August 17, 1999, an earthquake of 7.4 magnitude struck Turkey, resulting in the destruction of... more On August 17, 1999, an earthquake of 7.4 magnitude struck Turkey, resulting in the destruction of the cities Golcuk, Izmit, Adapazari, and Yalova. Three days later, the Israel Defense Force Field Hospital arrived at Adapazari, serving as a reinforcement hospital until the rehabilitation of the local medical facilities. Surgical services in the field hospital were supplied by general, orthopedic, and plastic surgeons. The authors evaluated all soft-tissue injuries managed at the hospital and assessed the need for plastic surgery services in a crisis intervention field hospital. Information was gathered regarding soft-tissue injuries throughout the activity of the hospital. In addition, patients' charts, operations' reports, and entry and evacuation logs were reviewed for all patients accepted and treated in the field hospital. Interviews of patients, local physicians, and citizens of Adapazari were performed to evaluate the medical situation in the first 3 days after the earthquake. A total of 1205 patients were treated by the field hospital in Adapazari; 138 (11.45 percent) of these patients sought aid for isolated soft-tissue injuries, 105 of which (76.09 percent) were earthquake-related. Twenty (51.28 percent) of the operations performed in the hospital were to treat soft-tissue injuries; 1.49 percent of all patients underwent minor surgical manipulations by the plastic surgeon on staff. Plastic surgery patients occupied 13.6 percent of the hospital beds. In conclusion, the authors find it beneficial to supply plastic surgery services at a field hospital in an earthquake situation.
The Journal of the American Academy of Orthopaedic Surgeons
Degenerative lumbar stenosis is a common cause of disabling back and lower extremity pain among o... more Degenerative lumbar stenosis is a common cause of disabling back and lower extremity pain among older persons. The process usually begins with degeneration of the intervertebral disks and facet joints, resulting in narrowing of the spinal canal and neural foramina. Associated factors may include a developmentally narrow spinal canal and degenerative spinal instability. Nonoperative management includes restriction of aggravating activities, physical therapy, and anti-inflammatory medications. If nonoperative treatment has failed, surgical treatment may be appropriate. Decompression should be performed so as to address all clinically relevant neural elements while maintaining spinal stability. If instability is present, autogenous intertransverse bone grafting is recommended. There may be an advantage to augmenting some of these procedures with internal fixation. Surgical success rates as high as 85% have been reported, but may be compromised by inadequate decompression, inadequate st...
Journal of Clinical Neurophysiology, 2016
Intra-operative Neuro-Monitoring (IONM) is commonly used during cervical spine surgeries. Patient... more Intra-operative Neuro-Monitoring (IONM) is commonly used during cervical spine surgeries. Patient positioning with head extension is associated with risk of neurological damage. This study evaluates the frequency of loss of neurophysiological potentials during head positioning, the usefulness of head repositioning to restore the potentials, and the effect on neurological outcome. We retrospectively reviewed consecutive cervical spine surgeries performed at the Israel Spine Center, Assuta Medical Center, during 2006-2013. Surgeries performed with neuromonitoring (transcranial-electric motor evoked potentials [tcMEP], somatosensory evoked potentials [SSEP], electromyographic recordings [EMG]) were included. Demographic data, medical history, findings at neurological examination and imaging, electrophysiological data recorded during surgery, and neurological outcomes were collected and analyzed. 381 patients met inclusion criteria. Loss of potentials was detected in nine patients during patient positioning and repositioning was undertaken with the aim of restoring electrophysiological signals. In 5/9 patients, repositioning resulted in immediate reappearance of potentials; in 1/5, potentials were affected again during decompression. In 4/9 repositioning did not immediately restore electrophysiological signals; in 1/4 potentials reappeared later during the decompression and in 3/4 potentials had not recovered till the conclusion of surgery. There were new neurological deficits in 2/9, including one patient with loss of potential that was not restored with repositioning and the one in whom potential was restored but lost again during decompression. IONM is an efficient tool to alert the surgical team to potential neurological damage. Head reposition often restores the electrophysiological signals with possible prevention of impending sequelae.
American Journal of Physical Medicine Rehabilitation Association of Academic Physiatrists, Nov 1, 2007
Lumbar epidural varices either primary or secondary to outflow obstruction have been implicated i... more Lumbar epidural varices either primary or secondary to outflow obstruction have been implicated in causing lumbar radiculopathy. We report a case of an adolescent male who presented with lumbar radiculopathy attributable to thrombosed lumbar epidural varix as a result of inferior vena cava thrombosis emanating from factor V Leiden mutation. This rare cause of radiculopathy was diagnosed on contrast-enhanced computerized tomography. All symptoms resolved shortly after initiation of intravenous heparin therapy. The relevant literature is reviewed.
International Journal of Spine Surgery, 2015
Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years... more Case reports and retrospective review of accidental durotomies in lumbar surgeries during 5 years. To draw attention to a potentially serious complication of incidental durotomy-remote cerebellar hemorrhage. Accidental durotomy is a frequent complication of spinal surgery. In most cases the outcome of incidental durotomy is favorable. A delayed potentially serious complication of CSF loss during and after lumbar surgery is remote cerebellar hemorrhage (RCH). During 2008-2012, 1169 lumbar spine procedures were performed at our spine center. In 210 surgeries incidental or intentional durotomies occurred. All patients with durotomies were managed with suturing of the dural wound followed by deep wound drainage left for 5 days and tight wound closure. Of the 210 patients with CSF loss three patients were identified to suffer from RCH-an incidence of 0.26%. The three patients ages 56, 67 and 75 years developed RCH between 36-192 hours after surgery. All three were managed with supportive treatment and close clinical supervision. A gradual clinical and radiological improvement was noted in all three patients. Severe headache after spinal surgery and or declining mental status should not be attributed only to low CSF pressure secondary to dural tearing. It can also be the result of remote cerebral or cerebellar hemorrhage. Once the diagnosis of RCH is made, close clinical supervision is mandatory. In most cases non-operative supportive treatment may lead to eventual full clinical recovery.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Jan 8, 2015
To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in ... more To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in the surgical management of lumbar degenerative spondylolisthesis and or spinal stenosis. During a 1-year period (June 2006 to July 2007), ten patients were enrolled in a non-randomized prospective clinical study. The primary indication was neurogenic claudication due to spinal stenosis with single-level degenerative spondylolisthesis. Patients were evaluated with X-rays and MRI scans, visual analog scale (VAS) for back and leg pain, the Oswestry disability questionnaire, and the SF-36 health survey preoperatively, at 6 weeks, 3 months and 6 months and at 1, 2, 3 and 7 years postoperatively. The VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 19 at 7 years follow-up. The VAS score for worse leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 8.8 at 7 years follow-up. The ODI dropped from 49.1 preoperatively to 13.5 at 6 weeks and 7.8 at 7 years f...