Lumbar intervertebral disc herniation in children less than 16 years of age. Long-term follow-up study of surgically managed cases

STUDY DESIGN: In this retrospective study, the long-term clinical results of lumbar intervertebral disc herniation in children less than 16 years of age were reviewed. OBJECTIVES: To evaluate the effectiveness of surgical treatment including posterior discectomy, extraperitoneal anterolateral discectomy, and anterior interbody fusion for lumbar intervertebral disc herniation in children less than 16 years of age. SUMMARY OF BACKGROUND DATA: Although previous follow-up studies on surgically managed lumbar intervertebral disc herniation in children and adolescents generally reveal good outcomes, few reports have focused on the time course of clinical findings and the long-term results. METHODS: The outcome of subjective symptoms, clinical signs, and time-related change of the intervertebral disc space in 11 patients were evaluated with an average follow-up period of 9 years (range, 5-12 years). RESULTS: The posterior discectomy procedure relieved clinical symptoms quickly. In the case of central herniation with or without intervertebral instability, extraperitoneal anterolateral discectomy or anterior interbody fusion led to favorable long-term results. Clinical symptoms (lower back pain, leg pain) and neurologic disturbance disappeared within 3 months after surgery. Recovery of normal straight leg raising test results (tight hamstrings), however, required much more time than recovery of other symptoms. Narrowing of the intervertebral disc space progressed up to 3-6 months after discectomy, but then disc space widening occurred. CONCLUSIONS: Satisfactory long-term clinical results and early return to school life were obtained with each surgical procedure. It is important to aim toward an early return to school via surgical treatment.     

Comparison of morphine and morphine with ketamine for postoperative analgesia

In addition to the patient's history and a thorough clinical investigation, magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) has been introduced to complete the findings for the diagnosis of internal derangement of the TMJ. However, 'dynamic information' is desirable to help us to understand the mechanism of internal derangement. This information is given for example by electronic axiography recording systems. The lack of any ability to assess joint function dynamically in MRI is a point of criticism. Using a computer-driven pseudodynamic MRI system (CINE mode) 'dynamic information' should be now available. In this investigation 21 patients with TMJ disorders were examined using both conventional static MRI and CINE mode. For the diagnosis of an anterior displaced disc with or without reduction in 18 cases (86%) it was only necessary to consider two static MRIs: a closed mouth position and a maximal open mouth position. Comparison showed there was no advantage in using CINE mode. Contrast and resolution of the static MRIs were shown to be better and so additional findings such as joint effusion and disc deformation could be diagnosed on static MRIs with greater certainty. Only in three (14%) cases was the dynamic information from CINE mode useful for the diagnosis of the displacement of the disc.     

Facial asymmetry: recognition of TMD

For many years researchers and clinicians have been aware of the varying presenting signs and symptoms common in the TMD patient. The symptom-complex frequently includes preauricular pain; cephalgia (predominantly frontal, temporal, occipital, vertex, retro- and periorbital); cervicalgia (immobility/stiffness); otalgia (congestion, vertigo, tinnitus). The most prominent signs are those of joint sounds (popping, click and crepitus due to disc displacement with reduction and/or osseous breakdown); restricted mandibular excursion (disc displacement without reduction); and mandibular deviation/deflection (disc(s) displacement).     

Measuring the anterior capsule opening after cataract surgery to assess capsule shrinkage

PURPOSE: To measure anterior capsule opening (ACO) size after acrylic intraocular lens (IOL) implantation and study the natural course of ACO reduction. SETTING: Kimura Eye and Internal Medicine Hospital, Hiroshima, Japan. METHODS: This study comprised 32 patients (38 eyes) having continuous curvilinear capsulorhexis, phacoemulsification, acrylic IOL implantation, and a self-sealing incision performed by 1 surgeon. A retroillumination photograph of the ACO was obtained with the Anterior Eye Segment Analysis System and converted to a computer image. The images were used to measure ACO size postoperatively and calculate the reduction ratio. Follow-up was 6 months. RESULTS: The postoperative reduction ratio in ACO size was 2.14% at 1 week, 3.83% at 1 month, 4.29% at 3 months, and 5.03% at 6 months. In a few cases, the reduction was progressively severe throughout the follow-up. CONCLUSIONS: The anterior capsule opening shrank rapidly during the first month after acrylic IOL implantation, followed by a slower progressive reduction in the subsequent 6 months. When severe, progressive shrinkage occurs, an anterior neodymium:YAG laser capsulotomy should be performed within 2 months postoperatively.     

18F]fluorodeoxyglucose uptake in neonatal acute lung injury measured by positron emission tomography

PURPOSE: Our goal was to investigate the role of serial dynamic contrast-enhanced SPGR MRI in the nonsurgical follow-up of patients with temporomandibular joint (TMJ) pain. METHOD: Ten patients (10 joints) with internal derangement of the TMJ were imaged with T1-weighted SE and serial postgadolinium SPGR MR pulse sequences. RESULTS: On T1-weighted images prior to treatment, the disk position was normal in one joint and anteriorly displaced without reduction in nine joints. After treatment, the disk remained normally positioned in one joint, was anteriorly displaced without reduction in eight joints, and was anteriorly displaced with reduction in one joint. The dynamic study after treatment showed a decrease in contrast enhancement of the posterior disk attachment in 7 of 10 joints. These seven patients had resolution or reduction in joint pain. CONCLUSION: These results suggest an association between a decrease in contrast enhancement of the posterior disk attachment and resolution or reduction in joint pain. This association was much stronger than the association between the clinical findings and the anatomy of the disk.     

Short-term effect of the use of a frozen-stored disc allograft for repair of the osteoarthritic sheep temporomandibular joint: a preliminary report

PURPOSE: The purpose of this experimental study was to evaluate the initial effect of a frozen-stored disc allograft on the osteoarthritic sheep temporomandibular joint (TMJ). MATERIALS AND METHODS: Bilateral osteoarthritis was induced in the TMJ of four sheep. Three months later, unilateral discectomy and frozen-stored disc allograft replacement were performed. The donor disc had been obtained from a healthy animal at killing. The disc was stored in a deep freezer at -70 degrees C for 1 month and thawed just before grafting. The contralateral joints were undisturbed and served as a control at 3 months. At 6 months after the initial procedure, 3 months after the repair, the four sheep were killed. RESULTS: All four grafted discs were perforated and displaced. In the repaired joints, the condylar articular surface was partly denuded in some areas, and part of the surface showed fibrous repair. The control joints showed osteoarthritic changes. CONCLUSION: Frozen-stored disc allograft is not a satisfactory interpositional material in the osteoarthritic sheep TMJ.     

Correlation between preoperative mouth opening and surgical outcome after arthroscopic lysis and lavage in patients with disc displacement without reduction

PURPOSE: This study was designed to evaluate the efficacy of arthroscopic lysis and lavage for patients with limited mouth opening. The relationship between preoperative mouth opening and the surgical outcome was determined. METHOD: Fourteen patients with 16 internally deranged joints were treated by arthroscopic lysis and lavage. All had received 10.4 (7 to 19) months of nonsurgical treatment before arthroscopy. The preoperative magnetic resonance images showed anterior disc displacement without reduction in all treated joints. RESULTS: Twelve of the 14 patients (86%) showed good reduction in pain and improved range of jaw movement on average follow-up of 28.5 (13 to 66) months. Two patients showed no improvement after arthroscopy and required open surgical procedures. The preoperative mouth opening of the successful group averaged 29.4 (22 to 35) mm, whereas the two failed cases had 10- and 19-mm openings, respectively (P < .05). CONCLUSION: Persistent limitation of mouth opening of more than 22 mm after nonsurgical treatment has a good prognosis when treated by arthroscopic lysis and lavage. However, those with greater limitation should probably have earlier surgical intervention.     

Why do we fail in aging the skull from the sagittal suture?

This study determined the variability of temporomandibular joint (TMJ) disk position in medial, central, and lateral aspects of the joint using magnetic resonance imaging (MRI). Subjects had clinical evidence of reciprocal TMJ clicking (N = 123) or restricted mandibular motion (N = 52). Eighty-nine asymptomatic volunteers provided a control group. Disk position was quantified on MRI by measuring the angle formed by a line through the middle of the condyle and perpendicular to the Frankfort plane and a line through the same midpoint of the condyle and tangential to the posterior-most aspect of the disk. The disk position in asymptomatic TMJs varied considerably with a tendency toward farther anterior placement in more lateral images. In 47 TMJs from a total of 52 TMJ5 (90%), restricted mobility was associated with anterior disk displacement (ADD) without reduction. The disk position demonstrated a mean displacement of 77 degrees without significant differences at the medial and lateral aspects of the condyle. One hundred TMJs from a total of 123 TMJs (81%) with reciprocal clicking demonstrated ADD with reduction. Tomograms revealed larger lateral displacements or rotational displacements in these joints, whereas medial images frequently showed similar ranges of disk positions as compared with asymptomatic TMJs. The results suggest that disk positions of up to +15 degrees on medial tomograms and +30 degrees on lateral tomograms should be regarded as normal variations. Furthermore, multisection analysis of all parasagittal images improved the separation between disk displacement and asymptomatic TMJs.     

Surgery of the upper cervical spine in rheumatoid arthritis. Indications and results apropos of 28 cases

PURPOSE OF THE STUDY: The goal of this study was to precise indications and surgical techniques for stabilisation with or without decompression of the upper cervical spine instability in rheumatoid arthritis. MATERIAL AND METHODS: 28 patients presenting upper cervical spine disease have been reviewed (mean age 57 years). These patients had been suffering from severe diffuse arthritis during an average of 14.5 years. The anterior atlanto-axial dislocation was most frequent (25 times), 1 posterior dislocation and 2 vertical dislocations. Odontoid lysis was noted 19 times. A subluxation of the lower cervical spine was present in 12 patients. SURGICAL TECHNIQUE: C1-C2 arthrodesis was performed 12 times (9 times with a loop wire and 3 isthmo-pedicular screws C2-C1), occipito-cervical arthrodesis with plates 16 times. Operative traction was necessary 5 times. The associated surgical gestures included 3 times a laminectomy, 2 times an enlargement of the occipital foramen, 1 section of the Arnold nerve. In 2 patients was associated a fixation of the lower cervical spine. RESULTS: With an average of 27 months follow-up, functional results (classified according to Ranawat's criteria) were satisfactory in 14 patients, improved in 7 patients, unchanged in 4 and bad in 3. The reduction of the anterior displacement in 25 patients was complete 11 times, partial 17 times and null 3 times. The reduction of the vertical displacement was complete once, partial 3 times. Arthrodesis fusion was obtained in 19 cases, 5 times it was a fibrous union and 4 pseudarthrosis occurred, all with C1-C2 loop wire. The rate of complications was high: 2 infections on bone site grafting requiring reoperation, 2 infections with secondary septicemia after lack of reduction. DISCUSSION AND CONCLUSION: Occipito-cervical arthrodesis is necessary as soon as the patient presents neurological signs. When there is an anterior dislocation associated with vertical dislocation, if there is posterior dislocation in case of osteoporosis of the posterior C1-C2 arc, or destabilisation of the lower cervical spine. C1-C2 arthrodesis is suggested when there is no important neurological signs, when displacement is limited to a pure anterior dislocation and in young patient with good bone quality.     

Indication and clinical results of laminoplasty for cervical myelopathy caused by disc herniation with developmental canal stenosis

STUDY DESIGN: The outcome of a herniated disc in patients with cervical myelopathy treated by laminoplasty without discectomy and in those treated conservatively was studied by magnetic resonance imaging. OBJECTIVES: To compare the surgical results of laminoplasty with those of anterior spinal fusion in patients with myelopathy caused by to cervical disc herniation and to make a treatment strategy for cervical disc herniation depending on these results. SUMMARY OF BACKGROUND DATA: Anterior discectomy and spinal fusion have had acceptable surgical results, but many complications have been reported, especially adjacent segment degeneration and bone graft complications. METHODS: Forty-seven patients with cervical disc herniation were examined in this study. Of them, 32 patients (mean age, 56 years) underwent laminoplasty without resection of the herniated disc. Seven patients with mild cervical myelopathy and 8 patients with radiculopathy (mean age, 53 years) were treated conservatively. As a control group, 44 patients (mean age, 50.3 years) who underwent anterior spinal fusion were examined. All patients in the laminoplasty group also had congenital spinal canal stenosis in which the ventrodorsal canal diameter was less than 13 mm. The association between the outcome of a herniated disc and clinical features was investigated. The severity of myelopathy was evaluated according to the Japanese Orthopaedic Association's scoring system. Surgical outcomes were evaluated by the system of Hirabayashi for determining recovery rate. RESULTS: The recovery rate averaged 67.9% in laminoplasty and 68.8% in anterior spinal fusion. There were no significant differences between the groups. No patients underwent anterior spinal fusion after laminoplasty. Follow-up magnetic resonance imaging showed regression of the size of the herniated disc in 15 of the 20 patients in the laminoplasty group and in 12 of 15 patients treated conservatively. In the MRI studies of the natural course of disc herniation, the size of the herniated disc decreased to almost half in 1 to 2 months and almost disappeared within 3 months after surgery. CONCLUSIONS: The size of the herniated disc in cervical lesions regressed as it does in the lumbar lesions. Laminoplasty for patients with narrowed spinal canals showed favorable surgical results. Therefore, the therapeutic method for cervical disc herniation should be chosen after taking the natural history of the disc herniation into consideration.     

Prevalence of morphological changes in the surfaces of the temporomandibular joint disc associated with internal derangement

PURPOSE: The purpose of this study was to determine the prevalence of morphological changes in the superior and inferior surfaces in the temporomandibular joint (TMJ) disc and relate them to disc displacement. MATERIALS AND METHODS: Thirty TMJs obtained from fresh cadavers were studied. The TMJs were dissected, and the superior and inferior surfaces of the disc were inspected and classified as intact, irregular, or perforated. These findings were corrolated to the position of the disc. RESULTS: There was a greater prevalence of morphologic changes in the inferior (57%) than in the superior surface (17%) of the disc (P < .001). This was found for joints both with normal disc position and those with disc displacement. There was no relationship between surface irregularities of the inferior surface and the position of the disc. Perforation was seen more frequently in joints with disc displacement than in those with normal disc position. CONCLUSION: Morphologic changes in the inferior surface of the TMJ disc are more prevalent than those in the superior surface, but this is not related to disc position. However, this needs to be considered when doing arthroscopy of only the superior joint compartment.     

Clinical experience in temporomandibular joint arthroscopy

Clinical experience of arthroscopy in 12 temporomandibular joints with a clinical diagnosis of closed lock was described. There were 10 patients and all were females with a mean age of 31.2 years (range 20 to 59 years). The antero-lateral approach was used for entry into 11 joints. The clinical findings were adhesions (64%), fibrillation (64%), anterior displacement of disc (36%) and scuffing of the articular surface of the glenoid fossa (9%). Two of the joints that had arthrocentesis prior to arthroscopy did not show any different findings from the rest. Of the 8 patients who had pre-arthroscopy pain, 7 patients (88%) had reduction of the symptom. Three patients (38%) had complete resolution of pain. The range of mouth opening (measured as maximal incisor opening) increased in all patients two weeks following arthroscopy. The average change in maximal incisor opening was 40.3% with a range of 22% to 85%. The mean follow-up was 34 months (range 4 to 68 months).     

Cumulative incidence of lumbar disc diseases leading to hospitalization up to the age of 28 years

STUDY DESIGN: A cohort study of 12,000 persons with a follow-up period ranging from birth to the age of 28 years. OBJECTIVES: To determine the cumulative incidence of lumbar disc disease leading to hospitalization in a well-defined geographic population, with special emphasis on age of onset and differences between the genders and among disease categories. SUMMARY OF BACKGROUND DATA: There are few published reports on low back pain in adolescence, and most of them are cross-sectional in design. METHODS: The Finnish National Hospital Discharge Register was used to identify all possible cases of lumbar disc disease. Copies of all hospital records regarding the diagnosis and course of the disease were collected and the hospitalizations were classified into three categories: 1) confirmed herniated nucleus pulposus (HNP), 2) unconfirmed HNP (sciatica symptoms without visible herniation), and 3) other low back diseases. The patients were classified according to the highest category of diagnosis achieved by each. RESULTS: Symptomatic low back pain leading to hospitalization first appeared around the age of 15 years, and the incidence rose more sharply from the age of 19, especially in men with other low back diseases. Men were hospitalized more than twice as often as women. CONCLUSIONS: Lumbar disc diseases leading to hospitalization begin early.     

Risk of long-term disability among patients with back pain

This follow-up study was designed to identify the differences between the TMJ movements of individuals undergoing orthognathic surgery, with and without positioning of the mandibular proximal segment. A further aim was to assess the location of the terminal hinge axis before and after surgery regarding variations due to mandibular advancement or set back, respectively combined two jaw osteotomy. Mechanical axiographic tracings were documented in 14 patients undergoing orthognatic surgery without positioning of the mandibular proximal segment. The terminal hinge axis position was marked by a tattoo. After surgery two more axiographic tracings were recorded over a follow-up period of 24 months. Changes to the terminal hinge axis position were also documented. Condylar guidance angles showed no differences, whereas Bennett angles decreased by an average of 25%. Subjective or objective TMJ symptoms after surgery could be observed in 64% of the patients, compared to 50% before surgery. Considerable variations in the position of the terminal hinge axis were observed nine months after surgery, especially in the two jaw group. In Class II individuals the terminal hinge axis was found in a cranial position both after 9 and 24 months. Class III individuals with two jaw surgery also gained a long term cranial localisation, whereas Class III patients with mandibular setback only demonstrated a hinge axis position inferior and anterior compared to the preoperative reference. No statistically significant differences were apparent between the axiographic condylar movement parameters in the present group as compared to data published employing condylar positioning.     

Morphologic changes in the elastic fibers of the temporomandibular joint after experimental disc perforation in the rabbit

PURPOSE: Elastic fibers in the attachment regions of the temporomandibular joint (TMJ) are considered important in the movements of the disc during jaw motion. This study was designed to determine whether there are change in the elastic fibers of the TMJ when the disc is perforated for a long period. MATERIALS AND METHODS: Each TMJ of five rabbits was surgically exposed, and a mediolateral perforation was made in the center of the articulating region of the disc with a scalpel. Five untreated and three sham-operated rabbits were used as controls. The TMJs were removed after 10 months and processed for histochemical demonstration of elastic fibers. RESULTS: Osteoarthritic changes and a significant decrease in number of the elastic fibers in the anterior-inferior attachment and posterior-inferior attachment of the TMJ disc were observed after disc perforation. Conversely, elastic fibers appeared in the fibrous tissue on the resorbed bone of the articular eminence. CONCLUSIONS: Experimental disc perforation changes the distribution and density of the elastic fiber in the TMJ as well as causes osteoarthritis. A knowledge of these facts may improve our understanding of perforation of the disc.     

Adolescent female craniofacial morphology associated with advanced bilateral TMJ disc displacement

The aim of this study was to determine if cephalometric measurement differences occurred between two groups of similarly aged female adolescents which differed with respect to their diagnoses of temporomandibular joint disc position on magnetic resonance images (MRI). One group consisted of 17 female adolescents exhibiting complete bilateral disc displacement affecting the temporomandibular joints (TMJ), while the second group of 17 female adolescents was diagnosed as having bilateral normal disc position on MRI. Independent sample t-tests identified statistically significant differences in cephalometric measurements between the two groups, but no age difference between the two groups was evident. The group with bilateral total disc displacement exhibited the following significant angular differences from the group with normal disc position: an increased mandibular and palatal plane relative to sella-nasion; posterior rotation of the mandible as illustrated by an increased angle between the posterior border of the mandibular ramus and sella-nasion; and a decrease in Rickett's facial axis. Significant differences in linear cephalometric variables were also evident between the two groups. Total posterior facial height and ramus height were reduced in the totally disc displaced group. Furthermore, a slight increase in the middle anterior facial height was noted, with a decrease in the posterior cranial base vertical height in the totally disc displaced group.     

Synthesis of inositol-containing glycophospholipids

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.     

Severe primary HIV-1 infection among black persons in Barbados

The purpose of this long-term follow-up was (1) to investigate disc changes in the olisthetic segment in patients treated conservatively, (2) to compare disc changes above the slipped vertebra in conservatively treated patients with those in operatively treated patients, and (3) to establish possible relations of disc changes to the degree of the slip and to subjective back pain symptoms of the patients. The subjects were 227 patients with isthmic L5 olisthesis diagnosed under 20 years of age (mean 13.8 years) with a mean follow-up of 15.4 (range 5-30) years. Of these, 145 patients had been treated with segmental fusion and 82 had been treated conservatively. At follow-up, standing anteroposterior and lateral radiographs as well as flexion/extension views of the lumbar spine were taken. Disc degeneration was graded semiquantitatively: 0 = normal disc height, 1 = decrease of disc height < 50%, 2 = decrease > or = 50%, and 3 = obliteration of the disc. In the conservatively treated patients degeneration of the olisthetic disc was distributed by grade as follows: O: n = 38, 1: n = 24, 2: n = 14, 3: n = 6. No motion at all was observed in the olisthetic segment in 40 patients (48%) with a mean slip of 30%, segmental motion of 4 degrees-18 degrees was found in 42 patients with a mean slip of 14%. There was a statistically significant association of the degree of slip to the severity of disc degeneration and non-mobility of the segment. Grade 1 degeneration of the L4/5 disc occurred in 25.6% of the conservatively treated patients and in 32% of 48 patients treated with L5-S1 fusion. This correlated with the severity of the slip, but not with pain symptoms or pathologic segmental mobility at the time of follow-up. Out of 84 patients with L4-S1 fusion, in 17% grade 1 degeneration of the L3/4 disc was observed, and 3 out of 13 patients (23%) with L3-S1 fusion had grade 1 degeneration of the disc above the fusion. The disc changes had no correlation with subjective pain symptoms. It is concluded that the natural course of isthmic spondylolisthesis is associated with disc degeneration and spontaneous stabilization of the olisthetic segment. Fusion operations do not significantly increase the rate of disc degeneration in the adjacent disc above the fusion after a mean postoperative follow-up of 13.8 years. No correlation between the number of degenerated discs or the degree of degeneration and subjective low back pain symptoms was found.     

Tethered cord syndrome in occult spinal dysraphism: timing and outcome of surgical release

OBJECTIVE: To investigate the influence of neurosurgical intervention on the appearance of upper motor neuron (UMN) signs in newborns diagnosed with occult spinal dysraphism and tethered cord (TC) during the first month of life. METHODS: A prospective study (1990 to 1996) of 22 consecutive newborns with occult spinal dysraphism monitored for the appearance of UMN signs. Untethering was performed when neurologic or urodynamic investigation indicated the presence of UMN dysfunction. RESULTS: Of 22 patients, 10 remained free of UMN symptoms during follow-up (mean, 67+/-22 months). Untethering was performed in 12 of 22 patients because of the presence of UMN symptoms. In 7 of these 12 patients, there was a documented asymptomatic period of 13+/-11 months before the onset of UMN symptoms. Untethering at a mean age of 18+/-17 months restored normal neurologic and urinary function in all patients (mean postoperative follow-up, 25+/-16 months). Of the 12 children, 5 presented with UMN signs at birth. In these children, untethering was performed at a mean age of 9+/-5 months. In two of these five patients, UMN symptoms did not resolve after surgery, and ongoing conservative bladder treatment was required (mean follow-up, 37+/-14 months). In none of the 12 operated children did signs of retethering occur. CONCLUSIONS: A significant number (10/22) of children born with occult spinal dysraphism and TC did not develop UMN symptoms during follow-up; neurosurgical correction after the appearance of an UMN sign restored normal neurologic and urinary function in all children; and untethering in children presenting at birth with UMN symptoms resulted in poorer outcome.     

In vivo treatment with recombinant IL-12 protects C57BL/6J mice against secondary alveolar echinococcosis

A sample of 259 patients with vertical maxillary hyperplasia, mandibular hypoplasia and anterior vertical open bite, collected from three different institutions, was analysed regarding temporomandibular joint (TMJ) sounds, condylar remodelling, and condylar resorption. All patients underwent Le Fort I osteotomies, and bilateral sagittal split advancement osteotomies were performed in 117 patients. Intraosseous wire fixation was used in 149 and rigid internal fixation in 110 patients. Cephalometric and orthopantomographic radiographs were available before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). The number of patients with TMJ sounds decreased from 38% to 31%. At the latest follow up 23.6% of the patients showed condylar remodelling, 7.7% unilateral condylar resorption and 7.7% bilateral condylar resorption. Condylar contours, as assessed on orthopantomographic radiographs, were classified as five different types. Condyles with preexisting radiological signs of osteoarthrosis or having a posterior inclination were at high risk for progressive resorption. Female patients with severe anterior open bite, high mandibular plane angle and a low posterior-to-anterior facial height ratio, who underwent a bimaxillary osteotomy, were prone to condylar resorption. Bone loss was predominantly found at the anterior site of the condyle. The incidence of condylar resorption was significantly higher after bimaxillary osteotomies (23%) than after only Le Fort I intrusion osteotomies (9%). Avoidance of intermaxillary fixation by using rigid internal fixation tended to reduce condylar changes, in particular in patients who underwent only a Le Fort I osteotomy. Rigid internal fixation in bimaxillary osteotomies resulted in condylar remodelling in 30% and progressive condylar resorption in 19% of the patients. Condylar changes were not significantly different after using either miniplate osteosynthesis or positional screws in bilateral sagittal split osteotomy procedures.