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Burton M. Shinners and Wallace B. Hamby

lesion, Barr 1 found the percentage of relief striking. Twenty-nine patients were relieved of pain. Of these 8 were able to resume all usual activities without residual difficulty; 9 were restricted by residual discomfort to lighter work, but otherwise were well. In 1941 several opinions were recorded concerning the results of treatment. Barr and Mixter 2 had found that patients were more improved if spinal fusion was done at the time of laminectomy. Of 94 patients with proved ruptured intervertebral discs, who had been followed for at least a year, 77 per cent

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Edgar F. Fincher, Bronson S. Ray, Harold J. Stewart, Edgar F. Fincher, T. C. Erickson, L. W. Paul, Franc D. Ingraham, Orville T. Bailey, Frank E. Nulsen, James W. Watts, Walter Freeman, C. G. de Gutiérrez-Mahoney, Frank Turnbull, Carl F. List, William J. German, A. Earl Walker, J. Grafton Love, Francis C. Grant, I. M. Tarlov, Thomas I. Hoen and Rupert B. Raney

” as far as spinograms are concerned. The patient with either an atypical history or findings, and the patient who has very severe sciatica of two to three weeks' duration and has had no relief from conservative measures, should enter the hospital for a spinogram. If a large defect is present, conservative measures should be discontinued. Another “must” for making a spinogram is the patient with low back pain who may have sciatica at one time or another and is to be considered for a spinal fusion. I think every patient who is to have spinal fusion should first have a

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Homer S. Swanson and Edgar F. Fincher

removed at the lumbosacral level. Postoperatively, he was relieved of his acute sciatica but continued to complain of constant low back pain. Because of persistence of symptoms, a spinal fusion was advised by the orthopedist, who had performed the original operation. Prior to this procedure, a lipiodol fluoroscopy was done to rule out a recurrent disc lesion. The oil was reportedly introduced at the 3rd interspace but undoubtedly it was introduced directly into the extradural cyst depicted in Fig. 1 , inasmuch as the oil appeared trapped in this cyst on later

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R. Glen Spurling and Everett G. Grantham

tear cannot be demonstrated, the exploration is listed as negative. Adequate decompression of the involved nerve root is, however, carried out. 8. Primary spinal fusion is never combined with simple removal of the ruptured intervertebral disc. Patients who continue to have incapacitating backache after simple disc surgery may require secondary spinal fusion, but a properly performed operation on the disc does not in any way interfere with subsequent fusion operations. 9. Convalescence is strictly supervised. The patient remains recumbent for 10 days

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Non-Traumatic Atlanto-Axial Dislocation

Report of Case with Recovery after Quadriplegia

Leonard A. Titrud, C. A. McKinlay, Walter E. Camp and Hewitt B. Hannah

count were normal. Her principal complaint was of some numbness in the finger tips of both hands. There was good muscular power in all extremities. The patient had been working at home and getting along quite well. Because of the fear that cervical infection had existed, spinal fusion was postponed. 4th Admission , Mar. 20, 1947. The cast which she had worn since Nov. 2, 1946 was bivalved. Operation , Mar. 21, 1947. Spinal fusion. Anesthetic: intratracheal nitrous oxide and oxygen and intravenous pentothal and curare. During the procedure 500 cc. saline and 750 cc

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John Raaf and George Berglund

disability award? How much does the average case cost the insurance carrier? What factors may influence the end results? Is a better result obtained when a protruded disc is found and removed than when there is a negative exploration or when exploration reveals an inflamed nerve root, adhesions about the nerve root, or some other pathological condition? Do private patients report better results than compensation patients? How often should spinal fusion accompany the removal of the protruded portion of the intervertebral disc? Often one has an impression, which may be

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Dean H. Echols and Frederick C. Rehfeldt

R ecently the orthopedic surgeons with whom we have been collaborating for the last 10 years on the problem of low back pain and sciatica made a follow-up study of 151 patients who had been treated surgically for these symptoms during a 5-year period. 1 They compared the results obtained by a neurosurgeon in cases of removal of ruptured lumbar intervertebral disks with the known results obtained in cases treated by disk removal combined with spinal fusion. The cases were rigidly selected by the orthopedists on the basis of conclusive demonstration at

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Glen O. Cross, James R. Reavis and William W. Saunders

. Kyphosis in patients with von Recklinghausen's disease has frequently been noted. Few of these patients have spinal cord tumors. Most if not all of the patients with meningoceles had kyphoscoliosis of some degree. One patient 1 had a spinal fusion for correction of the deformity 11 years before the discovery of the meningocele. Previous authors speculating on the origin of these lesions have agreed that a developmental defect either of the bone or of the dura precedes the appearance of the meningocele. That the actual herniation may progress is shown by the fact that

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John R. Russell and Paul C. Bucy

scoliosis ( Fig. 1 ) Fig. 1. Composite roentgenograms of spine showing scoliosis in 1942. On May 20, 1942, the orthopedic surgeon performed a spinal fusion with a inch tibial bone graft palced on the denuded laminae from the 10th thoracic to the 3rd lumbar vertebra. On June 9, 1942, a 2nd operation was done to correct the malposition of the tibial graft. Following this the wound became infected and drained for 4 months After recovery from the operation the patient was completely relieved of the twitching in the back muscles. He had no weakness or

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Protruded Lumbar Intervertebral Discs

Results Following Surgical and Non-Surgical Therapy

B. M. Shinners and W. B. Hamby

or indication for spinal fusions after the removal of disc protrusions. At present, opinions range from that of Barr, 1 who feels that practically all backs should be fused after disc surgery, to that of Caldwell and Sheppard 2 who concluded that “there is no indication for spinal fusion” in patients having operations for disc protrusion. We have attempted to find the answers to some of these questions in our own experience. It was not possible to re-examine personally a sufficiently large number of our patients, so we have conducted a second questionnaire