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Jack R. Engsberg, Kenneth S. Olree, Sandy A. Ross and T. S. Park

indicate the need for caution in performing an SDR in children with muscle weakness, a paucity of objective information is available to substantiate or refute the claim. Objective measures to quantify strength and weakness in children with CP have been described; 5, 10, 12 however, these measures have been used to investigate the abilities of children with CP to show gains in strength as a result of training. They have not been used in the clinical setting to aid in the selection of patients who are appropriate candidates to undergo SDR or in the evaluation of their

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Jack R. Engsberg, Sandy A. Ross and Tae Sung Park

an SDR in patients with muscle weakness; however, a paucity of objective information is available to support the claim. Objective measures designed to quantify strength and weakness in patients with CP have been described. 5, 10, 12 However, these measures have been used to investigate the abilities of patients with CP to show gains in strength as a result of training. They have not been used in the clinical setting to aid in patient selection for SDR or in outcome evaluation. Only one group of investigators has reported on objective measures of strength as a

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Tyler S. Cole, Kaith K. Almefty, Jakub Godzik, Amy H. Muma, Randall J. Hlubek, Eduardo Martinez-del-Campo, Nicholas Theodore, U. Kumar Kakarla and Jay D. Turner

C ervical spondylotic myelopathy (CSM) is the primary cause of spinal cord dysfunction in adults. 16 It typically has an insidious onset with symptoms that include hand numbness, hand weakness, loss of manual dexterity, gait difficulty, imbalance, and urinary symptoms such as urgency or hesitancy. The diminished hand strength and dexterity associated with CSM are key contributors to disability. Surgical decompression is the mainstay treatment for CSM and has been shown to improve hand function, but a majority of studies rely primarily on health-related quality

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Jack R. Engsberg, Kenneth S. Olree, Sandy A. Ross and T. S. Park

This investigation quantified pre- and postsurgery (8 months) hamstring muscle spasticity and strength in children with cerebral palsy (CP) undergoing a selective dorsal rhizotomy. Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for AB group prior to surgery; however they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. The results of spasticity testing in the present investigation agreed with previous studies indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

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Patrick Aimedieu and Reinhard Grebe

straightforwardly by a change in the tensile strength of the pia mater. Similarly, this holds for a diagnosis of crescent-shaped extraaxial fluid collections, which are observed to be diffusely spread over the hemisphere in cases of subdural hematoma, in contrast to “biconvex” extraaxial fluid collections, which constitute an epidural hematoma. If we take into account that the membrane covering the soft gray and white matter is elastic, the different observable manifestations become evident. 9 The effects on the brain of penetrating low-velocity injuries as well as those of

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Richard B. Raynor, James Pugh and Ilan Shapiro

W hen the cervical spine is discussed, the word “stability” occurs frequently. The term implies a resistance to anatomical change, even in the presence of structural changes. This means that the remaining elements not subject to change must exhibit the necessary strength to withstand the forces applied to them. Sometimes clinical considerations suggest that certain structural changes may be beneficial, but the danger of alteration in spine strength may impose limits to these changes. We are talking about the clinical meaning of “stability,” but a problem

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Chih-Chang Chang, Wen-Cheng Huang, Tsung-Hsi Tu, Peng-Yuan Chang, Li-Yu Fay, Jau-Ching Wu and Henrich Cheng

anatomical limitation and risk of VA injury. Currently the screw-rod system connecting the C1 lateral mass and C2 pedicle screws is a widely accepted option for AA fixation. Furthermore, in patients with anomalous VA or bone anatomy, there are several technical modifications to place a C2 pedicle screw, including a shorter C2 pars screw and translaminar screw. 8 , 28 Several biomechanical studies even demonstrated that all three kinds of C2 screws (i.e., pedicle, pars, and translaminar) had similar strength in vitro. Thus, a C2 pars or translaminar screw is often

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Leonardo B. C. Brasiliense, Nicholas Theodore, Bruno C. R. Lazaro, Zafar A. Sayed, Fatih Ersay Deniz, Volker K. H. Sonntag and Neil R. Crawford

placement of pedicle screws not only increases the risk of perforating adjacent parenchymal and neurovascular structures, it also leads to pedicle fractures and construct failure. For instance, in a study on the multidirectional flexibility of pedicle screw/rod instrumentation after iatrogenic pedicle injuries, stability of the construct decreased significantly after the pedicles were fractured, 17 but the effects of pedicle injuries on screw pullout strength have not been evaluated comprehensively. To our knowledge, only 1 study has investigated this subject. In 1991

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Chong-Suh Lee, Kyung-Chung Kang, Sung-Soo Chung, Won-Hah Park, Won-Ju Shin and Yong-Gon Seo

B ack muscle strength is one of the most important factors influencing low-back pain and functional disability. 11 , 13 , 15 , 19 Particularly for patients with symptomatic lumbar degenerative diseases managed with spinal surgery, it is critical to understand changes in back muscle strength and to improve it after surgery. Choi et al. 6 reported that patients who had undergone an operation for a herniated lumbar disc and participated in a lumbar extension exercise program had significant improvements in lumbar extensor power and size. A study by Kim et

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Jack R. Engsberg, Sandy A. Ross, David R. Collins and Tae Sung Park

, and strength data. This age requirement excluded approximately 40% of the patients who were being screened for and ultimately underwent an SDR. Specifically excluded from the investigation were children who had motor deficits resulting from neurological injury or illness that began after the 1st month of life and children with malformations of the central nervous system. Other exclusionary criteria included moderate to severe dystonia, athetosis, ataxia, and severe cognitive delay. Children were excluded if their parents reported that they were unable to follow