9/17/2010

First Spinal Fusion Reversal in U.S.!

First Spinal Fusion Reversal in U.S.!

SAN FRANCISCO, Calif. (Ivanhoe Newswire) -- 

A California doctor did the first spine fusion reversal surgery in the United States. It's a risky procedure, but for some patients, un-doing their initial surgery is the only option for pain relief.
Of the 150,000 spinal fusions done every year, one doctor believes he has an option that could replace up to 80 percent of these surgeries. 
Bobbie Jo Ramirez would never be able to throw a baseball in the backyard a month ago. But now that she has had spinal fusion reversal surgery, she can do more than she has in 10 years!
"I feel great," Ramirez told Ivanhoe.
A back injury led to the original fusion, doctors weld two vertebrae together to stabilize the spine. It left her stiff and in pain.
"It was excruciating," Ramirez recalled. "I mean just to try and roll yourself out of bed upright was just excruciating pain."
She had migraines three times a week, and the pain permeated throughout her body, forcing this softball fanatic to quit the game she loved.
"It started at the neck, but it radiates through your shoulders to your arms to your fingertips," Ramirez said.
Orthopedic surgeon Kenneth Light says many spinal fusions shouldn't be done.
"There is a common saying in the medical community and that is: ‘Never have a spinal fusion,’" Dr. Light shared. 
He says the surgery severely limits motion, and for some, the pain doesn't go away. Dr. Light became the first in the United States to reverse a fusion. He implants an artificial disk.
"Low and behold, we put the implant in. She woke up. She was fine," Dr. Light recalled. "She felt fine enough to go home the next day, and four weeks later, she is doing exceptionally well."
"I haven't had a headache since I came out of surgery," Ramirez said.
Critics are unsure if the implant will last, and there is a chance of paralysis if it fails. But Ramirez says reversing her fusion reversed her painful path.
"I feel like I made a decision that's going to give me life again," Ramirez explained.
The implant is made of the same materials that a hip replacement is made of. Likely candidates are people with a lot of back or neck pain and stiffness, preferably in the cervical region.

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here