Pathophysiology and Biomechanics of the Aging Spine

Aging of the spine is characterized by two parallel but independent processes: the reduction of bone mineral density and the development of degenerative changes. The combination of degeneration and bone mass reduction contribute, to a different degree, to the development of a variety of lesions. This results in a number of painful and often debilitating disorders. The present review constitutes a synopsis of the pathophysiological processes that take place in the aging spine as well as of the consequences these changes have on the biomechanics of the spine. The authors hope to present a thorough yet brief overview of the process of aging of the human spine

Posterior Instrumentation for Occipitocervical Fusion

Since 1995, 29 consecutive patients with craniocervical spine instability due to several pathologies were managed with posterior occipitocervical instrumentation and fusion. Laminectomy was additionally performed in nineteen patients. The patients were divided in two groups: Group A which included patients managed with screw-rod instrumentation, and Group B which included patients managed with hook-and-screw-rod instrumentation. The patients were evaluated clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, pain relief, complications and status of arthrodesis. The follow-up was performed immediately postoperatively and at 2, 6, 12 months after surgery, and thereafter once a year. Fusion was achieved in all but one patient. One case of infection was the only surgery related complication. Neurological improvement and considerable pain relief occurred in the majority of patients postoperatively. There were neither intraoperative complications nor surgery related deaths. However, the overall death rate was 37.5% in group A, and 7.7% in group B. There were no instrument related failures. The reduction level was acceptable and was maintained until the latest follow-up in all of the patients. No statistical difference between the outcomes of screw-rod and hook-and-screw-rod instrumentation was detected. Laminectomy did not influence the outcome in either group. Screw-rod and hook-and-screw-rod occipitocervical fusion instrumentations are both considered as safe and effective methods of treatment of craniocervical instability

The association of spinal osteoarthritis with lumbar lordosis

<p>Abstract</p> <p>Background</p> <p>Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis.</p> <p>Methods</p> <p>112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L₁to the bottom of L₅as well as from the top of L₁to the top of S₁. Furthermore, the angle between the bottom of L₅to the top of S₁was also measured.</p> <p>Results and discussion</p> <p>49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups</p> <p>Conclusions</p> <p>There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis.</p

Surgical outcome after spinal fractures in patients with ankylosing spondylitis

<p>Abstract</p> <p>Background</p> <p>Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine.</p> <p>The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned.</p> <p>Methods</p> <p>Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge.</p> <p>Results</p> <p>Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries.</p> <p>Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed.</p> <p>Conclusion</p> <p>The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.</p

Συνήθεις Τραυματισμοί Στην Πυγμαχία

Στην παρούσα πτυχιακή εργασία, αναλύονται οι συνηθέστεροι τραυματισμοί σε ένα από τα αρχαιότερα αθλήματα, αυτό της πυγμαχίας. Αρχικά παρουσιάζονται γενικά και ιστορικά στοιχεία για την πυγμαχία και τις κατηγορίες που την απαρτίζουν, την Επαγγελματική και την Ολυμπιακή – Ερασιτεχνική και τους αγωνιστικούς κανόνες για ασφαλή διεξαγωγή των αγώνων. Συνακόλουθα, καταγράφονται πιο κοινοί και συχνοί τραυματισμοί όπως προκύπτουν από τις υπάρχουσες στη βιβλιογραφία επιστημονικές μελέτες και η ορθή αντιμετώπισή τους. Το knockout από χτύπημα στο κεφάλι ή το σώμα, η άμεση αντιμετώπιση εντός και εκτός του αγωνιστικού χώρου αλλά και οι βραχυπρόθεσμες επιπτώσεις αυτού αναλύονται ακολούθως. Η σωστή αντιμετώπιση των επιπτώσεων του knockout, δεν περιορίζεται μονάχα στα σωματικά τραύματα αλλά και στις ψυχολογικές επιπτώσεις του στην υγεία των αθλητών. Καταλήγοντας, πραγματοποιείται συζήτηση για την σπουδαιότητα της άμεσης και αποτελεσματικής αντιμετώπισης των κοινών τραυματισμών και του knockout, και σχολιασμός για την αλλαγή των κανονισμών εντός και εκτός του αγωνιστικού χώρου, οι οποίες έχουν καταστήσει την πυγμαχία ένα ασφαλές άθλημα παρά τη βίαιη φύση της.ΟΧ

Võrdseid võimalusi ja õppimist soodustav koolijuhtimine ning koolide autonoomia

Artikkel põhineb koolijuhtimise Euroopa võrgustiku (EPNoSL) raames tehtud tööl,&nbsp;eelkõige 21 Euroopa riigi koolijuhtimise strateegiate süvauuringul ja aruteludel, mis&nbsp;toimuvad EPNoSLi veebiseminaridel, riikide õpikodades ja vastastikuse õppe üritustel,&nbsp;millest võtavad osa mitmes ELi riigis koolijuhtimisega seotud huvirühmad&nbsp;(sh Euroopa, riikliku ja kohaliku tasandi poliitikakujundajad, koolijuhid, õpetajad&nbsp;ja teised haridustöötajad, õppejõud, lapsevanemad ja õpilased). EPNoSL on Euroopas&nbsp;tegutsevast 42 institutsioonist koosnev võrgustik, mille eesmärk on parandada&nbsp;Euroopa koolide juhtimist nii poliitilisel kui ka praktilisel tasandil. Artiklis käsitletakse&nbsp;koolide autonoomia küsimust Euroopa koolijuhtimise strateegiate kujundamise&nbsp;kontekstis. Koolide autonoomiat peetakse tervikliku koolijuhtimise poliitika&nbsp;väljatöötamise oluliseks eeltingimuseks. Artikkel tugineb kõnealuse projekti raames&nbsp;välja töötatud laiaulatuslikule koolijuhtimise strateegia kujundamise raamistikule&nbsp;ja sellel on kaks põhieesmärki. Esiteks püütakse artiklis näidata, et selle asemel et&nbsp;otsida koolide autonoomia puhul ühte, kõigile sobivat lahendust, tuleks keskenduda&nbsp;konkreetset olukorda arvestavale strateegiale, mille eesmärk on saavutada&nbsp;kindlaksmääratud õpitulemused ja võrdsed võimalused. Teiseks on artiklis kirjeldatud&nbsp;seitset koolide autonoomia põhisuunda, mida on võimalik kohandada&nbsp;Euroopa eripalgeliste haridussüsteemidega. &nbsp;Full tex

De la relaxation au stretching

The article draws from the work conducted in the context of the European Policy Network on School Leadership (EPNoSL). In particular, it is based on an in-depth review of school leadership policies in 21 European countries and the discourse that is taking place in EPNoSL’s webinars, national workshops and peer learning activities organised in several EU countries with the participation of a variety of school leadership stakeholders (including policy makers at European, national, and local levels, school leaders, teachers and other professionals, academics, researchers, parents and students). EPNoSL is a network of 42 European institutions that aims at improving policy on, and practice in, school leadership in Europe. The article discusses the question of school autonomy in the context of school leadership policy development in Europe. School autonomy is considered as a critical precondition for the development of comprehensive school leadership policies. Based on the comprehensive framework of school leadership policy development that has been developed in the context of this project, the article undertakes two main tasks. Firstly, it attempts to show that instead of searching for universal solutions on the question of school autonomy, it is important to reflect on context-specific policies on autonomy that aim at the attainment of concrete learning and equity goals. Secondly, it specifies seven general directions for policies on school autonomy that are adaptive to the divergent experiences of European education systems