MacCarty, Collin S.

A group of 26 patients who had peripheral occlusive arterial disease of the lower extremity were studied before and after chemical or surgical unilateral lumbar sympathectomy. The temperatures of the gastrocnemius muscle and of the skin of the sural area were determined simultaneously preoperatively and postoperatively. Only patients who had undergone successful unilateral lumbar sympathetic denervation based on the postoperative area of anhidrosis were included. The data were obtained under basal conditions among the 26 patients, and the persons studied were divided into two groups. Group 1 was composed of 17 patients (65 per cent) who had a definite parallel increase of 1.2 C. in the temperature of the gastrocnemius muscle and the skin after unilateral sympathectomy. In group 2 (nine patients or 35 per cent) the temperature of the gastrocnemius muscle and the skin of the sural area was unchanged after unilateral sympathectomy. Since none of these patients were suitable for surgical bypass arterial-grafting procedures and all were in the older age group, not too much could be expected from the standpoint of an increase in temperature. However, when the temperature of the skin after operation increased, the temperature of the gastrocnemius muscle also increased.

Abstract The pathogenesis of postlaminectomy spinal deformity and instability in children was evaluated by reviewing appropriate roentgenographic findings. First, we reviewed spine roentgenograms of patients below 40 years of age who underwent spinal fusion for deformity and instability of the spine developing after a multiple level laminectomy. Two types of deformity were recognized on the roentgenograms: increased mobility between the vertebral bodies and wedging deformity of the ventral aspect of the vertebral bodies. Second, we did a follow-up study of another group of patients who had undergone laminectomy. We found the same two types of deformity in children, but not in adult patients. The incidence of deformity was higher after laminectomies of the cervical or cervicothoracic region than after lumbar laminectomies. Our data suggest that postlaminectomy spinal deformity can develop in children without irradiation or facet injury. The deformity is due to a wedging change in the cartilaginous portion of the vertebral body and to the viscoelasticity of ligaments in children. When treatment of this complication becomes necessary, anterior fusion may be effective in arresting progression. Prophylactic measures against the development of deformity are discussed. Our hypothesis concerning the mechanism of development of this complication supports the rationale of osteoplastic laminar resection and reconstruction instead of laminectomy, particularly in the management of children.