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MEDICAL LITERATURE ABSTRACTS

J.A.M.A. NoV 15, 1958

Pathogenetic Importance of the Thoracic Portion of the Vertebral Column. H. Kamieth. Arch, orthop. u. Unfali-Chir. 49:585.606 (No.5) 1958 (In German) [Munich, Germany].

The authors made a roentgenologic study of the thoracic spine in 100 patients with roentgenologically proved ulcers of the stomach and duodenum. The group included 83 men and 17 women. Sixty-one men and 11 women had duodenal ulcers; 20 men and 3 women had gastric ulcers; and the other 5 patients had both gastric and duodenal ulcers. Answers were sought to the following questions: 1. What morphologic and functional changes can be observed in the thoracic portion of the vertebral column? 2. What connections exist between the morphologic changes and the disturbances in the static functions'? 3, Is it possible that the morphologic and functional changes will act as pathogenetic factors'? The majority of patients (86 of 100) had lateral curvature scoliosis of the thoracic portion of the vertebra! column, which, however, was essentially postural, since it could be compensated by forward flexion in two thirds of the male patients and in about one-half of the female patients. A tendency to gradual fixation of the postural scoliosis was demonstrated by its appearance when a roentgenogram was made with the patient in the supine position. The convexity of the scoliosis was toward the right side in 60 of the patients and toward the left side in 21 and the remaining 5 patients had an S-shaped scoliosis. The percentile distribution 0'1 right-sided and left-s,d d scolioses coincided with the percentages of duodenal and gastric ulcers AI! the scolioses involved the vertebral segments corresponding to the stomach and at dueodrndum, that is, T-6 to T.9. The scolioses ware mild, some being so slight that they could hardly be differentiated from variations within the normal range. Spasticity of the musculature of the back was present in all but 17 of the 100 patients. Moreover, almost 90% of all the patients had pathological changes on the intervertebral disks These disk changes and their relationship to osteochondrosis of the vertebrae, to Schmorl's nodules, and to spondylitic processes are discussed, On the basis of diagrams the author explains the pressure, shifting, and rotational forces that are most important in the production of the functional changes 111 the intervertebral disks. Spatial infringement in the irtarvertebral disk canals seems to be of vital importance, and this contraction of the canals seerro; to be a complex process, In which morphologic and functional, as well as nerve root changes may playa part. It has not been definitely proved whether these various space..infringing factors or disturbing influences act directly on the nerve roots or indirectly by way of stasis and edema.taus changes in the intervertebral disk canals. There is also a possibility that the ligamentous apparatus, as well as the disks at the nerve roots, play a part. Morphologicosteogenic changes seem to be less important than in functional-dynamic changes. At any rata processes in the vertebral column seamed to playa part in 90 of the 100 patients with peptic ulcers.

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