All parts of the body which have a function, if used in moderation and exercised in labours in wh... more All parts of the body which have a function, if used in moderation and exercised in labours in which each is accustomed, become thereby healthy, well-developed, and age more slowly, but if unused and left idle they become liable to disease, defective in growth, and age quickly. Hippocrates D r. Bogduk has eloquently stated the case in favor of diskography as a diagnostic tool for identifying the isolated intervertebral lumbar disk that is painful in concordance with the patients low back symptoms. He likewise has separated out as nondiagnostic the patient with multiple level diskography pain and the patient with discordant diskography pain. His lucid separation of the elements in the controversy surrounding diskography and his review of the literature should be a reference for all students of degenerative spinal disorders. Back pain is virtually ubiquitous, 4 and it remains the most costly disorder in the U.S. 3 Most treatments for back pain, particularly surgery, are unproven and potentially harmful. 18 Back pain is also an exceedingly complex entity. This commentary draws attention to one, but not the sole, potential cause of back pain, the degenerated disk. Many patients with back pain do not have positive diskography. Furthermore, the correlation between positive diskography and the disk histology, computed tomography, or magnetic resonance imaging is not completely reliable. 9 Like-From the
Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots a... more Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots and the constructs may fail leading to restenosis of the cervical spinal canal. A simple laminoplasty technique has been developed using titanium miniplates that permits adequate decompression of the cervical spinal cord and bilateral cervical nerve roots, and successfully reconstructs an enlarged rigid spinal canal.
Journal of Trauma-injury Infection and Critical Care, Apr 1, 1990
A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-... more A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-contiguous spine fractures. Seventy-three per cent of the non-contiguous injuries were comprised of combinations of injuries in the cervical and thoracic regions or in the thoracic and lumbar regions. Forty-five per cent of fractures were a combination of compression fractures, 40% a combination of a compression fracture and a major spine fracture (i.e., one more likely to cause a neurologic deficit), and 15% a combination of major fractures.
Classic bladder exstrophy is a developmental defect resulting in pubic diastasis and bladder prot... more Classic bladder exstrophy is a developmental defect resulting in pubic diastasis and bladder protrusion through the abdominal wall. Within this spectrum of disease is cloacal exstrophy, defined by the development of omphalocele in addition to diastasis and bladder protrusion. This spectrum of diseases is caused by the failure of mesoderm tissue growth around the cloacal membrane during development, resulting in the described midline defects. This may include undergrowth of the pubic rami and external orientation of the anterior and posterior parts of the pelvis, contributing to a diastasis. Patients can also be born with neural tube defects and peripheral defects such as clubfoot. Long-term effects of bladder exstrophy may include incontinence, renal dysfunction, genital and body appearance dissatisfaction, impaired fertility, hip pain, and impaired gait. Treatment involves surgical closure of the bladder, repair of epispadias, and closure of the anterior abdominal wall with subsequ...
This is a report of a solitary lymphangioma in a vertebral body treated by excision and autogenou... more This is a report of a solitary lymphangioma in a vertebral body treated by excision and autogenous bone grafting. The literature for solitary lymphangioma is reviewed. An adolescent patient presented with low back pain and an abdominal mass associated with a radiographic lytic process in the L3 vertebral body. Direct continuity of the mass with the L3 body and without involvement of neural elements was demonstrated by computed tomography. Excision of the cystic mass and L3 body with subsequent reconstruction using cancellous iliac autograft was completed. At 20 months' follow-up, the patient was without pain and without evidence of recurrence. This is the first reported case of the occurrence of this entity in the vertebral body. Excision and bone grafting is accepted treatment. Careful observation for local recurrence is needed.
The Journal of Trauma: Injury, Infection, and Critical Care, 1990
A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-... more A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-contiguous spine fractures. Seventy-three per cent of the non-contiguous injuries were comprised of combinations of injuries in the cervical and thoracic regions or in the thoracic and lumbar regions. Forty-five per cent of fractures were a combination of compression fractures, 40% a combination of a compression fracture and a major spine fracture (i.e., one more likely to cause a neurologic deficit), and 15% a combination of major fractures.
Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots a... more Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots and the constructs may fail leading to restenosis of the cervical spinal canal. A simple laminoplasty technique has been developed using titanium miniplates that permits adequate decompression of the cervical spinal cord and bilateral cervical nerve roots, and successfully reconstructs an enlarged rigid spinal canal.
All parts of the body which have a function, if used in moderation and exercised in labours in wh... more All parts of the body which have a function, if used in moderation and exercised in labours in which each is accustomed, become thereby healthy, well-developed, and age more slowly, but if unused and left idle they become liable to disease, defective in growth, and age quickly. Hippocrates D r. Bogduk has eloquently stated the case in favor of diskography as a diagnostic tool for identifying the isolated intervertebral lumbar disk that is painful in concordance with the patients low back symptoms. He likewise has separated out as nondiagnostic the patient with multiple level diskography pain and the patient with discordant diskography pain. His lucid separation of the elements in the controversy surrounding diskography and his review of the literature should be a reference for all students of degenerative spinal disorders. Back pain is virtually ubiquitous, 4 and it remains the most costly disorder in the U.S. 3 Most treatments for back pain, particularly surgery, are unproven and potentially harmful. 18 Back pain is also an exceedingly complex entity. This commentary draws attention to one, but not the sole, potential cause of back pain, the degenerated disk. Many patients with back pain do not have positive diskography. Furthermore, the correlation between positive diskography and the disk histology, computed tomography, or magnetic resonance imaging is not completely reliable. 9 Like-From the
Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots a... more Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots and the constructs may fail leading to restenosis of the cervical spinal canal. A simple laminoplasty technique has been developed using titanium miniplates that permits adequate decompression of the cervical spinal cord and bilateral cervical nerve roots, and successfully reconstructs an enlarged rigid spinal canal.
Journal of Trauma-injury Infection and Critical Care, Apr 1, 1990
A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-... more A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-contiguous spine fractures. Seventy-three per cent of the non-contiguous injuries were comprised of combinations of injuries in the cervical and thoracic regions or in the thoracic and lumbar regions. Forty-five per cent of fractures were a combination of compression fractures, 40% a combination of a compression fracture and a major spine fracture (i.e., one more likely to cause a neurologic deficit), and 15% a combination of major fractures.
Classic bladder exstrophy is a developmental defect resulting in pubic diastasis and bladder prot... more Classic bladder exstrophy is a developmental defect resulting in pubic diastasis and bladder protrusion through the abdominal wall. Within this spectrum of disease is cloacal exstrophy, defined by the development of omphalocele in addition to diastasis and bladder protrusion. This spectrum of diseases is caused by the failure of mesoderm tissue growth around the cloacal membrane during development, resulting in the described midline defects. This may include undergrowth of the pubic rami and external orientation of the anterior and posterior parts of the pelvis, contributing to a diastasis. Patients can also be born with neural tube defects and peripheral defects such as clubfoot. Long-term effects of bladder exstrophy may include incontinence, renal dysfunction, genital and body appearance dissatisfaction, impaired fertility, hip pain, and impaired gait. Treatment involves surgical closure of the bladder, repair of epispadias, and closure of the anterior abdominal wall with subsequ...
This is a report of a solitary lymphangioma in a vertebral body treated by excision and autogenou... more This is a report of a solitary lymphangioma in a vertebral body treated by excision and autogenous bone grafting. The literature for solitary lymphangioma is reviewed. An adolescent patient presented with low back pain and an abdominal mass associated with a radiographic lytic process in the L3 vertebral body. Direct continuity of the mass with the L3 body and without involvement of neural elements was demonstrated by computed tomography. Excision of the cystic mass and L3 body with subsequent reconstruction using cancellous iliac autograft was completed. At 20 months' follow-up, the patient was without pain and without evidence of recurrence. This is the first reported case of the occurrence of this entity in the vertebral body. Excision and bone grafting is accepted treatment. Careful observation for local recurrence is needed.
The Journal of Trauma: Injury, Infection, and Critical Care, 1990
A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-... more A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-contiguous spine fractures. Seventy-three per cent of the non-contiguous injuries were comprised of combinations of injuries in the cervical and thoracic regions or in the thoracic and lumbar regions. Forty-five per cent of fractures were a combination of compression fractures, 40% a combination of a compression fracture and a major spine fracture (i.e., one more likely to cause a neurologic deficit), and 15% a combination of major fractures.
Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots a... more Accepted laminoplasty techniques may limit one's ability to decompress cervical nerve roots and the constructs may fail leading to restenosis of the cervical spinal canal. A simple laminoplasty technique has been developed using titanium miniplates that permits adequate decompression of the cervical spinal cord and bilateral cervical nerve roots, and successfully reconstructs an enlarged rigid spinal canal.
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Papers by Timothy Keenen