Jerzy E Kiwerski

Publications of Jerzy E Kiwerski

• [Factors effecting frequency of occurrence of back pain syndromes].

  Authors: Jerzy E Kiwerski

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(2):118-21.

  Low back pain syndromes are in the group of the commonest diseases observed in recent years and bear serious medical, social and economical burden. According to European data more than 70% ofLow back pain syndromes are in the group of the commonest diseases observed in recent years and bear serious medical, social and economical burden. According to European data more than 70% of population suffered from back pain at least for a week in the lifetime, and 15-40% of population experiences low back pain every year. There is alarming decrease in the age of first onset described by many authors. Peak morbidity is observed in persons aged between 35 and 55 years, but a recent Japanese study brings evidence that 66.7% of middle-school children has already experienced low back pain lasting for at least 1 week, and relapse rate exceeds 60%. Increase of incidence and morbidity of low back pain is linked to lifestyle alterations including significant limitation of physical activities since young age, changes of hobby preferences, alteration of work habits favoring activities performed in improper body position lasting for hours or even years, to dynamic physical work. Pain may be presented in any phase of spinal overload syndromes. Back pain may result from nocyceptive activation in spinal, paraspinal tissues as well as irritating of nervous structures within vertebral canal, when appears as a neuropathic pain. Pain in spondylolisthesis may be related to ligamentous constrain, particularly when posterior longitudinal ligament (densely supplied with nocyceptive endings) is involved. The paper describes the commonest back pain syndromes and spinal deformities resulting from long-lasting overload with their typical presentation.

• Cervico-cephalic syndrome in the course of degenerative disease of the cervical spine.

  Authors: Jerzy E Kiwerski

  Ortopedia, traumatologia, rehabilitacja. 09/2005; 7(4):444-6.

  This article contains a synthesis of views concerning cervico-cephalic syndrome, which results from degenerative changes in the cervical spine. The pathophysiology of the syndrome is discussed, alongThis article contains a synthesis of views concerning cervico-cephalic syndrome, which results from degenerative changes in the cervical spine. The pathophysiology of the syndrome is discussed, along with contemporary methods of diagnosis and therapy, with indications for conservative and surgical treatment.

• [Treatment of post-traumatic instability of the cervical spine--30 years experience]

  Authors: Jerzy E Kiwerski

  Ortopedia, traumatologia, rehabilitacja. 10(5):520-4.

  BACKGROUND: Assessment of the stability of the cervical spine following an injury is an important part of the diagnostic work-up. It is not always easy as the mechanism of injury does not alwaysBACKGROUND: Assessment of the stability of the cervical spine following an injury is an important part of the diagnostic work-up. It is not always easy as the mechanism of injury does not always determine the degree of spinal stability. An actual instability is often confused with increased compensatory instability that is still within physiological limits, i. e. excessive mobility of the segment positioned above the part that has been immobilised as a result of trauma or vertebral block. Spinal injuries with instability are usually an indication for surgery. On the basis of 30 years' experience, the author presents indications for anterior approach surgery, based on the mechanism of injury and the patient's neurological status following an injury to the cervical spine. MATERIAL AND METHODS: A total of 1,225 patients have been operated on. Indications are defined for surgery using rod or plate implants and compression plates. Radiographic and neurological outcome data are presented for 1138 who had been followed up for at least 6 months. RESULTS: A good radiographic outcome was obtained in a total of 78% patients, including 84% of the recipients of rod implants and 65% of the recipients of plate implants. Neurological improvement was seen in 68% of patients with neurological symptoms, including substantial improvements in 26% of the patients. CONCLUSIONS: 1. Assessment of spinal stability is an important element of diagnostic work-up. 2. It is essential to distinguish actual instability requiring surgery from a compensatory increase in mobility of the segment lying above the immobilised segment of the spine. 3. An anterior approach procedure, apart from stabilising the spine, serves to decompress the spinal cord and offers a chance of neurological and functional improvement.

• Surgery and subsequent rehabilitation for cervical spine tumours compressing neural structures.

  Authors: Jerzy E Kiwerski

  Ortopedia, traumatologia, rehabilitacja. 10(6):620-5.

  Bone malignancies account for merely about 1.5% of all cancers, with a small percentage of these tumours developing in the cervical spine. However, the cervical spine is also the site of benignBone malignancies account for merely about 1.5% of all cancers, with a small percentage of these tumours developing in the cervical spine. However, the cervical spine is also the site of benign tumours and neoplasms involving not only bony tissue. Benign tumours do not metastasize but pose a threat to the spinal cord when located intrathecally. Even though such tumours do not represent malignancy, they are considered to be locally malignant. The most common cervical spine neoplasms are intradural tumours, usually extramedullary: neurofibromas, meningiomas or gliomas.Indications for surgery depend of the nature and location of the tumour and the consequences of tumour growth. Surgery is obviously necessary for intrathecal tumours compressing the spinal cord. The choice of surgical approach and manner of stabilisation depend primarily on the location of the lesion and the presence of spinal cord compression.Rehabilitation is indicated in all patients, but is particularly important, and at the same time difficult, when the growth of the tumour has resulted in neurological disturbances. The task is all the more difficult when in the presence of a massive and high spinal cord damage. Rehabilitation programmes should be designed individually for each patient and should account for the degree of paresis, stage of the underlying malignant disease, survival prognosis, disturbances in the function of other systems, apart from musculoskeletal apparatus, age of the patient, his or her commitment to treatment and other factors.The treatment of malignant neoplasms is usually associated with an unfavourable outcome. However, combination drug treatments, radiation therapy and surgery with subsequent rehabilitation will often prolong survival, ameliorate suffering and improve patients' quality of life.

• Factors determining health awareness in persons after spinal injury with neurological complications. Pilot study.

  Authors: Piotr Tederko, Halina Limanowska, Jerzy Kiwerski, Tomasz Krasuski, Marek Krasuski

  Ortopedia, traumatologia, rehabilitacja. 12(6):542-53.

  Dedicated health education is a core intervention in comprehensive rehabilitation programmes. Health awareness of those disabled as a result of a spinal injury with neurological complications (SINC)Dedicated health education is a core intervention in comprehensive rehabilitation programmes. Health awareness of those disabled as a result of a spinal injury with neurological complications (SINC) has rarely been the subject of scientific analyses despite its importance for designing dedicated educational programs. To evaluate factors determining the health awareness of persons after SINC. 133 SINC patients (32 women) between 0.5 and 31 years after injury. An ad hoc questionnaire designed by the authors consisting of 150 detailed questions about the diagnosis, prophylaxis and management of typical health consequences of SINC. The mean test score (TS) was 56.6 points. TS correlated inversely with age in a statistically significant manner (correlation coefficient (CC) = -0.31). TS increased with the time elapsed since injury, with distinct increments at 1 year and 10 years after the event. Significantly higher TSs were noted in persons with university (64.6) and secondary education (65.7) compared with the rest of the group (37.9). Those unable to walk but able to use the wheelchair for independent locomotion had a higher TS (59.7) compared to wheelchair-bound persons unable to drive the wheelchair (47.5) and to persons with preserved walking ability (46.2). Significantly higher scores were achieved by inhabitants of towns above 100,000 population, those employed, members of an association for disabled persons, and respondents capable of independent self-care. There was an inverse correlation between TS and Beck's depression score (CC=-0.36). TS did not depend on gender. Interaction with other persons with SINC is perceived as the most important source of health related knowledge. Predictors of better health awareness in SINC persons include a young age, at least secondary education, more than 10 years since injury, participation in community rehabilitation organised by an association of persons with disability, being employed, being unable to walk, effective self-care, and absence of depression.