151
|
Winnik S, Hitz A, Wyden S, Peter U, Eriksson U, Stieger R. [Exacerbation of chronic lower back pain with an unexpected twist]. Praxis (Bern 1994) 2013; 102:747-750. [PMID: 23735767 DOI: 10.1024/1661-8157/a001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a case of an 88-year old male patient with known chronic lower back pain who presented in late August with progressive pain in his right knee and lower leg as well as paraesthesias. Diagnostic work-up revealed an acute Lyme-Borreliosis.
Collapse
|
152
|
Feng W, Feng TY, Bi YM, Wang F, Xu K, Wang SQ. [Spinal fixed-point rotating reduction in treating lumbar disc herniation by three-dimensional MRI]. Zhongguo Gu Shang 2013; 26:476-480. [PMID: 24015652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To observe three-dimensional space position change of nucleus pulposus and nerve root before and after treatment of lumbar disc herniation by spinal fixed-point rotating reduction, and explore the mechanisms. METHODS Totally 52 patients with L5S1 lumbar disc hernation treated by spinal fixed-point rotating reduction were collected from April 2009 to June 2011. There were 33 males and 19 females with an average age of 34.6 years old (ranged, 19 to 55). Three-dimensional MRI were performed to observe relationship between nucleus pulposus and related nerve root,configuration change of spine and pelvic on coronary MRI. RESULTS MRI showed relationship between nucleus pulposus and related nerve root mainly located on axillary, shoulder, front and surround. Vertebral displacement disappeared, lumbocrural pain alleviated after manipulative therapy. All patients were followed up from 2 to 28 months with an average of 12 months, and no recurred. All patients recovered work. Nucleus pulposus had no change,while lumbral spinal and pelvic curve changed before and after admission. CONCLUSION Lumbar disc herniation combined with single (multiple) vertebral displacement,can cause biomechanical properties of nucleus puplosus and related nerve root, while spinal fixed-point rotating reduction can correct vertebral displacement, recover balance between inside and outside of spinal.
Collapse
Affiliation(s)
- Wei Feng
- Department of TCM Manipulative Orthopaedic, General Hospital of Airforce, Beijing 100142, China.
| | | | | | | | | | | |
Collapse
|
153
|
Yang M, Ding GZ, Xu ZJ. [Diagnosis and management for the non-traumatic epidural sequestered cervical disc extrusion]. Zhongguo Gu Shang 2013; 26:471-475. [PMID: 24015651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the clinical characteristics and management of non-traumatic epidural sequestered cervical disc extrusion. METHODS From January 2002 to July 2011, the clinical data of 10 patients with non-traumatic epidural sequestered cervical disc extrusion were treated by anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection. Of them,there were 6 males and 4 females with an average age of 48.2 years old (ranged from 42 to 65), the course of disease ranged from 1 month to 4 years (mean, 15 months). All patients manifested numbness and weakness of four limbs, unstable walking and sphincter of oddi dysfunction. Preoperative MRI showed segmental cervical spinal cord compression. JOA scoring criteria was applied to evaluate preoperative and follow-up neurologic function. RESULTS Ten patients were followed up, and the duration ranged from 15 to 32 months, with an average of 21 months. No complications related to opreation occurred. Preoperative MRI showed nucelus puplposus sequestered longitudinal ligament were on equal signal on T1-weighted and corresponding pathological,while it showed equal and high signal on T2-weighted. JOA score were increased from 7.20 +/- 1.55 preoperative to 13.60 +/- 1.90 postoperative (t = -11.8, P < 0.001), and excellent in 3 cases, good in 6 cases and moderate in 1 case. CONCLUSION Anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection after early diagnosis is the key to success of treating non-traumatic epidural sequestered cervical disc extrusion.
Collapse
Affiliation(s)
- Min Yang
- Department of Orthopaedics ,Yijishan Hospital of Wan Nan Medical College, Wuhu 241001, Anhui, China
| | | | | |
Collapse
|
154
|
Gautschi OP, Stienen MN, Schaller K. [Spontaneous regression of lumbar and cervical disc herniations - a well established phenomenon]. Praxis (Bern 1994) 2013; 102:675-680. [PMID: 23692907 DOI: 10.1024/1661-8157/a001298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Symptomatic lumbar (LDH) and cervical disc herniations (CDH) are highly prevalent diseases that neurosurgeons and orthopaedic surgeons face every day. If symptom control cannot be achieved by nonsurgical means or in cases with severe or progressive neurological deficits, a surgical therapy is generally recommended. Nevertheless, the majority of patients will improve significantly or even completely without surgery over weeks until months after symptom onset. Still, when a recommendation is to be made concerning the further treatment in affected patients, it has to be kept in mind that the nonsurgical therapy may be associated with disabling pain and persisting neurological deficits with influence on the functional capacity, quality of life and ability to work for a variable period. Today, it is almost impossible to predict which patient will profit from nonsurgical therapy and which patient will require surgery during the clinical course because of incomplete alleviation. In this work, we present two current cases of patients with spontaneous regression of a LDH and a CDH.
Collapse
Affiliation(s)
- Oliver P Gautschi
- Service de Neurochirurgie, Hôpitaux Universitaires de Genève et Faculté de Médecine, Université de Genève, Geneve.
| | | | | |
Collapse
|
155
|
Peterson CK, Leemann S, Lechmann M, Pfirrmann CWA, Hodler J, Humphreys BK. Symptomatic magnetic resonance imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. J Manipulative Physiol Ther 2013; 36:218-25. [PMID: 23706678 DOI: 10.1016/j.jmpt.2013.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 12/24/2012] [Accepted: 12/27/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to compare self-reported pain and "improvement" of patients with symptomatic, magnetic resonance imaging-confirmed, lumbar disk herniations treated with either high-velocity, low-amplitude spinal manipulative therapy (SMT) or nerve root injections (NRI). METHODS This prospective cohort comparative effectiveness study included 102 age- and sex-matched patients treated with either NRI or SMT. Numerical rating scale (NRS) pain data were collected before treatment. One month after treatment, current NRS pain levels and overall improvement assessed using the Patient Global Impression of Change scale were recorded. The proportion of patients, "improved" or "worse," was calculated for each treatment. Comparison of pretreatment and 1-month NRS scores used the paired t test. Numerical rating scale and NRS change scores for the 2 groups were compared using the unpaired t test. The groups were also compared for "improvement" using the χ(2) test. Odds ratios with 95% confidence intervals were calculated. Average direct procedure costs for each treatment were calculated. RESULTS No significant differences for self-reported pain or improvement were found between the 2 groups. "Improvement" was reported in 76.5% of SMT patients and in 62.7% of the NRI group. Both groups reported significantly reduced NRS scores at 1 month (P = .0001). Average cost for treatment with SMT was Swiss Francs 533.77 (US $558.75) and Swiss Francs 697 (US $729.61) for NRI. CONCLUSIONS Most SMT and NRI patients with radicular low back pain and magnetic resonance imaging-confirmed disk herniation matching symptomatic presentation reported significant and clinically relevant reduction in self-reported pain level and increased global perception of improvement. There were no significant differences in outcomes between NRI and SMT. When considering direct procedure costs, the average cost of SMT was slightly less expensive.
Collapse
Affiliation(s)
- Cynthia K Peterson
- Departments of Chiropractic and Radiology, Orthopaedic University Hospital Balgrist, Zürich, Switzerland.
| | | | | | | | | | | |
Collapse
|
156
|
Vano-Galvan S, Vano-Galvan E, Grillo E, Jaén P. Chronic itch on the back associated with disc hernia--a case study. Aust Fam Physician 2013; 42:131-132. [PMID: 23529523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Sergio Vano-Galvan
- Department of Dermatology, Ramon y Cajal University Hospital, Madrid, Spain.
| | | | | | | |
Collapse
|
157
|
Allmendinger AM, Lee TC. Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch. Clin Imaging 2013; 37:756-61. [PMID: 23395554 DOI: 10.1016/j.clinimag.2012.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/07/2012] [Indexed: 11/18/2022]
Abstract
Spontaneous spinal cerebrospinal fluid (CSF) leaks are increasingly recognized in patients presenting with orthostatic headache and ultimately diagnosed with intracranial hypotension. While the precise cause of these spontaneous leaks is unknown, it is thought to result from underlying weakness in the spinal meninges and may be associated with meningeal diverticula or Tarlov cysts. Rarely, calcified intervertebral discs or bony osteophytes can result in CSF leakage, which has been described in the surgery literature but not well recognized in the radiology literature. The authors present three cases of patients presenting with CSF leaks from calcified thoracic disc protrusions that were successfully treated with epidural blood patches.
Collapse
|
158
|
Lavrador JP, Livraghi S, Pereira P, Pimentel J. Foreign body reaction to hydroxyapatite after anterior cervical discectomy with fusion. Acta Neurochir (Wien) 2013; 155:321-2. [PMID: 23275072 DOI: 10.1007/s00701-012-1601-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/13/2012] [Indexed: 11/24/2022]
|
159
|
Aganesov AG, Kheĭlo AL. [The miniinvasive technologies in surgical treatment of diseases and traumas of the spine]. Khirurgiia (Mosk) 2013:91-96. [PMID: 23503391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The analysis of miniinvasive surgery for degenerative and traumatic diseases of the spine was conducted. Such methods as microsurgical diskectomy, dynamic implants, vertebroplasty, vertebrae stenting were featured. The use of miniinvasive methods allow the sunstantioal decrease of the hospital-stay time and fasten the rehabilitation.
Collapse
|
160
|
Wells BJ, Zafari AM, Schaufele MK. When cardiologists have chest pain. J Med Assoc Ga 2013; 102:34-36. [PMID: 24665503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
161
|
Bai YB, Xu L, Xi JC, Mu XJ. [Diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery]. Zhonghua Yi Xue Za Zhi 2012; 92:3350-3353. [PMID: 23328597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery. METHODS From December 2009 to June 2010, 119 patients with lumbar disc herniation underwent discography and transforaminal endoscopic surgery under local anesthesia. There were 75 males and 44 females with a mean age of 44.8 years (range: 15 - 55). The mean disease course was 9 months (range: 3 - 72). The major symptoms were back pain and/or unilateral sciatica. The mean follow-up period was 26 months. All underwent lumbar radiography, computed tomography (CT) and magnetic resonance imaging (MRI) revealing 112 single level and 7 two-level disc herniations. There were 82 lateral and 37 para-medial disc herniations. Eight-nine patients had protruded discs while 30 had prolapsed and sequestered discs. There were no obvious lumbar stenosis, spondylolisthesis, fracture, infection or tumor cases. The preoperative and postoperative visual analogue scale (VAS) were used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index (ODI) and the Macnab score. Precise orientation and operation was performed under the guidance of pre-operative imaging, intra-operative fluoroscopy or CT and endoscopic exploration. RESULTS Among them, 117 cases had the surgery performed successfully. The mean operative duration was 85 min (range: 35 - 85) and the mean blood loss 13 ml (range: 1 - 50). One patient had L5 nerve root injury complicated with paraesthesia and weakness of the affected lower extremity and was relieved gradually after conservative treatment for over 3 months. Another one complicated with postoperative intradiscal infection was referred to another institution and lost follow-up thereafter. Five cases had no improvement at 6 months after the first surgery and were re-operated endoscopically. No one had a conversion into open surgery. They were followed up for a mean period of 26.1 months (range: 25 - 27). Five patients lost follow-up. VAS improved statistically significantly from preoperative 6.8 to postoperative 1.8 (P < 0.05). ODI decreased from preoperative 70.06 to 19.09 at the last follow-up. The Macnab results were excellent (n = 82, 68.9%), good (n = 20, 16.7%), fair (n = 8, 6.7%) and bad (n = 9, 7.7%) (including all patients lost to follow-up). And the excellent-to-good rate was 85.6%. CONCLUSION With fewer complications and a low recurrence rate, percutaneous transforaminal endoscopic surgery is safe and efficacious in the treatment of lumbar disc herniation.
Collapse
Affiliation(s)
- Yi-bing Bai
- Department of Orthopedics, PLA No. 309 Hospital, Beijing 100091, China
| | | | | | | |
Collapse
|
162
|
Arslan E, Demirci I, Kılınçaslan MO, Hacıfazlıoğlu C. Bilateral lumbar disc herniation at the same discal level: a new radiological appearance. Acta Neurochir (Wien) 2012; 154:2225-7. [PMID: 23053287 DOI: 10.1007/s00701-012-1513-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/24/2012] [Indexed: 11/27/2022]
|
163
|
Spader H, Grossberg J, Oyelese AA. Surgery in the treatment of lower back pain II--lumbar stenosis and disc herniations. Med Health R I 2012; 95:384-390. [PMID: 23346740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
164
|
Palmer KT, Griffin M, Ntani G, Shambrook J, McNee P, Sampson M, Harris EC, Coggon D. Professional driving and prolapsed lumbar intervertebral disc diagnosed by magnetic resonance imaging: a case-control study. Scand J Work Environ Health 2012; 38:577-81. [PMID: 22249859 PMCID: PMC3436743 DOI: 10.5271/sjweh.3273] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate whether whole-body vibration (WBV) is associated with prolapsed lumbar intervertebral disc (PID) and nerve root entrapment among patients with low-back pain (LBP) undergoing magnetic resonance imaging (MRI). METHODS A consecutive series of patients referred for lumbar MRI because of LBP were compared with controls X-rayed for other reasons. Subjects were questioned about occupational activities loading the spine, psychosocial factors, driving, personal characteristics, mental health, and certain beliefs about LBP. Exposure to WBV was assessed by six measures, including weekly duration of professional driving, hours driven at a spell, and current 8-hour daily equivalent root-mean-square acceleration A(8). Cases were sub-classified according to whether or not PID/nerve root entrapment was present. Associations with WBV were examined separately for cases with and without these MRI findings, with adjustment for age, sex, and other potential confounders. RESULTS Altogether 237 cases and 820 controls were studied, including 183 professional drivers and 176 cases with PID and/or nerve root entrapment. Risks associated with WBV tended to be lower for LBP with PID/nerve root entrapment but somewhat higher for risks of LBP without these abnormalities. However, associations with the six metrics of exposure were all weak and not statistically significant. Neither exposure-response relationships nor increased risk of PID/nerve root entrapment from professional driving or exposure at an A(8) above the European Union daily exposure action level were found. CONCLUSIONS WBV may be a cause of LBP but it was not associated with PID or nerve root entrapment in this study.
Collapse
Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK.
| | | | | | | | | | | | | | | |
Collapse
|
165
|
Bustamante-Vidales JC, Kleriga-Grossgere E, Zambito-Brondo GF, Higuera-Calleja J. [Sacral insufficiency, unexpected clinical entity as a cause of low back pain. Report of two cases]. CIR CIR 2012; 80:556-561. [PMID: 23336152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND sacral insufficiency fractures are a cause of debilitating pain in the elderly. These fractures were first described as a clinical entity in 1982. The bone in these patients is structurally weakened and often associated with diseases such as osteoporosis, cancer and immunological processes. This translates into back and pelvic pain unrelated to trauma. These fractures are usually caused by fatigue in most cases. Bone scans and MRI are the imaging studies with the most sensitivity for detecting sacral insufficiency. CLINICAL CASES two patients with sacral insufficiency fractures who were studied by MRI and bone scan, in whom the diagnosis of sacral insufficiency was made, were treated by sacroplasty. CONCLUSIONS sacral insufficiency is an underdiagnosed disease, caused by wide range of diseases, mainly osteoporosis. The studies of choice for diagnosis are MRI and bone scans. Techniques, such as percutaneous sacroplasty, produce significant improvements in pain scores and seem a suitable alternative for managing this disease.
Collapse
MESH Headings
- Accidental Falls
- Aged
- Bone Diseases, Metabolic/complications
- Bone Diseases, Metabolic/diagnosis
- Bone Diseases, Metabolic/diagnostic imaging
- Female
- Femur Head Necrosis/complications
- Femur Head Necrosis/diagnosis
- Femur Head Necrosis/surgery
- Fractures, Spontaneous/complications
- Fractures, Spontaneous/diagnosis
- Fractures, Spontaneous/diagnostic imaging
- Fractures, Stress/complications
- Fractures, Stress/diagnosis
- Fractures, Stress/diagnostic imaging
- Fractures, Stress/surgery
- Humans
- Imaging, Three-Dimensional
- Intervertebral Disc Displacement/complications
- Intervertebral Disc Displacement/diagnosis
- Low Back Pain/etiology
- Lumbar Vertebrae/pathology
- Magnetic Resonance Imaging
- Positron-Emission Tomography
- Sacrum/diagnostic imaging
- Sacrum/injuries
- Sacrum/surgery
- Spinal Fractures/complications
- Spinal Fractures/diagnosis
- Spinal Fractures/diagnostic imaging
- Spinal Fractures/surgery
- Spinal Stenosis/complications
- Spinal Stenosis/diagnosis
- Spondylolisthesis/complications
- Spondylolisthesis/diagnosis
- Spondylolisthesis/diagnostic imaging
- Tomography, X-Ray Computed
- Vertebroplasty
Collapse
|
166
|
Rey-Jouvin C, Sellam J, Chafai N, Yazid L, Miquel A, Berenbaum F. Clinical image: Spondylodiscitis due to a fistula between L5-S1 disc and colon. Joint Bone Spine 2012; 80:100-1. [PMID: 22959431 DOI: 10.1016/j.jbspin.2012.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Caroline Rey-Jouvin
- Service de rhumatologie, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, AP-HP, Paris, France
| | | | | | | | | | | |
Collapse
|
167
|
Dimar JR, Nathan ST, Glassman SD. The spectrum of traumatic Schmorl's nodes: identification and treatment options in 3 patients. Am J Orthop (Belle Mead NJ) 2012; 41:427-431. [PMID: 23365812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Schmorl's nodes may be present as a simple endplate intravertebral herniation following trauma or as a large cystic lesion of the vertebral body. In this article, we report on 3 patients with severe back pain following trauma resulting in traumatic Schmorl's nodes and pathologic fracture of the vertebral body. All 3 cases had antecedent trauma. Radiographs showed a cystic lesion in the vertebral body through the endplate with surrounding bony edema, indicative of fracture. In 2 cases, the integrity of the vertebral body was severely compromised, requiring vertebrectomy and fusion. The wide spectrum of presentation and treatment options of traumatic Schmorl's nodes are presented, ranging from symptoms that are responsive to treatment to pathologic fracture of the vertebral body leading to significant collapse and the need for major surgical stabilization.
Collapse
Affiliation(s)
- John R Dimar
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Kentucky, USA.
| | | | | |
Collapse
|
168
|
Hamid RS, Akhtar W, Shamim MS, Naqi R, Siddiq HI. Observer variation in MRI evaluation of patients with suspected lumbar disc herniation and nerve root compression: comparison of neuroradiologist and neurosurgeon's interpretations. J PAK MED ASSOC 2012; 62:826-829. [PMID: 23862259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To analyse inter-observer variation between a neuroradiologist and neurosurgeon in the MRI diagnosis of lumbar nerve root compression. Although lumbar MFI is primarily analyzed and reported by a radiologist, neurosurgeons often analyse it independently as they have sufficient clinical background as well as radiological expertise to diagnose most spinal pathologies on Magnetic Resonance Imaging (MRI). METHODS Retrospective analysis was carried out for images of 54 patients who underwent MRI between March and July 2010 of lumbar spine with suspected lumbar disc herniation and nerve root compression, at Aga Khan Hospital, Karachi, Pakistan. One fellowship trained neuroradiologist and one neurosurgeon evaluated the images on PACS system separately. Both observers were unaware of the patient's clinical history and each other's findings. Lumbar discs at L3-L4, L4-L5 and L5-S1 levels were evaluated by both observers for disc disease and nerve compression. Findings were recorded on a proforma and analysed with SPPS Version 16. RESULTS Total 162 lumbar discs were studied by both readers in 54 patients. Excellent inter-observer agreement was seen for the presence or absence of nerve root compression (Percentage agreement = 88.89%; k = 0.774; p = 0.737). For disc bulge, inter-observer agreement was fair but statistically insignificant (Percentage agreement = 72.84%; k = 0.414; p = 0.132). In case of disc herniation, although inter-observer agreement was fair, but the difference was statistically significant (Percentage agreement = 84.57%; k = 0.511; p = 0.002). CONCLUSION Inter-observer agreement between neuroradiologist and neurosurgeon in diagnosing nerve root compression due to lumbar disc disease was excellent. Agreement regarding disc bulge and herniation was fair.
Collapse
|
169
|
Koechlin NO, Bothmann M, Kast E, Oberle J, Hasler S, Sartoretti S, Binkert CA. [Unusual course of a planned lumbar microdiscectomy]. Praxis (Bern 1994) 2012; 101:865-867. [PMID: 22715079 DOI: 10.1024/1661-8157/a000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report the case of a 30-year-old female patient who underwent unilateral transverse sinus stenosis stenting due to a newly diagnosed idiopathic intracranial hypertension (Pseudotumor cerebri) with symptoms of papilledema, decreased visual acuity and headache. Resolution of the symptoms and improvement of magnetic resonance and ophthalmiologic findings could be documented.
Collapse
Affiliation(s)
- N O Koechlin
- Klinik für Neurochirurgie, Kantonsspital Winterthur
| | | | | | | | | | | | | |
Collapse
|
170
|
Stienen MN, Cadosch D, Fournier JY, Hildebrandt G, Gautschi OP. [Cervicobrachialgia - an update under special consideration of the surgical management]. Praxis (Bern 1994) 2012; 101:715-728. [PMID: 22618696 DOI: 10.1024/1661-8157/a000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The classic cervicobrachialgia results acutely from cervical nerve root compression by disc herniation or subacutely by radicular compression after progressive spondylotic changes of the cervical spine. The clinical presentation includes local and radiating pain syndromes that can be accompanied by sensorimotor deficits. Besides the medical history and a targeted clinical examination, supplementary radiographic means should be undertaken to confirm diagnosis. If no urgent surgical indication exists, conservative therapy should be initiated. However, with varying results of conservative and surgical therapy, chronic impairment can occur.
Collapse
Affiliation(s)
- M N Stienen
- Klinik für Neurochirurgie, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Germany.
| | | | | | | | | |
Collapse
|
171
|
Srinivasan V, Kesler H, Johnson M, Dorfman H, Walter K. Tophaceous pseudogout of the thoracic spine. Acta Neurochir (Wien) 2012; 154:747-50; discussion 750. [PMID: 22367409 DOI: 10.1007/s00701-012-1308-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 02/09/2012] [Indexed: 11/28/2022]
Abstract
Calcium pyrophosphate dihydrate deposition disease (CPDD, tophaceous pseudogout) is a rare crystal arthropathy characterized by pyrophosphate crystal deposition in joints, synovitis and chondrocalcinosis on imaging. We present the case of a 72-year-old man with 6 months of left chest pain; magnetic resonance imaging revealed a T9/T10 herniated disc. Intraoperatively, the material was sent for pathological analysis revealing pseudogout. Axial calcium pyrophosphate crystal deposition is rare but reported in the literature and found at the craniocervical junction and skull. Spinal calcium pyrophosphate crystal deposition is rare in the thoracic spine. It is often asymptompatic and can involve the disc or ligaments. This case demonstrates a unique presentation of CPDD.
Collapse
Affiliation(s)
- Vasisht Srinivasan
- Department of Neurosurgery, University of Rochester Medical Center, NY 14623, USA.
| | | | | | | | | |
Collapse
|
172
|
Koh J, Chaudhary V, Dhillon G. Disc herniation diagnosis in MRI using a CAD framework and a two-level classifier. Int J Comput Assist Radiol Surg 2012; 7:861-9. [PMID: 22392057 DOI: 10.1007/s11548-012-0674-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Disc herniation in the lumbar spine is a common condition, so an automated method for diagnosis could be helpful in clinical applications. A computer-aided framework for disk herniation diagnosis was developed for use in magnetic resonance imaging (MRI). MATERIALS AND METHOD A computer-aided diagnosis framework for lumbar spine with a two-level classification scheme for disc herniation diagnosis was developed using heterogeneous classifiers: a perceptron classifier, a least mean square classifier, a support vector machine classifier, and a k-Means classifier. Each classifier makes a diagnosis based on a feature set generated from regions of interest that contain vertebrae, a disc, and the spinal cord. Then, an ensemble classifier makes a final decision using score values of each classifier. We used clinical MR image data from 70 subjects in T1-weighted sagittal view and T2-weighted sagittal view for evaluation of the system. RESULTS MR images of 70 subjects were processed using the proposed framework resulting in successful detection of disc herniation with 99% accuracy, achieving a speedup factor of 30 in comparison with radiologist's diagnosis. CONCLUSION The computer-aided framework works well to diagnose herniated discs in MRI scans. We expect the framework can be adapted to effectively diagnose a variety of abnormalities in the lumbar spine.
Collapse
Affiliation(s)
- Jaehan Koh
- University at Buffalo, SUNY, Buffalo, NY 14260, USA.
| | | | | |
Collapse
|
173
|
Huang SR, Shi YY, Zhan HS. [Individual stratification diagnosis of lumbar intervetebral disc herniation]. Zhongguo Gu Shang 2012; 25:228-232. [PMID: 22712375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lumbar intervertebral disc herniation is one of the most common causes of lumbocrural pain with its uncertain causes and varied clinical manifestations which marked by the specific symptoms and signs. Effective individualized therapy scheme depends on the correct and timely multi-level diagnosis of this disease. The paper systematically proposed the multilevel diagnosis, including qualitative diagnosis, level diagnosis, diagnosis by exclusion,combined diagnosis, classification diagnosis, syndrome differentitation in different stages, and disease severity grading diagnosis etc. The content and methods of the multi-level diagnosis on each individual case has great significance to formulate the individualized therapy scheme and to promote the clinical research of LIDH.
Collapse
Affiliation(s)
- Shi-Rong Huang
- Department of Orthopaedics & Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM,Institute of Orthopaedics and Traumatology affiliated to Shanghai Academy of TCM, Shanghai, 200021, China.
| | | | | |
Collapse
|
174
|
|
175
|
Berkmann S, Fandino J. Pregnancy and childbirth after microsurgery for lumbar disc herniation. Acta Neurochir (Wien) 2012; 154:329-34. [PMID: 22037981 DOI: 10.1007/s00701-011-1207-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 10/07/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The influence of previous lumbar discectomy on pregnancy and childbirth has not been extensively studied. This study reports the course of pregnancies after lumbar discectomy. METHOD Twenty-six 31.5 ± 3.6-year-old patients who had delivered 39 children were included. All patients underwent lumbar microsurgical discectomy prior to childbirth. Demographic and surgical data were collected from hospital records and patient questionnaires. The presence and course of low back pain (LBP) and radiculopathy signs were noted. FINDINGS Mean latency between surgery and childbirth was 42.5 ± 34.8 months. Delivery was at gestational week 36 to 42, and the average weight of the newborn was 3,390 ± 0.490 g. Prevalence and new onset of symptoms during pregnancy was as follows: low back pain, 76% and 60%; leg pain 37% and 18%; motor deficits 13% and 6%; and sensory deficits 39% and 19%, respectively. No recurrent lumbar disc herniation was diagnosed within 6 months after pregnancy. Patients suffering from radicular pain during pregnancy were at risk of persistence of symptoms 6 months after delivery. Three patients had had surgery because of recurrent lumbar disc herniation during the follow-up of 7.73 ± 2.66 years. CONCLUSIONS The incidence of radicular pain during pregnancy after microsurgical discectomy for lumbar disc herniation was 18%. The incidence and prevalence of LBP are among the highest reported in the literature. The incidence of low back pain and radiculopathy signs does not change significantly with subsequent pregnancies. The operation rate for recurrent lumbar disc herniation or adjacent level disease after pregnancy seems not to be higher than the overall rate reported in the literature.
Collapse
Affiliation(s)
- Sven Berkmann
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
| | | |
Collapse
|
176
|
Huang SR, Shi YY, Zhan HS. [Diagnostic ideas and programs of lumbar intervetebral disc herniation]. Zhongguo Gu Shang 2012; 25:147-151. [PMID: 22577721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Lumbar intervertebral disc herniation (LIDH) is one of the most common causes of lumbocrural pain with its uncertain causes, varied clinical manifestations and featuring on each individual case. Effective individualized therapy scheme depends on the correct and timely diagnosis of this disease. Many evidence indicated that the nervous symptoms and signs have higher specificity and sensitivity, has great significance to the diagnosis of LIDH but usually has polytropy among different patients or different period and conditioning of the same patient to some degree. This article systematically reviewed and analyzed the diagnostic value of specific symptoms and signs, selected physical and photographical examination methods of LIDH, and proposed that LIDH can be accurately and timely evaluated by using these diagnostic factors and ways comprehensively and systematically, this will be the helpful ideas and program to the diagnosis of this disease.
Collapse
Affiliation(s)
- Shi-Rong Huang
- Department of Orthopaedics & Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Orthopaedics and Traumatology Affiliated to Shanghai Academy of Traditional Chinese Medicine, Shanghai 200021, China.
| | | | | |
Collapse
|
177
|
Wang SQ, Yu J, Feng MS, Luo J, Yang KX, Zhao GD. [Opinious of lumbar intervertebral disc herniation]. Zhongguo Gu Shang 2012; 25:55-57. [PMID: 22489525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Shang-Quan Wang
- Department of the Second Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical, Sciences, Beijing 100102, China.
| | | | | | | | | | | |
Collapse
|
178
|
Dovhyĭ IL. [Rehabilitation of radiculopathy of the spine lumbosacral region complicated with herniated disc depending on the type of hernia]. Lik Sprava 2012:93-96. [PMID: 23350123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article presents the results of treatment of 168 patients with radiculopathy lumbosacral spine, complicated hernias of intervertebral disc nucleus on the developed technique. The results show high efficacy of the treatment of this disease.
Collapse
|
179
|
M'kumbuzi VRP, Ntawukuriryayo JT, Haminana JD, Munyandamutsa J, Nzakizwanimana E. Accuracy of straight leg raise and slump tests in detecting lumbar disc herniation: a pilot study. Cent Afr J Med 2012; 58:5-11. [PMID: 26255334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the accuracy of the Straight Leg Raise (SLR) and slump tests in detecting Lumbar Disc Herniation (LDH). DESIGN Cross-sectional diagnostic accuracy study. SETTING Two referral hospitals in Kigali, Rwanda: King Faisal Hospital and Centre Hospitalier Universitaire de Kigali. SUBJECTS All patients aged 18 to 70 who had an MRI and who were experiencing pain in the low back, leg or low back and leg. INTERVENTIONS Closed Magnetic Resonance Imaging (MRI) investigations for each patient as witnessed by a radiologist who read the image were recorded by the first researcher and blinded to other researchers. The SLR and slump tests were performed three times on each patient by independent testers who were blinded to the result of the first test. The test order was randomized for each subject and the two tests were separated by one day wash-out period. MAIN OUTCOME MEASURES Data were analyzed using a 2x2 table to ascertain diagnostic statistics including sensitivity and specificity with 95% confidence intervals. RESULTS Thirty three from a possible 37 patients mean age 41.58 ± 10 years completed all of the tests. The sensitivity of SLR was greater (0.875; CI: 0.690-0.957) than that of the slump tests (0.800; CI: 0.6087-0.911) (p = 0.01) in detecting LDH. The specificity for SLR was 0.429 (CI: 0.158-0.750) and for slump was 0.714 (CI: 0.359-0.918). Substantial agreement (K = 0.774) was obtained between the SLR and MRI. CONCLUSION The SLR was more accurate in detecting LDH. Further validation of this pilot finding is required by studying a larger sample.
Collapse
Affiliation(s)
- V R P M'kumbuzi
- Department of Physiotherapy, Kigali Health Institute, P O Box 3286, Kigali, Rwanda.
| | | | | | | | | |
Collapse
|
180
|
Onofri E, Salesi M, Massoni F, Rosati MV, Ricci S. [Medical legal issues associated with the evaluation of herniated discs in seafarers to merchant ships]. Clin Ter 2012; 163:e365-e371. [PMID: 23099988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
"Seafarer" means person employed with any job on board a ship offshore, whether publicly or privately, excluding ships of war. Day by day a seafarer is forced to confront a reality in constant motion and live in environments that require awkward movements, and restricting the normal mobility of the person. In order to verify the frequency of herniated discs in this particular category of workers, given the recent introduction of INAIL tabulated diseases, a study was conducted on a sample of seafarers. Data analysis showed that 48.3% of the seafarers of the sample has herniated lumbar disc, and 34.5% of these duties in the deck, and 65.5% of the machine. The study of sample, varied as to age and task being performed, supports the assertion that the individual risk factors, especially age and obesity, are not strongly implicated in the genesis of disk herniation suffered by seafarers while the work factors (vibrations) play a more significant role in the onset of this disease. This consideration is part of a context, that of legal medical evaluation and in particular the causal relationship, which currently seems rather lacking in terms of literature and scientific production.
Collapse
Affiliation(s)
- E Onofri
- Dipartimento di Scienze Anatomiche, Università Sapienza, Roma, Italia
| | | | | | | | | |
Collapse
|
181
|
Stienen MN, Cadosch D, Hildebrandt G, Gautschi OP. [The lumbar disc herniation - management, clinical aspects and current recommendations]. Praxis (Bern 1994) 2011; 100:1475-1485. [PMID: 22124958 DOI: 10.1024/1661-8157/a000733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Lumbar disc herniation has a high prevalence and strong social-medical impact. Patients suffer from lower back pain that radiates from the spine. Loss of sensation or paresis adds to the clinical picture. The diagnosis should be confirmed by imaging in patients considered for surgery. High remission rates initially warrant conservative treatment (adequate analgesia and physiotherapy) in many patients. If this treatment does not lead to significant alleviation within 5-8 weeks, surgery should be performed to reduce the risk of chronic nerve affection. Posterior interlaminar fenestration is the intervention primarily conducted for this diagnosis. A relapse in the same region occurs in up to 10% of patients after months through years, which sometimes necessitates a reoperation if symptoms are pertinent.
Collapse
Affiliation(s)
- M N Stienen
- Klinik für Neurochirurgie, Kantonsspital St. Gallen.
| | | | | | | |
Collapse
|
182
|
Novosel'tsev SV, Malinovskiĭ EL, Smirnov VV, Savvova MV, Lebedeva VV. [Pathobiomechanical impairments of the vertebral column in intervertebral disk protrusion and herniation]. Vestn Rentgenol Radiol 2011:34-39. [PMID: 22420209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Magnetic resonance imaging of patients with intervertebral disk herniation was used to study the stages of degenerative and dystrophic processes in the spinal structures in the presence of intervertebral disk protrusion and herniation. Differences were found in the pathobiomechanical mechanisms in the spinal motor segments of herniation and protrusion in the area of their localization and in the adjacent spinal motor segments. Among the symptoms traditionally analyzed, joint facet joint arthritis and arthrosoarthritis classified as spondyloarthritis by radiodiagnosis were examined for their impact on the rate of herniation and protrusion.
Collapse
|
183
|
Lazarou I, Genevay S, Nendaz M. [Use of glucocorticoids in low back pain due to disc herniation with radicular involvement]. Rev Med Suisse 2011; 7:2041-2045. [PMID: 22073701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although systemic glucocorticoids are frequently used for the treatment of radicular pain due to disc herniation, there are only few studies available. No trial has successfully demonstrated the superiority of systemic glucocorticoids compared to placebo. Therefore their use is not recommended. Spinal injection using radiographic guidance appears to provide some beneficial short-term effect on pain. It might be offered when pain treatments according to the WHO steps have failed. Because rare but serious adverse events have been reported, transforaminal periradicular injections should only be used after thorough analysis of risks and benefits with the patient.
Collapse
Affiliation(s)
- Ilias Lazarou
- Service de médecine interne générale, HUG, 1211 Genève 14.
| | | | | |
Collapse
|
184
|
Ribeiro RP, Matos RM, Vieira A, Costa JM, Proença R, Pinto R. [Spontaneous regression of symptomatic lumbar disc herniation]. Acta Reumatol Port 2011; 36:396-398. [PMID: 22472931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Lumbar disc herniation is very common, sometimes leading to disability of the patient, and in a significant number of cases can only be solved with surgery. This paper reports a case with a large symptomatic disc herniation, which suffered spontaneous regression, and no surgery was necessary. The case is documented on serial MRI, consistent with the clinical improvement of the patient.
Collapse
Affiliation(s)
- R Pimenta Ribeiro
- Serviço de Ortopedia, Faculdade de Medicina da Universidade do Porto, Hospital São João, Portugal.
| | | | | | | | | | | |
Collapse
|
185
|
Petrushenko VV, Verba AV, Humeniuk KV, Martsynkovs'kyĭ IP, Stashchuk RP, Tul'chyns'kyĭ HV. [Observation of perforated duodenal ulcer in patient with sequestrated hernia of L(IV) - L(V) and pain syndrome]. Klin Khir 2011:69. [PMID: 22013696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
186
|
Abstract
OBJECTIVES The objectives were to evaluate the presenting signs and symptoms of spinal cord and cauda equina compression (SCC) and to determine the incidence of emergency department (ED) misdiagnosis. METHODS This was a retrospective chart review at an urban, tertiary care hospital of patients discharged from an inpatient stay (April 2008 through July 2009) with an International Classification of Diseases, Ninth Revision (ICD-9) code indicating spinal disease, who had visited the ED for a related complaint within the previous 30 days, and who had a final diagnosis of new SCC. Trauma and transferred patients were excluded. The authors defined a misdiagnosis as no ED-documented diagnosis of SCC and failure to perform an appropriate diagnostic study either prior to arrival, in the ED, or immediately upon admission. RESULTS Of 1,231 charts reviewed, 63 met inclusion criteria. The most common presenting symptoms in patients with SCC were pain (44, 70%), difficulty ambulating (38, 60%), and weakness (35, 56%). On physical examination, motor deficits (45, 71%) were more common than sensory deficits (27, 43%); however, 15 (24%) patients had no motor or sensory deficit, and 13 (23%) patients only had unilateral findings. Impaired gait was present in 14 patients of only 20 tested, three of whom had no associated motor or sensory deficit. SCC was misdiagnosed in 18 (29%, 95% confidence interval [CI] = 19% to 41%) cases, which resulted in a significant delay to diagnosis (median = 54 hours, interquartile range [IQR] = 38 to 77 vs. 5.3 hours, IQR = 3.0 to 15) in these patients. CONCLUSIONS SCC can have a subtle presentation with absent or unilateral motor and sensory deficits, but gait ataxia may be an additional finding. ED misdiagnosis of SCC in nontrauma patients is common.
Collapse
Affiliation(s)
- Andrea F Dugas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | | | | |
Collapse
|
187
|
Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J 2011; 20:690-7. [PMID: 21193933 PMCID: PMC3082683 DOI: 10.1007/s00586-010-1668-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/22/2010] [Accepted: 12/15/2010] [Indexed: 11/29/2022]
Abstract
Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50-70% of patients have urinary retention (CES-R) on presentation with 30-50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.
Collapse
Affiliation(s)
- Alan Gardner
- South Essex University Hospitals and The Essex Spine Centre, Brentwood, UK.
| | | | | |
Collapse
|
188
|
Pompan DC. Appropriate use of MRI for evaluating common musculoskeletal conditions. Am Fam Physician 2011; 83:883-884. [PMID: 21524028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
189
|
Arutiunov NV, Konovalov NA, Mel'nikova-Pitskheluri TV, Fadeeva LM, Tissen TP. [Noninvasive magnetic resonance myelography in patients with lumbosacral intervertebral disk herniation]. Vestn Rentgenol Radiol 2011:41-46. [PMID: 21866824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
For many decades X-ray myelography has remained one of the major diagnostic methods for spinal pathology. With the advent of computed tomography (CT), CT myelography using water-soluble contrast agents has been developed. Visualization of the subarachnoidal spaces of the spinal cord and dural sac without an intrathecal contrast agent has become possible with the emergence of magnetic resonance imaging (MRI). Its further development and improvement has brought to existence the new noninvasive technique MR myelography based on the suppression of a signal from the medulla and its enhancement from the cerebrospinal fluid-containing spaces. This paper compares routine X-ray myelography, CT myelography, and MR myelography used in the diagnosis of lumbosacral intervertebral disk herniation and assesses the informative value and benefits of MR myelography as a noninvasive diagnostic method for this pathology.
Collapse
|
190
|
Rapan S, Gulan G, Lovrić I, Jovanović S. Spontaneous regression of intervertebral disc herniation--case reports. Coll Antropol 2011; 35:211-215. [PMID: 21661374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. It is well known that the majority of LDH patients recover spontaneously. Since the advent of MRI, a spontaneous regression of fragment size of disc hernia occurs, as well as mitigation of subjective difficulties and neurological disorders. Therefore, surgical treatment is not always method of choice in this disease. Two cases of conservatively treated large disc extrusion which result in significant reduction of difficulties, with simultaneous reduction in fragment size of hernia which is documented by MR.
Collapse
Affiliation(s)
- Sasa Rapan
- J J Strossmayer University, Osijek University Hospital Center, Department of Orthopaedic Surgery, Osijek, Croatia.
| | | | | | | |
Collapse
|
191
|
Yu XW, Niu G, Yang J, Ni L, Zhang WS, Guo YM. [Quantitative evaluation for diagnostic efficacy of computed tomography and magnetic resonance imaging in patients with lumbar disc herniation]. Zhonghua Yi Xue Za Zhi 2011; 91:23-27. [PMID: 21418957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performances of CT and MRI in patients with lumbar intervertebral disc herniation through the Meta analytical method. METHOD The relevant English and Chinese articles published between 1980 and 2010 were searched in PubMed, Medline, Ovid database, Cochrane library and Chinese Periodical Web. According to the criteria for diagnostic researches published by Cochrane Method Group on Screening and Diagnostic Tests, each article was critically appraised and screened with regards to the absolute numbers of true-positive, false-negative, true-negative and false-positive. Statistical analysis was performed by the Meta-Disc version 1.4, SPSS 13.0 and Comprehensive Meta-analysis version II. Heterogeneity was tested and publication bias analyzed. And the pooled weighted sensitivity and specificity and the corresponding 95%CI were calculated. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUC) calculated to summarize and evaluate the diagnostic efficiency of CT and MRI in lumbar intervertebral disc herniation. Finally a sensitivity analysis was performed. RESULTS According to the criteria of internalization, 9 articles were included. Among them, the themes were CT (n = 3), MRI (n = 3) and CT & MRI (n = 3). Eight was prospectively studied and one retrospectively. At the diagnosis of lumbar intervertebral disc herniation, the pooled weighted sensibility and specificity and 95% confidence interval and area under SROC curve for CT to the lumbar intervertebral disc herniation was 0.73 (0.68 - 0.77), 0.78 (0.72 - 0.82) and 83.5% respectively. The MRI was 0.88 (0.83 - 0.91), 0.79 (0.71 - 0.87) and 88.8% respectively. There was statistically significant difference in the pooled weighted sensibility (P < 0.05); No statistically significant difference was found in the pooled weighted specificity (P > 0.05); And there was statistically significant difference in the AUC curve (P < 0.05). CONCLUSION After a meta-analysis of the diagnostic value of CT and MRI for the lumbar intervertebral disc herniation, MRI is more accurate than CT in the diagnosis of lumbar intervertebral disc herniation.
Collapse
Affiliation(s)
- Xue-Wen Yu
- PET-CT Department, First Hospital of Medical College of Xi'an Jiaotong University, Xi'an 710061, China
| | | | | | | | | | | |
Collapse
|
192
|
Mateo I, Lorenzo V, Foradada L, Muñoz A. Clinical, pathologic, and magnetic resonance imaging characteristics of canine disc extrusion accompanied by epidural hemorrhage or inflammation. Vet Radiol Ultrasound 2011; 52:17-24. [PMID: 21322383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Our aim was to characterize the magnetic resonance (MR) imaging features of canine disc extrusion accompanied by epidural hemorrhage or inflammation. We correlated the imaging characteristics of this type of disc extrusion in 46 dogs and compared these features with clinical signs and pathologic findings. Data from 50 control dogs with MR imaging features of a disc extrusion with no associated hemorrhage or inflammation, characterized by a T2-hypointense extradural mass, were used for comparison of the relative location of the two types of lesions and prognosis. Disc extrusion causing epidural hemorrhage or inflammation is more common in the caudal aspect of the lumbar spine than disc extrusions that do not cause signs of hemorrhage or inflammation (P < 0.05) in MR images. In dogs with disc extrusion and associated epidural hemorrhage or inflammation, there was no association between MR imaging features and signalment, the presence or absence of hemorrhage, or pathologic findings. The appearance of the lesion created by disc extrusion with epidural hemorrhage and inflammation encompasses a wide variety of imaging features, likely related to the duration of the hemorrhage and associated inflammatory changes. In 10 of 46 dogs these secondary changes masked identification of the disc extrusion itself in the MR images. An awareness of the variety of MR imaging features of disc extrusion accompanied by extradural hemorrhage or inflammation is important to avoid making an incorrect diagnosis and to facilitate a proper surgical approach. The prognosis of dogs with disc extrusion accompanied by hemorrhage or inflammation does not appear to be different than for dogs with disc extrusion and without imaging signs of epidural hemorrhage or inflammation.
Collapse
MESH Headings
- Animals
- Cohort Studies
- Contrast Media
- Dog Diseases/diagnosis
- Dog Diseases/epidemiology
- Dog Diseases/surgery
- Dogs
- Female
- Hematoma, Epidural, Spinal/complications
- Hematoma, Epidural, Spinal/diagnosis
- Hematoma, Epidural, Spinal/epidemiology
- Hematoma, Epidural, Spinal/surgery
- Hematoma, Epidural, Spinal/veterinary
- Intervertebral Disc Displacement/complications
- Intervertebral Disc Displacement/diagnosis
- Intervertebral Disc Displacement/veterinary
- Magnetic Resonance Imaging/methods
- Magnetic Resonance Imaging/veterinary
- Male
- Prognosis
Collapse
Affiliation(s)
- Isidro Mateo
- Resonancia Magnética Veterinaria, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | | | | | | |
Collapse
|
193
|
Suran JN, Durham A, Mai W, Seiler GS. Contrast enhancement of extradural compressive material on magnetic resonance imaging. Vet Radiol Ultrasound 2011; 52:10-16. [PMID: 21322382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Gadolinium-enhancement of compressive extradural material is detected occasionally with magnetic resonance (MR) imaging in dogs. Our goal was to characterize contrast enhancement of extradural compressive material associated with intervertebral disc herniation, and to evaluate the association between enhancement and histopathologic findings and the onset of clinical signs. Ninety-three dogs with a total of 99 lesions diagnosed as intervertebral disc herniation on MR imaging were assessed. Images were evaluated for lesion location, type of herniation, degree of compression, intramedullary T2-weighted (T2W) intensities, and contrast enhancement. In 23 dogs, surgically removed compressive material was evaluated histopathologically for hemorrhage, inflammation, neovascularization, fibroplasia, fibrosis, mineralization, necrosis, and chronicity. Contrast enhancement of extradural compressive material, meninges, and both the compressive materials and meninges was present in 51.5%, 39.4%, and 17.2% of lesions, respectively. Extradural enhancement occurred more frequently in extrusions than protrusions (P = 0.001). Meningeal enhancement and more severe neurologic deficits were significantly associated with a shorter duration of clinical signs (P = 0.04 and 0.01, respectively). Intramedullary T2W hyperintensities, present with 44.4% of lesions, were associated with more severe neurologic deficits (P = 0.001). Lesions with extradural enhancement were more often considered subacute to chronic in duration and more frequently associated with hemorrhage compared with nonenhancing material; however, no statistically significant association was established between contrast enhancement and histopathologic findings. Contrast enhancement of extradural compressive material and the meninges was found to be common with intervertebral disc herniation, and should not be interpreted as a specific sign of a mass lesion such as neoplasia.
Collapse
Affiliation(s)
- Jantra Ngosuwan Suran
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA
| | | | | | | |
Collapse
|
194
|
Aydin S, Kucukyuruk B, Yildirim H, Abuzayed B, Bozkus H, Vural M. Acute formation of lumbar discal cyst: what is the mechanism? J Neurosurg Sci 2010; 54:149-152. [PMID: 21423085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Lumbar discal cysts are extremely rare pathologies, with only few reports describing these lesions in the literature. Moreover, their definite pathogenesis is still unknown, with proposed theories based on radialogic and histologic findings. In this report, the authors present an acute formation of a discal cyst, which is reported for the first time. Also, we center our case on the discussion of the possible pathogenesis. Also, this is the first case of discal cyst reported in Turkey. A 67-year-old woman, whose complaints, and clinical and radiological findings demonstrated lumbar disc herniation with acute Modic 1 degererative changes of the adjacent end plates of L3-4 level. After medical and physical therapies, follow-up lumbar MRI has been taken to demonstrate a discal cyst formation on the adjacent intervertebral disc, showed cranially migrated cyst superior posterior on herniated disc, in 2 weeks period. The patient was treated by microsurgical resection of the cyst, and her complaints resolved completely.
Collapse
Affiliation(s)
- S Aydin
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
195
|
Ducoulombier V, Dehecq E, Luraschi H, Prudhomme C, Bessard D, Houvenagel E. [Kingella kingae spondylodiscitis in an adult]. Med Mal Infect 2010; 41:110-2. [PMID: 21093187 DOI: 10.1016/j.medmal.2010.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/05/2010] [Accepted: 09/30/2010] [Indexed: 11/20/2022]
|
196
|
Carlestam J. [Internal disc disruption (IDD)--an unknown diagnosis]. Lakartidningen 2010; 107:2908. [PMID: 21197792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
197
|
Goudie R. Complex issues. Can Fam Physician 2010; 56:1109. [PMID: 21075988 PMCID: PMC2980420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
198
|
Liu KX, Massoud B. Endoscopic anterior cervical discectomy under epidurogram guidance. Surg Technol Int 2010; 20:373-378. [PMID: 21082589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cervical discectomy is commonly required for spinal cord and nerve compression disorders. Currently, anterior cervical discectomy and fusion is the standard procedure for the treatment of cervical disc herniations and cervical degenerative disorders, whereas endoscopic cervical discectomy is considered an important alternative. Despite the advancement in surgical technology, endoscopically removing hard pathological tissues remains challenging. Inspired by lumbar epidurogram-guided decompression, we have developed an epidurogram-guided endoscopic cervical decompression technique. The technique uses contrast dye through cervical discography to generate an epidurogram. Under fluoroscopic view, the spinal cord is posterior to the contrast line. The endoscopic instruments can safely reach the epidural space, if it's necessary, as long as they stay anterior to the contrast line. We have used this technique to treat both soft and hard cervical disc herniations, and we have found it makes the surgical procedures safer when more aggressive decompression is required.
Collapse
|
199
|
Cheng F, You J, Rampersaud YR. Relationship between spinal magnetic resonance imaging findings and candidacy for spinal surgery. Can Fam Physician 2010; 56:e323-e330. [PMID: 20841571 PMCID: PMC2939133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To compare the prevalence of spinal abnormalities found on magnetic resonance imaging (MRI) in symptomatic surgical candidates and non-surgical patients. DESIGN Retrospective cohort study. SETTING A single academic spine surgery practice in Toronto, Ont. PARTICIPANTS A total of 1586 symptomatic patients referred during a 32-month period; based on chart review, patients were classified as surgical candidates (n=722), non-surgical patients (n=690), or indeterminate regarding surgical candidacy (n=174). MAIN OUTCOME MEASURES Prevalence rates of different spinal abnormalities between the 2 cohorts, including type, severity, and number of levels of abnormalities detected on lumbar MRI. RESULTS The total number of abnormalities did not differ between the 2 groups (P=.26). The non-surgical group exhibited more degenerative disk disease (P<.01), while surgical candidates had a higher prevalence of spinal stenosis and spondylolisthesis (P<.01). In multivariate analysis, age (adjusted odds ratio [AOR] per 10-year increase 3.33, 95% confidence interval [CI] 3.32 to 3.33), disk herniation (AOR 1.49, 95% CI 1.16 to 1.89), spinal stenosis (AOR 1.61, 95% CI 1.26 to 2.05), and spondylolisthesis (AOR 2.83, 95% CI 2.08 to 3.88) were independent predictors of surgical candidacy. CONCLUSION These results might enable physicians without specialty training in spinal disorders to more effectively use MRI reports when deciding on referral to surgical or non-surgical specialists. In jurisdictions with long wait times for elective spinal surgery consultation, a more directed referral is one of many steps necessary to improve patient access and management.
Collapse
Affiliation(s)
- Frederick Cheng
- University of Toronto, Department of Surgery, Toronto Western Hospital East Wing 1-441, 399 Bathurst St, Toronto, ON M5T 2S8
| | | | | |
Collapse
|
200
|
Modesto dos Santos V, Aristotelis Rocha de Sa D, Nascimento Cavalcanti de Oliveira ÉR, Barcelos MDS, Silva Paz BC, Andrade LM. Coexistent cervical spine fusion and thoracic disc herniations with acute myelitis. Infez Med 2010; 18:177-181. [PMID: 20956874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Thoracic disc herniations are commonly found in asymptomatic individuals, sometimes with genetic predisposition. Congenital fusions of cervical vertebrae occur in Klippel-Feil syndrome, which may be asymptomatic or cause compressive myelitis due to cervical instability or associated herniated discs. We report the case of a 72-year-old man with monophasic acute transverse myelitis probably caused by herpes simplex virus, coexistent with fused cervical vertebrae (C4-C5) and thoracic herniated discs. Establishment of the aetiology in cases of transverse acute myelitis can constitute a challenge in patients with cervical spine anomaly and disc herniations.
Collapse
|