1
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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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2
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Naber WJ, Netzloff CL, Bakshi RR. Atypical Cause for Back Pain and Sciatica in a 35-Yr-Old Woman With Fibromyalgia. Am J Phys Med Rehabil 2023; 102:e103-e105. [PMID: 36753441 DOI: 10.1097/phm.0000000000002203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Spinal and extrapelvic lesions causing sciatic symptoms are well recognized in clinical research and practice. 1-5 We present a 35-yr-old woman with a history of axial back pain and fibromyalgia who presented with episodes of radicular type pain down her legs and associated bilateral tingling in her feet. Medicinal and therapeutic interventions for traditional sciatica etiologies failed to provide relief. Lumbar magnetic resonance imaging showed mild multilevel degenerative changes and partially visualized fibroids, but no other significant spinal pathology was appreciated. Subsequent pelvic magnetic resonance imaging revealed an enlarged retroverted uterus with multiple fibroid lesions. The patient elected for laparoscopic myomectomy, which improved her likelihood of fertility while drastically alleviating her axial spine and lower extremity symptomology. This case reinforces the importance of keeping a broad differential that includes intrapelvic etiologies when traditional workup and treatment for sciatic neuropathy fails. To our knowledge, this is the first reported case of sciatic neuropathy secondary to uterine fibroids treated with the intent of both fertility improvement and pain relief.
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Affiliation(s)
- William J Naber
- From the Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
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3
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Filippini C, Saran S, Chari B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 2023:10.1007/s00256-023-04320-9. [PMID: 36917270 DOI: 10.1007/s00256-023-04320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.
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Affiliation(s)
- Claire Filippini
- Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - Sonal Saran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Basavaraj Chari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
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4
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Trager RJ, Prosak SE, Getty PJ, Barger RL, Saab ST, Dusek JA. Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report. Chiropr Man Therap 2022; 30:45. [PMID: 36253863 PMCID: PMC9575271 DOI: 10.1186/s12998-022-00451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations. CASE PRESENTATION A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient's symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome. CONCLUSION The key distinguishing features that led to a diagnosis of osteochondroma in this case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.
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Affiliation(s)
- Robert J. Trager
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Sarah E. Prosak
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Patrick J. Getty
- grid.443867.a0000 0000 9149 4843Musculoskeletal Surgical Oncology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Orthopaedic Surgery, Case Western Reserve University, 44106 Cleveland, OH USA
| | - Richard L. Barger
- grid.443867.a0000 0000 9149 4843Division of Musculoskeletal Radiology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Shahrazad T. Saab
- grid.67105.350000 0001 2164 3847Department of Pathology, Case Western Reserve University School of Medicine, 44106 Cleveland, OH USA
| | - Jeffery A. Dusek
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, 44106 Cleveland, OH USA
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5
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Porzionato A, Macchi V, Stecco C, Boscolo-Berto R, Loukas M, Tubbs RS, De Caro R. Clinical Anatomy and Medical Malpractice-A Narrative Review with Methodological Implications. Healthcare (Basel) 2022; 10:1915. [PMID: 36292362 PMCID: PMC9601975 DOI: 10.3390/healthcare10101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
Anatomical issues are intrinsically included in medico-legal methodology, however, higher awareness would be needed about the relevance of anatomy in addressing medico-legal questions in clinical/surgical contexts. Forensic Clinical Anatomy has been defined as "the practical application of Clinical Anatomy to the ascertainment and evaluation of medico-legal problems". The so-called individual anatomy (normal anatomy, anatomical variations, or anatomical modifications due to development, aging, para-physiological conditions, diseases, or surgery) may acquire specific relevance in medico-legal ascertainment and evaluation of cases of supposed medical malpractice. Here, we reviewed the literature on the relationships between anatomy, clinics/surgery, and legal medicine. Some methodological considerations were also proposed concerning the following issues: (1) relevant aspects of individual anatomy may arise from the application of methods of ascertainment, and they may be furtherly ascertained through specific anatomical methodology; (2) data about individual anatomy may help in the objective application of the criteria of evaluation (physio-pathological pathway, identification-evaluation of errors, causal value, damage estimation) and in final judgment about medical responsibility/liability. Awareness of the relevance of individual anatomy (risk of iatrogenic lesions, need for preoperative diagnostic procedures) should be one of the principles guiding the clinician; medico-legal analyses can also take advantage of its contribution in terms of ascertainment/evaluation.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Veronica Macchi
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Carla Stecco
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Rafael Boscolo-Berto
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
| | - Marios Loukas
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
| | - Ronald Shane Tubbs
- Department of Anatomical Sciences, True Blue Campus, St. George’s University, St. George 1473, Grenada
- Department of Neurosurgery, Tulane University, New Orleans, LA 70112, USA
| | - Raffaele De Caro
- Section of Anatomy, Department of Neuroscience, University of Padova, Via Gabelli, 65, 35127 Padova, Italy
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6
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Araque Cancar JC, Lázaro Rosado S, Del Palacio Salgado M, Morales Palacios MT. [Ischiofemoral impingement syndrome: Report of an unusual case]. Rehabilitacion (Madr) 2021; 56:159-163. [PMID: 33712287 DOI: 10.1016/j.rh.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
Ischiofemoral impingement syndrome is usually underdiagnosed; this syndrome forms part of the differential diagnoses to be included in hip pain. It was initially described with surgical procedures but, with the passage of time, various medical entities have been described, as well as techniques and postures that can aggravate this syndrome, which can even be associated with neurological involvement. Current treatment is initially conservative, consisting of rest, analgesia, cold and progressive exercises aimed at the lumber and gluteal muscles and lower extremities but there is no established standard of care.
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Affiliation(s)
- J C Araque Cancar
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - S Lázaro Rosado
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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7
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Intrapelvic Nerve Entrapment Syndrome Caused by a Variation of the Intrapelvic Piriformis Muscle and Abnormal Varicose Vessels: A Case Report. Int Neurourol J 2021; 25:177-180. [PMID: 33504131 PMCID: PMC8255827 DOI: 10.5213/inj.2040232.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/16/2020] [Indexed: 11/08/2022] Open
Abstract
Entrapment neuropathy of the sciatic nerve and pudendal nerve are painful syndromes that are often overlooked by physicians. Laparoscopic surgical interventions for nerve entrapment syndromes of the posterior pelvis focus on removing the compression lesion with the purpose of eliminating the suspected cause of sciatica, as well as pudendal neuralgia. Herein, the authors report the rare event of sciatic and pudendal nerve entrapment, which was caused by aberrant vessels and a variant piriformis muscle bundle, as a seldom-diagnosed cause of sciatica and pelvic pain, for both neurosurgeons and neuropelveologists. The authors present the laparoscopic decompression technique for the pudendal and sciatic nerves by giving our technical “tips and tricks” enriched by a surgical video.
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8
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Abouzeid B, El Hasbani G, Mufarrij I. Observational analysis of mesh related complications in urogynecologic procedures. J Robot Surg 2019; 14:377-382. [PMID: 31493187 DOI: 10.1007/s11701-019-01020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
Since the 1990s, the use of mesh has expanded in gynecologic surgeries in the aim of correcting pelvic organ prolapse. Because there has been a lot of complications that were reported, the U.S. Food and Drug Administration has requested the withdrawal of many products from the market. Recently, many countries have called for the suspension of vaginal mesh products from the market. The objective of this review is to analyze the incidence of the complications that arise after vaginal mesh surgeries with an insight to the American College of Obstetricians and Gynecologists recommendations on the management of those complications.
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Affiliation(s)
| | | | - Imad Mufarrij
- The George Washington University Hospital, Washington, DC, USA
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9
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Fernandez M, Moore C, Peng W, de Luca K, Pohlman KA, Swain M, Adams J. The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network. Chiropr Man Therap 2019; 27:19. [PMID: 31015956 PMCID: PMC6469207 DOI: 10.1186/s12998-019-0239-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who ‘often’ treated patients with LBRLP compared to those who treated LBRLP ‘never/rarely/sometimes’. Multiple logistic regression models identified independent factors associated with chiropractors who ‘often’ treated patients with LBRLP. Results A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them ‘often’ treating LBRLP. Chiropractors who ‘often’ treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who ‘often’ treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.
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Affiliation(s)
- Matthew Fernandez
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, Room 369, 17 Wally's Walk, Sydney, NSW Australia.,Chiropractic Academy for Research Leadership (CARL), Sydney, Australia
| | - Craig Moore
- Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.,3Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Wenbo Peng
- 3Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Katie de Luca
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, Room 369, 17 Wally's Walk, Sydney, NSW Australia.,Chiropractic Academy for Research Leadership (CARL), Sydney, Australia
| | - Katherine A Pohlman
- Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.,4Research Institute, Parker University, Dallas, Texas USA
| | - Michael Swain
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, Room 369, 17 Wally's Walk, Sydney, NSW Australia.,Chiropractic Academy for Research Leadership (CARL), Sydney, Australia
| | - Jon Adams
- 3Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
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10
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Romeo V, Cavaliere C, Sorrentino C, Ponsiglione A, Ugga L, Barbuto L, Verde F, Covello M. Clinical impact of coronal-STIR sequence in a routine lumbar spine MR imaging protocol to investigate low back pain. Medicine (Baltimore) 2018; 97:e10789. [PMID: 29879016 PMCID: PMC5999459 DOI: 10.1097/md.0000000000010789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim of this study is to assess the clinical impact of coronal short tau inversion recovery (STIR)-weighted magnetic resonance (MR) sequence, when acquired in a lumbar spine MR imaging protocol, in detecting significant extraspinal imaging findings in patients with low back pain (LBP).We retrospectively evaluated 931 lumbar spine MR examinations of patients with LBP. Extraspinal MR imaging findings were categorized as: probably related to LBP (Category 1), not related to LBP but with relevant implications on patient's care (Category 2), and not related to LBP without significant implications on patient's care (Category 3). For each MR imaging finding was also assessed if it was detectable or not on the conventional sagittal and axial acquisition planes.Of the 931 evaluated MR examinations, 60 (6.4%) showed additional extraspinal MR imaging findings, categorized as follows: 55% (33/60) probably related to LBP (Category 1), 22% (13/60) not related to LBP but with relevant implications on patient's care (Category 2), and 23% (14/60) not related to LBP and without significant implications on patient's care (Category 3). Among categories 1 and 2 (n = 46), the 72% (33/46) of imaging findings were detected only on coronal plane. Coronal-STIR sequence significantly changed patients' diagnostic work-flow in 3.5% (33/931) of cases.Coronal STIR sequence, acquired in a lumbar spine MR imaging protocol to investigate LBP, may aid radiologists in detecting additional extraspinal MR imaging findings that could be related to LBP, addressing to the most appropriate clinical management.
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Affiliation(s)
- Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | | | | | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Luigi Barbuto
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Francesco Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II
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11
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Xiao H, Zaslawski C, Vardy J, Oh B. Treatment of Sciatica Following Uterine Cancer with Acupuncture: A Case Report. MEDICINES 2018; 5:medicines5010006. [PMID: 29342919 PMCID: PMC5874571 DOI: 10.3390/medicines5010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/06/2018] [Accepted: 01/07/2018] [Indexed: 11/16/2022]
Abstract
For women, gynaecological or obstetrical disorders are second to disc prolapse as the most common cause of sciatica. As not many effective conventional treatments can be found for sciatica following uterine cancer, patients may seek assistance from complementary and alternative medicine. Here, we present a case of a woman with severe and chronic sciatica secondary to uterine cancer who experienced temporary relief from acupuncture.
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Affiliation(s)
- Henry Xiao
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Christopher Zaslawski
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Janette Vardy
- Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia.
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW 2137, Australia.
| | - Byeongsang Oh
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia.
- Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia.
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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12
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Possover M. Five-Year Follow-Up After Laparoscopic Large Nerve Resection for Deep Infiltrating Sciatic Nerve Endometriosis. J Minim Invasive Gynecol 2017; 24:822-826. [DOI: 10.1016/j.jmig.2017.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 11/29/2022]
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13
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Mathis S, Chapon F, Franques J. MRI and surgical lumbosacral trunk positioning palsy. Muscle Nerve 2017; 56:E36-E37. [PMID: 28556281 DOI: 10.1002/mus.25703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, Pellegrin Hospital, CHU Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Frédérique Chapon
- La Casamance Hospital, Aubagne, France.,European Hospital, Marseille, France
| | - Jérôme Franques
- La Casamance Hospital, Aubagne, France.,Saint Joseph Hospital, Marseille, France
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14
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Uppal J, Sobotka S, Jenkins AL. Cyclic Sciatica and Back Pain Responds to Treatment of Underlying Endometriosis: Case Illustration. World Neurosurg 2017; 97:760.e1-760.e3. [DOI: 10.1016/j.wneu.2016.09.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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15
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Matsumoto Y, Matsunobu T, Harimaya K, Kawaguchi K, Hayashida M, Okada S, Doi T, Iwamoto Y. Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica. World J Clin Oncol 2016; 7:414-419. [PMID: 27777884 PMCID: PMC5056333 DOI: 10.5306/wjco.v7.i5.414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/18/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study the clinical findings and characteristic features in sciatic notch dumbbell tumors (SNDTs).
METHODS We retrospectively reviewed the clinical outcomes and characteristic features of consecutive cases of SNDTs (n = 8).
RESULTS Buttock masses occurred in three patients with SNDT (37.5%). Severe buttock tenderness and pain at rest were observed in seven patients with SNDTs (87.5%). Remarkably, none of the patients with SNDTs experienced back pain. Mean tumor size was 8.4 ± 2.0 cm (range, 3.9 to 10.6 cm) and part of the tumor mass was detected in 2 patients in the sagittal view of lumbar magnetic resonance imaging (MRI).
CONCLUSION The clinical information regarding to SNDTs is scarce. The authors consider that above mentioned characteristic findings may facilitate the suspicion of pelvic pathology and a search for SNDT by MRI or computed tomography should be considered in patients presenting with sciatica without evidence of spinal diseases.
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16
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DeFroda SF, Daniels AH, Deren ME. Differentiating Radiculopathy from Lower Extremity Arthropathy. Am J Med 2016; 129:1124.e1-7. [PMID: 27401953 DOI: 10.1016/j.amjmed.2016.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Low back and lower extremity pain are among the most common complaints encountered by physicians. Distinguishing pain due to primary extremity pathology versus lumbar radiculopathy can be challenging. Careful physical examination and appropriate imaging with plain radiographs and advanced studies as needed are important in determining the cause of lower extremity complaints. Over-utilization of advanced imaging may reveal otherwise asymptomatic spinal pathology and can lead to an incorrect diagnosis. In patients in whom surgical intervention is being considered by a spine or arthroplasty surgeon, intra-articular or epidural steroid injections may help to reveal the underlying cause of pain via short-term symptomatic relief. Additionally, patients presenting with vague lower extremity pain after recent or distant joint arthroplasty should be considered for potential failure or infection of their implant before assuming the symptoms are coming from the lumbar spine.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopedics, Alpert Medical School of Brown University, Providence, RI.
| | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopedics, Alpert Medical School of Brown University, Providence, RI
| | - Matthew E Deren
- Department of Orthopedics, Alpert Medical School of Brown University, Providence, RI
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Ahmad M, Kumar A, Thomson S. The unique case of foot drop secondary to a large ovarian cyst. Br J Neurosurg 2014; 28:549-51. [PMID: 24447226 DOI: 10.3109/02688697.2013.847174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe the unique case of a 58-year-old woman who presented with right leg radiculopathy caused by an ovarian cyst mimicking lumbar pathology. A review of the literature shows that this is a rare case where a histologically confirmed benign ovarian cystadenoma (of indeterminate type) is shown to cause foot drop and radiculopathy.
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Affiliation(s)
- Maleeha Ahmad
- Department of Neurosurgical, The General Infirmary at Leeds , Leeds , UK
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Wang X, Zhao W, Wang Y, Hu J, Chen Q, Yu J, Wu B, Huang R, Gao J, He J. A self-administered method of acute pressure block of sciatic nerves for short-term relief of dental pain: a randomized study. PAIN MEDICINE 2014; 15:1304-11. [PMID: 24400593 PMCID: PMC4265330 DOI: 10.1111/pme.12338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives While stimulation of the peripheral nerves increases the pain threshold, chronic pressure stimulation of the sciatic nerve is associated with sciatica. We recently found that acute pressure block of the sciatic nerve inhibits pain. Therefore, we propose that, the pain pathology-causing pressure is chronic, not acute. Here, we report a novel self-administered method: acute pressure block of the sciatic nerves is applied by the patients themselves for short-term relief of pain from dental diseases. Design This was a randomized, single-blind study. Setting Hospital patients. Patients Patients aged 16–60 years with acute pulpitis, acute apical periodontitis, or pericoronitis of the third molar of the mandible experiencing pain ≥3 on the 11-point numerical pain rating scale. Interventions Three-minute pressure to sciatic nerves was applied by using the hands (hand pressure method) or by having the patients squat to force the thigh and shin as tightly as possible on the sandwiched sciatic nerve bundles (self-administered method). Outcomes The primary efficacy variable was the mean difference in pain scores from the baseline. Results One hundred seventy-two dental patients were randomized. The self-administered method produced significant relief from pain associated with dental diseases (P ≤ 0.001). The analgesic effect of the self-administered method was similar to that of the hand pressure method. Conclusions The self-administered method is easy to learn and can be applied at any time for pain relief. We believe that patients will benefit from this method.
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Affiliation(s)
- Xiaolin Wang
- Pain Medicine Program, IDD, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Pain in the upper anterior-lateral part of the thigh in women affected by endometriosis: study of sensitive neuropathy. Fertil Steril 2013; 100:122-6. [DOI: 10.1016/j.fertnstert.2013.02.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/22/2013] [Accepted: 02/27/2013] [Indexed: 12/19/2022]
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Wang W, Tan W, Luo D, Lin J, Yu Y, Wang Q, Zhao W, Wu B, Chen J, He J. Acute pressure on the sciatic nerve results in rapid inhibition of the wide dynamic range neuronal response. BMC Neurosci 2012; 13:147. [PMID: 23211003 PMCID: PMC3538510 DOI: 10.1186/1471-2202-13-147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 11/29/2012] [Indexed: 12/26/2022] Open
Abstract
Background Acute pressure on the sciatic nerve has recently been reported to provide rapid short-term relief of pain in patients with various pathologies. Wide dynamic range (WDR) neurons transmit nociceptive information from the dorsal horn to higher brain centers. In the present study, we examined the effect of a 2-min application of sciatic nerve pressure on WDR neuronal activity in anesthetized male Sprague–Dawley rats. Results Experiments were carried out on 41 male Sprague–Dawley albino rats weighing 160–280 grams. Dorsal horn WDR neurons were identified on the basis of characteristic responses to mechanical stimuli applied to the cutaneous receptive field. Acute pressure was applied for 2 min to the sciatic nerve using a small vascular clip. The responses of WDR neurons to three mechanical stimuli applied to the cutaneous receptive field were recorded before, and 2, 5 and 20 min after cessation of the 2-min pressure application on the sciatic nerve. Two-min pressure applied to the sciatic nerve caused rapid attenuation of the WDR response to pinching, pressure and brushing stimuli applied to the cutaneous receptive field. Maximal attenuation of the WDR response to pinching and pressure was noted 5 min after release of the 2-min pressure on the sciatic nerve. The mean firing rate decreased from 31.7±1.7 Hz to 13±1.4 Hz upon pinching (p < 0.001), from 31.2±2.3 Hz to 10.9±1.4 Hz (p < 0.001) when pressure was applied, and from 18.9±1.2 Hz to 7.6±1.1 Hz (p < 0.001) upon brushing. Thereafter, the mean firing rates gradually recovered. Conclusions Our results indicate that acute pressure applied to the sciatic nerve exerts a rapid inhibitory effect on the WDR response to both noxious and innocuous stimuli. Our results may partially explain the rapid analgesic effect of acute sciatic nerve pressure noted in clinical studies, and also suggest a new model for the study of pain.
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Affiliation(s)
- Wenxue Wang
- Department of Physiology, School of Life Science, Kuning 605000, China
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George SE, Clinton SC, Borello-France DF. Physical therapy management of female chronic pelvic pain: Anatomic considerations. Clin Anat 2012; 26:77-88. [DOI: 10.1002/ca.22187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/21/2012] [Indexed: 12/20/2022]
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Tenenbaum S, Arzi H, Shabshin N, Liberman B, Caspi I. Selective computed tomography-guided perisciatic injection as a diagnostic tool in multiple hereditary exostoses. Orthopedics 2012; 35:e1446-8. [PMID: 22955418 DOI: 10.3928/01477447-20120822-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple osteochondromas, also known as multiple hereditary exostoses, is an autosomal-dominant disease. Multiple osteochondromas are characterized by the development of cartilage-capped bony tumors, known as osteochondromas. Osteochondromas can cause limb deformities, limb-length discrepancies, angular deformations, bursitis, and impingement of adjacent tendons or neurovascular structures. They have also been reported as a cause of sciatic pain. Sometimes, more than 1 location of neural compression exists, thereby presenting a difficult diagnostic challenge for treating physicians. This article describes a patient with multiple hereditary exostoses and accompanying severe sciatic pain who was referred for a revision decompressive spine surgery. The patient's functional impairment was such that he was unable to sit for a few minutes. A selective computed tomography-guided perisciatic nerve injection was performed to differentiate between lateral spinal stenosis and peripheral nerve compression or impingement by an existing large pelvic osteochondroma. The patient reported substantial relief and regained the ability to sit pain free immediately postoperatively. Excision of a proximal femur osteochondroma was performed based on the results of a selective perisciatic nerve injection, resulting in successful resolution of his sciatic pain and functional impairment. The current case is an example of the diagnostic challenge in treating patients with multiple anatomic lesions that can cause symptoms and demonstrate how selective computed tomography-guided perisciatic nerve injection can aid clinicians in obtaining an accurate diagnosis and choosing the most appropriate surgical management.
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Affiliation(s)
- Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Ghezzi L, Arighi A, Pietroboni AM, Jacini F, Fumagalli GG, Esposito A, Bresolin N, Galimberti D, Scarpini E. Sciatic endometriosis presenting as periodic (catamenial) sciatic radiculopathy. J Neurol 2012; 259:1470-1. [DOI: 10.1007/s00415-011-6378-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/11/2011] [Accepted: 12/12/2011] [Indexed: 11/25/2022]
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Yu K, Meehan JP, Fritz A, Jamali AA. Osteochondroma of the femoral neck: a rare cause of sciatic nerve compression. Orthopedics 2010; 33. [PMID: 20704099 DOI: 10.3928/01477447-20100625-26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 39-year-old man presented with weakness and a nonmobile mass in the buttock of 5 months' duration. Hip flexion was limited to 70 degrees. Strength was diminished for both ankle/foot plantar and dorsiflexion. Sensation was decreased on the plantar and dorsal foot. A pedunculated osseous mass measuring 6x4 cm on the posterior femoral neck was seen on plain radiographs and magnetic resonance imaging. Electromyography showed moderate sciatic neuropathy of the peroneal and tibial branches. The patient underwent excision of the tumor through a posterior approach. Due to the risk of weakening the neck, two 7.3-mm cannulated screws were passed percutaneously into the head with fluoroscopic guidance. The final pathological report indicated the tumor was an osteochondroma. At 22-month follow-up, he had full resolution of the neurologic findings. Postoperatively, the patient reported improvement in numbness and tingling in the leg but continued to have moderate buttock pain. Left hip flexion increased to 115 degrees at last follow-up.The importance of protecting the medial femoral circumflex artery during approaches to the hip is paramount. In this case, the tumor arose from the central aspect of the quadratus femoris, with the superior muscle protecting the medial femoral circumflex artery from harm. Although osteochondromas are a rare cause of mass effect, they should be considered in the differential diagnosis of sciatic nerve compression in this anatomical location.
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Affiliation(s)
- Kimberly Yu
- Department of Orthopedic Surgery, UC Davis, Sacramento, California 95817, USA
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Morphological analysis in patients with sciatica: a magnetic resonance imaging study using three-dimensional high-resolution diffusion-weighted magnetic resonance neurography techniques. Spine (Phila Pa 1976) 2009; 34:E245-50. [PMID: 19333087 DOI: 10.1097/brs.0b013e318197162e] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective observational study of patients with sciatica. OBJECTIVE We investigated the effectiveness of 3-dimensional high-spatial resolution diffusion-weighted MR neurography based on steady state free precession (3-dimensional diffusion-weighted steady-state free precession [DW-SSFP]) in the diagnosis of sciatica. SUMMARY OF BACKGROUND DATA Patients with sciatica challenge a physician who desires a precise diagnosis for the etiology of the pain. Direct imaging of the sciatic nerve with high resolution and high contrast may contribute to accurate localization and help to find the causes of sciatica and provide reliable information to clinicians in treatment choice. Thus, we supposed that 3-dimensional DW-SSFP method have the ability to confirm the etiologies of sciatica. METHODS The 3-dimensional DW-SSFP sequence was performed on 137 patients with sciatica and 32 patients in control group. The postprocessing techniques were used to generate images of lumbosacral plexus and sciatic nerve, and the images acquired were assessed based on the presence or absence of nerve abnormality. The certainty of identifying the lumbosacral plexus and main branches from all cases was determined in each of the reconstruction planes for each case individually and assessed by using a 3-score scale. RESULTS All subjects were successfully performed. The sciatic nerve and its main branches were differentiated and a clear picture was obtained in all subjects. Compared with the control group, the presence of nerve root compression or increased T2 signal intensity changes can be observed in all patients. The mean score of certainty of identifying the sciatic nerve and main branches was 1.76 +/- 0.4, which indicate that the sciatic nerve and main branches can be identified with certainty. CONCLUSION The 3-dimensional DW-SSFP MRI with high spatial and sufficient contrast is an excellent technique to define the nature of sciatica and assists in prognostication and possibly in management.
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Benoist M. A survey of the "medical" articles in the European Spine Journal, 2007. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:171-9. [PMID: 18188613 DOI: 10.1007/s00586-007-0570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Benoist
- Département de Rhumatologie, Service de Chirurgie Orthopédique, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118, Clichy, France.
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