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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Heterotopic ossification is a recognized complication in patients with head injury, burns, paraplegia, or direct trauma to muscle tissue. Heterotopic ossification with hemiplegia following stroke is considered rare. A case of a 53-year-old patient with right hemiplegia who developed painful right hip, limiting range of movement and progress in ambulation, is presented. X-ray and laboratory tests confirmed the presence of heterotopic ossification, suggesting that this condition may not be so rare in patients with a cerebrovascular accident, but may escape recognition, with pain being considered to stem from soft-tissue strain, premorbid arthritis, or altered sensation commonly associated with stroke.
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PMID:Heterotopic ossification in hemiplegia following stroke. 357 39

The diagnosis of intramedullary spinal cord metastasis (ISM) is difficult, and treatment is usually ineffective. We review our own experience with ISM as well as the pertinent medical literature, and suggest a practical diagnostic and therapeutic approach. The problem of the diagnosis of ISM is essentially that of the differential diagnosis of a noncompressive myelopathy in a patient with systemic cancer. Most such patients prove to have ISM, meningeal carcinomatosis, radiation myelopathy, or paraneoplastic necrotizing myelopathy. Neurologic features of value in this differential diagnosis are pain, the tempo and mode of progression of symptoms, and tumor cells in the spinal fluid. Oncologic features of value are the location of the primary tumor, the past exposure to therapeutic radiation, cerebral metastases, and the extent of systemic metastatic disease. The myelogram in ISM is either normal or nonspecifically abnormal; therefore, the diagnosis must be made on clinical grounds. Although no single finding is diagnostic of ISM, a careful clinical analysis will lead to the correct diagnosis in most cases. Radiation therapy is effective treatment for ISM, but only if it is administered early, before paraplegia supervenes. Thus, the diagnosis should be made and treatment begun as soon as possible. Intramedullary spinal cord metastasis is often multifocal rather than solitary; therefore, whole-cord rather than local spinal radiation should be given, if possible. If local radiotherapy is chosen, the construction of the portal can be based on the myelogram or, in the event of a normal study, on the clinical localization of the tumor.
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PMID:Intramedullary spinal cord metastasis. Diagnostic and therapeutic considerations. 357 64

Diffuse burning dysesthetic sensations distal to the level of spinal injury are the most common and disabling painful sequelae of traumatic spinal cord injury (SCI). In a cross-sectional study of 19 SCI patients, clinical characteristics and results of 3 validated pain measurement instruments (McGill Pain Questionnaire, Sternbach Pain Intensity and Zung Pain and Distress Scale) were used to develop a profile of function-limiting dysesthetic pain syndrome (DPS). Compared to a cohort of 147 patients admitted to the Midwest Regional Spinal Cord Injury Care System during the time period of the study, subjects were more likely to have paraplegia, incomplete sensory myelopathy, gunshot wounds to the spine and non-surgical spinal stabilization. Most patients described the pain as 'cutting,' 'burning,' 'piercing,' 'radiating' and 'tight.' The majority of patients located the pain internally and in the lower extremities. Values obtained from 6 McGill Pain Questionnaire subscales, 2 Sternbach Pain Intensity ratings and the Zung Pain and Distress index equalled or exceeded those reported for other pain syndromes. Use of these validated pain measures resulted in a systematic comprehensive assessment of function-limiting DPS following SCI.
Pain 1987 Apr
PMID:Function-limiting dysesthetic pain syndrome among traumatic spinal cord injury patients: a cross-sectional study. 358

Five cases of documented traumatic herniated nucleus pulposis are presented all occurring within the cervical region. The incidence of herniated disc in cervical spinal cord injury is 0.7%. The incidence of herniated disc in bilateral facet dislocations is 2.3%. The common features are radicular pain, incomplete syndrome, and bilateral facet dislocations. A routine myelogram is the most helpful test to establish the diagnosis.
Paraplegia 1987 Apr
PMID:Identification of herniated nucleus pulposis in spinal cord injury. 358 10

Between 1976 and 1984, twenty-one patients with ankylosing spondylitis were treated surgically. Eight patients with rigid thoracic kyphosis underwent a two-stage combined procedure. The average correction was 36 degrees. Eight patients underwent a single-stage lumbar osteotomy with Harrington compression instrumentation. The average correction was 31 degrees. Five patients presented with stress fractures and back pain. All underwent combined anterior and posterior surgery. The average correction was 9 degrees. Two patients underwent anterior decompression for progressive paraplegia. Both showed improvement in neurologic function. At follow-up, all but one patient had improvement in pain and spinal alignment. There have been no deaths or persistent neurologic problems from these procedures.
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PMID:Ankylosing spondylitis: experience in surgical management of 21 patients. 358 19

The authors report a case of a 71-year-old man, who had thoracic pain, flaccid paraplegia, sensory loss below the level of Th10, and disturbance of the sphincter control. CT myelography disclosed an isodensity epidural mass lesion from Th10 to L2, which compressed the spinal cord ventrolaterally. Laminectomy was immediately performed and an epidural hematoma was verified. The literatures of spinal epidural hematoma located in the thoraco-lumber region were reviewed.
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PMID:Idiopathic thoraco-lumbar spinal epidural hematoma. Case report and review of literature. 362 67

In a retrospective analysis of 149 patients with metastatic spinal tumors, the postoperative outcome was compared in patients who had posterior decompressive laminectomies alone (PL) and patients who had supplemental posterior stabilization at the time of laminectomy (PLS). The object of the analysis was to define the indications for stabilization. Posterior stabilization relieved pain, improved sphincter function, and encouraged ambulatory status. The use of adjunctive radiotherapy preceding laminectomy did not significantly improve the patient's postoperative course. Sex, age, initial symptom, length of time from onset of initial neurologic symptom to the time of laminectomy, the presence or duration of pain or sensory loss, the number of vertebrae involved with tumor, and the presence of widespread metastatic disease did not seem to influence the results of the surgical treatment. The presence of significant motor dysfunction, which was rapidly progressive before surgery, or profound sphincteric dysfunction prior to decompressive laminectomy was more frequent in patients who had unsatisfactory results. Decompressive laminectomy with stabilization should be considered in patients: with progressive neurologic symptoms, who are ambulatory, but whose pain increases despite radiotherapy, and who are ambulatory and were receiving radiotherapy for pain relief but who display neurologic dysfunction. For patients with established paraplegia and sphincter dysfunction, decompressive laminectomy and posterior stabilization are adjunctive measures of pain control.
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PMID:Laminectomy for metastatic epidural spinal cord tumors. Posterior stabilization, radiotherapy, and preoperative assessment. 372 Jan 4

In the last decade, operative decompression of cord and cauda, internal fixation with rods, bony fusion and early ambulation, have become more popular in the management of thoracolumbar injuries with neurological deficit. Computer-tomography, CT myelography and peroperative ultrasonography provided direct evidence, that, without surgical decompression, reduction of displaced bone and disc fragments, propelled into the spinal canal, is often incomplete, not only after postural reduction, but also after rod instrumentation. The percentage of patients with incomplete paraplegia who show improvement of neurological deficit after surgical reduction and stabilization, is probably greater than that noted with postural management. There are, however, shortcomings in the classification of neurological deficit, which hamper adequate comparison. Further research in this field is necessary. The value of the surgical approaches is mainly in immediate stabilization, which diminishes pain, facilitates nursing care and allows more rapid mobilization. This results in a shorter stay in hospital and earlier active rehabilitation. That decompression of the neural elements provides improved neurological recovery seems likely, but has so far not been proven. Management of these patients, preferably admitted to specialized units, should be carried out by an orthopedic surgeon and a neurosurgeon in cooperation. The orthopedic surgeon is mainly concerned with management of the spine; the neurosurgeon with management of the paraplegia, operations being carried out by both.
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PMID:The value of more aggressive management in traumatic paraplegia. 373

Two patients are described who developed severe pain in the thoracic region after windsurfing in rough weather. On examination there were signs of a thoracic cord lesion. Investigations revealed no evidence of cord compression and, since the symptoms and signs resolved spontaneously, an ischaemic aetiology is postulated.
Paraplegia 1986 Jun
PMID:Spinal cord injury during windsurfing. 374

An acute spinal epidural abscess is a rare cause of paraplegia, seen in seven patients over a period of ten years. All patients had fever and severe localized back-pain. Unless treated, within hours or a few days, there will be root defects and rapidly progressive paraplegia. Staphylococcus is the most frequent causative organism and clinically manifest septicaemia is common. Rapid diagnosis and treatment are essential in deciding the patient's fate. Myelography is an important additional examination as it demonstrates the abscess in 96% of cases. Non-contrast radiology is of little value. High-dosage antibiotics and surgical spinal decompression are the cardinal treatment procedures. Antibiotics alone are justified only so long as there are no neurological deficits and neurosurgical intervention, if needed, is immediately available.
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PMID:[Acute spinal epidural abscess]. 376 10


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