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

We prospectively studied 50 consecutive ambulatory cerebral palsy (CP) patients to determine the incidence of isthmic spondylolisthesis. In addition, we examined the relationship of hip flexion contractures to development of spondylolisthesis and low back pain. Three patients who had undergone previous spine operation were eliminated from the study group. Of the remaining 47 patients, one patient (2%) demonstrated an asymptomatic grade I spondylolisthesis. Another patient (2%) demonstrated spondylolysis without spondylolisthesis. Only six patients reported occasional low back pain. Pain did not correlate with increasing age, increasing hip flexion contracture, or decreasing sacrofemoral angle. The incidence of spondylolisthesis in this group of ambulatory CP patients with hip flexion contractures is similar to that in the general population. Hip flexion contractures did not predispose the group to spondylolisthesis or low back pain. Periodic screening of asymptomatic ambulatory CP patients for spondylolisthesis is not recommended.
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PMID:Incidence of spondylolisthesis in ambulatory cerebral palsy patients. 841 51

We analyzed the clinical, vocational and radiologic outcomes of 63 consecutive posterolateral lumbosacral fusions performed with transpedicular fixation. The indication for surgery was long-standing intractable lumbar and/or radiating pain with spondylolysis-olisthesis in 31 cases, degenerative disc disease and/or facet joint arthrosis in 23 cases and pain after laminectomy/decompression in 9 cases. Radiographic union was finally achieved in 30 out of the 63 cases. Fixation device-related complications, such as screw misplacement, breakage, bending and loosening, occurred in 33 cases. 15 patients underwent refusion. 43 patients obtained good pain relief. There was no correlation between bony healing and a good clinical outcome. 28/49 preoperatively employed patients returned to work. There was no correlation between relief of pain and return to work. 20 patients retired on a full disability pension. The clinical results were best in the spondylolysis-olisthesis group. Only 2/15 patients with markedly reduced spondylolisthesis maintained the reduction. In 3 patients, progressive disc degeneration above the level of fusion was observed. We conclude that posterolateral lumbosacral fusion with transpedicular fixation provides a satisfactory clinical outcome in patients with spondylolysis-olisthesis, but the high incidence of complications related to the fixation device in the other indications studied is a serious drawback of the method.
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PMID:Posterolateral lumbosacral fusion with transpedicular fixation: 63 consecutive cases followed for 4 (2-6) years. 861 6

The aim of this study was to clarify the clinical role of bone single photon emission tomography (SPET) of the lumbar spine in young persons with persistent lumbar pain which might be due to spondylolysis. Thirty-one bone SPET studies were performed on 25 patients (19 males, 6 females) aged 7-26 years (average 15.6 years) who had suffered lumbar pain associated with physical activity, and who were suspected of having spondylolysis. Planar and SPET images of the lumbar spine were obtained 2-3 h following the injection of 99Tc(m)-methylene diphosphonate using a single-head rotating gamma camera. The findings on the bone scintigram were compared with those on the radiograph. Bone scintigraphy at presentation was positive in only 7 of 15 sites of the pars interarticularis defects demonstrated on plain radiographs. On the other hand, seven sites of the pars interarticularis which were normal on the radiograph were positive on bone SPET. As clinical symptoms improved after immobilization using a lumbar corset, bone SPET tended to revert towards normal. The planar image was abnormal in only 8 (42%) of the 19 abnormal sites on the SPET image. A bone SPET study is indicated in patients who are negative on radiological tests and who are still suspected of having spondylolysis. If SPET is positive in these patients, the increased bone uptake is most likely suggestive of a state of 'stress reaction', and may be a good indicator for patient management. If negative, further radiological examinations will be required for proper assessment of the origin of lumbar pain.
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PMID:Bone SPET of symptomatic lumbar spondylolysis. 873 15

Treatment of spondylolysis and minor form of spondylolisthesis in childhood is usually conservative and includes physical therapy, a temporary reduction in sport activities or the use of an orthosis. Persisting pain despite conservative therapy, neurological symptoms and progressive sliding on x-ray may indicate surgical treatment. We report about the results in 25 patients operated by direct repair of the isthmus between 1982 and 1990 in the Orthopaedic Hospital in Mannheim. In 75% of the cases the special hook-screw by Morscher was used. The other patients were operated according to the original method described by Buck or by the Scott procedure with wire fixation. The clinical and radiological results were available in all patients by a mean follow-up of 8.9 years (4-12 years). All juvenile patients had good or very good clinical results. Within the adult group half of the patients had fair or worse clinical results. Only in 3 out of 14 cases we found bony consolidation of both arches. In 6 cases the x-ray showed pseudoarthrosis on both sides. In 3 of these patients spondylodesis had to be performed. Because of the bad results of direct repair in adult patients, we looked for further criteria, which are necessary to achieve good clinical and radiological results. In addition of the age, the condition of the disc is important. In adolescent patients (more than 16 years old) we documented a degeneration of the disc by NMR or by intraoperative discography.
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PMID:[Clinical and radiological isthmus reconstruction in lumbar spondylolysis and minimal spondylolisthesis]. 876 24

Between 1988 and 1993, we treated 21 adults with symptomatic lumbar spondylolysis by a combined surgery of posterior stabilization and anterior interbody fusion. Our indication for this combined surgery was persistent pain that was unresponsive to conservative measures and segmental instability on flexion-extension roentgenogram. The patients' mean age at the time of surgery was 34 years (range 24-42 years). All patients showed degenerated disks on preoperative magnetic resonance imaging. The mean follow-up period was 30.4 months. The clinical result was excellent or good in 95%, and the radiographic fusion was successful in 95%. Prolonged pain at the donor site was the most common complication, which usually disappeared by 3 months after the operation. We recommend the combined surgery of posterior instrumentation and anterior fusion to stabilize symptomatic adult lumbar spondylolysis.
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PMID:Posterior pedicular screw instrumentation and anterior interbody fusion in adult lumbar spondylolysis or grade I spondylolisthesis with segmental instability. 879 73

The most common causes of serious low back pain in children include spondylolysis, Scheuermann disease and musculoligamentous injury. Questions should be asked about the mechanism of onset and exacerbating factors, and the frequency, duration and severity of the pain. The examination should check gait and alignment, flexibility, strength and reflexes, and localize and evaluate the pain. Warning signs of serious problems include constant pain in a child younger than 11 years of age that lasts for several weeks or occurs spontaneously at night, repeatedly interferes with school, play or sports, or is associated with marked stiffness and limitation of motion, fever or neurologic abnormalities. Pain at the lumbosacral junction may suggest spondylolysis or spondylolisthesis. Scheuermann disease is diagnosed by the observance of wedging, irregularity or growth disturbance of three successive vertebrae. Musculoligamentous pain may result from injury to or overuse of muscles or joints of the back. Rare causes include discitis, tuberculosis, bone or spinal cord tumor, pyelonephritis and retroperitoneal infection.
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PMID:Evaluating the child with back pain. 890 Mar 53

This article describes the scintigraphic appearance of both a symptomatic and asymptomatic retroisthmic cleft in two athletes with low back pain. This lesion, which involves the lamina, is the least common of the neural arch defects of which spondylolysis is the most common. The anatomy of the lesion is discussed and illustrated. The literature about the possible cause of these lesions is reviewed. The report emphasizes the valuable role of radionuclide bone imaging in patients who have pain of potentially osseous origin, and who have a lesion of uncertain physiologic significance seen on an anatomic study such as a plain x-ray, CT scan, or MRI.
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PMID:The retroisthmic cleft. Scintigraphic appearance and clinical relevance in patients with low back pain. 906 69

We analysed the complications encountered in 102 consecutive patients who had posterolateral lumbosacral fusion performed with transpedicular screw and rod fixation for non-traumatic disorders after a minimum of two years. Of these, 40 had spondylolysis and spondylolisthesis, 42 a degenerative disorder, 14 instability after previous laminectomy and decompression, and six pain after nonunion of previous attempts at spinal fusion without internal fixation. There were 75 multilevel and 27 single-level fusions. There were 76 individual complications in 48 patients, and none in the other 54. The complications seen were screw misplacement, coupling failure of the device, wound infection, nonunion, permanent neural injury, and loosening, bending and breakage of screws. Screw breakage or loosening was more common in patients with multilevel fusions (p < 0.001). Screws of 5 mm diameter should not be used for sacral fixation. Forty-six patients had at least one further operation for one or several complications, including 20 fusion procedures for nonunion. The high incidence of complications is a disadvantage of this technically-demanding method.
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PMID:Complications of transpedicular lumbosacral fixation for non-traumatic disorders. 946 Sep 78

Spondylolysis and spondylolisthesis occur predominantly in the lower lumbar spine. Besides congenital defects such as predisposition of spondylolysis the correlation between competitive sports activities and an increased incidence of spondylolysis is proved. In early stages, complete healing can be achieved by conservative treatment (abstinence from sports activities for 3 months, orthesis). Persistence of pain, neurologic symptoms and progression of vertebral slipping are indications for operative treatment (reconstruction of the isthmus, dorso-ventral spondylodesis). The exercise tolerance depends on the extent of instability, progression of vertebral slipping and clinical symptoms. The limits of exercise tolerance vary among the individual athletes and require the decision of the physician. Backstroke swimming, abdominal and back muscle strengthening exercises, and types of sport involving smooth movements are advisable. Sports education in school is possible without restriction in patients with stable spondylolysis and in those with spondylolisthesis without unfavourable concomitant factors.
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PMID:[Spondylolysis and spondylolisthesis and sports]. 943 59

The majority of patients with symptomatic spondylolysis can be treated conservatively. Only when symptoms persist in spite of conservative treatment surgery may be indicated. In young patients, however, fusion of a mobile segment should be avoided, but a direct repair of the pars defect can be attempted. This procedure allows complete healing and possibly avoids degeneration of the intervertebral disk. For this purpose Morscher developed the hook screw, which connects the arch with the anterior articular process. It allows compression of the defect without crossing the defect with the screw. A follow-up study of the first 33 patients with a follow-up time of 3.5 years on average showed a good subjective result in 79% of the patients. In patients younger than 20 years of age, however, the result was good in 87.5% of cases. The reason for the better results in young patients is that in older patients the origin of the pain is often not the pars defect, but the degeneration of the intervertebral disk. Direct repair of spondylolysis is therefore indicated when pain persists after 6 months of conservative treatment or there is a progressive olisthesis of not more than 10 mm. After the end of growth an MRI study of the intervertebral discs should show whether there is degeneration or not. Direct repair is indicated only in the absence of disc degeneration. After the age of 25 years this procedure should not be carried out.
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PMID:[Direct screw repair of spondylolysis with the hooked screw]. 943 61


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