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

Thirty-three patients who had undergone anterior cervical fusion for degenerative disc disease were reviewed to determine the efficacy of the procedure. Only patients who were available for examination and who had undergone operation at least one year previously were included in the review. Nearly all had had arm pain and three-quarters neck pain. Diminished neck movement and neurological abnormalities in the arms had been frequent findings. Diagnosis from the clinical features and plain radiographs is described. Myelography was not used routinely and discography was not used at all. Indications for operation and surgical technique are described. Results show that pain in the neck and arm was relieved in a high proportion of cases and that the neurological abnormalities often recovered. It is concluded that this operation is safe and has a definite place in the relief of pain from cervical disc degeneration resistant to conservative treatment.
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PMID:Anterior cervical fusion. A review of thirty-three patients with cervical disc degeneration. 32 91

Ninety-six patients who had undergone disc excision and midline spinal fusion and 36 patients who had had simple disc excision had spinal radiographs made 10 or more years postoperatively. Claw spurs were found most commonly at the L2-3 and L3-4 levels in fusion patients, particularly male laborers. Traction spurs with segmental hypermobility were found more commonly at the L4-5 level in patients whose spines were not fused, particularly women. Total lumbar flexion-extension was greater in nonfusion than in fusion patients, but the L1-3 mobility was greater in those who had undergone fusion, suggesting a compensatory increase in the range of lumbar motion. Segmental mobility at levels of surgery in nonfusion patients was similar in those with good and those with poor clinical results. Disc space narrowing was common at levels of operation, but did not correspond to the clinical result. Pseudarthrosis was demonstrated in 26% of fusion patients, but was of no clinical significance. Although complex radiographic changes follow lumbar disc surgery, with or without failure, it is concluded that the plane radiograph is of little aid in determining the source of postoperative pain. The sole exception is that of acquired spondylolysis, which was found in 2.5% of this group of fusion patients, and was clearly associated with a poor clinical outcome. Symptomatic degenerative disc disease at levels above lumbar spinal fusions appears to be an uncommon clinical problem.
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PMID:A comparison of radiographic findings in fusion and nonfusion patients ten or more years following lumbar disc surgery. 53 21

Recent reports have attempted to compare the relative value of discography and MRI in the evaluation of lumbar degenerative disc disease. None has compared the accuracy of the two techniques in regard to the detection of disc herniation specifically, and none has offered surgical correlation. In this prospective study, both techniques were used to evaluate 264 disc levels in 90 patients with incapacitating low back pain or radicular pain. The results showed an 86% agreement level both between tests and between the orthopaedist and radiologist on each test. Surgical findings agreed with diagnostic studies at 63 of 76 levels in 57 patients who underwent operative treatment. An analysis of the relative sensitivity and specificity of each test in the diagnosis of degeneration and herniation revealed that the greater sensitivity of MRI in the detection of herniation was the only statistically significant difference (p < 0.05).
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PMID:Comparison of MRI and discography in the diagnosis of lumbar degenerative disc disease. 149 39

Functional and surgical outcomes are reported in two consecutive groups of patients who underwent one- and two-level lumbosacral fusion. The first group underwent standard posterolateral lumbosacral fusion, and the second group underwent lumbosacral fusion with compression U-rod instrumentation. Fusions were carried out over all painful, abnormal levels documented by discography. the pseudarthrosis rate without instrumentation was 35%, in contrast to 6% with instrumentation. In both groups of patients with chronic low-back pain secondary to degenerative disc disease, solid lumbosacral fusion was associated with decreased pain and higher return to work rates. Poorest results were associated with prolonged periods of preoperative disability and long-term disability claims.
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PMID:Results of lumbosacral fusion for degenerative disc disease with and without instrumentation. Two- to five-year follow-up. 156 70

The cause of back pain in many patients in unknown. The pain experienced by patients with osteoarthritis of large joints has been associated with intraosseous abnormalities of elevated pressure, venous dilatations, and abnormalities of pH, pCO2, and pO2. Magnetic resonance imaging demonstrates an abnormal signal in the vertebral bodies of some patients with degenerative disc disease. The intraosseous pressure as well as the intraosseous pH, pO2, and pCO2 in a group of patients undergoing anterior spine surgery was studied, and the results were correlated to the preoperative magnetic resonance imaging appearance. Vertebral bodies with an abnormal magnetic resonance imaging signal had pressures 55% higher than vertebral bodies with a homogeneous signal; they also had significantly decreased pH and increased pCO2. Bodies with Type I changes had pressures 73% higher than those with a normal signal. No differences in pO2 were identified. These findings suggest that abnormalities of intraosseous pressure or blood gas concentrations may be related to mechanisms of pain production in some patients with back pain. These abnormalities can be identified by magnetic resonance imaging. Further investigation is needed to determine if therapeutic manipulation of these variables can be effective in relieving axial spinal pain.
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PMID:Relationship between vertebral intraosseous pressure, pH, PO2, pCO2, and magnetic resonance imaging signal inhomogeneity in patients with back pain. An in vivo study. 183 Jul 3

Kluger's "Fixateur Interne" proved to be an excellent tool not only in spinal trauma for repositioning of impacted fractures and transpedicular stabilization of the dorsal column but also in other forms of thoracic or lumbar instability. After spinal tumor excision from a dorsal approach and vertebral replacement with methylmethacrylate additional stability through dorsal fixation was achieved with this device. Spondylodiscitis, symptomatic spondylolisthesis, spinal instability from degenerative disc disease as well as "non-union" following previous surgery could be cured using Kluger's internal fixation. Rare complications, i.e. from broken screws or rods (5%) caused no problems, but some patients required a second operation for readjustment of malpositioned screws which were causing pain or neurological deficit.
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PMID:Kluger's "fixateur interne" for spinal instability. 187 Jul 17

The results of 50 intersomatic arthrodeses, performed via an anterior approach, because of chronic, disabling low back pain with degenerative disc disease, was evaluated with a mean follow-up of 7 years (revision rate = 74.5 p. cent). Preoperative exploratory discography of the overlying and underlying vertebrae was systematic. The overall functional results evaluated according to an original quotation scale, show that only less than half of the patients who were operated upon are markedly improved at maximum follow-up. The clinical course of pain radiating to the lower extremities and associated with disabling lumbalgias, seems to be on a par with the course of lumbalgias and does not require a posterior surgical approach. Factors improving the success rates are an effective fusion (in first intention in 80 p. cent of the cases) and a healthy neo-joint from a discographic standpoint; factors that deteriorate the long-term success rate (and not short-term), essentially socio-professional ones (work related accidents). The contribution of the discographic data is emphasized: they anticipate the deterioration of the neo-joint discs, which, when present, causes most of the functional failures. Although these results are imperfect, arthrodesis (the authors remain faithful to the intersomatic arthrodesis), may not be completely excluded as treatment of essential disabling lumbalgias, resisting to medical and physiotherapeutic treatments.
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PMID:[Results of intersomatic arthrodeses in essential lumbalgia]. 213 13

One hundred one referred adult patients (ages 20-63; mean, 36 years) with painful idiopathic scoliosis were evaluated. None had prior surgical treatment. Severity of pain was graded and localized over radiographic deformities in the coronal and sagittal planes. Radiographic changes in primary as well as full and fractional compensatory curves were studied. Degrees of scoliosis, percent correction on side bending, vertebral body rotation at curve apex, spinal balance, and lateral olisthesis in the coronal plane, degenerative disc disease, and other degenerative changes in all curves were measured and graded in both the coronal and sagittal planes. Lordosis and kyphosis were measured on all standing sagittal radiographs. Forty-one patients had pulmonary function studies. Multiple variable statistical analysis (Spearman correlation coefficients) of the data found fractional lumbosacral curves most painful and disabling. Scoliosis greater than 40 degrees and kyphosis greater than 50 degrees correlated with increasing pain and decreasing forced vital capacity. Reduction in forced vital capacity also correlated with curve rigidity. Rotation correlated closely with degrees of scoliosis (r = 0.70; P less than 0.0001) and had the highest correlation with pain (r = 0.59; P less than 0.0001) of all radiographic findings and deformities studied.
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PMID:Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis. 253 6

The escalation of airline travel compounded by federal deregulation, fostering crowded airports, delayed flights, and inconvenient gate scheduling, has forced the frequent flyer to run from one gate to another, carrying heavy under-the-seat bags. Eleven busy executive, nine men and two women, developed cervical radicular pain complaints associated with weakness and painful dysesthesias in the involved extremity. Four had right C6 root symptoms and seven had left C7 complaints. All had evidence, by x-ray, of cervical degenerative disc disease and three had abnormal electromyograms. Treatment, consisting of intermittent cervical traction after moist heat, as well as a modification of their travel habits including the use of a folding wheeled cart, in every instance resolved these complaints.
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PMID:Airport induced "cervical traction" radiculopathy: the OJ syndrome. 281 59

The role of lumbar spine arthrodesis in the treatment of low back pain disorders remains a highly disputed and controversial subject. There are no clear-cut indications for lumbar spine fusion in lumbar degenerative disc disease. In fact, lumbosacral fusion when added to appropriate decompressive surgery has failed on careful statistical analysis to significantly improve the results over decompressive surgery alone. Moreover, in several large series in the literature of lumbosacral fusion in conjunction with discectomy, the results in patients who developed a pseudoarthrosis did as well as matched cases who obtained an excellent arthrodesis. These results should not be surprising since there does not appear to exist a generally accepted operational definition of mechanical (lumbar instability) pain. The author, however, is of the opinion that lumbosacral arthrodesis will prove to have a definite, albeit small, role in the management of the intractable and incapacitating low back pain disorders. This is based on personal clinical experience and the belief that the phenomenon of intractable and incapacitating mechanical low back pain syndromes do exist. Carefully performed prospective clinical studies are requisite to define the mechanical low back pain syndrome and the role of lumbar arthrodesis in the treatment of the low back pain disorders. Given our present limitations, the author suggests that lumbosacral arthrodesis be reserved for patients suffering spondylotic low back pain syndromes who have the following characteristics: intractable and disabling pain; primary complaint of segmental mechanical pain; radiologic evidence consistent with "instability"; minimal or no segmental disease above proposed site of arthrodesis; and minimal or absent psychosocial-economic pain.
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PMID:Low back pain disorders: lumbar fusion? 294 71


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