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

Sciatica must always be first considered as a medical problem. Operation is indicated only for refractory cases. Analysis of more than 4 036 operations shows the best indications for surgery. These consist of typical disc sciatica, sciatica with excessive pain, with paralysis and with cauda equina syndrome. Myeloradiculography was not carried out routinely, being reserved for atypical forms. A negative radiculography is not necessarily a contraindication. The results of foraminotomy are less constant than after removal of a disc prolapse. It benefits 60 p. cent of patients, however. Some reserve applies to its use since it is not possible to predict those patients who will be relieved. There exist finally those cases in which the organic origin of the pain cannot be proved, at which time the surgeon should refuse operation which may be an aggravating factor.
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PMID:[The role of surgery in the treatment of sciatica. An experience of more than 4000 operations]. 121 10

Prognosis of cancerous tumors of the spine depends above all on their neurological consequences. The authors have wondered whether osteosynthesis of the spine -- in addition to decompressive surgery -- can improve patient's survival and fonctional results. 23 patients, 20 with a metastatic tumor and 3 with a plasmocytoma were treated in this way. All of them had neurological deficits, 4 had isolated radicular symptoms, 1 a cauda equina syndrome and 18 a spinal cord compression (7 of which were complete). 20 of these patients suffered intractable pain of the spine. All the patients underwent decompressive surgical removal of tumor through laminectomy, associated with a bilateral posterior metallic osteosynthesis. The type of osteosynthesis consisted of two metallic plates placed along each articular column and screwed into the articular processes and the vertebral body through the pedicles of the adjacent normal vertebrae. Cobaltotherapy was added in 14 cases, hormonotherapy in one case and radioactive 131 1 in one another patient. Selective spinal angiography, performed in one case of thoracolumbar tumor was found useful in the location and avoidance of Adamkiedwicz's artery. With regard to the complication, there were two operative wound infections requiring reoperation. Our series -- in comparaison with others -- prove the effectiveness of the combined procedure. Patients without complete spinal deficit had a 20 months survival average. Patients with complete deficit had the same survival as in comparative group. But all the 20 patients suffering pain in the spine were substantially relieved. Such a combined procedure is indicated in cases of tumors involving the vertebrae, whether or not the epidural space is invaded especially when there are riskes of unstable fracture and only partial neurological deficits. The technique may be extended even to complete paraplegia because of its worth while antalgic effects. Thus this method -- by consolidating the spine -- relieving pain and consequently allowing kinesitherapy to be resumed earlier is able to improve the functionnal status and increase survival of the patients.
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PMID:[Posterior osteosynthesis in the treatment of spinal cord tumors]. 122 83

Even the careful and knowledgeable spine surgeon will encounter a variety of neurologic complications during and after routine lumbar laminectomy. These include dural and nerve root injuries; cauda equina syndrome; and formation of scar tissue, extradural and intradural (arachnoiditis). The surgeon must be prepared to identify each of these problems and deal with them effectively at the time of the procedure and in the immediate postoperative and follow-up periods. The physician evaluating the multiply-operated lumbar spine patient must use an organized approach. The origin of the problem in most instances is a faulty decision to perform the original operative procedure. Further surgery on an "exploratory" basis is not warranted in any situation and most likely will lead only to further disability. There should be definite objective findings to substantiate the patient's symptoms. The etiology of each patient's symptoms. must be accurately localized and identified. Medical status and psychosocial situation--as well as orthopedic and neurologic findings--should be evaluated at the time of the initial consultation. Once the spine is identified as the probable source of symptoms, specific features should be sought in the patient's clinical history, physical examination, and roentgenographic studies. The number of previous operations, length of pain-free interval, and predominance of leg versus back pain are the major historic signposts. The presence of a tension sign and the neurologic findings are the focal points of the physical examination. Plain roentgenograms, motion films, water-soluble myelogram, computed axial tomography, and magnetic resonance imaging with contrast have specific roles in the workup.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neurologic complications and lumbar laminectomy. A standardized approach to the multiply-operated lumbar spine. 139 83

Authors present a case of a cutaneous T. cell lymphoma (mycosis fungoides) complicated by a cauda equina syndrome. Crural and sciatic radicular pain were due to epidural lumbar involvement by tumoral process. After surgical decompression completed by chemotherapy the evolution was uneventful. This case is the second one reported in the literature.
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PMID:[Cauda equina syndrome complicating cutaneous T-cell lymphoma (mycosis fungoides)]. 185 40

A study of 42 synovial cysts arising from the lumbar facet joint is presented. Intraspinal cysts caused radicular pain and cauda equina syndrome in 11 patients. In a series of 1,400 lumbar laminotomies for a herniated disk, 31 incidental nodules arising from the exposed facet as paraarticular masses were found and excised. The limited number of reports in the orthopedic and neurosurgical literature has not dealt adequately with the etiology or incidence of these benign lesions. The neuroradiologic appearance and histopathologic findings are briefly discussed.
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PMID:Synovial cysts of the lumbar facet joint. 185 55

Four new cases of ankylosing spondylitis complicated by a cauda equina syndrome are reported. Similarly to the previous descriptions, the patients present with long-standing and severe spondylitis at the time when neurological symptoms, mainly radicular pain, develop. Computed tomography of the lumbar spine demonstrates in all cases typical laminar erosions and posterior arachnoid diverticula. Up to now, magnetic resonance imaging has rarely been performed in this particular pathology, though it is helpful in determining the anatomical relations and the nature of the lesions. Based on the previous publications, our study aims at describing the clinical and pathogenic aspects of the disease and defining the most useful diagnostic investigations and treatment choices. Therapeutic possibilities are often limited because of a late diagnosis. Better knowledge of this rare complication could lead to earlier recognition and more efficient therapy.
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PMID:[Ankylosing spondylarthritis and partial cauda equina syndrome. Apropos of 4 cases and review of the literature]. 192 99

In a 63-year old male patient coccygodynia, initially isolated then complicated by incomplete cauda equina syndrome, could be attributed to large perineurel meningeal cysts on the sacral nerve roots. The diagnosis was suspected at computerized tomography and nuclear magnetic resonance and confirmed by sacculoradiculography. Intradural injections of corticosteroids provided lasting pain relief. Arachnoid cysts are often asymptomatic, by they may be responsible for coccygodynia and/or incomplete cauda equina syndrome. Their presence is suggested by the characteristics of the symptoms which are paroxysmal, exacerbated in standing position, relieved in dorsal position and revived by percussing the sacrum. Treatment is medical in most cases. The decision to operate depends on the persistence and intensity of pain and on whether signs of neurological defecit are present.
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PMID:[Coccygodynia disclosing Tarlov's cysts]. 209 31

Low back pain is common, but a herniated intervertebral disk is the cause in only a small percentage of cases. Most symptomatic disk herniations result in clinical manifestations (pain, reflex loss, muscle weakness) that resolve with conservative therapy, and only 5% to 10% of patients require surgery. Sciatica is usually the first clue to disk herniation, but sciatica may be mimicked by other disorders that cause radiating pain. Because more than 95% of lumbar disk herniations occur at the L4-5 or L5-S1 levels, the physical examination should focus on abnormalities of the L5 and S1 nerve roots. Plain radiography is not useful in diagnosing disk herniation, but more sophisticated imaging (myelography, computed tomography, or magnetic resonance imaging) should generally be delayed until a patient is clearly a surgical candidate. Conservative therapy includes nonsteroidal anti-inflammatory drugs, brief bed rest (often for less than 1 week), early progressive ambulation, and reassurance about a favorable prognosis. Muscle relaxants and narcotic analgesics have a limited role, and their use should be strictly time-limited. Conventional traction and corsets are probably ineffective. Except for patients with the cauda equina syndrome, surgery is generally appropriate only when there is a combination of definite disk herniation shown by imaging, a corresponding syndrome of sciatic pain, a corresponding neurologic deficit, and a failure to respond to 6 weeks of conservative therapy.
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PMID:Herniated lumbar intervertebral disk. 237 66

We treated eleven skeletally mature patients who had a high-grade lumbosacral spondylolisthesis by a single-stage operation that involved posterior spinal decompression, posterolateral arthrodesis with autogenous iliac-crest graft, and anterior arthrodesis with a fibular graft inserted from the posterior approach. We did not attempt to correct the deformity. Preoperatively, all but one patient had severe pain in the back and lower limb; the exceptional patient had severe pain only in the low back. All but one patient had sensory deficits and objective motor impairment before the operation, and five had cauda equina syndrome. Six patients had had a previous operation that had failed. The duration of follow-up ranged from two to twelve years. A solid fusion was obtained in all patients, and all had major or complete neurological recovery. The results did not deteriorate with time.
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PMID:Spondylolisthesis treated by a single-stage operation combining decompression with in situ posterolateral and anterior fusion. An analysis of eleven patients who had long-term follow-up. 231 39

The cauda equina syndrome is an uncommon and poorly understood complication of ankylosing spondylitis. The clinical and radiologic findings in five patients with this syndrome are described. Typical findings include cutaneous sensory impairment of the lower limbs and perineum with sphincter disturbances. Motor impairment occurs less frequently, and associated pain is an inconstant feature. Enlargement of the caudal sac and dorsal arachnoid diverticula that erode the lamina and spinous processes are characteristic myelographic and computed tomographic findings. The pathogenesis of the cauda equina syndrome in ankylosing spondylitis remains unknown but may be due to demyelination, post-irradiation ischemia, or compression from spinal arachnoiditis.
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PMID:Cauda equina syndrome complicating ankylosing spondylitis. 232 76


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