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

Two cases are reported in which patients presented with complaints of foot pain, and a clinical suspicion of radiculopathy was supported by current perception threshold testing. Chiropractic manipulation of the lumbar spine resulted in alleviation of the lower extremity symptoms. Current perception threshold testing is a valuable neurologic testing modality that is noninvasive, nonaversive, and highly reliable for evaluation of sensory nerves where neuropathy is suspected. This technology has been described for evaluation of diabetic neuropathy, uremic screening, and alcohol and chemical toxicity. Additionally, current perception threshold is useful for evaluation of other neuropathies, such as carpal tunnel syndrome and other entrapment neuropathies. The authors encourage further investigation of this modality in the diagnosis and evaluation of peripheral neuropathy and unexplained foot pain secondary to spinal nerve impingement.
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PMID:Current perception threshold in evaluating foot pain. Two case presentations. 164 17

Eighteen patients who were initially diagnosed as having trochanteric bursitis refractory to conventional therapy are reported. The most common causes of pseudotrochanteric bursitis were lumbar radiculopathy (L2, L3), lumbar facet syndrome with pain referred to the lateral thigh, and entrapment neuropathies involving the subcostal, and the lateral cutaneous branches of the iliohypogastric nerves. Less common causes were undisplaced femoral neck fracture, adiposa dolorosa, and hip abductor muscle strain. Diagnosis was facilitated by selective neuroblockade.
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PMID:"Pseudotrochanteric bursitis": the differential diagnosis of lateral hip pain. 146 85

Since November 1988, 28 patients with lumbar L5 radiculopathy refractory to conservative care and with a radiologically verified central or mediolateral disc herniation at the level of L4/L5 had had a percutaneous discectomy. Radiological verification consisted of spinal CT +/- myelography, +/- myelo-CT, +/- MRI. A short-term follow-up analysis of at least 2 months taking the clinical and functional status as well as the professional reintegration into account revealed a 64.3% (18/28 patients) satisfactory outcome and a 32.1% (10/28 patients) failure rate. Of the latter 28.6% (8/28 patients) required further open surgery. One patient whose pain had only partially in regressed was shown at open operation to have a sequestered cranial prolapse as revealed by spinal CT after the percutaneous procedure. There were no major complications. One patient developed a sequestered extraforaminal herniation through the nucleotomy canal three weeks after the procedure. One patient bled for 2 minutes. There were no major vessel injuries. One patient reported local muscular pain, and enhanced nerve root pain after introduction of the trocar sleeve.
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PMID:Lumbar percutaneous discectomy. Initial experience in 28 cases. 174 70

The problems presented by unsuccessful posterior lumbar interbody fusion (PLIF) have not been addressed. The cases of 12 patients who presented with failed PLIF were reviewed. Five patients were male and seven female (age range, 24-50 years; mean age, 40 years). All patients underwent at least one PLIF; many had undergone other procedures. A total of 37 procedures had been performed on the 12 patients. Chronic radiculopathy was present in all patients, as detected with electromyographic or nerve conduction velocity examination. At the time of reconstructive surgery, in the 11 patients in whom the canal was explored, all had extensive epidural fibrosis. Nine of the 12 patients had pseudarthrosis of the previous PLIF. Four patients had evidence of motion segment dysfunction at nearby levels: two had positive discograms adjacent to the PLIFs; one developed a facet syndrome at L5-S1, caudal to an L4-5 PLIF; and one demonstrated frank segmental instability at L2-3, cranial to a previous PLIF at L3-4. Twelve patients underwent a total of 22 procedures after referral. Eleven patients initially underwent decompression and fusion, and one patient underwent a sympathectomy. Seven patients underwent an additional 10 procedures, including repeat decompression, repair of pseudarthrosis, and implantation of an epidural analgesic pump system. After all surgical treatment, five patients rated their pain as improved. Seven patients were thought to have a solid fusion. The presence of a solid fusion did not correlate with satisfactory relief of pain (chi-square). Continued extremity pain was the predominant complaint of all the patients. Two shortcomings of the PLIF were evident.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The failed posterior lumbar interbody fusion. 183 32

Epidural spinal cord stimulation by means of chronically implanted electrodes was carried out on 121 patients with pain of varied benign organic etiology. In 116 patients, the pain was confined to the back and lower extremities and, of these, 56 exhibited the failed-back syndrome. Most patients were referred by a pain management service because of failure of conventional pain treatment modalities. Electrodes were implanted at varying sites, dictated by the location of pain. A total of 140 epidural implants were used: 76 unipolar, 46 Resume electrodes, 12 bipolar, and six quadripolar. Patients were followed for periods ranging from 6 months to 10 years, with a mean follow-up period of 40 months. Forty-eight patients (40%) were able to control their pain by neurostimulation alone. A further 14 patients (12%), in addition to following a regular stimulation program, needed occasional analgesic supplements to achieve 50% or more relief of the prestimulation pain. Pain secondary to arachnoiditis or perineural fibrosis following multiple intervertebral disc operations, when predominantly confined to one lower extremity, seemed to respond favorably to this treatment. Uniformly good results were also obtained in lower-extremity pain secondary to multiple sclerosis. Pain due to advanced peripheral vascular disease of the lower limbs was well controlled, and amputation below the knee was delayed for up to 2 years in some patients. Pain due to cauda equina injury, paraplegic pain, phantom-limb pain, pure midline back pain without radiculopathy, or pain due to primary bone or joint disease seemed to respond less well. Patients who responded to preliminary transcutaneous electrical nerve stimulation generally did well with electrode implants. Notable complications included wound infection, electrode displacement or fracturing, and fibrosis at the stimulating tip of the electrode. Three patients in this series died due to unrelated causes. Epidural spinal cord stimulation has proven to be an effective and safe means of controlling pain on a long-term basis in selected groups of patients. The mechanism of action of stimulation-produced analgesia remains unclear; further studies to elucidate it might allow spinal cord stimulation to be exploited more effectively in disorders that are currently refractory to this treatment modality.
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PMID:Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. 186 42

Although soft-tissue calcification is common in collagen vascular disease, paraspinal calcification in the cervical spine has not been described before. We studied five women with large, lobulated, predominantly homogeneous calcific masses centered on synovial articulations in the neck. Changes consisting of either osteolysis or erosions were evident. All patients had radiculopathy, focal pain, or stiffness. In two patients, the presence of hydroxyapatite crystals was confirmed on biopsy. Symptomatic cervical paraspinal calcifications in patients with collagen vascular disease cause large soft-tissue masses that mimic tumoral calcinosis.
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PMID:Cervical paraspinal calcification in collagen vascular diseases. 187 39

The Prospective Lumbar Discectomy Study enrolled 740 patients in a multiphysician, multicenter, consecutive patient protocol to evaluate the indications and efficacy of lumbar discectomy. Five hundred and thirteen patients could be evaluated at 3 months after surgery. Stepwise logistic regression showed that the factors of fraction of pain referred to the back, work-related injury, absence of back pain on straight leg-raise examination, correspondence of leg pain to typical radicular patterns, leg pain on straight leg-raise examination, and reflex asymmetry were independently predictive of good outcome from surgery. Univariate analysis of the case with different numbers of predictive factors present showed that use of the operating microscope, sensory deficit, central disc bulge, and free disc fragment were correlated with outcome only in subgroups. An analysis of unsatisfactory outcomes showed two patterns: one of failure as a result of mechanical back pain and one of failure as a result of radiculopathy. Factors predictive of outcome did not influence the type of failure. In a stepwise logistic regression analysis, facetectomy and preoperative sensory deficit were associated with increased likelihood of mechanical back pain failure, while preoperative motor deficit was associated with an increased likelihood of radicular failure. The results support several intuitively derived and commonly believed principles of lumbar disc surgery.
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PMID:Lumbar disc surgery: results of the Prospective Lumbar Discectomy Study of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. 188 76

Traumatic and degenerative changes in the spine at the level of the neck are frequent causes of pain in the neck, often associated with radiculopathy and sometimes even myelopathic symptoms. The signs and symptoms can generally be attributed to a problem of instability for which there are no specific criteria. If conservative treatment does not help, satisfying results can be achieved by a stable intercorporeal fusion using the modified Robinson technique. An EMG and a cervical myelogram must be carried out before surgical stabilization. In 154 patients followed for an average of 12 years, 75% observed resolution of the pain and paresthesias after surgical stabilization. These results correspond to those described in the literature. The best results are achieved if the signs and symptoms are experienced for no longer than 1 year and if the patient is under age 40.
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PMID:Anterior cervical spine fusion in treatment of cervicobrachialgia. 192 57

There were 55 patients (soft disc, 21 and spondylosis, 34) who underwent anterior cervical discectomy without fusion (ACD) using an operating microscope. Discectomy of a single level was performed on 48 cases and two levels on 7. There were 37 patients with radiculopathy, and 18 patients with myelopathy or myeloradiculopathy who were followed clinically for 2-13 years postoperatively. Overall 81% of patients were improved in soft disc herniation, and no significant differences were noted between the group of radiculopathy and myelopathy. In spondylosis all but one patient reported initial relief of their preoperative symptoms; however, overall improvement was noted in only 16 patients (47%). The causes of symptomatic deterioration after ACD for spondylosis were later symptomatic recurrence in 5 patients, severe neck pain in 4, and development of new symptoms due to adjacent spur formation in 2. The authors eventually added interbody fusion in 4 cases. Cervical spine roentgenograms almost always showed a loss of height of the interspace and an anterior angulation immediately after ACD, but the alignment of the spine tended to improve with time, so that, at last follow-up, 82% had a good alignment. A spontaneous osseous fusion occurred in 74% of cases. An adjacent spur formation was observed in 3 patients with spondylosis. The most troublesome complication was neck and/or scapular pain. This pain usually subsided spontaneously, but this continued for more than 4 years postoperatively in 4 patients with spondylosis. Using an operating microscope ACD is a safe and effective procedure for patients with soft disc herniation, but the authors still prefer anterior cervical discectomy with interbody fusion for the patients with advanced spondylosis.
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PMID:Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. 202 99

Forty-five patients underwent surgical reconstruction with transpedicular fixation of the lumbar spine with narrow AO DCP plates. Preoperatively, all patients underwent spinal imaging with either magnetic resonance imaging, computed tomography, or myelogram as well as provocative discography to determine the location and the number of symptomatic segments. The minimum follow-up in this series was 2 years. The determination of solid posterior fusion in the presence of plate instrumentation was difficult. The patients in the series were classified as having 1) solid fusion; 2) radiographic flaws within the posterolateral fusion without implant failure; or 3) frank pseudarthrosis with implant failure. Thirty-six (80%) of the patients had a solid fusion, 9 of whom required an additional anterior interbody fusion to obtain symptom control. Twenty percent of the patients in the series had radiographic evidence of reabsorption without implant failure. Four patients in the series (8.8%) had screw breakage, three of which required anterior interbody fusions. The highest rate of reabsorption and pseudarthrosis implant failure was in the 12 patients who had three-level instrumentation; 33% of these patients required anterior interbody fusion to obtain a solid arthrodesis. The average preoperative pain scale was 8.9, and the average postoperative pain scale was a 3.3. Twenty-two patients in the series were cigarette smokers and had a slightly lower fusion rate than non-smokers. They did, however, have a higher use of narcotics after surgery. Forty percent of the patients in this series continued to have radiculopathy after their reconstruction. This study demonstrates the utility of transpedicular fixation in salvage lumbar surgery in obtaining a solid arthrodesis with a beneficial clinical result. Anterior interbody fusions are highly successful in the management of pseudarthrosis and implant failure after transpedicular instrumentation.
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PMID:Reconstruction of failed lumbar surgery with narrow AO DCP plates for spinal arthrodesis. 202 35


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