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

Four patients who had a giant-cell tumor of the spine were managed in Ramathibodi Hospital from 1986 to 1993. All of the patients are female and the age onset was between 14-36 years. The location of the lesions was distributed in the sacrum (2 cases), lumbar spine (1 case) and cervical spine (1 case). Surgical approach was determined by the location, extent of involvement and feasibility of marginal resection. Anterior approach was performed in cases of tumor mass confined to the vertebral body and posterior approach was done in cases of posterior neural arch involvement. Adjuvant therapy and preoperative internal iliac artery ligation contributed to successful treatment in cases of sacral involvement. After follow-up of fifteen to fifty months (average, 30 months), the pain subsided and neural symptoms improved. Roentgenograms showed no evidence of local recurrence.
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PMID:Treatment of giant-cell tumor of the spine: report of four cases. 857 65

Anterior thoracic discectomy procedures with endplate ablations and posterior spinal fusions are advocated for patients with severe scoliosis. These surgical procedures traditionally are accomplished through extensive open thoracotomy incisions. At Children's Hospital Medical Center, Cincinnati, surgical team members have used a minimally invasive procedure, video-assisted thoracoscopic surgery (VATS), to release the anterior spines of patients with scoliosis. This surgical technique has many benefits, including reduced blood loss, decreased postoperative pain, and improved postoperative pulmonary function. Perioperative nurses play key roles in the team approach to patient care through provision of preoperative education programs for patients and family members, organization of OR equipment, anticipation of possible intraoperative complications, and postoperative patient care planning. The implementation of a VATS program within an institution requires a significant financial investment and a long-term commitment to the ongoing education of OR personnel.
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PMID:Video-assisted thoracoscopic releases of scoliotic anterior spines. 865 68

Anterior cervical discectomy and vertebral interbody fusion is a widely used technique in the treatment of radicular or cord compression. Instead of using autologous bone removed from the iliac crest, a heterologous bovine dowel was used for fusion. Sixty-six patients presenting with radicular pain or myelopathy were entered into the study retrospectively. Medial herniated, soft or calcified disc, osteophytes with and without herniated disc material, and bony stenosis at one or two levels were shown by CT or MRI studies. Postoperatively, 88% of the patients noted relief of pain and motor improvement. Most of the patients' sensory deficits and myelopathy improved within 6-12 months. No complications occurred and only one re-operation had to be performed at the same level. In the follow-up period between 1-4 years, no cases of instability after surgery were reported. Operating time and postoperative pain were reduced because bone harvest from the iliac crest was not necessary. In postoperatively performed CT and MRI, the bovine dowel was surrounded by a "halo"-like structure and the specific structure of the bovine implant was still present. No real bony fusion occurred, but clinical stability was equivalent to autologous bone fusion reported in the literature. However, there was no MRI evidence of "living bone tissue" within the bovine dowel. This finding is in contrast to the current belief that the bovine implant is replaced or infiltrated by bony growth.
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PMID:Bovine dowels for anterior cervical fusion: experience in 66 patients with a note on postoperative CT and MRI appearance. 878 61

Cervical spondylosis is caused by degenerative disc disease and usually produces intermittent neck pain in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilization, isometric exercises, and medication. Neurologic symptoms occur infrequently, usually in patients with congenital spinal stenosis. For these patients, magnetic resonance imaging is the preferred initial diagnostic study. Because involvement of neurologic structures on imaging studies may be asymptomatic, consultation with a neurologist is advised to rule out other neurologic diseases. In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or unless there is progressive neurologic deficit. If indicated, a surgical procedure may be done through the anterior or posterior cervical spine; results are gratifying, with long-term improvement in 70% to 80% of patients. Cervical spondylotic myelopathy is the most serious and disabling condition of this disease. Because many patients have nonprogressive minor impairment, neck immobilization is a reasonable treatment in patients presenting with minor neurologic findings or in whom an operation is contraindicated. This simple remedy will result in improvement in 30% to 50% of patients. Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits. Anterior cervical approaches are generally preferred, although there are still indications for laminectomy. Surgical results are modest, with good initial results expected in about 70% of patients. Functional outcome noticeably declines with long-term follow-up, which raises the question of whether, and how much, surgical treatment affects the natural course of the disease. Prospective randomized studies are needed to answer these questions.
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PMID:Cervical spondylosis. An update. 885 84

In a retrospective study of 6 patients (9 eyes) with posterior scleritis, we analyse the symptoms, the clinical signs and the ancillary tests of the disease. A decreased vision and an ocular or periocular pain are found in 8 cases of 9. Anterior involvement like redness is found in all the cases. In 7 eyes, we observe a diffuse or localized exudative retinal detachment. B-scan ultrasonography is the most helpful ancillary test, showing in all the examined eyes a scleral thickening. In 2 patients, we find a systemic disease associated with the posterior scleritis.
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PMID:[Posterior scleritis: apropos of 6 cases]. 898 37

Criteria for choosing operative techniques for the treatment of thoracolumbar burst fractures remain disputed, particularly in neurologically intact patients. A retrospective study of 25 patients with thoracolumbar burst fractures was performed to assess fracture characteristics, operative approaches, fixation, radiographic results, and neurological, functional, and pain outcomes. Anterior corpectomy, allograft strut, and plate fixation were performed in 14 patients with or without neurological deficit when vertebral compression or canal encroachment was at least 40% or kyphosis was 15 degrees or more with a stable posterior column. In nine cases, an anterior operation and a posterior segmental fixation were combined for similar deformity and three-column instability. Posterior transpedicular decompression, fixation, and fusion were used primarily for two symptomatic patients with less than 40% encroachment and at most 40% compression. Overall, 21 patients (84%) were walking and 18 (72%) were continent at follow-up evaluation (mean 16.3 months) versus eight (32%) and 11 (44%) at presentation, respectively. Preoperatively, 17 patients experienced neurological deficit; 16 improved and 12 increased one Frankel grade. No patient deteriorated. Prior employment or activity level was resumed by 19 patients (76%) and only four patients professed incapacity. Pain was eliminated after 18 procedures (72%), all anterior or combined approaches. Restoration of anatomical alignment (< 5 degrees) was achieved in 19 cases. No anterior construct failed and only one patient treated posteriorly had postoperative kyphosis progression. Operative morbidity occurred in three cases (12%). Satisfactory neurological and functional outcomes were achieved in a majority of patients with thoracolumbar burst fractures after correction of canal compromise, middle column compression, and attendant deformity. These results indicate that anterior decompression and a weight-bearing strut graft are critical to clinical success in patients with significant vertebral destruction.
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PMID:Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit. 898 81

Anterior disc position has been highly correlated with temporomandibular disorders (TMD). It was hypothesized that internal derangement of the temporomandibular joint may be a part of a joint phenotype that imparts an increased risk for joint disorders. If this hypothesis is true, an increased prevalence of joint disorders in individuals diagnosed with displaced discs should be expected. A total of 263 symptomatic TMD patients and 82 asymptomatic volunteers was examined. Asymptomatic volunteers with anteriorly displaced discs were twice as likely as asymptomatic volunteers without disc displacements to report pain/dysfunction in other joints. Symptomatic patients with and without displaced discs reported an increase in other joint problems three to four times greater than in asymptomatic subjects. Compared to symptomatic TMD patients without disc displacement, symptomatic TMD patients with anteriorly displaced discs were also twice as likely to report other family members as being affected by TMD. Familial aggregation of TMD and an increased prevalence of other joint problems in these individuals may represent more than a serendipitous occurrence.
J Orofac Pain 1996
PMID:Relationship of other joint problems and anterior disc position in symptomatic TMD patients and in asymptomatic volunteers. 899 12

Dental attrition ranked according to a validated severity scale correlated with age as a proxy for functional wear in 148 asymptomatic subjects. Anterior, posterior, mediotrusive, laterotrusive, and total attrition severity was analyzed. The geometric contribution of canine attrition to the variance of posterior attrition was also tested through correlations, and the time span required to record a statistically significant difference in attrition using the scale was determined. Age explained 12.6% of the differences the total attrition scores (P < .001, Spearman's rho), 6.4% of the anterior scores (P < .01), and 20.9% of the laterotrusive scores (P < .0001). Canine wear in subjects aged 20 to 49 years explained between 20% to 34% of the posterior attrition (P < .05 to P < .001), 6% to 36% of the mediotrusive attrition (P < .05 to P < .01), and 20% to 29% of the laterotrusive attrition (P < .05 to P < .001). At least 20 to 30 years was necessary to show significant clinical differences, except that laterotrusive attrition changes could be discriminated in only 10 years for the 20- to 29-year-old group. Notable attrition was already evident in the 20- to 29-year-olds, and accelerated wear rates prior to age 20 years were not maintained in most areas of the dentition. A nonlinear progression with age was observed, thereby inhibiting prediction of subsequent attrition from prior levels. Attrition was concluded to have multifactorial etiology, with age and the geometry of canine guidance having a significant influence, in addition to commonly accepted parafunction.
J Orofac Pain 1995
PMID:The degree to which dental attrition in modern society is a function of age and of canine contact. 899 26

Anterior instrumentation in the treatment of thoracolumbar fractures has progressed significantly during the past 2 decades. These fixation systems have evolved to meet the anatomic, biomechanical, and imaging challenges associated with internal fixation of the thoracolumbar spine. The evolution of these devices will be reviewed, and from this, the indications and surgical techniques necessary for the safe and effective use of the device will be discussed. This study also reports the authors' initial clinical experience using the Z plate anterior thoracolumbar plating system in the treatment of thoracolumbar burst fractures. The study consists of 12 consecutive adult patients who underwent a 1-stage anterolateral decompressive and stabilization procedure for burst fractures from T9-L3. The indications for surgery included neurologic deficits, deformity, progressive kyphosis, and late pain. Ten of the 12 patients maintained their postoperative sagittal alignment or a significant portion of their kyphosis reduction. Two patients with severe kyphotic deformities greater than 50 degrees lost 10 degrees and 20 degrees of their reduction at last followup. All 3 patients with neurologic deficits recovered. There were no neurologic or perioperative complications. Eleven of the 12 patients obtained a good or excellent functional outcome. Anterior arthrodesis using instrumentation stabilization after a 1-stage anterolateral decompression and reduction procedure can yield successful clinical results in the treatment of thoracolumbar burst fractures.
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PMID:Anterior instrumentation in the management of thoracolumbar burst fractures. 902 Feb 9

The adult patient who complains of anterior hip pain is a dilemma frequently encountered by the primary care physician. Detailed history taking, physical examination, and plain x-ray films are indicated for the initial evaluation. Anterior hip pain is often diagnosed as musculoskeletal strain/sprain and treated with a conservative regimen represented by the acronym NICER (nonsteroidal anti-inflammatory drugs, ice, compression, elevation, and rest) with or without physical therapy. On occasion, this therapy fails to eradicate the symptoms. When these symptoms are refractory to diagnosis by conventional means, a more comprehensive evaluation of the etiology is warranted. Refractory pain is defined in the authors' practice as pain that persists after 4 weeks of initial conservative management. This subsequent evaluation includes the use of such laboratory tests as complete blood cell count with differential count, Chem 20 health profile, erythrocyte sedimentation rate, and an arthritic panel (assessment of rheumatoid factor, antinuclear antibody, C-reactive protein). Ancillary radiologic tests warranted include a nuclear bone scan, a magnetic resonance imaging scan, a computed tomography arthrogram with hip aspiration, and/or a scan of white blood cells labeled with indium 111. The test chosen depends on the etiology most suspected. A useful diagnostic algorithm for the investigation of anterior hip pain in the adult is provided. An illustrative case presentation of carcinoma of an unknown primary site presenting as anterior hip pain demonstrates the algorithm as it applies in the authors' practice.
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PMID:Anterior hip pain in the adult: an algorithmic approach to diagnosis. 931 47


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