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

A woman, born in 1923, suffered since menarche of pain of the vertebra and has had a headache during menstrual periods. 1963 she developed a transverse lesion of the cord with an incomplete paraplegia because of an endometriosis externa of spinal canal. After a 12 years symptomless interval, she complained again of a transverse lesion. Histological examination disclosed an endometrioid carcinoma with infiltration of vertebral bodies. The rare occurrence of malignant transformation in endometriotic tissue is pointed out.
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PMID:[Endometrioid carcinoma of the spinal canal (author's transl)]. 91 20

From April 1980 to August 1984, 11 cases of fracture--dislocation of spine at the level of T-11 to L-2 with obvious kyphosis at the site of displacement, with paraplegia, were treated by vertebrectomy through posterior median approach. The operations were performed 2 to 28 weeks, averaging 8 weeks, after injury. 5 of the 9 patients who had complete paraplegia suffered also causalgia in both legs. The other 2 had incomplete paraplegia only. Follow-up study, 4 years and 5 months post-operation on average, revealed complete reduction of the fracture-dislocation in 10 patients and incomplete in one, getting solid bony union in all. Concerning the neurological findings of the 9 complete paraplegic patients, 5, who had suffered from causalgia got varying degree of relief, 5 regained sensation of pain in region 2 segments lower, of the 2 incomplete paraplegic patients, 1 regained sensation of pain in both legs and muscular power of degree 4 in both thighs, so that walking became possible, while the another one fell into complete paraplegia, because of compression of the cord at T-10 happened during operation and showed no signs of recovery afterward.
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PMID:[Vertebrectomy in treating fracture-dislocation of the spine with paraplegia]. 277 45

In the last decade, operative decompression of cord and cauda, internal fixation with rods, bony fusion and early ambulation, have become more popular in the management of thoracolumbar injuries with neurological deficit. Computer-tomography, CT myelography and peroperative ultrasonography provided direct evidence, that, without surgical decompression, reduction of displaced bone and disc fragments, propelled into the spinal canal, is often incomplete, not only after postural reduction, but also after rod instrumentation. The percentage of patients with incomplete paraplegia who show improvement of neurological deficit after surgical reduction and stabilization, is probably greater than that noted with postural management. There are, however, shortcomings in the classification of neurological deficit, which hamper adequate comparison. Further research in this field is necessary. The value of the surgical approaches is mainly in immediate stabilization, which diminishes pain, facilitates nursing care and allows more rapid mobilization. This results in a shorter stay in hospital and earlier active rehabilitation. That decompression of the neural elements provides improved neurological recovery seems likely, but has so far not been proven. Management of these patients, preferably admitted to specialized units, should be carried out by an orthopedic surgeon and a neurosurgeon in cooperation. The orthopedic surgeon is mainly concerned with management of the spine; the neurosurgeon with management of the paraplegia, operations being carried out by both.
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PMID:The value of more aggressive management in traumatic paraplegia. 373

The role of decompression in spinal metastases with neurologic deficit is controversial. This series demonstrates that the benefit from decompression depends on the nature of the tumor and the neurologic status of the patient. Prognosis is good for patients with incomplete paraplegia, intact sphincter control, a long duration of neurologic deficit and pain, and a gradual onset of compression. The prognosis is poor in cases with complete paraplegia, loss of sphincter control, a short duration of neurologic deficit and pain, and a sudden onset of compression. Surgery is not advocated for all cases, because many patients are already very ill. Surgery is recommended only for selective cases in which the prognosis is good. However, decompression is only palliative. Posterior decompression is preferred, inasmuch as the surgery is less extensive compared to anterior decompression and fusion.
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PMID:The results of decompression of cord or cauda equina compression from metastatic extradural tumors. 710 64

Twenty-five cases of unstable fractures and fracture-dislocations of the spine are reviewed. They were treated at the Catholic Medical College and Centre in a 3-year period, 1975 to 1978. 1. Eleven of the 25 patients were treated by anterior interbody fusion performed at 6 to 8 weeks from injury or initial surgery. 2. Eleven patients had neurological deficits, 3 with incomplete lesions and 8 with complete lesions. Open reduction and decompression laminectomies were performed on patients having neurological deficits prior to anterior interbody fusion. Two patients with incomplete paraplegia showed marked neurological recovery whilst one with complete paraplegia regained some sensation. 3. Solid clinical fusion was obtained in all but one patient within four months of interbody fusion. 4. Amongst the 18 patients with kyphosis at the time of admission 10 had a final improvement of their kyphosis ranging from 3 to 10 degrees (average 6 degrees). Three had no change and 5 demonstrated a mild increase of kyphosis (average 4 degrees). 5. Pain was relieved in 21 patients out of 25. The advantages of this technique include effective stabilization, prevention of late deformity and relatively early mobilization without internal fixation.
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PMID:Anterior interbody fusion in fractures and fracture-dislocations of the spine. 727 16

88 patients with thoracolumbar fractures and short-segment (mono or two segment) pedicle instrumentation from the years 1985-92 had a follow-up examination after an average time of 5.6 years. The 56 men and 32 women had an average age of 32.6 years at the time of injury, 24 patients primarily had a complete and 43 patients an incomplete paraplegia, 21 patients showed no neurological deficits. The operative decompression of the spinal cord and stabilization of the injured spine by short segment pedicle instrumentation led to a complete or partial remission of the neurological deficits in 93% of the patients with incomplete paraplegia. Operative stabilization allowed an early mobilization and rehabilitation of these patients. We found no tendency to an increased complication rate in patients with neurological deficits compared to patients without neurological deficits. Patients with initially incomplete paraplegia complained more often about pain than all the other patients. Despite intensive rehabilitation and retraining programs handicapped patients had obvious disadvantages regarding their further careers.
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PMID:Long-term results of pedicle stabilized thoracolumbar fractures in relation to the neurological deficit. 962 47

Twenty-two patients with benign tumors or tumor-like lesions of the spine (vertebral echinococcal cysts, eosinophilic granuloma) presented with back pain and deformity. The duration of pain ranged from 1 to 6 years. Five patients had incomplete paraplegia at admission. Spine deformity was observed in patients with osteoid osteoma, osteoblastoma, hemangioma, and vertebral echinococcal involvement. All patients underwent clinical evaluation, laboratory studies, and histologic studies. Electromyogram studies were performed in patients who had a neurologic deficit or nerve root irritation. Imaging evaluation consisted of plain films, bone scans, computed tomography scans, and magnetic resonance imaging scans. Fifteen patients had lumbar involvement; 7 had thoracic involvement. For 18 patients, management included tumor excision and thorough debridement of the lesion. Spinal instrumentation and fusion were used to correct the deformity and treat the instability in 5 patients. Patients were followed for 1 to 8 years. Of the 5 patients with incomplete paraplegia, 4 recovered completely, and the fifth (who had spinal cord hemangioma) improved 2 grades on Frankel's scale. The remaining patients were disease free and returned to routine daily activities. Benign tumors or tumor-like lesions of the thoracolumbar or lumbar spine are very rare and easily misdiagnosed in patients with persistent back pain. Patients whose symptoms progress or fail to respond over an appropriate period of time should be evaluated further. Complete excision of the tumor followed by spinal instrumentation in the presence of deformity or instability is the treatment of choice.
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PMID:Back pain caused by benign tumors and tumor-like lesions of the thoracolumbar spine. 1119 30

The AO-Magerl classification is widely accepted for the appropriate management of patients with thoracolumbar burst fractures; however, it fails to assess the ability of the injured spine to withstand compressive loading and cannot predict instrumentation failure after short-segment posterior fixation. The load-sharing classification depends on the degree of comminution and apposition of bony fragments.We retrospectively classified according to both classifications 100 consecutive patients with 1-level thoracolumbar burst fractures treated nonoperatively or operatively within a 7-year period. Sixty neurologically intact patients (60%) were treated nonoperatively, 15 (15%) had short posterior instrumentation, 15 (15%) had short anterior instrumentation, and 10 (10%) had combined short posterior instrumentation and anterior strut grafting. Twenty-five of the 40 (60%) surgically treated patients had neurological impairment on admission. Clinical outcome was assessed using a pain and working ability scale. Mean follow-up was 52 months (range, 24-70 months). Function was satisfactory in 55 (92%) nonoperatively treated patients and in 33 (83%) surgically treated patients. Neurological improvement by American Spinal Injury Association (ASIA) grade was observed in patients with incomplete paraplegia (70% of neurologically impaired patients) who were treated operatively.The combination of AO-Magerl and load-sharing classifications provides for accurate selection of treatment, surgical approach, and length of instrumentation, and can guide the decision for additional anterior surgery.
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PMID:Combination of the AO-Magerl and load-sharing classifications for the management of thoracolumbar burst fractures. 2034 67

To analyze the characteristics and treatment of middle-super thoracic fractures associated with the sternum fracture, twenty six patients with middle-super thoracic fractures associated with the sternum fracture were retrospectively reviewed. The intimate information of patients including age, gender, cause of injury, site of the sternal fracture, level and type of thoracic vertebral fracture, spinal cord injury and associated injuries were included in the analysis. There were 12 compressed fractures, 11 fracture-dislocations, two burst fracture and one burst-dislocation in this study. Six patients had a complete lesion of the spinal cord, nine sustained a neurologically incomplete injury and 11 were neurologically intact. Nine patients were treated non-operatively and 17 were underwent surgery. All patients were followed up for 8~99 months. Our results showed that road traffic accidents (RTA) and fall were the dominated in the causes. All six patients with a complete paralytic lesion were not recovered with any significant function. Four out of eleven neurologically intact patients had local pain although ten of them remained normal function and one patient turn up tardive paralysis. One of nine patients with incomplete paraplegia returned to normal and four recovered with some function. These study suggested that the sternum is one of the important parts in constructing thoracic cage and plays an important role in maintain the stabilization of the thoracic vertebra. Because of the unique anatomy and biomechanics of the thoracic cage, the classification commonly applied to thoracic vertebra fractures is not suitable for middle-super thoracic fractures associated with the sternum fracture. Middle-super thoracic fractures associated with the sternum fracture was marked by violent force, severe fractures of spine, severe injuries of spinal cord and high incidence of associated injuries. These cases confirm the existence and clinical relevance of the fourth column of the thoracic spine and its role for spinal stability in the patient with middle-super thoracic fracture.
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PMID:Treatment of middle-super thoracic fractures associated with the sternum fracture. 2630 52

Brain-machine interfaces (BMIs) provide a new assistive strategy aimed at restoring mobility in severely paralyzed patients. Yet, no study in animals or in human subjects has indicated that long-term BMI training could induce any type of clinical recovery. Eight chronic (3-13 years) spinal cord injury (SCI) paraplegics were subjected to long-term training (12 months) with a multi-stage BMI-based gait neurorehabilitation paradigm aimed at restoring locomotion. This paradigm combined intense immersive virtual reality training, enriched visual-tactile feedback, and walking with two EEG-controlled robotic actuators, including a custom-designed lower limb exoskeleton capable of delivering tactile feedback to subjects. Following 12 months of training with this paradigm, all eight patients experienced neurological improvements in somatic sensation (pain localization, fine/crude touch, and proprioceptive sensing) in multiple dermatomes. Patients also regained voluntary motor control in key muscles below the SCI level, as measured by EMGs, resulting in marked improvement in their walking index. As a result, 50% of these patients were upgraded to an incomplete paraplegia classification. Neurological recovery was paralleled by the reemergence of lower limb motor imagery at cortical level. We hypothesize that this unprecedented neurological recovery results from both cortical and spinal cord plasticity triggered by long-term BMI usage.
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PMID:Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients. 2786 7


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