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Query: UMLS:C0344329 (collapse)
 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Localized bone marrow relapse is rare in acute lymphoblastic leukemia. Discordant bone marrow specimens were found in an 11-year-old asymptomatic girl who had been in remission for six years and off chemotherapy for 2 1/2 years. One bone marrow sample showed marked leukemic infiltration, whereas marrow from another site was normal. Three months later, with normal peripheral blood counts, she developed severe back pain and x-ray evidence of vertebral collapse and periosteal changes in the pubic bone. At that time three of the four areas of bone marrow sampled showed leukemic involvement. Reinduction therapy was begun, and she is now in remission on maintenance chemotherapy. At this time, it is unclear whether routine performance of marrow aspirations and biopsies from multiple sites, in periodic follow-up examinations of patients with acute leukemia would allow earlier detection of relapse frequently enough to justify the procedure. The issue of localized bone marrow involvement, if more common than previously reported, should be addressed at the time a decision is being made to discontinue therapy.
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PMID:Localized bone marrow relapse in acute lymphoblastic leukemia. 28 70

Recent work on degenerative lumbar curves has focused on stable deformities with entrapment syndrome secondary to spondylotic compression. A review of our local experience with degenerative lumbar curves shows that approximately half of the 14 cases have had a less typical radiographic presentation of short reciprocating lumbar curves thought to be on the basis of asymmetric intervertebral osteochondrosis. In these latter cases, marked spondylotic ridging and intervertebral buttressing were absent; therefore, major decompressive surgery on the residual posterior elements may increase instability and hasten further collapse. Although most patients have had good relief of radicular leg complaints with decompressive procedures, several patients had persistent low-back pain that appeared to have a mechanical basis. In those instances of potentially increased postoperative instability or persistent mechanical back complaints, consideration should be given to augmenting decompressive procedures with Harrington instrumentation and fusion for these painful collapsing lumbar spines.
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PMID:Degenerative lumbar scoliosis. 51 44

A 16-year-old boy is reported in whom back pain, due to localised osteoporosis and partial collapse of a lumbar vertebra, drew attention to unsuspected acute lymphoblastic leukaemia. The patient responded promptly to induction therapy, his symptoms disappeared, and he is presently in the maintenance programme. The skeletal lesion continues to heal slowly. Attention is drawn to this unusual presentation of acute lymphoblastic leukaemia, and the importance of bone-marrow examination in the study of unexplained cases of osteoporosis is emphasised.
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PMID:Vertebral rarefaction in acute lymphoblastic leukaemia. 105 60

Of special concern in the management of neurogenic tumours arising in the thorax is spinal-cord compression resulting from either intraspinal lesions or vertebral-body destruction and collapse. A review of 16 cases disclosed three dumbbell tumours, six intrathoracic tumours, one case of neurofibromatosis with multiple intraspinal neurogenic tumours, two malignant neurogenic tumours with vertebral-body destruction causing spinal-cord compression and four foraminal lesions with central intraspinal (extradural) extension. There were 3 men and 13 women, ranging in age at the time of operation from 37 to 79 years. Three patients, of the six with intrathoracic tumours, were asymptomatic; the remaining 13 had preoperative symptoms ranging in duration from 3 weeks to 12 months (average, 9 months). Back pain with intercostal neuralgia was present in eight patients and neurologic signs were present in six patients. A routine chest radiograph was abnormal in 10 patients, and x-rays of the thoracic spine were abnormal in 4 of the other 6 patients. The tumour was excised surgically in all patients. Complications developed postoperatively in two patients: one had Horner's syndrome, transient paraparesis and bleeding; the other had a small subarachnoid-cutaneous fistula. The authors conclude that dumbbell neurogenic tumours and those causing vertebral-body destruction and collapse demand a multidisciplinary one-stage surgical approach. If the lesion is malignant and resection is not complete, radiotherapy or chemotherapy is necessary.
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PMID:Central neurogenic tumours of the thoracic region. 139 56

A group of 26 patients aged 47-81 years (average 67) with spinal osteoporosis and back pain for more than 6 months were investigated with planar and SPECT bone scintigraphy and anterior and lateral x-rays of the thoracolumbar spine. Abnormal activity on bone scintigraphy was found in all patients, of whom 22 had multiple lesions. A total of 17 (65%) patients had abnormal activity associated with collapsed vertebral bodies, 5 (19%) had degenerative disk disease, and 21 (81%) had facetal joint disease. Of 112 lesions identified by SPECT, 60 (54%) were localized to the apophyseal joints. Facetal lesions were commoner in those patients with more collapsed vertebrae, and 32 facetal lesions (54%) were associated with collapse of the vertebra immediately above or below. Bone scintigraphy findings suggest that in some individuals with osteoporosis and chronic back pain, collapse of the vertebral body or degenerative disk disease are causes of pain. However, the high frequency of increased apophyseal joint activity suggests that the facet joint may also be an important site of origin of pain in these individuals. Bone scintigraphy may identify a subgroup of osteoporotic patients with chronic back pain who would benefit from treatment to the facet joints.
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PMID:Osteoporosis and chronic back pain: a study with single-photon emission computed tomography bone scintigraphy. 148 30

Fifty-six breast cancer patients with metastatic spinal cord compression were consecutively treated with radiation therapy alone. All patients received steroids plus chemotherapy and/or hormonal therapy. Emergency radiation therapy was administered using a split-course regimen: 5 Gy for 3 days, stopped for 4 days and, only in responders, a further 3 Gy for 5 days (time dose fractionation 68). Median follow-up was 22 months (range, 4 to 52 months). Response and survival were assessed on the basis of, pretreatment and posttreatment walking capacity, presence of vertebral body collapse or osteolysis, presence of other metastatic sites apart from bone and chemotherapy and/or hormonal therapy. In 89% of patients with back pain the pain disappeared or lessened. Four of 6 cases (67%) with urinary dysfunction responded to radiation therapy. Of 35 cases with motor dysfunction at the time of diagnosis, 21 (60%) regained the ability to walk and another five (14%) who were able to walk with support at diagnosis did not deteriorate. All 21 cases without motor deficits before treatment maintained good motor performance after radiation therapy. Response to therapy was better in pretreatment walking than in nonwalking patients (97% vs 69%; p less than 0.02). Probability of duration of response at 1 year was 59% and 10% for posttreatment walking and nonwalking patients, respectively (p less than 0.0001). One year survival probability was 66% for posttreatment walking and 10% for posttreatment nonwalking patients, respectively (p less than 0.0001). Pretreatment and posttreatment ambulatory status were the most important prognostic factors.
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PMID:Radiation therapy of spinal cord compression caused by breast cancer: report of a prospective trial. 152 68

Burst fracture of the fifth lumbar vertebra is a rare injury. We report the cases of seven patients who were treated conservatively by immobilization for six to eight weeks in a body-jacket cast that included one lower extremity to the knee. The patients were allowed to walk ten to fourteen days after the injury. A thoracolumbosacral orthosis was worn for an additional three months. No patient had an injury to the sacral root. Two patients had mild lower lumbar motor-root deficits that resolved within one year. All patients had an occasional backache, and two had intermittent radicular-type pain in the distribution of the fifth lumbar or first sacral-nerve root. The degree of compromise of the spinal canal could not be directly related to the degree of neurological deficit; that is, a large compromise of the spinal canal did not necessarily result in a major loss of neurological function. There was no early or late loss of lordosis between the cephalad end-plate of the fourth lumbar vertebra and the cephalad aspect of the sacrum, and there were no signs of progressive collapse of the vertebral body in any patient. In our series, the burst fractures of the fifth lumbar vertebra were stable injuries that caused minimum neurological deficits, and treatment by immobilization in a body-jacket cast was effective.
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PMID:Burst fracture of the fifth lumbar vertebra. 154 67

It is important to remember that ESCC is a complication of systemic malignancy and usually denotes disseminated disease with poor survival rates. Early diagnosis is crucial. The initial symptom is almost always back pain, which is local, radicular, or both. Following neurologic examination and radiography, MRI scanning or myelography/CT is immediately indicated if radiculopathy or myelopathy is present or if the radiographs of the spine are abnormal. In cancer patients with local back pain and normal findings on neurologic examination and radiography of the spine, there is still a probability of 0.1 of significant ESCC. Therefore, urgent CT/MRI scanning is justified. At present, the best treatment for ESCC remains unknown. In the majority of patients, radiotherapy is the most readily available and appropriate option because it is equal in effect to posterior decompressive laminectomy in both radiosensitive and radioresistant tumors. In patients with posterior epidural disease without tissue diagnosis, laminectomy with or without stabilization should be performed. Posterior decompressive laminectomy alone is contraindicated in patients with vertebral collapse. In selected instances of anterior epidural compression without tissue diagnosis or after failure of radiotherapy, an anterior surgical approach or synchronous vertebral decompression with posterior stabilization may be indicated. In the future, after appropriate clinical trials, vertebral body resection may be the optimal approach in de novo selected patients with ESCC with radioresistant tumors and limited systemic spread of the disease.
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PMID:Metastatic epidural spinal cord compression. 175 28

Back pain due to vertebral collapse is the main symptom of postmenopausal osteoporosis. The clinical picture in these crush fractures varies, depending on the type and the location of fracture, but in general, a new vertebral crush fracture gives rise to severe pain that immobilizes the patient and necessitates bedrest. In this double-blind controlled clinical trial, 56 patients who had recently (within the last 3 days) suffered an osteoporotic vertebral fracture were hospitalized for a period of 14 days. Salmon calcitonin (100 IU) or placebo injections were given daily. Pain was rated daily on a 10-point scale by the same observers. Blood and urinary parameters were also evaluated. The results showed a significant (P less than 0.001) difference in pain intensity between the calcitonin group and the placebo group. This beneficial effect was generally apparent from the second day of treatment onward, and over the following 2 weeks, the patients were able to sit and stand, and gradually started to walk again. A significant decrease in urinary hydroxyproline and urinary calcium was also noted in the calcitonin group. It is concluded that calcitonin exerts a beneficial effect on back pain following a vertebral crush fracture.
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PMID:Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study. 181 59

Typical causes of back pain in the athlete include muscle strain, intervertebral disc injury, interspinous bursitis, and spondylolysis. If initial evaluation does not indicate that any of these potential conditions is the cause, the physician or trainer should consider less common conditions. In this report, we discuss the identification and management of five unusual causes of back pain in the high school and college athlete: (a) disc space collapse after herniated disc excision, (b) sacralization of L5, (c) facet fracture of L5, (d) fracture of the lumbar vertebral apophysis, and (e) interosseous herniation of the lumbar disc.
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PMID:Unusual causes of back pain in athletes. 183 64


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