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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The average thickness of the last 3 lumbar disks was measured using an automatic image analyzer in 53 patients who were regularly followed-up both clinically and radiographically for an average period of 14.8 years (extremes: 6 and 39 years). This retrospective study showed that disks do not necessarily become pinched with age, even in patients with lumbago, that the rate of disk pinching is extremely variable from one patient to another, that disk collapse takes an average of 20 to 30 years, that there is a correlation between the severity of the lumbago and the rate at which the disk pinches, and that there are rapidly evolutive discopathies which are responsible for severe lumbago.
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PMID:[Measurement of the variation in the thickness of lumbar disks over time in patients with lumbago]. 252 72

Low back pain and/or pain radiating to one or both lower limbs can result from causes other than intervertebral disc disease. Recently three patients presented with low back pain radiating down the legs. When CT examination of the lumbar spine proved unrewarding, magnetic resonance imaging (MRI) was performed. Avascular necrosis (AVN) of the femoral head was diagnosed and subsequently treated before femoral head collapse occurred. In patients with unexplained low back pain, AVN of the hip should be considered and ruled out by MRI, even if conventional plain films, polytomes, and radionuclide scans are negative. The early diagnosis of AVN of the femoral head may be critical in determining whether a surgical revascularization procedure might be successful in treatment, or replacement with an endoprosthesis will be necessary, if femoral head collapse has already occurred.
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PMID:Magnetic resonance imaging and the diagnosis of avascular necrosis of the femoral head. 366 57

Degenerative spondylolisthesis is the result of chronic disc degeneration with secondary segmental spinal instability. Localized collapse and translational and rotational vertebral subluxation result in low back pain and radiculopathy. Twenty patients with L4-5 degenerative spondylolisthesis having back pain and radiculopathy were treated with a combination of decompressive laminectomy and distraction arthrodesis with short parallel Harrington rods. Patients were ambulated immediately after operation. Minimum follow-up was 2 years (average, 31.6 months). Satisfactory results were obtained in 17 patients (85%). No intraoperative complications occurred. The spondylolisthesis progressed significantly in one patient and the Harrington rods loosened in another. The procedure appears to assist in reducing pathologic motion contributing to low back pain and to relieve traction or compression forces on neural structures by restoring spinal canal anatomy.
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PMID:Decompression and distraction-derotation arthrodesis for degenerative spondylolisthesis. 371 26

Bone scintigraphy has been studied in two groups of patients presenting with low back pain. In one group of 38 patients suffering "nonspecific" back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings.
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PMID:The diagnostic value of bone scintigraphy in patients with low back pain. 622 95

A 79-year-old Afro-Caribbean woman presented with a 5-month history of low back pain and a 2-month history of weakness of the lower limbs associated with cauda equina syndrome. A plain X-ray of the lumbar spine showed a collapse of the L4 body consistent with osteomyelitis. An MRI scan of the lumbar spine showed narrowing of the L3/4 disc space, destruction of the adjacent vertebral bodies and an epidural abscess. She was admitted to hospital and treated with a high dose of i.v. antibiotics followed by radical surgical excision of the lesion through a combined anterior and posterior approach with instrumentation. Tissue culture grew Streptococcus milleri. One week after surgery the patient developed septicaemia. A blood culture grew Pseudomonas aeruginosa, which was successfully treated with antibiotics. She eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Streptococcus milleri is a rare causative organism in osteomyelitis, this being only the eighth reported case in the literature. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result.
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PMID:Cauda equina syndrome secondary to lumbar spondylodiscitis caused by Streptococcus milleri. 872 96

Two important goals in treating acute low back pain are to return the patient to regular activity as quickly as possible and to do so in a manner that is cost-effective. By following a logical treatment protocol, the clinician is often able to provide the treatment necessary to provide the patient with relief. Referral to an orthopedist or neurosurgeon may be appropriate in only a minority of cases. Thus, after the initial history and physical examination, ruling out (or in) conditions that require urgent or emergent care is essential. These conditions include cauda equina syndrome, circulatory collapse due to expanding abdominal aortic aneurysm, and tumor, infection, and other underlying disorders as a cause of low back pain. Patients without these conditions can be started on conservative therapy-without radiographic or laboratory tests-regardless of the specific diagnosis. Conservative therapy consists of passage of time, controlled physical activity, physical modalities (e.g., cryotherapy or thermotherapy), local injections, nonsteroidal anti-inflammatory drugs, and muscle relaxants. Because low back pain is so common, even the small proportion of patients who do not improve after 6 weeks of conservative therapy represents a sizable number. The location and radiation of pain are used as initial guides to classifying these patients into four groups: those with localized pain, sciatica, anterior thigh pain, or posterior thigh pain. Each follows a different diagnostic path, which will be described herein.
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PMID:A clinician's approach to acute low back pain. 921 55

In posterior lumbar interbody vertebral fusion operations, variously sized, rectangular shaped, defatted, freeze-dried, gas-sterilised cortical bone allografts were used in combination with cancellous bone autografts from excised posterior elements. Single-level fusion, with or without internal fixation, was undertaken in 38 patients aged 50 years or less with disc herniation or a failed discectomy (the younger group) and in 33 women aged 60 years or more with degenerative spondylolisthesis (the older group). Of the various observable indicators of union, changes in the allograft-host interface alone proved to be of practical use. The incidence of nonunion in patients managed with pedicle screws, with a hook and rod system or without internal fixation was 0 of 8 patients; 1 of 14 patients; and 3 of 16 patients, respectively, in the younger group, and 0 of 11 patients; 0 of 8 patients; and 2 of 14 patients, respectively, in the older group. Of the six patients with nonunion, three had persistent low back pain and only two had mobility of the fused segment which was evident on lateral radiographs during flexion and extension. No patient had graft collapse. The decrease in the height of the intervertebral space, chiefly due to settlement of the allograft into the vertebral bodies, in the younger and older groups averaged 1.1 and 1.6 mm, respectively. We concluded that this simplified technique is mechanically sound and effective in maintaining the height of the intervertebral space. Even when the graft failed to unite, fibrous union could be obtained without graft collapse. Combination with a simple internal fixator, such as a compression rod, facilitates bone union.
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PMID:Defatted, gas-sterilised cortical bone allograft for posterior lumbar interbody vertebral fusion. 965 69

17 yrs. old boy presented with low back pain and progressive deformity with no history of trauma or tuberculosis. Clinically there was tender knuckle formation at L2 level. X-rays showed vertebra plana (concentric collapse) at L2 level along with skull involvement. While being investigated patient developed partial collapse at L3 level and pelvis involvement within a week. On biopsy from L3 vertebra the lesion was found to be eosinophilic granuloma. This is a case report of a rare instance in which acute progression of eosinophilic granuloma occurred involving multiple skeletal sites in an adult.
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PMID:Rapidly progressive polyostotic eosinophilic granuloma involving spine: a case report. 977 Aug 61

Acquired degenerative disc disease causes gradual disc space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. Surgical treatment aims to re-expand the intervertebral space and stabilize the involved segment in balanced alignment until fusion is complete. The prevailing methods make use of a twin cage device of predetermined size. Their implantation requires extensive exposure, entailing the sacrifice of posterior stabilizing structures. The procedure also results in significant traction on the dural sac and the cauda equina and is thereby a potential source of neurologic damage. The new expandable spinal spacer (ESS) was designed to mitigate all the shortcomings alluded to above. A prospective multicenter clinical study was conducted of 87 patients with chronic low back pain due to degenerative disc disease, treated by posterior lumbar interbody fusion (PLIF) using a newly designed ESS. The study protocol was approved by the ethics committees of all the participating institutions. The objective was to test the safety and efficacy of the device. Each participant was followed periodically for >1 postoperative year. The ongoing record included intraoperative difficulties and complications, if any, radiologic evidence of fusion and clinical outcome as scored by pre- and postoperative questionnaires pertaining to pain intensity and degree of disability. No dural lacerations or neurologic deficit occurred. There were no mechanical failures of the spacer. Radiologic study demonstrated fusion in all but one patient. Disc space height that averaged 7.53 +/- 2.42 mm before surgery increased to 10.03 +/- 2.00 mm at the time of surgery and stabilized at 9.47 +/- 2.10 mm upon final follow-up. Visual Analog Scale and Oswestry Index decreased by 60% and 58%, respectively. PLIF using the ESS achieves the same ultimate outcome as do other methods currently in use but does not share the handicaps and hazards and is more user-friendly to the surgeon.
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PMID:Posterior lumbar interbody fusion for degenerative disc disease using a minimally invasive B-twin expandable spinal spacer: a multicenter study. 1452 94

A review of the patient files from our institution's oncology department showed that between 1950 and 2000, 11 patients were diagnosed with hemangioendothelioma of the spine, a rare, low-grade malignant vascular tumor. After reevaluation of the diagnoses by orthopaedic oncologists and pathologists, three patients were excluded; therefore eight patients formed the study group. The eight lesions were located in the thoracic (three) or lumbar spine (five, one in each vertebral level). Computed tomography scans revealed expansile lytic process. All lesions involved the vertebral body, but only one was diffuse with spinous process involvement. Treatment included: external beam irradiation alone (one patient), curettage and external beam irradiation (one patient), laminectomy and external beam irradiation (two patients), anterior resection only (two patients), and anterior resection with postoperative external beam irradiation (two patients). Patients without spinal stabilization had chronic low back pain; no patient with spinal stabilization had such pain. One patient who had surgical resection and radiation therapy had a radiation-induced sarcoma develop after 4 years. One patient who was treated with radiation therapy alone had a metastatic lung lesion develop. No other patient had tumor recurrence or progression. Therefore, patients with hemangioendothelioma of the spine may be treated with radiation therapy alone, surgery alone, or a combination thereof. However, because the number of patients in the current series was small, no definitive recommendations regarding treatment may be made. Resection of large lesions and stabilization of vertebral collapse may decrease back pain.
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PMID:Hemangioendothelioma of the spine. 1504 14


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