摘要:

Study Design.A case of intraforaminal synovial cyst is reported.Objectives.To stress the importance of the way intraforaminal synovial cyst, a very rare condition, causes a peculiar position of the nerve root in the foramen and to describe the required surgical approach.Summary of Background Data.Intraforaminal synovial cyst is a highly unusual finding. The existence of this rare entity raises the problem of differential diagnosis with other space-occupying lesions of the neural foramen, such as herniated disc, neurinoma, neurofibroma, and metastatic lesionsMethods and Results.A 64-year-old woman suffered a right L4 radiculopathy with motor deficit. Computed tomography showed a space-occupying lesion in the L4–L5 foramen isodense with the disc. Magnetic resonance images showed a right intraforaminal cystic lesion at the L4–L5 level with no enhancement after intravenous infusion of gadolinium. A 3-cm cystic lesion, which appeared to arise from the L4–L5 facet joint without direct communication, was excised from the L4–L5 foramen. In contrast with intraforaminal disc herniation, downward displacement of the L4 nerve root was observed. Two months after surgery, the patient was pain-free and neurologic examination revealed no motor deficit.Conclusions.An unusual intraforaminal presentation of a lumbar synovial cyst demonstrates the importance of considering this entity and of adapting the surgical technique to avoid injury to the nerve root.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case is reported in which a 45-year-old man developed cauda equina syndrome caused by enlargement of an L4–L5 juxtafacet cyst diagnosed 4 months earlier.Objectives.To highlight the short interval that can elapse between the discovery of a juxtafacet cyst and its remarkable progression.Summary of Background Data.Although juxtafacet cysts are acquired lesions, how long they take to develop remains unclear. Hemorrhage is a well-known cause of rapid or even dramatic cyst enlargement. This is the first report providing magnetic resonance imaging evidence of rapid, remarkable enlargement of a nonhemorrhagic juxtafacet cyst.Methods.The patient underwent conservative treatment for an L4–L5 right juxtafacet cyst diagnosed by magnetic resonance imaging during evaluation of posttraumatic lower back pain. Four months later, the patient presented with severe pain radiating down the right lateral leg, urinary retention, and impaired dorsal flexion of the right foot. Repeat magnetic resonance imaging showed the cyst now markedly enlarged and occupying almost the entire width of the canal.Results.The cyst was removed, and the patient’s symptoms abated. At 15 months after surgery, he is symptom-free.Conclusions.Juxtafacet cyst may occasionally enlarge and cause severe symptoms within months.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.Two institutional experiences in nonteratomatous sacral tumors of the child were analyzed retrospectively.Objectives.To examine noncongenital nonteratomatous sacral tumors, which are more common in older infants and, as a group, are rare.Summary of Background Data.Pediatric sacral tumors usually occur in the newborn period, with most of these tumors being sacrococcygeal teratomas. Other common benign congenital tumors of the sacrum include lipomas, dermoids, and epidermoids.Methods.Six patients were found in a 6-year period. Four patients underwent posterior resection of their tumors. One underwent a combined anterior and posterior approach. One patient underwent a posterior resection and will undergo a second stage anterior approach later to allow for chemotherapy and radiation to shrink the intrapelvic portion of the tumor.Results.Ages ranged from 8 to 11 years. Three were males, and three were females. Five of six presented with back pain, three had constipation, and two had gait difficulties. Pathologies were diverse. They included ganglioneuroma (n= 1), myxopapillary ependymoma (n= 2), primitive neuroectodermal tumor (n= 1), aneurysmal bone cyst (n= 1), and Ewing’s sarcoma (n= 1). No progression of disease has occurred in the follow-up period of 1.5 to 7 years (average, 5 years). Radical resection did not result in instability.Conclusions.In contradistinction to adults, in whom chordomas and metastases are the most common primary and secondary tumors, the pediatric group does not have a predominant pathology. Tumors may attain extremely large sizes and may be very vascular. Multiple therapeutic methods may be required, including adjuvant chemotherapy and, possibly, embolization. Because of the wide range of pathologies, prognosis is varied.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case is reported in which severe postburn kyphosis is treated with combined plastic surgery and Milwaukee bracing.Objectives.To demonstrate that severe kyphosis can develop secondary to burn scars and that spine surgery can be avoided.Summary of Background Data.Nothing is available in the literature on this subject.Methods.A 14-year-old boy had severe burns of the arms, anterior neck, and anterior torso with a resulting 90° stiff kyphosis.Results.The patient was treated by multiple plastic surgery procedures combined with a Milwaukee brace, which corrected his kyphosis to a normal alignment.Conclusions.Spine surgery was avoided with quality plastic surgery and Milwaukee brace management.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case was reported in which paradoxical air embolism arose from the patent foramen ovale in scoliosis surgery.Objectives.To present a case of suspected paradoxical air embolism after scoliosis surgery.Summary of Background Data.Embolic accident during scoliosis surgery may be caused by air, thrombus, or fat. There is growing attention on patent foramen ovale involved in paradoxical embolism. The devastating consequences are caused by multiple artery occlusions.Methods.Details of a recent documented neurologic complication (paraplegia, weakness of right arm, and blurry vision) after scoliosis surgery have been analyzed in medical publications.Results.The surgical procedure was not imputed. The causative role of epidural catheter for analgesia was considered, but it is likely that a paradoxical embolism occurred in this case, based on the multifocal (cerebral and spinal) neurologic dysfunction, the evidence of cerebral ischemia (on computed tomography), and the presence of a patent foramen ovale (on postoperative transesophageal echocardiography). Although no intraoperative embolism detection was available, air embolism was highly suspected because there was no absolute argument to exclude cruor or fatty embolism.Conclusions.It is critical to detect a patent foramen ovale before surgery and cerebral embolization intraoperatively. This might permit ascertainment of the etiologic diagnosis in case of a complication in surgery for scoliosis.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A multicenter randomized study with a 2-year follow-up period and an independent observer was conducted.Objective.To compare three commonly used surgical techniques to achieve lumbar fusion primarily in terms of their ability to reduce pain and decrease disability in patients with severe chronic low back pain.Summary of Background Data.Lumbar fusion can be used to reduce pain and decrease disability in patients with chronic low back pain, and different surgical techniques are available. The reported results after fusion surgery vary considerably, but most studies are retrospective and/or performed on heterogeneous patient groups. Spine surgeons commonly use the techniques presented in this report. However, in the absence of randomized trials it is difficult to know whether any one of them is better than the others for these patients.Methods.From 1992 through 1998, 294 patients referred to 19 spinal centers were blindly randomized into four treatment groups: three surgical groups (n = 222) and one nonsurgical group (n = 72). The sociodemographic and clinical characteristics did not differ among the groups. Eligibility included patients 25 to 65 years of age with therapy-resistant chronic low back pain that had persisted for at least 2 years and radiologic evidence of disc degeneration (spondylosis) at L4–L5, L5–S1, or both. Only patients randomized to one of three surgical groups were analyzed in the current study: Group 1 (posterolateral fusion; n = 73), Group 2 (posterolateral fusion combined with variable screw placement, an internal fixation device; n = 74), and Group 3 (posterolateral fusion combined with variable screw placement and interbody fusion; n = 75). The “circumferential fusion” in Group 3 was performed either as an anterior lumbar interbody fusion (n = 56) or as a biomechanically similar posterior lumbar interbody fusion (n = 19). The groups were composed of 51%, 58%, and 40% men respectively, and the respective mean ages were 44, 43, and 42 years. The patients had experienced low back pain for at least 2 years (mean, ≈8 years). They had been on sick leave for approximately 3 years. Pain was measured by a visual analog scale, and disability was assessed by the Oswestry Low Back Pain Questionnaire, the Million Visual Analogue Score, and the General Function Score. Depressive symptoms were measured by the Zung Depression Scale. The global overall rating of the result was assessed by the patient and an independent observer after 2 years. Hospitalization data including operation time, blood loss, blood transfusion, and days of hospitalization in connection with surgery were reported, along with complications and the fusion rate. Records from the Swedish Social Insurance Board providing information on sick leave and economic compensation for Swedish residents were used to evaluate the patients’ work status.Results.An independent observer examined 201 (91%) of 222 patients after 2 years, after 18 “group changers” and 3 dropouts had been excluded from the analyses. All surgical techniques were found to reduce pain and decrease disability substantially, but no significant differences were found among the groups. In all three groups, the patients rated the overall outcome similarly, as did the independent observer. The more demanding techniques in Groups 2 and 3 consumed significantly more resources in terms of operation time, blood transfusions, and days in hospital after surgery. The early complication rate was 6% in Group 1, 16% in Group 2, and 31% in Group 3. The fusion rate, as evaluated by plain radiograph, was 72% in Group 1, 87% in Group 2, and 91% in Group 3.Conclusions.All the fusion techniques used in the study could reduce pain and improve function in this selected group of patients with severe chronic low back pain. There was no obvious disadvantage in using the least demanding surgical technique of posterolateral fusion without internal fixation.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A randomized, assessor-blinded clinical trial was conducted.Objective.To investigate the relative effectiveness of three manual treatments and back school for patients with subacute low back pain.Summary of Background Data.Literature comparing the relative effectiveness of specific therapies for low back pain is limited.Methods.Among the 5925 inquiries, 206 patients met the specific admission criteria, and 200 patients randomly received one of four treatments for 3 weeks: back school, joint manipulation, myofascial therapy, and combined joint manipulation and myofascial therapy. These patients received assessments at baseline, after 3 weeks of therapy, and 6 months after the completion of therapy. The primary outcomes were evaluated using visual analog pain scales and Roland–Morris activity scales.Results.All four groups showed significant improvement in pain and activity scores after 3 weeks of care, but did not show further significant improvement at the 6-month follow-up assessment. No statistically significant between-group differences were found either at the 3-week or 6-month reassessments.Conclusions.For subacute low back pain, combined joint manipulation and myofascial therapy was as effective as joint manipulation or myofascial therapy alone. Additionally, back school was as effective as three manual treatments.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A cluster randomized, controlled trial was performed.Objectives.To assess the clinical effectiveness and cost–effectiveness of adding patients’ referral to neuroreflexotherapy intervention to the usual management of subacute and chronic low back pain in routine general practice.Summary of Background Data.Neuroreflexotherapy consists of the temporary implantation of epidermal devices in trigger points in the back and referred tender points in the ear. The efficacy of this procedure for treating subacute and chronic low back pain has been demonstrated in previous randomized, double-blind, controlled clinical trials.Methods.Twenty-one primary care physicians working in seven primary care centers of the Spanish National Health Service in Palma de Mallorca, Spain, were randomly assigned to the intervention group (n= 11) or the control group (n= 10). The physicians recruited patients who had low back pain that had lasted for 14 or more days despite drug treatment and who did not meet criteria for surgery. The 45 patients recruited by physicians from the control group were treated according to the standard protocol, whereas the 59 patients recruited by physicians from the intervention group were, in addition, referred to neuroreflexotherapy intervention. The analysis of variables was performed taking into account that physicians, not patients, were randomly assigned.Results.Patients underwent clinical evaluations at baseline and 15, 60, and 365 days later. At baseline, median intensity of pain was higher in patients undergoing neuroreflexotherapy than in control patients (visual analogue scale, 6.07; range, 4.67–8.80vs.5.15, range 4.11–8.00) and median duration of pain was also higher (48.1, range 28.4–211.1vs.17.5, range 15.0–91.5 days). At the last follow-up visit, patients treated with neuroreflexotherapy showed greater improvement than did control patients in low back pain (visual analogue scale, 5.5; range, 3.7–8.8vs.1.9; range, −1.2–3.0;P< 0.001); referred pain (visual analogue scale, 3.6; range, 2.7–7.3vs.0.6; range, −1.5–2.0;P= 0.001); and disability (Roland–Morris scale, 8.7; range, 2.0–13.3vs.2.0; range, −1.5–6.7;P= 0.007). Moreover, neuroreflexotherapy intervention was associated with a significantly (P< 0.035) lower number of consultations to private or public specialists, fewer indications of radiographs by primary care physicians, lower cost of drug treatment, and less duration of sick leave throughout the follow-up period. There were also differences in favor of neuroreflexotherapy intervention in the cost–effectiveness ratio for pain, disability, and quality of life that persisted in the most optimistic, the most conservative, and the average (break-even case) assumptions.Conclusions.Referral to neuroreflexotherapy intervention improves the effectiveness and cost–effectiveness of the management of nonspecific low back pain.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.In a laboratory study, 21 human lumbar spine segments were used to determine whether intraosseous pressure increases occur during axial-compressive loading conditions under two displacement rates.Objective.To determine whether an intraosseous pressure rise is associated with burst fracture formation.Summary of Background Data.Burst fractures are high-speed injuries usually associated with neurologic deficit. An internal pressure rise has been implicated as a critical factor in burst fracture formation. The authors hypothesize that the internal pressure increases with increasing input velocity.Methods.The internal pressure changes were measured in spine segments using two displacement rates: 10 mm/s (slow speed) and 2500 mm/s (high speed). Failure load and energy absorption were determined for both groups. The resultant fracture types were determined from postinjury radiographs.Results.The initial peak internal pressure decreased from slow- to high-speed tests (P< 0.01). Overall peak pressure, failure load, and energy absorbed at failure were not significantly different. Slow-speed tests resulted in compression fractures, whereas high-speed tests resulted in burst and compression fractures.Conclusions.The current research did not support the current theory of burst fracture formation. There was a decrease in measured internal pressure from the slow- to high-speed groups, and burst fractures still were produced. The theory could be potentially modified to suggest that the nucleus entering the vertebral body acts as a wedge, splitting the vertebral body apart and enabling the bony fragments to be pushed into the canal space.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID