ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The anatomy and physiology of the nerve root complex in the lumbar spine are reviewed, with special reference to the effects of mechanical deformation of nerve roots in association with intervertebral disc herniation and spinal stenosis. Biomechanical aspects of nerve root deformation induced by compression are discussed. The functional changes induced by compression can be caused by mechanical nerve fiber deformation but also may be a consequence of changes in nerve root microcirculation, leading to ischemia and formation of intraneural edema. Nerve root compression can, by different neurophysiologlc mechanisms, induce motor weakness and altered sensibility or pain. Intraneural edema and demyelination seem to be critical factors for the production of pain in association with nerve root compression.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The nerve root canal Is an essential part of the spinal canal. Though It Is an appendage of the spinal canal, the nerve root canal, like the Inguinal canal, has Its own anatomical boundaries and relationships. A knowledge of Its anatomy is necessary In the understanding and treatment of lowback pain.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Eleven patients who presented with sciatica that was aggravated by standing and walking had definite neurologic signs in only half the cases and normal myelograms in seven. Differential blocks of the L4, L5, and S1 nerve roots identified the symptomatic levels by temporarily relieving the pain in all patients done. CT scans showed minimal enlargement of the articular facets, but an absence of periradicular fat and an increased volume of neural tissue due to the presence of proximally placed dorsal root ganglia in the nerve root canal. Decompression of the symptomatic ganglia by surgical removal of the medial third of the overlying apophyseal joint resulted in satisfactory pain relief in 70% of these patients.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Anatomic studies using cadavers showed that three factors are responsible for radicular symptoms. The first is congenital or acquired abnormalities of nerves and nerve roots—the intradural segmental arrangement of rootlets, congenital anomalies of the nerve roots, and the furcal nerve. Another factor is changes of bone and soft tissue around nerves and nerve roots—indentation of nerve roots and extremely transverse courses of nerve roots. The third factor Is a correlation of two other factors—spatial relationship of the nervous tissue to osseous and nonosseous elements of the spinal canal and the intervertebral foramen. In the intervertebral foramen, the nerve root is surrounded by a rather thick membranous structure, an epiradicular sheath, which is responsible for a tubular form obtained in nerve root Infiltration. Anatomic abnormalities can be observed In contrast studies, but the defects revealed do not correspond necessarily with neurologic symptoms. In such cases, nerve root Infiltration Is very useful for a functional diagnosis. The analysis of radicular symptoms with nerve root Infiltration showed that radicular pain and/or claudication are caused mainly by single nerve root involvement, irrespective of the findings obtained by contrast studies. Furthermore, therapeutic effect of nerve root infiltration can be expected in any disease and it can be applied as a final trial of conservative treatment.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This syndrome occurs in two types of patients: (1) the elderly person with degenerative scoliosis and (2) a somewhat younger adult population with isthmic spondylolisthesis and at least 20% slip. On plain radiograph, the Ferguson view (25° caudocephalic) is best for visualizing the condition, however, CT is by far the best diagnostic tool. To show this far laterally, the “window” on the CT scanner must be opened wider than usual. Both coronal and parasagittal views will demonstrate the condition, but the coronal is the most valuable. Symptoms are classical spinal nerve compression. Usually it is the L5/S1 level that is involved, but other levels can be. At surgery, it is most important that nerve decompression be carried far enough laterally. This can mean sacrificing the lower half of the pedicle and the entire transverse process. Part of the body of S1 and of the sacral ala can be removed if the surgeon perfers. Because so much bone is removed, instability is a factor to be seriously considered. How to decompress adequately and still maintain stability often poses a most difficult problem.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Electrodiagnostic testing is an important part of the investigation of spinal nerve root and cord function. These tests are utilized to confirm and document suspected neuronal lesions. Characteristics of a spinal nerve root lesion, including chronicity, level, sensory or motor dysfunction, and severity, can be estimated by utilizing multiple testing procedures. Tests available include needle electromyography, H-reflexes, F-responses, bulbocavernous reflex responses, and somatosensory evoked responses recorded over the spine and head. Each test has unique advantages and disadvantages and none can be considered of sufficient sensitivity to exclude the other tests. By using case examples the lack of correlation between electrodiagnostic testing and spinal pain has been illustrated.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Lumbar spinal nerves may be entrapped (a) at the back of the disc (b) laterally in the central canal, (c) in the cauda equina, (d) more laterally in the nerve canal, and (e) posteriorly in the zygapophyseal joints. There is a spectrum of degenerative change in both joints and disc. Changes at these three sites can produce (a) dysfunction, (b) disc herniation, (c) instability, (d) lateral entrapment, and (e) central stenosis. The clinical significance is that many patients become symptom free on nonoperative treatment. Some with nerve entrapment require decompression. Those with instability may need a fusion. The pain from a disc lesion or from stenosis may come from irritation and inflammation of the dura. The motor loss in these lesions may be due to reflex inhibition and vascular insufficiency rather than from nerve compression. It is vitally important to identify accurately the nerve that is entrapped.

ISSN:0362-2436    

出版商:OVID    

年代:1984

数据来源: OVID