Spine
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Prospective observational cohort. ⋯ The presence of epidural IFNgamma-immunoreactivity corresponding to >10 pg/mL predicted significant pain relief after epidural steroid injection with >95% accuracy. These results suggest that IFNgamma may be part of a biochemical cascade triggering pain in sciatica; IFNgamma-immunoreactivity may aid as a biomarker for predicting the response to steroid therapy and/or surgical intervention, and may serve as a future therapeutic target.
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A retrospective study of 61 patients with cerebral palsy (CP) and neuromuscular scoliosis treated by either a combined anterior-posterior spinal arthrodesis or a posterior-only arthrodesis with the unit rod. ⋯ We demonstrate that excellent correction in severe pelvic obliquity can be achieved in smaller, more flexible curves using an all-posterior PSF, and in larger, less flexible curves using an anterior release with PSF.
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Four cases of computed tomography and magnetic resonance imaging documented lumbar nerve root compression associated with a vacuum disc communicating with the epidural space are presented. ⋯ Although the vacuum disc is considered a common imaging finding of no or not much pathologic significance, occasionally intradiscal gas may leak into the spinal canal. Detection of an epidural gaseous collection at the same level with a vacuum disc strongly suggests a communication between the intervertebral disc and the epidural space. Epidural gas collections can be implicated as a possible cause of radicular symptoms and should be considered in the differential diagnosis of lumbar radiculopathy.
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Case Reports
Malignant pleural mesothelioma presenting as low back pain: diagnosed by bone scan coordinating with F-18 FDG PET/CT.
Case report. ⋯ The present case highlights both the value of a Tc-99m MDP bone scan when MPM presents, unusually, as low back pain, and the importance of carefully interpreting bone scan images, especially for photopenic defects. It also indicates the usefulness of F-18 FDG PET/CT study in MPM in a difficult histopathological diagnosis.
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Hydrostatically induced disruption of flexed lumbar intervertebral discs followed by microstructural investigation. ⋯ Flexion places the anulus at risk by facilitating nuclear flow, limiting circumferential disruption while promoting radial rupture, and rendering the endplate/vertebra junction vulnerable to failure. Flexion may play a developmental role in those herniations possessing a central posterior radial rupture that incorporates a short span of endplate disruption along the apex of the vertebral rim.