Spine
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The CT/discographic findings from 225 discs in 91 low-back pain patients were compared to the pain provocation during the injection of contrast into the disc. The radiographic appearance of disc deterioration demonstrating disc degeneration and annular disruption of each disc was classified separately using a fourpoint scale: normal, slight, moderate, or severe. ⋯ The CT/discogram presents an axial view of the disc that allows a subgrouping of disc deterioration that can discriminate between peripheral deterioration (degeneration) and internal deterioration (disruption). The disruption supposedly occurs earlier and is more likely to be the source of exact pain reproduction.
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Comparative Study Clinical Trial Controlled Clinical Trial
Chemonucleolysis versus surgery in lumbar disc herniations: correlation of the results to preoperative clinical pattern and size of the herniation.
A prospective study was carried out on the results of chemonucleolysis or surgery in 156 patients who had lumbar disc herniations. All patients were considered as potentially good candidates for chemonucleolysis. Seventy-two received a chymopapain injection and 84 underwent surgery. ⋯ The results of chemonucleolysis in patients who had large herniations were significantly inferior to those of surgery: at final follow-up the results were satisfactory in 50% of patients in the chemonucleolysis group and 89% of those in the surgery series. Chemonucleolysis appears to be the treatment of choice in most patients with small disc herniations and an effective alternative to surgery in most patients with medium-size herniations when the preoperative clinical pattern indicates a slight or moderate nerve root compression. In all large herniations and in small- or medium-size herniations causing a severe nerve root impingement, surgery should be preferred to chemonucleolysis.
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Translatory segmental instability was provoked by successive axial traction and compression of the lumbar spine in 117 patients with a known spondyl- or retro-olisthetic displacement. Lateral spot radiography showed an anteroposterior translatory movement of 5 mm or more in 24 of 45 patients with lytic spondylolisthesis of L5, in all of 7 patients with degenerative spondylolisthesis of L4, and in 37 of 65 patients with a retro-olisthetic displacement of L3, L4, or L5. ⋯ Severity of low-back pain (LBP) symptoms did not show any correlation with the degree of the maximal displacement but correlated significantly with the amount of instability both in the case of spondyl- and retro-olisthesis. Traction-compression radiography proved a simple and practical method to diagnose and measure translatory segmental instability even when conventional flexion-extension load failed to provoke any abnormal movement (eg, in the case of spondylolisthesis).
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Nineteen upper cervical spine specimens were dissected to examine the macroscopic and functional anatomy of alar ligaments. They are on both sides, symmetrically placed, approximately 10-13 mm long and elliptical in cross-section 3 X 6 mm in diameter. The fiber orientation is dependent on the height of dens axis, mostly in the cranial caudal direction. ⋯ The ligaments limit the axial rotation in the occipito-atlanto-axial complex (to the right by left alar and vice versa) as well as in side bending. The ligament is most stretched, and consequently most vulnerable, when the head is rotated and in addition flexed. This mechanism, common in whiplash injuries, could lead to irreversible overstretching or rupture of the ligaments especially as the ligaments consist of mainly collagen fibers.
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Randomized Controlled Trial Clinical Trial
Epidural morphine for pain relief after lumbar laminectomy.
A prospective randomized trial was conducted to evaluate the effectiveness of epidural morphine for pain relief after lumbar laminectomy. Thirty-three male patients were studied in two groups. At the end of surgery, Group 1 patients (15) received 2 mg morphine in 5 ml saline through an epidural catheter. ⋯ There was no respiratory or cardiovascular depression detected in patients in either group. Nine patients in Group 1 and five patients in Group 2 had transient postoperative urinary retention that required catheterization. Only one patient in Group 1 had mild pruritus and three patients in Group 2 had nausea.