Spine
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Two cases of symptomatic atlanto-axial dislocation in association with Down's syndrome are reported. The first patient showed spinal cord compression and had an ossiculum terminale; the second showed neck pain and had anteriorly inclined facet joint of the axis. ⋯ Both patients were treated successfully by posterior fusion of C1 and C2 in the maximally obtained position of reduction. In cases of symptomatic atlanto-axial dislocation when the spinal cord is at risk, surgical stabilization is the treatment of choice.
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Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review. The majority of the films were taken because of lumbar complaints. The mean lumbosacral (LS) angle (L2-Sacrum) was 45.05 degrees +/- .85 degrees. ⋯ There was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed. A "routine" supine lateral lumbar spine roentgenogram is a very accurate means of measuring lordotic angles. A lordotic angle of less than 23 degrees defines hypolordosis and more than 68 degrees, hyperlordosis.
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Case Reports
Lumbar paraspinal compartment syndrome. A case report with physiologic and anatomic studies.
A 24-year-old man presented with severe low-back pain and paraspinal muscle spasm after exertion. Elevation in temperature, white blood cell count, serum muscle enzymes, and urine myoglobin, as well as computer tomographic evidence of paraspinal muscle edema and necrosis, were present. No etiology could be documented, and the possibility of an acute exertional compartment syndrome was entertained. ⋯ These indicated a physiologic behavior similar to other known compartments for which compartment syndromes have been described. Variation in intracompartmental pressure occurred as a function of body posture, erector spinae isometric contraction, and active intra-abdominal pressurization. We suggest this patient had a paraspinal compartment syndrome and have described pressure characteristics of this compartment in normal men.
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The results of intraspinal narcotic analgesia (INA) in 43 patients with chronic nonmalignant pain syndromes are reviewed. A protocol has been established to improve proper patient selection and includes three phases of study. ⋯ In those patients qualifying for continuous delivery systems (CDS), 65% had good to excellent relief of pain while 34% were considered failures for a variety of reasons. Apparent tolerance development in many of the patients was, in fact, due to technical problems with the epidural catheter instead.