Journal of spinal disorders
-
Case Reports Comparative Study
Neurogenic motor evoked potentials: a prospective comparison of stimulation methods in spinal deformity surgery.
Neurogenic motor evoked potentials (NMEPs) elicited by spinal cord stimulation via the spinous processes (SP-NMEP) have been widely accepted as a sensitive method of monitoring motor tract function. SP-NMEP requires additional surgical dissection as well as electrodes within the wound, making the method somewhat inconvenient. A less invasive percutaneous method of spinal cord stimulation (PERC-NMEP) has more recently been described. ⋯ Although SP-NMEP responses were more readily obtainable than PERC-NMEP, the reliability of the two methods was not significantly different. Both methods were found to be sensitive to neurologic deficit. The present study suggests that when responses are obtained, the percutaneous method is reliable enough to obviate the spinous process method of monitoring the motor function of the spinal cord.
-
Studies attempting to correlate facet blocking with successful relief of pain after fusion have reached unfavorable results. These studies, however, did so in a retrospective fashion, and facet blocking was not the sole criterion by which surgical candidates were chosen. The current study is the first to use facet blocking in a prospective fashion and as the definitive criterion by which patients were chosen. ⋯ Nineteen of 23 described 90% relief, 3 patients had 50-90% partial relief, and 1 failed by self-assessment. A preoperative mean Prolo score of 3.95 (range 2-7) improved to 7.7 (range 3-10) with fusion. Provocative facet blocking can be used to successfully predict outcome in patients undergoing arthrodesis for chronic low back pain.
-
Circulation disturbances in the cauda equina and nerve roots have been implicated in the genesis of neurogenic intermittent claudication (NIC) in patients with lumbar spinal stenosis (LSS). We report the clinical results of lipoprostaglandin E1 (lipo-PGE1) treatments in patients with NIC. Lipo-PGE1 was administered intravenously for 10 consecutive days to 40 patients, 31 of whom showed a response to the treatment. ⋯ We observed increased blood flow in seven of these eight patients, after the intraoperative administration of lipo-PGE1. Lipo-PGE1 produced symptomatic improvement for a limited period in the treatment of NIC associated with LSS. The drug appeared to exert its effects through an increase in the circulation of blood in the nerve roots and the cauda equina.
-
Inter- and intraobserver variability in grading lumbar fusion status radiographically was assessed. The objective was to determine the interobserver variability and intraobserver reproducibility in the assessment of two level noninstrumented lumbar fusions. Fifty sets of radiographs with anteroposterior, left and right bending, and flexion-extension lateral views were assessed by six observers of varying experience and background, with fusion status graded. ⋯ Intraobserver reproducibility was higher in more experienced observers. The results indicate only fair reliability in terms of interobserver agreement to grading of lumbar fusion status. Variability in assessing lumbar fusion radiographically may explain some of the variability in fusion rates reported in the literature and poor correlation that can be seen between clinical outcome and radiologic outcome.
-
A case of a large L3-L4 intervertebral disc herniation causing a widening of the intervertebral foramen is reported. There was a soft-tissue mas within the spinal canal and intervertebral foramen. ⋯ There exists a degree of overlap between the imaging of herniated discs and spinal neurinomas. When this overlap involves several aspects, such as anatomic configuration, mass enhancement, and secondary foraminal dilatation, the differential diagnosis between a herniated disc and a neurinoma may be problematic.