Journal of spinal disorders
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Case Reports
Nonglucocorticoid-induced lumbar epidural lipomatosis: a case report and review of literature.
A case of nonglucocorticoid-induced lumbar epidural lipomatosis in a middle-aged black woman with neurogenic claudication is presented. The etiology, diagnosis, management, and outcome are discussed in detail.
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A new classification of flexion-distraction injuries of the spine is described based on the bony and soft tissue injuries to the posterior complex and the anterior column. In addition, the classification includes the status of the vertebral body, that is, the association of a wedge-compression fracture or a burst injury. The soft tissue component provides a rationale for surgical intervention. Most injuries were treated by compression instrumentation, but it is recommended that those injuries associated with a burst component require distraction instrumentation.
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The cause of lumbar radicular symptoms often remains elusive after standard clinical and radiographic evaluation. Selective nerve root block is a useful test to indicate whether the pain is neural in origin and/or whether nerve root is pain producing in these patients with equivocal clinical and imaging studies. Over 8 years, the author performed selective nerve root blocks in 215 patients. ⋯ Overall, there were 38 good (53%), 16 fair (23%), and 17 poor (24%) surgical results. The results for those patients who had had prior surgery were disappointing (52% poor). These data reaffirm that surgical intervention should only be recommended for previously operated-upon patients with unequivocal findings.
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A retrospective review of the hospital records of 80 patients undergoing elective lumbar spine surgery was performed, in order to determine the effect of anesthetic technique on various clinical parameters. Forty patients receiving epidural bupivacaine anesthesia were matched with 40 patients receiving general endotracheal anesthesia; these two groups were homogeneous based on age, sex, type of operative procedure, and number of spinal levels operated upon. ⋯ In a follow-up surgery, 38 of 40 patients who received epidural anesthesia were satisfied with the technique. For patients undergoing decompressive lumbar spine surgery, epidural bupivacaine anesthesia is an effective, well tolerated technique with several potential advantages, and an acceptable incidence of complications, as compared with general endotracheal anesthesia.
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Lumbar nerve root anesthesia using a local anesthetic was performed in 100 cases of sciatica. The neurological state before and after nerve block was recorded and also the degree of pain alleviation caused by the block. Three indications for the block were used in the study: unilateral sciatic pain and normal findings on myelography and/or CT or MR (n = 51), minor myelographic findings that possibly but not necessarily explained the patient's symptom (n = 40), and multiple pathological findings on myelography (n = 9). ⋯ No side effects of the procedure were noted. Patients with pain alleviation after anesthesia were offered an operative nerve root decompression and short-term results of this decompression seem to be comparable to conventional disc surgery. Anesthetizing the lumbar nerve root outside the intervertebral foramen may be considered in the preoperative evaluation of patients with sciatic pain and minor or no radiographic findings.