The accuracy of medical history and physical examination to indicate level of nerve root compression in patients with herniated lumbar disc.

A study of 95 cases of surgically documented lumbar disc herniation revealed that the correct level of nerve root compression could be identified in 68.4% by the pattern of radicular pain found in the patients. In 51.6% by physical examination for motor weakness and in 44.2% by an abnormal response of pin prick sensation. The combination of a complete history and physical findings will increase the predictive value of these basic diagnostic tools. This study confirms the usefulness of the medical history and physical examination in the diagnosis of the level of herniated lumbar discs.

Semen parameters retrieved by electroejaculation in spinal cord injured Thai men: Preliminary report.

Semen characteristics from seven spinal injured Thai men retrieved by electroejaculation were studied at Spinal cord injury unit and Infertility unit, Siriraj hospital. The mean age of the subjects was 24.7 years. Three cases had sperm count within normal limit ( > 20x106/c.c. ) and oligospermia in three cases. One case had azoospermia. All had low motility or no motility at all. All had leukospermia ( > 1x106/c.c. ) except one case. This study shows the change in semen parameters and may help for planning the management of spinal cord injured men.

Single level of posterior closing-wedge and anterior extension lumbar osteotomy for ankylosing spondylitis.

From 1993 to 1997 we treated 11 consecutive patients who had progressive spinal kyphosis due to ankylosing spondylitis by a posterior closing-wedge and anterior extension lumbar osteotomy and interspinous process wiring. The average correction was 44o (37-57) with a mean loss of correction after operation of 11.2o (6-20). The average operating time was 130 minutes (80 to 180) and blood loss was 486 ml (400-700). The osteotomy corrected all patients sufficiently to allow them to see ahead and improve their posture. There were no complication of implant failure as well as nerve root injury.

The possibility of MAB method for controlling spasticity.

Muscle afferent block method (MAB) for controlling spasticity was studied in six paralyed patients who had severe spasticity of bilateral adductor muscles by injecting 0.5 percent xylocaine + 99.5 percent ethanol (10 : 1 cc) and 5 percent phenol directly into the right and left adductor muscles respectively without making any attempt to locate the nerve sites. The study evaluated the treatment by passive abduction and spastic scale. The result showed that spasticity could be decreased both sides. Five percent phenol produced better result and longer duration of 3-4 days compared with 1-2 days when 0.5 percent xylocaine + 99.5 percent ethanol was used.

A study of pavlov ratio in Thai people.

A study of lateral cervical spine x-rays in 50 normal Thai volunteers was carried out to find the Pavlov ratio in Thai people. The results were compared with the standard values commonly used as reference values. These values are derived from published figures obtained in Westerners whose build and bone structure are quite different from Thais. The results of this study showed that the corresponding values of the Pavlov ratio at spinal levels C3, C4, C5, C6 and C7 were 0.96, 0.96, 0.98, 0.95 and 0.91. The average Pavlov ratio for all levels was found to be 0.95. There is no different from the foreign results. Hence, the use of published reference of the narrow status of the cervical canal can be confidently compared to reference values now known to be appropriate to Thais.

Outcome of the spinal injured patients at the first spinal injury unit in Thailand.

The first Spinal Injury Unit in Thailand was established at Siriraj Hospital, Mahidol University, Bangkok, Thailand. There is an extensive acute clinical database program in place for the acute care section as well as active database collection in progress for the acute rehabilitation section. The information presented in this paper represents management and outcome statistics compiled from the medical records of all 150 patients who were admitted to the Siriraj Spinal Injury Unit for acute spinal injuries between Frbruary,1995, and December,1996. The survey group included 90 males and 60 females, ranging in age from 2 to 70 with a mean age 34.4 years of age for the entire group. After data was compiled for the entire survey group, analysis revealed that traffic accidents (cars and motorcycles) were the primary cause of injury (69.3% of the cases) followed by injuries due to falls (17.3% of the cases). The injuries were further classified according to the site or level of injury, with cervical injuries leading the list, comprising 50% of the injuries. An investigation into the degree of neurological deficit was also made, with the incidence of complete neurological deficit occurring in 38% of all cases studied. Associated problems for the subjects included urinary tract infection(22.1%), muscle spasm and pain(12.2%), gastric ulcers(9.1%), pressure sores(7.6%) and psychological problems(3.0%). Patients with complete neurological deficit required longer hospitazation than those with incomplete neurological deficit for recovery. This also reflected in the average cost for hospitazation: $1,800 per patient for cases involving complete neurological deficit, $1,500 for those with incomplete lesion, and $520 for those without neurological deficit. The research conducted for this study using a clinical database collection program enables medical personal to provide more precise information about the course of treatment for patients admitted for spinal injuries. Most importantly, it enables medical personal to plan and prepare for treatment of patients admitted for spinal injury in a more systematic manner to promote more successful treatment for mutual benefit of doctors as well as their patients.