Case report 792. Eosinophilic granuloma of bone.

Eosinophilic granuloma is commonly thought of as a disease of children which can occur in either the axial or the appendicular skeleton. Only approximately 10% of cases occur in patients over the age of 40 years, and only approximately 12% of lesions occur in the pelvis, with no previously illustrated cases of this combination of age and location. These facts along with the nonspecific radiographic appearance made biopsy necessary for the correct diagnosis in the patient described.

The laminar space in the diagnosis of rotational flexion injuries of the cervical spine.

We measured the distance between the spinolaminar line and the articular pillars of the cervical spine (the laminar space), identified on lateral radiograph, to determine the diagnostic value of changes in this measurement in cases of unilateral facet dislocation. Twenty-seven cases of unilateral facet dislocation were compared with 70 normal spines and with 29 cases of hyperflexion injuries without unilateral facet dislocation. Abrupt alteration of the laminar space between two adjacent levels was found to be an accurate measure of rotation of the spine at the levels concerned; on the basis of this alteration, we were able to correctly diagnose 23 of 27 cases of unilateral facet dislocation and 22 of 23 cases of unilateral facet dislocation between C2 and C6. In only two of the 70 normal cases was a similar alteration of the laminar space seen, and one of these was due to a previous fracture. In none of the 29 cases of hyperflexion injury without unilateral facet dislocation was there abrupt alteration of the laminar space. We conclude that abrupt alteration of the laminar space is an accurate determinant for rotational anomalies of the cervical spine and, in particular, for unilateral facet dislocation.

Magnetic resonance assessment of the distribution of lumbar spine disc degenerative changes.

The lumbar spine magnetic resonance (MR) studies in 246 consecutive patients who suffered from persistent back and leg pain were evaluated for the degree of degenerative disc disease and the presence of disc bulging, prolapse, or herniation. No patient had a history of previous back surgery. In those patients, degenerative disc changes increased with age until the fifth decade of life, after which a relatively similar proportion of patients had degenerative disc disease. Significant dehydration and degeneration occurred in less than 5% of the upper two disc spaces while L4/5 and L5/S1 had marked changes in greater than 20%. Prolapse and herniation progressively increased with each lower interspace, where at L5/S1 it was present in nearly one-third of the patients. Although a few patients had disc prolapse or herniation with a nondegenerated disc, there was a relationship between the presence of disc degeneration and prolapse or herniation.