Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively.

STUDY DESIGN: A prospective cohort study of consecutive patients. OBJECTIVE: Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively. METHODS: Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage. RESULTS: Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group. CONCLUSION: The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression. LEVEL OF EVIDENCE: 2.

Intradural Extramedullary Spinal Cord Metastasis of the Prostate: A Case Presentation and Review of the Literature.

Prostate cancer is associated with vertebral metastasis in up to 10% of patients; however, intradural spinal cord metastases (ISCM) are much less frequent. We present the clinical and histopathological findings of a patient with ISCM arising from prostate. A PubMed literature search for ISCM from the prostate yielded a total of nine additional cases. ISCM of the prostate occurs at a late stage of systemic disease and the prognosis is generally poor. Decompressive surgery followed by adjuvant radiation therapy may help reduce intractable pain and stabilize neurological symptoms, thereby improving quality of life.

An uncommon side effect in a common procedure: a case report of an adverse reaction to prilocaine during a Bier's block.

This case report describes a rare side effect during a Bier's block. During local anaesthetic injection, the patient suffered a sudden onset painful petechial rash localised to the upper limb, distal to the tourniquet, without systemic effect. After deflation of the tourniquet, the pain resolved and no systemic effects were seen. The skin changes settled without treatment over one week. The discussion summarises standard technique and precautions required for a Bier's block. It also evaluates risks and complications.

Ocular infection preceding major epidural abscess.

Staphylococcal bacteremia is an important clinical entity. A 74-year-old lady presented with an isolated staphylococcal ocular infection; this was treated with a short course of antibiotics, a prolonged course of steroids, and discharge from hospital with outpatient clinic followup. She represented three weeks later to the emergency department with back pain, raised inflammatory markers, and positive blood cultures. On magnetic resonance imaging (MRI), an extensive epidural collection was seen. This was surgically decompressed, and she was treated with appropriate intravenous antibiotics. Despite a complicated postoperative course, she made an excellent recovery. This case reviews the important clinical and radiological features of the presentation of a major epidural abscess and it also suggests a potentially unusual primary source. The clinician is reminded to always have a high index of suspicion regarding staphylococcal bacteremia and the potential for seeding to the epidural space.