ABSTRACT
This article reports on a study of 51 consecutive patients (83 lumbar discs) with back pain who underwent anterior interbody lumbar fusion or combined anterior and posterior fusion at the same operation during a 2-year period. All patients met the criteria for diagnosis of a painful internal disc disruption and/or failed back syndrome and have had a lengthy trial of conservative treatment consisting of rest, physical therapy, back support, nonsteroidal anti-inflammatory drug therapy, and guarded activity; this treatment was often supplemented by epidural cortisone injections, pain management, and functional rehabilitation. Patients with prolonged back pain who failed with conservative care after a minimum of 12 months of severely disabling symptoms were selected for surgery on the basis of a positive dynamic discogram reproducing their exact pain and demonstrating a morphologically degenerative disc (internal disc disruption). For the purpose of this study, patients were categorized into three groups and followed up for 15-36 months after the operation. There were no deaths or major complications, and the overall success in achieving measurable diminution of preoperative pain was 80%. This article discusses preliminary conclusions on the efficacy and safety on anterior and anteroposterior fusion for lumbar disc pain.
Subject(s)
Intervertebral Disc Displacement/surgery , Lumbar Vertebrae , Spinal Fusion/methods , Adult , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement/physiopathology , Male , Pain Measurement , Palliative Care/methodsABSTRACT
A prospective comparison of 97 discs in 50 patients studied by both magnetic resonance imaging and discography showed a high correlation in the identification of the degenerative disc between these two modalities.
Subject(s)
Intervertebral Disc/diagnostic imaging , Intervertebral Disc/pathology , Magnetic Resonance Imaging , Spinal Diseases/diagnosis , Adult , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Middle Aged , RadiographyABSTRACT
An unusual case of solitary eosinophilic granuloma of rib in a young adult man is reported. He presented only with referred signs and symptoms distant from the lesion. This is a unique presentation and demonstrates the ubiquitousness of this disease when localizing signs and symptoms are absent.
Subject(s)
Eosinophilic Granuloma/diagnosis , Ribs , Adult , Humans , MaleABSTRACT
We have reported the case of an anterolateral dislocation of the proximal tibiofibular joint in a soccer player, apparently the second case in the literature. As in that reported by O'Rourke and McManus, this patient was attempting to gain his balance and this may indeed be an important contributing factor. Ogden's classification is now well accepted and has been reviewed along with a discussion of the mechanisms of injury. The diagnosis can generally be made by clinical examination and confirmed by roentgenographs. Treatment usually consists of closed reduction with 3 weeks of casting. In complicated cases, however, resection of the fibular head may be required.
Subject(s)
Athletic Injuries/etiology , Fibula/injuries , Joint Dislocations/etiology , Knee Injuries/etiology , Soccer , Sports , Tibia/injuries , Adult , Athletic Injuries/diagnosis , Athletic Injuries/therapy , Casts, Surgical , Humans , Immobilization , Joint Dislocations/diagnosis , Joint Dislocations/therapy , Knee Injuries/diagnosis , Knee Injuries/therapy , Knee Joint/anatomy & histology , Male , Stress, MechanicalABSTRACT
Twenty-nine consecutively treated patients over a 5-year period with upper extremity reflex sympathetic dystrophy were admitted to Massachusetts General Hospital for prolonged continuous stellate ganglion blockade. Diagnosis was based on the presence of pain, decreased joint motion, trophic changes, and vasomotor disturbances. Selection for blockade was made on the failure to improve with outpatient physical therapy, tranquilizers, and mild analgesics. Treatment consisted of indwelling-catheter injections of bupivacaine hydrochloride every eight hours to the stellate ganglion for an average of 7 days, supplemented with vigorous physical therapy. Improvement during treatment was documented in all but two patients with regard to pain and decreased joint motion and in two-thirds with regard to trophic and vasomotor changes. Long-term follow-up demonstrated a relapse rate of 25%, but marked improvement persisted in the rest and normal status was attained in four of 26 patients at an average of 3 years later.
Subject(s)
Autonomic Nerve Block , Bupivacaine/administration & dosage , Reflex Sympathetic Dystrophy/therapy , Stellate Ganglion , Adult , Aged , Arm , Catheters, Indwelling , Female , Follow-Up Studies , Humans , Injections , Male , Middle Aged , Physical Therapy Modalities , Retrospective StudiesSubject(s)
Axillary Artery , Shoulder Fractures/complications , Thrombosis/etiology , Female , Humans , Middle AgedSubject(s)
Hemangioma/complications , Hydrarthrosis/etiology , Knee Joint , Synovial Membrane , Adolescent , Adult , Child , Child, Preschool , Diagnostic Techniques, Surgical , Follow-Up Studies , Humans , Knee Joint/diagnostic imaging , Knee Joint/surgery , Male , Recurrence , Tomography, X-Ray ComputedABSTRACT
The use of computed tomographic scanning is presented in aiding in the diagnosis of synovial hemangioma of the knee, and demonstrates the value of this technique in evaluating intraarticular masses.
ABSTRACT
Three cases of thermal burns to the anterior tibia are reported to bring attention to this complication resulting from the use of high-speed air-power equipment in the drilling of the tibial pin in ankle arthrodesis. In each case, excess heat was generated at the pin-bone interface, which was followed by a full-thickness burn. In the first case, debridement led to complete wound healing. In the second, a myocutaneous pedicle was required, and in the third, osteomyelitis resulted. This complication may hopefully be avoided by predrilling the bone and observing recommended methods of heat dissipation.
