Lumbar monoradiculopathy due to unilateral facet hypertrophy.

Twenty-two patients presented during the last 3 years with unilateral symptoms and signs of a lumbar monoradiculopathy indistinguishable from those of a disc herniation. All had compression of the nerve root posteriorly by a hypertrophic facet without anterior compression from the disc. None of the patients had spinal claudication. Preoperative evaluation with computed tomographic (CT) scanning was disappointing as the pathology was correctly defined in only 1 of 10 patients. Lumbar myelography was helpful, but did not always localize the lesion. The decision to operate was based primarily on the clinical grounds of persistent or progressive radiculopathy. The operative techniques used were two-level hemilaminectomy in 7 patients, single level laminectomy in 4, and multilevel laminectomy in 11. Surgical exploration revealed that the site of compression ranged from the medial canal to the lateral recess. The root was compressed by inferior facets 8 times and by superior facets 14 times. Back pain was relieved in 12 of 15 patients, and leg pain was relieved in 19 of 21. Neurological deficit was relieved in 19 and improved in 3. It is concluded that standard CT and myelographic techniques may not anatomically define the point of radicular compression. Intraoperatively the root must be explored from its dural origin to a point beyond the pedicle to ensure adequate decompression. Most, but not all patients with hypertrophic radicular compression will improve after surgical decompression.

Prevalence of mastoid infection in prehistoric Arizona Indians.

In view of th reported high prevalence of otitis media and mastoiditis in the present-day Indian inhabitants or Arizona, when an opportunity arose to examine the skulls of prehistoric Indians in the collection of the Arizona State Museum, University of Arizona, Tucson, Arizona, it was thought that determining the prevalence of mastoiditis in them might be helpful in the treatment and prevention of mastoid infections in the present-day population. Our findings are compared with those of two other studies of mastoiditis in prehistoric Indians in another area of the United States.

Lower cranial nerve palsies due to Pseudomonas osteomyelitis of the skull base.

A patient with pseudomonas osteomyelitis of the base of the left posterior fossa is reported. His clinical course was one of progressive paresis of the left 8th, 10th, and 11th cranial nerves. There have been three prior reports of osteomyelitis of the base of the skull not in contiguity with an infected paranasal sinus. Our patient subsequently developed osteomyelitis in the 3rd to 5th cervical vertebrae.

Ultrasonic evaluation of intracranial pathology in infants: a new technique.

A prospective study had demonstrated the clinical usefulness of water-delay ultrasound as a means of routinely imaging the intracranial contents in infants younger than one year of age. Correlation between ultrasound and CT images was excellent, showing both normal and pathological anatomy. This technique is most helpful in the detection of hydrocephalus and other "fluid lesions" (subdural hygroma or hematoma, Dandy-Walker cyst, porencephalic cyst) and in evaluation of response to therapy. Because small amounts of intraventricular and subependymal hemorrhage cannot be detected by ultrasound, CT remains the procedure of choice when these conditions are suspected. The water-delay method is accurate and inexpensive, rarely requires patient sedation, and avoids exposure to ionizing radiations.