Morphological changes of the multifidus muscle in patients with symptomatic lumbar disc herniation.

OBJECT: Lumbar disc herniations are associated with segmental muscle alterations of the ipsilateral segmental multifidus muscle. The aim of the present study was a histopathological analysis of the myopathological changes of the multifidus muscle and correlation with the duration of radicular symptoms. METHODS: Multifidus muscle biopsies were performed in 20 patients during discectomy. Specimens were obtained from the area of the multifidus muscle innervated by the nerve from the level of the affected disc. Histopathological findings were classified according as neurogenic tissue syndrome and nonspecific myopathological syndrome, and these results were correlated with the duration of radicular symptoms. RESULTS: Results of multifidus muscle biopsies were classified as neurogenic tissue syndrome in 12 patients and as nonspecific myopathological syndrome in 8. The mean (+/- SD) duration of radicular symptoms was 10.75 +/- 7.9 months in patients with neurogenic tissue syndrome and 4.37 +/- 3.9 months in patients with a nonspecific myopathological syndrome. There was a positive correlation between group assignment and symptom duration (correlation coefficient 0.457, p = 0.043). CONCLUSIONS: A long duration of radicular symptoms is associated with a neurogenic tissue syndrome, whereas a nonspecific myopathological tissue syndrome is seen in patients with shorter duration of symptoms. This suggests that patients with long duration of radicular symptoms originating from a lumbar disc herniation have an increased risk for neurogenic muscular changes, and that consideration should be given to an earlier surgical intervention.

Tight hamstring syndrome and extra- or intraspinal diseases in childhood: a multicenter study.

Tight hamstrings syndrome (THS) has been attributed to a number of disorders. Most authors argue that tight hamstring syndrome is determined in the majority of cases by a protruding or slipped vertebral disc. The term "disc related tight hamstring syndrome" is usually used to describe the condition. However, tight hamstring syndrome in childhood can also be an initial symptom of a usually severe disease. We reviewed retrospectively 102 children who had presented to our clinics with tight hamstring syndrome in the past 22 years (between 1980 and 2001). To our knowledge, this study includes the largest number of patients with tight hamstring syndrome analysed so far. Seventy four children (73%) suffered from severe underlying diseases. In more than one-third of all THS cases (38 of 102 cases; 37%), we observed intra- or extraspinal tumorous alterations. In 15% of the cases (15 of 102), osteomyelitis or spondylodiscitis was diagnosed. Only in 27% of the cases (28 of 102), disc protrusion, one of the commonly known underlying diagnoses (14 cases), or higher-grade spondylolisthesis/spondyloptosis (14 cases) were the inciters. Our results suggest that tight hamstring syndrome in childhood can be an initial symptom of an associated, usually severe disease. We conclude that therefore further diagnostic evaluation is required when tight hamstring syndrome is observed. A rapid initiation of an adequate primary therapy could be indicated.

Spondylodiscitis in childhood: results of a long-term study.

STUDY DESIGN: Retrospective study to gather long-term data clinical, paraclinical, and radiographic data on nonoperatively managed cases of childhood spondylodiscitis. OBJECTIVES: To analyze and assess the clinical, laboratory, and radiologic findings in children with spondylodiscitis and to document the efficacy of conservative treatment based on the long-term clinical, functional, and radiologic outcomes of these patients. SUMMARY OF BACKGROUND DATA: Childhood spondylodiscitis is an extremely rare entity that often presents an nonspecific clinical picture. Treatment strategies are mainly conservative. Assessment of the clinical and radiologic outcomes of these patients is essential for prognosis and for justification of nonoperative management. METHODS: According to our hospital records, 25 children (17 girls and 8 boys) with a mean age of 6.1 years (range: 2 months-12 years) were hospitalized for spondylodiscitis between 1968 and 1988. Parameters related to the duration of symptoms, clinical manifestations, diagnostic workup, and course of treatment were reviewed. Twenty of the patients (75%) returned for clinical and radiologic follow-up at least 10 years after discharge (range 10-23 years). RESULTS: All of the patients presented with uncharacteristic signs and symptoms. Laboratory markers of inflammation were only moderately elevated. On average, the diagnosis of spondylodiscitis was established after a delay of 14 weeks (range 2 days-60 weeks). All levels of the spine were affected, whereby the thoracic and lumbar spine were preferential sites. The radiographic studies revealed destruction of adjacent vertebral bodies in 12 cases (48%). The remaining 13 patients (52%) had isolated disc involvement without radiographically detectable bone destruction. An abscess was detected by computed tomography in only 1 case. At the time of follow-up, 16 patients (80%) were asymptomatic and had unrestricted spinal mobility. Four patients (20%) had restricted spinal mobility with local kyphosis, which could be documented objectively on radiograph film. In 12 cases (60%), healing was accompanied by fibrous ankylosis and high-grade narrowing of the intervertebral disc space, as was demonstrated radiologically. Eight patients (40%) exhibited fusion of the vertebrae (4 partial, 4 complete). Four patients (20%) had residual defects. CONCLUSIONS: Our study shows that the course of childhood spondylodiscitis is generally benign. Segmental orbony ankylosis may occur during the healing process but normally does not lead to serious functional deficits. Neurologic deficits were not observed in any of our patients. Conservative management must be intensive, but the results are good. Biopsy is not required except in the few cases where diagnostic uncertainty prevails.

Ultrasonographic imaging of fractures of the clavicle in newborn infants.

Fractures of the clavicle in the neonate are usually diagnosed by clinical examination and confirmed by plain radiography. Exposure of newborn infants to irradiation should be avoided if possible. Following the clinical examination of 2978 neonates, 15 had suspected fractures of the clavicle. All were confirmed by ultrasound. In combination with clinical examination, ultrasound is a satisfactory alternative to radiological assessment for the diagnosis of fractures of the clavicle in newborn children.

Permanent thoracic myelopathy resulting from herniation of a calcified intervertebral disc in a child.

This retrospective study was made to illustrate the rare occurrence of neurologic deficits resulting from intervertebral disc calcification (IDC) in a child. Most authors agree that juvenile IDC is usually a benign, self-limiting disease with excellent prognosis. The symptoms subside spontaneously in 95% of patients. Conservative treatment is therefore usually sufficient. Reviewing the English-speaking literature, only two further cases of operated juvenile IDC with myelopathy have been published. In the current report, we describe a case of permanent thoracic myelopathy resulting from juvenile IDC treated by urgent decompressive thoracic laminectomy. At the 3-year follow-up examination, the patient had not recovered fully. Persisting deficits in motor and sensory function were observed.