RESUMO
Lower back pain is a common complaint of patients seen in our consultations. Despite progress, surgical procedures are still often unsuccessful in relieving pain. Blocks performed in the epidural spaces or more often in the articular facets have provided poor relief of chronic lower back pain. The pain has vegetative components. Considering anatomic findings, we describe the innervation of the peridiscal tIssues which suffer during degenarative conditions. We analyze the course of the autogenic nerves mediating lumbar pain, and select the site of the blocks necessary to obtain optimal selective pain relief. A well-defined block at the level of the communicating rami is described.
Assuntos
Dor Lombar/terapia , Bloqueio Nervoso , Ensaios Clínicos como Assunto , Humanos , Dor Lombar/patologia , Nervos Espinhais/anatomia & histologia , Coluna Vertebral/anatomia & histologiaRESUMO
The authors report five patients with detrusor inactivity in suprasacral spinal cord lesions with perineal spasticity. In all of these cases with cervical or high thoracic lesions treatment with an alpha-blocking drug (Phenoxybenzamine) allowed bladder activity to return. These results suggest that the sacral parasympathetic centre is under the inhibitory influence of the sympathetic nervous system.
Assuntos
Músculo Liso/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Bexiga Urinária/fisiopatologia , Administração Oral , Humanos , Injeções Intravenosas , Região Lombossacral , Masculino , Contração Muscular , Fenoxibenzamina/uso terapêutico , Pressão , Fatores de Tempo , Uretra/fisiopatologia , Micção/efeitos dos fármacosRESUMO
Articular chondrocalcinosis (ACC), which is due to the precipitation of calcium pyrophosphate microcrystals, is known to produce symptom of acute arthritis or chronic degenerative polyarticular lesions. It is more rarely responsible for rapidly destructive lesions of the joints suggesting a metabolic or neurological process. The case reported here of a 66 year old woman with major lesions of the L1-L2 intervertebral space, together with other cases already published, shows that the destructive spinal forms of ACC may also present as subacute spondylodiscitis. The latter, however, merely represents 4.9% of all destructive articular lesions of ACC and 5.2% of the vertebral localizations of all forms of the disease.
