Praxis
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Comparative Study
[Role of surgical treatment of low back pain and lumbo-sciatica].
Low back pain alone without any sciatica is not an appropriate indication for lumbar disc surgery. The only exception might be a clinically and radiologically proven segmental instability. However a conservative multidisciplinary treatment should precede surgery. ⋯ The appropriate surgical indication and the postoperative reeducation are of utmost importance for good results. The patients history, neurological examination, neuroradiological imaging and failed conservative treatment modalities are key elements to define appropriate surgical candidates. Microdisectomy remains the "gold standard" for surgical treatment of lumbar disc disease assuring a better quality of life at long term follow up.
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Many conditions are associated with neck stiffness. Because of the threatening consequences, bacterial meningitis needs special consideration. The sensitivity of the physical examination is discussed: absence of fever, neck stiffness and altered mental status excludes the diagnosis of bacterial meningitis. ⋯ A previous CT-scan to exclude increased intracranial pressure is indicated only in special risk situations and delayed antibiotic treatment must be avoided. Ceftriaxon is the standard empiric treatment in immunocompetent adult patients. According to the risk for pneumococcal resistance addition of vancomycin or rifampicin is indicated.