Spine
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A retrospective review was made of 30 patients who had failed multiple traditional surgical procedures for low-back pain, sciatic pain, or both. The most common cause of the poor results appeared to be failure of initial selection, even though all patients appeared to meet traditional indications for operative intervention. Psychosocial problems (eg, drug abuse, alcoholism, marital discord, personality disturbances) were prevalent, but were not initially recognized. Thoughtful assessment of patients being considered for initial lumbar spine surgery, which includes objective psychological testing, may reduce the incidence of unsuccessful lumbar spine surgery.
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Forty-two intradiscal injections were performed in 29 patients having lumbar disc disease, 19 of whom had nonradiating back pain and 20 of whom had back and leg pain. Discograms were abnormal for 27 patients, but myelograms were abnormal for only four. Twenty-two injections (52%) gave relief of pain for a minimum of one month, but only 14 (33%) for at least three months. ⋯ Contrast and anesthesia discograms were abnormal for all patients, but myelograms were abnormal for only four. Thirteen injections (65%) gave relief of pain for a minimum of one month, but only three (15%) for at least three months. Of the 14 patients, three (21%) have obtained relief lasting six months to several years and have not required surgery.
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Twenty of 26 consecutive patients with sciatica caused by myelographically proven disc protrusions who were treated by chemonucleolysis with chymopapain made useful recovery. There were no major complications attributable to the procedure. Certain diagnostic and clinical criteria are described which appear to be important in producing a favorable result following chemonucleolysis.