Spine
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Review Case Reports
Cauda equina syndrome in patients undergoing manipulation of the lumbar spine.
Cauda equina syndrome has been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1989 revealed ten reported cases of cauda equina syndrome in patients undergoing manipulation without anesthesia. This article presents three new cases where a temporal association was found between the onset of cauda equina symptoms and lumbar manipulation. ⋯ As a consequence, the patients went untreated for several days. This may have led to residual symptomatology. It is concluded that patients who present with bowel or bladder disturbances, leg weakness, or rectal and genital sensory changes after manipulation, be recognized as experiencing a cauda equina syndrome.
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To explore the relationship between surgical approach and chronic posterior iliac crest donor site pain, 151 bone graft harvests with follow-up periods longer than 1 year were evaluated using a detailed questionnaire and follow-up clinical visits. There was no difference in the incidence of chronic donor site pain between harvests performed through the primary midline incision versus a separate lateral oblique incision (28 vs 31%). ⋯ The association of chronic donor site pain with residual back pain was also greater in the spinal reconstructive group. Thus, it appears that incidence of chronic donor site pain is more dependent on diagnosis than on surgical approach.
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Persistent lower extremity pain after unsuccessful lumbar surgery continues to be a disabling condition. The results of deafferentation procedures for radiculopathy have been disappointing. Hence, the prospect of isolating a potentially reversible component of extremity pain is quite attractive. ⋯ Although the results of thermography initially seemed to correlate with clinical outcome, further follow-up failed to yield any correlation. Additionally, no specific combination of response to blockade or thermogram was predictive of the clinical success after sympathectomy. Now, lumbar sympathectomy is not recommended in the setting of chronic radiculopathy and persistent extremity pain.
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The occurrence, varieties, and distribution by race and sex of the arcuate foramina observed in 1,000 consecutively seen cervical spine radiographs are reported. The complete foramen is significantly more common in males, without any racial predilection. The partial foramen is commonest in white females. The rate of occurrence seems independent of age.