Spine
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A comprehensive review of the literature dealing with lumbar discography was conducted. ⋯ Most of the current literature supports the use of discography in select situations. Particular applications include patients with persistent pain in whom disc abnormality is suspect, but noninvasive tests have not provided sufficient diagnostic information or the images need to be correlated with clinical symptoms. Another application is assessment of discs in patients in whom fusion is being considered. Discography's role in such cases is to determine if discs within the proposed fusion segment are symptomatic and if the adjacent discs are normal. Discography appears to be helpful in patients who have previously undergone surgery but continue to experience significant pain. In such cases, it can be used to differentiate between postoperative scar and recurrent disc herniation and to investigate the condition of a disc within, or adjacent to, a fused spinal segment to better delineate the source of symptoms. When minimally invasive discectomy is being considered, discography can be used to confirm a contained disc herniation, which is generally an indication for such surgical procedures. Lumbar discography should be performed by those well experienced with the procedure and in sterile conditions with a double needle technique and fluoroscopic imaging for proper needle placement. Information assessed and recorded should include the volume of contrast injected, pain response with particular emphasis on its location and similarity to clinical symptoms, and the pattern of dye distribution. Frequently, discography is followed by axial computed tomography scanning to obtain more information about the condition of the disc.
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The lumbar zygapophysial joints are a potential cause of back and lower extremity pain. Absolute diagnosis of lumbar zygapophysial joint-mediated pain is based on selective analgesic injections of these joints or their nerve supply. ⋯ A critical review of previous studies assessing the role of diagnostic and potentially therapeutic zygapophysial joint injection procedures is presented. The need for future studies is addressed, and current recommendations for the role of zygapophysial joint injection procedures based on this critical scientific review are provided.
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The development and construction of a specific instrument for measuring quality of life in adolescents with spine deformities was investigated. ⋯ The instrument developed for measuring quality of life in patients with spine deformities during the period of bone growth has validity, internal consistency, and high test-retest reliability. The conceptualization of quality of life of the Quality of Life Profile for Spine Deformity includes psychosocial dimensions and pain and function.
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From a prospective and consecutive study on degenerative lumbar spine disorders containing 416 patients, all patients with a severely reduced or absent strength of the extensor hallucis longus muscle (n = 35) before surgery were identified. ⋯ The incidence of pronounced extensor hallucis longus paresis in lumbar nerve root compression varied between 5-11%. Recovery after surgery was common in disc herniation and lateral spinal stenosis but did not occur in central stenosis. Complete recovery was most common in disc herniation, and recovery occurred mainly during the first 4 months after surgery.
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This study retrospectively, reviewed the effects of pedicle screw fixation on lumbosacral fusion for degenerative conditions. The records and radiographs of a group of patients treated by wide decompression and fusion of the lumbosacral spine and by one surgeon were studied. Two treatment groups were identified by fusion technique; one group received autologous bone graft only, and second group was treated by autologous bone grafting supplemented with pedicle screw fixation. ⋯ Use of pedicle screw and rod fixation with the Edwards system led to significantly improved results in lumbosacral fusions over autogenous bone graft alone, with a lower complication rate. The use of spinal is a valuable adjunct to achieve lumbosacral fusion in patients who have undergone decompressive surgery for the spine.