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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This is a retrospective single-patient case report with a literature review. ⋯ Traumatic bilateral atlantoaxial rotatory subluxation is uncommon in adults. This probably is due to the unique biomechanical features of the atlantoaxial articulation and the probable lethality of injury to the adjacent medulla or vertebral arteries before presentation at the trauma center.