Spine
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Comparative Study
A clinical study of degenerative spondylolisthesis. Radiographic analysis and choice of treatment.
Surgical treatment of degenerative spondylolisthesis in 27 patients by means of anterior lumbar interbody fusion and in 14 patients by means of posterior decompression yielded average degrees of recovery of 77% and 56%, respectively. Preoperative analysis of myelograms, and computed tomographies after myelography indicated that anterior shifting of the inferior articular process of the slipping vertebra was the main factor responsible for compression of the nervous tissue in the early stages of degenerative spondylolisthesis. ⋯ In the later stages of degenerative spondylolisthesis, osteophytes on the superior articular processes of the lower vertebra were an additional factor in compression, and patients should be treated by posterior decompression. Computed tomographies after myelography provided the key images for identifying pathologic processes in degenerative spondylolisthesis and selecting appropriate surgical procedures.
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This article has had as its purpose the delineation of the complexity of the production of pain on an organic basis as opposed to any psychological amplification. The issues addressed apply directly to the problem of spinal pain. Classical nociception arising in the structures of the spine thus would include the application of mechanical and chemical stimuli to muscles, ligaments, apophyseal joint capsules, bone, and other structures with adequate innervation, particularly the anterior dura and its extensions. ⋯ Further, the fact that the nervous system changes its activities in response to chronic pain, particularly that arising from damaged neural elements, is of paramount importance in understanding how chronic pain syndromes differ so greatly from simple nociceptive events. Insidious deafferentation ongoing in spinal nerve roots subject to chronic compression and fibrosis offers a fertile field for research into the origin of permanent pain in patients in whom application of accepted therapies does not result in relief. All of this material must be considered by the clinician who is challenged with analyzing spinal pain problems in patients.
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Case Reports
Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy.
To evaluate the morphologic changes of the spinal cord in patients with cervical myelopathy due to cervical spondylosis and ossification of the posterior longitudinal ligament, the authors measured the thickness and signal intensity of the cervical cord with magnetic resonance imaging in healthy adults and patients with cervical myelopathy, and compared these findings. In patients with cervical myelopathy, the preoperative and postoperative magnetic resonance imaging findings were compared with the severity of myelopathy and postoperative results. In healthy adults, the anteroposterior diameter of the cervical cord was 7.8 mm at the C3 level and decreased at lower levels. ⋯ In the group with ossification of the posterior longitudinal ligament, surgical results were good when the postoperative anteroposterior diameter was increased, whereas in the cervical spondylotic myelopathy group there was no relationship between the two parameters. In the patients with myelopathy, a high intensity area was observed in about 40% of all patients before operation and about 30% after operation. However, the presence or absence of a high intensity area did not correlate with the severity of myelopathy or with surgical results in the group with ossification of the posterior longitudinal ligament and the cervical spondylotic myelopathy groups.
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An unselected sample of outpatient subjects (n = 330) with localized nonspecific low back pain (LBP) was studied. Investigation consisted of clinical assessment, physical examination, and psychiatric interview based on the DSM-III classification. A psychiatric disorder, according to the DSM-III criteria (axis I) was found in 41% of the subjects. ⋯ Cluster analysis provided support for a four-group classification of low back pain, which may be interpreted through the relationships between psychological disturbances and the LBP clinical features. The results call for further investigation of the complex relationship between psychological disturbances and back pain. However, clinicians must be aware of the interest of a minimal psychiatric assessment in low back pain patients: psychiatric disorders frequently appear in these patients and an appropriate treatment of the psychiatric syndrome may reduce back pain.