Spine
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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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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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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.
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Computed tomography/discography was performed in 378 patients (403 discs) with lumbar disc herniation receiving intradiscal therapy. The grade of disc degeneration defined by the Dallas discogram description correlated closely with age. ⋯ The development of these herniation routes has been well explained by the findings of earlier histopathologic and biomechanical studies. Computed tomography/discography was very useful in observing the detailed features of HNP such as the range, site of maximum protrusion and protrusion size.