Spine
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Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review. The majority of the films were taken because of lumbar complaints. The mean lumbosacral (LS) angle (L2-Sacrum) was 45.05 degrees +/- .85 degrees. ⋯ There was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed. A "routine" supine lateral lumbar spine roentgenogram is a very accurate means of measuring lordotic angles. A lordotic angle of less than 23 degrees defines hypolordosis and more than 68 degrees, hyperlordosis.
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Case Reports
Lumbar paraspinal compartment syndrome. A case report with physiologic and anatomic studies.
A 24-year-old man presented with severe low-back pain and paraspinal muscle spasm after exertion. Elevation in temperature, white blood cell count, serum muscle enzymes, and urine myoglobin, as well as computer tomographic evidence of paraspinal muscle edema and necrosis, were present. No etiology could be documented, and the possibility of an acute exertional compartment syndrome was entertained. ⋯ These indicated a physiologic behavior similar to other known compartments for which compartment syndromes have been described. Variation in intracompartmental pressure occurred as a function of body posture, erector spinae isometric contraction, and active intra-abdominal pressurization. We suggest this patient had a paraspinal compartment syndrome and have described pressure characteristics of this compartment in normal men.
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The results of intraspinal narcotic analgesia (INA) in 43 patients with chronic nonmalignant pain syndromes are reviewed. A protocol has been established to improve proper patient selection and includes three phases of study. ⋯ In those patients qualifying for continuous delivery systems (CDS), 65% had good to excellent relief of pain while 34% were considered failures for a variety of reasons. Apparent tolerance development in many of the patients was, in fact, due to technical problems with the epidural catheter instead.
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A systematic approach to low-back pain is presented that relies on the classification of patients according to their symptoms. Rational systems of physiotherapy are proposed for each group and incorporated into an algorithmn. One hundred forty-two patients with mechanical low-back pain have been treated, and their response has been assessed by means of a postal questionnaire. ⋯ Eighteen percent of patients became completely free of pain, and 59% experienced a reduction in pain level. The most effective treatment was education in back care, followed closely by an exercise program. The responses were different in the various subgroups, and a series of revised flow charts is presented.
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Some of the chronic pains that follow disc rupture, myelography, and discectomy may be due to injury to peripheral nerves or nerve roots. The neural mechanisms underlying these pain syndromes are discussed and possible etiologies examined. The roles of peripheral and central changes in neuronal activity and connectivity are explored: plasticity in the nervous system may either be the cause of pain in the 5% of people who develop chronic pain after nerve injury or what prevents pain in the 95% who do not become painful after nerve injury. More research on the behavior of damaged nerves and their central connections is essential.