Spine
-
A case of thoracic chordoma successfully treated with surgical excision is reported and described. Thoracic chordomata presenting as posterior superior mediastinal tumors occur infrequently and may be highly malignant lesions. Early radical surgery through thoracotomy provide the best hope of cure, and radiation offers only temporary regression of tumor.
-
Techniques for assessing daily function in Patients with back pain are generally crude and limited in scope. We therefore examined a "health status" questionnaire, the Sickness Impact Profile (SIP) to assess its measurement characteristics in such patients. Eighty patients with mechanical low-back pain completed the SIP and a physical examination at a walk-in visit and again three weeks later. ⋯ Validity of psychosocial subscales was confirmed by significant associations with patient anxiety and psychiatric problems. Scores changed in the expected directions when patients were evaluated three weeks later. The SIP is thus valid, reliable, sensitive to clinical changes, and comprehensively assesses a wide range of dysfunctions.
-
From 1973 to 1981, 94 patients suffering from low-back pain, with or without spread into the lower extremities, were candidates for therapeutic spinal cord stimulation. The etiology of pain in all cases was lumbosacral spinal fibrosis due to multiple myelographies and surgical interventions on the lumbar spine. ⋯ The concept of spinal arachnoiditis is reviewed and the term lumbosacral spinal fibrosis proposed. The treatment of this chronic painful and disabling disease is discussed.
-
An investigation of the clinical relevance of the location of the intercrestal line in relation to the pattern of disc degeneration in the lower lumbar spine is presented. An analysis of the discograms from 89 symptomatic patients has demonstrated a difference in the incidence of disc degeneration in the L4-5 and L5-S1 disc spaces dependent on the position of the intercrestal line. This difference supports the hypothesis that additional protection will be given to those L5-S1 discs with which high intercrestal lines are associated as compared to those associated with intercrestal lines lying lower down the spine. A corollary of this hypothesis is that for any individual there is an increased likelihood that the L4-5 disc space will undergo degeneration from the influence of normal mechanical stresses before the L5-S1 disc space if the intercrestal line lies comparatively high up the spine.
-
The lumbar intervertebral discs are innervated posteriorly by the sinuvertebral nerves, but laterally by branches of the ventral rami and grey rami communicantes. The posterior longitudinal ligament is innervated by the sinuvertebral nerves and the anterior longitudinal ligament by branches of the grey rami. ⋯ Medial branches supply the multifidus, intertransversarii mediales, interspinales, interspinous ligament, and the lumbar zygapophysial joints. The distribution of the intrinsic nerves of the lumbar vertebral column systematically identifies those structures that are potential sources of primary low-back pain.