Spine
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Several factors were studied for their association with the prevalence of chronic low-back syndromes, sciatica, and unspecified low-back pain (LBP) in 2,946 women and 2,727 men (age range, 30-64 years) participating in the Mini-Finland Health Survey, a project aimed at comprehensive evaluation of the population's health. On the basis of a standardized clinical examination, a physician diagnosed sciatica in 5.1% and LBP in 11.6% of the subjects. Those with a previous traumatic back injury had a 2.5-fold risk of having sciatica or LBP. ⋯ Diabetics were found to have a significantly decreased prevalence of LBP (OR, 0.4; 95% CI, 0.3-0.8). Many factors, independent of each other, determine the occurrence of chronic low-back syndromes. The determinants of sciatica and LBP are different to some extent.
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Comparative Study
Awake discography. A comparison study with magnetic resonance imaging.
This study was undertaken to determine the correlation between awake discography findings and magnetic resonance imaging in the evaluation of symptomatic lumbar disc disease. The study included 164 consecutive patients who underwent evaluation with discography and magnetic resonance imaging for lumbar disc disease from August 1987 to September 1989. Chronic low-back pain, with or without radicular symptoms, was the presenting complaint in each case. ⋯ Magnetic resonance imaging showed normal findings and the discogram abnormal findings in 34 discs (7%), of which 21 (5%) recreated exact symptoms and 13 (2%) caused no pain. Magnetic resonance imaging is a static test and discography the only available dynamic test for disc evaluation. Awake discography is a diagnostic study that can determine which abnormal discs are symptomatic via the pain response.
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Patients with chronic low-back pain are frequently diagnosed as depressed. However, many of the neurovegetative signs of depression may also result from pain. The purpose of the present study was 1) to investigate the relationship between commonly used measurements of depression and pain perception; and 2) to examine the utility of differentiating between somatic signs and cognitive/affective symptoms of depression in patients with chronic low-back pain. ⋯ Analyses revealed significant correlations between depression scores and self-reported pain intensity. The cognitive/affective subscale of the Beck Depression Inventory resulted in the only nonsignificant correlation with pain intensity. These findings suggest that commonly used measurements of depression are confounded with pain symptomatology and that the cognitive/affective category of the Beck Depression Inventory may prove to be a more accurate measurement of depression in patients with chronic low-back pain.
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Case Reports
Influence of the ultrasonic surgical aspirator on the dura and spinal cord. An electrohistologic study.
The influence of the ultrasonic surgical aspirator on the dura and underlying spinal cord was examined. Spinal-cord-evoked potential was simultaneously recorded. ⋯ With 60% energy at 20 seconds and 80% energy at both 10 and 20 seconds, spinal-cord-evoked potential showed wave changes. In light of these results, it is suggested that in using the ultrasonic surgical aspirator on the dura, the electrohistologic safety limit be set at 60% energy and the maximum time duration at one point less than 10 seconds.