Spine
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This review examines, in a condensed manner, many of the major achievements related to spinal cord injury research during the last quarter century. Most of the advances have been made within the past 10 years. They include such basic and clinical tools as evoked potentials, regional and local spinal blood flows, neurophysiologic monitoring systems, and methods that detail the morphology and contents of cord tissue. ⋯ Such work has exposed significant aspects in the biochemistry and vascular mechanics associated with trauma to the cord. A growing and intriguing area of spinal injury research lies in probing the factors related to neuronal plasticity and regeneration of the cord tissue. This review also examines the role of experimental animal models as well as the clinical and experimental therapies available for acute and chronic spinal cord injury.
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The anatomy of the lumbar mamillo-accessory ligament (MAL) was studied by gross dissection in six cadavers. The MAL bridges the mamillary and accessory processes of each lumbar vertebra and encloses the medial branch of the dorsal ramus in an osseofibrous tunnel. The tunnel maintains the proximal course of the medial branch in a constant relationship to bone. ⋯ The MAL morphologically appears to represent remnants of transversospinal elements in the lumbar region, and is ossified in over 10% of lower lumbar vertebrae. Ossification may interfere with some percutaneous denervation techniques. The MAL may be a site of entrapment of the medial branch and may be a source of low-back pain.
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A retrospective review was made of 30 patients who had failed multiple traditional surgical procedures for low-back pain, sciatic pain, or both. The most common cause of the poor results appeared to be failure of initial selection, even though all patients appeared to meet traditional indications for operative intervention. Psychosocial problems (eg, drug abuse, alcoholism, marital discord, personality disturbances) were prevalent, but were not initially recognized. Thoughtful assessment of patients being considered for initial lumbar spine surgery, which includes objective psychological testing, may reduce the incidence of unsuccessful lumbar spine surgery.
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Forty-two intradiscal injections were performed in 29 patients having lumbar disc disease, 19 of whom had nonradiating back pain and 20 of whom had back and leg pain. Discograms were abnormal for 27 patients, but myelograms were abnormal for only four. Twenty-two injections (52%) gave relief of pain for a minimum of one month, but only 14 (33%) for at least three months. ⋯ Contrast and anesthesia discograms were abnormal for all patients, but myelograms were abnormal for only four. Thirteen injections (65%) gave relief of pain for a minimum of one month, but only three (15%) for at least three months. Of the 14 patients, three (21%) have obtained relief lasting six months to several years and have not required surgery.