Spine
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The relationship between herniated lumbar disc and abnormalities of the transverse process of the lumbosacral junction was investigated. Two hundred consecutive patients with positive myelographic findings of herniated lumbar disc were reviewed. Sixty patients presented abnormalities of the transverse process to satisfy the criteria for lumbosacral transitional vertebra. ⋯ In types III and IV, there are no herniations at the level of the lumbosacral transitional vertebra and no increase in the incidence of herniations just proximal to the lumbosacral transitional vertebra. The Type II lumbosacral transitional vertebra presents herniated lumbar disc at the level of transition. It also presents a greater than normal incidence of herniations at the level just above the lumbosacral transitional vertebra.
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From April 1978 to October 1982, the authors performed 44 pelvic fixations as part of L-rod instrumentation of a spinal deformity. Thirty scoliosis and revision scoliosis cases with a minimum of 1 year follow-up were analyzed for changes of the instrumentation with respect to the pelvis, angular changes at the lumbosacral junction, radiolucency about the portions of the rods providing pelvic fixation, and success of lumbosacral fusion. The technique for fixation was different among three groups of patients. A pelvic fixation technique in which the pelvic segments of the rods were longer than 6 cm, completely intraosseous through their iliac course, and within 1.5 cm of the sciatic notch, yielded the best results.
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Twenty patients with atlanto-axial instability treated by posterior spinal fusion were reviewed. Patients with atlanto-axial instability due to congenital causes usually presented late with chronic myelopathy and treatment in these patients was associated with poor surgical results. Atlanto-axial fusion for fracture non-unions offers immediate stability, reliability, few complications, and good range of neck movement after surgery. Occipito-cervical fusion is indicated whenever atlanto-axial fusion is surgically not feasible.
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Comparative Study
Industrial low-back pain. A prospective evaluation of a standardized diagnostic and treatment protocol.
This investigation applied a diagnostic and treatment protocol to two groups of industrial workers: 5,300 employees at Potomac Electric Power Company ( PEPCO ) for two years and 14,000 United States Postal Service workers for one year. An "active" system in which patients were evaluated weekly was implemented at the power company, and a "passive" system in which patients were seen only once was instituted at the U. S. ⋯ S. Postal Service demonstrated a decrease in the number of low-back pain patients (41%), in days lost from work (60%), and in financial costs (55%). These results, along with our observations about the study, led us to the following conclusions: (1) Good medicine leads to cost savings in treating industrial low-back pain. (2) Use of a standardized medical approach and nomenclature is necessary and practical, for consistent care. (3) A good record keeping system is essential to perform useful medical analyses for identifying scientific problems. (4) Unbiased medical surveillance leads to changes in behavior of both treating physicians and patients. (5) The outcome for most low-back pain patients in industry is not as grim as previously perceived if their medical management is approached in an organized manner.
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Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy.