Spine
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The anatomy and physiology of the nerve root complex in the lumbar spine are reviewed, with special reference to the effects of mechanical deformation of nerve roots in association with intervertebral disc herniation and spinal stenosis. Biomechanical aspects of nerve root deformation induced by compression are discussed. ⋯ Nerve root compression can, by different neurophysiologic mechanisms, induce motor weakness and altered sensibility or pain. Intraneural edema and demyelination seem to be critical factors for the production of pain in association with nerve root compression.
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From a retrospective study of 412 thoracolumbar injuries, the author introduces the concept of middle column or middle osteoligamentous complex between the traditionally recognized posterior ligamentous complex and the anterior longitudinal ligament. This middle column is formed by the posterior wall of the vertebral body, the posterior longitudinal ligament and posterior annulus fibrosus. The third column appears crucial, as the mode of its failure correlates both with the type of spinal fracture and with its neurological injury. ⋯ These four well-recognized injuries have been studied carefully in clinical terms as well as on roentgenograms and computerized axial tomograms. They were then subdivided into subtypes demonstrating the very wide spectrums of these four entities. The correlation between the three-column system, the classification, the stability, and the therapeutic indications are presented.
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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.
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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.
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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.