Spine
-
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.
-
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.
-
Twenty of 26 consecutive patients with sciatica caused by myelographically proven disc protrusions who were treated by chemonucleolysis with chymopapain made useful recovery. There were no major complications attributable to the procedure. Certain diagnostic and clinical criteria are described which appear to be important in producing a favorable result following chemonucleolysis.
-
Percutaneous lumbar medial branch neurotomy is a technique for facet denervation in which the target is specifically the medial branch of the dorsal ramus. The radiology of the technique is illustrated, and the technical aspects of the procedure are described. The accuracy of previous techniques for facet denervation as compared with medial branch neurotomy is reviewed in a comparative analysis of radiographs illustrating the various techniques. It is suggested that the greater accuracy of medial branch neurotomy will permit a more adequate trial of the rationale and efficacy of facet denervation.
-
Selective lumbosacral radiculography and block was performed on 106 patients, using 60% Conray or Dimer-X and 1% lidocaine mixed with corticosteroid. The technique of this method is reported, and the radiculographic findings and diagnostic value of this method are discussed. According to our experience, this method is technically simple and very useful in determining the limit of the lumbosacral nerve root lesion, and occasionally can be used to relieve radicular symptoms. We think it is an especially excellent diagnostic technique for disorders featuring nerve root entrapment in the lateral foraminal recess, in which accurate localization cannot be determined by the other auxiliary diagnostic measures.