Clinical orthopaedics and related research
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After 43 years of investigating the intervertebral disk, the long term results of the management of patients from the standpoint of pain are not significantly different than they were prior to the identification of the herniated disk nor do they seem to be significantly different than no treatment at all. This should at least suggest that the phenomena of low back pain is far more complex than can be accounted for on the basis of a simple mechanical-pressure theory of disk derangement. ⋯ It seems most appropriate to attack lumbar disk disease from this standpoint because except in uncommon cases, the pathological process is benign and self limiting. It also seems logical that major advancements in the management of "diskogenic" back pain will depend upon an appreciation of the importance of controlling neural inflammation in the early phases of the disease rather than developing new techniques of managing irreversible neural lesions and their iatrogenetic or psychiatric sequelae.
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Clin. Orthop. Relat. Res. · Nov 1977
Biography Historical ArticleLumbar disk lesions in retrospect and prospect: Joseph S. Barr. Address tape-recorded May 1961.
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Clin. Orthop. Relat. Res. · Oct 1977
Case ReportsKyphotic deformity of the spine in ankylosing spondylitis.
Patients who present with apparent kyphotic deformity of the spine associated with ankylosing spondylitis may have their main deformity in the hip joints, in the lumbar spine, the thoracic spine, or it may be primarily cervical in situation. If any major correction is to be carried out, then the correction should be done in the area of the main deformity. Deformity in each of these areas is amenable to surgical correction, but this requires a very careful assessment, meticulous preoperative planning, and very precise attention to operative technique to allow reasonably consistent success without major risk to the patient.
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Infections of the spine usually involve the vertebral body and therefore by definition produce a kyphosis. Non-tuberculous infection usually staphylococcal and in the lumbar spine, is often diagnosed late and can involve the cord. Open exploration and stabilization with graft should therefore be considered. ⋯ The treatment of spinal tuberculosis should be aimed at correcting 5 basic defects associated with the disease and the deformity: mechanical instability; chronic smoldering infection; spinal cord and nerve root compression; disturbance of spinal growth; depressed lung function. The cornerstone to effective treatment for spinal tuberculosis is drug therapy and the anterior fusion operation. For the established tuberculous kyphosis, which is always a fixed deformity, multiple staged operations and gradual correction used the Halo-pelvic apparatus is the best treatment available at present.
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Clin. Orthop. Relat. Res. · Oct 1977
Transcutaneous electrical neurostimulation: a new therapeutic modality for controlling pain.
Transcutaneous electrical neurostimulation relieves chronic and acute pain by blocking the transmission of pain impulses with comfortable electrical stimulation of light touch sensation. The original Gate Control Theory of Melzack and Wall provides a working model to explain the significant pain relief afforded patients. As high as 80% of selected patients presenting with a wide variety of causes could achieve some relief after treatment. This comfortable, safe method is finding wide application in clinical practice.