Journal of spinal disorders
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Randomized Controlled Trial Multicenter Study Clinical Trial
Pain from the lumbar zygapophysial joints: a test of two models.
One hundred seventy-six consecutive patients with chronic low-back pain and no history of previous lumbar surgery were studied to test the clinical criteria of Fairbank et al. and Helbig and Lee for zygapophysial joint pain. All patients underwent a history, examination, and a series of zygapophysial joint injections or blocks of the medial branches of the dorsal ramus with lignocaine. ⋯ None of the clinical features tested was found to be associated with response to the confirmatory block. The Fairbank et al. and Helbig and Lee criteria were shown to be unreliable in distinguishing pain of zygapophysial joint origin from pain of other origins.
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Review Case Reports
Spinal epidural lipomatosis: two new idiopathic cases and a review of the literature.
Thoracic spinal epidural lipomatosis, a rare cause of myelopathy, is most commonly associated with exogenous corticosteroid use. The authors present the clinical, magnetic resonance imaging, computed tomography, and surgical findings for two patients with idiopathic epidural lipomatosis, successfully treated with decompressive laminectomy accompanied by fatty debulking, followed for > 3 postoperative years. They review the literature on idiopathic spinal epidural lipomatosis as well as cases associated with exogenous steroid use.
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The electrophysiological, neurological, and neuropathological correlates of the spinal cord ischemia induced by the aortic cross-clamping of cats were studied with the goal of developing the reliable evoked spinal cord potentials (ESCPs) for the monitoring of spinal cord ischemia. The five types of ESCPs were elicited as follows; descending ESCPs recorded from the L2 and L5 vertebral levels, vertex motor evoked potential from the L2 vertebral level, ascending ESCP from the T1 vertebral level, and segmental ESCP after sciatic nerve stimulation. The late negative waves of both descending ESCP from L5 and segmental ESCP were susceptible to ischemia. ⋯ Therefore, the late negative wave of the descending ESCP from L5 served as the most reliable index for spinal cord ischemia. When aortic clamping was continued for > or = 30 min after the disappearance of the late negative wave of descending ESCP from L5, the amplitude recovery of this wave decreased to 25%, resulting in paraplegia. Histologically, the posterior horn of the gray matter in the lumbar enlargement was the most vulnerable to ischemia.
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The clinical and radiographic results of lumbar isthmic spondylolisthesis were compared between interspinous block-assisted anterior interbody fusion (block-assist group, n = 16) and anterior interbody fusion with no use of the block (nonassist group, n = 17) with an average follow-up of 7 years (range 1 1/3-13 years). Satisfactory relief of low-back pain, significantly early interbody union (union rate 88%, p < 0.05), and spontaneous fusion of pars defect (fusion rate 44%, p < 0.05) were obtained in the block-assist group. In the nonassist group, interbody union was markedly delayed (p < 0.05), the union rate was 53%, and spontaneous fusion of the pars was found in 12% of patients. The overall clinical results at final follow-up in both groups did not show a statistically significant difference, but the results tended to be superior in the block-assist group.