Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
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Case Reports
Congenital absence of lumbosacral articular facet joint associated with conjoined nerve root: a case report.
We report a rare case of congenital absence of the L5-S1 facet joint, which was associated with a conjoined nerve root. Combination of these two anomalies has been quite rarely reported in the literature. A 39-year-old man presented with acute low back pain and right leg radiating pain. ⋯ Intraoperative findings revealed that the right L5 nerve root and S1 nerve root were conjoined, and the conjoined nerve root was compressed by L5-S1 disc herniation, which led to impairment of the conjoined nerve root by a single-level lumbar disc herniation. After removal of the disc herniation, his right leg pain immediately subsided, however muscle weakness and sensory disturbance persisted. Surgeons should be aware of this nerve root anomaly when examining a patient who shows an unusual clinical presentation and/or congenital osseous anomaly.
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Cervical degenerative pathology produces pain and disability, and if conservative treatment fails, surgery is indicated. The aim of this study was to determined whether anterior decompression and interbody fusion according to Cloward is effective for treating segmental cervical degenerative pathology and whether the results are durable after a 10-year-minimum follow-up. ⋯ The Cloward procedure proved to be a suitable and effective technique for treating segmental cervical degenerative pathology, allowing good clinical and radiographic outcomes even at a long-term follow-up.
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Cerebro-spinal fluid leakage from a spinal stab wound is rare, and usually not a life-threatening injury. Pneumocephalus, a possible rare complication of traumatic cerebro-spinal fluid leakage, can potentially lead to intracranial hemorrhage and death. We describe two cases of spinal stab wounds complicated by cerebro-spinal fluid leakage, one of them developing into severe pneumocephalus. Both patients recovered completely with the following treatment protocol: (a) trendelenburg positioning of the patient, (b) insertion of a continuous-drainage cerebro-spinal fluid catheter into the lumbar thecal sac, (c) primary suture of the leaking skin wound, (d) IV antibiotic therapy.
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Patient age, radiographic severity of osteoarthritis (OA), and severity of symptoms are typically considered as the three key factors in selecting the osteoarthritic patients for total knee arthroplasty (TKA). The purpose of this study was to evaluate the associations between the three selection criteria and the postoperative outcomes including patient satisfaction. We also attempted to determine whether the patients not fully satisfying the criteria are different from the typical candidates in postoperative outcomes. ⋯ This study indicates that, when considering TKA as a treatment option, orthopedic surgeons need to comprehend the selection criteria in an overall view to offer the best timing for optimal postoperative outcomes.
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Randomized Controlled Trial
Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain.
The efficacy and safety of the association of celecoxib [a selective cyclooxygenase-2 (COX-2) inhibitor] and pregabalin (commonly used to control neuropathic pain), compared with monotherapy of each, were evaluated for the treatment of chronic low-back pain, a condition known to be due to neuropathic as well as nociceptive pain mechanisms. ⋯ Combination of celecoxib and pregabalin is more effective than monotherapy for chronic low-back pain, with similar adverse effects.