The spine journal : official journal of the North American Spine Society
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Multicenter Study
Lumbar extraforaminal entrapment: performance characteristics of detecting the foraminal spinal angle using oblique coronal MRI. A multicenter study.
Previous conventional magnetic resonance imaging reports on extraforaminal entrapment (e-FE) on L5-S1 have been problematic because of their complexity or lack of sensitivity and specificity. In this study, we propose a simple diagnostic method for e-FE. ⋯ Determining differences in the FSN angle between the symptomatic and asymptomatic sides of greater than 10° via OC-T2WI represented a simple, readily available, and complementary diagnostic method for lumbar e-FE.
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Odontoid fractures are the most common geriatric cervical spine fractures. Nonunion rates have been reported to be up to 40% and mortality up to 35%, and poor functional outcomes are common. Atlantoaxial instability (AAI) is a plausible prognostic factor, but its role has not been previously examined. ⋯ Patients with acute odontoid fractures and severe AAI may be more likely to experience nonunion and mortality, suggesting the possibility that aggressive management could be warranted. Further investigation with a large prospective study including patient-important functional outcomes is justified.
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Controlled Clinical Trial
Driving reaction time before and after surgery for disc herniation in patients with preoperative paresis.
The effect of many types of surgeries on driving reaction time (DRT) has been reported. Although lumbar disc herniation is one of the most common spinal diseases, the effect on DRT has not been investigated. ⋯ A significant reduction in DRT in patients with right- and left-sided pareses was found after surgery, indicating a positive effect of surgery. The improvement in DRT seen immediately postoperatively and the lack of a generally accepted threshold for DRT would suggest that for both patient samples, it is safe to continue driving after hospital discharge. However, patients should be informed accordingly.
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Observational Study
Patients with low back pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data.
The clinical presentation and outcome of patients with nonspecific low back pain (LBP) are very heterogeneous and may be better understood by the recognition of reproducible subgroups. One approach to subgrouping is the identification of clinical course patterns (trajectories). However, it has been unclear how dependent these trajectories are on the analytical model used and the pain characteristics included. ⋯ The clinical course of LBP is complex. Most primary care patients do not become pain-free within a year, but only a small proportion reports constant severe pain. Some distinct patterns exist which were identified independently of the way the outcome was modeled. These patterns would not be revealed by using the simple summary measures traditionally applied in LBP research or when describing a patient's pain history only in terms of duration. The appropriate number of subgroups will depend on the intended purpose of subgrouping.
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Craniocervical dural arteriovenous fistula (dAVF) is rare as compared with the typical thoracolumbar dAVFs of the spine and usually presents with hemorrhagic manifestation, predominantly intracranial subarachnoid hemorrhage. ⋯ Even though hemorrhagic presentation is fairly common in craniocervical dAVFs, there is no report of a craniocervical dAVF presenting with spinal subdural hemorrhage. The present case further highlights the propensity of these vascular lesions to bleed and emphasizes the clinical importance of including these lesions in the differential diagnosis of hemorrhage in the vicinity of foramen magnum region, whether subarachnoid or subdural in location. Physicians treating spinal pathologies should be aware of this entity and clinical presentation, as an angiography needs to be considered in these cases to direct appropriate referral and treatment.