The spine journal : official journal of the North American Spine Society
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Case Reports
Isolated extraosseous epidural myeloma presenting with thoracic compressive myelopathy.
Multiple myeloma is the commonest primary malignancy of the spine, but it rarely presents as an extraosseous epidural tumor with only five cases reported in literature so far. ⋯ Isolated extraosseous epidural myeloma without destruction or collapse of vertebral bodies should be included in the differential diagnosis of epidural mass lesions causing spinal cord compression. The overall prognosis in terms of survival is poor, but early decompression can prevent neurological deterioration and improve quality of life.
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Image-guided cervical nerve injections are being performed with increasing frequency. Severe complications are being reported. ⋯ A technique for cervical nerve injection is described with the results of the injection. This technique may allow some standardization in the procedure, decrease the learning curve for training physicians, and minimize the potential complications.
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Low back pain (LBP) is a widespread musculoskeletal condition that frequently occurs in the working-age population. Numerous occupational physical activities have been implicated in its etiology. ⋯ A summary of existing studies was not able to find any high-quality studies that satisfied more than two of the Bradford-Hill causation criteria for occupational standing or walking and LBP. Based on the evidence reviewed, it is unlikely that occupational standing or walking is independently causative of LBP in the populations of workers studied.
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This commentary is a product of the North American Spine Society (NASS). It was approved by the NASS Board of Directors and accepted for publication outside The Spine Journal's peer review process.
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Controlled Clinical Trial
Cytokine evaluation in individuals with low back pain using discographic lavage.
The pathophysiology underlying degenerative disc disease and its implication in painful syndromes remain unclear. However, spine magnetic resonance imaging (MRI) can demonstrate changes in disc water content and the annulus; provocative discography purportedly identifies degenerate discs causing serious low back pain; and biochemical assays have identified local inflammatory markers. No study to date has correlated pain on disc injection during discography evaluation with relevant MRI findings and biochemical markers. ⋯ Among the potential inflammatory markers tested in this Phase 1 study, IFN-gamma immunoreactivity was most commonly elevated in discogram "positive" discs but absent in asymptomatic controls. However, this marker was also frequently elevated in degenerative but "negative" discography discs. From these findings, Phase 2 and Phase 3 validity studies are reasonable to pursue. Phase 4 utility studies may be performed concurrently to assess this method's predictive value in outcome studies.