A review of diagnostic ultrasound of the spine and soft tissue.

BACKGROUND: Current medical applications for diagnostic ultrasound are numerous. The technology is attractive because of its ease of use, noninvasive nature and low cost. Recent technological advances have improved ultrasound images of spine-related soft tissues. OBJECTIVE: To examine and summarize the spine-related diagnostic ultrasound literature to help aid in understanding its possible applications. DATA SOURCES: This literature search was part of a larger search in which several hundred musculoskeletal diagnostic ultrasound articles were collected. MEDLINE from 1970 to present was searched electronically. Chiropractic Research Archives Collection (Vol. I-IV) were inspected manually. Bibliographies and references from studies obtained were examined thoroughly for additional references. DATA SYNTHESIS: All articles related to diagnostic ultrasound and its spinal applications were collected and reviewed, except those focusing on intraoperative spinal ultrasound in neurosurgery. RESULTS: Ultrasound has long been used to measure the spinal canal, detect cord abnormalities and examine soft tissue abnormalities. Recently, it has been used to quantify scoliotic curves, measure multifidus muscle size and image sciatic nerve lesions. CONCLUSION: Several well-documented applications of spine-related diagnostic ultrasound, along with many new possible applications, make this technology important to any clinician interested in noninvasive diagnostic applications for the spine and soft tissue.

Comparison of leg length inequality measurement methods as estimators of the femur head height difference on standing X-ray.

OBJECTIVE: To assess the validity and reliability of prone and supine measurements of leg length inequality and to determine the potential use of measurements at the iliac crests and patient demographics as predictors to estimate standing leg length differential. DESIGN: Repeated prone and supine measurements of leg length inequality were made by an experienced chiropractor and compared with iliac crest and femur head measurements made on X-rays of standing patients. Multiple regression analysis was performed. SETTING: Private chiropractic practice. PARTICIPANTS: The first 50 new patients with low back pain that were X-rayed were included in the study. RESULTS: Intraexaminer reliability was excellent for the prone measurements. The supine tests were less reliable. The prone measurements were highly correlated with the standing X-ray femur head measurement. The supine measurements were poorly correlated. Measurements of deficiency at the iliac crests on X-ray were most highly correlated with X-ray measurements of discrepancy. In multiple regression, the prone measurements and duration of problem were the only significant predictors of standing X-ray difference. CONCLUSIONS: In this study, crest measurements were made on X-ray; the degree of accuracy with which millimeter differences can be measured clinically on patients is unknown. In a few cases, the supine measurements were more accurate than the prone; however, the supine test validity was poor when compared with the standing X-ray measurements, and reliability was less than expected. Supine measurements should not be used to estimate standing leg length discrepancy in new low back pain patients but perhaps can be used in other clinically meaningful ways. Intraexaminer reliability of the prone measurements was higher, but further investigations need to focus on interexaminer reliability. The prone measurement as a predictor holds promise, but new measurement tools must be developed.

The validity of the prone leg check as an estimate of standing leg length inequality measured by X-ray.

OBJECTIVE: To determine if prone leg length measurements for inequality are valid to estimate standing X-ray measured differences. DESIGN: Leg length inequality (LLI) was measured, in millimeters, with each patient prone and with a standing X-ray, by an experienced chiropractor. Correlation between the two was calculated, and dependent t test performed. SETTING: Private chiropractic practice. PARTICIPANTS: The first 50 new patients with low back pain (LBP) who were X-rayed were included in the study. RESULTS: Correlation between the two variables was 0.71. Standard error of estimation was 5.4 mm. In 54% of subjects, the prone measurement was within 3 mm of the X-ray LLI; in 12%, however, opposite legs were identified as being "shorter" between the two methods. In 76% of patients, prone measurements were within 6 mm of X-ray, but there was 12-mm difference between the two measurement methods in 8% of the comparisons. CONCLUSIONS: Despite positive correlation, prone leg length measurements for inequality are not entirely valid estimates of standing X-ray differences. Large differences between prone and X-ray measurements in some cases indicate that one should be cautious when using the prone method alone to estimate leg length discrepancy. Additional research is needed to determine the causes of measurement differences between the two methods. Other methods for estimating standing leg length differential must be developed and evaluated for validity.

Cutaneous metastases. Report of two cases of prostatic cancer.

Less than 5 percent of internal malignant tumors metastasize to the skin. Prostatic carcinoma accounts for a small percentage of such tumors. The lesions are solid, rarely ulcerate, are few in number and are usually localized to the groin, the head, or the neck. The occurrence of cutaneous metastases from prostatic carcinoma frequently signifies well-advanced disease and portends a rapidly fatal course.

Use of the iced cystogram to differentiate bladder neck and external sphincter obstruction.

An iced cystogram was done on 31 patients with neurogenic bladder and voiding dysfunction. We observed 5 distinguishable patterns upon which therapeutic measures to improve balance could be based. We found the iced cystogram to be a simple, inexpensive yet reliable technique to assess detrusor sphincter imbalance. With the information obtained from this study the therapeutic options were delineated more clearly and the results of the treatment were made more predictable.