RESUMO
Following the successful use of lumbar discography in the management of lumbo-sciatic pain, attention focused on the possibility of using such intradiscal injections in the management of cervico-brachial disorders. Much has been written on the subject of cervical discography. However, little is of use to the clinician seeking objective validation of this procedure. Many papers relate to specific workers' own experiences and one cannot but be disturbed at the wide diversity of opinion that has been expressed on the efficacy of cervical discography. In this paper, we review the extensive literature on cervical discography and present our own findings from both in vitro and clinical studies. We conclude that as a technique to locate symptomatic levels, cervical discography is worthless but that the findings of a normal nuclear image will probably indicate an asymptomatic level. Also, we feel that reliance on pain reproduction during injection is doubtful.
Assuntos
Disco Intervertebral/diagnóstico por imagem , Cadáver , Vértebras Cervicais , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Humanos , Injeções , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Pessoa de Meia-Idade , Dor/etiologia , RadiografiaRESUMO
Fifty-two patients with unilateral sciatica caused by intervertebral disc herniation were selected on strict clinical and radiological criteria. All patients had failed to respond to conservative measures. Patients in this trial group randomly were allocated surgery or Chymopapain. During the same period, a further 71 patients, who were put forward for the trial, and did not fulfill the trial criteria, were offered Chymopapain as an alternative to surgery. Both groups were assessed at one month, three months, and one year--progress being recorded by clinical examination and visual analogs. The failure rate in the two Chymopapain groups were comparable, with 52% and 47%, but were significantly higher than the surgical group (11%). Surgery in the failed Chymopapain group frequently was delayed and unrewarding. Failures can be predicted at one month posttreatment, and early surgery may be indicated to prevent chronic scarring.
Assuntos
Quimopapaína/uso terapêutico , Endopeptidases/uso terapêutico , Deslocamento do Disco Intervertebral/terapia , Adolescente , Adulto , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Distribuição AleatóriaRESUMO
By observing the variation of intradiscal pressure occurring at different body postures, it is possible to infer a functional hydrostatic behavior of a lumbar disc. Results from such observations on normal discs are already available. However, observations on degenerate discs are largely restricted to in vitro studies. The authors are now able to report a series of recordings taken from discographically degenerate lumbar discs in patients presenting with low-back pain. In this study of twenty patients, pressure observations were made on 21 normal and 19 abnormal discs. From the results that the authors have obtained, they can reaffirm that normal discs behave predictably and as previously described. The abnormal discs, however, did not behave as a single group. They showed patterns of pressure changes in different postures often dissimilar from that shown by the normal discs both in the absolute values recorded and the sequential changes that occur during the postural change. Unfortunately, the authors were unable to correlate either the extent or character of disc degeneration with the observed variation in pressure changes.
Assuntos
Dor nas Costas/fisiopatologia , Disco Intervertebral/diagnóstico por imagem , Postura , Humanos , Disco Intervertebral/fisiologia , Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiologia , Vértebras Lombares/fisiopatologia , RadiografiaRESUMO
One hundred patients who had sustained a fracture of the tibial shaft and had been treated by internal fixation were reviewed to obtain information on residual ankle and subtalar disability. This study reinforces the belief that early mobilisation of patients with tibial shaft fractures does help to preserve subtalar movement.
Assuntos
Articulação do Tornozelo/fisiopatologia , Tornozelo/fisiopatologia , Pé/fisiopatologia , Fixação Interna de Fraturas , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Fraturas Fechadas/cirurgia , Humanos , MasculinoRESUMO
Modern anthropometric techniques were used to investigate two groups of subjects, one with various syndromes associated with pain in the lower back and the other a control group. Analysis confirmed previous reports that people prone to pain in the back have a greater standing height than people who are not. To investigate this further two new components of height, namely pelvic height and suprapelvic height, were calculated in addition to the established calculation of subischial height. Consecutive components, namely suprapelvic height, pelvic height and subischial height, together constituted the standing height of a subject. The main finding of this investigation was that the relatively large standing height of the subject prone to back pain was due only to the pelvic component.
Assuntos
Antropometria/métodos , Dor nas Costas/diagnóstico , Pelve/anatomia & histologia , Adulto , Idoso , Dor nas Costas/etiologia , Estatura , Humanos , Perna (Membro)/anatomia & histologia , Masculino , Pessoa de Meia-Idade , PosturaRESUMO
A review of 77 patients with traumatic central cord syndrome revealed that atypical variations are more common than the existing literature suggests and that these may be seen in a wide variety of acute injuries to the cervical spine. In general the outcome is good; a favourable prognosis on admission is suggested by good hand function, hyperpathia, Lhermitte's sign and normal perianal sensation. The study has highlighted the value of regular muscle charting and has cast doubt on previous neuroanatomical assumptions about the syndrome.
Assuntos
Traumatismos da Medula Espinal/diagnóstico , Acidentes de Trânsito , Adulto , Traumatismos em Atletas/diagnóstico , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Exame Neurológico , Prognóstico , Radiografia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , SíndromeRESUMO
A new X-ray cassette holder is described which not only facilitates the taking of X-ray films, particularly lateral views, but also stabilizes the part being X-rayed during exposure of the film.
Assuntos
Radiografia/instrumentação , Humanos , OrtopediaRESUMO
The hypothesis is advanced that there are additional and exceptional indications for the use of internal fixation in the patient with multiple injuries. Eleven case studies of patients who sustained major injuries support this hypothesis.
Assuntos
Fixação Interna de Fraturas , Traumatismos da Perna/cirurgia , Acidentes de Trânsito , Adolescente , Adulto , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Humanos , Traumatismos da Perna/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgiaRESUMO
To determine the role of surgery in vertebral neoplasia, we conducted a retrospective review of patients undergoing surgery for vertebral neoplasia in the Royal Orthopaedic Hospital, Birmingham, and Coventry and Warwickshire Hospital, Coventry. Surgery included decompression, stabilisation or both. The neurological status was assessed by Frankel grading before and after surgery. Of 70 patients undergoing surgery, 14 were neurologically intact preoperatively, and a further 25 were weak but ambulatory. Following surgery, 35 were intact, and a further 22 were ambulatory. Sixty-six patients (94%) obtained good pain relief. Survival correlated with histology and younger age at presentation, but not with level, neurology at presentation or type of surgery. We conclude that neurological status, pain relief and mechanical stability are better after appropriate surgery than after radiotherapy or inappropriate surgery. Failure to consider the surgical option may deny the chance of significant neurological recovery.