Is cervical discography of any value?

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.

A comparison of surgery and chemonucleolysis in the treatment of sciatica. A prospective randomized trial.

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.

The effect of postural changes on the inferred pressures within the nucleus pulposus during lumbar discography.

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.

Hindfoot disability after a tibial shaft fracture treated by internal fixation.

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.

A study revealing a tall pelvis in subjects with low back pain.

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.

A reappraisal of acute traumatic central cord syndrome.

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.

A dual function X-ray cassette holder.

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.

Internal fixation in patients with multiple injuries.

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.

Surgical management of vertebral neoplasia: who, when, how and why?

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.