Value of diagnostic methods in diagnosis of the disc disease.

Background. Injury of the intravertebral disc after precise clinical evaluation should be confirmed by different radiographic methods. Although diagnostic methods have recently progressed, there are still problems with proper diagnosis concerning the level of pain provocation.
The aim of this study was a comparison of clinical signs of disc prolapse with different radiographic methods and intraoperative findings.
Material and methods. 180 histories of patient treated in the Orthopaedic Clinic of Medical Centre for Postgraduate Education between 1994-2002 were analysed. The most frequent was Lasegue's sign and spine movement limitation. All patients underwent lumbar spine x-ray in order to eliminate bone pathologies of vertebrae. Before making - of operative treatment a decision of magnetic resonance imaging or computer topography were always done. Radiculography was performed only in cases of multilevel disc hernitation and when clinical signs were not obvious.
Conclusions.
1.Clinical examination and first of all different intensity of pain (over 4 degrees in VAS scale) and radiographic imaging were followed by MRI or CT in order to confirm the diagnosis.
2.CT allowed to precise a diagnosis in the case of diagnostic uncertainty among patients with long history of back pain.
3.Compatibility of x-ray (narrowing of vertebral space) with intraoperative findings was 80%. Compatibility of MRI was 96%, and computer tomography 94%.

MRI of the intervertebral disc in lumbar disc disease.

Background. MRI of the intervertebral disc in discopathy of the lumbar spine have been presented.
Material and methods. a group of 51 patients clinically diagnosed as discopathy of the lumbar spine were subjected to three MR imaging procedures. Imaging was performed before surgery, 6 weeks after surgery, and 12 weeks after surgery.
Results. The MRI was consistent with the surgery findings in 88.2% of cases. Instead, images taken 6 weeks after surgery were non-characteristic and difficult to differentiate. In the spinal canal tissue was visible with the image similar to nucleus pulposus herniation, granulation from a growing haematoma, or after surgery scar. Twelve weeks after surgery, the MR image is characteristic and correlated with the patient's clinical state.
Conclusions.
1. MRI image allows an evaluation of intervertebral disc healing after discectomy.
2.MRI 12 weeks post-surgery correlates with patient's clinical symptoms.
3.MRI with Gd-DTPA contrast enhanced allows a precise analysis of the causes of unsatisfactory results of operative treatment.

Differential diagnosis of post-surgery scars and recurrent lumbar disc herniation in MRI.

Background. Spine MR had a significant progress on disc disease diagnosis, reasons of operative treatment failure, and reccurrence of pain.
The aim of the study was to estimate by the use of MRI the causes of pain among patient after discectomy, and to compare them with intraoperative findings.
Material and methods. Between 1994-1998 in the Orthopaedic Clinic in Otwock 42 patients (18 women and 24 men) who underwent discectomy were examined. They suffered from steady back and leg pain. On the base of standard MRI it was not possible to precisely diagnose the cause of pain. A introduction of paramagnetic
Gd-DTPA allowed more precise diagnosis and to ascertain if pain is caused by recurrence of disc hernitation or postoperative scar.
Conclusions.
1. MR was an examination of choice in postoperative diagnosis in disc disease.
2. An examination with Gd-DTPA contrast enhanced allows to differentiate between postoperative scar and recurrent disc herniatation.
3. If postoperative scar is confirmed, the indication for reoperation should be raised very carefully.

Pain in the spine in the context of discopathy and degenerative changes, with particular attention to post-traumatic lesions.

Pain of the cervical spine is either directly or indirectly dependent on degenerative changes in the cervical dinks. Traumatic injury to the cervical spine may result in a cervical syndrome some years later as a result of degenerative changes. Cervical disk protrusuion or degenerative changes can be compared to a similar condition which occurs in the lumbar spine. Differential diagnosis in cases with only local cervical syndrome is difficult. In cases with brachialgia due to disk protrusion or exostosis of the uncinate processes (with segmental syndromes), careful clinical examination is very helpful in diagnosis. Despite the various causes for cervical disk syndromes, the conservative treatment is quite uniform. In cases where results of conservative treatment are non satisfactional, surgery should be disenssed. In cases with massive neurologic deficits, operation is necessary. Authors describe new spine graft "Tibone" for anterior interbody cervical fusion.

[Results of treatment of unilateral sacralization of transverse process of the fifth lumbar vertebrae]. / Wyniki leczenia jednostronnej sakralizacji wyrostka poprzecznego V kregu ledzwiowego.

Pathology and symptomatology of unilateral sacralization of transverse process of the fifth lumbar vertebrae articulating with sacral and iliac bone is presented. Five patients (4 females, 1 male) aged 27-42 are reported. Symptoms included spinal pain, radicular pain, L4/L5 disc prolapse, and lumbar scoliosis. Patients were operated on: resection of the transverse process has been done in all cases, discectomy in 2 cases. Good results were found at the mean follow-up of 3 years. Author's experience supports idea of early surgical intervention in described condition.

[Thoracic outlet syndrome]. / Barkowy zespól uciskowy peczka naczyniowo-nerwowego.

Results of surgical treatment for thoracic outlet syndrome in 7 patients are reviewed. The symptom has been caused by cervical rib in 5 cases, in 1 case by the first rib anomaly and in 1 case by disturbed attachment of m.scalenus anterior. A case of misdiagnosed cervical rib is described in details; the patient has been operated on peripherally and serious iatrogenic complications followed. Ineffectiveness of pharmacotherapy and physiotherapy is pointed out. Surgical treatment resulted in remission of symptoms in 6 cases; in case of patient with iatrogenic complications marked improvement has been achieved. The aim of this paper is to demonstrate, that thoracic outlet syndrome promptly diagnosed and surgically treated has good prognosis.

[Two cases of coexisting dysplasia fibrosa and mesenchymoma]. / Dwa przypadki równoczesnego wystepowania dysplazji wlóknistej kosci z mezenchymoma.

Two patients with dysplasia fibrosa who also had a tumor of mesenchymal origin are presented. One of them underwent one time resection of dysplasia fibrosa focus and the tumor, the other had the tumor resected 17 years after surgical resection of focus in the femur. The authors suggest an etiologic relationship between these two conditions based on mesenchymal changes--the occurrence never described previously. They also indicate efficacy of surgical treatment.

[Complications of vertebral disc and spinal diseases after manipulation therapy]. / Powiklania choroby dyskowej i chorób kregoslupa po zabiegach kregarskich.

Complications caused by manipulation therapy in 3 cases of spine condition and 22 cases of vertebral disc disease observed in relatively short period of time are presented. In the first instance the patients were not diagnosed by physician. In the second one in all cases the nucleus pulposus protruded under the anterior ligament or into the spinal canal. It resulted in marked worsening of the patient's condition. The mechanism of disc damage has been determined intraoperatively. The authors conclude that manual therapy not preceded by precise diagnosis is highly hazardous.