Occurrence of bilateral sacroiliitis and ossification of anterior spinal ligaments in the same patient.

Abstract Enthesopathy and ligament calcification may occur in both the degenerative and inflammatory types of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis. Despite their fairly frequent occurence in rheumatic disease care settings, few reports of their presence in the same patient have appeared in the literature. In this report, we present the case of a male patient with chronic low back pain, who had both ossification of anterior spinal ligaments and bilateral sacroiliac joint ankylosis, and discuss the known pathogenesis of diffuse idiopathic skeletal hyperostosis.

Diurnal variation of antidiuretic hormone and urinary output in spinal cord injury.

INTRODUCTION: Healthy individuals have a nocturnal decrease in urine output due to increased plasma antidiuretic hormone levels at night. This does not occur in spinal cord injury and most patients experience nocturnal polyuria, which triggers dysreflexic crises secondary to urinary bladder overdistension, and interferes with patients' sleep due to the need for extra catheterization. OBJECTIVE: To evaluate the diurnal variation in ADH level, urinary output, and plasma and urine osmolality in SCI patients with regard to their level of injury and in comparison with age- and sex-matched healthy individuals. MATERIALS AND METHODS: Sixteen ASIA-A spinal cord-injured patients, eight with paraplegia, eight with tetraplegia, and eight healthy individuals, were evaluated for urinary output, urine and serum osmolality, and antidiuretic hormone levels during day and night hours. RESULTS: Absence of diurnal variation in urinary output and antidiuretic hormone secretion was detected in both paraplegic and tetraplegic patients, while antidiuretic hormone levels rose significantly at night in the control group. CONCLUSION: Antidiuretic hormone levels should be monitored both day and night in spinal cord injury patients, with severe nocturnal polyuria. Treatment with desaminocystein-D-arginine vasopressin can be attempted when conservative measures fail to control nocturnal polyuria, especially in patients who are on an intermittent catheterization program.

Double spinal cord injury in a patient with ankylosing spondylitis.

Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The first injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized.

Hyperbaric oxygen therapy: implications for spinal cord injury patients with intrathecal baclofen infusion pumps. Case report.

A patient with a cervical spinal cord injury receiving intrathecal baclofen for spasticity control underwent a 7 week course of hyperbaric oxygen therapy to induce healing of an ischial decubitus ulcer. After completion of this treatment and during a routine baclofen infusion pump refill, the actual pump reservoir volume exceeded computer measurements obtained with telemetry. Examination of the physiology of hyperbaric oxygen therapy in relation to infusion pump function revealed that the intraspinal pressures attained during hyperbaric oxygen therapy produced retrograde leakage of cerebrospinal fluid into the infusion pump reservoir.

Isokinetic measurement of trunk muscle strength in women with chronic low-back pain.

OBJECTIVES: To investigate the relationships among chronic low-back pain and obesity, total spinal range of motion, and trunk muscle strength. The short-term impact of trunk muscle strengthening exercises on this condition was also examined. DESIGN: A controlled, prospective study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength. The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo, and the control group included 20 age-matched women without known low-back trouble. The Davenport Index was used to calculate the body mass indexes of all subjects. The Oswestry Disability Questionnaire was used to assess pain in the study group. Full flexion and extension ranges of motion were measured, then isokinetic measurements of trunk muscles were performed at 60-, 120-, and 180-degrees/sec velocities. Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle. RESULTS: Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain (P < 0.05). After a 15-day standard trunk strengthening exercise program in the patient group, trunk muscle strength was found to be increased (P < 0.05). CONCLUSIONS: Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain, and a trunk muscle strengthening program will be helpful in reducing the pain.

Assessment of spasticity using isokinetic dynamometry in patients with spinal cord injury.

OBJECTIVES: To determine the value of isokinetic dynamometric measurement of passive resistance in quantifying spasticity. SETTING: Turkey. METHODS: Thirty-three spastic spinal cord-injured patients and 14 age-matched normal individuals were studied. Five consecutive flexion-extensions of the knee, abduction-adductions of the hip, and dorsal-plantar flexions of the ankle were performed at specific velocities (15, 30, 60, 90 and 120 degrees /s) using a computerized isokinetic dynamometer set at the continuous passive motion mode. We recorded maximum torque and the sum of torque amplitudes for five repetitions of each type of joint motion at all velocities. RESULTS: Maximum torque values and the sum of torque amplitudes were both significantly higher in spastic patients than in controls, and there was a positive correlation between torque values and Ashworth scores. There was no significant linear increase in torque values associated with increasing velocity for any of the motions in either controls or patients. CONCLUSION: Isokinetic dynamometric measurement of passive resistance appeared to be a valuable tool for assessing and quantifying spasticity, as well as other types of hypertonus.

Intrathecal baclofen: does tolerance occur?

Concern over the development of tolerance in patients on continuous intrathecal baclofen therapy has arisen as this new form of treatment for spasticity has gained wider use. We have studied time-dose relationships in 18 spinal cord injured patients who have undergone intrathecal baclofen infusion pump implantation since February 1988 in our facility. Our data show that there was a significant increase in baclofen dosage needed to control spasticity during the first 12 months post implantation. After 12 months, however, no significant changes in dosage requirement was detected. In addition, there was no significant difference between completely and incompletely spinal cord injured patients with regard to both the initial dose and the tolerance trend.