Reducing Errors in Transition from Acute Stroke Hospitalization to Inpatient Rehabilitation.

Objective: Effective stroke care does not end with acute treatment during hospitalization, but extends through rehabilitation and secondary stroke prevention. In transitions across care environments, stroke patients are vulnerable to errors in communication of diagnosis and treatment. This study aimed to demonstrate that formalized communication between the neurology team and the rehabilitation medicine team would promote secondary stroke prevention and minimize interruptions during rehabilitation.

Cervicogenic headache.

Chronic headache is a significant medical and socioeconomic problem resulting in severe disability and impairment. The term "cervicogenic headache" was coined by Sjaastad in 1983, who also proposed criteria for its diagnosis. Cervicogenic headache as described by Sjaastad et al is characterized as recurrent, long lasting, severe unilateral headache arising from the neck.

The evolution of informed consent: failures of the current system of human protection.

The reliance of subjects and researchers on the current regulatory scheme for human subject protection is misplaced. Investigators often assume that compliance with the requirements of the Common Rule, including Institutional Review Board approval of their research project, adequately fulfills the spirit of the federal regulation and protects them from liability for lack of adequate informed consent. Subjects and physicians referring subjects, believe that institutional approval of studies assures that they are scientifically valid and ethical.

Vascular supply to the lumbar spine: an intimate look at the lumbosacral nerve roots.

The vascular supply of the lumbar vertebral column is a diverse collection of arteries originating from both central and peripheral sites. Until recently, the majority of these studies have been dedicated to the blood supply of the spinal cord and vertebral bodies. More recent effort has been directed toward the identification of the vascular supply to the lumbar nerve roots.

Clinical evidence of chemical radiculopathy.

It is universally accepted that an anatomic abnormality such as a herniated disc or spinal stenosis can lead to radicular leg pain. There is some controversy as to whether radicular pain can be caused by a non-structural, solely biochemical disorder. Prior studies using biochemical analysis of inflammatory mediators of the disc or surrounding structures have enumerated many possible biochemical mediators of radicular pain.

Interventional spine research: the evolution of informed consent.

The future success of the field of interventional pain medicine depends on proof of positive outcomes. Evidence based medicine has an increasing relationship to insurance reimbursement. This makes new modes of pain management dependent upon human subject research.

Painless foot drop: an atypical etiology of a common presentation.

Weakness of the dorsiflexor muscles of the foot is a relatively common presentation. In most cases, the etiology involves a peripheral injury to the common peroneal nerve. These patients usually present with lower motor neuron findings on evaluation.

Randomized controlled trials in interventional spine: perils and pitfalls.

It is the responsibility of clinician investigators to advance clinical knowledge and specifically its application to patient care. Randomized controlled trials remain near the top of the hierarchy of evidence based medicine. The acquisition of evidence based medicine by means of randomized controlled trials presents general difficulties and additional pitfalls specific to interventional treatments.

Incidence of vocal cord dysfunction after fluoroscopically guided steroid injections in the axial skeleton.

Objective: To report on the incidence of dysphonia and/or associated throat symptoms after steroid injections in the axial skeleton.

Design: A prospective cohort study.

Setting: Academic spine center.

MR lumbar discography with intradiscal gadolinium in patients with severe anaphylactoid reaction to iodinated contrast material.

Objective: Describe our experience using discography with intradiscal gadolinium and MR lumbar discography in patients with a history of severe anaphylactoid reaction to iodinated radiocontrast agents.

Design: Observational study of 14 patients.

Methods: From 1997 to 1999, 14 patients were referred for lumbar discography with intradiscal gadolinium followed by MRI.

Etiologies of failed back surgery syndrome.

Study Design: Retrospective chart review.

Objective: To report the epidemiologic data of nonsurgical and surgical etiologies of failed back surgery syndrome (FBSS) from two outpatient spine practices.

Summary Of Background Data: FBSS has been offered as a diagnosis, but this is an imprecise term encompassing a heterogeneous group of disorders that have in common pain symptoms after lumbar surgery.

Inciting events initiating injection-proven sacroiliac joint syndrome.

Objective: To determine the inciting events leading to the development of sacroiliac joint syndrome (SIJS).

Methods: This was a retrospective descriptive cohort series from an academic interdisciplinary spine center. Consecutive patients presenting with low back or buttock pain with or without leg symptoms who met specific inclusion and exclusion criteria for the diagnosis of SIJS were included in the study.

Abdominal pain secondary to a sacral perineural cyst.

Background Context: Perineural cysts are commonly found in the sacral region and are incidently discovered on imaging studies performed for the evaluation of low back and/or leg pain.

Purpose: To report on a patient presenting with abdominal pain secondary to a large sacral perineural cyst.

Study Design/setting: Case report.

A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain.

Background Context: Lumbar zygapophysial joints are currently believed to be a cause of axial low back pain. Once this diagnosis is made, decisions about when to institute a particular intervention and which treatment to offer is regionally and specialty dependent.

Purpose: To perform a critical review of prior published studies assessing the use of interventional treatment options for the treatment of lumbar zygapophysial joint syndrome.

Sacral stress fracture in a female field hockey player.

We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction.

Epidemiology of spine tumors presenting to musculoskeletal physiatrists.

Objective: To report the incidence and epidemiologic formation of previously undetected primary and secondary spine tumors presenting as spinal and/or extremity pain to a physiatrist practicing in an academic or private practice multidisciplinary spine center.

Design: Multicenter retrospective chart review.

Setting: Three multidisciplinary spine settings (1 academic, 2 private).

Dysphonia associated with epidural steroid injection: a case report.

A 46-year-old patient with left-side low back pain developed symptoms of dysphonia and throat irritation 24 hours after receiving a fluoroscopically guided steroid injection into the epidural space. A direct laryngoscopy performed before a second injection detected no abnormalities. When dysphonia reappeared 48 hours after that injection, laryngoscopy revealed edema in the anterior vocal cord with thick surrounding mucous.

"EMG disease" with bulbar muscle involvement: a case report.

We report the first case of diffuse abnormal insertional activity with bulbar muscle involvement. Electromyography performed 5 months earlier reported multilevel radiculopathy. A repeat electromyography study revealed short trains of positive waves without fibrillation potentials, diffusely present in all tested muscles.