Lumbar Radicular Pain Response to First Injection with Non-particulate Steroid.

Introduction Recent studies on the use of transforaminal epidural steroid injection (TFESI) to treat lumbar radicular pain have highlighted controversies pertaining to the choice of corticosteroid agent utilized in lumbosacral TFESI, in terms of both safety and efficacy. The primary objective was to characterize the radicular pain response after a first transforaminal injection with dexamethasone. The secondary objective was to document the response of those who failed to respond to a dexamethasone injection when particulate steroid was utilized for a second injection.

Advances in technology and surgical technique in spine surgery.

This comprehensive review article encompasses a broad variety of topics within the spinal literature and includes an update on the latest technology and techniques for the spine.

Seated transforaminal injection approach in severe lumbar stenosis.

The use of seated positioning for the performance of a fluoroscopically guided transforaminal lumbar epidural injection is presented. An 81 year old gentleman presented with a lumbar radiculopathy with radiographs demonstrating foraminal stenosis arising in the setting of offending disc pathology, multilevel and advanced central canal compromise, and a scoliotic deformity. He was unable to tolerate prone positioning secondary to radicular pain.

Atypical proximal limb pain of suspected high lumbar stenotic origin arising from severe aortoiliac disease--Leriche's syndrome.

We present the cases of two middle aged women who were referred to our physiatric spine center with chronic and proximal lower extremity pain complaints of suspected upper lumbar and stenotic origin. Their histories, physical examinations, and imaging studies were not convincing for a primary radicular pain generator. Non-invasive arterial Doppler studies demonstrated a significant brachial to high thigh pressure discrepancy without a focal segmental drop affecting the more distal lower extremity vasculature.

Complications of halo fixation of the cervical spine.

Halo fixators play an integral role in stabilizing the cervical spine. They are most widely used after upper cervical to midcervical spine fractures and dislocations and as a supplement to various surgical fixation techniques. Compared with supine cervical traction techniques, halo fixators allow early patient mobilization and shorten hospital stays.

Resolution of pronounced painless weakness arising from radiculopathy and disk extrusion.

In this retrospective, consecutive case series, we report the nonsurgical and rehabilitation outcomes of consecutive patients who presented with pronounced painless weakness arising from disk extrusion. Seven consecutive patients who chose physiatric care were followed clinically, and strength return was monitored. Each presented with predominantly painless radiculopathy, functionally significant strength loss, and radiographic evidence of disk extrusion or sequestration.

Whiplash: fact or fiction?

Cervical sprain/strain or whiplash injuries are a common cause of acute and chronic musculoskeletal impairments and are ubiquitous after rear-end automobile collisions. The diagnosis is largely subjective and the ideal treatment controversial. Unfortunately, the majority of compensated litigation claims are associated with whiplash-type injuries secondary to motor vehicle accidents.

Measurement variability in the assessment of sagittal alignment of the cervical spine: a comparison of the gore and cobb methods.

Background: Reconstructive procedures of the cervical spine are being performed with increasing frequency. Maintenance of physiologic sagittal alignment is an essential component of reconstructive procedures of the spine. Two methods exist for measuring sagittal alignment in the cervical spine: the Gore and Cobb methods.

Therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain.

Objective: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain.

Design: Retrospective study with independent clinical review. A total of 15 patients who met specific physical examination or electrodiagnostic criteria and failed to improve clinically after at least 4 wks of physical therapy were included.

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.

Severe coronary artery disease presenting with a chief complaint of cervical pain.

We present the case of a 49-yr-old man with cervical pain of 14 wk of duration. Physical examination and magnetic resonance imaging of the cervical spine demonstrated no neurologic abnormality or corroborative pathology. Cardiac catheterization demonstrated advanced multivessel disease.

Pathophysiology of inflammatory, degenerative, and compressive radiculopathies.

In answering the patient's question regarding how treatments are likely to "help [her] herniated disc," the mechanical and chemical components of radiculopathy should be addressed. Focal disc abnormalities often can be observed in those without pain, and symptomatic discs can become asymptomatic. Disc lesions can resolve radiologically with time, and patients' symptoms can improve before their radiographs.