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.

Outcomes of therapeutic selective nerve root blocks for whiplash induced cervical radicular pain.

This study was designed to investigate the clinical efficacy of fluoroscopically guided therapeutic cervical selective nerve root blocks (SNRBs) in patients with whiplash induced cervical radicular pain. Study design was restrospective with independent clinical review. Twenty two patients were included.

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.

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome.

Objective: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome.

Design: A retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy.

Therapeutic zygapophyseal joint injections for headaches emanating from the C2-3 joint.

Objective: To report our experience using fluoroscopically guided therapeutic intra-articular C2-3 zygapophyseal joint injections in patients with chronic headaches after a whiplash event.

Design: Restrospective study (n = 18 patients) with independent clinical review. Each patient experienced persistent daily headache symptoms which failed to improve after at least 3 mo of physical therapy, activity restriction, and the use of oral analgesics.

Nonsurgical treatment for radicular of pain of zygoapophyseal joint cyst origin: therapeutic selective nerve root block.

We report the first case of zygoapophyseal joint cyst-induced radicular pain successfully treated with therapeutic selective nerve root block. A 56-year-old dentist presented with pain involving the lateral thigh, lateral calf, and foot dorsum that worsened with standing and walking. Magnetic resonance imaging of the lumbar spine showed a cyst emanating from the right L4-L5 zygoapophyseal joint, resulting in central canal and lateral recess stenosis.

Nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain.

Objective: To evaluate the role of fluoroscopically guided injection procedures in the nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain.

Design: Retrospective study with independent clinical review.

Participants: Fourteen patients (average age, 60.

Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review.

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

Study Design: Retrospective study with independent clinical review.

Participants: Twenty subjects (10 men, 10 women) with mean age 56.

Injuries and special concerns of female figure skaters.

Figure skaters are often young athletes involved in an extremely stressful, structured environment that is focused solely on skating. These athletes are at risk for a multitude of psychologic concerns, including poor communication skills, performance anxiety, stress, and family issues. Helping athletes develop self-awareness, techniques to control stress and anxiety, motivational strategies, ability to maintain concentration, and emotional balance is best done with the guidance of a sports-trained counseling professional.

Sacroiliac joint pain referral zones.

Objective: To determine the patterns of pain referral from the sacroiliac joint.

Study Design: Retrospective.

Participants/methods: Fifty consecutive patients who satisfied clinical criteria and demonstrated a positive diagnostic response to a fluoroscopically guided sacroiliac joint injection were included.

Deep venous thrombosis and pulmonary embolism as a complication of bed rest for low back pain.

A case of bilateral lower extremity deep venous thrombosis and pulmonary embolism as a complication of bed rest prescribed for an acute low back pain episode is presented. A 29-year-old woman with low back pain was prescribed more than 2 weeks of bed rest, during which she developed progressive bilateral lower extremity complaints that were ascribed to nerve root irritation. Her symptoms were initially treated with physical therapy and epidural steroid injections.

Variation in the deoxynucleotide composition between organic and nonorganic strawberries.

The differences in xenobiotic chemical content between organic and nonorganic products can be chemically measured. In this study, the deoxynucleotide composition of strawberry samples is used to demonstrate chromatographic methods of quantifying the differences between pesticide- and toxic-exposed strawberries. The samples were analyzed by (32)P labeling and two-dimensional thin-layer chromatography.

An unusual extraspinal cause of bilateral leg pain.

Low back pain with pain radiating to the lower extremities is common in patients referred to a spine center. Lumbar spine pathology is commonly the etiology of such symptoms, but extraspinal causes of back and leg pain can manifest as a radicular disorder. Extraspinal etiologies must be considered in the workup of back and leg pain.