Relation between pain location and disc pathology: a study of pain drawings and CT/discography.

Objective: The purpose of this study was to determine whether pain location indicated in pain drawings was related to the specific lumbar disc level(s) that was abnormal in appearance and painful upon discographic injection.

Design: Data were collected prospectively.

Setting: This study was conducted in a spine specialty clinic.

Relationship of pain drawings to invasive tests assessing intervertebral disc pathology.

It has been found that the pain patterns in pain drawings are related to the presence of herniated disc identified by myelography. The purpose of this study was to determine whether the pattern of pain in the drawings or the type of pain indicated (aching, burning, numbness, pins and needles, stabbing) was related to the presence of symptomatic disc pathology identified by CT/discography. In a subgroup of patients who underwent myelography, the relationship of the drawings to myelographic findings was also investigated.

Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion.

Study Design: Two hundred-forty consecutive patients underwent laparoscopic instrumented interbody fusion using custom-designed instrumentation and BAK (Sulzer Spine Tech, Minneapolis, MN) fusion cages. The surgeries were performed at eight spine centers during U.S.

Vibration pain provocation can improve the specificity of MRI in the diagnosis of symptomatic lumbar disc rupture.

Objective: The purpose of this study was to determine if vibration pain provocation could be combined with magnetic resonance imaging (MRI) to increase its specificity in identifying symptomatic disc disruption identified by discography.

Design: Prospective single-blind study.

Setting: Data were collected at a spine specialty clinic and at a diagnostic imaging center.

Video-assisted thoracoscopic excision of herniated thoracic disc: description of technique and preliminary experience in the first 29 cases.

This study evaluates the technique and results of video-assisted thoracoscopic surgery (VATS) for the treatment of symptomatic thoracic disc herniation. Results were compared with a literature review of open surgical techniques of thoracic disc excision with regard to efficacy, safety, and surgical outcomes. VATS has recently been described for thoracic surgery as having the advantage of decreased postoperative pain and morbidity, faster patient recovery, and shortened intensive care unit (ICU) hospitalization.

Use of chiropractic manipulation in lumbar rehabilitation.

The beneficial effects of manipulation in relieving symptoms and enhancing spinal flexibility can be a valuable tool in the transition of persons with low back pain into lumbar rehabilitation programs. Manipulation may hasten their entry into active care, or permit them to complete programs that might otherwise be interrupted by symptomatic recurrence. Manipulation science and technical procedures are reviewed as a basis to help understand the utility of properly integrated chiropractic manipulation strategies.

Endoscopic techniques in spinal surgery.

Minimally invasive techniques are becoming more widespread in the surgical subspecialties. Standard open surgical procedures are being modified to become less invasive, with the hopes of decreased recovery time, lessened morbidity, and ultimately, cost savings. Improvements in technology have allowed the surgeon to peer into body cavities and create potential spaces such as the retroperitoneum and the neuroforaminal space without the need for traditional extensile surgical approach.

Laparoscopic fusion of the lumbar spine in a multicenter series of the first 34 consecutive patients.

The purpose of this study was to describe the development of the laparoscopic technique for anterior lumbar fusion and to evaluate the clinical results of a first case series of patients. The in vivo porcine model was used first to develop the technique of transperitoneal laparoscopic interbody fusion. Afterwards, operative time, blood loss, perioperative complications and length of stay were recorded for the first 34 patients who underwent laparoscopic fusion of L4-5 or L5-S1 at two medical centers in 1994.

Discographic pain report. Influence of psychological factors.

Study Design: The possibility of a relationship between discographic pain responses and Minnesota Multiphasic Personality inventory scores was investigated.

Objectives: To determine if patients with elevated Minnesota Multiphasic Personality Inventory scale scores were more likely to report pain on the injection of a nondisrupted disc than were patients without such high scores.

Summary Of Background Data: In general, injection into disrupted discs provokes pain, whereas injection into nondisrupted discs does not.

Lumbar discography. Position statement from the North American Spine Society Diagnostic and Therapeutic Committee.

Study Design: A comprehensive review of the literature dealing with lumbar discography was conducted.

Objective: The purpose of the review was to generate a position statement addressing criticisms of lumbar discography, identify indications for its use, and describe a technique for its performance.

Summary Of Background Data: Lumbar discography remains a controversial diagnostic procedure.

Early changes in bone mineral density above a combined anteroposterior L4-S1 lumbar spinal fusion. A clinical investigation.

Study Design: Fifteen patients meeting rigid study entrance criteria for undergoing a combined anteroposterior L4-S1 spinal fusion as a first time operation were included in the study. Bone mineral density changes at adjacent segments (L3 and L2) were assessed by scanning patients in the anteroposterior and lateral projections before surgery and 3 and 6 months after surgery.

Objectives: To prospectively evaluate changes in bone mineral density at adjacent segments after lumbar spinal fusion and postoperative bracing.

A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description.

Study Design: This report is a preliminary description of the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy.

Objective: This report sought to describe the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy.

Summary Of Background Data: In a landmark study that compared video-assisted thoracoscopic surgery for peripheral lung lesions with thoracotomy, video-assisted thoracoscopic surgery reduced postoperative pain, improved early shoulder girdle function, and shortened hospital stay.

The association between pain drawings and computed tomographic/discographic pain responses.

Study Design: Pain drawings were scored and their relationship to discographic pain responses was investigated.

Objectives: The purpose of this study was to determine if there was a relationship between patients indicating pain in nonanatomic patterns on pain drawings (possibly suggestive of a tendency to overreport pain) and discographic pain responses, and in particular, if patients with abnormal drawings were more likely to provide false-positive discographic pain reports.

Summary Of Background Data: Patients with abnormal pain drawings have been found to have elevated scores on the hysteria and hypochondriasis scales of the Minnesota Multiphasic Personality Inventory.

Intradiscal pressure measurements above an instrumented fusion. A cadaveric study.

Study Design: An in vitro study to determine the intradiscal pressure changes during flexion in levels above a simulated fusion was performed.

Objectives: To determine if intradiscal pressure increases more during flexion in discs above an instrumented spinal segment compared to an uninstrumented segment.

Summary Of Background Data: The progressive degeneration of intervertebral discs adjacent to a fused or fixed segment is a phenomenon that is noted but poorly understood.

Motions of the head and thorax during neck manipulations.

Objective: The purpose of this study was to determine the amplitudes and variations of preload positioning and displacements of the head and thorax during spinal manipulative therapy (SMT) applied to C2.

Design: This experimental study measured the biomechanics of SMT applied to C2.

Setting: Biomechanics Laboratory, Mechanical Engineering and Applied Mechanics, University of Michigan and Spinal Ergonomics and Joint Research Laboratory, National College of Chiropractic.

Laser disc decompression. The importance of proper patient selection.

Study Design: The value of adherence to selection criteria for laser disc decompression (LDD) was evaluated. A total of 204 patients who underwent LDDs were identified. Follow-up information could be obtained for 164 (80.

A multicenter retrospective study of the clinical results of the LINK SB Charité intervertebral prosthesis. The initial European experience.

Objective: This study is a multicenter, retrospective review of the initial clinical results of an artificial disc replacement, the LINK SB Charité intervertebral prosthesis.

Methods: Independent analysis by chart review included patient demographics, surgical data, and a comparison of presurgical to follow-up data. Data were analyzed from 93 patients (average age = 43.

Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.

Study Design: Thirty-five patients with spinal fractures in a series of 1019 patients deteriorated neurologically while in the hospital. Thirty-two were available for review.

Objectives: To determine whether there was a preponderance of a fracture type associated with early neurologic deterioration.

How customer satisfaction can influence clinical outcome in a back specialty clinic.

Determining what defines quality is the aim of the study produced at the Texas Back Institute. Bob Reznik, M.B.

Residual gait abnormalities in surgically treated spondylolisthesis.

The authors retrospectively studied seven patients who had in situ fusion as adolescents for high-grade (IV, V) spondylolisthesis unresponsive to more conservative means. All patients achieved solid bony union; their pain was relieved; and hamstring spasm had resolved. The authors sought to determine whether crouch gait or any other abnormalities could be demonstrated in patients exhibiting clinical parameters of success.

Canal clearance in burst fractures using the AO internal fixator.

The purpose of this study was to evaluate the ability of posterior distraction delivered by the AO internal fixator to effect a satisfactory reduction of the intraspinal fragments in burst fractures. The overall decompression achieved was from an initial compromise of 54% to a residual encroachment of 40%. Canal clearance proved most effective when carried out in the first 4 days, with an initial canal compromise of between 34 and 66%.