| 1. |
- Albeck, Michael J, et al.
(författare)
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A controlled comparison of myelography, computed tomography, and magnetic resonance imaging in clinically suspected lumbar disc herniation
- 1995
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Ingår i: Spine. - 0362-2436. ; 20:4, s. 443-448
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN. A controlled prospective blinded study. OBJECTIVES. To compare the diagnostic power of myelography, computed tomography and magnetic resonance imaging in the diagnosis of low lumbar disc herniation. METHODS. Eighty patients with monoradicular sciatica were examined by myelography, computed tomography, and magnetic resonance imaging, and all underwent subsequent surgery. The images were evaluated twice in a blinded fashion, and the diagnostic power of the modalities was expressed by a decision-analytic regret function. RESULTS. In 57 patients (71%) a disc herniation at the expected level was disclosed at surgery. The largest amount of diagnostic information was gained from computed tomography, followed by magnetic resonance imaging and myelography. Both computed tomography and magnetic resonance imaging were significantly informative, whereas this was not the case for myelography. CONCLUSION. The results indicate that computed tomography or magnetic resonance imaging should be the first choice for imaging in patients with suspected lumbar disc herniation.
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| 2. |
- Annertz, Mårten, et al.
(författare)
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No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients
- 1995
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Ingår i: Spine. - 0362-2436. ; 20:4, s. 449-453
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN. Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES. To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA. Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS. The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS. Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION. No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned.
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| 3. |
- Axelsson, Paul, et al.
(författare)
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Mechanics of the external fixation test in the lumbar spine. A roentgen stereophotogrammetric analysis
- 1996
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Ingår i: Spine. - 0362-2436. ; 21:3, s. 3-330
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: By implanting tantalum indicators percutaneously during application of pedicular screws, lumbosacral mobility could be studied with roentgen stereophotogrammetric analysis in seven patients having a diagnostic external fixation test. OBJECTIVES: To determine the mechanical effects on the segmental mobility during an external fixation test of the lumbar spine. SUMMARY OF BACKGROUND DATA: External pedicular fixation test of the lumbar spine has been reported a valuable prognostic instrument in fusion for low back pain. METHODS: A Magerl external fixation device was applied in seven patients with low-grade spondylolysis-olisthesis. By using roentgen stereophotogrammetric technique, the intervertebral translations in the lumbosacral segment were determined. Each patient had three separate examinations; with the frame fixed, with the frame loosened, and without frame 6 weeks after screw removal. RESULTS: With the external frame fixed, the sagittal intervertebral translations were significantly reduced, in three cases to a level beneath the accuracy of the measuring method. One patient had the same immobilizing effect even with the frame loosened while for the others loosening of the frame meant regained mobility of the segment. CONCLUSION: The properties of the external fixator give an adequate mechanical basis for the prognostic external fixation test in lumbar fusion.
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| 4. |
- Axelsson, Paul, et al.
(författare)
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The spondylolytic vertebra and its adjacent segment. Mobility measured before and after posterolateral fusion
- 1997
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Ingår i: Spine. - 0362-2436. ; 22:4, s. 7-414
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: By using roentgen stereophotogrammetric analysis in six patients having tantalum indicators implanted at a preoperative external fixation test, the mobility in the spondylolytic lumbosacral level and its adjacent segment could be studied before fusion and during the course of postoperative fusion consolidation. OBJECTIVE: To study the mobility effects on the segment adjacent to a lumbar fusion over time from the preoperative situation until fusion healing as defined by roentgen stereophotogrammetric analysis. SUMMARY OF BACKGROUND DATA: In vitro studies indicate that the altered biomechanical situation after lumbar fusion increases the intradiscal pressure and changes the kinematics in the juxtafused segment. METHODS: Six patients with low grade spondylolysisolisthesis were scheduled for fusion of the spondylolytic lumbosacral segment after a preoperative external fixation test. The latter procedure also included implantation of tantalum markers for spinal roentgen stereophotogrammetric analysis. Each patient was examined by roentgen stereophotogrammetric analysis at four separate occasions: before fusion (2 months after removal of the external frame) and 3, 6, and 12 months after surgery. The translatory movements of the L5 vertebra in relation to sacrum and of the L4 vertebra in relation to the L5 vertebra were calculated at each examination. RESULTS: For the juxtafused L4-L5 level, increased and decreased mobility patterns could be identified. Transformation of the preoperative mobility in the lumbosacral segment to the adjacent segment during fusion consolidation was verified in two patients but was not a general phenomenon. CONCLUSION: Fusion of the lumbosacral segment can alter the kinematics of the adjacent segment, redistributing the mobility toward relative hypermobility in the juxtafused segment.
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| 6. |
- Brynhildsen, Jan, 1962-, et al.
(författare)
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Is Hormone Replacement Therapy a Risk Factor for Low Back Pain Among Postmenopausal Women?
- 1998
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 23:7, s. 809-813
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Cross-sectional study with two age cohorts.Objective: To assess whether women receiving hormone replacement therapy after menopause have a higher prevalence of back problems than women who do not receive such treatment.Background: Back pain is a common medical problem: throughout life and especially during pregnancy. Hormonal factors have been proposed as a possible contributor.Patients and Methods: A validated postal questionnaire was sent in early 1995 to all 1324 women of 55 years and 56 years of age residing in Linkoping, Sweden. This questionnaire included questions about current rent hormone replacement treatment, previous and current back problems, medical care for back problems, parity, exercise and smoking habits, and occupation.Results: The questionnaire was returned by 84.7% of the women. There was a significant, albeit weak, positive association between current use of hormone replacement treatment and low back pain. Previous back problems during pregnancy was a strong risk factor for current back pain, whereas neither current smoking nor regular physical exercise was a risk factor according to multiple logistic regression analysis. The interaction of smoking and an occupation involving heavy lifting significantly affected back pain.Conclusions: Women receiving hormone replacement treatment had a slightly, but significantly, higher prevalence of current back pain than nonusers (48% vs. 42%, respectively, P < 0.05), which could not be explained by differences in occupation, smoking habits, or current physical activity. Although the association be-tween hormone replacement therapy and back problems is weak and probably of minor clinical importance, it is speculated that hormonal effects on joints and ligaments may be involved.
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