Correct placement of transpedicular screws for spinal fusion seems to be more difficult than it looks. The computed tomography scanning is useful for differential diagnosis of postoperative radicular syndromes after lumbar transpedicular fixation.
The CMS 50 device provides precise reproducible measurements of the active range of motion of the cervical spine in all three planes. Criteria such as age, sex, body weight, and athletic activity influence the range of motion of the cervical spine.
Volunteer studies of experimental, low-velocity rear-end collisions have shown a percentage of subjects to report short-lived symptoms, but the cause of these symptoms remains unknown. It is unclear whether the symptoms arise from biomechanical stress causing injury or from psychological stress causing symptom expectation and anxiety. Similarly, the cause of symptoms remains obscure in virtually all "whiplash" patients because it is impossible to identify acute pathology in many cases. In this study subjects were exposed to placebo collisions that almost completely lacked biomechanical stress. It was highly probable that if the symptoms reported following low-velocity collisions were not due to injury but to other factors (including misattribution of symptoms from other sources), then the proportion of subjects reporting symptoms would be similiar to that reported for volunteers in true (experimental) low-velocity, rear-end collisions. A total of 51 volunteers (33 males and 18 females, mean age 32.4 years) were recruited through local newspaper advertisements. An experimental set-up for a placebo collision was constructed using two standard European cars. At time T0, prior to the placebo collision, a history and physical examination was performed, including a psychological analysis (Freiburger Personality Inventory). A symptom history and physical examination were also performed at time T1, immediately after the placebo collision, and the subjects completed symptom questionnaires 3 days (time T2) and 4 weeks (time T3) after the placebo collision. Data analysis included a determination of the predictive value of psychological data for the presence of symptoms following exposure to a placebo collision. At time T1, 9 out 51 participants (17.6%) indicated symptoms. Within 3 days (time T2) after the placebo collision, 10 (19.6%) of the subjects had symptoms, and within 4 weeks (time T3) 5 subjects (9.8%) had symptoms. Of the last group, two of the five did not relate these symptoms to the "collision". Subjects who endorsed symptoms at time T1 had significantly higher scores on the psychological scale of psychosomatic disorders (measured at time T0). Subjects endorsing symptoms at time T2 had significantly higher scores on emotional instability. There was also a tendency to higher scores on this sub-scale for subjects with whiplash-associated disorders (WAD) at time T3. A discriminant analysis using all four psychological scales from time T0 had a power of 87%, 83% and 92% for correct classification of subjects as asymptomatic times T1, T2 and T3, respectively. Approximately 20% of subjects exposed to placebo, low-velocity rear-end collisions will thus indicate WAD, even though no biochemical potential for injury exists. Certain psychological profiles place an individual at higher risk for phenomenon.
In 82 asymptomatic subjects aged 8-62 years we evaluated the menisci by magnetic resonance imaging (MRI). Using a 1.0-tesla imager spin-echo sequences (SE 700/20), partial-saturation sequences (500/10), and short-time inversion-recovery sequences (1600/130/30) were performed. For grading the degeneration of the meniscus, a standard classification (grades 0-4) was used. Positive MRI findings correlated with the patients' age. In SE sequences, a grade 0 meniscus was found in 45.5% of all cases, grade 1 in 33.2%, grade 2 in 16.1%, grade 3 in 4.5%, and grade 4 in 0.7%. In PS sequences, we found grade 0 in 23.9%, grade 1 in 27.5%, grade 2 in 31.5%, grade 3 in 15.9%, and grade 4 in 1.1%. In STIR sequences, we found grade 0 in 56%, grade 1 in 25.4%, grade 2 in 11.1%, grade 3 in 6%, and grade 4 in 1.6%. Correlation of meniscus degeneration with subjects' age showed an increase of grade 3 and 4 lesions with advancing age. Subjects older than 50 years presented with grade 3 and 4 lesions in the SE sequence in 28.5% of the cases, in PS sequences in 40.7%, and in STIR sequences in 25%. In asymptomatic subjects, MRI shows an increasing prevalence of meniscal alterations which correlates with age. Especially in subjects older than 50 years, a significant number of meniscal tears must be expected. This shows the potential danger of the use of MRI alone as a basis for the determination of surgical intervention.
To determine the reliability of lumbar nerve root sheath infiltration, a prospective study was performed. Ninety-four patients were randomized into three groups. In the first group of 33 patients, 0.5 cc of dye (Telebrix N, 30 g) was applied at nerve root L4, in the second group of 30 patients, 1.0 cc, and in the third group of 31 patients, 2.0 cc. The infiltration was guided by computer tomography. The diffusion of the dye was documented with computed tomography of the affected segment L4-5. The images were evaluated by an unbiased observer. The results showed that in the first group the dye diffused to the adjacent ipsilateral nerve roots L3 and/or L5 in nine patients. In the second and third groups this diffusion was seen in 9 and 11 patients, respectively. A diffusion into the psoas muscle was documented in 4, 10 and 22 patients, respectively. These latter differences were statistically significant (P < 0.01). Diffusion into the psoas muscle is especially important because the nerve roots converge in this muscle to become a plexus, and they are no longer surrounded by their dural sheaths. Diagnostic lumbar nerve root sheath infiltration should be performed by an experienced examiner. To guarantee high reliability, the tip of the needle should be placed as near as possible to the affected nerve root. The amount of local anaesthetic should be as small as possible, 0.5 cc or preferably less.
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