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Curtis W Slipman

Publications and source records attributed to Curtis W Slipman.

33 records · Page 2Linked to original sources
PubMed2002

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. Patients with a history of a severe anaphylactoid reaction to iodinated radiocontrast media or those who refused the use of iodinated contrast material were included in the study. RESULTS: In fourteen patients, 58 discs were studied. The post discography MRIs identified seven annular tears and seven annular fissures. None of the fourteen patients reported symptoms suggestive of allergic reaction either during or after discography. CONCLUSIONS: Discography using intradiscal administration of gadolinium followed by MRI provides a method of obtaining a clinically pertinent study in a subset of patients who likely would not be offered the procedure, secondary to severe anaphylactoid reactions to iodinated contrast materials.

Journal Article↗
PubMed2002

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. The current literature primarily diagnoses for the various etiologies of FBSS from a surgical perspective. To our knowledge, there is no study that investigates the myriad of surgical and nonsurgical diagnoses from a nonsurgical perspective. METHODS: Specific inclusion and exclusion criteria were developed for a list of 42 nonsurgical and surgical differential diagnoses of FBSS. The determination of which category, surgical or nonsurgical, each diagnosis was placed into depended upon the categorization of those diagnoses in previously published literature on FBSS. Each of the authors reviewed the definitions, and they came to a unanimous agreement on each diagnosis' inclusion and exclusion criteria. Data extraction was then carried out in each of the two involved institutions by using the key words discectomy, laminectomy, and fusion to identify all the patients who had any combination of low back, buttock, or lower extremity pain after lumbar discectomy surgery. These charts were then individually reviewed to extract epidemiologic data. RESULTS: A total of 267 charts were reviewed. One hundred and ninety-seven (197) charts had a complete workup. Of these, 11 (5.6%) had an unknown etiology, and 186 had a known diagnosis. Twenty-three (23) various diagnoses were identified. There was approximately an equal distribution between the incidences of nonsurgical and surgical diagnoses; 44.4% had nonsurgical diagnoses and 55.6% had surgical diagnoses. The most common diagnoses identified were spinal stenosis, internal disc disruption syndrome, recurrent/retained disc, and neural fibrosis. CONCLUSION: FBSS is a syndrome consisting of a myriad of surgical and nonsurgical etiologies. Approximately one half of FBSS patients have a surgical etiology. Approximately 95% of patients can be provided a specific diagnosis.

Journal Article↗
PubMed2002

"EMG disease" with bulbar muscle involvement: a case report.

We report the first case of diffuse abnormal insertional activity with bulbar muscle involvement. Electromyography performed 5 months earlier reported multilevel radiculopathy. A repeat electromyography study revealed short trains of positive waves without fibrillation potentials, diffusely present in all tested muscles. Positive waves were also found in the bulbar innervated muscles; these included the trapezius, frontalis, and the orbicularis oculi. This entity is important to recognize because confusion with neuromuscular syndromes can occur.

Adult↗
PubMed2002

Dysphonia associated with epidural steroid injection: a case report.

A 46-year-old patient with left-side low back pain developed symptoms of dysphonia and throat irritation 24 hours after receiving a fluoroscopically guided steroid injection into the epidural space. A direct laryngoscopy performed before a second injection detected no abnormalities. When dysphonia reappeared 48 hours after that injection, laryngoscopy revealed edema in the anterior vocal cord with thick surrounding mucous. Full clinical resolution of the dysphonia was apparent by laryngoscopy 15 days after the second injection. The mechanism of dysphonia after epidural steroid injection is unknown, but it may result from a systemic steroid effect.

Anti-Inflammatory Agents↗
PubMed2002

Anatomy of the intervertebral foramen.

The intervertebral foramen serves as the doorway between the spinal canal and periphery. It lies between the pedicles of neighboring vertebrae at all levels in the spine. A number of categorization schemes have been attempted to describe the boundaries of the intervertebral foramen. No uniform agreement has been made on which classification best describes this area. Studies of the nerve root canals have clearly noted variations in the angle of take-off from the thecal sac, length of the nerve root, and placement of the dorsal root ganglion from different lumbar levels. The nerve root canal receives a dual blood supply from central and peripheral sources. The dorsal root ganglion also has a dual vascular supply that aids in preventing damage to this vital foraminal structure. The presence of ligamentous structures within the foramen has been demonstrated by a number of recent studies. These ligaments serve a protective and organizational role for the neurovascular structures of the foramen. A thorough knowledge of the intervertebral foramen will allow the understanding of the pathological and degenerative changes that cause compression or injury to these foraminal structures.

Journal Article↗
PubMed2002

Painless foot drop: an atypical etiology of a common presentation.

Weakness of the dorsiflexor muscles of the foot is a relatively common presentation. In most cases, the etiology involves a peripheral injury to the common peroneal nerve. These patients usually present with lower motor neuron findings on evaluation. In contrast, if upper motor neuron findings were present a central lesion should be suspected and appropriate imaging studies are performed. We describe a patient with painless foot drop and lower motor findings on examination that was diagnosed with multiple sclerosis. This case demonstrates that multiple sclerosis can masquerade as a peripheral process in some patients.

Journal Article↗
PubMed2002

Clinical evidence of chemical radiculopathy.

It is universally accepted that an anatomic abnormality such as a herniated disc or spinal stenosis can lead to radicular leg pain. There is some controversy as to whether radicular pain can be caused by a non-structural, solely biochemical disorder. Prior studies using biochemical analysis of inflammatory mediators of the disc or surrounding structures have enumerated many possible biochemical mediators of radicular pain. However, such studies have not definitively demonstrated whether these inflammatory mediators are the causes of radicular pain or whether these mediators are simply products of the degenerative cascade. The purpose of this paper is to report upon patients who satisfy strict criteria affirming a diagnosis of radiculopathy in the presence of normal imaging studies. The study was designed as a prospective case series of patients fulfilling inclusion and exclusion criteria at a university hospital outpatient physiatric spine practice. Inclusion criteria consisted of symptoms of extremity pain greater than axial pain, examination findings demonstrating a new myotomal deficit that correlates with the root level predicted by the dermatomal pain distribution, and failure to improve after at least 4 weeks of active physical therapy. Magnetic resonance imaging void of local nerve root pathology as per review by the first author and the interpreting radiologist was required. Each patient had to have a positive electromyographic study for an acute radiculopathy. Each patient had to have a positive fluoroscopically guided diagnostic selective nerve root block. In summary, this paper provides clinical evidence that anatomic abnormalities are not required to cause radiculopathy, thus implying that a biochemical etiology is likely to play a significant role in radiculopathy and radicular pain.

Journal Article↗
PubMed2002

Vascular supply to the lumbar spine: an intimate look at the lumbosacral nerve roots.

The vascular supply of the lumbar vertebral column is a diverse collection of arteries originating from both central and peripheral sites. Until recently, the majority of these studies have been dedicated to the blood supply of the spinal cord and vertebral bodies. More recent effort has been directed toward the identification of the vascular supply to the lumbar nerve roots. These studies have conclusively documented the presence of a dual blood supply to the nerve roots. In addition, this dual vascular supply has been discovered to have the capability for bi-directional flow. This unique property may allow for prevention of localized, compressive ischemic symptoms secondary to either herniated disc material or osteophytes. The nutrient contributions of the cerebrospinal fluid and venous supply to nerve roots have also been investigated. Early studies indicate that they may play a greater role than suspected. The presence of multiple sources of nutrient supply to the lumbar nerve roots enables them to be resistant to the potential compressive phenomenon that may occur in the lumbar spine.

Journal Article↗
PubMedDate not supplied

Provocative cervical discography symptom mapping.

BACKGROUND CONTEXT: In a small prospective study assessing 10 symptomatic and 10 asymptomatic subjects, Schellhas et al. compared cervical discography to magnetic resonance imaging. Within that study he reported on the distribution of pain for the C3-C4 to C6-C7 levels. Four years later, Grubb and Ellis reported retrospective data from his 12-year experience using cervical discography from C2-C3 to C7-T1 in 173 patients. To date, no large prospective study defining pain referral patterns for each cervical disc has been performed. PURPOSE: To conduct a prospective visual and statistical descriptive study of pain provocation of a cohort of subjects undergoing cervical discography. STUDY DESIGN/SETTING: Prospective multicenter descriptive study. METHODS: Pain referral maps were generated for each disc level from patients undergoing cervical discography with at least two levels assessed. If concordant pain was reproduced in a morphologically abnormal disc, the subject immediately completed a pain diagram. An independent observer interviewed the subject and recorded the location of provoked symptoms. Visual data were compiled using a body sector bit map, which consisted of 48 clinically relevant body regions. Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated. RESULTS: A total of 101 symptom provocation maps were recorded during cervical discography on 41 subjects. There were 10 at C2-C3, 19 at C3-C4, 27 at C4-C5, 27 at C5-C6, 16 at C6-C7 and 2 at C7-T1. Predominantly unilateral symptoms were provoked just as often as bilateral symptoms. The C2-C3 disc referred pain to the neck, subocciput and face. The C3-C4 disc referred pain to the neck, subocciput, trapezius, anterior neck, face, shoulder, interscapular and limb. The C4-C5 disc referred pain to the neck, shoulder, interscapular, trapezius, extremity, face, chest and subocciput. The C5-C6 disc referred pain to the neck, trapezius, interscapular, suboccipital, anterior neck, chest and face. The C6-C7 disc referred pain to the neck, interscapular, trapezius, shoulder, extremity and subocciput. At C7-T1 we produced neck and interscapular pain. Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated. CONCLUSIONS: In conclusion, these results confirm the observations of prior investigators that cervical internal disc disruption can elicit axial and peripheral symptoms. The particular patterns of pain generation allow the discographer to preprocedurally anticipate disc levels to assess. With these data, the number of disc punctures that are required can be limited rather than routinely assessing all cervical discs.

Cervical Vertebrae↗
PubMedDate not supplied

A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain.

BACKGROUND CONTEXT: Lumbar zygapophysial joints are currently believed to be a cause of axial low back pain. Once this diagnosis is made, decisions about when to institute a particular intervention and which treatment to offer is regionally and specialty dependent. PURPOSE: To perform a critical review of prior published studies assessing the use of interventional treatment options for the treatment of lumbar zygapophysial joint syndrome. STUDY DESIGN: Evidence-based medicine analysis of current literature. METHODS: A database search of Medline (PubMed, Ovid and MDConsult), Embase and the Cochrane database was conducted. The keywords used were low back pain, lumbar zygapophysial joint, lumbar facet joint, radiofrequency denervation, medial branch block, and intraarticular injection. After identifying all relevant literature, each article was reviewed. Data from the following categories were compiled: inclusion criteria, randomization of subjects, total number of subjects involved at enrollment and at final analysis. statistical analysis used, intervention performed, outcome measures, follow-up intervals and results. Guidelines described by the Agency for Health Care Policy and Research were then applied to these data. RESULTS: This review determined that the evidence for the treatment of lumbar zygapophysial joint syndrome with intraarticular injections should be rated as level III (moderate) to IV (limited) evidence, whereas that for radiofrequency denervation is at a level III. CONCLUSIONS: Current studies fail to give more than sparse evidence to support the use of interventional techniques in the treatment of lumbar zygapophysial joint-mediated low back pain. This review emphasizes the need for larger, prospective, randomized controlled trials with uniform inclusion and exclusion criteria, standardized treatment, uniform outcome measures and an adequate duration of follow-up period so that definitive recommendations for the treatment of lumbar zygapophysial joint-mediated pain can be made.

Denervation↗
PubMedDate not supplied

Abdominal pain secondary to a sacral perineural cyst.

BACKGROUND CONTEXT: Perineural cysts are commonly found in the sacral region and are incidently discovered on imaging studies performed for the evaluation of low back and/or leg pain. PURPOSE: To report on a patient presenting with abdominal pain secondary to a large sacral perineural cyst. STUDY DESIGN/SETTING: Case report. METHODS/PATIENT SAMPLE: A 47-year-old woman was referred to a specialized multidisciplinary spine center with complaints of left lower quadrant abdominal pain and left leg pain. Of significant note was the presence of constipation and urinary frequency over the preceding 8 months. Physical examination was normal. Magnetic resonance imaging of the lumbosacral spine revealed large perineural cysts eroding the sacrum and extending to the pelvis. The presence of abdominal symptoms prompted a neurosurgical consultation. However, after considering the possible risks associated with the surgical procedure, the patient opted to follow the nonsurgical route. RESULT AND CONCLUSIONS: Although commonly visualized, sacral perineural cysts are rarely symptomatic. When symptomatic, it may be secondary to its size and location. Presence of abdominal pain in a patient with back and/or leg pain should prompt the evaluation of the lumbosacral spine.

Abdominal Pain↗