Prevalence and clinical features of internal disk disruption in patients with chronic low back pain.
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Humans↗
Biomedical subjects
E J Carragee
Publications and source records attributed to E J Carragee.
Increased rates of complications in patients with severe ankle fractures following interinstitutional transfers.
A retrospective review of 80 consecutive patients treated at a county hospital for ankle fracture/dislocations (initial displacement > 10 mm) was undertaken. Seventy-seven patients fulfilled the requirements for documentation and follow-up. Eighteen patients were transferred from another facility and 59 patients were seen at our institution primarily. The transfer and no-transfer groups were similar in age, sex, follow-up, type of ankle fracture, and number of concomitant injuries. The no-transfer group had a slightly higher Injury Severity Score and incidence of active medical problems. Patients were transferred to this public hospital for financial considerations in 89% of the cases. The patients seen in transfer had a higher rate of overall complications (67% vs. 26%; p = 0.0001), including deep infections (11% vs. 1.7%) and major reduction failures (17% vs. 7%). Higher rates of complications were also found in patients with delayed time to operation, psychiatric or substance abuse problems, and those with skin abrasions or blisters. Analysis of variance indicated that transfer status was the strongest predictor of complications. Hospital stays were also longer in the transferred group.
Adolescent↗
Bilateral facet dislocation at the lumbosacral joint. A report of a case and review of literature.
Traumatic facet dislocation of the lumbosacral joint is uncommon. This report of a bilateral L5-S1 facet dislocation is compared with prior reported unilateral and bilateral cases with respect to mechanism of injury, neurologic injury, surgical reduction and fixation, and clinical outcome. Attention to the disk injury is recognized as essential to prevent cauda equina or root compression after reduction and fixation of the dislocation.
Accidents, Occupational↗
Early complications in the operative treatment of ankle fractures. Influence of delay before operation.
We have reviewed the early complications of 121 surgically treated closed ankle fractures; the complication rate was 30%, with 14 major and 22 minor complications. Fractures with skin blisters or abrasions had more than double the overall complication rate. Fracture-dislocations had three times as many major complications as simple fractures, and those not fixed within 24 hours had a 44% major complication rate compared to 5.3% in those operated upon as emergencies. Patients transferred from another medical facility had high complication rates, especially if they had fracture-dislocations. We conclude that operative treatment of ankle fractures must be delivered in a timely fashion, especially in severe fractures. We would caution against the practice of transferring patients with serious ankle fractures before completion of definitive care.
Adolescent↗
Repetitive trauma and nerve compression.
Repetitive movement of the upper extremity, whether recreational or occupational, may result in various neuropathies, the prototype of which is the median nerve neuropathic in the carpal canal. The pathophysiology of this process is incompletely understood but likely involves both mechanical and ischemic features. Experimentally increased pressures within the carpal canal produced reproducible progressive neuropathy. Changes in vibratory (threshold-type) sensibility appears to be more sensitive than two-point (innervation density-type) sensibility. The specific occupational etiologies of carpal neuropathy are obscured by methodologic and sociological difficulties, but clearly some occupations have high incidences of CTS. History and physical examination are usually sufficient for the diagnosis, but diagnostic assistance when required is available through electrophysiological testing, CT scanning, and possibly MRI. Each of these tests has limitations in both sensitivity and specificity. Treatment by usual conservative means should be combined with rest from possible provocative activities. Surgical release of the carpal canal is helpful in patients failing conservative therapy. Occupational modifications are important in both treatment and prevention of median neuropathy due to repetitive trauma.
Carpal Tunnel Syndrome↗
Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects.
BACKGROUND CONTEXT: No previous study has used magnetic resonance imaging (MRI) to evaluate changes of posterior disc bulging and intervertebral foraminal size in the normal spine with flexion-extension movement, comparing L4-5 versus L5-S1 intervertebral levels. PURPOSE: To determine changes in posterior disc bulging and intervertebral foraminal size with flexion-extension movement, comparing L4-5 versus L5-S1 intervertebral levels. STUDY DESIGN: An in vivo study of magnetic resonance kinematics with spine flexion extension. METHODS: Spines of three volunteers with no history of low back pain were scanned in neutral, flexion, and extension positions in a vertically open MRI system. MRI was repeated after 6 hours of normal activity and an additional 4 hours of heavy activity with a weighted vest. Posterior bulging of the intervertebral disc and the size of intervertebral foramen were measured at the L4-5 and L5-S1 levels. RESULTS: With spine flexion, posterior bulging of the discs increased at L4-5 in eight of nine measurements (three different spine-loading states for each of three subjects) and L5-S1 discs in six of nine measurements. In most cases, posterior bulging decreased with extension. No significant difference was noted in the degree of disc bulge between levels. Foraminal size at L4-5 increased with flexion and decreased with extension, and the extent of these changes was greater at the L4-5 level than at L5-S1. CONCLUSIONS: This pilot study demonstrates two distinct behavior characteristics of the normal spine with flexion-extension movement.
Adult↗
Psychological and functional profiles in select subjects with low back pain.
BACKGROUND CONTEXT: Some researchers have found a correlation of poor treatment outcomes in patients with low back pain and abnormal psychological profiles, whereas others have failed to confirm this correlation. A critical feature of this debate has been whether abnormal psychological profiles seen in patients with back pain are the result of the ongoing back pain or whether pre-existing psychological features predispose to a poor clinical outcome. PURPOSE: To determine the relationship of psychometric testing scores to the presence and duration of back pain of differing causes. STUDY DESIGN/SETTING: This was a prospective observational study of the psychological profiles of groups of patients with low back pain and controls. PATIENT SAMPLE: Subjects having a variety of painful back conditions (n=310) were compared with a control group of subjects without low back complaints who had undergone cervical spine surgery (n=73). OUTCOMES MEASURES: Psychometric testing (Modified Zung and Modified Somatic Pain Questionnaire) was performed along with pain scores (visual analog scale [VAS]), a standardized Low Back Pain Questionnaire, and the Oswestry Low Back Pain Disability Questionnaire in the evaluation of back pain and control subjects. METHODS: The subjects with painful back conditions included patients with presumed discogenic pain undergoing discography (n=95); patients with symptomatic isthmic spondylolisthesis coming to fusion (n=61); patients with chronic vertebral osteomyelitis before diagnosis and treatment (n=39). There was also a nonpatient group of soldiers with chronic low back pain not seeking medical care (n=115). The control subjects without low back pain consisted of a group who had undergone cervical spine surgery (n=73). Psychometric testing was performed and compared in the evaluation of subjects having these different painful back conditions. Analysis was done comparing pain scores, function scores, and psychological testing scores between the symptomatic and asymptomatic groups. RESULTS: The VAS maximum in last week score for the entire group was 7.1, and scores were not significantly different in all low back pain groups. The Oswestry scores were poorest in the discography group compared to spondylolisthesis and osteomyelitis. Functional scores were similar in the soldiers with low back pain and controls without low back pain. Both Depression and Somatic Pain scores were most abnormal in the discogenic low back pain group. Only 21% of this group had normal scores, compared with 71% of the spondylolisthesis group, 79% of osteomyelitis group, and 88% of the group with chronic low back pain not seeking treatment (p<.001 in all groups). The asymptomatic control group had 85% normal scores. CONCLUSIONS: Despite similar pain levels and pain duration, patients with the discographic diagnosis of discogenic back pain have poorer functional scores and very abnormal psychological scores compared with other subjects with chronic low back pain resulting from spondylolisthesis requiring surgery or chronic pyogenic osteomyelitis. Chronic moderately severe mechanical low back pain in healthy subjects was not associated with abnormal psychological scores or functional disability.
Adaptation, Physiological↗
Discography. a review.
BACKGROUND CONTEXT: Discography is used today as the basis of the diagnosis of discogenic back and neck pain. As such, it plays a pivotal role in the formulation of treatment plans for patients complaining of chronic axial spine pain. PURPOSE: A brief history of discography is described here, followed by a discussion of the current uses of discography, the technique involved, and recent studies questioning its validity. STUDY DESIGN/SETTING: A selective review of discography articles from peer-reviewed literature from 1967 to 2000 is provided. We included articles analyzing the validity of discography as well as those concerning its proper use, technique, and complications. METHODS: Articles relevant to the subject of discography were systematically reviewed for recommendations regarding technique, the interpretation of results, and conclusions regarding its validity. RESULTS: The specificity of discography is dramatically affected by the characteristics of the patient examined. In a patient with chronic pain states and psychiatric risk factors, the specificity was determined to be at most 20%. In healthy patients with no chronic pain states and a normal psychiatric profile, the specificity was found to be at most 90%. The ability of a patient to determine reliably the concordance of pain provoked during discography is poor. We could find no data addressing the sensitivity of the study. CONCLUSIONS: Clinicians who use discography to determine treatment pathways for their patients need to critically examine the validity of the test. Recent studies examining the specificity of discography have led us to proceed much more cautiously in interpreting the results of discography.
Back Pain↗