Biomedical subjects

J A McCulloch

Publications and source records attributed to J A McCulloch.

6 recordsLinked to original sources

PubMed1991

Chymopapain versus conventional surgery for lumbar disc herniation. 10-year results of treatment.

We reviewed two comparable groups of patients who had been treated for lumbar disc herniation by chymopapain chemonucleolysis (145) or conventional surgical discectomy (91). They were reviewed 10 years after treatment by questionnaire, followed by a personal interview by an independent observer. The results of the surgically treated groups were slightly better than those treated with chymopapain. In particular, there was significantly better early relief of leg and low back pain, and fewer patients needed a second procedure. Complications were few in both groups.

Activities of Daily Living↗

PubMed1979

Failed lumbar disc surgery and repeat surgery following industrial injuries.

One hundred and seventy-nine of the compensation patients in this study who had one low-back operation had to have repeat back surgery. One hundred and three Workmen's Compensation Board patients who were reoperated on by a number of surgeons in the Toronto area were independently reviewed with one to two years of follow-up. Many had residual back pain, limited lumbar movement, presisting nerve-root deficits, and psychological disturbances. Forty per cent of the second operations were successful. Subsequent operations yielded progressively poorer results and made more patients worse than better. Operations were frequently undertaken without clear indications or evidence of correctable organic lesions. The results of repeat operations were better when the preceding operation had given more than six months' relief, when sciatica overshadowed back pain, and when a definite recurrent disc herniation was found. Scarring and neurolysis, previous infection, repair of a pseudarthrosis, and adverse psychological factors precluded a good result. Careful patient selection based on total evaluation of the disability including psychological assessment, accurate localization of the lesion by detailed investigation, and, most important, a logical sequence of decisions based on clear, objective criteria are prerequisites for this complex and demanding surgery. Caution and restraint are required when contemplating repeat back surgery.

Accidents, Occupational↗

PubMed1978

Lateral lumbar discography.

The technique of lateral lumbar discography is described and compared with that of posterior lumbar discography. Its safety is demonstrated in a series of 1500 patients, only four of whom developed complications of note. Of these four, three developed discitis and one a retroperitoneal haemorrhage, all of which settled with conservative treatment.

Humans↗

PubMed1977

Percutaneous radiofrequency lumbar rhizolysis (rhizotomy).

Low back pain may arise from degenerative changes in the posterior joints of the lumbar spine. These joints are innervated by a branch of the posterior primary ramus, which follows an anatomically constant course. Pain impulses from these joints can be interrupted by coagulating this nerve with a radiofrequency wave, the probe having been placed in the area of the nerve percutaneously. Percutaneous lumbar rhizolysis was carried out under local anesthesia on an outpatient basis in 82 patients, most of whom had multiple level rhizolysis. Rhizolysis was successful in 67% of patients with mechanical low back pain without evidence of disc herniation and nerve-root compression or psychogenic pain, who had not previously undergone an operation for relief of the pain.

Back Pain↗

PubMed1977

Chemonucleolysis.

A prospective study of 480 patients who underwent enzymatic dissolution of the nucleus pulposus with chymopapain is reported. Seventy per cent of patients with the clincial criteria for a disc herniation had a favourable response to chemonucleolysis. The commonest cause of failure was persistent back pain. In patients with sequestered discs or lateral recess stenosis surgical intervention was not made more difficult by chemonucleolysis. Those with a previous operation, spinal stenosis or psychogenic components to the disability had very poor results. Complications were few and easily managed.

Adult↗

PubMedDate not supplied

Percutaneous radiofrequency lumbar rhizolysis (rhizotomy).

Low-back pain may arise from degenerative changes in the posterior joints of the lumbar spine. These joints are innervated by a branch of the posterior primary ramus, which follows an antomically constant course. Pain impulses from these joints can be interrupted by coagulating the nerve with a radiofrequency wave, the probe having been placed in the area of the nerve percutaneously. Percutaneous lumbar rhizolysis was carried out under local anesthesia on an outpatient basis in 82 patients, most of whom had multiple level rhizolysis, Rhizolysis was successful in 67% of patients with mechanical low-back pain without evidence of disc herniation and nerve-root compression or psychogenic pain, who had not previously undergone an operation for relief of the pain.

Back Pain↗