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Biomedical subjects

Philip H Lander

Publications and source records attributed to Philip H Lander.

4 recordsLinked to original sources
PubMed2005

Lumbar discography: current concepts and controversies.

Lumbar provocation discography is an invasive diagnostic procedure to identify pain originating from within the lumbar discs. Specific morphological changes within the disc, classified as radial fissures, can be imaged following the injection of radiopaque contrast into the nucleus pulposus. The reproduction of concordant low back and/or referred somatic pain to the lower extremity under controlled conditions and the demonstration of annular radial tears are part of a spectrum of internal disc disruption that is separate from disc degeneration. A review of the validity and technique of lumbar discography as well as recently described causes of false positive responses are presented.

Adult↗
PubMed2005

Incidence of intravascular uptake during fluoroscopically guided lumbar disc injections: a prospective observational study.

BACKGROUND: Although there are many in vivo studies evaluating lumbar disc injections, no studies have described the occurrence of intravascular uptake of contrast on discography. This phenomenon, however, has been well documented for other fluoroscopically-guided, contrast-enhanced spinal injections. OBJECTIVES: To document the phenomenon and incidence of intravascular uptake during fluoroscopically-guided, contrast-enhanced lumbar disc injections. DESIGN: A prospective, observational, community-based study. METHODS: The incidence of fluoroscopically-confirmed intravascular uptake of contrast material was documented in 160 patients representing a subset of individuals presenting to a small private community hospital for evaluation and treatment of lower back pain. These patients underwent fluoroscopically-guided lumbar disc injections for therapeutic and/or diagnostic purposes. RESULTS: A total of 280 discs from L1-2 to L5-S1 were studied. The degree of disc degeneration of the evaluated discs was scored using the Adams' scoring criteria for intervertebral disc degeneration. The incidence of intravascular uptake as well as any correlation between stage of disc degeneration and intravascular uptake was statistically evaluated. A total of 40 out of 280 discs (14.3%) demonstrated intravascular uptake. Detection of intravascular uptake usually required real-time fluoroscopy. There was no statistical correlation between the degree of disc degeneration and the incidence of intravascular uptake. No disc infections or other adverse sequelae occurred. CONCLUSION: This is the first study, to our knowledge, that addresses the incidence of intravascular uptake during lumbar disc injections in patients with low back pain. The presence of intravascular uptake may have implications both clinically and diagnostically in regards to interpretation of lumbar discography and adverse events related to loss of injected medications into the vascular system.

Journal Article↗
PubMed2003

Minimally invasive surgery for ablation of osteoid osteoma of the spine.

STUDY DESIGN: Compare the effectiveness of two different techniques for the management of osteoid osteoma of the spine. OBJECTIVE: To describe the technique, feasibility, and indications of two different minimally invasive surgical methods for the treatment of osteoid osteoma of the spine. SUMMARY OF THE BACKGROUND DATA: Current treatment of osteoid osteoma of the spine is usually conventional surgical excision. The successful treatment of osteoid osteoma of the appendicular skeleton by percutaneous radiofrequency probe ablation is known; however, there have been only a few cases reported utilizing this method to treat osteoid osteoma of the spine. The high success rate of percutaneous transpedicle vertebral biopsy and diskectomy led us to believe this technique can also be applicable for the treatment of osteoid osteoma of the spine. METHODS: Two patients with symptomatic osteoid osteoma of the spine underwent two different surgical managements with local anesthesia. In one patient, the osteoid osteoma was localized in the apex of the right L4 superior articular process joint. Under computed tomography guidance he underwent radiofrequency coagulation with the use of a radiofrequency generator at 90 degrees for 240 seconds. The lesion in the second patient was located in the right pedicle of the T9 vertebra close to the exiting nerve root and was cored out by means of a special percutaneous instrument designed for percutaneous biopsy under fluoroscopic guidance. RESULTS: Both patients experienced immediate relief of pain, resumed their regular activities, and also remained free of symptoms after the 2.5- and 3-year follow-up. CONCLUSION: Minimally invasive surgery can successfully be applied in the treatment of osteoid osteoma of the lumbar spine. When the nidus is not adjacent to the neural elements radiofrequency thermal ablation can be an effective and safe treatment of osteoid osteoma in the spine.

Adult↗