Biomedical subjects

R P Jackson

Publications and source records attributed to R P Jackson.

6 recordsLinked to original sources

PubMed1992

The facet syndrome. Myth or reality?

The lumbar facet joint has long been considered a significant source of low back pain (LBP). Facet blocks with anesthetic and cortisone, and even facet denervation procedures, have been recommended as treatment for patients with LBP. The literature, however, fails to conclusively document the role of the facet in the production of LBP. Based on a review of the literature and the author's clinical studies, the following statements appear to be appropriate and defensible: (1) The lumbar facet joints are very important biomechanically. (2) The facet is not a common or clear source of significant pain. (3) The facet syndrome is not a reliable clinical diagnosis. (4) Injection of intraarticular saline into the facets in control cases is as effective as local anesthetic and steroids in relieving the patient's pain temporarily. (5) Response to facet joint injection in patients with LBP does not correlate with or predict their clinical results after solid posterior lumbar fusion, and it should not be used preoperatively as a clinical criterion in selection of patients for fusion. (6) More prospective, controlled and randomized clinical studies are recommended.

Adult↗

PubMed1978

External skeletal fixation in severe limb trauma.

Ten patients with 12 severe limb injuries managed by external skeletal fixation over 2 years are presented. Two major indications for external skeletal fixation divided the fractures into groups: A) extensively open fractures requiring wound care and closure by other than primary methods, and B) grossly unstable fractures requiring stabilization for soft-tissue support and fracture alignment. Group A was composed of five extremity fractures with skin and muscle loss and deep tissue contamination. Wound management was the primary problem. Wound closure, prevention of an infection, and limb salvage were the treatment goals in this group. Group B was seven severely comminuted extremity fractures with significant swelling and in some cases, questionable soft-tissue survival. Five were open, but not extensively. Instability was the primary problem. Fracture control, soft-tissue support, and limb salvage were the treatment goals in this group. Mean followup period for all fractures was 9.4 months. No amputations, deep infections, or deaths resulted. Wound care and closure were facilitated in all open fractures. Loss of contused tissues with marginal vascular supply was felt to be minimized. Delayed unions were common in both groups. Two malunions and one nonunion occurred. Treatment goals in both groups were accomplished.

Adolescent↗

PubMed1977

Osteoid osteoma and osteoblastoma. Similar histologic lesions with different natural histories.

A study of 9 new cases of osteoid osteoma and 3 new cases of osteoblastoma demonstrated very similar histologic findings. Both lesions were extremely vascular and frequently showed areas with histologic features of an aneurysmal bone cyst. Differentiation between the 2 lesions often depended on their clinical features and radiographic appearances. A review of 851 osteoid osteomas and 181 osteoblastomas from the literature supported a difference, however, in the natural history of the 2 lesions with osteoid osteomas tending toward regression, and osteoblastomas tending toward progression and possible late malignant transformation. Osteoid osteomas were found to have a 4.5% recurrence rate compared with a 9.8% recurrence rate for osteoblastomas (p less than 0.01). No recurrence has ever been reported after complete en-bloc resection of either lesion and this must be considered the surgical treatment of choice for both lesions where possible. Despite apparent incomplete excisions, cures are achieved in many cases among both lesions.

Adolescent↗

PubMedDate not supplied

The management of nerve root entrapment syndromes associated with the collapsing scoliosis of idiopathic lumbar and thoracolumbar curves.

From 1969 through 1978, 30 adults presented with painful idiopathic scoliosis and associated radicular symptoms. Fifteen had major thoracolumbar curves and 15 had major lumbar curves. Ten (33%) had physical findings of the nerve root entrapment, 4 having two roots entrapped. Root entrapments in the sciatic distribution were most common and arose on the side opposite the major curve, coming from the concavity of compensatory lumbosacral curves (7 of 9 patients). Root entrapment in a femoral nerve distribution came from the concavity of the major curve (1 patient). Whether in a major or compensatory curve, entrapments usually arise in the concavity (8 of 10 patients). Mechanisms of root entrapment vary, but foraminal compression and pedicular kinking were most common. When major deforming curves are corrected fairly completely, most nerve root entrapments are relieved; sciatic entrapments are decompressed by spontaneous straightening of the lumbosacral curve. Dwyer instrumentation and fusion has been the most effective method of surgical management in carefully selected cases.

Adult↗

PubMedDate not supplied

Intracortical and subperiosteal lesion of unknown etiology.

A painful intracortical and subperiosteal lesion of the fibula with a 14 year follow-up is reported to regress to a painfree state. Infection is favored in the differential diagnosis. Biopsy with histological and radiographical correlation are essential for exclusion of: osteoid osteoma, osteoblastoma, periostitis, glomus tumor, eosinophilic granuloma, enostosis, hemangioma of bone, giant cell tumor, simple cyst, aneurysmal bone cyst, non-ossifying fibroma, polyostotic fibrous dysplasia, hyperparathyroidism, Paget's disease, localized area of avascular necrosis, stress fracture and even metastatic disease.

Bone Diseases↗

PubMedDate not supplied

Recurrent osteoblastoma: a review.

A review of 3 new osteoblastomas and 181 previously reported osteoblastomas revealed 18 recurrences (9.8% recurrence rate). Recurrence was more common in the spine and pelvis. Recurrences were reported as late as 9 years after excision of osteoblastomas and long-term follow-up is indicated in this lesion. Five recurrences were reported to undergo apparent sarcomatous change. Complete en bloc resection is the preferred treatment of osteoblastomas. No recurrence has ever been reported after complete resection, however, apparent incomplete excision has given cures in many cases. Radiotherapy does not appear to prevent recurrence. Its immediate postoperative use is not recommended and may possibly be associated with apparent late sarcomatous change in some cases. Since the efficacy of radiotherapy in the treatment of established recurrence still remains obscure, further surgical intervention is indicated.

Bone Neoplasms↗