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At least 37 records · Page 2Linked to original sources
PubMed1976

Narrow lumbar spinal canal with "vascular" syndromes.

Symptoms suggestive of vascular origin, both venous and arterial, may be the presenting complaints in patients with lumbar spondylosis. Fourteen patients suspected of having vascular intermittent claudication were found to be free of vascular disease, but had cauda equina compromise from herniated disk, osteoarthritis, and hypertrophic ligaments. Complete follow-up data were available for seven patients. In three, claudication seemed typical; in four, atypical. At operation, herniated intervertebral disks, osteophytic bone, or hypertrophied ligamenta flava, or a combination, were found. All benefited from lumbar laminectomy. When patients with vascular-like symptoms are found to be free of arterial or venous disease, lumbar spondylosis (narrow lumbar canal syndrome) should be considered. Chronic incapacitation pain without vascular disease provides a clue, as does electromyography. Plain X-ray films of the lumbar spine do not show the abnormality; thus, myelography should be carried out even in the absence of neurologic signs.

Aged↗
PubMed2026

No Efficacy of Dexamethasone Injections for Acute Sciatica: A Double-Blind Randomized Study Versus Saline.

BACKGROUND: The efficacy of caudal injections for patients with acute sciatica remains controversial. The DEXHIA study was designed to evaluate whether ultrasound-guided caudal injection of dexamethasone provides superior clinical outcomes compared with saline placebo. METHODS: This prospective, randomized, placebo-controlled, double-blind trial included adult patients with sciatica secondary to lumbar disc herniation of less than 3 months' duration. Participants were randomly assigned in a 1:1 ratio to receive either 16 mg of dexamethasone (4 mL) diluted with 16 mL of saline (DEXA group) or 20 mL of saline alone (PLACEBO group), administered by ultrasound-guided caudal epidural injection. The primary outcome was the change in the Oswestry Disability Index (ODI) at 3 weeks. Secondary outcomes included leg pain and low back pain assessed by visual analogue scale (VAS), health-related quality of life (SF-36), need for repeat epidural injection, and need for lumbar surgery. Clinical assessments were performed at 3 weeks, 3 months, and 6 months. RESULTS: A total of 106 patients were randomized, with 53 participants assigned to each treatment group. The primary endpoint was not met, as the improvement in ODI at 3 weeks did not differ significantly between groups (mean change: -9.5 ± 4.4 in the DEXA group versus -13.8 ± 4.4 in the PLACEBO group; p = 0.18). No significant differences were observed for any relevant secondary outcome at any follow-up time point. During the 6-month follow-up, 34 patients in the DEXA group and 30 patients in the PLACEBO group underwent a second, non-blinded injection of dexamethasone (ns). Lumbar surgery was performed in 10 patients in the DEXA group and nine patients in the PLACEBO group (ns). Injection-related adverse events were mild and transient but occurred more frequently in the DEXA group. CONCLUSIONS: Caudal injection of soluble dexamethasone conferred no clinical benefit over saline placebo in patients with acute sciatica. SIGNIFICANCE STATEMENT: Epidural injections are widely used worldwide for the treatment of resistant sciatica and have been extensively studied in multiple meta-analyses. However, their clinical value remains debated due to the limited methodological quality of most available studies. We conducted a methodologically rigorous randomized, placebo-controlled trial, which yielded negative results. These findings question the efficacy of caudal epidural injection of a non-particulate corticosteroid administered via a remote (sacrococcygeal) approach for disc-related sciatica. TRIAL REGISTRATION: The trial was registered under European Clinical Trials No. 2021-001571-17 and ClinicalTrials.gov identifier NCT05000658.

Adult↗
PubMed1979

A study on tension signs in lumbar disc hernia.

The laminae were removed from the lower lumbar spines of five cadavers within four hours of death. A short length of rubber tube was inserted between the nerve roots and the lumbar disc and the tension monitored using semiconductor pressure transducers. The angulatory stresses exerted on the lumbar nerve roots during tension sign tests were found to correspond to clinical experience.

Adolescent↗
PubMed1979

Electrodiagnosis of compression of individual nerve roots of the cauda equina.

Segmental electrodiagnosis of compression of individual nerve roots of the cauda equina has been attempted in 45 patients, including cases of disc hernia, spondylsis and spondylolisthesis. The needle electrode was inserted into the nerve root either just lateral to the intervetebral foramen or through the posterior sacral foramen. The recordings made on stimulating a single nerve root were somatosensory evoked potential, the cauda equina action potential and the M and H waves. Mixed spinal nerve root action potentials were also recorded by stimulating the sciatic, peroneal and tibial nerves. It was shown that a diagnosis could be made from the somatosensory evoked potential, the H wave and root pain reproduction, and also the diagnosis of a subclinical compression involvement. In other words, the neurophysiological state of dysfunction of individual roots in each aspect of compression can be expressed.

Action Potentials↗
PubMed1979

The recurrence of pain following operation for herniated lumbar disc: fresh herniation or extradural scar tissue?

The clinical findings, the appearance of the myelogram and the findings at re-operation are described in 34 patients who had persistent or recurrent pain following operation for removal of a herniated lumbar disc. An attempt was made to distinguish before re-operation whether the residue symptoms were due to recurrence of, or a fresh disc herniation, or to extradural scarring. Persistence of pain after the initial operation or the time interval before pain re-appeared did not help to distinguish the causative pathology. A recurrent disc herniation was found if a different disc was involved, but was else best distinguished by myelographic demonstration of a short indentation in the contrast column at the level of a disc or a short root sleeve with a thickened associated nerve root. An absence of indentation in the column suggested extradural scarring. At re-operation disc herniation and extradural scarring without herniation were found in approximately equal numbers of patients.

Cicatrix↗
PubMed1976

[Anomalies of the pattern of lumbosacral nerve roots and its clinical significance (author's transl)].

Twenty personal observations and 18 cases collected from the literature are analysed. The most frequently encountered anomaly were: common dural origin of 2 nerve roots and common exit of 2 nerve roots through the intervertebral foramen. Other anomalies comprised: interradicular connections and Y-shaped or horizontla course of the nerve root. Multiple anomalies were not encountered. In 9 out of 20 patients in the own series and in 6 out of 18 patients reported in the literature, history and clinical findings suggested prolapsed intervertebral disc, operation revealed only nerve root anomalies. Decompression produced improvement or complete relieve of previously existing signs and plain X-rays is not possible. The diagnosis is based on myelographic findings. The pathogenesis of the anomalies is discussed. It is suggested that they should not be considered as a causative factor of low back pain or sciatica.

Adult↗
PubMed1979

[Cauda equina syndrome with total myelographic block (author's transl)].

Twenty-seven cases of complete subarachnoid block discovered through myelography are analysed with regard to the causes of obstruction, the neurologic symptoms, and the cerebrospinal fluid. The neurologic signs in cases of cauda equina compression, most often caused by massive disc protrusions (20 patients), vary considerably and rarely correspond to the gross myelographic findings. Bilateral neurologic symptoms of any degree with or without sphincter disturbance were observed in 21 among 27 cases and are signs of cauda compression. In contrast to cases of sciatica with unilateral root compression and radicular symptoms neurological symptoms are not reliable in revealing the site of the lesion in cases of massive central disc protrusions. Therefore radiculography (myelography of the cauda equina) is necessary for diagnosis. In addition to the well-known elevation of the spinal fluid protein and pleocytosis, the presence of neutrophile granulocytes is frequently found (11 of 20 cases) in cytological analysis.

Cauda Equina↗
PubMed1978

Techniques in transfemoral lumbar epidural phlebography.

For lumbar epidural phlebography an even distribution of the injected contrast medium over the epidural and intervertebral venous system is of the greatest importance in order to prevent the false positive diagnosis of a lumbar disk lesion due to an artificial filling defect. Various catheter placement techniques and other procedures designed to enhance epidural opacification are compared in this respect. In the author's opinion, selective injection of the contrast medium into an intervertebral vein, when possible, leads to the most reliable epidural filling.

Catheterization↗
PubMed1977

Endocystography in cystic neurilemmoma.

During myelographic evaluation for a suspected herniated disc, a cystic neurilemmoma in the lower lumbar region was inadvertently punctured and a contrast study of the interior of the lesion resulted. The possibility of puncture of a cystic mass should be considered in the differential diagnosis when a complete block is encountered above and below the site of needle puncutre, and particularly when the contrast column demonstrates a relatively smooth biconcave appearance.

Cysts↗
PubMed1979

Electromyographic examination of gluteal muscles in the differential diagnosis of lumbar herniated discs.

The aim of the present investigation was to establish the value of gluteal muscles (m.gluteus medius, GME; m.gluteus maximus, GMX) as segmental reference muscles in the topical diagnosis of lumbar root compression syndromes. The methodological rationale consisted in determining the frequency with which denervation potentials could be recorded in the GME and GMX of patients with clinically and electromyographically well-defined monosegmental or bisegmental lumbar root compression syndromes. Of the L5-syndromes (N=36), 81% revealed denervation potentials in GME, but only 6% in GMX. Of the S1 syndromes (N=26), 63% exhibited denervation potentials in GMX and 32% in GME. L5 syndromes showed a better correlation of positive findings to GME than S1 syndromes to GMX. As far as the differential diagnosis is concerned, the advantages of recording EMG from GME and GMX are two-fold: (a) the immediate certainty of excluding a peripheral nerve lesion and (b) a reduction in the incidence of false negative findings.

Adult↗
PubMed1979

Subclinical organic psychosyndromes on intrathecal injection of metrizamide for lumbar myelography.

Eighteen patients with symptoms and signs of possible lumbar disc herniation, who had no evidence of a preexisting organic psychosyndrome were included in the study. An organic psychosyndrome was found in six of them 10 h after lumbar myelography with metrizamide. The psychosyndrome, which was characterized by impaired memory and depression, could be demonstrated only by psychometric methods. In these patients metrizamide could be demonstrated within the basal cisterns by computed tomography 8 h after lumbar injection of the contrast medium. The organic psychosyndrome was completely reversible; five days after myelography it could not be detected any more by psychometric means. The development of an organic psychosyndrome in six of the 18 patients suggests a neurotoxic effect of metrizamide. This assumption is supported by hypo- and areflexia in four patients after intrathecal metrizamide as well as by EEG changes seen in three patients after myelography. There was no correlation between the EEG changes or reflex abnormalities and the organic psychosyndrome.

Adult↗
PubMed1975

Protrusion of calcified cervical discs into the spinal canal in children. A report of two cases.

The occurrence of calcified discs with large calcified masses protruding into the spinal canal in two children is reported. The discs affected had increased height in the acute stage. Air myelogram, performed in one case with muscular weakness in the hand demonstrated compression of the spinal cord. The condition improved on conservative treatment without sequelae in both cases.

Calcinosis↗
PubMed1979

Relative efficacy of clinical examination, electromyography, plain film radiography, myelography and lumbar phlebography in the diagnosis of low back pain and sciatica.

The procedures used in the investigation of low back pain and sciatica have been subjected to a double statistical analysis to determine their diagnostic accuracy, since contradictory opinions have been expressed in the literature. It was found that only lumbar phlebography was more accurate than the most simple procedure, the clinical examination. Myelography is more accurate than clinical examination only in making a positive diagnosis. In this case, it equals the reliability of lumbar phlebography, but so does plain film radiography which however leads to a positive diagnosis less constantly. Lumbar phlebography is the most accurate procedure for making a negative diagnosis, mainly by avoiding a false negative conclusion. A comparison is made with the statements in the literature and the complementary use of the different procedures is proposed for the investigation of low back pain and sciatica.

Adolescent↗
PubMed1978

[Anterior lumbar disc herniations (author's transl)].

Anterior lumbar disc herniations can easily and clearly be evidented by discography. The morbidity and, especially, the clinical importance of this entity, however, has been described by some authors only. According to our own experience with discography, ventral lumbar disc herniation seems to be correlated with a painful syndrome consisting of both a typical and circumscribed backache and pain radiating into the abdominal cavity and genital area along the lateral aspect of the lumbar region.

Back Pain↗