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PubMed1995

Non-traumatic spinal cord diseases in Ibadan, Nigeria: aetiology and prognostic factors.

In this hospital based study, we analysed the clinical records of 104 patients having various spinal cord diseases seen between 1988 and 1993 with a view to delineating diagnostic and prognostic features. The patients comprised 80 males and 24 females with a mean age of 45 years. The mean duration of disease at presentation was 11 months and the average duration of stay in hospital was five months. Spondylotic myelopathy (31 subjects) predominated. It showed cervical predilection, infrequent sphincteric dysfunction and low ESR. Tuberculous disease of the spine (26 subjects) was next in frequency. The presentation of the TB cases was similar to those of neoplastic causes but the latter had a worse prognosis. There was a predilection for the dorsal spine and a high ESR. Myelitis occurred in the younger age group, showed dorsal spine predilection and relatively low ESR. The prognostic factors include duration of disease at entry, duration of hospital stay, presence of complication, motor power above grade three and absence of flacidity. The preventable causes of death include: deep vein thrombosis with subsequent pulmonary embolism and septicaemia.

Adolescent↗
PubMed2005

[Role of surgery in spinal degenerative disease. Analysis of systematic reviews on surgical and conservative treatments from an evidence-based approach].

INTRODUCTION: The lifetime prevalence of invalidating back pain in general population caused by Spinal Degenerative Disease (SDD) is about 70-80%. Global costs related to this disease are enormous (1-2% gross domestic product). From an Evidence-based point of view, there is a striking discrepancy between the use of many available surgical techniques (especially for spinal fusion) and the lack of scientific support. METHODS: The authors carefully reviewed all published metaanalysis on SDD therapies up to December 2003. Treatment recommendations were classified according to levels of evidence (strong, moderate, mild or lack of evidence) for both surgical and conservative measures. RESULTS: Forty-four metaanalysis were selected (nine on lumbar surgery, three on cervical surgery and thirty-two on other therapies). Relating surgery, there is strong evidence favouring early laminectomy in cauda equina syndrome secondary to lumbar disc herniation; discectomy or microdiscectomy are superior to chemo-nucleolysis in lumbar prolapse and spondylosis; and fusion surgery (probably noninstrumented) in adult isthmic spondylolysthesis or degenerative spondylolysthesis with spinal stenosis. In cervical spondylosis and radiculomyelopathy, discectomy seems as effective as discectomy plus fusion, which does not seem to be better than untreated SDD beyond 24 months. Preoperative antibiotics seem to prevent infection in spinal surgery. No benefit of surgery is demonstrated in discogenic pain. None of conservative therapies are supported by strong evidence. Antidepressants improve pain perception but do not influence the functional status. DISCUSSION: Although lumbar instrumented surgery has nearly doubled over two decades and the annual growth is about 20%, clinical results do not seem to have improved, not even global fusion rates. The increasing use of fusion surgery for cases other than spinal deformities, spondylolysthesis or spinal stenosis plus lysthesis may be related to multiple technical and clinical-epidemiological factors where huge financial and commercial interests must be considered. It is crucial to differentiate subsets of patients prone to benefit from surgery. It is discussed whether randomized trials incorporating sham operations are ethically justifiable, because of the lack of sound evidence for many spinal procedures. The efficacy of most conservative treatments is mild or moderate (mainly transient) and they should be probably used in combination. CONCLUSIONS. There is no strong evidence favouring most of surgical procedures for SDD from an evidence-based approach. It seems necessary that scientific organizations studying SDD create clinical guidelines relating its multidisciplinary and integral management, recognizing that, up to now, few interventions positively modify in the long-term the natural history of the disease.

Diskectomy↗
PubMed1976

Transthoracic approach for Pott's disease.

Spinal tuberculosis with paraplegia, although decreasing in incidence, remains a problem in certain sections of the United States and in most underdeveloped nations. Evacuations of the tuberculous abscess, debridement of necrotic bone, and fusion of the anterior spine are maneuvers performed increasingly by thoracic surgeons. Twenty-two patients with Pott's disease and symptoms of back pain, gibbous deformity, and neurological deficit underwent thoracotomy. Nine were paraplegic prior to operation. Postoperatively, spinal fusion occurred in all cases. All paraplegic patients can walk now, and 17 of the 22 treated operatively have been completely rehabilitated and are in school or working. The average hospital stay was 2.4 months. There was 1 operative death. Medical treatment for Pott's disease consisted of bed rest and chemotherapy and resulted in progressive neurological deficit in 2 patients with an average hospital stay of 2.2 years. We believe operative treatment offers two distinct advantages: excellent reversal of even long-standing paraplegia and markedly shortened hospital stay.

Adolescent↗
PubMed1984

Spinal and cortical evoked potentials following stimulation of the posterior tibial nerve in the diagnosis and localization of spinal cord diseases.

Evoked potentials from unilateral stimulation of the posterior tibial nerve at the ankle were recorded over the spinous processes L5, L1, C2 and Cz' in 30 normal subjects (Table Ia, b and c), 11 patients with multiple sclerosis (Table II) and 8 patients with a proven space-occupying spinal cord lesion (Table III). Delayed sensory conduction of both absolute latencies and side to side differences of P40 was seen in 91% of MS patients. Additional recording of spinal evoked potentials over L5, L1 and C2 did not significantly increase the percentage of abnormal responses. The spinal cord evoked responses therefore have their diagnostic importance in localizing the demyelinating process to the spinal or supraspinal section of the sensory pathway and in excluding peripherally delayed impulse conduction. The absolute latencies were within normal limits or only slightly delayed in the spinal tumor group. The interpeak latencies between the lumbar and the cervical or cortical responses showed less variability as compared to the absolute ones and revealed slight delays in some cases. Diagnostically more important seems the amplitude quotient between the cortical and the lumbar evoked potentials (P40/S response) which was below the normal range in two thirds of the tumor group patients.

Adolescent↗
PubMed1988

Cerebrospinal fluid immunoreactive substance P and somatostatin in neurological patients with peripheral and spinal cord disease.

We have measured substance P-like (SPLI) and somatostatin-like (SLI) immunoreactivities in cerebrospinal fluid of 49 patients with peripheral (polyneuropathy, lumboischialgia) and spinal cord disease and in 16 control patients. The patient groups showed significantly higher CSF SPLI levels than controls while the mean SLI levels were unchanged. Fractionated sampling of CSF (total volume 30 ml) in 20 patients with various neurological diseases showed no significant differences between early and late fractions for SLI. In contrast, lumbar-cisternal concentration gradients were negative for SPLI, total protein and IgG, and positive for the dopamine metabolite homovanillic acid and the serotonin metabolite 5-hydroxyindolacetic acid. This suggests that SPLI may be released into the lumbar CSF from lower levels of the neuraxis, presumably the spinal cord and spinal ganglia, whereas SLI stems from diffuse CSF secretion without spinal preponderance.

Adult↗
PubMed1994

[Evaluation of selective lumbar radiculography and radicular block].

We analyzed 56 patients who received selective lumbar radiculography and radicular block (88 procedures in total). The underlying conditions were spinal diseases in 43 cases, cancer pain in 6 cases, post-herpetic neuralgia (PHN) in 5 cases and reflex sympathetic dystrophy (RSD) in 2 cases. In the spinal disease group, 24 cases showed complete pain relief and 12 cases showed partial pain relief after the therapy, with a success rate of 83.7%. In the cancer pain group, 3 cases showed complete pain relief and one showed partial pain relief (success rate: 66.7%). In the PHN group, 1 case showed complete pain relief and 2 showed partial pain relief (success rate: 60%). In the RSD group, all cases showed pain relief. When examined 3 months after this treatment, the effect had persisted in 15 cases from the spinal disease group, in 1 case from the cancer pain group, in 2 cases from the PHN group and in 2 cases from the RSD group. Selective lumbar radiculography and radicular block are useful in identifying a nerve root responsible for abnormalities. In addition, this procedure is expected to exert a long-lasting therapeutic effect in cases indicated for the procedure.

Adult↗
PubMed1996

Large scale deletions of the 5q13 region are specific to Werdnig-Hoffmann disease.

Spinal muscular atrophy (SMA) is characterised by degeneration of anterior horn cells of the spinal cord and represents the second most common, lethal, autosomal recessive disorder after cystic fibrosis. Based on the criteria of the Internatinal SMA Consortium, childhood SMAs are classified into type I (Werdnig-Hoffmann disease), type II (intermediate form), and type III (Kugelberg-Welander disease). Recently, two genes have been found to be associated with SMA. The survival motor neurone gene (SMN) is an SMA determining gene as it is absent in 98.6% of patients. A second gene, XS2G3, or the highly homologous neuronal apoptosis inhibitory protein gene (NAIP) have been found to be more frequently deleted in type I than in the milder forms (types II and III). We investigated the correlation between the clinical phenotype and the genotype at this loci. A total of 106 patients were classified into type I (44), type II (31), and type III (31) and analysed using SMN, markers C212 and C272, and NAIP mapping upstream and downstream from SMN respectively. The combined analysis of all markers showed a large proportion of type I patients (43%) carried deletions of both SMN and its flanking markers (C212/272) and NAIP exon 5), as compared with none of the patients with type II or III SMA. The presence of large scale deletions involving these loci is specific to Werdnig-Hoffman disease (type I) and allows one to predict the severity of the disease in our series.

Adult↗
PubMed2000

Low back pain in hospital outpatients in Lomé (Togo).

OBJECTIVE: To determine the patterns of low back pain and the conditions associated with this symptom in outpatients attending the rheumatology unit of the Lomé Teaching Hospital. METHODS: Medical records of patients seen over a ten-year period were studied retrospectively. RESULTS: Among the 9,065 patients seen during the study period, 3,204 (35.34%; 1,850 women and 1,354 men) had low back pain. Mean age at onset was 41 years, and mean duration of low back pain was three years. Diseases associated with low back pain were as follows: degenerative spinal disease, N = 3,054 (95.32%); spinal infections, N = 79 (2.47%); spondyloarthropathies, N = 44 (1.37%); and tumors, N = 27 (0.84%). The patterns of degenerative spinal disease included low back pain (N = 1,535, 47.91%), low back pain with nerve root pain suggestive of disk herniation (N = 1,108, 34.58%), and low back pain with nerve root pain and claudication suggestive of lumbar spinal stenosis (N = 411, 12.83%). Schöber's index was abnormal in 831 of the 1,408 patients (59%) with acute pain or disk herniation. Most patients with lumbar spinal stenosis were women (72.26%) and were aged 35 to 64 years. Findings suggestive of tuberculosis were present in 62 of the 79 patients with lumbar spinal infection. Among the 44 patients with spondyloarthropathies, 15 had ankylosing spondylitis and 11 had infection with the human immunodeficiency virus (HIV). Multiple myeloma was present in ten patients and metastatic tumors in eight. CONCLUSION: Low back pain seems to be as common in sub-Saharan Africa as in occidental countries, with a prevalence of one-third among rheumatology outpatients. Lumbar spinal stenosis seems more common than in the occident and is mainly observed in woman. Schöber's index is not useful for measuring forward bending of the lumbar spine in Africans. The epidemiology of spondyloarthropathies in sub-Saharan Africa has been changed by the expanding HIV epidemic, despite the low prevalence of the HLA B27 phenotype.

Adult↗
PubMed1994

Medical and occupational preconditions for vibration-induced spinal disorders: occupational disease no. 2110 in Germany.

The current state of scientific knowledge of the biodynamic behaviour of the vertebral column under the influence of whole-body vibration whilst sitting and results from epidemiological studies caused the medical board of experts on occupational health of the Federal Ministry of Labour in Germany to add a new occupational disease to the official list of occupational diseases. The occupational disease "diseases of the lumber spine from disc degeneration caused by long-term (mainly vertical) whole-body vibration exposure" has been introduced. The medical preconditions with the symptoms and the diagnostic methods are presented. With regard to the occupational preconditions for the acknowledgement of this occupational disease, a procedure is suggested which leads to the determination of the total occupational vibration exposure dose. Another requirement for recognition is that the chronic recurrent complaints have caused the patient to avoid any form of vibration exposure.

Biomechanical Phenomena↗
PubMed1989

An evaluation of magnetic resonance imaging at The Royal North Shore Hospital of Sydney, 1986-1987.

The diagnostic accuracy and clinical utility have been evaluated of 2810 consecutive magnetic-resonance-imaging examinations that were performed on a 1.5-T Signa magnetic-resonance-imaging unit at The Royal North Shore Hospital of Sydney between November 1986 and December 1987. The average accuracy of magnetic resonance imaging was 80%, and ranged from 21%-98% in various brain-disease and spinal-disease categories, compared with the average provisional premagnetic-resonance-imaging diagnostic accuracy of 64%, and an average accuracy of computed tomography of 45%. Clinical follow-up at three months after magnetic-resonance-imaging investigation indicated that, as a result of the magnetic-resonance-imaging examination, patient management was altered in 70% of cases, and patient outcome was altered in 62% of cases.

Australia↗
PubMed1998

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease.

We studied the efficacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (-176 ml, P < 0.001), the bladder pressure on voiding (-19 cm water, P < 0.01), and the urethral pressure (-24 cm water, P < 0.001) were significantly decreased. The modality of voiding was improved in 10 patients (i.e. micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic effect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.

Adult↗
PubMed1996

Peripheral vascular disease in spinal cord injury patients: a difficult diagnosis.

The timely detection of peripheral vascular disease (PVD) in spinal cord injury (SCI) patients is difficult because the usual symptoms of claudication and rest pain are absent. In fact, the initial manifestation of PVD in SCI patients is often advanced gangrene, so that healing, primarily or following major amputation, is either difficult and prolonged or impossible. In addition, sacral and ischial pressure sores common among SCI patients may be exacerbated and reconstruction made more difficult by PVD. Five SCI patients presented with lower extremity gangrene as the initial recognized manifestation of PVD at our institution between January 1992 and January 1994. All 5 patients had risk factors for PVD. Four out of ten limbs in these patients required amputation, either above the knee or below the knee. Three patients required concurrent vascular reconstruction of the aortoiliac segments, including an aortobiprofunda femoral bypass, an iliac embolectomy with femoral-femoral bypass, and iliac angioplasty. Three patients had ischial and/or sacral pressure sores that had recurred following multiple musculocutaneous flap reconstructions before vascular disease was recognized. The timely diagnosis of PVD involving the iliac segment in the SCI patient is sometimes overlooked and is often necessary to optimize the treatment of both lower extremity ulcers and sacral/ ischial pressure sores common among these patients.

Adult↗