[Pain syndromes of the lumbar spine: therapeutic and diagnostic procedures (author's transl)].
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Biomedical subjects
Publications and source records attributed to A Benini.
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In some cases with the clinical and myelographic diagnosis of lumbar root compression due to disc herniation, exploration fails to reveal any lesion of the intervertebral disc. Sometimes the source of the root compression is found to be articular: process impingement in stenotic recessus lateralis of the spinal canal. Pathogenesis and surgical therapy of such lesion are discussed. It is suggested that in such cases radical exposure of the nerve root should be undertaken, even if it should prove necessary to sacrifice articular facets.
An almost typical sciatic syndrome can be occasionally associated with a thickening of the leptomeninges, producing a type of chronic fibroplastic meningitis in the region of the cauda equina. We report here four personal cases, which showed atypical myelographic patterns. The roots of the cauda equina were compressed both by the cystic and by the fibrosing types. In the cases described, the removal of the altered leptomeninges under the operating microscope produced a satisfactory result. A completely symptomfree outcome can rarely be achieved, as the pathological tissue cannot be completely removed.
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Anatomy and clinical patterns of dissociated distal paralysis of the radial nerve ("supinator syndrome" or paralysis of posterior interosseous nerve) due to trauma, tumors, rheumatic diseases and with spontaneous onset are discussed in the light of the literature and 6 personally observed cases, 5 of them with traumatic lesions. Surgical exploration and intraneural neurolysis resulted in total or partial remission in 5 instances. In our experience surgical exploration should be performed at the earliest moment after spontaneous recovery is no longer to be expected.
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