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Biomedical subjects

L L Wiltse

Publications and source records attributed to L L Wiltse.

52 records · Page 3Linked to original sources
PubMedDate not supplied

Surgery for intervertebral disk disease of the lumbar spine.

There is little doubt that surgical treatment of lumbar spine pain is often unsatisfactory. It is likely that we are using a cannon when a peashooter properly aimed would do a better job. Various injection techniques, especially injection of the disk itself would seem to be a rational approach. Scarring around the spinal nerves and dura is an unsolved problem. The search for an interposition membrane goes on. Fat grafts are being advocated, but it is too early to evaluate their efficacy. The problem of how to adequately decompress the nerves in spinal stenosis without jeopardizing spinal stability is still unsolved. Interbody fusion still carries a high failure rate as far as fusion is concerned, but what is worse, failure to relieve the pain for which it was done remains frequent. Spine pain programs concentrating upon training in exercises, training in the proper way to perform the activities of daily living and especially psychological counseling and operant conditioning probably represent the greatest single recent advance in the rehabilitation of the low back sufferer. Finally, there is an unfulfilled need for more accurate reporting of our subjective clinical results if advances are to be made in this area, where pain is the principal problem.

Arthrodesis↗
PubMedDate not supplied

Multiplanar computerized tomography in the normal spine and in the diagnosis of spinal stenosis. A gross anatomic-computerized tomographic correlation.

The limitations of current diagnostic tools, including myelography, in localizing the anatomic lesion in spinal stenosis are well recognized. The purpose of this study is to investigate whether computerized tomography can more effectively define the normal and abnormal osseous structures compromising the boundaries of the spinal canal, nerve root canal, and intervertebral foramen. This study is a pathologic-radiographic correlation between CT scans and sections of spine specimens that were so scanned. The tomographic images investigated were multiplanar, that is, simultaneously presenting transverse, coronal, and sagittal images. Spine specimens were chosen to show how the technique applies to the normal spine, as wel as to selected specimens with spinal stenosis. The role of the discs and apophyseal joints in shaping the intervertebral foramina and lateral recesses is emphasized in both normal and abnormal specimens. This study shows that computerized tomography can precisely localize anatomic lesions and, by comparison of the image to the gross anatomic specimen, that it is a reliable portrayal of the anatomic fact.

Humans↗
PubMedDate not supplied

Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome.

This syndrome occurs in two types of patients: (1) the elderly person with degenerative scoliosis and (2) a somewhat younger adult population with isthmic spondylolisthesis and at least 20% slip. On plain radiograph, the Ferguson view (25 degrees caudocephalic) is best for visualizing the condition, however, CT is by far the best diagnostic tool. To show this far laterally, the "window" on the CT scanner must be opened wider than usual. Both coronal and parasagittal views will demonstrate the condition, but the coronal is the most valuable. Symptoms are classical spinal nerve compression. Usually it is the L5/S1 level that is involved, but other levels can be. At surgery, it is most important that nerve decompression be carried far enough laterally. This can mean sacrificing the lower half of the pedicle and the entire transverse process. Part of the body of S1 and of the sacral ala can be removed if the surgeon prefers. Because so much bone is removed, instability is a factor to be seriously considered. How to decompress adequately and still maintain stability often poses a most difficult problem.

Adult↗
PubMedDate not supplied

The management of patients with back pain and idiopathic vertebral sclerosis.

Twenty-two patients with severe back pain associated with radiologic evidence of vertebral sclerosis are reported. There were 19 women and 3 men; the average age was 42 years. Duration of pain averaged 4.3 years. The characteristic radiologic findings were diffuse sclerosis of the anterior inferior portion of the vertebral body and narrowing of the adjacent disc space. There was no extension of the sclerosis beyond the vertebral body, no paravertebral mass, and no loss of vertebral height. These radiologic characteristics, in conjunction with other clinical findings, should permit a diagnosis without the need for biopsy.

Adult↗
PubMedDate not supplied

Epidural cortisone injections in the young athletic adult.

The lumbar epidural cortisone injection can be a useful adjunct in the conservative management of the athlete with a symptomatic lumbar disc and associated irritated neural elements. Thirty-two young athletes (ages ranging from 17 to 30 years) with a clinical diagnosis of a symptomatic lumbar disc and sciatica were treated with lumbar epidural cortisone injections. All had had disabling symptoms persisting for a minimum of 2 weeks, with an average duration of 3.6 months. Dramatic abatement of symptoms and a significantly hastened return to competiton (a positive response) was seen in 14 (44%) of the 32 athletes following injection. Although the results were encouraging, we found the success rate of this study group to be less dramatic than larger reported series in the general population.

Adolescent↗
PubMedDate not supplied

Stress reactions involving the pars interarticularis in young athletes.

A stress reaction involving the pars interarticularis of the lumbar spine was confirmed in seven young athletes with a positive technetium pyrophosphate bone scan. No pars defects were detectable on their lumbosacral roentgenograms, which included oblique views. The return to normal levels of radioactive uptake on repeat bone scans correlated closely with their clinical course. If the bony reaction is recognized early, it may heal at a subroentgenographic level and prevent the development of lumbar spondylolysis. These early lesions usually show unilateral increased uptake at one lumbar level on the bone scan and, initially, the athlete localizes the pain to the corresponding unilateral lumbar paraspinous area. The "one-legged hyperextension test" is positive on the ipsilateral side and aggravates the pain. Treatment consists of avoiding the aggravating activities and resting. The average time for return to pain-free competition was 7.3 months. These developing defects may be the source of considerable prolonged disability in the young athlete, particularly if undiagnosed and untreated.

Adolescent↗
PubMedDate not supplied

The treatment of spinal stenosis.

Decompression usually relieves leg pain and enables the patient to walk normal distances. Some back pain may remain. This is often helped by a light elastic support. If there was loss of sensation and motor power before operation, return may be considerable. The operation is only a small part of the total treatment of spinal stenosis. By relieving the pressure on nerves and blood vessels, it paves the way for the postoperative measures previously outlined. These are aimed at rebuilding atrophied muscles and restoring movement to stiff joints. We emphasize the importance of dealing not only with central stenosis involving the central canal, but also of making certain that there is no compression of the spinal nerves in their canals as they pass out through the foramina.

Adult↗