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Biomedical subjects

N Bogduk

Publications and source records attributed to N Bogduk.

At least 19 recordsLinked to original sources
PubMed1996

Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain.

BACKGROUND: Chronic pain in the cervical zygapohyseal joints is a common problem after whiplash injury, but treatment is difficult. Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint, but the efficacy of this treatment has not been established. METHODS: In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical zygapophyseal joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment. The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level. RESULTS: The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group (P=0.04). At 27 weeks, seven patients in the active-treatment group and one patient in the control group were free of pain. Five patients in the active-treatment group had numbness in the territory of the treated nerves, but none considered it troubling. CONCLUSIONS: In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind, placebo-controlled local anesthesia, percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief.

Adult↗
PubMed1996

The value of medical history and physical examination in diagnosing sacroiliac joint pain.

STUDY DESIGN: This prospective study evaluated the diagnostic utility of historically accepted sacroiliac joint tests. A multidisciplinary expert panel recommended 12 of the "best" sacroiliac joint tests to be evaluated against a criterion standard of unequivocal gain relief after an intra-articular injection of local anesthetic into the sacroiliac joint. OBJECTIVES: To identify a single sacroiliac joint test or ensemble of test that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinically valuable. SUMMARY OF BACKGROUND DATA: No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion standard. METHODS: Historical data was obtained, and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks. Ninety percent or more relief was considered a positive response, and less then 90% relief was considered a negative response. RESULTS: There were 45 positive and 40 negative responses. No historical feature, none of the 12 sacroiliac joint tests, and no ensemble of these 12 tests demonstrated worthwhile diagnostic value. CONCLUSION: Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study.

Adolescent↗
PubMed1996

Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study.

STUDY DESIGN: The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks. OBJECTIVE: To determine the prevalence of cervical zygapophysial joint pain among patients with chronic neck pain (more than 3 months' duration) after whiplash injury. SUMMARY OF BACKGROUND DATA: The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition. METHODS: Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 zygapophysial joint. Patients who had positive responses concluded investigations. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection. RESULTS: Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 zygapophysial joint pain was 50%. Among those without C2-C3 zygapophysial joint pain, placebo-controlled blocks revealed the prevalence of lower cervical zygapophysial joint pain to be 49%. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%). CONCLUSION: Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance.

Accidents, Traffic↗
PubMed1996

Pain and psychologic symptoms of Australian patients with whiplash.

STUDY DESIGN: A survey of pain intensity and psychological symptoms in patients with chronic neck pain after whiplash injury. OBJECTIVES: To describe the pain and psychological profiles of patients with chronic whiplash. SUMMARY OF BACKGROUND DATA: Reports in the literature mention a constellation of symptoms associated with chronic whiplash injury but no systematic survey using objective patient report measures has been reported. METHODS: One hundred forty consecutive referred patients with chronic neck pain after a motor vehicle accident were studied using the SCL-90-R psychological profile and the McGill Pain Questionnaire. RESULTS: Psychological profiles and pain intensity ratings, similar to profiles obtained from patients suffering from rheumatoid arthritis and low back pain of organic origin, were obtained. CONCLUSIONS: The SCL-90-R is a convenient instrument to administer to patients with whiplash. It yielded a characteristic profile of pain and appears to be more expedient than other psychometric tests for these patients.

Adult↗
PubMed1996

Lumbar discography.

Lumbar discography has been suggested as a means of testing the lumbar disc as a source of back pain. While some clinicians believe that discography helps to identify conditions such as internal disc disruption, and to verify painful disc levels in anticipation of surgery, others find the test unproven and of questionable benefit. While the existence of internal disc disruption is itself hotly debated, Dr. Bogduk and Dr. Modic have focused on fundamental issues in formulating their opinions on the use of this modality. While both agree that prospective, controlled clinical trials are needed, Dr. Bogduk feels that the usefulness of discography has been shown and that the test provides valuable information to the clinician and the patient. Dr. Modic feels strongly that the test has no proven efficacy in improving patient outcomes, and feels, in fact, that it leads to inappropriate surgery.

Back Pain↗
PubMed1996

Modelling the muscles of the scapula morphometric and coordinate data and functional implications.

Modelling of the shoulder mechanism is dependent upon reliable data on the morphometry and points of attachment of the relevant muscles. In this paper, the authors present coordinate data which have been derived from the radiography of dissected cadavers. All of the coordinates have been normalised with respect to reference dimensions of the relevant segments (humerus, scapula, clavicle and trunk). Similarly the measurements of physiological cross-section area (PCSA) have been normalised with respect to that of deltoid. The measurements of PCSA have been shown to agree largely with the work of Veeger et al. [J. Biomechanics 24, 615-629 (1991)] and Karlsson and Peterson [J. Biomechanics 25, 189-199 (1992)]. While the majority of the descriptions of morphometry concur with accepted texts there are some notable disagreements, particularly concerning trapezius.

Anatomy, Cross-Sectional↗
PubMed1996

Faking a profile: can naive subjects simulate whiplash responses?

The psychological symptom checklist, the SCL-90-R (Derogatis 1983), has been used to assess patients with a number of chronic pain syndromes. For whiplash injury, a characteristic profile has been found (Wallis et al. 1995). However, there is still a belief that patients with neck pain following whiplash injury may be malingering, and therefore the utility of the SCL-90-R as a screen for possible malingering is assessed here. Forty pain-free university students were asked to simulate chronic pain 6 months after a motor vehicle accident in order to ensure compensation. The SCL-90-R, McGill Pain Questionnaire and a visual analogue pain scale were used. Students' scores were compared with those of a group of 132 whiplash patients (Wallis et al. 1995). Differences between the two groups were striking; the students scored significantly higher than patients on all subscales of the SCL-90-R and on the visual analogue pain scale (Mann-Whitney P-values all less than 0.001). However, pain scores for both groups on the McGill Pain Questionnaire were similar. The conclusion was that it is very difficult for an ingenuine individual to fake a psychological profile typical of a whiplash patient.

Adult↗
PubMed1996

Issues in anatomy: the external anal sphincter revisited.

Textbooks of anatomy often fail to reflect controversies or new developments in anatomy. This impinges on the conduct of examinations in anatomy with respect to whether the correct answer is what appears in the textbook or what is known in the research literature. The example of the external anal sphincter is addressed. Whereas textbooks portray this muscle as having three, essentially circular parts, past and more recent work denies this description. Rather, the sphincter consists of three loops; one formed by puborectalis, one stemming from the coccyx and one stemming from the pre-anal skin. Surgeons in training should recognise that anatomy is not a static science and that idealized descriptions that occur in textbooks do not necessarily reflect actual anatomy or controversies about it.

Anal Canal↗
PubMed1995

The prevalence and clinical features of internal disc disruption in patients with chronic low back pain.

STUDY DESIGN: This was a cross-sectional analytic study of patients with chronic low back pain. OBJECTIVE: To investigate whether the criteria for internal disc disruption, as adopted by the International Association for the Study of Pain, could be satisfied in patients with chronic low back pain and to test whether there were any conventional clinical features that could identify this condition. SUMMARY OF BACKGROUND DATA: Internal disc disruption has been postulated as an important cause of low back pain. To diagnose this condition, the International Association for the Study of Pain taxonomy requires that pain be reproduced on provocation discography and that computed tomography discography reveal internal disc disruption, provided that as a control, stimulation of at least one other disc fails to reproduce pain. METHODS: Ninety-two consecutive patients with chronic low back pain and no history of previous lumbar surgery were studied. Each patient underwent a standard physical examination. Computed tomography discography was performed at a minimum of two levels. RESULTS: The diagnostic criteria for internal disc disruption were fully satisfied in 39% of patients, most commonly at L5-S1 and L4-L5. None of the clinical tests used could differentiate between those patients with internal disc disruption and other patients. CONCLUSIONS: A diagnosis of internal disc disruption can be made in a significant proportion of patients with chronic low back pain, but no conventional clinical test can discriminate patients with internal disc disruption from patients with other conditions.

Adult↗
PubMed1995

The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain.

STUDY DESIGN: A prospective cross-sectional analytic study. OBJECTIVES: To assess in patients with chronic low back pain whether the presence or absence of pain originating from the lumbar zygapophysial joints correlates with changes seen on computed tomography. SUMMARY OF BACKGROUND DATA: Results of studies have been divided as to whether or not radiologic imaging is able to predict those patients with pain originating from the zygapophysial joints. METHODS: Sixty-three patients with low back pain lasting for longer than 3 months underwent computed tomography and blocks of the zygapophysial joints at L5-S1, L4-L5, and L3-L4. The zygapophysial joints of all images were scored by three independent, masked radiologists. RESULTS: Interobserver agreement was poor with intraclass correlation coefficients of 0.34-0.66 using total joint scores for all three assessors. Using the results of a repeat assessment with two radiologists there was no statistically significant difference in joint scores between those with and those without pain originating from the zygapophysial joint. CONCLUSIONS: Computed tomography has no place in the diagnosis of lumbar zygapophysial joint pain.

Adult↗
PubMed1995

Epidural steroids.

Although perhaps only controversial internationally, epidural steroids have become the focus of litigation in Australia. The literature provides endorsement but offers little compelling data on rationale and efficacy. Steroid preparations appear to be chemically safe, provided they are accurately injected into the epidural space. Hazards occur if intrathecal penetration is not recognized. Conventional techniques do not guarantee that injectates reach the desired target nerve.

Adrenal Cortex Hormones↗
PubMed1995

The prevalence of chronic cervical zygapophysial joint pain after whiplash.

STUDY DESIGN: A survey of the prevalence of cervical zygapophysial joint pain was conducted. OBJECTIVES: To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA: In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks. METHODS: Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order. RESULTS: A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%). CONCLUSION: In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.

Adult↗
PubMed1995

The sacroiliac joint in chronic low back pain.

STUDY DESIGN: This was a cross-sectional analytic study. OBJECTIVES: In relation to pain from the sacroiliac joint, this study sought to establish 1) its prevalence, 2) the validity of pain provocation, 3) whether any arthrographic abnormalities predict a response to joint block, and 4) whether certain pain patterns discriminate patients with this diagnosis. SUMMARY OF BACKGROUND DATA: The true prevalence of sacroiliac joint pain is unknown and despite a plethora of clinical tests, none of these tests has been validated against an established criterion standard. To our knowledge, arthrography of the sacroiliac joint had never been studied. METHODS: Forty-three consecutive patients with chronic low back pain maximal below L5-S1 were investigated with sacroiliac joint blocks under image intensifier using radiographic contrast followed by 2% lignocaine. Information was obtained on pain provocation, analgesia, and image pattern. RESULTS: Thirteen patients (30%) obtained gratifying relief of their pain. Nine of these also exhibited tears of their ventral capsule. Groin pain was the only pain referral pattern found to be associated with response to sacroiliac joint block. CONCLUSION: The sacroiliac joint is a significant source of pain in patients with chronic low back pain and warrants further study.

Adult↗
PubMed1995

The surgical anatomy of thoracic facet denervation.

Thoracic percutaneous facet denervation has been employed for the treatment of thoracic zygapophysial joint pain. But the surgical anatomy of this procedure has been assumed to be the same as for lumbar medial branch neurotomy. To establish the anatomical basis for thoracic medial branch neurotomy, an anatomical study was undertaken. Using an X40 dissecting microscope, a total of 84 medial branches from 7 sides of 4 embalmed human adult cadavers were studied. The medial branches of the thoracic dorsal rami were found to assume a reasonably constant course. Upon leaving the intertransverse space, they typically crossed the superolateral corners of the transverse processes and then passed medially and inferiorly across the posterior surfaces of the transverse processes before ramifying into the multifidus muscles. Exceptions to this pattern occurred at mid-thoracic levels (T5-T8). Although the curved course remained essentially the same, the inflection occurred at a point superior to the superolateral corner of the transverse process. At no time during the dissection were nerves encountered crossing the junctions between the superior articular processes and transverse processes which have been the target points advocated for thoracic facet denervation. Rather, the results of this study indicate that the superolateral corners of the transverse processes are more accurate target points.

Adult↗
PubMed1995

Anatomy and physiology of headache.

Headache is a vast field with many different varieties of headaches and classifications. However, all headaches have a common anatomy and physiology. All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus. A mastery of the relevant anatomy and physiology of the trigeminocervical nociceptive system serves to predict and summarise the many varieties of headache systematically and with reference to their mechanisms.

Headache↗
PubMed1995

Diagnostic value of C2-3 instantaneous axes of rotation in patients with headache of cervical origin.

Previous investigators have suggested that patients suffering headache stemming from the C2-3 segment of the cervical spine can be identified by detecting an abnormal axis of rotation of that segment. The present study tested this hypothesis by correlating the location of the instantaneous axis of rotation (IAR) of the C2-3 segment with diagnostic blocks of the C2-3 zygapophysial joint in a sample of patients with headache. We found no significant correlation between the location of the axis and the response to diagnostic blocks. Previous false-positive assertions appear to be due to insufficient attention to the precision and reproducibility of the techniques used to determine IARs.

Adult↗