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Biomedical subjects

S W Wiesel

Publications and source records attributed to S W Wiesel.

At least 19 recordsLinked to original sources
PubMed1992

Impairment evaluation based on spinal range of motion in normal subjects.

Spinal range of motion is a major determinant of impairment in many disability rating schedules used today. The validity of using spinal motion as the primary variable for impairment ratings must be questioned because of the large spectrum of age-related changes in motion in a normal population. The purpose of this investigation was to test the validity of this concept by determining spinal impairment in normal subjects using one of the more popular rating systems, the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. Ninety-five individual measurements of cervical and lumbar spine motion were performed on each of 81 healthy subjects by two examiners using the double-inclinometer method. Based on the AMA criteria, all of the normal subjects were noted to have some degree of impairment ranging from 2 to 38.5%, with a mean value of 10.8%. The level of impairment increased with age for cervical, lumbar, and total impairment percentages (p = 0.0001). The current method of impairment determination based on spinal motion may not accurately reflect impairment in many patients. Impairment may be overestimated by up to 38%. Alternate methods of impairment evaluation should be developed that are more specific for individuals with true functional impairment and that account for age-related differences in spinal motion.

Adult↗
PubMed1992

Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective study.

A prospective study was undertaken to establish the normal spectrum and timing of gadolinium-enhanced magnetic resonance (MR) imaging findings in 15 patients who had resolution of symptoms after successful lumbar disk surgery. Enhancement of the facet joints (in 88% of disk levels) and paraspinal muscles (100%) decreased gradually after surgery. Enhancement of the decompressed nerve root tracked proximally toward the conus medullaris in 62% at 3 weeks and was absent in all by 6 months postoperatively. Areas of intermediate signal intensity with peripheral enhancement and mass effect were seen on T1-weighted images at the site of the original disk herniation in 38% at 3 weeks and 12% at 3 months, despite complete relief of leg pain. These results reveal that even in successfully treated (asymptomatic) patients, residual mass effect on the neural elements may frequently simulate a recurrent or residual disk fragment. There is an orderly progression of imaging changes during the first 6 months after lumbar surgery that limits the interpretation of MR examinations during that period.

Adult↗
PubMed1992

Postoperative diskitis: distinguishing early MR imaging findings from normal postoperative disk space changes.

To distinguish early magnetic resonance (MR) imaging findings in postoperative diskitis from normal postoperative changes, a prospective study was performed in 15 asymptomatic patients (17 disk levels) who underwent uncomplicated lumbar diskectomy and seven patients with proved postoperative diskitis. On postoperative MR images, four of the asymptomatic patients had a finding that could also be seen in patients with diskitis. Gadolinium enhancement was useful in making the distinction and occurred as follows: (a) vertebral bone marrow: all seven diskitis patients and one asymptomatic patient; (b) disk space: five diskitis patients and three asymptomatic patients; and (c) posterior anulus fibrosus: all seven diskitis patients and 13 asymptomatic patients (14 of 17 levels). This entire triad of findings, which is strongly suggestive of postoperative diskitis, was not seen in any of the asymptomatic patients. Changes in the disk space and adjacent bone marrow on pre- and post-contrast MR images after routine diskectomy are uncommon and should not be assumed to be normal postoperative changes without careful consideration and analysis for early diskitis.

Adult↗
PubMed1992

Neurologic complications and lumbar laminectomy. A standardized approach to the multiply-operated lumbar spine.

Even the careful and knowledgeable spine surgeon will encounter a variety of neurologic complications during and after routine lumbar laminectomy. These include dural and nerve root injuries; cauda equina syndrome; and formation of scar tissue, extradural and intradural (arachnoiditis). The surgeon must be prepared to identify each of these problems and deal with them effectively at the time of the procedure and in the immediate postoperative and follow-up periods. The physician evaluating the multiply-operated lumbar spine patient must use an organized approach. The origin of the problem in most instances is a faulty decision to perform the original operative procedure. Further surgery on an "exploratory" basis is not warranted in any situation and most likely will lead only to further disability. There should be definite objective findings to substantiate the patient's symptoms. The etiology of each patient's symptoms. must be accurately localized and identified. Medical status and psychosocial situation--as well as orthopedic and neurologic findings--should be evaluated at the time of the initial consultation. Once the spine is identified as the probable source of symptoms, specific features should be sought in the patient's clinical history, physical examination, and roentgenographic studies. The number of previous operations, length of pain-free interval, and predominance of leg versus back pain are the major historic signposts. The presence of a tension sign and the neurologic findings are the focal points of the physical examination. Plain roentgenograms, motion films, water-soluble myelogram, computed axial tomography, and magnetic resonance imaging with contrast have specific roles in the workup.(ABSTRACT TRUNCATED AT 250 WORDS)

Arachnoiditis↗
PubMed1992

Epidemiology of spinal stenosis.

Although spinal stenosis has been recognized for nearly 190 years, no exact definition has yet been agreed on, a fact that has made incidence and prevalence studies all but impossible to interpret. The age at onset clearly correlates with the underlying pathomechanics. The disease appears to affect more men than women, except for degenerative spondylolisthesis, which affects more women. Occupation and somatotype do not appear to correlate with the development of symptomatic spinal stenosis. Although they are statistically more likely to have a smaller canal diameter, the black population does not seem to have a high incidence of symptomatic stenosis. Finally, although many syndromes have been reported to be associated with the development of spinal stenosis, the concomitant presence of degenerative changes appears to be a prerequisite to the development of symptomatic spinal stenosis.

Adult↗
PubMed1992

Natural history and pathogenesis of cervical disk disease.

As the cervical spine ages, degenerative processes occur that involve the intervertebral disk as well as facet joints. Some individuals experience pain as this process evolves. In many instances, it can be difficult to correlate a patient's symptoms with the associated changes. This article reviews the appropriate anatomy and biochemistry of the cervical spine and presents the pathologic entities that are encountered.

Aging↗
PubMed1991

Low back pain.

Low back pain is a very common and significant problem in our society, and there are both mechanical and psychosocial aspects to its etiology. This paper presents a systematic approach to the treatment of common types of low back pain. Treatment, beginning with conservative care, is outlined in this paper in the form of an algorithm. Current research directed at both the diagnostic and treatment aspects of low back pain is addressed.

Back Pain↗
PubMed1991

The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage.

The purpose of this study was to determine whether there was any difference in the clinical outcome between groups of patients treated with lumbar discectomy and vertebral endplate curettage as compared with disc fragment excision without endplate curettage. Eighty-three patients requiring lumbar disc excision for herniated nucleus pulposus were evaluated retrospectively at minimum 2-year follow-up. Forty-three patients had undergone fragment excision and disc space curettage at one center, whereas 40 patients underwent fragment excision without curettage at two other centers. There was no increased rate of reherniation or reoperation in the excision-only group. Vertebral endplate curettage carries a risk of annular penetration and damage to the great vessels. This study shows that this potentially dangerous step of the operation is unwarranted. In addition, patients who underwent endplate curettage had a higher incidence of low-back pain on follow-up.

Adult↗
PubMed1991

The current approach to the medical diagnosis of low back pain.

A small number of patients who present with low back pain will have an underlying medical disorder as the source of their pain. Patients who fail to respond to conservative management with controlled physical activity and nonnarcotic analgesics should have a thorough re-evaluation to detect possible sources of nonmechanical pain. Symptoms of fever, weight loss, recumbency pain, morning stiffness, acute severe pain, or colicky back pain represent specific entry points into the algorithm for diagnosis of back pain from underlying systemic illnesses. These patients will generally require a plain roentgenographic examination with subsequent scintography, MRI, CT, laboratory work, and biopsy as indicated by any positive findings during the diagnostic work-up. Therapy for individuals with nonmechanical low back pain is directed at the specific medical disorder that is the cause of their symptoms.

Algorithms↗
PubMed1990

Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly?

The utility or futility of flexion-extension radiographs in the diagnosis of lumbar spine segmental instability is a controversial issue. Previous investigations have reported a large range of normal motion and a significant overlap of symptomatic and asymptomatic motion patterns. The authors' goal was to define normal lumbosacral motion in vivo using ordinary weight-bearing lateral flexion-extension radiographs from 40 volunteers without the use of computers or special X-ray equipment. Calculation of dynamic vertebral translation, defined as the change in relative position from flexion to extension, provided a more accurate assessment of vertebral motion than measurement of static displacement on a flexion or extension view alone. Normal lumbar vertebral levels should have less than 3.0 mm of dynamic anteroposterior (AP) translation (less than 8% of vertebral body width). Although 42% of the normal subjects had at least one level with a static olisthesis greater than 3.0 mm in either flexion or extension, only 5% had a dynamic AP translation greater than 3.0 mm. These data have suggested that the previously reported large range of motion and frequency of overlap between symptomatic and asymptomatic patients may be significantly decreased (eightfold) by calculating dynamic motion, rather than static vertebral positions. The authors believe these data will provide the basis for reassessment of flexion-extension radiography in the diagnosis of lumbar spine instability.

Adult↗
PubMed1990

Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.

We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.

Adult↗
PubMed1989

A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain.

The efficacy of trigger-point injection therapy in treatment of low-back strain was evaluated in a prospective, randomized, double-blind study. The patient population consisted of 63 individuals with low-back strain. Patients with this diagnosis had nonradiating low-back pain, normal neurologic examination, absence of tension signs, and lumbosacral roentgenograms interpreted as being within normal limits. They were treated conservatively for 4 weeks before entering the study. Injection therapy was of four different types: lidocaine, lidocaine combined with a steroid, acupuncture, and vapocoolant spray with acupressure. Results indicated that therapy without injected medication (63% improvement rate) was at least as effective as therapy with drug injection (42% improvement rate), at a P value of 0.09. Trigger-point therapy seems to be a useful adjunct in treatment of low-back strain. The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication.

Acupuncture Therapy↗
PubMed1989

The pathogenesis of cervical spondylosis.

Cervical spondylosis is a generalized disease process affecting all levels of the cervical spine. Cervical spondylosis encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental instability. The natural history of cervical spondylosis is associated with the aging process. Senescent and pathologic processes are thus morphologically indistinguishable. Clinical manifestations of cervical spondylosis may arise when morphologic sequelae are superimposed on a developmentally narrow spinal canal. The two clinical syndromes of spondylotic radiculopathy and myelopathy are distinct, yet they may overlap.

Cervical Vertebrae↗
PubMed1989

Posterior acetabular fracture-dislocations: fragment size, joint capsule, and stability.

In acetabular fractures, the size of a significant posterior wall fragment remains undefined as it affects joint stability. The purpose of this study was to quantitatively evaluate fragment size and hip stability in cadaveric specimens after serial osteotomies. Also, the role of the posterior capsule, in the various osteotomies, was evaluated for changes in hip stability. We found that fragments involving 25% or less of the acetabulum are insignificant, i.e., do not affect joint stability, while fragments involving 50% or more are significant. The significance of transitional fragments (25-50% of the acetabulum) is determined by the posterior capsule.

Acetabulum↗
PubMed1988

Low back pain in the competitive tennis player.

The etiologies of low back pain and the biomechanics and pathology of the lumbar spine as they relate to tennis stroke mechanics have been reviewed, and a treatment protocol has been presented. A recent survey of the Men's Professional Tennis Tour is the only article found that discusses low back pain in tennis players; the orthopaedic and sports medicine literature is otherwise devoid of any relevant studies. Because this one survey indicates that 38 per cent of 143 tennis players missed at least one tournament because of low back problems, it seems obvious that an epidemiologic study on low back pain in racquet sports is vital to a more thorough understanding of the problem.

Athletic Injuries↗
PubMed1988

Evaluation and outcome of low-back pain of unknown etiology.

Between January 1980 and January 1985, 5,362 patients with low-back pain were evaluated prospectively using a standard approach. The majority improved with routine therapy or could be placed in a definitive diagnostic group. One hundred and nine (2%), however, failed to improve or could not be assigned a specific diagnosis. These patients, defined as having chronic low-back pain of unknown etiology, were referred to a rheumatologist for evaluation. The average time to referral was 6 months. A specific diagnosis was obtained for 14 of the 109 patients. The remaining 95 were placed on new treatment plans, which included detoxification, a change of physicians, and arbitrary changes in therapy. The results indicated that approximately 75% of the group had 50% or greater reduction of pain, and half of the workers' compensation patients returned to some form of employment (although perhaps only intermittent).

Back Pain↗
PubMed1988

Low back pain: development and five-year prospective application of a computerized quality-based diagnostic and treatment protocol.

A standardized protocol for low back pain was developed and computerized so that it could be used as a concurrent monitoring system for large patient populations. The software incorporated a relational database management system (RDBMS) and C language, a flexible, general-purpose programming language that is fast and portable. The protocol was then applied to a uniform group of industrial patients for 5 years. The results demonstrated that a quality-based protocol could be successfully computerized and applied to a large group of patients as a concurrent monitoring system. Quality care was insured by adherence to the computerized protocol. Associated economic results showed decreases in actual number of accidents each year (from 98/year prior to the study to 42/year in the last study year), in lost work days (from 3640/year before the study to 2118/year in the last year), and in costs (savings averaged $430,000/year). The goal of this study was to provide quality medicine; the economic benefits were a bonus. The monitoring system differed from those of the past in that it was driven by the basic medical information taken from the history, physical examination, and radiograph findings. The monitoring physicians were unbiased because they were not allowed to become involved in the patient's ongoing care. There was no rebound phenomenon (an initial drop in cases followed by a gradual return to the prestudy level); this was attributed to the constant monitoring of each case from beginning to end. These results led to the following conclusions: (a) Computerization of a standardized medical approach for low back pain is practical.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗