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Biomedical subjects

S W Wiesel

Publications and source records attributed to S W Wiesel.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1987

Antibiotic penetration into rabbit nucleus pulposus.

A rabbit model was used to determine the penetration of four commonly used antibiotics (clindamycin, tobramycin, cephalothin, and oxacillin) into the nucleus pulposus after receiving an 8-hour course of intramuscular antibiotic injections. Clindamycin and tobramycin achieved therapeutic levels in the nucleus pulposus and both were present in greater than 50% of serum levels. Cephalothin was not detected in the nucleus pulposus and penetrated at less than 4% of serum levels at 1 hour after injection. The data were inconclusive regarding oxacillin penetration.

Animals↗
PubMed1985

The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study.

Seventy-three patients with lumbar radicular pain syndromes were treated in a prospective, randomized, double-blind fashion with either seven milliliters of methylprednisolone acetate and procaine or seven milliliters of physiological saline solution and procaine. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus pulposus or spinal stenosis. No statistically significant difference was observed between the control and experimental patients with either acute disc herniation or spinal stenosis. Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of a second injection of epidural steroids administered to the patients whose pain did not respond within twenty-four hours to an injection of either eighty milligrams of methylprednisolone acetate combined with five milliliters of 1 per cent procaine or two milliliters of sterile saline combined with five milliliters of 1 per cent procaine. Therefore, a decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.

Adrenal Cortex Hormones↗
PubMed1985

The multiply operated lumbar spine.

In conclusion, it needs to be stressed that the physician should take an organized approach in evaluating the multiply operated spine patient. The origin of the problem in most patients is a faulty decision to perform the original procedure. Further surgery on an "exploratory" basis is not warranted and will lead only to further disability. Another operation is indicated only when there are objective findings to justify it. Multiply operated back patients need a total assessment. The cause of each patient's complaints must be accurately localized and identified. In addition to the orthopaedic evaluation, the patient's psychologic and general medical status must be thoroughly investigated. Once the spine is identified as the source of his symptoms, specific features should be sought in the patient's clinical history, physical examination, and roentgenographic studies. The number of previous operations, characteristics of the pain-free interval, and predominance of leg versus back pain are the major historical points. The neurologic examination and the presence of a tension sign are the important physical findings. Plain roentgenograms, motion films, metrizamide myelography, and computerized axial tomography have a specific place in the work-up. When all the information is integrated, the physician can separate patients with mechanical problems from those with arachnoiditis. If repeat surgery is undertaken, the approach must be a new level because the dura has no osseous protection at the previous laminectomy site. The midline scar tissue should be left intact and the nerve roots exposed laterally. Finally, the surgeon should be prepared to repair a dural tear, for this is the most common complication of a repeat laminectomy.

Arachnoiditis↗
PubMed1985

The development of a cervical spine algorithm and its prospective application to industrial patients.

Disorders of the cervical spine are prevalent among industrial employees, but there has been no standardized approach to the treatment and diagnosis of these patients. The purpose of this study is to present a protocol (an algorithm, in this case computerized) designed for cervical spine patients and to evaluate the results of its application to a group of industrial patients with neck problems. The results demonstrated reductions in number of patients seen (by 54%), in number of lost work days (by 65%), and in costs (by 63%). We conclude that good medicine leads to cost savings in treatment of cervical spine injuries and that use of a computerized algorithm is both necessary and practical for consistent care in the compensation setting.

Absenteeism↗
PubMed1984

Industrial low-back pain. A prospective evaluation of a standardized diagnostic and treatment protocol.

This investigation applied a diagnostic and treatment protocol to two groups of industrial workers: 5,300 employees at Potomac Electric Power Company ( PEPCO ) for two years and 14,000 United States Postal Service workers for one year. An "active" system in which patients were evaluated weekly was implemented at the power company, and a "passive" system in which patients were seen only once was instituted at the U.S. Postal Service. The physicians were unbiased , in that they could not take part in the patients' ongoing care. The results in both groups demonstrated significant and continuous reductions in number of incidents, in days lost from work, in low-back surgery, and in financial costs. The number of low-back pain patients at PEPCO decreased 29% the first year and 44% the second; days lost from work decreased 51% the first year and 89% the second; low-back surgery dropped 88% the first year and 76% the second year. Results for the U.S. Postal Service demonstrated a decrease in the number of low-back pain patients (41%), in days lost from work (60%), and in financial costs (55%). These results, along with our observations about the study, led us to the following conclusions: (1) Good medicine leads to cost savings in treating industrial low-back pain. (2) Use of a standardized medical approach and nomenclature is necessary and practical, for consistent care. (3) A good record keeping system is essential to perform useful medical analyses for identifying scientific problems. (4) Unbiased medical surveillance leads to changes in behavior of both treating physicians and patients. (5) The outcome for most low-back pain patients in industry is not as grim as previously perceived if their medical management is approached in an organized manner.

Absenteeism↗
PubMed1984

A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients.

In order to study the type and number of CAT scan abnormalities of the lumbar spine that occur in asymptomatic people, 52 studies from a control population with no history of back trouble were mixed randomly with six scans from patients with surgically proven spinal disease, and all were interpreted by three neuroradiologists in a blinded fashion. Irrespective of age, 35.4% (26.6%, 51.0%, and 31.3%) were found to be abnormal. Spinal disease was identified in an average of 19.5% (23.8%, 22.7%, and 12.5%) of the under 40-year-olds, and it was a herniated nucleus pulposus in every instance. In the over 40-year-old age group, there was an average of 50% (29.2%, 81.5%, and 48.1%) abnormal findings, with diagnoses of herniated disc, facet degeneration, and stenosis occurring most frequently.

Adult↗
PubMed1981

Treatment of dural tears associated with spinal surgery.

We reviewed the cases of five consecutive patients with tears of the spinal dura with postoperative leaks of cerebrospinal fluid. Problems in cluded the persistence of cerebrospinal-fluid fistulas in four patients and a late symptomatic pseudomeningocele in one, all requiring reoperation and meticulous closure of the dura. Dural tears should be repaired at the time of the original operation either directly or utilizing a fascial graft or a tissue-plug technique. When the leak is first noted in the postoperative period, reoperation for repair of the dura is recommended.

Adult↗
PubMed1979

Longitudinal fractures of the sacrum: case report.

A longitudinal fracture of the sacrum without an associated neurologic deficit is described. It was treated by bedrest successfully. The case is compared to the usual transverse or oblique sacral fracture: we feel that because the sacral nerve roots were pushed to either side of the fracture there were no neurologic problems in the case presented.

Adult↗