[Lumbago due to stenosis of the spinal canal].
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Selective cases have been presented to demonstrate the usefulness of computed tomography in disorders of the spine and spinal cord. The osseous structures are more readily demonstrated than the soft tissues. The cord is difficult and inconsistently identified. However, cystic lesions (syringomyelia) may, at times, be demonstrated. The transverse projection of the CT scan is an added benefit in demonstrating bony spinal lesions. The use of metrizamide with faster scanners should improve the usefulness of this technique in evaluating intraspinal lesions.
Within a period of 27 years, 65 patients were operated on because of a spinal neurinoma. 34 women and 31 men had fallen ill, the average age at the time of operation being 42 years. Preoperatively 33 patients already showed an incomplete or complete transverse lesion with the mean duration of the disease being 40 months. After the operation 75.3 per cent of the neurinoma patients showed an improvement. 66.1 per cent were able to walk on their own, 9.2 per cent needed support. 41.5 per cent became again fit to work. Six patients (9.2%) are in need of care. The total lethality, related to three years post operationem, was 10.7 per cent.
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Low back ache and pain in the legs are not always due to disc displacement and lumbar spinal degenerative changes. Some infrequent, but really not very rare diseases are presented in order to avoid mistakes which can have serious consequences for the patients. Degenerative changes of the lumbar spine are very common, not only in aged people. A superficial examination of the patient with back ache and/or pain in the legs can lead to a fallacious tie-up between such lesions and disturbances and complaints which are not connected to them.
Magnetic resonance is the best noninvasive modality for imaging the size, shape, position, and presence or absence of compression of the spinal cord. MR is less optimal than CT for the assessment of intrinsic bone abnormalities. Myelography and CT have, as their chief advantage relative to MR, short data acquisition times. Consequently, MRI has the problem of image degradation from patient motion. The advent of gadolinium-DTPA as a paramagnetic contrast agent (following FDA approval) is expected to increase the sensitivity of MR further in defining neoplasms arising from intramedullary, intradural-extramedullary, and extradural locations. In view of the ability of multiplanar MR to demonstrate neoplasms that affect the spinal cord, the use of sedation and pain medication protocols appears justified. Moreover, to eliminate intrinsic artifacts arising from cardiac pulsation, respiration and CSF flow, MR imaging must utilize advanced techniques such as flow compensation and cardiac gating.
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