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At least 1,711 records · Page 95Linked to original sources
PubMed1996

Radiologic interpretation of vacuum phenomena.

"Vacuum" phenomena may occur within peripheral joints or in the spine. These phenomena are related to the accumulation of gas, principally nitrogen, under physiologic or pathologic circumstances. Within the spine, vacuums may occur within the intervertebral discs and are useful indicators of intervertebral osteochondrosis , spondylosis deformans, Schmorl's nodes, and limbus vertebrae. In addition, intraosseous vacuum may occur within the vertebral bodies usually related to osteonecrosis. Under physiologic conditions, naturally occurring peripheral vacuums cannot exist in the presence of joint fluid. This is often an easy, inexpensive, noninvasive means of excluding a joint effusion. In this review, the appearance, clinical importance, pathogenesis, and pitfalls of spinal and extra-spinal vacuums are discussed.

Arthrography↗
PubMed1996

[Helical CT for lumbosacral spinal].

PURPOSE: The aim of this study was to investigate the efficacy of helical CT for lumbosacral pathology. MATERIALS AND METHODS: We performed helical CT with multiplanar reconstruction, including the formation of oblique transaxial and coronal images, in 62 patients with various lumboscral disorders, including 32 non-enhanced CT and 36 CT after myelography. We correlated the appearance of the stenotic spinal canal and neoplastic disease with the findings on MRI obtained at nearly the same time. RESULTS: We obtained helical CT images in all cases in about 30 seconds. The diagnostic ability of helical CT was roughly equal to that of MRI in patients with spondylosis deformans, spondylolisthesis and herniated nucleus pulposus. There was no significant difference in diagnostic value for degenerative lumbosacral disease with canal and foramnial stenosis between non-enhanced and post-myelography helical CT. However, non-enhanced helical CT could not clearly demonstrate neoplastic disease because of the poor contrast resolution. CONCLUSION: Helical CT was useful in evaluating degenerative disorder and its diagnostic value was nearly equal to that of MRI. We considered that helical CT may be suitable for the assessment of patients with severe lumbago owing to the markedly shortened examination time. However, if helical CT is used as a screening method for lumbosacral disease, one must be careful of its limitations, for example, poor detectability of neoplastic disease, vascular anomalies and so on.

Adult↗
PubMed1996

Contingent negative variation response in chronic pain patients.

The present study assesses central processing of subjective appraisal, expectancy, orientation and reaction time as indexed by Contingent Negative variation (CNV) response in chronic pain patients. Waves N1, P3 and CNV were recorded during a CNV paradigm in a simple reaction time task with a constant interstimulus interval (ISI) of 1 sec. CNV was measured from CZ x FZ in controls and chronic pain patients suffering from cervical spondylosis and low backache due to sciatica. Duration of pain was 5 to 10 years and intensity varied from moderate to severe as adjudged by Visual Analogue Scale. CNV experiment consisted of 32 trials of S1 and S2 motor response sequence. Each trial consisted of warning sound click stimulus (S1) followed by the imperative stimulus in the form of flashes (S2). S2 could be terminated by the subject quickly by pressing a response button with the dominant hand. Cursors were hand set to score the latencies for N1 and P3 potentials to S1, maximal CNV amplitude was scored as the largest negative ongoing potential immediately prior to S2 onset. Similarly Reaction Time (RT), Orientation (O) and Expectancy (E) wave amplitudes and latencies were recorded. There was a significant increase in P3 latency, RT in chronic pain patients, indicating that there is a blunting of cognitive functions and increase in reaction time in patients suffering from chronic pain. These patients also take more time to orient to CNV paradigm.

Adult↗
PubMed1996

[Postoperative radiotherapy in the prevention of heterotopic ossification after endoprosthetic hip joint replacement].

BACKGROUND: Following total hip arthroplasty high-grade heterotopic ossification occurs with a range of 0.5 to 27%. Local postoperative hip irradiation using different dosage and fractionation schedules reduces the incidence in high-risk cases on an average of 8%. The present retrospective study compares results after conventionally fractionated and high-dose radiotherapy. PATIENTS AND METHOD: A total of 50 hips (46 patients) from 2 different risk groups had complete follow-up. In group I (40 hips [80.0%]) radiotherapy was indicated after surgical excision of pre-existing high-grade heterotopic ossification, in group II (10 hips [20.0%]) for several risk factors (contralateral heterotopic ossification [n = 7], hypertrophic osteoarthritis [n = 2], spondylosis hyperostotica [n = 1]). In 28/50 cases (56.0%) conventionally fractionated irradiation with total doses ranging from 12.0 to 20.0 Gy was given, in 22/50 hips (44.0%) a high-dose irradiation consisting of 10.0 Gy given in 2 fractions on each of the first 2 postoperative days was applied. After a minimal observation period of 6 months (median: 22 months, range: 6 to 56 months) roentgenograms were analysed using a modified Brooker score. RESULTS: At follow-up, 2 hips in group I had recurrence of high-grade heterotopic ossification with the stages IIIA and IVB. In 1 case radiotherapy was interrupted after 3 x 2.0 Gy due to sepsis (IIIA), in the other case ectopic bone recurred from bony islands which layed outside the radiation portal (IVB). In group II, 9 patients had stage 0 and 1 patient stage IA. Statistical analysis using the Wilcoxon test showed a highly significant reduction of the amount of pre-existing heterotopic ossification (p < 0.0001) for both fractionation schedules. The comparison of both fractionation groups with the Whitney-Mann-U-test (p = 0.92) showed no statistical significant difference. CONCLUSIONS: The data about the high therapeutic efficacy of postoperative radiotherapy for prevention of heterotopic ossification were confirmed. Both fractionation schedules led to a sufficient reduction of high-grade heterotopic ossification in the 2 treated risk groups.

Adult↗
PubMed1997

Anterior plate instrumentation for disorders of the subaxial cervical spine.

Anterior cervical plate instrumentation is useful in the maintenance of cervical alignment, the prevention of graft extrusion, and the development of late deformity as well as potentially avoiding the need for a secondary posterior cervical procedure in the setting of cervical trauma. Its role in cervical reconstruction after decompression for cervical spondylosis is evolving. The definite risks of anterior cervical instrumentation should be considered, that is, screw and plate displacement or screw violation of neurologic structures, before the implementation of this form of fixation.

Biomechanical Phenomena↗
PubMed1997

Photopenia in chronic vertebral osteomyelitis with technetium-99m-antigranulocyte antibody (BW 250/183).

UNLABELLED: Photon-deficient areas in 99mTc/111 in white blood cell (WBC) images for diagnosing vertebral osteomyelitis have been published often. This study retrospectively evaluated whether the use of 99mTc-labeled monoclonal antigranulocyte antibodies (BW 250/183) is superior to WBC and whether it offers higher specificity. METHODS: The study included 81 patients (46 men, 35 women; mean age 55 +/- 2 yr; from 1989 to 1995) with clinically suspected vertebral osteomyelitis who underwent scintigraphic imaging after intravenous injection of 555 MBq 99mTc-labeled monoclonal antigranulocyte antibodies. Forty patients suffered from osteomyelitis (20 men, 20 women; mean age 56 +/- 6 yr), 6 patients had metastases, 28 patients had spondylosis and disk herniation and 5 patients vertebral compression fractures. Diagnosis was not histologically verified in 2 patients. Planar imaging was performed at 4 and 24 hr postinjection. Histology of osteomyelitis was available in 30 patients, clinical follow-up in 10 patients. Visual uptake scores and quantitative uptake scores of the suspected areas were calculated. The results were compared to a semiquantitative histological score (high, medium, low grade) as well as to the scintigraphic scores. RESULTS: Scintigraphy showed photopenia in all patients with histologically proven vertebral osteomyelitis, independent of the grade of infection. A quantitative evaluation of 4 and 24 hr postinjection demonstrated a 58% increase of the uptake score in cases of histologically proven high-grade infections. This increase was seen predominantly in the thoracic spine but not in lumbar spine. All nonosseous paravertebral abscesses (n = 2) showed positive images and an increasing uptake over 24 hr. CONCLUSION: Paravertebral soft tissue infections can be differentiated excellently, whereas vertebral osteomyelitis, vertebral tumors or fractures can be localized, but no differentiation is possible.

Aged↗
PubMed1997

Feasibility and complications of single-plane and biplane versus multiplane transesophageal imaging: a review of 2947 consecutive studies.

OBJECTIVE: To analyze and compare the incidence of procedural complications and failure of intubation with various sizes of probes used in transesophageal echocardiography. DESIGN: Retrospective chart review. SETTING: A Canadian, tertiary care hospital. PATIENTS: A total of 2947 consecutive transesophageal echocardiographic patient examinations between January 1992 and March 1996 at the University of Ottawa Heart Institute, Ottawa, Ontario. RESULTS: The multiplane probe (MP) was used in 1274 studies, biplane (BP) in 1642 and single plane (SP) in 31. Data for BP and SP were combined because of their similar size. Complications or failed intubation occurred in 86 studies (2.9%). There were 53 complications (1.8%) and 40 failed intubations (1.4%). Seven patients (0.3%) had both. Complications were death in one, tracheal intubation or bronchospasm in nine, bleeding in nine, angina in two, pulmonary edema in two, superficial thrombophlebitis in two, supraventricular tachycardia in one and minor adverse events in 27. Complications were unrelated to the choice of probe (MP 2%, BP and SP 1.7%, not significant). Failure of intubation (40 cases) was more common with MP than with BP and SP (2.3% versus 0.7%, P = 0.0003, OR 3.5, 95% CI 1.7 to 7.5). The main reasons for failure were cervical spondylosis in 16 patients and hypersensitive pharynx despite topical anesthesia and sedation in 13 patients. Of 21 cases of failed MP intubation, 16 (76%) were subsequently successful with BP. CONCLUSIONS: Serious complications with transesophageal echocardiography, although infrequent, do occur. The MP carries a 3.5-fold increased risk of failed intubation. In the majority of failures, successful intubation can be achieved with a smaller probe.

Echocardiography, Transesophageal↗
PubMed1996

[Comparative assessment of conventional spin echo sequences and turbo spin echo in the study with magnetic resonance of the lesions of the spinal cord].

In the last few years, new magnetic resonance (MR) pulse sequences called Fast or Turbo Spin Echo (TSE) sequences have become available. This kind of T2-weighted images is particularly useful for the study of spondylosis and degenerative spinal conditions, because it both reduces involuntary motion artifacts and its acquisition time is shorter than that of conventional SE T2-weighted images. Our study was aimed at assessing the diagnostic gain of this new type of pulse sequences in intrinsic spinal cord conditions. Therefore, we acquired TSE and conventional SE sequences, consequently, in 36 patients with intrinsic spinal cord conditions, which were apparent on T2-weighted images, and then compared the sensitivity, contrast resolution, and depiction of lesion margins and extent in both acquisition techniques. The results of our study follow: even though all lesions were identified with both techniques, contrast resolution was higher with TSE than with conventional SE images. Lesion margins and extent were substantially equally depicted with both techniques. Finally, TSE sequences had the same, and sometimes even higher, diagnostic yield than conventional SE sequences: therefore, TSE can be considered the sequence of choice in the study of intrinsic spinal cord conditions.

Adult↗
PubMed1997

Neck injury after repeated flexions due to parachuting.

A 37-yr-old, previously healthy officer developed a severe pain in the right shoulder and parethesia in the right I-III fingers during a high-altitude low-opening parachute jump. The pain started after a sudden neck flexion while he was checking the developing canopy, well before landing. Electroneuromyography revealed damage to the right C7 nerve root. Cervical radiography showed severe spondylosis and discus degeneration in the CV-VII region; magnetic resonance image demonstrated posterior disk protrusions in this area. Military aviators flying high-performance aircraft often have similar problems in the cervical spine; they have been attributed to effects of high + Gz forces in association with twisted head positions. Parachutists appear to face similar risks. Selection of the optimal head position during the parachute opening and use of light helmets should be emphasized.

Adult↗
PubMed1996

[Imaging with magnetic resonance imaging of the operated cervical spine].

The Authors report their personal experience with postoperative neuroradiologic studies in surgical patients with a herniated disk and/or degenerative cervical spondylosis. Twenty-six patients were enrolled: 16 of them underwent anterior diskectomy, 7 posterior decompressive laminectomy and 3 vertebral body removal. The patients were submitted to pre- and postoperative MRI with high field equipment (Signa 1.5 T, General Electrics), using sagittal SE T1- (TR/TE 360/15), PD and T2-weighted (TR/TE/FA 2000/40/120) sequences and T2-weighted GE axial sequences (TR/TE/FA 400/34/30). FSE sequences (TR/TE/ETL 4000/95/8) were used in 15 cases instead of the above T2-weighted SE sequences. The main postoperative MR findings were analyzed. In particular, the morphological and signal features of bone grafts, of vertebral end-plates, of the subchondral bone and of the surgical site were studied. After anterior diskectomy, the most frequent MR features were massive signal changes in the bone graft and lower vertebral plates, which were hypointense in T1 and hyperintense in T2; the adjacent subchondral bone also exhibited signal changes. Other postoperative MR findings accounted for early postoperative mobility (4 cases of persistent myelomalacia and 3 of bone graft fracture with consequent spinal instability) and late mobility (2 cases of herniated disk, 5 of spinal stenosis and one pseudomeningocele). The main limitation of MRI in postoperative cervical spine studies was the presence of ferromagnetic artifacts during SE, and even more GE, sequences; these artifacts were the main cause of misdiagnoses. In our experience, this troublesome limitation was overcome with FSE sequences but diagnostic accuracy remained poor in 4 patients. MRI, thanks to its multiparametric and multiplanar yield, is the gold standard for the examination of several early and late postoperative features and of postoperative mobility in the cervical spine. Moreover, T2-weighted FSE acquisitions are better than conventional SE to this purpose, because examination time is shorter, myelographic effect is improved and the sensitivity to ferromagnetic artifacts reduced.

Adult↗
PubMed1997

[Small hand muscle atrophy as an initial sign in HTLV-I associated myelopathy].

A 68-year-old female had been well until the age of 52 when she noticed weakness and atrophy of her right small hand muscles. She began to have gait disturbance at the age of 63. On admission, neurological examinations revealed atrophy and weakness of the small hand muscles on both sides as well as spastic paraparesis. As the antibody titer for human T-lymphotropic virus type I (HTLV-I) was elevated both in the serum and CSF, a diagnosis of HTLV-I associated myelopathy (HAM) was made. Electrophysiological studies showed neurogenic changes and suggested anterior horn cell involvement. After oral administration of prednisolone, her spasticity and gait disturbance improved slightly. Small hand muscle atrophy can be one of the initial signs of HAM, and may mimic amyotrophic lateral sclerosis and cervical spondylosis.

Aged↗
PubMed1997

[Delayed exacerbation of cervical myelopathy in a case of juvenile muscular atrophy of unilateral distal upper extremity].

We reported a case in which cervical myelopathy exacerbated 20 years after the stabilization of juvenile muscular atrophy of unilateral distal upper extremity. The patient presented progressive weakness in the right proximal upper extremity and spastic paraparesis in addition to the long-lasting muscular atrophy of right distal upper extremity. Plain x-ray showed severe cervical spondylosis with kyphosis of the cervical spine. Dynamic study on MRI disclosed cervical spinal cord atrophy and compression enhanced in both flexion and extension position of the neck. Malalignment (kyphosis) and severe spondylotic change of the cervical spine seemed to affect the spinal cord with little functional reservoir, manifesting the delayed exacerbation of myelopathy. We conclude that malalignment and subsequent spondylotic change of the cervical spine would be significant factors to determine the long term prognosis of patients with juvenile muscular atrophy of unilateral distal upper extremity.

Arm↗
PubMed1997

[Sagittal balance of the spine].

PURPOSE OF THE STUDY: The authors examined the modifications of sagittal shape and muscular functions in different vertebral diseases in order to investigate their correlations and to specify the role of hip extension in standing posture. MATERIALS AND METHODS: We included 57 patients presenting various diseases, among which lumbar kyphosis, spondylosis and spondylolisthesis, backache and lumbar stenosis. We measured joint mobility (hip extension, lumbar flexion), muscular retractions (ilio-psoas, hamstrings, rectus femoris), and muscular strength (spine flexors and extensors, hamstrings, quadriceps femoris). On standing lateral x-rays, measurements were made of various spinal and pelvic parameters, among which the "pelvi-femoral angle", proposed by the authors for hip extension evaluation. RESULTS: There was a significant correlation between pelvi-femoral angle and pelvic backward tilting (r = 0.8037 p < 0.01). This angle can therefore be considered as fundamental for evaluation of sagittal posture. Characteristic abnormalities were found for each pathogenic group, notably for lumbar kyphosis and spondylolisthesis. DISCUSSION: Upright posture is secondary to hip extension and lumbar lordosis, and an optimal and economic standing posture is obtained when balance between these two phenomena is correct. In lumbar kyphosis pelvic modifications such as hip extension, and pelvic backward tilt-up arise compensating the anterior displacement of the center of gravity, while in spondylolisthesis, anterior displacement is secondary to sacral obliquity. CONCLUSION: It is very important to evaluate the pelvis position in sagittal spinal diseases, in order to understand postural deterioration mechanisms. Lumbar kyphosis and spondylolisthesis are two examples of failure of upright posture.

Adolescent↗
PubMed1997

Comparison of risk factors for lacunar infarcts and other stroke subtypes.

BACKGROUND: Lacunar infarction (LI) is an ischemic stroke subtype with unique clinical, radiological and pathological features. Its relation to other stroke subtypes is unclear. To better understand the underlying pathological process of LI, we compared the risk factors of LI with those of other stroke subtypes. METHODS: During the study period (from January 1, 1990 to December 31, 1991), 240 consecutive patients with first-ever strokes admitted to the stroke unit of our hospital were enrolled to the study and were classified into one of the four stroke subtypes (52 with LI, 80 atherothrombotic infarcts, 38 cardiogenic embolism and 70 brain hemorrhage) based on their computed tomography (CT) and clinical features using the guideline developed by the National Institute of Neurological Disorders. Eighty outpatients of similar age who had either low back pain or cervical spondylosis were recruited from the clinics of Neurology to serve as non-stroke controls. Data collected included demographics, lifestyle, and other vascular risk factors. Detailed physical and neurological examination, blood biochemistry and Doppler ultrasound on cervical vessels were performed. RESULTS: Our investigations revealed that LI is a common stroke subtype accounting for 21% of all first-ever strokes in our hospital. Like ischemic stroke patients, those with LI were much more likely to have hypertension, diabetes, heart disease and carotid disease when compared with non-stroke controls. Patients with brain hemorrhage had less history of diabetes and lower levels of cholesterol than LI patients. CONCLUSIONS: LI patients seemed to share more risk factors with ischemic stroke patients than with brain hemorrhage patients. These shared risk factors suggest a possibly similar underlying pathological process between ischemic strokes and LI patients. Careful screening for those risk factors should be part of the mandatory clinical management for the prevention of LI.

Aged↗
PubMed1997

[Sciatica caused by avulsion of the vertebral limbus in children].

PURPOSE OF THE STUDY: Sciatica is very rare in children. We report a particular from due to traumatic avulsion of the posterior vertebral limbus. The purpose of this study was to give the principal clinical and radiological aspects of this entity and to discuss the treatment which should be different from that of common adult disk herniation. MATERIALS: From 1980 to 1992, 10 children were examined for a sciatica (7 boys and 3 girls aged from 10 years 1 month to 15 years 2 months). Sciatica appeared in all cases during sport activities and sometimes after a sport accident. Lumbar spine stiffness was encountered in all cases. Radiculalgia was unilateral in 7 cases, bilateral in 3 cases, in L5 territory in 3 and S1 in 7 cases. 4 children had deficitary neurological signs: 3 abolitions of achilles reflex, 1 weakness of foot dorsi-flexors. Standard x-rays showed in 4 cases the avulsed fragment in the vertebral canal. Spondylosis was encountered in 3 cases and spondylolisthesis in one case. Diagnosis was possible in all cases with CT Scan, M.R.I., when done showed a normal disk signal. Three children were managed by a conservative treatment by rest or brace. Seven had a surgical treatment: resection of the avulsed fragment in 6 and total diskectomy in one. The mean follow-up was five years (2 to 8 years). RESULTS: There was no complication. At last follow-up all children had a good result without sciatica recurrence. DISCUSSION: Many factors allow us to think that avulsion of the vertebral rim in children is of traumatic origin. CT Scan is the best exploration for this particular lesion. It enabled evaluation of fragment volume and location. Magnetic resonance imaging showed uninjured disks. Removal of the avulsed fragment without diskectomy seems possible in children.

Adolescent↗
PubMed1997

[Advances in DPX densitometry].

The author provides information on modern densitometric examinations and their development in the past three decades. He analyses in brief the possibilities of densitometry on the basis of the double x-ray absorptiometry on the basis of his own experience and data gained from literature. The current standard software equipment includes the measurement of the lumbal PA projection, lumbal lateral, coxae PA and entire body PA. The apparatus detects the quantity of minerals in bones in form of BMC (bone mineral content) and BMD (bone mineral density) values, and compares the measured values of density with the average values in the healthy population. It automatically evaluates statistical values of the Z and T score. The bone density can be measured with the accuracy of 3-5%, the error of reproducibility is 1-2%. The apparatus represents an ideal equipment for the measurement of bone density under normal anatomic conditions of the skeleton and in early stages of the disease which is manifestant by changes in bone tissue. As soon as the condition includes deformations of the skeleton and osteoproductive changes, especially osteochondrosis, spondylosis and the presence of osteophytes, the result becomes inaccurate. The study drafts the trend in densitometry in frame of therapeutic, preventive and research activities in orthopaedics. (Fig. 4, Ref. 16.)

Absorptiometry, Photon↗
PubMed1997

[Destructive spondyloarthropathy of the cervical spine in hemodialyzed patients].

To assess the prevalences and neurological symptoms of destructive spondyloarthropathy (DSA) and other cervical spinal diseases in long-term hemodialysis, a questionnaire survey of the medical histories and subjective sensory-motor symptoms was taken on 191 patients undergoing dialysis for 0.2-23 years (mean 8.6 +/- 6.3) with a mean age of 56.6 +/- 11.8 years (range 23-86). Furthermore, plain radiographic examinations of the cervical spine were carried out in 90% of the patients, and neurologic examinations were also performed on 29 patients. DSA was diagnosed in 18 cases (10%): moderate narrowing of the intervertebral space (NIS-I) in 8, severe narrowing (NIS-II) in 18, ossification of posterior longitudinal ligaments (OPLL) in 6, cervical spondylosis (CS) in 12 and other abnormalities in 6; 104 cases were normal. NIS-I was considered to reflect an early stage of DSA. The age of patients with DSA (mean 61.5 +/- 10.2 years), as well as with CS, was significantly higher than the normal group (52.2 +/- 10.6; p < 0.001), but younger than CS (68.5 +/- 10.0). The duration of dialysis in DSA patients (mean 12.1 +/- 6.0 years) was the longest and significantly longer than normal (7.7 +/- 6.5; p < 0.01) and (:S patients (3.8 +/- 3.0; p < 0.001). Through comparative evaluations of prior histories of the diseases, such as diabetes mellitus, carpal tunnel syndrome, amyloid osteoarthropathy (AOA) and parathyroidectomy, along with large calcification of the nuchal soft tissues on plain films, it was found that DSA, in conjunction with NIS-I, correlated with only AOA (p < 0.05). Subjective sensory symptoms, which consisted chiefly of arthralgic type followed by polyneuritic type, were noted in 60% of all patients and 56% of DSA patients. No significant differences were evident between any two particular groups. The score of subjective motor symptoms of the lower extremities in 5 patients with myelopathy was significantly higher than that in 5 other patients without neurological disorders (p < 0.05). Thirty-eight percent of DSA patients showed myelopathy; the frequency was higher than those of previous similar studies (0 = 5%). In conclusion, this study demonstrated that 1) DSA occurred in 10% of dialysis patients, which was also evident in previous reports (9 = 10%); this prevalence was higher than those of CS or OPLL, 2) DSA correlated with the duration of dialysis and AOA, 3) subjective motor symptoms of the lower extremities could indicate presence of myelopathy whereas subjective sensory symptoms contributed little to differential diagnosis, and 4) a careful neurologic examination can more frequently disclose myelopathy in patients with DSA than so far believed.

Adult↗
PubMedDate not supplied

[The x-ray diagnosis of spinal lesions depending on the age of the patient].

Results are submitted of X-ray study of spinal column in 578 patients aged 12-84, presenting with different degenerative-dystrophic alterations. X-ray picture of osteochondrosis, deforming spondylarthrosis, and spondylosis in different portions of the spine is outlined as is frequency together with age-related characteristics thereof.

Adolescent↗