1/16. Atypical clinical presentation of ankylosing spondylitis.OBJECTIVES: To describe a subgroup of patients with ankylosing spondylitis (AS), whose disease evolved without the characteristic inflammatory back pain or significant disability. methods: Three patients who were diagnosed in their late 5th decade of life as having AS are described. Information about asymptomatic cases of AS or patients who were unaware of their disease was gathered from case reports and from studies involving HLA-B27-positive individuals. Another source of information derived from studies that investigated conditions known to be a complication of AS, such as heart block or aortic regurgitation. RESULTS: The data collected from the literature suggest that 1.5% to 10% of the patients with AS are asymptomatic or have very mild disease. These patients are diagnosed late in the course of the disease. CONCLUSIONS: Because of the mild nature of the symptoms, the real prevalence of atypical AS is unknown. The information gathered from the literature allows to delineate 4 subgroups of patients with AS: (1) Classic AS with characteristic clinical and radiographic manifestations; (2) Asymptomatic AS with characteristic radiographic findings; (3) Asymptomatic AS with extra-articular features as the presenting manifestations; (4) Symptomatic AS without radiographic supporting evidence. patients with asymptomatic or mild symptoms deserve more attention, because a better understanding of the factors that affect the expression of pain in different individuals may generate better pain control therapies.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/16. Case report: reduction of low back pain in a professional golfer.Previous research agrees that the majority of injuries that affect male golfers are located in the lower back and that they are related to improper swing mechanics and/or the repetitive nature of the swing. This study describes the trunk motion and paraspinal muscle activity during the swing of a golfer with related low back pain (LBP) and assesses the effect of a 3-month period of muscle conditioning and coaching on these variables. motion of the trunk was measured using three-dimensional video analysis and electromyograms (EMGs) were recorded from the same six sites of the erector spinae at the start and end of the 3-month period. At the end of the period, the golfer was able to play and practice without LBP. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the left erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future. In conclusion, further research with more subjects would now be warranted in order to test the findings of this program for the prevention of low back in golfers as piloted in this case report.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/16. VATER association: is it recognised by rheumatologists?The authors describe an adult patient with history of chronic low back pain and recurrent prostatitis, marked limitation of lumbar spine motion and a radiograph demonstrating fused lumbar vertebrae, which suggest a diagnosis of spondylarthropathy. However, the absence of radiographic evidence of sacroilitis, the nature of the vertebral defects and a history of imperforate anus pointed towards the diagnosis of VATER association, rather than a spondylarthropathy. Although most patients with VATER association are diagnosed during infancy, the musculoskeletal anomalies can be overlooked while the potentially life-threatening problems are under treatment. These anomalies may become evident later in life. Therefore, in a rheumatologic practice, when evaluating patients with back pain and vertebral anomalies, one should become familiar with the varied manifestations of VATER association.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/16. Stress fractures of the sacrum. An atypical cause of low back pain in the female athlete.low back pain is a common finding in an athletically active premenopausal female population. We describe an unusual cause of persistent low back/sacroiliac pain: a fatigue-type sacral stress fracture. Plain radiographs, bone scans, computed tomography, and magnetic resonance imaging studies were obtained in the female athletes to determine the nature of the pathologic abnormality. The most significant risk factor for fatigue-type sacral stress fractures was an increase in impact activity due to a more vigorous exercise program. Potential risk factors such as abnormal menstrual history, dietary deficiencies, and low bone mineral density were examined. The clinical course was protracted, with an average 6.6 months of prolonged low back pain before resolution of symptoms. Sacral fatigue-type stress fractures did not preclude the athletes from returning to their previous level of participation once healing had occurred.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/16. Long-term therapy of chronic non-malignant pain with potent opioids in an active police officer.PURPOSE: To report the successful long-term use of methadone and tramadol in treating low back pain in a marine police officer. Principal findings: The patient sustained a work-related injury having fallen down stairs while on duty in 1990. After multiple operations for a prolapsed L5/S1 intervertebral disk, he was first seen at our pain clinic in 1994. Numerous systemic medications, invasive procedures, physiotherapy and psychotherapy were used to treat his pain, but without sustained effect. methadone was started in late 1995 and tramadol in 2000. The current maintenance doses are methadone 20 mg and tramadol 200 mg, both twice daily. Apart from some initial disruption, the patient was soon able to return to full time work. Regular performance reports from his supervisors have always been excellent. CONCLUSION: The use of methadone in this police officer with chronic low back pain has been very successful despite the demanding nature of his job. The controversy surrounding, and further suggestions regarding long-term use of opioid therapy for non-malignant pain are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/16. Vertebral osteonecrosis associated with the use of intradiscal electrothermal therapy: a case report.STUDY DESIGN: This report describes a case of vertebral body osteonecrosis associated with the use of intradiscal electrothermal therapy. OBJECTIVES: To alert clinicians to a previously unreported complication, vertebral body osteonecrosis, after an intradiscal electrothermal therapy procedure. SUMMARY OF BACKGROUND DATA: The intradiscal electrothermal therapy procedure is a new treatment that has been advocated in the management of chronic low back pain of discogenic origin. The intradiscal electrothermal therapy procedure uses a fluoroscopically guided thermal catheter to heat the intervertebral disc. A review of the literature regarding this procedure has not revealed osteonecrosis as a complication. methods: The patient's work-up and postoperative course are documented, and all medical records were reviewed retrospectively. RESULTS: The patient's pain had improved only minimally at initial follow-up after L5-S1 combined anterior and posterior spinal fusion, undertaken after intradiscal electrothermal therapy failure. CONCLUSIONS: Intradiscal electrothermal therapy has gained increasing popularity in the treatment of discogenic low back pain, in large part because of its minimally invasive nature and perceived low risk for major complications. Previous reports in the literature have not noted any major complications associated with the proper use of this device. Clinicians should be advised that intradiscal electrothermal therapy can be associated with complications, which in the current case, led to osteonecrosis of the vertebral body.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/16. Proximal tibiofibular joint dysfunction and chronic knee and low back pain.This article reports a case of joint dysfunction of the proximal tibiofibular joint that produced knee, thigh and low back pain of 5 yr duration. An injury of a simple nature apparently caused the onset of symptoms. Manipulation of the proximal tibiofibular joint resulted in immediate and dramatic relief of symptoms. This case illustrates how a relatively minor incident can result in longstanding pain and disability. Examination and treatment procedures for the proximal tibiofibular joint dysfunction are described.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/16. cauda equina syndrome in patients undergoing manipulation of the lumbar spine.cauda equina syndrome has been implicated as a potential complication of spinal manipulation. A review of the literature from 1911 to 1989 revealed ten reported cases of cauda equina syndrome in patients undergoing manipulation without anesthesia. This article presents three new cases where a temporal association was found between the onset of cauda equina symptoms and lumbar manipulation. The type of manipulation administered and the relationship between the treatment and symptoms is reviewed. In each of these cases both the chiropractic practitioner and the emergency room physician failed to comprehend the nature of the problem and take appropriate action. As a consequence, the patients went untreated for several days. This may have led to residual symptomatology. It is concluded that patients who present with bowel or bladder disturbances, leg weakness, or rectal and genital sensory changes after manipulation, be recognized as experiencing a cauda equina syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/16. Nerve sheath tumors involving the sacrum. Case report and classification scheme.Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/16. Fifth ventricle: an unusual cystic lesion of the conus medullaris.STUDY DESIGN: Cystic dilatation of the fifth ventricle on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. The authors describe a personal case of 'fifth ventricle' and review the pertinent literature. OBJECTIVE: To emphasize the importance of including the fifth ventricle in differential diagnosis of lesions of the conus medullaris to ensure proper treatment. SETTING: italy. methods: A 30-year-old woman was referred to us for recurrent low back pain. The patient was assessed by clinical, electrophysiological (motor evoked potential, somatosensorial evoked potential and electromyography of the perineal and lower limb muscles) and urodynamic investigations as well as a magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement, subsequently extended to the entire vertebral column and brain. Follow-up consisted of periodic clinical evaluation and lumbar-sacral MRI after 1 and 2 years. RESULTS: General physical examination, electrophysiological and urodynamic investigations were all negative, confirming the subjective nature of the patient's symptoms. Lumbar-sacral MRI demonstrated the presence of a cyst lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the terminal ventricle. By extending the MRI investigation to the entire vertebral column and brain, it was possible to exclude an association with other malformations of the central nervous system. Clinical and radiological follow-up confirmed the nonevolutive nature of the lesion 1 and 2 years later. CONCLUSIONS: The lack of clinical symptoms and the stability of the radiological situation at 1 and 2 years follow-up motivated our choice of conservative treatment.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
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