1/11. chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine.OBJECTIVE: The chiropractic care of a patient with vertebral subluxations, neck pain, and cervical radiculopathy after a cervical diskectomy is described. CLINICAL FEATURES: A 55-year-old man had neck pain and left upper extremity radiculopathy after unsuccessful cervical spine surgery. INTERVENTION AND OUTCOME: Contact-specific, high-velocity, low-amplitude adjustments (i.e., Gonstead technique) were applied to sites of vertebral subluxations. rehabilitation exercises were also used as adjunct to care. The patient reported a decrease in neck pain and left arm pain after chiropractic intervention. The patient also demonstrated a marked increase in range of motion (ROM) of the left glenohumeral articulation. CONCLUSION: The chiropractic care of a patient with neck pain and left upper extremity radiculopathy after cervical diskectomy is presented. Marked resolution of the patient's symptoms was obtained concomitant with a reduction in subluxation findings at multiple levels despite the complicating history of an unsuccessful cervical spine surgery. This is the first report in the indexed literature of chiropractic care after an unsuccessful cervical spine surgery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/11. Radiculitis distress as a mimic of renal pain.It is the experience of the urological author that radiculitis secondary to costovertebral joint derangement is the most common cause of lower abdominal pain. However, this pain is sometimes made worse when the patient is subjected to a flank incision for presumed renal disease, since the aftermath of a flank incision may be a downward pull on a rib owing to detachments of muscles attached to its superior surface. Emotional problems, too, befall many patients with radiculitis-despondency over delayed diagnoses or sensitivity at having been told their complaints are psychosomatic. Most often theses difficulties disappear spontaneously once the pain is relived. Definitive diagnosis requires orthopedic techniques. Unfortunately, few orthopedists are well versed or interested in the syndrome of renal pain. When they are, erroneous diagnosis can be corrected and a course of conservative or surgical treatment prescribed, with excellent results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/11. Artificial disc insertion following anterior cervical discectomy.OBJECTIVE AND IMPORTANCE: Fusion following anterior cervical discectomy has been implicated in the acceleration of degenerative changes in the adjacent spinal segments. Discectomy followed by implantation of an artificial cervical disc maintains the functionality of the spinal unit, while still providing excellent symptomatic relief. We describe our preliminary experience with implantation of the Bryan Cervical Disc System in two cases of single-level cervical disc herniation. CLINICAL PRESENTATION: Two male patients presented with a left C6 radiculopathy, without evidence of myelopathy. magnetic resonance imaging revealed a disc herniation at C5-6 in both cases. Pre-operative flexion and extension radiographs demonstrated preserved motion at the involved levels. INTERVENTION/TECHNIQUE: Following a standard anterior cervical decompression, precision drilling of the vertebral endplates was carried out using a drill attached to a bed-mounted, gravitationally-referenced retraction frame. An artificial cervical disc, composed of a polyurethane nucleus with titanium endplates, was fitted between the contoured endplates without fixation to the vertebral bodies. No complications were experienced during the insertion of the prosthesis, or in the postoperative course. Both patients experienced immediate postoperative resolution of their radicular pain and were discharged from hospital the following day. At nine months following surgery, both patients continue to have complete relief of radicular symptoms. Postoperative radiographs at six months following surgery confirm accurate placement of the prosthesis and preserved mobility of the functional spinal unit. CONCLUSION: Insertion of the Bryan artificial cervical disc prosthesis following anterior cervical discectomy is a relatively straightforward procedure, which appears to be safe and provides good clinical results, without requiring additional surgical time. Long-term follow-up is required to assess its safety, efficacy, and ability to prevent adjacent segment degeneration.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/11. Anterior cervical fusion using porous hydroxyapatite ceramics for cervical disc herniation. a two-year follow-up.BACKGROUND CONTEXT: The Smith-Robinson Method (SR), which employs autogenous bone, is the current standard for anterior cervical fusion (AF) surgery. However, autogenous bone has graft-related complications and morbidity, and harvesting it increases trauma and risk to the patient. The use of hydroxyapatite ceramic (HAP) inserts may provide a superior alternative. PURPOSE: To determine the efficacy of using HAP in AF. STUDY DESIGN/SETTING: A retrospective study of patients who had AF surgery with wide decompression and porous HAP inserts used to treat cervical disc herniation (CHD). PATIENT SAMPLE: We evaluated 36 patients who had single-level AF using HAP for CHD, without internal fixations, clinically and radiographically with a minimum follow-up of 2 years. There were 25 men and 11 women, with an average age of 49 years (age range, 24-78 years). Preoperative diagnosis included 25 cases with myelopathy and 11 cases with radiculopathy. OUTCOME MEASURES: We established four grades to classify the degree of bony fusion between the HAP and vertebra, based on any motion at the fused segment, any radiolucent zones (RZ) between vertebral bodies and the grafted HAP, and anterior or posterior bone formations on grafted HAPs. We evaluated the severity of myelopathy by applying the japan Orthopaedic association (JOA) scoring system. We evaluated the surgical outcome of the myelopathy patients using the Hirabayashi recovery rating, and for the radiculopathy patients, we used the Herkowitz criteria. methods: We retrospectively reviewed the radiographic and clinical records of all 36 patients from surgery up to periods ranging from 2 to 7 years after surgery, with the average period of follow-up being 4.5 years. We systematically classified the degree of bony fusion into four grades ranging from Grade 1 nonunion to Grade 4 complete union. RESULTS: None of the subjects showed Grades 1 and 2 fusion. Eleven percent of the cases showed Grade 3 and 89% showed Grade 4. Loss of height of the fused segment was observed in 29 cases with an average of 1.6 mm. A decrease of lordotic angle of the fused segment was observed in six cases with an average of 2.3 degrees. Four cases revealed cracked HAP inserts but achieved Grade 4 bone fusion. There was no evidence of collapse or displacement of HAPs. The results of the 11 radiculopathy patients were excellent in 10 cases and good in the remaining case. The recovery rate of the 25 myelopathy patients was 73.0%. CONCLUSIONS: Our method of anterior cervical fusion surgery using porous HAP inserted into resected end plates, combined with a wide decompression procedure, had clinical and radiographic results so satisfactory that we conclude that it can effectively replace the use of autogenous bone for treating cervical disc herniation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/11. Far-lateral disk herniation: case report, review of the literature, and a description of nonsurgical management.OBJECTIVE: To review the history and examination of a far-lateral lumbar intervertebral disk herniation (FLLIDH), as well as the treatment and outcomes of a nonsurgical approach. CLINICAL FEATURES: A 60-year-old healthy male subject had a 3-week history of right buttock and calf pain. He initially had a left lateral list and asymmetrical pelvic landmarks. Range of motion (ROM) of the lumbar spine revealed full and pain-free lumbar flexion, right-sided pain with lumbar extension and left side bending, and painful and restricted left side bending. neurologic examination was unremarkable. INTERVENTION AND OUTCOME: The patient was treated with a lumbar epidural and nerve root injection, as well as manipulation. Physical therapy consisted of deweighting treadmill, autotraction, and strengthening exercises. Outcomes were measured by using the Modified Oswestry Questionnaire, as well as a numerical pain rating scale. His initial Oswestry was 73%, pain 9/10 at presentation. Upon discharge, the Oswestry was 0% and pain was rated as 0/10. CONCLUSION: A significant decrease was noted in both the Oswestry Questionnaire, as well as the pain rate. The patient returned to running on alternate days for a minimum of 30 minutes, which was his primary goal. This case demonstrated a positive outcome using a multidisciplinary approach in a patient diagnosed with a FLLIDH. He obtained his goals and his function was fully restored.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/11. Reversal of anterior cervical fusion with a cervical arthroplasty prosthesis.This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level. Six months after the original surgery, he underwent re-exploration. decompression and arthroplasty were effected at the C6-C7 level. The old fusion was removed at the C5-C6 level and remobilized, and an arthroplasty was performed. At discharge, the patient's neck pain and hand symptoms had improved, and he had motion demonstrable on radiologic imaging at C5-C6. This is the first reported case of reversal of a cervical fusion with re-establishment of motion and represents an alternate acceptable management of pseudoarthrosis or recent spinal fusion.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/11. Cervical arthroplasty complicated by delayed spontaneous fusion. Case report.The authors describe the case of a 55-year-old woman who presented with a left C-6 radiculopathy and neck pain and in whom there was evidence of disc/osteophyte compression of the left C-6 nerve root. The patient underwent a C5-6 anterior cervical decompression and placement of a Bryan disc prosthesis. More than 7000 cervical discs have been inserted worldwide. Postoperatively, dynamic imaging demonstrated loss of motion at the instrumented level. The patient suffered persistent neck and arm pain that was slow to resolve. Seventeen months after the initial surgery osseous fusion was observed across the interspace and posterior surface of the prosthesis. This is the first documented case of fusion occurring at the level at which cervical arthroplasty had been performed. The precise reason for this phenomenon is unclear, but potential contributing factors include patient-related issues, poor motion due to neck pain, or possibly implant-related issues. To date, this is an exceedingly rare complication and warrants careful and prolonged follow up of all arthroplasty-treated cases.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/11. Idiopathic neuralgic amyotrophy: an illustrative case report.OBJECTIVE: To describe the case of a patient diagnosed with neuralgic amyotrophy (NA) illustrating pertinent aspects of differential diagnosis, the use of clinical neurophysiological procedures to aid in establishing the diagnosis, and issues of management. CLINICAL FEATURES: A 39-year-old male soldier presented with a rapid onset of marked loss of left shoulder movement. This started acutely early one morning as a sharp, severe lower neck pain progressing over the following 2 weeks to a less severe dull ache in the left shoulder and arm. Pain was rapidly replaced with weakness. physical examination and electrodiagnostic investigation helped establish a diagnosis of NA. INTERVENTION AND OUTCOME: The patient was reassured that this is normally a self-limiting condition. Range of motion exercises progressing to a strengthening program was prescribed. He was progressing well; however, we lost contact because of his commitments in the armed service. CONCLUSION: When a patient presents with shoulder and arm pain of neurogenic origin, NA should be a consideration. Differentiating NA from radiculopathy is especially important in making management decisions. With a careful history and physical examination, the diagnosis may be made without the need for ancillary investigations. Neuralgic amyotrophy is a self-limiting condition requiring reassurance and monitoring.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/11. Carcinomatous encephalomyelopathy in conjunction with encephalomyeloradiculitis.A man, aged 63, had an illness which lasted 11 months from onset with pain under the left costal margin which radiated to the epigastrium, until his death from cardiac failure. His symptoms consisted principally of parasthesias and proximal weakness of both upper and lower extremities with atrophy of the shoulder and pelvic girdles. He developed pyramidal tract signs, became euphoric, emotionally unstable and mentally retarded. There was no clinical evidence of cerebellar dysfunction. Bronchogenic carcinoma was suspected from a tomograph of the thorax, but, in spite of extensive clinical and laboratory studies, the diagnosis was verified only postmortem. The CSF cell count was high at first but diminished as the disease progressed. Muscle biopsies revealed chronic generalized denervation without signs of myopathy. Neuropathologically, encephalomyeloradiculoneuritis concentrated on the spinal cord was combined with severe rarefaction of the ganglion cells of the anterior horns and with bilateral degeneration of the lateral pyramidal spinocerebellar and posterior tracts. A more diffuse process was obvious in the anterolateral tracts of the lumbar region. Polyneuropathy concentrated in the distal region was accompanied by slight inflammatory reaction in the sciatic nerve. Cerebellocortical degeneration which exceeded physiological age-related rarefaction was also present. The findings are discussed in relation to the literature.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/11. Radiculitis distress as a mimic of renal pain.It is the experience of the urological author that radiculitis secondary to costovertebral joint derangement is the most common cause of lower abdominal pain. However, this pain is sometimes made worse when the patient is subjected to a flank incision for presumed renal disease, since the aftermath of a flank incision may be a downward pull on a rib owing to detachments of muscles attached to its superior surface. Emotional problems, too, befall many patients with radiculitis--despondency over delayed diagnoses or sensitivity at having been told their complaints are psychosomatic. Most often these difficulties disappear spontaneously once the pain is relieved. Definitive diagnosis requires orthopedic techniques. Unfortunately, few orthopedists are well versed or interested in the syndrome of renal pain. When they are, erroneous diagnosis can be corrected and a course of conservative or surgical treatment prescribed, with excellent results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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