Lumbar canal stenosis: start with nonsurgical therapy.
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Although surgery is widely viewed as the definitive therapy for lumbar spinal stenosis, no randomized trials have compared surgical vs medical treatment. One study found that 60% of surgically treated patients improved, compared with 30% of those treated nonsurgically. We believe an initial nonsurgical approach is advisable for most patients. (+info)
Inpatient hospital care for back disorders in relation to industry and occupation in Finland.
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OBJECTIVES: The variation in hospital admission rates was studied for back disorders by industry and occupational title among gainfully employed Finns. METHODS: Admissions to Finnish hospitals in 1996 among 25- to 64-year-olds, based on the Hospital Discharge Register, were linked with sociodemographic data from the 1995 population census for the following primary diagnoses [International Classification of Diseases, 10th revision (ICD-10)]: all back disorders (M40.0-54.9; N (individual patients) 7,253), lumbar intevertebral disc disorders (M51.0-M51.9, N = 3,863), and other common back disorders (ICD-10: M47.1-47.2, M47.8-47.9, M48.0, M54.1, M54.3-54.5, M54.8-54.9; N = 2,433), with the total occupationally active workforce (same age range and gender) as reference. Age-standardized hospitalization rate ratios (SRR) were calculated. RESULTS: The highest SRR values for hospitalization for any back disorder were found for fishing (SRR 195), "other" mining and carrying (SRR 168), and sewage and refuse disposal (SRR 152) among the men and water transport (SRR 158), wood product (SRR 149) and pulp, paper and paper product (SRR 145) manufacturing among the women. Computer activities (SRR 44) among the men and insurance and pension funding (SRR49) among the women had the lowest SRR values. The occupations reindeer breeders and herders (SRR 495), agricultural workers (SRR 232), and paper product workers (SRR 205) among the men and plastic product (SRR 233), laundry (SRR 224), and agricultural (SRR 219) workers among the women had the highest SRR values. The lowest SRR values were observed for upper white-collar employees in public administration [men (SRR 40) and women (SRR 61)]. CONCLUSIONS: Hospitalization rates for back disorders were high for several physically strenuous industries and occupations. (+info)
Skin cancer screening.
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BACKGROUND: Skin cancer is the most common malignancy occurring in humans, affecting 1 in 5 Americans at some time during their lives. Early detection of cancerous lesions is important for reducing morbidity and mortality. CASE DESCRIPTION: The patient was a 79-year-old woman who was receiving physical therapy for cervical stenosis. The physical therapist identified a mole with suspicious characteristics, using the ABCD checklist for skin cancer screening. The patient was referred to her primary care physician, and the lesion was removed and identified as basal cell carcinoma. OUTCOMES: Early detection of this lesion allowed for complete excision, with no further treatment of the area warranted. DISCUSSION: Physical therapists can aid in detection of suspect lesions with knowledge of the basic screening techniques for skin cancer, which may help reduce the morbidity and mortality caused by these lesions. (+info)
Postoperative outcome of lumbar spinal canal stenosis after fenestration: correlation with changes in intradural and extradural tube on magnetic resonance imaging.
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PURPOSE: To evaluate the serial changes in clinical results and the intradural and extradural spaces on magnetic resonance imaging (MRI) after bilateral fenestration in 48 patients with lumbar spinal canal stenosis (LSCS). METHODS: A prospective interventional study was performed to study the clinical results, magnetic resonance imaging scans among patients who were followed up for more than 3 years. RESULTS: All patients showed improvement in clinical symptoms after operation, but clinical results deteriorated in 9 (19%) patients. Postoperative MRI scans showed that poor dural tube expansion, grouping of the cauda equina, and decrease in the cross-sectional area of the dural tube were factors associated with poor outcomes. The cross-sectional area of the dural tube and images of the cauda equina observed by MRI, before and after fenestration and during follow-up, reflected changes in clinical symptoms involving decompressed segments. CONCLUSION: Serial changes in the cross-sectional area of the dural tube and images of the cauda equina observed preoperatively, postoperatively, and on follow-up by MRI may be useful when evaluating patients' condition before and after operation. It is also useful for predicting outcomes. (+info)
Perioperative stroke in the brain and spinal cord following an induced hypotension.
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A 49-year-old woman presented with stupor and paraplegia following an induced hypotension. The temporal relationship to the induced hypotension and the absence of a clear embolic source on diagnostic tests support a causal association between the hypotensive episode and the ischemic infarct. However, despite the association, a cause-and-effect relationship could not be automatically inferred. (+info)
A new minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy: surgical technique and preliminary results.
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Degenerative cervical disorders predominantly lead to anterior spinal cord compression (by bony spurs at the posterior margin of the vertebral body or by degenerated disc), which may be central and/or foraminal. In a smaller percentage of cases, there is encroachment of the canal mainly from posterior by bulging yellow ligaments or bony appositions, resulting in compression syndromes of roots or spinal cord. The aim of this work is to present a minimally invasive posterior approach avoiding detachment of muscles for the treatment of cervical radiculopathy and myelopathy. Thirteen patients suffering from cervical radiculopathy (four patients) or myelopathy (nine patients) were operated according to this technique. In principle, the technique secures access to the diseased spinal segment via a percutaneously placed working channel (11 mm outer diameter and 9 mm inner diameter). The cervical paraspinal muscles are not deflected, but just spread between their fibres by special dilators. All further steps are performed through this channel under control of three-dimensional vision through the operating microscope. The mean follow-up period was 17 months (one patient died 9 months postoperatively), and patients were evaluated using a modified version of the Oswestry Index, called the Neck Disability Index (NDI), and the visual analogue scale (VAS) for neck and arm pain. The mean NDI (P<0.0001) improved from 13.2 (preoperatively) to 4.8 (postoperatively). The VAS for arm pain (P<0.001) and for neck pain (P<0.001) also showed marked postoperative improvement. Complete recovery of the preoperative neurological deficit was found in four patients, while the remaining eight patients showed improvement of the neurological symptoms during the follow-up period. There were no intra-operative or postoperative complications and no re-operation. The preliminary experience with this technique, and the good clinical outcome, seem to promise that this minimally invasive technique is a valid alternative to the conventional open exposure for treatment of lateral disc prolapses, foraminal bony stenosis and central posterior ligamentous stenosis of the cervical spine. (+info)
Qualitative assessment of cervical spinal stenosis: observer variability on CT and MR images.
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BACKGROUND AND PURPOSE: Several studies have been undertaken to validate quantitative methods of evaluating cervical spinal stenosis. This study was performed to assess the degree of interobserver and intraobserver agreement in the qualitative evaluation of cervical spinal stenosis on CT myelograms and MR images. METHODS: Cervical MR images and CT myelograms of 38 patients were evaluated retrospectively. Six neuroradiologists with various backgrounds and training independently assessed the level, degree, and cause of stenosis on either MR images or CT myelograms. Unknown to the evaluators, 16 of the patients were evaluated twice to determine intraobserver variability. RESULTS: Interobserver agreement among the radiologists with regard to level, degree, and cause of stenosis on CT myelograms showed kappa values of 0.50, 0.26, and 0.32, respectively, and on MR images showed kappa values of 0.60, 0.31, and 0.22, respectively. Intraobserver agreement with regard to level, degree, and cause of stenosis on CT myelograms showed mean kappa values of 0.69, 0.41, and 0.55, respectively, and on MR images showed mean kappa values of 0.80, 0.37, and 0.40, respectively. CONCLUSION: MR imaging and CT myelographic evaluation of cervical spinal stenosis by using current qualitative methods results in significant variation in image interpretation. (+info)
Differential diagnostics in patients with mild lumbar spinal stenosis: the contributions and limits of various tests.
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Lumbar spinal stenosis (LSS) and diabetic polyneuropathy are common ailments of older age. Many people suffer from both at the same time. In such patients it may sometimes be difficult to separate signs and symptoms that could be attributed to either disease. This study evaluates the contributions and limits of various tests, especially the exercise treadmill test (ETT) and electrophysiological examination, in the diagnostics of patients with mild LSS. Twenty-nine patients with mild LSS documented by computed tomography (CT) participated in this study. Sixteen of the patients had neurogenic claudication (LSS NC+), and 13 patients did not (LSS NC-). Patients with LSS were compared with a group of 24 patients with diabetic polyneuropathy and 25 healthy volunteers. The distance covered, the time spent walking and the reasons for preliminary termination of the ETT were evaluated in all groups. Initial electrophysiological examination included electromyography (EMG) from the upper and lower extremities and motor evoked potentials (MEPs) to the lower extremities. LSS NC+ patients covered a significantly shorter distance and the time spent walking was significantly shorter than in LSS NC- patients and in the two control groups. The main reason for preliminary termination of the ETT was the development of NC in 67% of the LSS NC+ patients. In contrast, no LSS NC- patient and none from the control groups revealed NC, but 31% of LSS NC- patients were not able to finish the ETT for other reasons (e.g. dyspnoea). Electrophysiological parameters evaluated from the upper extremities distinguished diabetic patients from LSS patients. The latencies of the tibial F-wave, soleus H-reflex and spinal MEP response reliably distinguished healthy volunteers from diabetic patients and LSS patients, and particularly LSS patients from diabetic patients. The chronodispersion of the tibial F-wave distinguished LSS NC+ patients from the other groups. The results of the study show that electrophysiological examination contributes to the differential diagnostics between mild lumbar spinal stenosis and diabetic polyneuropathy. The contribution of electrophysiological methods in verification of NC in LSS patients is limited (chronodispersion of the tibial F-wave only). The ETT is useful in confirmation of NC and walking capacity verification, but restriction of walking capacity should be carefully analysed. (+info)