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Background: Exposure to radiation over many years prompts concerns regarding potential health-related effects, particularly the incidence of cataracts and the development of cancer. The purpose of this study was to examine and compare the exposure of the examiner to radiation during myelography versus radiculography and root block.Methods: A total of 114 examinations were performed in our institute in the 6 months. Sixty-two examinations were performed during myelography in the first 3 months (MG group), while 52 were performed during radiculography and root block in the last 3 months (RB group). The examiner wore a torso protector, a neck protector, radiation protection gloves, and radiation protection glasses. Optically stimulated luminescence (OSL) dosimeter badges were placed on both the inside and the outside of each protector. The dosimeters were exchanged every month. Radiation doses (mSv) were measured as the integrated radiation quantity every month from the OSL dosimeters. The effective dose and the equivalent doses of hand, skin, and eyes were investigated.Results: The mean equivalent doses were significantly lower outside the neck, torso, eye protectors, and inside the torso protector in the RB group than in the MG group. Conversely, the mean equivalent dose was significantly lower outside the hand protector in the MG group than in the RB group. The use of a neck protector significantly decreased the effective dose compared to the non-use of a neck protector in the RB group.Conclusions: The present study showed the standard radiation exposure to the examiner during myelography, radiculography, and root block. Receiving full protection including a neck protector and protection gloves is an easy and reliable means to reduce radiation exposure. [ABSTRACT FROM AUTHOR]

Purpose: Glial cells in the spinal cord of a lumbar radiculopathy model were investigated using immunohistochemical methods. Neuropathic pain is a consequence of neural plasticity. In models of neuropathic pain models, roles for glial cells in the development of pain behaviors have been reported. Accumulating evidence suggests that activation of p38 mitogen-activated protein kinase (p38) in glial cells contributes to the pathogenesis of neuropathic pain. We examined whether activation of glial cells is involved in the development of neuropathic pain-like behavior observed in a model of lumbar radicular pain that we developed. However, the pathogenesis of lumbar radiculopathy and in particular the effect of spinal glial activation on pain transmission in the dorsal horn of the spinal cord are still not fully known. Methods: The left L5 spinal root of Sprague-Dawley rats was ligated proximal to the DRG to produce models of lumbar radiculopathy. Protein levels of phosphorylated-p38 (p-p38) in the spinal cord were quantified by Western blot analysis. Double-immunofluorescense studies of p-p38 and specific markers of glia and neurons were performed to determine when and which types of cells were activated in the spinal cord. Results: We observed p38 activation in hyperactive microglia in the dorsal horn ipsilateral to surgery at 1 and 7 days after root constriction, but not in astrocytes or neurons. Conclusions: Constriction of the lumbar root activated microglia in the spinal cord at 1 and 7 days after surgery, and then returned to normal state at 28 days after surgery, while pain behavior continued. These findings suggest that development of lumbar radicular pain may be initiated by activation of microglia. [ABSTRACT FROM AUTHOR]

Abstract: This study will define a normal range of values for the cross-sectional area (CSA) of the C5-C8 ventral rami in normal subjects and will assess the interexaminer reliability of the CSA measurements. We also describe the normal sonoanatomy of the C5-C8 ventral rami. Thirty-three normal subjects (20 female) were scanned bilaterally. The mean CSA and reference ranges for the C5, C6, C7 and C8 ventral rami were 7.1 ± 4.1 mm2, 10.6 ± 4.3 mm2, 12.1 ± 4.1 mm2 and 10.7 ± 4.8 mm2, respectively. The intraclass correlation coefficient (ICC) demonstrated good reliability with a coefficient of 0.76 overall, with individual level coefficients at C5, C6, C7 and C8 of 0.69, 0.71, 0.76 and 0.72, respectively. This is the first study to obtain normative CSA measurements of the C5-C8 ventral rami. (E-mail: daniel.haun@logan.edu) [Copyright &y& Elsevier]

Abstract: Background context: After spinal fusion surgery, postoperative management often includes imaging with either computed tomography (CT) or magnetic resonance imaging (MRI) to assess the spinal canal and nerve roots. The metallic implants used in the fusion can cause artifact that interferes with this imaging, reducing their diagnostic value. Stainless steel is known to produce large amounts of artifact, whereas titanium is known to produce significantly less. Other alloys such as vitallium are now being used in spinal implants, but their comparison to titanium and stainless steel has not been well documented in the orthopedic literature. Titanium is a desirable metal because of its light weight and lower production of artifact on imaging, although it is not as stiff as stainless steel. Vitallium is proposed as a replacement for titanium because it has stiffness similar to stainless steel, while still being as light as titanium. Purpose: The purpose of this study was to compare the amount of artifact produced on MRI and CT by three types of spinal implants: stainless steel, titanium, and vitallium. Study design: A prospective experimental design was used to compare three types of spinal implants used in posterior spinal fusion surgery. Outcome measures: The resulting images were evaluated by a radiologist to measure the amount of artifact (in millimeters) and by an orthopedic surgeon to assess the diagnostic quality (on a Likert scale). Methods: A porcine torso was used for repeated MRI and CT scans before and after implantation with pedicle screws and rods made of the three metals being studied. Results: Images produced after the insertion of vitallium rods and titanium screws as well as those with titanium rods and screws were found to have less artifact and a better overall diagnostic quality than those produced with stainless steel implants. Overall, there was not a difference between the amount of artifact in the spinal images with vitallium and titanium rods, with the exception of a few trials that showed small but statistically significant differences between the two metals, where titanium had slightly better images. Conclusions: If vitallium rods are used in posterior spinal surgery in place of implants made of titanium or stainless steel, any postoperative imaging of the spine using MRI or CT should have amounts of artifact that are similar to titanium and better than stainless steel. [Copyright &y& Elsevier]

Résumé: Nous rapportons un cas d’hypertrophie des muscles tibiaux et, de façon moins importante, des muscles du mollet précédé d’un syndrome lombaire et d’une sciatique. La myélographie lombaire a révélé une compression d’origine discale au niveau de la racine nerveuse L5. La biopsie musculaire des muscles péroniers a montré une prédominance des fibres de type I et une hypertrophie sans infiltration inflammatoire. Nous considérons la possibilité qu’une radiculopathie, pas uniquement au niveau de la racine nerveuse S1 mais également en L5, puisse déclencher une hypertrophie musculaire et qu’elle doit être prise en compte dans le diagnostic différentiel de l’hypertrophie unilatérale localisée du membre inférieur. [Copyright &y& Elsevier]

The two most prevalent forms of nerve root cyst are perineural (Tarlov) cysts and meningeal diverticula. They occur most commonly in the lumbosacral region, where cyst expansion can produce local pain, radiculopathy, and bowel or bladder dysfunction. These lesions are best diagnosed with MRI, which also yields useful information on related neural and osseous anatomy. Techniques such as simple decompression and percutaneous needle aspiration have proven ineffective as treatments since they do not prevent continued cyst expansion or refilling. Our experiences lead us to concur with recent trends in the literature, which have favored more definitive surgical treatments aimed at the fundamental cause of meningeal cyst formation. Surgery for Tarlov cysts involves exposure, identification of neural structures, and cyst wall resection. Treatment of meningeal diverticula is similar, but also involves osteum identification and ligation. [ABSTRACT FROM AUTHOR]

Summary: Our goal was to determine the neuron-specific enolase (NSE) concentration in cerebrospinal fluid (CSF) and plasma in patients with the acute brain infarction (BI) and analyze the correlation between the measured NSE concentration and infarct volume and the degree of neurological and functional deficit. The study included 55 patients aged 56–68 with BI in the acute phase. The control group consisted of 16 patients subjected to diagnostic radiculography. The results showed a significant increase of NSE concentration within the first seven days in patients compared to the controls (2.838±0.504 ng/ml CSF and 4.479±0.893 ng/ml plasma). A significant correlation was found between NSE concentration and infarction volume and the degree of neurological and functional deficit both in the CSF (r=0.828, r=0.735, r=0.796; p<0.001) and in plasma (r=0.810, r=0.681, r=0.783; p<0.001). The results suggest that an early determination of this marker in CSF and plasma in patients with BI could be a valuable diagnostic factor. [Copyright &y& Elsevier]

Purpose: To determine conditions which influence transfer of iopamidol from lumbosacral cerebrospinal fluid (CSF) to blood. Methods: Iopamidol transfer was measured in 32 patients over 180 min after radiculography and compared with patient variables. Results: Iopamidol transfer began early in 12 patients, more slowly in 13 patients, and was not detected during sample period in 7 patients. Transfer of sequential samples correlated highly with each other (r>0.8). Transfer was more pronounced in patients with prominent nerve root sleeves on radiculogram (p=0.006, t test), and correlated inversely with body weight (r=−0.4258), and with albumin CSF/serum quotient (r=−0.4702). Conclusion: Early iopamidol transfer probably indicates transfer through spinal arachnoid villi and granulations with CSF bulk flow. Prominent nerve root sleeves may facilitate access to transfer sites. No transfer during sample period suggests no such spinal transfer, possibly due to sparse access to or presence of spinal transfer sites. Inverse correlation of transfer with body weight may reflect influence of body weight on retroperitoneal venous pressure, which regulates outflow of CSF and of compounds dissolved in it. Awareness of wide interindividual transfer variation and steady intraindividual transfer may help to specify dosage and effect expectation of intrathecal drug therapy. [Copyright &y& Elsevier]

BACKGROUNDThe use of an interbody bone graft during anterior cervical discectomy remains a controversial topic. This study presents the outcome of 64 consecutive patients who underwent anterior cervical discectomy without an interbody fusion.METHODSSixty-four consecutive patients underwent anterior cervical discectomy without interbody fusion by one surgeon at Indiana University School of Medicine between April 1994 and February 1998. A retrospective analysis of these cases was performed to evaluate outcome of this procedure. Outcome was determined using the criteria of Odom and Finney.RESULTSIn our series of patients, the mean age was 49.4 years, and the mean time of follow-up was 8.5 months. The presentation was as follows: 69% radiculopathy alone, 23% combined myelopathy and radiculopathy, and 8% myelopathy. Although 31% of the patients had symptoms for more than 1 year, the mean duration of symptoms of the remainder of patients was 3.2 months. The majority of patients had single-level disease (77%); however, 25% underwent 2 level discectomies, and 2% underwent 3 level discectomies. Twenty-four patients (38%) had soft disc herniation, and 40 patients (62%) had hard disc herniation. Of the 64 patients, 91% had either good or excellent outcomes, 9% had satisfactory outcomes, and none had a poor result. Ninety-six percent of the patients with soft disc herniation had good or excellent outcomes, whereas 88% of the patients with hard disc had good or excellent outcomes (p = 0.217). Ninety-one percent of the patients who worked before surgery returned to work after their operation. None of the patients required reoperation at the operative level or exhibited instability at the operative level. Postoperative complications included transient intrascapular pain (13%), kyphotic deformity (3%), transient vocal cord paralysis (2%), and temporary dysphagia (2%). No significant difference in age or outcome existed when comparing males to females.CONCLUSIONSatisfactory results can be attained by discectomy without an interbody fusion in the surgical management of cervical disc disease. [Copyright &y& Elsevier]

Abstract: Discal cysts are rare lesions and uncommon causes of low back pain and radiculopathy. Despite growing evidence regarding the clinical, pathological and radiological presentation of these lesions, we do not yet have a detailed understanding of their natural history, etiology or pathogenesis. To our knowledge this is the first report of multiple and multilevel discal cysts, and possible mechanisms of pathogenesis are proposed. [Copyright &y& Elsevier]