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Background: Endoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high rates of nerve damage, a steep learning curve, and prolonged surgical times, often occurring during the creation of the operative channel. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety. We aimed to analyse the anatomical data of Kambin's triangle via CT imaging to define the parameters of the safe operating area for transforaminal posterior lumbar interbody fusion (TPLIF), providing crucial insights for clinical practice. Methods: We selected the L4–L5 intervertebral space. Using three-dimensional (3D), we identified Kambin's triangle and the endocircle within it, and recorded the position of point 'J' on the adjacent facet joint as the centre 'O' of the circle shifts by angle 'β.' The diameter of the inscribed circle 'd,' the abduction angle 'β,' and the distances 'L1' and 'L2' were measured from the trephine's edge to the exiting and traversing nerve roots, respectively. Results: Using a trephine with a diameter of 8 mm in TPLIF has a significant safety distance. The safe operating area under the TPLIF microscope was also clarified. Conclusions: Through CT imaging research, combined with 3D simulation, we identified the anatomical data of the L4–L5 segment Kambin's triangle, to clarify the safe operation area under TPLIF. We propose a simple and easy positioning method and provide a novel surgical technique to establish working channels faster and reduce nerve damage rates. At the same time, according to this method, the Kambin's triangle anatomical data of the patient's lumbar spine diseased segments can be measured through CT 3D reconstruction of the lumbar spine, and individualised preoperative design can be conducted to select the appropriate specifications of visible trephine and supporting tools. This may effectively reduce the learning curve, shorten the time operation time, and improve surgical safety. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate, using ultrasonography, the morphological changes of the sciatic nerve in the dorsal thigh in terms of its cross-section area (CSA) in patients with unilateral S1 radicular symptoms. Methods: This observational study was performed in 15 participants (12 females; mean age 46.9 ± 9.9 years; mean body mass index 26.5 ± 4.7 kg/m2) diagnosed with unilateral S1 radiculopathy. The CSA of the sciatic nerve was measured and evaluated bilaterally by ultrasound imaging at three levels of the dorsal thigh; at the gluteal fold, proximal quarter-thigh, and mid-thigh. The values for the symptomatic and asymptomatic sides of each patient were compared. Results: The mean CSA values of the symptomatic (39.6 ± 15.6 mm²) and asymptomatic (32.9 ± 11.2 mm²) sciatic nerves at the level of the GF were measured. A signifi cant increase of the CSA at this level on the patients‘ symptomatic side was observed (P = 0.02; d = 0.49, i.e., medium size of the eff ect). At proximal quarter-thigh and mid-thigh levels, the side-to-side diff erence did not reach a level of signifi cance. Conclusion: An enlargement of the nerve CSA at the gluteal fold level was observed on the symptomatic side with sciatica, while those changes were generally present during the period when the patient complained about the subjective symptoms. Ultrasound imaging may be a useful, available tool to assess morphological changes of the sciatic nerve in unilateral S1 radicular symptomatic patients. [ABSTRACT FROM AUTHOR]

In this report, we presented a 65 year-old male case having right leg pain due to L5 radiculopathy. Based on the radiological examination including CT, MRI and radiculography, double crash impingement of L5 nerve root due to L4-5 lateral recess and L5-S foraminal stenosis was diagnosed. Because of the strong pain, he could not work anymore. His job was a general manager of big hospital, he needed to return to job as soon as possible. We decided to conduct the full-endoscopic decompression surgery of ventral facetectomy (FEVF) for L4-5 lateral recess stenosis and foraminoplasty (FELF) for L5-S foraminal stenosis. The technique can be done under the local anesthesia with only 8 mm skin incision; thus, it must be the least invasive spine surgery. Soon after the surgery, he could return to the original job as a general manager. In conclusion, the full-endoscopic decompression surgery for the spinal canal stenosis such as FELF and FEVF would be minimally invasive procedure and it enable patients the quick return to the original activity. [ABSTRACT FROM AUTHOR]

Cervical nerve root infiltrations are frequently performed in patients with radiculopathy, and computed tomography (CT) is commonly used for image guidance. With the traditional anterolateral approach, catastrophic side events due to spinal ischemia have been reported. To minimize risk, a dorsal approach has been advised, but the safety of this dorsal approach has not been studied systematically. In a 5-year period, 137 cervical nerve root infiltrations using a dorsal approach were performed on 109 patients and retrospectively reviewed. In our series, no major complications like spinal ischemia, spondylodiscitis, large hematomas with the need for surgery or severe allergic reactions occurred. In conclusion, using a dorsal approach, CT-guided cervical nerve root infiltrations with an extraforaminal needle position seem to be a safe intervention. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the prevalence of vulnerable vessels around the target of cervical transforaminal epidural steroid injection at the C3-C7 cervical nerve root levels in a clinical setting. Design: Retrospective, cross-sectional study was conducted. Participants: Patients complaining of neck or arm pain with no previous surgical history and who had undergone both precontrast and contrast- enhanced neck computed tomography were included retrospectively. Results: In 26 (21.0%) of 124 patients, none of the vulnerable vessels around the target of cervical transforaminal epidural steroid injection around both sides of the C3-C7 nerve roots were observed. Of 248 cervical root levels, the C3 level had 103 vessels (41.5%), the C4 level had 110 vessels (44.4%), the C5 level had 98 vessels (39.5%), the C6 level had 59 vessels (23.8%), and the C7 level had 34 vessels (13.7%) close to each target nerve root. In addition, variations of the vertebral artery at the C4-C7 level were observed in 11 (8.9%) of 124 patients. Conclusions: To prevent unexpected critical complications involving injury to vulnerable vessels during cervical transforaminal epidural steroid injection, it is recommended to routinely evaluate the vulnerable vessels around the cervical nerve root with computed tomography or Doppler ultrasound before cervical transforaminal epidural steroid injection, especially for the upper cervical nerve root level. [ABSTRACT FROM AUTHOR]

The article describes the case of a 44-year-old woman diagnosed with polyradiculoneuropathy involving the facial nerve and spinal nerve roots. Magnetic resonance imaging was performed to search for carcinomatous infiltration of nerve roots. A differential diagnosis of porphyria and lupus were considered. Schirmer's test was made after the woman's facial palsy was resolved.

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. Extraforaminal decompression of the L5 nerve root remains a challenge due to anatomic constraints, severe level-degeneration, and variable anatomy. The purpose of this study is to introduce the use of navigation for transmuscular transtubular decompression at the L5/S1 level and report on radiological features and clinical outcome. Methods. Ten patients who underwent a navigation-assisted extraforaminal decompression of the L5 nerve root were retrospectively analyzed. Results. Six patients had an extraforaminal herniated disc and four had a foraminal stenosis. The distance between the L5 transverse process and the para-articular notch of the sacrum was 12.1 mm in patients with a herniated disc and 8.1 mm in those with a foraminal stenosis. One patient had an early recurrence and another developed dysesthesia that resolved after 3 months. There was a significant improvement from preoperative to postoperative NRS with the results being sustainable at follow-up. ODI was also significantly improved after surgery. According to the Macnab grading scale, excellent or good outcomes were obtained in 8 patients and fair ones in 2. Conclusions. The navigated transmuscular transtubular approach to the lumbosacral junction allows for optimal placement of the retractor and excellent orientation particularly for foraminal stenosis or in cases of complex anatomy. [ABSTRACT FROM AUTHOR]

Melanotic or melanocytic schwannoma is a rare tumour usually involving spinal nerve roots but can also present at other anatomical locations. Although there are less than 200 cases reported, melanotic schwannomas can have distinctive imaging features but there is limited recent literature on its often characteristic radiological appearances. Recent publication of the largest case series thus far has suggested melanotic schwannoma to be a separate entity to other schwannomata and that its reclassification to a malignant lesion be under consideration. We present a case series over an 11-year period to highlight salient imaging features with reference to the current concerns regarding its malignant potential. [ABSTRACT FROM AUTHOR]

Aim This randomized clinical trial was designed to evaluate the effect of pulsed electromagnetic field therapy ( PEMF) in the management of patients with discogenic lumbar radiculopathy. Methods Forty patients suffering from lumbar radiculopathy due to lumbar disc prolapse were randomly assigned to one of two groups: a study group that included 20 patients who received PEMF therapy and a control group that included 20 patients who received placebo treatment. Both groups were evaluated at bases line and after 3 weeks by using a visual analogue scale ( VAS) (0-10), somatosensory evoked potentials ( SSEPs) for selected dermatomes and Modified Oswestry Low Back Pain Disability Questionnaire ( OSW), and findings were compared before and after treatment. Results Significant differences were observed between both groups before and after application of PEMF therapy relative to VAS ( P = 0.024), total OSW ( P < 0.001), and other domains of OSW score (pain intensity [ P = 0.009], personal care [ P = 0.01], lifting [ P < 0.001], walking [ P < 0.001], sitting [ P < 0.001], standing [ P < 0.001], sleeping [ P < 0.001], social life [ P < 0.001] and employment [ P = 0.003]). Other significant differences were observed between both groups relative to SSEP latency and amplitude of the evaluated dermatomes on the right side ( P = 0.022 and P = 0.001, respectively), and left side latency and amplitude ( P = 0.016 and P = 0.002, respectively). Conclusion PEMF therapy is an effective method for the conservative treatment of lumbar radiculopathy caused by lumbar disc prolapse. In addition to improvement of clinically observed radicular symptoms, PEMF also seems effective in reducing nerve root compression as evidenced by improvement of SSEP parameters after treatment. [ABSTRACT FROM AUTHOR]

The article discusses a study on the significance of lumbosacral radiculography using 3D magnetic resonance (MR) rendering or morphologic information to help in the diagnosis of symptomatic extraforaminal disc herniation. Patients who had extraforaminal or combined disc herniations were included in the study. It concludes that lumbosacral radiculography via 3D MR rendering is a useful method for obtaining diagnostic information association to symptomatic extraforaminal disc herniation.

Surgery is the standard treatment for the extremely rare pathology of isolated anomalous systemic arterial supply to normal lung (ISSNL). We describe our experience with this anomaly in a 29-year-old male presenting with recurrent haemoptysis that was successfully treated with a combination of metallic coils and cyanoacrylate glue. In addition to contributing to the extremely limited data on endovascular therapeutic options in ISSNL, we also intend to raise the awareness among endovascular therapists of the need to be cautious ofand preserve the radiculomedullary/pial branches arising from an anomalous artery before embolising it. [ABSTRACT FROM AUTHOR]

Introduction: Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of low-back pain with radiculopathy. Most interventional pain physicians strongly believe in their efficacy and safety. Recent Cochrane systematic reviews have disclosed controversial results and have questioned the effectiveness of ESIs. Moreover, a few neurological adverse events have been reported recently. Methods: A literature search of systematic reviews analysing the effectiveness and complications of ESIs was carried out. The scientific quality of the reviews was assessed using the validated index of Oxman and Guyatt. We relied on data abstraction and quality ratings of the placebo-controlled trials as reported by high-quality systematic reviews. Results: Two types of systematic reviews were found. The Cochrane high-quality systematic reviews combining the three approaches and different pathologies were predominantly non-conclusive. The second type of review, emanating from the US Evidence-based Practice Centers, distinguishing between the routes of administration and between the principal pathologies found a moderate short-term benefit of ESIs versus placebo in patients with disc herniation and radiculitis, in keeping with the clinical experience. ESIs are generally well tolerated and most complications are related to technical problems. Cases of paraplegia, complicating the foraminal route and related to the violation of a radiculomedullary artery, have been recently reported. They are predominantly observed in previously operated patients. Conclusions: Epidural steroid injections have a moderate short-term effect in the management of low-back pain with radiculopathy. Severe neurological complications are exceptional, but call for research for alternative approaches to the foramen as well as for means to detect an eventual arterial injury. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Case Description—A 12-year-old Thoroughbred was examined because of signs of depression, neck stiffness, and poor performance. Clinical Findings—Physical examination revealed that the horse was dull, appeared depressed, was reluctant to raise its neck and head above a horizontal plane, and had a temperature of 38.5°C (101.3°F). No radiographic or scintigraphic abnormalities of the neck were found; however, high plasma fibrinogen concentration and relative lymphopenia were identified and the horse was seropositive for antibodies against Borrelia burgdorferi. Analysis of CSF revealed neutrophilic inflammation, and results of a PCR assay of CSF for B burgdorferi DNA were positive. Immunologic testing revealed severe B-cell lymphopenia and a low serum lgM concentration consistent with common variable immunodeficiency. Treatment and Outcome—The horse responded well to doxycycline treatment (10 mg/kg [4.5 mg/lb], PO, q 12 h for 60 days) and returned to normal exercise. However, 60 days after treatment was discontinued, the horse again developed a stiff neck and rapidly progressive neurologic deficits, including severe ataxia and vestibular deficits. The horse's condition deteriorated rapidly despite IV oxytetracycline treatment, and the horse was euthanatized. Postmortem examination revealed leptomeningitis, lymphohistiocytic leptomeningeal vasculitis, cranial neuritis, and peripheral radiculoneuritis with Wallerian degeneration; findings were consistent with a diagnosis of neuroborreliosis. Clinical Relevance—Nervous system infection with B burgdorferi should be considered in horses with evidence of meningitis and high or equivocal serum anti-B burgdorferi antibody titers. Evaluation of immune function is recommended in adult horses evaluated because of primary bacterial meningitis. [ABSTRACT FROM AUTHOR]

Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and double-door laminoplasty) and to determine their appropriate surgical indications based on the results. Tension-band laminoplasty (TBL, one method of open-door type) was performed in 33 patients and double-door laminoplasty (DDL) in 20 patients. The operation level ranged from C2 to C7 in all patients. The width of the spinal canal and the inclination angle of the lamina at the C5 and C6 levels were measured using a computer software program (Image J) and pre- and postoperative CT films. Concerning the degree of enlargement of the spinal canal, the mean expansion ratio at the C5 level was 148.9% in TBL and 148.2% in DDL, and there was no significant difference between them. However, at the C6 level, it was 159.0% in TBL and 140.3% in DDL, which was significantly larger in TBL than DDL ( p < 0.05). The increase of inclination angle of the lamina was 11.0° in TBL and 19.0° in DDL at the C5 level, and 9.2° in TBL and 19.3° in DDL at the C6 level. At both the C5 and C6 levels, it was significantly larger in DDL than TBL ( p < 0.0001). In conclusion, the appropriate surgical indications of TBL were considered to be (1) cervical spondylotic myelopathy (CSM) combined with hemilateral radiculopathy, (2) severe prominence of ossification of the posterior longitudinal ligament (OPLL), and (3) patients with tiny spinous processes who cannot undergo DDL. Those of DDL were considered to be (1) usual CSM, (2) small and slight prominence of OPLL, (3) CSM combined with bilateral radiculopathy, and (4) cervical canal stenosis combined with instability necessitating posterior spinal instrumentation surgery. [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]

To examine the diagnostic value of history, physical examination and needle EMG in predicting nerve root compression on MRI in patients with clinical suspicion of lumbosacral radicular syndrome (LSRS). Subjects comprised 202 consecutive patients from January 2006 to March 2007 with suspicion of LSRS referred by general practitioners. Clinical evaluation consisted of history, physical examination, EMG and MRI. Bivariate and multiple logistic regression analyses were used to calculate the diagnostic value of each test item compared to radiological nerve root compression. 95 patients (47%) had radiological nerve root compression. Significant predictors of radiological nerve root compression were dermatomal radiation [odds ratio (OR) 2.1], more pain on coughing, sneezing or straining (OR 2.4), positive straight leg raising (OR 3.0) and ongoing denervation on EMG (OR 4.5). 15 patients (7%) had ongoing denervation on EMG without radiological nerve root compression. In clinical practice, dermatomal radiation, more pain on coughing, sneezing or straining, positive straight leg raising and ongoing denervation on EMG may be used to predict nerve root compression on MRI. EMG may also be of additional value in patient with clinical suspicion of lumbosacral radicular syndrome without nerve root involvement on MRI. [ABSTRACT FROM AUTHOR]

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]

Studies examined the neurological involvement of ankylosing spondylitis (AS) are limited. This study aimed to assess the frequency of myelopathy, radiculopathy and myopathy in AS correlating them to the clinical, radiological and laboratory parameters. Included were 24 patients with AS. Axial status was assessed using bath ankylosing spondylitis metrology index (BASMI). Patients underwent (a) standard cervical and lumbar spine and sacroiliac joint radiography, (b) somatosensory (SSEP) and magnetic motor (MEP) evoked potentials of upper and lower limbs, (c) electromyography (EMG) of trapezius and supraspinatus muscles. Patients’ mean age and duration of illness were 36 and 5.99 years. Bath ankylosing spondylitis metrology index mean score was 4.6. Twenty-five percent ( n = 6) of patients had neurological manifestations, 8.3% of them had myelopathy and 16.7% had radiculopathy. Ossification of the posterior (OPLL) and anterior (OALL) longitudinal ligaments were found in 8.3% ( n = 2) and 4.2% ( n = 1). About 70.8% ( n = 17) had ≥1 neurophysiological test abnormalities. Twelve patients (50%) had SSEP abnormalities, seven had prolonged central conduction time (CCT) of median and/or ulnar nerves suggesting cervical myelopathy. Six had delayed peripheral or root latencies at Erb’s or interpeak latency (Erb’s-C5) suggesting radiculopathy. Motor evoked potentials was abnormal in 54% ( n = 13). Twelve (50%) and five (20.8%) patients had abnormal MEP of upper limbs and lower limbs, respectively. About 50% ( n = 12) had myopathic features of trapezius and supraspinatus muscles. Only 8.3% ( n = 2) had neuropathic features. We concluded that subclinical neurological complications are frequent in AS compared to clinically manifest complications. Somatosensory evoked potential and MEP are useful to identify AS patients prone to develop neurological complications. [ABSTRACT FROM AUTHOR]

We present two cases in which the diagnosis was complicated by the presence of a weak muscle innervated by a compressed motor root in the intervertebral foramen (IVF) at an atypical level. The patients were 59- and 53-year-old men; they presented with marked atrophy and weakness predominantly in a unilateral deltoid. Neuroimaging revealed narrowing of the nerve root sleeve at the C5/6 IVF due to a herniated disk or osteophyte. Predominant atrophy and weakness of the deltoid were not consistent with radiculopathy at the C5/6 IVF, i.e. C6 radiculopathy. During an extended observation period to rule out motor neuron disease, their weakness did not spread and the patients underwent posterior medial facetectomy and anterior foraminotomy. This produced marked improvement of the deltoid weakness soon after the operation. We considered unexpectedly wide motor innervation of the C6 nerve root predominantly in the deltoid, anatomic variations in the C5 root such as the trunk of the C5 root entering into the C5/6 IVF, and descending anastomoses connecting the C5 and C6 rootlets as possible explanations. Awareness of this rare presentation may aid in the diagnosis and surgical management of these patients. [ABSTRACT FROM AUTHOR]

Melanoma is an interesting tumor, showing the appearance of metastasis without any trace of its primary lesion. To report a very rare case of malignant melanoma in the sacrum with unknown primary origin. The authors present a case of a 52-year-old man who was admitted with increasing lower back, left buttock, and left lower extremity pain, and dysuria. Plain radiograph, computed tomography scan, and magnetic resonance imaging revealed a destructive lesion in the sacrum and left ilium, which infiltrated the spinal canal and sacroiliac joint. The tumor cells were immunoreactive for HMB-45. The pathological diagnosis was malignant melanoma. No obvious primary malignant melanoma was detected on the skin surface, on the oral or anal mucosa, or in the fundus oculi. Following radiotherapy and chemotherapy, the severe buttock pain disappeared and the patient was able to walk without impediment. However the patient died nine months after initial diagnosis. Malignant melanoma in the sacrum with an unknown primary site, showing S1 radiculopathy is reported for the first time. The melanoma could have been a metastatic tumor of the sacrum, although the primary site was not detected. The incidence of primary melanoma is increasing faster than any other cancer. Thus treatment of patients with spinal metastasis of melanoma is an important challenge for orthopedic surgeons. [ABSTRACT FROM AUTHOR]

The article presents an observational pilot study which investigates the effect of right and left radiculopathy on driver reaction time (DRT), and the effect of selective nerve root block (SNRB) on DRT. It reports that the study identified significant DRT changes both in radicuopathy and after SNRB. It concludes that the right and left radiculopathic patients should be advised about possible changes in their DRTs post SNRB.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

STUDY DESIGN.: Prospective case-control study of multifidus muscle atrophy in 39 patients with unilateral lumbosacral radiculopathy and lumbosacral disc herniation and 20 controls. OBJECTIVE.: To evaluate quantitatively the asymmetry of multifidus muscles in unilateral lumbosacral radiculopathy with disc herniation (herniated intervertebral disc; HIVD) by using magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA.: Histologic and morphologic changes of multifidus muscles have been reported in lumbosacral disc herniation, but there are few imaging studies on the changes of multifidus muscles in unilateral radiculopathy. METHODS.: Bilateral multifidus muscles in L3–L4, L4–L5, and L5–S1 levels were detected in fast spin-echo T1 axial MRI images. The total cross-sectional area (CSA) of multifidus muscles (TMA) and the density of pure muscle CSA (PMA) were measured by a computerized analysis program, and the ratios of PMA to TMA (PMA/TMA) and the PMA ratios of involved to uninvolved sides (IMA/UMA) were calculated. The patients were divided into 2 groups according to the electrodiagnosis results: a radiculopathy (RAD) group and an HIVD group without definite radiculopathy. RESULTS.: Fourteen patients had lumbosacral radiculopathies (RAD group) while 25 had no radiculopathy (HIVD group). No significant difference was found between the RAD and HIVD groups in TMA, PMA, and PMA/TMA. In terms of the criteria for the upper limit of IMA/UMA, 78.6% in the RAD group had an abnormal IMA/UMA ratio in at least 1 level, compared with 24% in the HIVD group and 10% in the control group. Thus, more cases with less muscle volume in the involved side were seen in the RAD group than in the HIVD and control groups. CONCLUSION.: Asymmetry of the multifidus muscles as seen in MRI was a useful finding to assess patients who had unilateral lumbosacral radiculopathy with HIVD. This may reflect the denervation of multifidus muscles in lumbosacral radiculopathy. [ABSTRACT FROM AUTHOR]

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration. [ABSTRACT FROM AUTHOR]

Lumbosacral radiculopathy is a relatively common condition, affecting approximately 1–10% of the population. Herniation of nucleus pulposus from the intervertebral disc initiates a strong inflammatory response that can result in pain with or without spinal nerve injury. Both inflammatory and mechanical factors are involved in the pathophysiology of radiculopathy. Each has a role in nerve injury while inflammation is thought to be the key mediator of radicular pain. The natural history of radiculopathy is generally favorable, with approximately 40% of patients experiencing significant improvement in symptoms within 6 weeks, and 90% demonstrating significant relief in long-term follow-up. [ABSTRACT FROM AUTHOR]

The role of corticosteroids in the treatment of radiculopathy from a disc herniation is to provide temporary improvement of the disabling symptoms while the condition resolves. In addition, corticosteroids provide neuroprotective effects on the involved nerve roots. Early studies of corticosteroids for radiculopathy contained multiple methodological flaws and failed to demonstrate consistent results. Since each of these studies used inaccurate and less effective injection techniques, their results do not apply to current practice. More recent studies with better designs and more precise injection techniques have shown epidural corticosteroid injections to be an effective treatment for radiculopathy from herniated nucleus pulposus. The literature on systemic corticosteroids remains limited. [ABSTRACT FROM AUTHOR]

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]

Knowledge of segmental innervation of skeletal muscles is essential for diagnosing lumbar radiculopathy. Myotomes and dermatomes are traditionally thought to be innervated by a single spinal segment, but experimental studies have shown that this pattern of segmental innervation allows considerable overlap. This implies that muscles (or dermatomes) are innervated not only by axons of one spinal segment, but also partially by axons of adjacent spinal levels. We describe a patient in whom overlap in segmental innervation complicated adequate diagnosis of a recurrent lumbar hernia. Further, we present an outline of electrophysiological and anatomical studies on segmental innervation. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate the effect of (i) prone position and (ii) interferential therapy (IFT) combined with prone position on H-reflex and pain intensity and distribution in patients with lumbosacral radiculopathy (LSR). Two groups of subject participated in this study: a patient group of 28 males with confirmed unilateral LSR and a healthy group of 28 males. The soleus H-reflex, pain intensity and pain distribution were recorded in four different conditions: immediately after 3&ThickSpace;min of resting in prone position, immediately after 20&ThickSpace;min of rest in prone position, immediately after 10&ThickSpace;min of IFT (H-reflex was recorded during ongoing IFT) and immediately after 20&ThickSpace;min of IFT. The results showed that both prone position and IFT had no statistically significant effect on the soleus H-reflex of healthy and patient groups throughout the four different conditions. In contrary, they caused significant improvement in pain intensity and distribution. The findings of this study indicated that neither prone position nor IFT had a decompression effect on the H-reflex of the compromised nerve root. The significant improvement in pain intensity and distribution is most probably placebo more than substantial physiological or anatomical changes involved in the compromised nerve root. [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]

SUMMARY: STUDY DESIGN A prospective, multicenter, cross-sectional analysis of data from the National Spine Network database.OBJECTIVES To compare the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey, and to compare the impact of these symptoms among patients of varying age and symptom duration.BACKGROUND Degenerative disorders of the cervical spine can cause debilitating symptoms of neck and arm pain. Physicians generally treat radiculopathy more aggressively than axial neck pain alone, although it has never been shown that the presence of radiculopathy leads to a greater impairment of physical and mental function.MATERIALS AND METHODS SF-36 Health Survey data were collected from all consenting patients seen within the National Spine Network. Patients with symptoms referable to the cervical spine (as per their physician) were included (n = 1,809). SF-36 scores for all eight scales (bodily pain (BP), vitality (VT), general health (GH), mental health (MH), physical function (PF), role physical (RP), role emotional (RE), and social function (SF), and two summary scales (Physical Component Summary [PCS] and Mental Component Summary [MCS]) were calculated. Age/gender normative scores were subtracted from the scale scores to produce a negative “impact” score, which reflected how far below normal health status these patients were. Patients were grouped according to location of symptoms (axial only, radicular only, or axial and radicular), age (younger than 40, 40 to 60, and older than 60 years), and symptom duration (acute: <6 wk; subacute: 6 wk-6 mo; and chronic: >6 mo). SF-36 scores were compared between all groups using analysis of variance and multiple comparisons with Bonferroni adjustment.RESULTS Patients who presented with both axial and radicular symptoms had the lowest SF-36 scores relative to age and gender norms. These scores were significantly lower than those for patients with only axial or only radicular symptoms across all eight subscales (P < 0.05- P < 0.0001). Scores for patients with only axial pain were significantly lower than for patients with only radicular pain for VT (P < 0.04) and GH (P < 0.004). Patients younger than 40 and those between ages 40 to 60 years were significantly more impacted by their symptoms than patients older than 60 years for all eight scales (P < 0.01). PCS scores were similar for acute, subacute, and chronic groups, whereas MCS scores were significantly worse for patients with chronic pain.CONCLUSIONS Combined neck and arm pain were much more disabling than either symptom alone. Younger patients (younger than 40 or 40-60) were more affected by these symptoms than patients older than 60 years. In addition, as symptom duration increased, a negative impact on mental health was observed, although chronic symptoms did not affect physical health. This study suggests that patients with a significant component of axial pain in conjunction with cervical radiculopathy should be considered the most affected of all patients with cervical spondylosis. Given the evidence that the treatment methods at the disposal of physicians are effective, this study suggests that prompt treatment of these patients may help avoid the harmful effects of chronic symptoms on mental functioning, especially among younger patients who were found to be more impacted by the symptoms. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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]

A retrospective study was conducted on 67 patients undergoing posterior cervical foraminotomy (PCF) for unilateral intraforaminal soft and hard disc disease. Neurologic impairment, employment, and severity of associated signs were assessed preoperatively and at a 3.1-year average follow-up (range, 1.5–7 years). Diminution or complete disappearance of radicular symptoms was observed in 62 cases (93%), 3 months to 3 years after surgery. Minimal neurologic deficits persisted in 5 cases (7%). Neck pain improved in 62 cases, remained unchanged in three, and progressed in two cases with severe preoperative deficits. Fifty-three patients (79%) returned to their previous occupation; only seven (10%) retired prematurely on the basis of disc disease alone. Based on Prolo’s functional economic outcome rating scale, 60 patients (90%) showed excellent economic outcome. Posterior cervical foraminotomy is an efficient means of decompressing lateral spinal roots compromised by soft disk herniations or osteophytic spurs, without the risk of an anterior approach with or without fusion. Careful patient selection and microsurgical technique are essential in obtaining consistent, excellent results. Additionally, the recent trend toward minimally invasive techniques and key-hole operations in neurosurgery and other specialisations favours the posterior approach. [ABSTRACT FROM AUTHOR]

We describe two unusual surgical cases who presented with extraforaminal lumbar disc herniation that occurred at two adjacent vertebral levels simultaneously and unilaterally. Magnetic resonance imaging and selective nerve root infiltration followed by radiculography helped to outline the herniated disc material. Lateral fenestration and microsurgical foraminal widening of the affected vertebral levels allowed a complete and safe relief of the compressed nerves. [ABSTRACT FROM AUTHOR]

The article offers information concerning the spinal stenosis. The associated conditions of spinal stenosis include rheumatoid arthritis, diabetes, Paget's disease of the spine, and arachnoiditis. Several cases involving patients with spinal stenosis are also presented. The author asserted that spinal stenosis is regarded as correctable lesion and that skilled radiculography can be used for its diagnosis.

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]

STUDY DESIGN.: Case report and clinical discussion. OBJECTIVE.: To describe a rare case of intradural cervical disc herniation in a patient with Klippel-Feil syndrome (KFS). SUMMARY OF BACKGROUND DATA.: KFS is a congenital spinal malformation characterized by the failure in segmentation of 2 or more cervical vertebrae. The development of a cervical disc herniation in a nonfused segment is uncommon. Intradural disc herniation is rare, with only 21 cases reported in the cervical region. METHODS.: We present a case of a 52-year-old woman with KFS (C5–C6 fusion) who developed acute radiculopathy secondary to an intradural cervical disc herniation. Neurologic examination revealed a mild (Grade 3/5) decrease in motor function of the fingers and difficulty in performing fine motor tasks with right hand. RESULTS.: The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation and anterior plating; exploration of the surgical field revealed 2 intradural disc fragments. After surgery, she experienced a complete remission of the symptoms. CONCLUSION.: To our knowledge, this is the first case of intradural cervical disc herniation in a KFS patient described in the literature. [ABSTRACT FROM AUTHOR]

The physicians have found in their practice that patients who present to their office with clinically significant cervical disk herniations are often seen, upon entering the examination room, fully abducting their shoulder with their arm over their head with the elbow flexed in an attempt to alleviate their radicular pain. The abducted shoulder correlates with the ipsilateral side of the affected nerve root. It is thought that this position decreases tension on the nerve root by creating slack on the nerve and, thus, decreasing the patient's radicular symptoms.

Authors: Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain; Judson J. Somerville, The Pain Management Clinic of Laredo Current measurements of the outcomes of chronic radiculopathy treatment are limited to subjective criteria: level of pain, range of motion, etc. Our previous study showed that nerve conductivity does not correlate well with the intensity of pain after treatment of radiculopathy (1). In the current study we looked at the Pain Tolerance Threshold (PTT) as a possible measurement of the results of radiculopathy treatment. Twenty patients with chronic radiculopathy (13 lumbar and 7 cervical) underwent epidural steroid injections at the level of involvement. Before, and approximately one week after the procedure, we measured PTT in both the involved and contralateral extremity at 3 different frequencies (5Hz, 250Hz, and 2000 Hz) using Neurometer. Level of pain was also assessed using a Visual Analog Scale (VAS). Initial PTT results showed great interpersonal variability. Nearly half of the patients did not show significant differences in PTT between affected and unaffected sides. Of interest, the majority experienced intolerable pain at 2000 Hz stimulation at lower than maximal intensity output, which contradicts previous findings (2). Dynamics of the PTT measurements after treatment did not directly correlate with changes in the level of pain. Nevertheless, in 7 out of 8 patients with low PTT (relative to the unaffected side) it increased significantly, with noticeable decrease of VAS score. Similar results were not found in patients with either normal initial PTT score or minimal improvement of pain. 1. Mironer YE, Somerville JJ The current perception threshold evaluation in radiculopathy: efficacy in diagnosis and assessment of treatment results. Pain Digest 1998;8:37–38. 2. Liu SS, Gerancher JC, Bainton BG, et al. The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Anesth Analg 1996;82:98–102. [ABSTRACT FROM AUTHOR]

Discusses the abstract of the article 'Diagnosis of Lumbar Disc Protrusion: A Comparison Between Magnetic Resonance Imaging and Radiculography,' by E.P. Szypryt, et al., published in the 'Journal of Bone & Joint Surgery.'