[Show abstract][Hide abstract] ABSTRACT: Back pain poses a serious clinical problem in some cases, because under the clinical symptoms of back pain might be other hidden diseases. The aim of this study was to present difficulties in diagnosis and treatment of various diseases of the spine and 2. description to the flagship division, based on the traffic lights.
The clinical material is based on a group of 20 patients with diagnostic and therapeutic difficulties, among 1825 patients treated due to low back pain. Diagnosis was based on clinical examination and various imaging techniques. In the case of cancer biopsy was performed, and in specific and nonspecific infections of the spine treated surgically toward the microscopic examination of tuberculous granulation tissue or inflammatory. The diagnosis of osteoporotic fractures was based on the digital 3D CT. The studied group of 20 patients were divided according to color flag system.
Among the analyzed patients 14 received red flag, 5 yellow and 1 black. The red flag has received seven patients with spinal infection, 3 patients with cancer and two with osteoporotic fracture, and 2 patients with low back pain due to an aortic aneurysm. Yellow flag received 5 patients with compensation claims.
1. In patients with back pain, diagnostic examinations should be administered according to a particular order. Clinical and radiographic examinations are basic tools which should be supplemented by the modern techniques of MRI and CT. 2. Histopathological evaluation of tissue preparations facilitates the diagnosis of an infection or tumour. 3. Classification according to colored flags are useful in clinical practice. It describes the degree of risk of serious illness and difficulties in therapy.
[Show abstract][Hide abstract] ABSTRACT: The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient-a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3wk each. She breastfed her second baby for 4mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7yr.
Journal of Clinical Densitometry 06/2012; · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The paper presents the case of a 73-year-old patient with a history of tuberculosis of the hip in childhood who received an Exeter total hip prosthesis. Tuberculosis recurred 58 years after primary infection and 9 years after THA. The authors analyzed the available literature, which described only a few case reports, because Mycobacterium tuberculosis infections of a joint implant after THA are extremely rare. They are frequently the result of local reactivation of the pathogen or, less commonly, an overlooked diagnosis of tuberculosis at the time of endoprosthesis implantation. Proper diagnostic work-up of infection is particularly difficult because synovial fluid cultures are usually negative. In addition, a coexisting Staphylococcus aureus infection may obscure the clinical presentation. In post-THA patients, complete anti-TB treatment is recommended. Particular caution should be observed in patients from regions with high TB morbidity or with a history of pulmonary and operated joint tuberculosis.
[Show abstract][Hide abstract] ABSTRACT: The development of diagnostic imaging facilitates evaluation of spinal anatomy, but there is no full correspondence between morphologic and pathologic changes observed in radiographic studies and clinical findings. The aim of the study was to: 1. Evaluate the degree of signal intensity and degenerative changes of intervertebral discs in the lumbar spine on MRI. 2. Estimate interrater reliability of classification of pathology between experienced and inexperienced medical doctors.
The sample consisted of 89 persons aged between 18 and 21 years. MRI scans of the lumbar spine were evaluated by the use of a console for digital analysis by three medical doctors with different levels of experience.
Evidence of dehydration of intervertebral disc was found in 3.37%-4.49% at the L4-L5 level, and in 13.48%-15.73% of cases at the L5-S1 level. Interrater reliability ranged from full agreement at levels where degenerative changes are rarely observed to fair and poor agreement at L4-L5 and L5-S1. Intrarater reliability showed full agreement on higher levels to good and very good at l4-l5 and l5-S1 levels. Interrater reliability concerning the degree of degenerative changes was 0.6 for Th12 to L4, but was poor at L4-L5 and L5-S1. Intrarater reliability ranged from full agreement at higher levels to poor at L3-L4-L5 and moderate at L5-S1.
1. Asymptomatic intervertebral disk changes were found in 30% of the study participants. 2. Evaluation of the degree of degenerative changes of intervertebral discs requires specialist training and experience.
[Show abstract][Hide abstract] ABSTRACT: Advances in digital computed tomography prompted the authors to use this technique to measure correlations between the lumbar spinal canal and the dural sac. The aim of the study was to: 1. Evaluate the value of surgical decompression of neural structures using digital computed tomography. 2. Establish mathematical correlations between the surface area of the dural sac and the narrowed spinal canal before and after the operation. MATERIAL AND METHODS. The analysis involved 33 patients who underwent lumbar stenosis surgery. Complete clinical records and imaging examination reports were available for this group of patients.
1. Statistically significant differences in spinal canal height at L4 and L5 were found between the control group (N) and the surgically treated group before and after surgery. L4: Reference--16.85 mm, before surgery--14.10 mm; after surgery--15.8 mm. L5: Reference--17.77 mm, before surgery--15.79 mm; after surgery--15.83 mm. 2. Statistically significant differences were found in the ratio of the surface area of the spinal canal and vertebral body surface area at L4 and L5 between the control group (N) and the operated group before surgery. L4: Reference--19.5%, before surgery--17.7%, after surgery--20.3%. L5: Reference--19.37%, before surgery--14.25%; after surgery--17.93%. 3. Statistically significant differences were found in the ratio of the surface area of the dural sac to the spinal canal surface area at L4 and L5 between the control group (N) and the operated group before surgery. L4: Reference--69.84%, before surgery--51.82%, after surgery--67.36%. L5: Reference--70.31%, before surgery--61.40%; after surgery--69.46%.
1. The ratio of the surface area of the spinal canal to the vertebral body surface area at L4 and L5 after surgery was statistically comparable to the value obtained for a normal spine. 2. The ratio of the surface area of the dural sac to the spinal canal surface area at L4 and L5 after surgery was statistically comparable to the value obtained for a normal spine.
[Show abstract][Hide abstract] ABSTRACT: The authors present the advantages and disadvantages of the Denis and AO classifications based on a review of classical and recent literature concerning the evolution of classification of thoracolumbar spine conditions. The newest classification of fractures proposed by Vaccaro (TLICS - Thoracolumbar Injury Classification Severity Score) is discussed in detail. Special attention is given to instability in these fractures. The principles of modern operative treatment are briefly discussed. Short transpedicular segmental stabilization and immobilization is a commonly accepted approach in unstable fractures with neurological deficits.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Chronic use of steroids in acute lymphoblastic leukemia is a significant supportive therapy. Whereas steroids have adverse effect on vessels leading to avascular osteonecrosis of femur head (ANFH). The aim of the study was to present a ANFH of three young persons diagnosed too late that ended with implantation of total hip arthoplasty (THA). DESCRIPTION OF CASES AND RESULTS: Authors described chemotherapy of acute lymphoblastic leukemia according to established program. The fight for patient's life finished with success, but with side effect--ANFH. It was not diagnosed in an early period, because diagnosis was based only on X-ray of the hips. According to literature pain in the hip accompanying negative X-ray, should be supplemented with MRI, which allows confirmation of oedema of femur head bone marrow. Only early decompression in I degree of ANFH according to ARCO classification may stop a further progress of disease. Pain, impairment of gait, and necrosis covering over 30% of head was an indication for THA. CONCLUSION: THA of hip among young people is allowed when joints are completely destroyed and painful.
Chirurgia narzadow ruchu i ortopedia polska 01/2010; 75(2):121-5.
[Show abstract][Hide abstract] ABSTRACT: Introduction. The problem of lumbar stenosis has been analysed at length in the literature as the number of patients with low back pain of this aetiology continues to increase. The aim of this study was:1. to carry out a prospective study assessing the dimensions of spinal canal on the basis of CT data and to compare patient data with a control group.2. to determine if the sagittal and transverse dimensions and surface area of the spinal canal are sufficiently sensitive and robust measures of spinal canal stenosis at L3, L4 and L5 levels.
Material and methods. The investigational group consisted of 176 patients (93 men, 83 women). A total of 528 vertebral levels were evaluated and compared with a control group consisting of 42 persons. Digital CT scans were obtained with a precision of 0.01 mm and 0.01 mm(2). A discriminative function algorithm was used to classify cases according to the level of stenosis.Results. The mean sagittal dimension at L3 was 13.26 mm and the mean transverse dimension was 23.36 mm, with a surface area of 244.39 mm(2). At L4, the mean sagittal dimension was 14.12 mm, the mean transverse dimension was 24.60 mm, and the surface area was 267.70 mm(2). At L5, the mean sagittal dimension was 14.76 mm, the mean transverse dimension was 31.38 mm, and the surface area was 303.99 mm(2). The most important factors influencing the quality of classification were height, width and surface area. Student's t test with a significance level at p=0.05 revealed statistically significant differences. The accuracy of classification in discriminative analysis was 92.66%.
Conclusions. The proposed indicators of the sagittal and transverse dimensions and surface area of the spinal canal were useful in assessing quantitative changes with this investigational technique. The sagittal dimension had the greatest sensitivity in the evaluation of stenosis.
[Show abstract][Hide abstract] ABSTRACT: The study of lumbar spine pathology requires adequate preparation and knowledge of the normal structure of this part of the spine. The main goal of the study was to assess spinal canal morphology with computed tomography. The sagittal and interpedicular dimensions and surface area were considered the most important measurements. An additional goal was to assess the shape of the spinal canal and intervertebral joint angles.
Computed tomography was used to assess the lumbar spinal canals of 42 people to an accuracy of 0.01 using a special console for digital analysis.
The mean sagittal dimension showed minor differences and ranged from 15.75+/-0.886 at the L3 level to 17.77+/-1.619 at the L5 level. The mean interpedicular dimension was significantly different between the levels, increasing from 24.75+/-2.173 at L3 to 34.57+/-3.332 at L5. Similar results were obtained as regards the mean surface area of the spinal canal. The surface area was 277.2+/-36.15 mm2 at the L3 level, compared to 297+/-9.90 mm2 at L4 and 386.5+/-50.55 mm2 at L5. The spinal canal shape at the L4-L5 level was triangular or trefoil in all 42 patients. No significant differences were found between the angles of right and left intervertebral joints.
Our results do not differ from those described in literature. A sagittal dimension over 15 mm, and an interpedicular dimension of more than 25 mm are characteristic of a normal spinal canal. The results constitute reference data for further studies concerning lumbar stenosis.
[Show abstract][Hide abstract] ABSTRACT: Publications concerning the shape of the spinal canal and degenerative changes in the intervertebral joints have not described this issue in full detail to date, especially with regard to the causes of pain syndromes associated with degenerative changes in intervertebral joints. The aim of the study was to assess the shape of the spinal canal and joint surface angles at L3, L4 and L5.
The study involved 176 patients with clinical and radiological evidence of spinal canal stenosis confirmed by computed tomography.
Morphometric measurements were conducted to a precision of 0.01 degrees . At the level of L4-L5, a triangular spinal canal was found in 66 patients, and a trefoil spinal canal in 71. The results demonstrate that, in the group of 176 patients with spinal canal stenosis, mean differences between right and left angles were 11.37 degrees at the L3 level, 9.40 degrees at the L4 level, and 11.57 degrees at the L5 level. In the control group, mean differences were 2.15 degrees at the L3 level, 2.26 degrees at the L4 level, and 2.98 degrees at the L5 level. Statistically significant differences between the groups were found for p= 0.05 at each level (L3, L4, L5). The level of significance of angular differences at these levels warrants the conclusion that there is joint incongruence that may give rise to degenerative changes.
While the most common pathomechanism underlying degenerative changes is vertebral sinking in the course of disc disease and emerging intervertebral instability, abnormal intervertebral angles can also lead to instability that gives rise to degenerative changes.