Lumbar-sacral Spine Research Articles

Diagnostic possibilities of sonography in lumbosacral pain

Ultrasound examination results of 83 athletes and ballet dancers with lumbar-sacral pain syndrome caused by osteochondrosis, spondylolysis of lower lumbar vertebrae, pathology of lumbar-sacral spine ligaments are presented. Technique of ultrasonography of the lumbar spine from anterior and posterior accesses is given. Pathological changes in various structures lumbar spine (intervertebral disks, ligamentous system) at overloading are described. The advantages of ultrasonography, i.e. informativeness, low invasiveness, possibility of the repeated examination during the treatment are noted.

Pott's disease in Senegal

The purpose of this study is to report our experience on Pott's disease in Senegal, which belongs to the group of least-developed countries .In these countries, tuberculosis is still a public health issue. Regarding spine tuberculosis, we attempted to implement a diagnostic and therapeutic approach appropriate for our conditions of medical practice. The authors reported a retrospective epidemiological and clinical study of 255 patients suffering from tuberculosis of the spine. Theses patients were hospitalized at the University Hospital of Fann in Dakar from January 1986 to July 1998. Sixty percent came from the capital, the mean age was 34.9 years, there were 136 males for 119 females, and antituberculosis immunization were not done every time. Associated extra-spinal tuberculosis, predominantly tuberculosis of the lung, was observed in 28.2 patients (59%). Of 37 patients tested for human immunodeficiency virus (HIV) infection, only one was positive. Patients came late to the hospital, leading to a high percentage of neurological complications (79.2%). Our diagnostic strategy was based on epidemiological and clinical criteria already defined by Martini. Thoracic spine (53.8%) and lumbar sacral spine (21.7%) were the column vertebral segments most frequently involved. All patients received antituberculosis chemotherapy, and only 39 patients underwent surgery with laminectomy without posterior instrumentation. Functional outcome study was done for 89 paraplegic patients: 26 (29%) went to Frankel grade D or E and, among 27 operated patients, nine entered theses grades. Seventeen patients (11.5%) died. We developed the concept of "spinal-cord rescue," which focuses more on neurological rather than biomechanical issues.

Confirmation of the presence of Mycobacterium tuberculosis complex‐specific DNA in three archaeological specimens

AbstractThis journal published the first reported identification of Mycobacterium tuberculosis complex (MTB) DNA in ancient human remains but concerns were raised about the article two years after publication. These were based on methodology which, in the field of ancient DNA, was still developing. Here we present a re‐examination of the 1993 research conducted on three specimens which exhibited palaeopathologies indicative of tuberculosis. The specimens were: an ulna from pre‐European‐contact Borneo, a spine from Byzantine Turkey, and a lumbar‐sacral spine from 17th century Scotland. There was insufficient material to permit re‐examination of all of the original samples. The earlier results were confirmed in two independent laboratories using different methodologies. MTB DNA complex‐specific DNA amplicons were obtained, and sequenced in both laboratories, in a re‐analysis of samples which supported the earlier findings. Copyright © 2002 John Wiley & Sons, Ltd.

CHRONIC KNEE PAIN IN A HIGH SCHOOL FOOTBALL PLAYER

HISTORY: A 17 year old high school senior football player was referred for evaluation of right knee pain of two years duration. He reported no injury to the knee. He denied swelling, lockng, catching, or instability. He localized the pain to the back of his knee. Over the past three to four months he has had significant worsening of the pain with some radiation of the pain up his posterior thigh and down his calf. He denied any back pain. He has not played football this year because of the pain. His previous work up and treatment included x-ray and MRI of the knee, which were unremarkable. Physical therapy for the knee failed to alleviate his symptoms. PHYSICAL EXAMINATION: Examination of the knee revealed no swelling or effusion. He had no tenderness to palpation. He had normal flexion to 135○, but could not fully extend the right knee without pain, unless he flexed the left knee. He had no instability with varus or valgus stress at 0○ and 30○. He had a negative Lachman's, McMurray's, and patellar compression tests. Examination of his back revealed no tenderness to palpation. Flexion and extension of his back worsened his knee pain. Motor strength of his lower extremities was 5/5, deep tendon reflexes were 2+ and symmetrical, and his sensory exam was nonfocal. He had a positive straight leg raise on the right as well as a positive cross over straight leg raise of the left. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans Popliteal artery aneurysm Herniated nuceus pulposus of lumbar-sacral spine Neoplasm (Osteoid osteoma) TESTS AND RESULTS: Anterior-posterior, lateral, and oblique radiograph of the lumbar-sacral spine: no fracture, spondylolysis, spondylolithesis, or other bony abnormality.MRI of lumbar-sacral spine: large disc herniation of L5-S1 filling the right lateral recess and right neural foramen, central disc herniation at L4-5 with spinal stenosis and bilateral foraminal narrowing, and mild disc herniation at L3-4 and L2-3. FINAL DIAGNOSIS: Multiple disc herniations with right lower extremity radiculopathy TREATMENT AND OUTCOMES: Prednisone 60mg per day for 5 days Pediatric orthopedic referal with subsequent microdiscectomy