Radicular Type Research Articles

Atypical Cause for Back Pain and Sciatica in a 35-Yr-Old Woman With Fibromyalgia.

Spinal and extrapelvic lesions causing sciatic symptoms are well recognized in clinical research and practice. 1-5 We present a 35-yr-old woman with a history of axial back pain and fibromyalgia who presented with episodes of radicular type pain down her legs and associated bilateral tingling in her feet. Medicinal and therapeutic interventions for traditional sciatica etiologies failed to provide relief. Lumbar magnetic resonance imaging showed mild multilevel degenerative changes and partially visualized fibroids, but no other significant spinal pathology was appreciated. Subsequent pelvic magnetic resonance imaging revealed an enlarged retroverted uterus with multiple fibroid lesions. The patient elected for laparoscopic myomectomy, which improved her likelihood of fertility while drastically alleviating her axial spine and lower extremity symptomology. This case reinforces the importance of keeping a broad differential that includes intrapelvic etiologies when traditional workup and treatment for sciatic neuropathy fails. To our knowledge, this is the first reported case of sciatic neuropathy secondary to uterine fibroids treated with the intent of both fertility improvement and pain relief.

Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia

BackgroundThe objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). MethodsA prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. ResultsWe recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7–10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1–4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15–96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15–96.93). ConclusionType of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.

Intradural extramedullary spinal masses treated at the Wits teaching hospitals between 2014 - 2017

Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and 2017. 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed, and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was unchanged in the remainder. IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery.

Dentin Dysplasia Type I: A Rare Case

Dentin dysplasia is a rare autosomal dominant disturbance of dentin formation which results in either bulbous, discoloured crowns or early exfoliation of the teeth. It has been classified into two types; type I or radicular dentin and type II or coronal dentin dysplasia. Here we present a case of dentin dysplasia type I in a 12 year old patient highlighting the clinical and radiographic features.

Dentin dysplasia: A rare case report

Dentin dysplasia (DD) is an autosomal dominant disorder affecting both the deciduous and permanent dentitions. The affected individual has normal size, shape, and color of crown, and pattern of eruption but abnormally short and stunted roots leading to premature exfoliation. DD is classified into two types: DD type I - radicular DD and DD type 2 - coronal DD. We present a case of DD type Ia in a 12-year-old boy, highlighting the clinical, radiographic, and histopathologic features with a brief note on treatment and preventive care.

The efficacy and safety of corticosteroids in the treatment of acute and chronic pain

Over the past three decades, corticosteroids have become part of a multimodal approach in the management of both cervical and lumbar degenerative disc diseases. Pain management specialists from various fields had a front row seat, and actively participated in the evolution from primarily oral steroid therapy to the development of various fluoroscopically-guided epidural steroid injection approaches. In this review we discuss the different forms of oral and injectable corticosteroids that have been used by different physician specialties in treating acute and chronic pain. We delineate differences between longer-acting particulate ('insoluble') (i.e. methylprednisolone and triamcinolone) and shorter-acting non-particulate steroids ('soluble') (i.e. betamethasone and dexamethasone), and their utilization while performing different epidural injections. We also discuss the presence of different preservatives in the injectable corticosteroid preparations, as well as some simple techniques to reduce the preservative concentrations, which might improve the safety of those injections. Furthermore, we want to illustrate the existing debates within the pain management physician community with regards to the current guidelines as they pertain to the type of steroids, techniques and approaches used to manage radicular type spinal pain. We discuss the underutilization and overutilization of selected injection techniques and some concerns that the United States Food and Drug Administration (FDA) raised, regarding the safe use of corticosteroids in pain management. We also elaborate upon the usefulness of some expensive tools such as digital subtraction angiography, which has been promoted by some in the medical community, and the difference in surgery rates for patients that have been treated by different physician specialties who use corticosteroids to manage pain. This review will emphasize that there is always room for improvement with respect to the following of published guidelines, and will accentuate the importance of reviewing the literature prior to making important clinical decisions.

Role of the Self-Administered, Self-Reported History Questionnaire to Identify Types of Lumbar Spinal Stenosis: A Sensitivity Analysis.

Study DesignCase-control design.PurposeTo evaluate the role of the self-administered, self-reported history questionnaire (SSHQ) in identifying types of lumbar spinal stenosis (LSS).Overview of LiteratureDiagnosis of types of LSS is controversial.MethodsA total of 235 patients with LSS were asked to respond to the SSHQ. All of these patients recovered following surgical treatment. The classification of LSS patients was based on history, physical examinations, and imaging studies. It is considered to be the gold standard. Radicular and neurogenic claudication types of LSS were based on the SSHQ developed by Konno et al. Two categories of LSS were determined based on the SSHQ tool and gold standard. Finally, a sensitivity analysis was carried out to evaluate the diagnostic value of the SSHQ.ResultsThe mean age of patients was 59.4 years. According to the criteria for gold standard, patients were diagnosed with the radicular type (n=103), and neurogenic claudication type (n=132). The questionnaire had desirable sensitivity, specificity, and accuracy in categorizing the two types of LSS: 97.8%, 66.6%, and 96.8% for the radicular type, and 97.0%, 80.0%, and 95.7% for the neurogenic claudication type.ConclusionsOur findings indicate that the SSHQ is a reliable and a valid measure and it may be a clinical diagnosis support tool for identifying patients with two types of LSS.

Bilateral radicular dens in dente in mandibular premolars

Dens invaginatus (DI) is a rare developmental anomaly that results from an invagination of the enamel organ into the dental papilla during odontogenesis. The invagination ranges from a slight pitting (coronal type) to an anomaly occupying most of the crown and root (radicular type). Radicular DI is an unusual dental anomaly. Although a clinical examination may reveal a deep fissure or pit on tooth surface, but radiographic examination is the most realistic way to diagnose the invagination. The objective of this case presentation is to report a rare case of radicular dens invaginatus bilaterally in mandibular premolars.

Radicular Dens Invaginatus: Report of a Rare Case

Dens invaginatus is a developmental anomaly resulting from invagination of a portion of crown forming within the enamel organ during odontogenesis. The invagination ranges from a slight pitting (coronal type) to an anomaly occupying most of the crown and root (radicular type). Although a clinical examination may reveal a deep fissure or pit on the surface of an anterior tooth, radiographic examination is the most realistic way to diagnose the invagination. The objective of this case presentation is to report a rare case of radicular dens in dente, which is a rare dental anomaly.

Clinical Outcome of Nonoperative Treatment for Lumbar Spinal Stenosis, and Predictive Factors Relating to Prognosis, in a 5-Year Minimum Follow-up

A prospective long-term follow-up study of nonoperative treatment for lumbar spinal stenosis (LSS) and multivariable analysis of the prognosis. To clarify the outcomes of nonoperative treatment for LSS over a long-term follow-up, and to extrapolate factors relating to the prognosis of treatment. The indicators of treatment for LSS remain controversial, and few reports have evaluated the prognosis of its nonoperative treatment, or extrapolated the factors that aid prognosis. One hundred twenty patients who received inpatient nonoperative treatment were followed up for 5 years or longer. Patients' nerve involvement and myelographic findings were classified, and the disturbance level of activities of daily living (ADL) at final follow-up was graded. The association between patients' age and sex, classification of nerve involvement and myelographic findings, recovery rate by initial nonoperative treatment, presence or absence of degenerative spondylolisthesis/scoliosis, and disturbance level of ADL were evaluated statistically to extrapolate prognostic factors. In all, 52.5% of patients showed no hindrance to ADL at follow-up. Patients who were classified as radicular type, or responded well to initial nonoperative treatment, exhibited statistically better results than did other patients. In contrast, accompanying degenerative scoliosis tended to be related to a poorer prognosis. The current study demonstrated the long-term follow-up outcome of nonoperative treatment for LSS. Important factors relating to the prognosis were demonstrated. These factors could aid the decision-making process for treatment of LSS patients.

The Prognosis of Conservative Treatments for Lumbar Spinal Stenosis

A prospective study. To identify outcomes of aged patients with lumbar spinal stenosis (LSS) treated conservatively and to examine factors that control the prognosis. There have been no reports evaluating the outcomes of conservative treatments for elderly LSS patients. A total of 89 patients, 70 years of age and older, who underwent in-hospital conservative treatment were included. The Japanese Orthopedic Association's score (JOA score) and the disturbance level of activities of daily living (ADL) were used for evaluation. Nerve involvement was classified into radicular, cauda equina, and mixed type. Myelographic findings were classified into central defect with or without block and root defect. Associations between disturbance level of ADL, nerve involvement, and myelographic classifications were investigated. The mean JOA score increased from 11.1 points at admission to 15.9 points at discharge, with 14.3 points maintained at the follow-up; 48.8% of radicular type showed no obstacle in ADL at the follow-up compared with 33.3% of the other types; 13.3% of central defect with block showed no obstacle in ADL compared with 47.8% of the other types with significant difference. The prognosis of conservative treatment for aged LSS was relatively good. Radicular type may be a candidate for conservative treatment. However, patients with complete block in the myelogram may not respond favorably to conservative treatment.

Incidence of neurologic complications related to thoracic epidural catheterization.

Due to potential neurologic sequelae, the risk:benefit ratio of thoracic epidural analgesia is controversial. Surprisingly, however, few available data address neurologic complications. The incidence of neurologic complications occurring after thoracic epidural catheterization was studied in patients scheduled for abdominal or abdominothoracic surgery. A total of 4,185 patients were studied, including 2,059 during the prospective phase of the study and 2,126 during the retrospective phase. After thoracic epidural catheterization, all patients received general anesthesia. Patients' neurologic status was assessed by an anesthesiologist using clinical criteria after operation and after epidural catheter removal. If neurologic complications were suspected, a neurologist was consulted. The incidence of specific complications was compared for different thoracic puncture sites: upper (T3/4-6/7), mid (T7/8-8/9), and lower (T9/10-11/12) catheter insertion levels. The overall incidence of complications after thoracic epidural catheterization was 3.1% (n = 128). This included dural perforation (0.7%; n = 30); unsuccessful catheter placement (1.1%; n = 45); postoperative radicular type pain (0.2%; n = 9), responsive to catheter withdrawal in all cases; and peripheral nerve lesions (0.6%; n = 24), 0.3% (n = 14) of which were peroneal nerve palsies probably related to surgical positioning or other transient peripheral nerve lesions (0.2%; n = 10). No signs suggesting epidural hematoma were recognized, and there were no permanent sensory or motor defects attributable to epidural catheterization. Unintentional dural perforation was observed significantly more often in the lower (3.4%) than in the mid (0.9%), or upper (0.4%) thoracic region. A single patient experienced severe respiratory depression after receiving epidural buprenorphine but recovered without sequelae. Thoracic epidural catheterization for abdominal and thoracoabdominal surgery is not associated with a high incidence of serious neurologic complications. In fact, the incidence of puncture- and catheter-related complications is less in the mid and upper than in lower thoracic region, and the predicted maximum risk for permanent neurologic complications (upper bound of the 95% confidence interval) is 0.07%.

A radicular dens invaginatus

A case of the radicular type of dens invaginatus involving a mandibular third molar is reported. The clinical presentation and histopathology are described and the development and significance of such lesions discussed.

Proliferation kinetics-study of the growth of keratocysts: Morpho-functional explanation for recurrences

The mode of growth of the odontogenic keratocyst is of decisive importance in the strategy and radicality of its surgical removal. The high rate of recurrence reported in the literature is striking. Staining with haematoxylin-eosin for histological examination provides only limited information on growth. Serial sections of a keratocyst obtained by fractionated curettage were prepared and the proliferation patterns of epithelium and connective tissue were studied by means of autoradiography and DNA cytophotometry and compared with those of an odontogenic reference cyst of the radicular type. The epithelium of the keratocyst examined clearly showed a higher rate of proliferation than that of the radicular cyst. The connective tissue was also growing very actively with a high rate of proliferation and this growth behaviour is at least partly responsible for the invasive and destructive growth of the keratocyst. In contrast to the radicular cyst, proliferation of the epithelium of the keratocyst is multicentric being simultaneous within the growth centres. As a result the epithelium "buds" with formation of satellite cysts in the alveolar bone and peripheral epithelial islands located in the connective tissue. A case is reported of a keratocyst treated by radical curettage with subsequent freshening of adjacent bone with a bur. Our morphological findings are an important contribution to the present discussion of the various methods of treating keratocysts.

Peripheral nervous system involvement in multiple sclerosis: [formula omitted] and C. Yiannikas (Dept. of Medicine, University of Sydney, Sydney, NSW 2006, Australia)

Objective The study was to investigate the clinical and electrophysiologic feature of peripheral nervous system involvement in multiple sclerosis(MS). Methods A retrospective analysis of 14 cases of MS associated with peripheral abnormalities was conducted. Results The clinical feature was decreased sensation in peripheral or radicular type distribution,radicular pain and atrophy. Peripheral nerve abnormalities were more frequently observed than those of radicular abnormalities. Neuropathic symptoms were mild and weren't present in every episode. They were presenting early stage of episode and the duration was short. Disease course and neurologic disability were similar to non peripheral nerve abnormalities in MS. The most frequent electrophysiologic abnormalities noted were slow sensory conduction,prolonged distal latencies,low motor amplitude,prolonged F wave responses. Conclusion The prognosis of MS together with peripheral nerve abnormalities is similar to non peripheral abnormalities.

Paraplegia in myelomatosis--a study of 20 cases.

A retrospective study of 20 cases of multiple myelomatosis and paraparesis treated during 1966-77 is presented. All patients but one had been submitted to decompressive laminectomy. A close correlation between duration of paraparesis before operation and prognosis was found, eight patients with a duration of paraparesis of several days remaining paraplegic. No particular paraparesisprone patient group with respect to duration of myelomatous disease, Ig class or various laboratory findings could be identified. In several instances radionuclide scan was effective in localizing vertebral lesion. In most patients radicular type back pain signalled vertebral damage and subsequent paraparesis. In many cases long survival after operation and excellent to good functional results made surgery a worthwhile procedure. The importance of postoperative radiotherapy and adequate chemotherapy is stressed.

Intraspinal epidural reticulosarcomas. Study of 34 cases

Foi realizado um estudo de 34 casos de reticulossarcomas localizados no tecido epidural intraespinal. Assinala-se sua maior freqüência entre homens com mais de 50 anos, embora pacientes mais jovens possam ser acometidos, principalmente entre 15 e 29 anos. A distribuição segmentar dos tumores permite um diagnóstico diferencial, sendo a região torácica a sede mais freqüentes de sarcomas. O principal sintoma encontrado nos pacientes com reticulossarcoma foi a dor, do tipo radicular, que serve para diferenciar os tumores intra e extra-medulares, tendo sido de aparecimento precoce em 15 dos pacientes estudados, precedendo em muitos meses e até anos os demais sintomas. Classificou-se os tumores reticulohistiocitários epidurais do canal vertebral em três grupos, de acordo com seu aspecto tecidual e celular e, principalmente, com a presença e distribuição da reticulina. Relacionou-se o tempo de evolução desses tumores com seu aspecto histopatológico, chegando-se à conclusão que os tumores classificados no grupo III apresentam um período evolutivo maior que os demais, o que nos levou a pensar que crescem mais lentamente, apresentando, portanto, melhor prognóstico que os demais tipos, muito embora todos os tipos de reticulossarcomas possam apresentar um prognóstico mais favorável quando precocemente diagnosticados e tratados adequadamente.

Dilated composite odontome: Reports of two cases, one bilateral and one radicular

A plea has been entered to discontinue the name dens in dente and to substitute for it the term dilated composite odontome which conforms more to the present-day theory of aberrant morphogenesis. A search of the dental literature has brought to light an earlier report and description of this condition, thus giving the primary authorship to Salter. Two additional cases have been presented for the record, one being bilateral, the other an example of the radicular type.

Early Cases of Spondylarthritis Anchylopoetica

Advanced spondylarthritis presents no diagnostic difficulties. Reports in the literature generally describe the final stage, with the kyphotic, stiff back and typical roentgen changes, calcification of the ligaments and ankylosis of the intervertebral joints. During the last 20 years however, a study of the early stages has commenced. The works of Krebs (14, 15, 16) and Scott (18, 19), at the beginning of the 1930's. showed that the disease practically always manifests itself symmetrically at the onset, with arthritis in the sacro-iliac joints, but, strangely enough, without the appearance of any local symptoms in this region. The early symptoms are diffuse. They usually appear in the form of attacks of pain, of myalgic or radicular type: the pain may move from one region to another with pain-free intervals. It can happen that misjudgement of cases may continue for several years while such diagnoses are given as rheumatism, myalgia, growing pains and fibrositis etc. In all their irregularity, however, the symptoms are yet in some way characteristic. Scott even bases the diagnosis solely on the anamnesis, though roentgen changes may be absent in the sacroiliac joints. He calls the symptoms prespondylitic and has encountered them in 95 % of 300 cases. He goes so far as to say that spinal symptoms first appear when arthritis of the sacro-iliac joints has reached the stage of ankylosis. The disease is often overlooked owing to the remarkable circumstance that, as mentioned before, no local symptoms proceed from these joints. A reliable diagnosis can only be made through radiographic examination of the sacro-iliac joints, Lecture given at a meeting of the Nordisk Reumatologisk Fijrening in Oslo,