Migration of a bullet in the lumbar intervertebral disc space causing back pain. Case report

A 41-year-old man presented with low-velocity gunshot injury in the right abdomen. Neuroimaging showed the bullet located in the L2-3 intervertebral disc space, but neurological examination found no abnormalities. Exploratory laparotomy was performed because of retroperitoneal hematoma. Two months after the gunshot injury, the patient presented with severe low back pain. Serial neuroimaging showed that the bullet had migrated in the intervertebral disc space. The bullet was removed via right L2 hemilaminectomy. The patient had no complaints after the operation. Early recognition and surgical intervention for bullets embedded in the intervertebral disc space may present with neurological and related complications.     

Bertolotti's syndrome. A cause of back pain in young people

Bertolotti's syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease. We analysed the elective MR scans of the lumbosacral spine of 769 consecutive patients with low back pain taken between July 2003 and November 2004. Of these 568 showed disc degeneration. Bertolotti's syndrome was present in 35 patients with a mean age of 32.7 years (15 to 60). This was a younger age than that of patients with multiple disc degeneration, single-level disease and isolated disc degeneration at the L4/5 level (p 相似文献   

The lumbar disc and low back pain.

The lumbar disc serves to sustain compression loads and is subject to tension and shear in forward bending and rotation. Its outer third is innervated and can be a source of pain. The annulus fibrosus may be injured in rotation and flexion of the lumbar spine and may become symptomatic as a ligamentous injury. Compression injuries of the disc are initially asymptomatic but may set in train a degradative process that, in time, leads to internal disc disruption, which becomes symptomatic as a result of chemical or mechanical irritation of nociceptors in the annulus fibrosus. Disc prolapse is but one possible end stage of internal disc disruption and represents the culmination of a series of destructive processes affecting the disc. This condition can be symptomatic while the external appearance of the disc remains normal and before nerve roots are affected in any way.     

Serial lumbar dynamometry in low back pain.

To determine the significance of changes in motor performance as measured by lumbar dynamometry, serial lumbar dynamometry was performed on a group of 45 male Workers' Compensation patients with chronic "mechanical" low back pain and in a group of 20 healthy male volunteers. The patients were men aged 20-60 years, whose current episode of low back pain had lasted for at least 3 months (mean 19.5 weeks, range 12-47 weeks). Testing was performed at entry into a "back school" program of therapy and again 2 weeks and 4 weeks later. The control group showed a slight improvement in almost all variables of strength and range of motion between the first and second tests but no significant change between the second and third tests. This was consistent with a learning effect. The patient group was analyzed as a whole and also in two groups based on their response to the Waddell maneuvers at entry: Waddell score 0-2 (no excessive illness behavior) and 3-5 (excessive illness behavior). As a whole, the patients showed significant progressive improvement in most variables on successive tests. The group with the low Waddell score had significantly greater strength and range of motion than the group with the high Waddell score but the trend of improvement with time was similar in the two groups. The authors conclude that in this sample of patients with low back pain, serial lumbar dynamometry reveals a progressive improvement in performance, which is greater than the improvement expected from the natural history of physical recovery and greater than the improvement expected from an increase in strength and range of motion attributable to the therapeutic exercises performed and is much larger than any learning effect related to the test procedure.     

Thoracolumbar hernia: A rare cause of back pain

We report a case of a hernia through the thoracolumbar fascia in a young adult male who presented with pain and swelling in the thoracolumbar region. Surgical repair of the defect was performed in the superficial layer of the thoracolumbar fascia and, 18 months following surgery, he remained asymptomatic. The purpose of this report is to make clinicians aware of a thoracolumbar hernia as a rare cause of back pain.     

Synovial cyst of a lumbar facet joint: a rare cause of back pain and sciatica

Summary Intraspinal synovial cysts, sometimes referred to as ganglion cysts, are uncommon lesions which may present as acute or chronic low back pain, with or without radicular symptoms. We present two patients who presented with back pain and radicular symptoms attributable to the unusual pathology of an intraspinal synovial cyst.     

Diagnostic challenge: bilateral infected lumbar facet cysts - a rare cause of acute lumbar spinal stenosis and back pain

Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5) cysts. This report highlights diagnostic clues for identifying infection of a facet cyst.     

The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain

Spinal fusion became what has been termed the “gold standard” for the treatment of mechanical low back pain, yet there was no scientific basis for this. Operations of fusion for low back pain were initially done at the beginning of the last century for back pain thought to be related to congenital abnormalities or for past spinal infection. The recognition of the disc as a cause of sciatica, commonly associated with back pain, and the recognition that a degenerate disc led to abnormal movement suggested the concept that this abnormal movement was the cause of pain, and this abnormal movement came to be called “instability”. Much biomechanical expertise confirmed the fact that degenerate discs led to abnormal movement, there were many hypothesis as to why this caused pain. However clinical results of fusion for back pain were unpredictable. The failure of pedicle screws and cage fusion to improve the clinical results of fusion despite near 100% fusion success, and the introduction of “flexible stabilization” and artificial discs, which demonstrated that despite the often unpredictable movement permitted by of these devices, clinical success was similar to fusion, directed attention to the other role of the disc, that of load transfer, which these devices also affected. Abnormal load transfer was already known to be critical in other joints in the body and had led to the use of osteotomy to realign joints. The relevance of load transfer to the future design of spinal implants used in the treatment of low back pain is discussed, and some finite element studies are reported demonstrating the likely effect of abnormal loading beneath an incompletely incorporated plate of an artificial disc, perhaps explaining in part the somewhat disappointing clinical results to date of the implantation of artificial discs.     

Acute renal ischemia--unusual cause of lumbar pain

Acute renal artery occlusion is rarely found in daily clinical practice. Its rarity and inespecific clinical presentation are responsible for late diagnosis or diagnostic errors, with symptoms frequently being erroneously attributed to other more common entities. There is no consensus in what concerns therapeutic options. Multiple treatment modalities are described in the available literature. Some defend anticoagulant therapy and support measures only while others recommend other more invasive alternatives reaching even open surgery. The authors present two additional case reports of acute embolic renal ischemia. A thorough literature review is also presented comprehending etiological, clinic, diagnostic and therapeutic aspects.     

An unusual cause of back pain in athletes

This paper reports 2 patients who developed chronic overuse tendinitis of the pelvic insertion of the sacrospinalis muscle. Despite prolonged courses of conservative therapy their symptoms did not improve. Following operative release of the sacro-spinalis, the symptoms settled dramatically and the function of their backs returned to normal.     

An unusual cause of low back pain: solitary lumbar spine osteochondroma in a 71-year-old man

Introduction

Osteochondroma is a common benign tumor affecting bone that usually occurs in the appendicular skeleton rather than that in the axial skeleton. These lesions are more commonly reported with spinal involvement in cases of hereditary multiple exostoses.

Case report

Symptomatic spinal osteochondromas generally occur in young adults in the second and third decades with local spinal pain, or neurologic deficit as more common manifestations. This report describes an unusual symptomatic spine osteochondroma in a 71-year-old man.

Conclusion

Our case and review of the literature, only seven other cases of spinal symptomatic osteochondromas in elderly patients previously reported, suggest possible growth beyond skeletal maturity.     

下腰椎内固定融合手术后复发性腰痛及下肢放射痛23例原因分析

目的分析椎弓根螺钉内固定下腰椎融合手术后腰痛原因。方法随访2001年1月~2003年12月采用椎弓根螺钉内固定下腰椎融合手术103例,男43例,女60例;腰椎滑脱28例,腰椎管狭窄54例,腰椎间盘突出症21例。随访时进行问卷调查及X线、CT或MRI检查,并分析手术后腰痛的可能原因。结果随访时间3~5年,疗效优良80例(77.7%);术后有明显腰痛或腰痛伴下肢放射痛23例(22.3%)。邻近节段疾病11例(2节段融合7例,1节段融合4例;10.7%),内固定使用不当3例,椎弓根螺钉断裂2例,减压不完全2例,高位椎间盘突出1例,不明原因4例。结论邻近节段疾病、内固定使用不当、内固定失败是复发性腰痛主要原因。原有退变基础、减压范围超过融合节段、融合节段的长短都是产生邻近节段疾病的重要的危险因素。