Showing papers in "Spine in 1988"

Accelerated degeneration of the segment adjacent to a lumbar fusion.

Abstract: Previously reported biomechanical studies on the effects of various types of spinal fusion procedures upon the adjacent segment indicate a significant degree of increased stress at that segment. This study presents 18 patients in whom new symptoms developed from the segment adjacent to a fusion after an average symptom-free interval of 8.5 years (1-38 years). The most common pathologic condition at the adjacent segment was hypertrophic degenerative arthritis of the facet joints. Spinal stenosis was found there in eight cases; severe disc degeneration in five; degenerative spondylolisthesis in two; and spondylolysis acquisita in one.

Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens.

Abstract: Using data from 16 published reports, the authors correlated macroscopic disc degeneration grades with age, sex, and spine level in 600 lumbar intervertebral discs from 273 cadavers (ages: 0-96 years). Male discs were more degenerated than female discs at most ages; significantly so in the second, fifth, sixth, and seventh decades. On average, L4-L5 and L3-L4 level discs showed more degeneration than discs at other lumbar levels. These macroscopic findings corroborate radiographic data from epidemiologic studies. The calculations suggest that higher mechanical stress, perhaps combined with longer nutritional pathways, may be responsible for the earlier degeneration of male discs.

Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement

Abstract: The increased popularity of pedicle fixation prompted research to address two issues: the reliability and validity of roentgenograms as a technique for evaluating the success of pedicle fixation, and the effects of surgical factors on successful fixation. Thus, does approach--the point and angle of screw insertion, surgeon experience, practice, level of the spine involved, and screw size--effect success of pedicle fixation? Eight fresh thoracolumbar spines were harvested and cleaned of all soft tissues. Two surgeons, one more experienced in pedicle fixation than the other, used two pedicle fixation approaches (Weinstein and Roy-Camille) on both the left and right sides at levels T11-S1 of each specimen. All screws were placed under anteroposterior (AP) and lateral c-arm control. For specimens 1 to 3, 5.5 mm screws were used at T11-L1, and 7.0 mm screws at L2-S1. Unacceptable failure rates at L2 and L3 for the first three specimens resulted in a change of instrumentation for the remaining specimens, with 5.5 mm screws used at T11-L3 and 7.0 mm screws at L4-S1. When surgeons completed the fixations for a specimen, AP and lateral roentgenograms were taken and both surgeons independently evaluated the films to assess the success of each fixation. Failure was defined as evidence of any cortical perforation on any side of the pedicle in or outside of the spinal canal. After completing the roentgenogram evaluation, the specimen was transected in the midline, and the success of each pedicle fixation was evaluated by visual/tactile inspection. There were no disagreements between surgeons on the visual/tactile evaluations of the specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical evaluation of spinal fixation devices: I. A conceptual framework.

Abstract: In the field of spinal fixation devices, there is a profusion of new instrumentations. Often, the biomechanical evaluation is done in a nonstandardized manner, which makes it difficult to compare the results of one researcher with those of another, for the same device or for different devices. There

Swelling pressure of the lumbar intervertebral discs: influence of age, spinal level, composition, and degeneration.

Abstract: The fluid content of the intervertebral disc is important in determining its mechanical response and also its transport and biologic properties. Fluid content depends on the proteoglycan content of the tissue and on the relationship of the external load to the disc's swelling pressure. The influence of proteoglycan content and external load on the hydration of nuclei from 32 human lumbar discs was measured. Swelling pressure of the same specimens was measured by equilibrium dialysis. The influence of age (14-91 years) and spinal level was noted. Proteoglycan content of the discs fell with age, and for all spines tested, proteoglycan content was lowest in the L5-S1 disc; no systematic change in collagen content was found. The hydration of the discs, as received, also fell with increase in age; in each complete lumbar spine tested, the L1-L2 and the L5-S1 discs had the lowest hydration at postmortem examination. As the stress applied to the discs was increased, hydration decreased. Although a stress of 0.10-0.23 MPa maintained the disc slices at their postmortem hydration, under a stress of about 0.6-0.8 MPa, most discs lost 40-60% of their initial fluid. The relationship between change in hydration and swelling pressure was found to depend on the composition of the disc rather than on age or degree of degeneration; the relationship between equilibrium hydration and swelling pressure could be predicted satisfactorily for a disc of known collagen and proteoglycan content.

Morphology and Treatment of Occipital Condyle Fractures

Abstract: During the last 4 years, the authors have had six cases of occipital condyle fractures, a very rare injury. Medline search yielded reports of 20 occipital condyle fractures in the literature. Of the six treated by the authors, one death (by pontine hemorrhage) occurred in a patient with a displaced avulsion fracture on the right occipital condyle (Type III). All others attained solid union with appropriate immobilization. Morphologically, one presented with an impacted fracture of the occipital condyle (Type I), one with a basilar skull fracture that included an occipital condyle fracture (Type II), and four had avulsion fractures of the occipital condyle. The latter are potentially unstable since loss of integrity of alar ligaments may coexist. Type I and II are stable, and the authors recommend treatment with a semiconstrained cervical orthosis. Type III injuries, which are potentially unstable, require rigid immobilization.

The cervical zygapophysial joints as a source of neck pain.

Abstract: Diagnostic cervical medial branch blocks and zygapophysial joint blocks were used to test the hypothesis that the cervical zygapophyseal joints can be the source of pain in patients with idiopathic neck pain. Complete temporary relief of all symptoms was obtained in 17 out of 24 consecutive patients. Two major groups of patients were those with neck pain and headache stemming from the C2-3 joints, and those with neck pain and shoulder pain stemming from the C5-6 joints. Internal-control observations in nine of the 17 patients established the diagnostic validity of the blocks used. The high yield of positive responders in this study probably reflects the propensity of patients with zygapophysial joint syndromes to gravitate to a pain clinic when this condition is not recognised in conventional clinical practice.

New uses and refinements of the paraspinal approach to the lumbar spine.

Abstract: The paraspinal approach was described by our group in 1968. It differs from the approach described by Melvin Watkins in 1953 in that it is a longitudinal separation of the sacrospinalis group between the multifidus and longissimus, and not between the lateral border of the entire sacrospinalis group and quadratus lumborum. Also, Watkins removed a flake of the iliac crest with muscles attached, which he swung cranially and medially. This article also describes several refinements not mentioned in the original article and gives several new uses for the approach. Specifically, its use for removing a far lateral disc, decompressing a far out syndrome, inserting pedicle screws, and for decompressing the opposite side from inside the vertebral canal is described.

Instantaneous axes of rotation of the lumbar intervertebral joints.

Abstract: Lateral radiographs of ten normal individuals were studied to determine the location of the instantaneous axis of rotation (IAR) of every lumbar vertebra for the movements of flexion and extension from the upright position and flexion from the fully extended position; and errors involved in the technique were quantified to establish confidence limits for the results of the calculations. The distribution of the IARs was found to fall within a small range from the mean location at each level, particularly for the movement of flexion from the extended position. Within-observer and between-observer errors occurred in tracing and superimposing radiographs and marking x and y coordinates. Unacceptably large errors occur when the movement of the joint is less than 5 degrees, and only the IAR for flexion from extension can be plotted with acceptable confidence. This result invalidates the notion that plotting centrodes may be of diagnostic value in recognizing mechanical disorders. The determination of a single extension to flexion IAR may be of more value clinically, to which end this study provides essential normative data.

Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation.

Abstract: Vertebral transpedicular screws provide secure attachment for posterior spinal fixation devices. Screw design details, biomechanics, and implantation safety depend upon anatomic constraints, especially from the pedicle and body. Previous morphometric data were limited; thus, a retrospective study wa

1988 Volvo award in biomechanics. The triaxial coupling of torque generation of trunk muscles during isometric exertions and the effect of fatiguing isoinertial movements on the motor output and movement patterns.

Abstract: Previous studies have shown that reduction of precise motor control accompanies local muscular fatigue. The effects of isodynamic fatiguing of flexion and extension trunk movements on the movement patterns and the motor output of the trunk were investigated. Twenty male subjects with no history of low-back pain for the past 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position and velocity of each axis. Resistances were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a sagittal plane resistance equal to 70% of their maximum isometric extension strength in the upright position. The minimum resistances in the coronal and transverse planes were set up at 7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Analysis of variance, the MANOVA procedure with a repeated measure design, was performed among the selected parameters of the first, middle and last three repetition cycles. The selected parameters are the trunk motor output and movement patterns; the total angular excursion, range of motion, maximum and average torque and angular velocity of the trunk. All the selected parameters were significantly reduced in the sagittal plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction in the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structure is loaded in a more injury prone pattern, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.

Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies.

Abstract: We suggest that lumbar degenerative kyphosis be included as one of the abnormal sagittal curvatures in which a kyphosis or a marked loss of lordosis is seen in the lumbar spine, caused by degenerative changes in middle-aged and elderly. One hundred and five consecutive patients were investigated, most of whom complained of low-back pain, often with a long history. They all walked in a forward bending posture, either all the time or only when exhausted. In roentgenograms, most cases showed a marked loss of the sacral inclination, as well as multiple disc narrowing and/or vertebral wedging in the lumbar region. These subjects showed a definite weakness of the lumbar extensors compared to the flexors, and therefore a reversed ratio of extensors/flexors muscle power compared with normal controls and other types of spinal curvatures. Weakness of the lumbar extensors was clearly shown by isokinetic measurement and a marked atrophy of these muscles with fatty infiltration was demonstrated by CT scanning.

Three-dimensional movements of the upper cervical spine.

Abstract: Knowledge of the normal movements of the occipito-atlanto-axial joint complex is important for evaluating clinical cases that may be potentially unstable. The purpose of this in vitro study was to quantitatively determine three dimensional movements of the occiput-C1 and C1-C2 joints. Ten fresh cadaveric whole cervical spine specimens (occiput to C7) were studied, using well-established techniques to document the movements in flexion, extension, left and right lateral bending, and left and right axial rotation. Pure moments of a maximum of 1.5 N-m were applied incrementally, and three-dimensional movements of the bones were recorded using stereophotogrammetry. Each moment was applied individually and in three load/unload cycles. The motion measurements were made on the third load cycle. Parameters of neutral zone, elastic zone, and range of motion were computed. Neutral zones for flexion/extension, right/left lateral bending, and right/left axial rotation were, respectively: 1.1, 1.5, and 1.6 (occiput-C1); and 3.2, 1.2, and 29.6 degrees (C1-C2). Ranges of motion for flexion, extension, lateral bending (one side), and axial rotation (one side) were, respectively: 3.5, 21.0, 5.5, and 7.2 degrees (occiput-C1 joint) and 11.5, 10.9, 6.7, and 38.9 degrees (C1-C2 joint). The greatest intervertebral motion in the spine was axial rotation at the C1-C2 joint, with the neutral zone constituting 75% of this motion.

Thoracolumbar “Burst” Fractures Treated Conservatively: A Long-Term Follow-up

Abstract: This report addresses the long-term results of nonoperative treatment for fractures of the thoracolumbar spine. Forty-two patients meeting specified inclusion criteria were contacted and completed questionnaires. In all cases, nonoperative treatment was the only treatment received. The average time from injury to follow-up was 20.2 years (range, 11 to 55 years). The average age at follow-up was 43 years (range, 28 to 70 years). There were 31 men and 11 women in this series. Seventy-one percent of the injuries were the result of motor vehicle accidents. The most common sites of injury were T12-L2, which accounted for 64% of the injuries. Seventy-eight percent of the patients had no neurologic deficits at the time of injury. At follow-up, the average back pain score was 3.5, with 0 being no pain at all and 10 being very severe pain. No patient demonstrated a decrease in their neurologic status at follow-up, and no patient required narcotic medication for pain control. Eighty-eight percent of patients were able to work at their usual level of activity. Follow-up radiographs revealed an average kyphosis angle of 26.4 degrees in flexion and 16.8 degrees in extension. The degree of kyphosis did not correlate with pain or function at follow-up. Based on this review, nonoperative treatment of thoracolumbar burst fractures remains as a viable alternative in patients without neurologic deficit and can lead to acceptable long-term results.

A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy.

Abstract: The risks and success of surgery for multiple level cervical spondylotic radiculopathy differs from that of single level disease. The problems associated with multiple level anterior fusion over single level fusion include higher pseudoarthrosis rates than that associated with single level disease. Bilateral and multiple level laminectomy carries the risk of potential instability. Cervical laminoplasty, until recently, has only been performed for myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL) or cervical stenosis. The purpose of this report is to compare the results and complications of 45 patients with a least a 2-year follow-up who had undergone anterior fusion, cervical laminectomy, or cervical laminoplasty for the surgical management of multiple level cervical radiculopathy due to cervical spondylosis. 18 patients (58 levels) underwent anterior fusion, 12 patients (38 levels) had a cervical laminectomy, and 15 patients (57 levels) underwent a cervical laminoplasty. Roentgenograms indicated spinal stenosis (sagittal diameter less than 12 mm) at 28 levels (15 patients) for the anterior fusion group, 14 levels (9 patients) in the laminectomy group, and 24 levels (13 patients) in the laminoplasty group. Subluxation (2 mm or less) was present at 14 levels (13 patients) in the anterior fusion group, nine levels (9 patients) in the laminectomy group, and 15 levels (8 patients) in the laminoplasty group. Loss of lordosis was present in eight patients undergoing anterior fusion, six patients undergoing laminectomy, and six patients who had a laminoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

1988 Volvo award in clinical sciences. Facet joint injection in low-back pain. A prospective statistical study.

Abstract: From January 1980 through December 1984, 454 patients were evaluated with facet joint injections. All had the chief complaint of low-back pain, normal neurologic examinations and no root tension signs. Three hundred and ninety completed the protocol, which included a lumbar motion pain assessment before and after facet injection. A total of 127 variables were studied. There were 229 males and 161 females with a median age of 38. Facet joint arthrograms were performed prior to intra-articular injection of local anesthetic and cortisone. Initial mean pain relief was only 29%. Variables correlating significantly (P less than 0.05) with more postinjection pain relief were older age, prior history of low-back pain, normal gait, maximum pain on extension following forward flexion in the standing position, and the absence of leg pain, muscle spasm and aggravation of pain on Valsalva. Greatest pain relief immediately after injection was seen with lumbar extension and rotation, motions reported to stress the facet joints or aggravate pain of facet joint origin. Patients with more pain on lumbar extension and rotation as a group, however, did not get more pain relief. From this study we were not able to identify clinical facet joint syndromes or predict patients responding better to this procedure. The facet joints were not commonly the single or primary source for low-back pain in the great majority (greater than 90%) of patients studied.

The outcome of surgery for lumbar disc herniation. I. A 4-17 years' follow-up with emphasis on somatic aspects.

Abstract: Records of 575 patients operated on for the first time for lumbar disc herniation have been reviewed. Four to 17 years after the operation 371 (65%) patients answered a questionnaire on number of reoperations, working capacity, lumbar or sciatic pain as well as necessity of treatment. Of these, 255 (70%) still complained of back pain, and 83 (23%) of this group complained of constant heavy pain; 172 patients (45%) have a residual sciatica; 131 (35%) are still under some kind of treatment; 47 (14%) patients are receiving a disability pension. Repeat operations were performed in 17%. Based on the criteria given by Spine Update 1984 as related to justified or unjustified indication there was no statistical difference in long-term results concerning the above-mentioned criteria of success. The so-called justified indication for disc herniation neurosurgery does not necessarily imply a good long-term result. In the preoperative investigation, not only symptoms and neurological signs, but also the socially and personally defined career of the illness are of importance. The patients with complaints, mainly those receiving a pension, are psychologically conspicuous and show more psychopathological features as monitored by MMPI than the patients without complaints after surgery. Psychological assessment should increasingly be used in the preoperative evaluation, especially in patients who do not present an absolute indication for neurosurgical intervention.

Tensile strength of spinal ligaments.

Abstract: Spinal ligaments from 41 fresh human male cadavers were tested. The ligaments were tested in situ by sectioning all elements except the one under study. The force deflection curves demonstrated a sigmoidal shape, and the point at which an increase in deflection was obtained with decreasing force was taken as failure. The force and deformation at failure are shown for each ligament as a function of spinal level.

Lateral Lumbar Spinal Canal Stenosis: Classification, Pathologic Anatomy and Surgical Decompression

Abstract: The lateral region of the lumbar spinal canal is subject to pathologic alterations which encroach upon the neural structures located within. In order to further understanding and facilitate communication among specialists in diverse disciplines, a subdivision of the lateral region is proposed to com

An analytical investigation of the mechanics of spinal instrumentation.

Abstract: Three-dimensional nonlinear finite element models of the intact L4-5 one motion segment/two-vertebrae and L3-5 two motion segments/three-vertebrae were developed using computed tomography (CT) films. The finite element mesh of the L4-5 motion segment model was modified to simulate bilateral decompression surgery. The mesh was further altered to achieve stabilization, using an interbody bone graft and a set of Steffee plates and screws. The model behavior of the intact specimen in all loading modes and of the stabilized model in compression, flexion, and extension modes were studied. The stresses in the cancellous bone region were found to decrease. The interbody bone graft, due to an overall decrease in stresses in the bone below the screw, transmits about 80% of the axial load as compared with 96% transmitted by an intact disc in an intact model. Thus, the use of a fixation device induces a stress shielding effect in the vertebral body. The results indicate that although the bone graft transmits lesser loads than the intact disc, it is active in transmitting loads. The presence of low stresses in the cancellous bone region and high localized stresses in the cortical pedicle region surrounding the screw, compared with the intact case, suggests that the screws are likely to become loose over time. The use of an interbody bone graft alone or in combination with any existing fixation device also induces higher stresses at the adjacent levels. This may be responsible for the adverse iatrogenic effects seen clinically.

Functional radiographic diagnosis of the cervical spine: flexion/extension.

Abstract: The cervical spines of 59 adults were examined by means of functional roentgenograms. They were divided into two groups consisting of 28 healthy adults and 31 patients who had sustained soft tissue injury to the cervical spine and who were complaining of neck pain. Roentgenographic lateral views were taken in active flexion and extension as well as in passive maximal flexion and extension. Measurements using the techniques of Penning and Buetti-Bauml were made by three observers independently. There was a highly significant difference between the active and passive segmental ranges of motion in healthy adults. Based on the normal values obtained in this study, 19 hypermobile segments could be diagnosed during the active examination, while 31 hypermobile segments were found during the passive examination. In addition, the active examination found 60 hypomobile segments, while the passive examination showed only 43 hypomobile segments. The Penning Method of measurement was found to be more reliable than that of Buetti-Bauml. If possible, the functional roentgenogram examination of the cervical spine in the sagittal plane should be performed by including passive movement and the range of motion should be compared with the normal values obtained by passive examination.

The innervation of the cervical intervertebral discs

Abstract: Microdissection and histologic studies were undertaken to determine the innervation of the cervical intervertebral discs. The cervical sinuvertebral nerves were found to have an upward course in the vertebral canal, supplying the disc at their level of entry and the disc above. Branches of the vertebral nerve supplied the lateral aspects of the cervical discs. Histologic studies of discs obtained at operation showed the presence of nerve fibers as deeply as the outer third of the anulus fibrosus. These anatomic findings provide the hitherto missing substrate for primary disc pain and the pain of provocation discography.

Vertebral body and posterior element morphology: the normal spine in middle life

Abstract: Multiple morphologic parameters were studied in 50 normal adult vertebral columns ranging in age from 20 to 40 years at the time of death. Posterior element morphology is highly variable and largely unpredictable. Minimum pedicle diameters ranged from 1.8 mm at T6 to 6.4 mm at L5, and did not correlate with any more readily measured vertebral dimensions. Penetration of 5 mm screw threads through pedicle cortex can be expected to occur routinely in the lower thoracic spine, and in a lesser but significant number of lumbar vertebrae.

Progressive isoinertial lifting evaluation. I. A standardized protocol and normative database.

Abstract: Dynamic tests of trunk strength and lifting capacity have become more popular in recent years, offering certain advantages over static isometric tests in measuring patient progress in functional restoration programs for spinal disorders. However, equipment for performing such tests is expensive to buy, complex to run, and requires technical expertise and clinical volume unavailable in most physician offices. In this study, a new dynamic test known as Progressive Isoinertial Lifting Evaluation (PILE) is described, which draws upon prior psychophysical and isoinertial methods. An industrial sample of 61 male and 31 female incumbent workers were tested using the PILE, and a variety of anthropometric normalizing factors were evaluated. The isolation of an "Adjusted Weight" (AW) normalizing factor is documented, after which normative data are presented for male and female workers utilizing lumbar (0-30 inches) and cervical (30-54 inches) dynamic protocols.

The pain of discography

Abstract: Tentative d'explication de la douleur lors de la discographie a partir de l'hypothese selon laquelle la concentration de Vaso Intestinal Peptide et de substance P varie au cours de cette exploration dans le ganglion spinal

Anterior lumbar interbody fusion.

Abstract: Anterior lumbar interbody fusion (ALIF) was first reported in 1906 and is currently an acceptable option for surgical treatment of spondylolisthesis. A careful preoperative evaluation is critical, as most complications are approach related. Both retroperitoneal and transperitoneal approaches are utilized for exposing the lower lumbar levels most commonly associated with spondylolisthesis. A wide variety of options are available for the interbody graft, including autogenous bone grafts and titanium cages, as well as graft adjuncts such as bone morphogenetic protein (rhBMP-2). Both radiographic results and health related quality of life (HRQOL) studies have established ALIF as a reliable procedure for the treatment of spondylolisthesis. Known complications of ALIF include vascular damage, injury to peritoneal viscera, ileus, and retrograde ejaculation.

The role of anterior lumbar fusion for internal disc disruption.

Abstract: Internal disc disruption is a syndrome of traumatically induced low-back pain arising from the intervertebral disc The diagnosis is confirmed by abnormal discography with concordant pain reproduction at the affected level or levels Thirty-four patients with internal disc disruption at one level were followed for an average of 29 months Eighteen (53%) underwent anterior lumbar fusion at the L4–5 disc, 11 (32%) at the L5-S1 disc and the remainder at the L3–4 or L2–3 disc Bank bone was used in all but seven patients for interbody fusion Treatment was Judged a success by the patient returning to work or normal activities and requiring either no medications or an anti-inflammatory drug only By the above criteria 25 patients (74%) had successful outcome of treatment The average time to return to work or normal activities was 61 months The overall union rate was 73% with an average time to union of approximately 12 months Complications consisted of graft extrusion requiring revision and retrograde ejaculation These occurred in one patient and were the only complications in the series We concluded that disc excision and anterior interbody fusion is an effective treatment for internal disc disruption

The lumbar facet syndrome.

Abstract: A clinical study was undertaken to formulate better criteria for accurate diagnosis of the lumbar facet syndrome and for predicting treatment response to facet joint injection. Twenty-two consecutive patients with a clinical diagnosis of lumbar facet syndrome, made by conventional diagnostic criteria, who were then treated with facet joint injection, were reviewed for their treatment responses. New diagnostic criteria were formulated based on a scoring system derived from the values observed in this review study. The scoring system has a total of 100 points, allocated as follows: back pain associated with groin or thigh pain, 30 points; well-localized paraspinal tenderness, 20 points; reproduction of pain with extension-rotation, 30 points; corresponding radiographic changes, 20 points; and pain below the knee, -10 points. A score of 60 points or more indicates a very high probability of satisfactory response to facet joint injection (100% prolonged response in this study). When only the conventional criteria were used, the overall results of prolonged relief of pain after facet joint injection was 50%. A "scorecard" system is proposed that may give a higher degree of diagnostic accuracy and predictability of successful response to facet joint injection.

Degenerative adult onset scoliosis.

Abstract: There are people who have no history of scoliosis who develop spinal deformity of a progressive nature as adults, associated with severe degenerative disc disease The clinical syndrome associated with this deformity is not well documented In an attempt to describe this clinical syndrome more precisely, 21 patients with the diagnosis of degenerative scoliosis were identified and reviewed Review included history with pain drawings when available, physical examination, bone densities, and standing spinal roentgenograms Patients with spinal compression fractures, spondylolyses, prior history of scoliosis or radiographic findings consistent with an idiopathic scoliosis were excluded Our review shows that these patients can develop, along with progressive scoliosis, loss of lumbar lordosis with a resulting flat back deformity These patients commonly present in the sixth decade with a predominantly stenotic symptom complex, but often lack the classic feature of relief in a sitting posture The number of male and female patients was approximately equal Roentgenogram findings show a high angle deformity over a short number of spinal segments and an absence of bony features associated with idiopathic scoliosis such as lateral vertebral wedging and alterations of the lamina The incidence of this condition remains to be established