1/10. chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique.OBJECTIVE: To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator methods chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II). CLINICAL FEATURES: A 29-year-old woman had unremitting coccygeal pain of 3 weeks' duration. The problem began after she had moved heavy boxes while at work. The pain was characterized by a continual dull ache in the coccygeal region, accompanied by intermittent sharp pain, particularly upon sitting or rising from a seated position. She had been taking self-prescribed over-the-counter analgesics (aspirin and ibuprofen) for 3 weeks without obtaining relief. INTERVENTION AND OUTCOME: Treatment consisted of mechanical force, manually assisted, short-lever (MFMA) chiropractic adjusting procedures to the coccygeal area, primarily the sacrococcygeal ligament. The AAI II was used to deliver the adjustment according to diagnostic and treatment protocol specified for AMCT. The patient experienced first treatment. CONCLUSION: chiropractic coccygeal manipulation may be effectively delivered via instrumental adjustment in certain cases of coccygodynia. The use of an AAI II in administering the coccygeal adjustment has the benefit of being a gentle, noninvasive procedure, as well as being comfortably tolerated by the patient. This method of coccygeal adjustment may bear consideration in certain cases of coccygodynia.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/10. Ligament-sparing lumbar microdiscectomy: technical note.BACKGROUND: The prevention or inhibition of postoperative adhesions is a significant goal for successful lumbar discectomy, not only to reduce the probable risk of recurrent radiculopathy, but also to improve the likelihood of success of re-operation. methods: We describe a new technique for sparing the ligamentum flavum in lumbar microdiscectomy. The superficial layer of the ligament is removed by horizontal splitting. Additional horizontal splitting of the ligament yields a paper-thin deep layer. Lateral vertical splitting and retraction is then carried out to provide a sufficient operative window. The split ligament returns to its original position after releasing the retraction, thereby closing the operative window. RESULTS: This method could preserve a layer of the ligamentum flavum to act as a physical barrier, which in turn greatly restricts the peridural fibrosis. CONCLUSIONS: This ligament-sparing technique enables surgeons to preserve the original anatomic plane and to reduce the extent of postoperative adhesion.- - - - - - - - - - ranking = 6keywords = ligament (Clic here for more details about this article) |
3/10. spondylolysis as a cause of low back pain in swimmers.low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/10. Impairment-based examination and disability management of an elderly woman with sacroiliac region pain.BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of a cluster of sacroiliac tests in conjunction with an impairment-based model of examination, diagnosis, and management of sacroiliac region pain. CASE DESCRIPTION: The patient was a 74-year-old woman with an 18-month history of low back, left buttock, and groin pain following a misstep. The initial symptoms were intermittent. The symptoms became constant and limited her walking tolerance to 5 minutes, which affected her ability to care for her grandchildren. She was examined using a cluster of sacroiliac tests that examined: (1) innominate active mobility, (2) innominate positional symmetry, and (3) sacroiliac ligament tenderness. OUTCOMES: Following 4 treatments for identified impairments, the patient had unlimited walking tolerance and she resumed an active caregiving role for her grandchildren. DISCUSSION: This case illustrates the use of an impairment-based model for examination and management of an elderly patient with what appeared to be sacroiliac joint dysfunction.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/10. Baastrup's disease as a cause of neurogenic claudication: a case report.STUDY DESIGN: A rare case of Baastrup's disease as a cause of spinal canal stenosis in a patient with double-level spondylolisthesis is reported. OBJECTIVES: To report an intraspinal synovial cyst as an extension of neoarthrosis of Baastrup's disease causing spinal canal stenosis, and to review the relevant literature. SUMMARY OF BACKGROUND DATA: Baastrup's disease, more commonly known as kissing spines, has been implicated as a cause for low back pain. Neoarthrosis between the spinous processes has been described, but this is the first report in the literature of an extension of the synovial cavity to the intraspinal space resulting in extradural compression. methods: A 50-year-old woman with double-level spondylolisthesis and symptoms of instability and neurogenic claudication was evaluated and treated using spinal decompression and fusion. RESULTS: Radiographs showed a double-level spondylolisthesis at L3-L4 and L4-L5 levels, and magnetic resonance imaging showed the presence of a neocyst formation in the interspinous region and another cyst in the posterior epidural space at the same level causing dural compression. There was a suggestion of continuity between the two cysts that was confirmed at surgery. The neoarthrosis and the cyst were excised, and spinal decompression and fusion were performed. The patient had good relief of symptoms. CONCLUSIONS: Baastrup's disease leading to neoarthrosis formation with synovial cavity and causing low back pain has been reported previously. The cyst can enter into the epidural space through the midline cleft of the ligamentum flavum to result in extradural compression.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/10. Traumatic lumbosacral dislocation: report of two cases.STUDY DESIGN: A retrospective study of 2 patients with traumatic lumbosacral dislocation. OBJECTIVES: To discuss the difficulty in making diagnosis and the effect of surgical treatment. SUMMARY OF BACKGROUND DATA: Traumatic lumbosacral dislocation is an uncommon injury, which creates diagnostic difficulty and is typically managed by open reduction internal fixation of the lumbosacral spine. methods: Medical notes and imaging of the 2 patients were reviewed. RESULTS: Both patients were engaged in high-energy accidents and had concomitant injuries. Patient 1 was initially misdiagnosed as having L5 lytic spondylolisthesis and was treated with a lumbar corset. She developed progressive low back and left leg pain. Eleven months after the accident, a bilateral lumbosacral dislocation with right S1 superior facet fracture, disc rupture, posterior soft tissue disruption, and a resultant Grade 4 L5-S1 traumatic spondylolisthesis was identified. She underwent open reduction, followed by a staged anteroposterior spinal arthrodesis using instrumentation with excellent results. Patient 2 sustained a unilateral L5-S1 facet dislocation without neurologic deficit, which reduced spontaneously. The evaluation demonstrated a grossly disturbed posterior ligamentous complex adjacent to the lumbosacral articulation. A combined anteroposterior spinal fusion with instrumentation was performed with favorable outcome. CONCLUSION: Meticulous clinical examination and careful imaging assessment, including CT and MRI, assist an early diagnosis in cases of lumbosacral dislocation. Open reduction and circumferential bony fusion restore segmental stability and painless function.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
7/10. Bowel injury as a complication of microdiscectomy: case report and literature review.Intestinal injury is a rare complication of lumbar disc surgery, resulting from inadvertent penetration of the anterior annulus fibrosus and anterior longitudinal ligament. patients typically complain of abdominal pain and distention developing over the course of several days. Imaging with plain upright chest radiographs or abdominal computed tomography may demonstrate free air in the abdominal cavity. We report a case of intestinal perforation after microscopic lumbar discectomy and present the diagnostic postoperative imaging. In addition, we review the relevant literature and discuss techniques that may be employed to avoid this complication.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
8/10. Percutaneous laser disc decompression in the treatment of discogenic back pain.OBJECTIVE: Our aim was to evaluate the effects of percutaneous laser disc decompression (PLDD) as discogenic pain treatment using the MacNab criteria. BACKGROUND DATA: Discogenic back pain is believed to be produced from tears in the posterior longitudinal ligament and annulus fibrosus. This pain is exacerbated through increases in intradiscal pressure via provocative discograms and transmitted through the sinuvertebral nerve. MATERIALS AND methods: A total of 37 patients were selected based on clinical findings and provocative discograms. These patients underwent PLDD to the affected disc and were interviewed via telephone and outcome evaluated based on the MacNab criteria. RESULTS: Survey results revealed that 14 patients (44%) reported a good response, 14 (44%) reported a fair response, and four (12.5%) reported a poor response. The 28 patients (88%) who reported a good and fair response were considered to be successful cases. CONCLUSION: PLDD is a safe, effective, and minimally invasive procedure that can be used to treat patients with discogenic back pain.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
9/10. Unusual CT/MR features of putative ligamentum flavum ossification in a North African woman.To display the unusual spinal CT and MR findings in a 48-year-old North African woman presenting with two adjacent intracanalar mineralized epidural outgrowths exhibiting mature bone organization with "cortical" and "trabecular" areas and pseudoarthritic changes at their interface. An unusual form of ligamentum flavum ossification (LFO) was speculated, of which features are discussed under the light of the available literature.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
10/10. Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review.Dense peridiskal fibrosis was encountered during a lumbar diskectomy for a chronic lumbar disk herniation. Posteriorly the adhesions involved the annulus, dura mater, nerve roots, posterior longitudinal ligament, and sequestrated disk material. Anteriorly the iliac vessels were also densely adherent to the disk. When disk material was removed from a standard posterior approach, the left common iliac vein tore, leading to severe hypotension. Vascular injury by instruments has been described by many clinicians, but this indirect mechanism of injury has not been reported in the literature, nor has extensive peridiskal fibrosis been described in a spine without a history of previous surgery.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
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