Cases reported "Low Back Pain"

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1/17. Fibro-fatty nodules and low back pain. The back mouse masquerade.

    BACKGROUND: Few useful interventions exist for patients with persistent low back pain. We suggest that a fibro-fatty nodule ("back mouse") may be an identifiable and treatable cause of this and other types of pain. methods: We describe 2 patients with painful nodules in the lower back and lateral iliac crest areas. In both cases, the signs and symptoms were unusual and presented at locations distant from the nodule. One patient complained of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis for several years. RESULTS: In both patients, symptoms appeared to be relieved by multiple injection of the nodule. DISCUSSION: There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multiple puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS: Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and unaccountable symptoms in the lower abdomen, inguinal region, or legs.
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2/17. Septic arthritis of a lumbar facet joint due to pyonex.

    We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.
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3/17. Postdural puncture headache: an imaging-guided management protocol.

    IMPLICATIONS: We propose an imaging-based algorithm for the management of headache caused by the inadvertent puncture of dura that occurs sporadically during epidural analgesia. Its implementation can identify those postdural puncture headache cases that cannot benefit from epidural blood patches, and their unnecessary application can consequently be avoided.
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ranking = 6
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4/17. Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: a case report.

    STUDY DESIGN: A case report of discal cyst treated by percutaneous CT-guided puncture and steroid injection. OBJECTIVES: To present the efficacy of percutaneous CT-guided puncture and steroid injection for the treatment of this disorder. SUMMARY OF THE BACKGROUND DATA: Surgical removal of the cyst is usually performed for the treatment of this disorder. However, it was recently reported that direct CT-guided puncture and steroid injection was useful for the treatment of intraspinal synovial cyst. methods: A 37-year-old man experienced low back pain and right lower extremity pain with sensory abnormality over the right leg and foot. MRI revealed an extradural spherical mass with low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging behind the L5 vertebral body. On discography, contrast medium rapidly flowed into the cyst through a thin channel from the neighboring disc cavity. Based on these findings, a diagnosis of discal cyst was made. Percutaneous CT-guided puncture and steroid injection were performed. RESULTS: low back pain, right extremity pain, and numbness disappeared immediately after the procedure. On MRI examination, the cyst gradually diminished in size after the procedure. CONCLUSION: CT-guided percutaneous puncture and steroid injection may be a useful procedure for the treatment of discal cyst.
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ranking = 9
keywords = puncture
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5/17. Chronic inflammatory granuloma mimics clinical manifestations of lumbar spinal stenosis after acupuncture: a case report.

    STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To present a case of chronic inflammatory epidural granuloma formed after acupuncture. SUMMARY OF THE BACKGROUND DATA: A number of cases of complications resulting from acupuncture have been reported, including acute infection, hemorrhage, and direct injury to internal organs or neural tissues. However, to the best of our knowledge, there has been no report of epidural granuloma formed following acupuncture and mimicking clinical manifestations of lumbar stenosis. methods: A 68-year-old woman suffered from low back pain and sciatica aggravated by acupuncture. We reviewed her medical record, imaging studies, microscopic findings of the mass, and related literature. RESULTS: Microscopic examination revealed the mass as a chronic inflammatory granuloma. From her previous history and imaging study, the mass, which compressed the lumbar forth nerve and dural sac,was highly suspected to have been formed after acupuncture. Surgical decompression and excision of the epidural mass relieved her symptoms. CONCLUSION: Chronic inflammatory granuloma may be formed as a complication of acupuncture. Under such circumstances, surgical excision of the mass may be an effective way of relieving the symptoms.
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ranking = 10
keywords = puncture
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6/17. low back pain in pregnancy.

    The aim of this case report is to discuss the subject of acupuncture in pregnancy and which acupuncture points, or areas, are safe to needle. low back pain in a 21-year-old Caucasian primigravida at 24 weeks gestation was incapacitating and acupuncture was offered. Prior to pregnancy investigations had excluded a serious organic cause and acupuncture was employed successfully to control pain and improve function. Acupuncture can be offered to sufferers of low back pain in pregnancy after risk / benefit analysis is undertaken and informed patient consent is obtained.
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ranking = 5
keywords = puncture
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7/17. Acupuncture for low back pain in pregnancy.

    Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from the mostly historical and anecdotal claims that acupuncture can promote abortion, coupled with the fact that spontaneous early pregnancy loss is common, and litigation is increasing. This case report describes the circumstances that lead to the author using deep paraspinal and periosteal acupuncture throughout a patient's pregnancy to help control her low back pain.
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ranking = 7
keywords = puncture
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8/17. low back pain following epidural blood patch.

    A patient underwent outpatient knee arthroscopy with spinal anesthesia administered at the patient's request. The patient was discharged after a 3-hour recovery period. Three days later, the patient returned because of a headache that had begun the evening after surgery and progressively worsened. Treatment with caffeine and hydration for presumed postdural puncture headache resulted in relief for approximately 1 hour. An epidural blood patch was then performed and relieved symptoms for 3 hours until backache began and worsened over the next 7 hours. Computed axial tomography showed epidural air. After symptomatic treatment and observation overnight, the patient was released, and follow-up by telephone was planned. For 2 days, symptoms persisted. Therapy with aspirin 600 mg 4 times daily resulted in acute and significant relief. The backache resolved after 1 week. A review of the literature on backache following epidural blood patch is presented.
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ranking = 1
keywords = puncture
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9/17. Spondylodiscitis as the first manifestation of Whipple's disease -a removal worker with chronic low back pain.

    Whipple's disease is a rare systemic infectious disease caused by the actinobacterium tropheryma whipplei. Spondylodiscitis is an extremely rare manifestation of the infection and has previously been described in only three case reports. We present a 55-year-old man with persistent lumbago and signs of systemic illness, but without any gastrointestinal symptoms or arthralgia. The signal response in the lumbar spine in magnetic resonance tomography, both native and after intravenous gadolinium administration, was compatible with spondylodiscitis at the L4/L5 level. culture of a specimen obtained by radiographically guided disc puncture and repeated blood cultures remained sterile. tropheryma whipplei was detected by PCR amplification in material obtained from the disc specimen, from a biopsy of the terminal ileum and from the stool. The histology of duodenum, terminal ileum, colon and disc material was normal and, in particular, showed no PAS-positive inclusions in macrophages. Long-term antibiotic treatment with sulphamethoxazole and trimethoprim was successful, with marked improvement of the low back pain and normalisation of the systemic inflammatory signs. The possibility of Whipple's disease must be suspected in the case of a 'culture-negative' spondylodiscitis even if there are no gastrointestinal symptoms and no arthralgia present.
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ranking = 1
keywords = puncture
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10/17. Iatrogenic intraspinal epidermoid tumor: two cases and a review of the literature.

    STUDY DESIGN: Two cases of patients whom intraspinal epidermoid tumors presented and were successfully removed 6 years after neonatal lumbar puncture are reported. OBJECTIVE: To describe the presentation of this type of spinal tumor and strategies for diagnosis and treatment. SUMMARY OF BACKGROUND DATA: cells iatrogenically implanted into the spinal canal during lumbar puncture can slowly grow until symptomatic. diagnosis can be difficult and is often delayed. MRI appears to offer some advantages in diagnosis provided that gadolinium is used. Treatment is by surgical excision. methods: The first patient, a 6-year-old boy, presented with severe episodic hip pain of unknown etiology. MRI of the lumbar spine revealed a 1-cm epidermoid at L1-L2. The second child, a 6-year-old girl, presented with low back pain and dragging of the feet. MRI revealed a mass at L3. RESULTS: In both cases, complete excision via lumbar laminectomy was performed. Both patients were asymptomatic at the 1-year follow-up with resolution of preoperative weakness. CONCLUSIONS: This study highlights an uncommon but not rare tumor that may present to the spine specialist in a variety of ways. The diagnosis is often delayed. The advent of MRI has improved the ease and accuracy of diagnosis. Complete excision is usually possible and is curative.
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ranking = 2
keywords = puncture
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