Cases reported "Low Back Pain"

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21/25. Unusual presentation of isolated sacral tuberculosis.

    tuberculosis is as old as mankind. Vertebral tuberculosis is fairly common form of bone and joint tuberculosis. However, isolated sacral tuberculosis is rare. It may present as an atypical sacral lesion having epidural granuloma without destruction of sacrum on MRI and plain x-rays. This atypical presentation may lead to delay in diagnosis and treatment. This case report intends to emphasize that spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion particularly in developing countries. early diagnosis and treatment can prevent or minimize the neurological morbidity in such cases.
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keywords = sacrum
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22/25. Replacement laminoplasty in selective dorsal rhizotomy: possible protection against the development of musculoskeletal pain.

    The authors present a retrospective review of 35 patients who underwent selective dorsal rhizotomy between 1990 and 1992. The first 15 patients underwent laminectomy from L1 to the sacrum without replacement of the posterior elements. The subsequent 20 patients had the laminae replaced during wound closure. No patient in either group developed spinal instability or symptomatic deformity. However, 4 patients in the first group (mean follow-up period 35 months) developed significant low-back pain of musculoskeletal origin following minor accidents (mean time to injury 12 months). No patients in the group in whom the laminae were replaced (mean follow-up period 24 months) developed back pain. This review suggests that although the lumbar laminae are not essential for the structural integrity of the spine, their removal may predispose to musculoskeletal injury and associated pain. The authors propose a mechanism for these findings and recommend replacement of the posterior elements when possible.
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keywords = sacrum
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23/25. fatigue fracture of the sacral bone associated with septic arthritis of the symphysis pubis.

    Fractures of the pubic rami are almost invariably associated with fractures of the posterior arch of the pelvic ring. Two women, aged 50 and 67 years, with septic arthritis of the symphysis pubis attended by severe low back pain, were followed with CT and MR imaging of the pelvis, as well as bond scintigraphy in one patient. In the first patient sacral fractures with severe displacement were revealed, prompting stabilizing symphysiodesis. In the second patient an undisplaced fatigue fracture was confirmed in the right half of the sacrum. In patients with pelvic laxity following arthritis of the symphysis and post-traumatic osteolysis associated with low back pain, displaced or occult fractures of the bones adjacent to the sacroiliac joints should be considered.
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ranking = 1
keywords = sacrum
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24/25. Insufficiency fractures of the sacrum: a cause of low back pain after lung transplantation.

    Insufficiency fractures of the sacrum were diagnosed during the first year after successful transplantation in four (5.6%) of 71 lung and heart-lung transplant recipients. Each patient had development of low back pain after minor or no trauma; all had osteoporosis. In each instance, plain radiographs failed to demonstrate the fracture, and the diagnosis was established by radionuclide bone scanning that demonstrated the characteristic "butterfly" (bilateral sacral fracture) or "half-butterfly" appearance (unilateral sacral fracture). Sacral insufficiency fractures, a significant cause of low back pain in lung transplant recipients, may be underdiagnosed in this population because routine radiographs do not usually reveal the fracture; bone scanning is the preferred diagnostic modality.
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ranking = 5
keywords = sacrum
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25/25. Chondromyxoid fibroma of the ala of the sacrum presenting as a cause of lumbar pain in an adolescent.

    We report a case of chondromyxoid fibroma of the ala of the sacrum: its presentation, diagnosis, treatment, and resolution. Although this tumor is admittedly rare, our case demonstrates the need for careful evaluation of pack pain in an adolescent.
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ranking = 5
keywords = sacrum
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