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Search Results for : Cervical Radiculopathy
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Bilateral neurogenic hip arthropathy. A case report.
Author(s): Kopec, K; Kusz, D; Cielinski, L; Wojciechowski, P; Hajduk, G
Journal: Neuro Endocrinol Lett 2010 Apr 1; Vol. 30, Issue 6; Page(s) 709-14
[Medline ID - 20038935]

Neurogenic arthropathy is a rare joint disorder, characterized by rapid progression and marked destruction of articular surfaces (known as Charcot's joint) with only mild to moderate pain. Most cases are related to diabetic neuropathy, but they may complicate the course of other neurogenic clinical conditions such as neurosyphilis (tabes dorsalis), syringomyelia, myelomeningocele, Peroneal Muscular Atrophy, spine or peripheral nerve injury, alcoholism and avitaminosis. Loss of superficial sensation and proprioception plays a pivotal role in development of arthropathy because it affects the joint's normal protective reflexes and leads to joint instability, degeneration and destruction. The authors describe an unusual case of bilateral neurogenic hip arthropathy in a 61-year old women who developed this condition in the course of multilevel lumbar spondylosis with spinal and nerve root compression. The patient underwent a successful bilateral hip replacement and remains almost asymptomatic contrary to literature reports that suggest high risk of complications after the operative treatment of Charcot's joints.

[Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy]
Author(s): Levin, OS; Mose; ĭkin, IA
Journal: Zh Nevrol Psikhiatr Im S S Korsakova 2010 May 5; Vol. 109, Issue 10; Page(s) 30-5
[Medline ID - 20037567]

An open controlled study of efficacy of the vitamin B complex (milgamma) has been performed in 38 patients with vertebrogenic lumbosacral radiculopathy suffered from moderate or severe pain during 1 month or longer. Patients have been randomized into 2 equal groups: in the main group milgamma has been prescribed in the combination with diclofenac; patients of the control group have received diclofenac only. Treatment efficacy has been assessed by clinical scales in the 10th and 24th days, and by the results of telephone interview after 3 and 6 months. A trend to higher efficacy of the treatment of the main group compared to that of the control group assessed with the Visual Analogue Scale was observed during all the study but the difference reached the level of statistical significance only to the 24th day. The assessment of qualitative characteristics of pain with the Neuropathic Pain Scale revealed decreasing of intensive, acute and sensitive pain only in patients of the main group. The moderate or substantial improvement was noted in 66% patients received the combination therapy and only in 34% patients received diclofenac. At the 3rd months, between-group differences were still significant (the pain was absent or minimal in 63% patients of the main group and 34% of the control one). The results revealed the potentiation of analgesic effect of diclofenac by the vitamin B complex. Using of milgamma in combination with NSAIDS leads to the rapid and long-standing regress of pain syndrome in patients with lumbosacral radiculopathy.

[Efficacy of gabapentin in patients with discogenic lumbosacral radiculopathy]
Author(s): Levin, OS; Mose; ĭkin, IA
Journal: Zh Nevrol Psikhiatr Im S S Korsakova 2010 Apr 21; Vol. 109, Issue 12; Page(s) 60-5
[Medline ID - 20037523]

Optimal conservative therapy of discogenic lumbosacral radiculopathy is a matter of debates. Contemporary guidelines recommend measures that predominantly have an influence on nociceptive mechanisms. However the mixed nature of pain in patients with discogenic radiculopathy requires approaches used for treatment of neuropathic pain. We carried out an open pilot study on efficacy of the anticonvulsant gabapentin in 25 patients with discogenic lumbosacral radiculopathy who were divided into two groups (with duration of pain episode 1 month or less and more than 1 month). Gabapentin was used in increasing doses up to 3600 mg/day. To the end of 8-week trial, the significant reduction of pain and restricted mobility was found. The reduction of symptoms was more rapid in the group with earlier onset of treatment. In both groups, the reduction of vertebral syndrome and neuropathic pain characteristics was noticed as well. The clinically significant effect was found in 59% of patients with early onset of treatment with gabapentin and in 51% of patients with later onset. These results suggest that early use of gabapentin (tebantin) holds promises for treatment of discogenic radiculopathy.

[Failed back syndrome in patients after the surgery for compressive lumbosacral radiculopathy]
Author(s): Esin, RG; Danilov, VI; Minkina, ISh; Esin, OR
Journal: Zh Nevrol Psikhiatr Im S S Korsakova 2010 Mar 12; Vol. 109, Issue 11; Page(s) 37-41
[Medline ID - 20032952]

A study of 80 patients after the surgery for compressive lumbosacral radiculopathy revealed that myogenic trigger zones and skin zones of hyperalgesia in lumbar and low extremities on the side of radicular compression and the contralateral side were formed before the surgery. Trigger zones remained in the latent state after the surgery in 33 patients who had no anxiety and depressive symptoms before the operation. These zones were treated with exercises (a fitness program). Symptoms of anxiety and depression that predict the relapse of pain in the post-surgery period were noted in 47 patients. The relapse of pain followed the < < blazed way > > in these patients but it was caused by the pain conditioned by trigger zones formed before the surgery in the insufficiency of the antinociceptive system. Moreover, an iatrogenic zone emerged in the post-surgery scar. Treatment of this group of patients should include antidepressants (velaxin), local anesthetics (novocaine, plasters with 5% lidocaine gel) and later - a fitness program.

Accuracy of contrast-enhanced MDCT and MRI for identifying the severity and cause of neural foraminal stenosis in cervical radiculopathy: a prospective study.
Author(s): Douglas-Akinwande, AC; Rydberg, J; Shah, MV; Phillips, MD; Caldemeyer, KS; Lurito, JT; Ying, J; Mathews, VP
Journal: AJR Am J Roentgenol 2010 Jan 27; Vol. 194, Issue 1; Page(s) 55-61
[Medline ID - 20028905]

OBJECTIVE: The purpose of this study was to determine the accuracy of IV contrast-enhanced MDCT and MRI for evaluation of the severity and cause of neural foraminal stenosis in patients with cervical radiculopathy. SUBJECTS AND METHODS: Eighteen patients with cervical radiculopathy prospectively underwent contrast-enhanced MDCT and MRI. Contrast-enhanced MDCT scans were acquired at 1-mm thickness and reconstructed in oblique axial (parallel to disk) and sagittal (perpendicular to neural foramen) 2-mm sections without a gap. The MRI sequences used were sagittal T1-weighted, fast spin-echo T2-weighted, 3D fast spin-echo T2-weighted, axial T2-weighted, and 3D gradient-recalled echo. Three neuroradiologists independently and blindly rated the severity and cause of neural foraminal stenosis on a 4-point scale. Using the same scale at surgery, one of three surgeons rated the severity and cause of neural foraminal stenosis, and the results were used as the reference standard. Interobserver and intraobserver agreement (kappa) was calculated. RESULTS: For severity of neural foraminal stenosis, the sensitivities of contrast-enhanced MDCT (50/55, 91%) and MRI (55/57, 96%) were similar, as were their specificities (contrast-enhanced MDCT, 13/24, 54%; MRI, 11/24, 46%). For cause of neural foraminal stenosis, the accuracies of contrast-enhanced MDCT (46/54, 85%) and MRI (45/57, 79%) were similar. Interobserver ag reement on severity of neural foraminal stenosis was moderate to almost perfect for contrast-enhanced MDCT (kappa=0.50-1.00) and MRI (kappa=0.43-1.00). For cause of neural foraminal stenosis, interobserver agreement was moderate to substantial for contrast-enhanced MDCT (kappa=0.52-0.76) but only fair for MRI (kappa=0.23-0.39). Intra observer agreement was very high for severity of neural foraminal stenosis (contrast-enhanced MDCT, kappa=0.85; MRI, kappa=0.80) and cause of neural foraminal stenosis (contrast-enhanced MDCT, kappa=0.86; MRI, kappa=1.00). CONCLUSION: Contrast-enhanced MDCT is as accurate as MRI in evaluation of the severity and cause of neural foraminal stenosis and may have better interobserver agreement.

Spontaneous regression of lumbar herniated disc.
Author(s): Chang, CW; Lai, PH; Yip, CM; Hsu, SS
Journal: J Chin Med Assoc 2010 Mar 11; Vol. 72, Issue 12; Page(s) 650-3
[Medline ID - 20028647]

Intervertebral disc herniation of the lumbar spine is a common disease presenting with low back pain and involving nerve root radiculopathy. Some neurological symptoms in the majority of patients frequently improve after a period of conservative treatment. This has been regarded as the result of a decrease of pressure exerted from the herniated disc on neighboring neurostructures and a gradual regression of inflammation. Recently, with advances in magnetic resonance imaging, many reports have demonstrated that the herniated disc has the potential for spontaneous regression. Regression coincided with the improvement of associated symptoms. However, the exact regression mechanism remains unclear. Here, we present 2 cases of lumbar intervertebral disc herniation with spontaneous regression. We review the literature and discuss the possible mechanisms, the precipitating factors of spontaneous disc regression and the proper timing of surgical intervention.

Gabapentin monotherapy in patients with chronic radiculopathy: the efficacy and impact on life quality.
Author(s): Yildirim, K; Deniz, O; Gureser, G; Karatay, S; Ugur, M; Erdal, A; Senel, K
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 1; Page(s) 17-20
[Medline ID - 20023359]

OBJECTIVE: The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. METHODS: Thirty-five patients with radicular pain and diagnosed as L4, L5 or S1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). RESULTS: Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 +/- 10.4, range: 24-60 years); mean radiculopathy duration was 16.4 +/- 14.2 months (range: 3-48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. CONCLUSION: Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy.

Extraspinal sciatica revealing late metastatic disease from parotid carcinoma.
Author(s): Le Manac'h, AP; Rousselet, MC; Massin, P; Audran, M; Levasseur, R
Journal: Joint Bone Spine 2010 May 5; Vol. 77, Issue 1; Page(s) 64-6
[Medline ID - 20022535]

Sciatica is a clinical symptom usually caused by a disk herniation and less often by other conditions such as tumors, infections, or inflammatory diseases. We report the case of a woman in whom sciatica led to the identification of a large pelvic metastasis from a carcinoma of the parotid gland.

Nonmedicinal therapy in the management of ankle arthritis.
Author(s): Rao, S; Ellis, SJ; Deland, JT; Hillstrom, H
Journal: Curr Opin Rheumatol 2010 Apr 20; Vol. 22, Issue 2; Page(s) 223-8
[Medline ID - 20019616]

PURPOSE OF REVIEW: The incidence of ankle osteoarthritis has increased in recent years, in part, secondary to vehicular trauma. This review describes conservative and operative intervention strategies along with current research related to the management of ankle osteoarthritis. RECENT FINDINGS: Self-reported physical function in patients with ankle osteoarthritis is equivalent to or worse than that of patients with endstage kidney disease, congestive heart failure, or cervical-spine pain and radiculopathy. Nonoperative-intervention strategies such as assistive devices, orthoses, and viscosupplements are frequently used in this clinical population. However, limited objective data are available examining outcomes following nonoperative intervention. Ankle fusion serves as a standard-surgical treatment for end-stage ankle osteoarthritis. The limitations of ankle fusion include prolonged immobilization, a relatively high risk of nonunion, and adjacent joint arthritis. Increasing evidence supports the safety and efficacy of total-ankle arthroplasty (TAA). Current (third generation) TAA prostheses feature cementless design and ligament preservation with reduced bone resection and improved instrumentation. SUMMARY: Limited objective evidence exists to guide clinical decision-making related to nonoperative choices such as assistive devices, orthoses, and viscosupplements. Outcomes from prospective clinical trials indicate that newer total ankle-arthroplasty designs provide substantial pain relief in patients with end-stage ankle osteoarthritis.

Magnetic resonance imaging for low back pain: indications and limitations.
Author(s): Sheehan, NJ
Journal: Ann Rheum Dis 2010 Feb 2; Vol. 69, Issue 1; Page(s) 7-11
[Medline ID - 20007621]

Magnetic resonance imaging (MRI) is the preferred investigation for most spinal diseases and is increasingly requested for people with low back pain (LBP). However, determining the cause of back pain is complicated as it is often multifactorial and anatomical abnormalities are common in the spine and may not necessarily translate into clinical symptoms. Thus, national guidelines discourage the use of MRI in non-specific LBP and recommend reserving it for the investigation of severe or progressive neurological deficits or for those cases in which serious underlying pathology is suspected. It also has an acknowledged role in planning surgical management in cases of radiculopathy and spinal stenosis. This review summarises the indications for MRI in LBP and calls for improved education of patients and health professionals in the limitations of this investigation.
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Clinical Conditions

 - A/C Degeneration

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 - Cervical Disc Degen

 - Cervical Sprain

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 - Cervical Osteoarthritis

 - Cervical Radiculopathy

 - Cervical Spine Instability

 - Cervical Spondylosis

 - Cervical Torticollis

 - Chronic Low Back Pain

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 - Facet Arthropathy

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