The prevalence of disc aging and back pain after fusion extending into the lower lumbar Spine: A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis

Purpose: To determine the long-term outcome after fusion for adolescent idiopathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences.

Material and Methods: Thirty-two patients with adolescent idiopathic scoliosis, who had undergone spinal fusion using Harrington rods to the lower lumbar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionnaires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without scoliosis was subjected to the same examinations.

Results and Conclusion: There were significantly more degenerative disc changes ( p<0.0001), disc height reduction ( p=0.0010) and end-plate changes ( p<0.0001 for both upper and lower end-plates) in the lowest unfused disc in the patient group compared with the control group. The MR findings in the lowest unfused disc, but not the one above, in the patient group correlated to lumbar pain intensity as well as to the diminished lumbar lordosis.

Markers of nerve tissue injury in the cerebrospinal fluid in patients with lumbar disc herniation and sciatica

STUDY DESIGN

The light subunit of neurofilament protein, S-100 protein, neuron-specific enolase, and glial fibrillary acidic protein were determined in the cerebrospinal fluid in patients with lumbar disc herniation and in control patients.

OBJECTIVES

To determine whether nerve root injury caused by disc herniation increases the levels of nerve and glial cell injury markers in the cerebrospinal fluid.

SUMMARY OF BACKGROUND DATA

Markers of nerve tissue injury can be analyzed in the cerebrospinal fluid, allowing characterization of the cell types involved and the degree of disease in patients with neurologic disorders.

METHODS

Cerebrospinal fluid samples were obtained by preoperative lumbar puncture in patients who underwent surgery for lumbar disc herniation and in patients who underwent lower extremity surgery (control group), neurofilament protein (light subunit) and glial fibrillary acidic protein were analyzed by enzyme-linked immunosorbent assay and S-100 protein and neuron-specific enolase by radioimmunoassay and luminescence immunoassay, respectively. In the disc herniation group the concentrations of the four markers were evaluated regarding possible correlation to patient history, computed tomographic findings, and clinical findings.

RESULTS

Cerebrospinal fluid concentration of neurofilament protein (light subunit) and S-100 were increased in the disc herniation group compared with that in control subjects (1158 +/- 383 ng/L vs. 152 +/- 14 ng/L, P < 0.01; 1963 +/- 231 ng/L vs. 1003 +/- 152 ng/L, P < 0.05, respectively). No statistical differences in neuron-specific enolase and glial fibrillary acidic protein concentrations were observed between the groups. Disc herniation patients with fewer than 3 months' duration of subjective symptoms had higher neurofilament protein levels than did patients with longer duration. None of the markers was related to preoperative clinical or computed tomographic findings. Patients with persistent neurologic findings at follow-up 2-3 months after surgery had higher levels of neurofilament protein before surgery compared with-those without sequelae.

CONCLUSIONS

Patients with disc herniation and sciatica have increased concentrations of neurofilament protein and S-100 in the cerebrospinal fluid, which indicates damage of axons and Schwann cells in the affected nerve root.

Long saphenous vein saving surgery for varicose veins. A long-term follow-up

The autologous saphenous vein is widely recognised as the graft material of choice in infra-inguinal arterial reconstructions. This study was undertaken to evaluate the long-term results of long saphenous vein saving surgery compared with standard stripping. Forty-two patients with varicose veins were randomly allocated to treatment, either with standard stripping of the long saphenous vein or high ligation. In both groups, local varicosities were avulsed and insufficient perforators ligated, on the basis of physical examination and phlebography. Follow-up was performed 52 +/- 5 months postoperatively. The recurrence rate was 12 and 11% in the stripping and the high ligation group respectively. At follow-up, the venous return time was increased significantly in both groups (P greater than 0.001). Vein mapping by means of high-resolution, real-time ultrasound at follow-up showed that 78% of the preserved saphenous veins were suitable for use as arterial conduits. These results suggest that removal of the long saphenous vein per se is of no therapeutic value if insufficient perforators have been ligated. It is possible to perform elective vein surgery for varicose veins with good results and preserve the long saphenous vein, which in turn can be used for future arterial reconstruction in most cases.

Asymptomatic leiomyosarcoma of the inferior vena cava. Incidental finding at ultrasonography

A case of leiomyosarcoma of the inferior vena cava is presented. The tumor was incidentally found at ultrasonography of a patient who underwent a follow-up examination after surgery for carcinoma of the colon. The tumor was resected and the patient was alive and well one year postoperatively at which time repeat ultrasonography and inferior vena cavography showed no remaining tumor.

Common bile duct obstruction due to an intraluminal mass of candidiasis in a previously healthy child

A 3 6/12-year-old previously healthy girl had intermittent attacks of abdominal pain following a blunt abdominal trauma. At admission to the hospital, she had jaundice and hepatomegaly. Results of laboratory tests indicated an obstructive pattern, and ultrasonography revealed an intraluminal mass in the distal common bile duct. At surgery, the mass was confirmed as the cause of obstruction, and it was removed. Microscopic analysis indicated that the amorphous material was fungi infested. Growth cultures from bile and feces yielded Candida albicans. Postoperative treatment with T-tube drainage and antimycotic drugs led to an uneventful recovery. Clinical, biochemical, and ultrasonographic follow-up have shown no evidence of recurrence. A possible cause and effect relationship between the trauma and the development of biliary obstruction is suggested.

Width of the normal ankle joint

An investigation of the talocrural joint was performed in 160 normal adults, 80 males and 80 females. The joint space was measured on films at six locations, three in the antero-posterior and three in the lateral view of the ankle. The average joint space in men was 3.4 mm and in women 2.9 mm, which is a significant difference (p less than 0.001). The joint space was wider in the medial part when evaluating the antero-posterior view, but did not change with age.

Progressive bilateral thinning of the parietal bones

Observation of a case of progressive bilateral parietal thinning within a period of 14 years induced us to study skull films of 3,636 consecutive patients. Parietal thinning was found in 86 patients (2.37%). It was more common in women, with a sex ratio of 1:1.9. The mean age of the females was 72 years, and that of the males 63 years. Previous skull films of 25 of these patients were available and showed progression in 10. It is concluded that parietal thinning is a slowly progressive disease of middle-aged and old patients and is not an anatomical variant or congenital dysplasia of the diploe.

Computer tomography of ovarian dermoid cysts

Five patients with ovarian dermoid cysts (benign cystic teratomas) were examined by CT. The appearance of these tumours at CT as well as at conventional radiography is discussed. It is concluded that CT adds valuable information in the preoperative evaluation of cystic teratomas.