STUDY DESIGN: A retrospective analysis of the patients who had cauda equina syndrome caused by a herniated lumbar disc. OBJECTIVES: To assess the clinical debates concerning the diagnosis, treatment, and results of treatment. SUMMARY OF LITERATURE REVIEW: This syndrome has been considered as an absolute indication of surgical treatment in the herniated lumbar disc and poor prognosis after surgery were reported. Although there are debates on the timing of surgery, early recognition early surgical treatment are recommended for a better results of treatment. MATERIALS AND METHODS: 23 consecutive patients having a cauda equina syndrome caused by herniated lumbar disc were reviewed retrospectively. They were 14 males and 9 females having ages of 41.6 in average. The incidence of this syndrome was 3.8% of the patients who had surgical treatment of herniated lumbar disc. RESULTS: All patients had bladder dysfunction in addition to the low back pain and radicular pain in the leg, but five patient did not recognize their urinary retention which were shaded by severe leg pain. A surgical treatment were performed for all patients at 6.8 days in average after onset of the bladder dysfunction. At follow-up of 3 years and 3 months in average after surgery, 20 patients(86.9%) had satisfactory resolution of the low back pain and leg pain, and all patients had complete recovery of motor weakness except one patients who had residual foot drop. Bladder function recovered satisfactorily in 18 patients (78.3%), but 4 patients had some difficulty of urination and one patient needed a sphinterotomy for urination. CONCLUSIONS: The cauda equine syndrome in herniated lumbar disc was often not recognized early and a poor result of treatment was not rare, particularly in the patients who had acute onset and severe bladder dysfunction. So, early diagnosis and active surgical treatment are recommended for a better results of treatment.
Cauda Equina* ; Diagnosis ; Early Diagnosis ; Female ; Follow-Up Studies ; Foot ; Humans ; Incidence ; Leg ; Low Back Pain ; Male ; Polyradiculopathy* ; Prognosis ; Retrospective Studies ; Urinary Bladder ; Urinary Retention ; Urination

No abstract available.
Adult* ; Humans

STUDY DESIGN: A retrospective review of the patients who have a fixation failure of instrumentalion for the spinal fusion in lumbar region. OBJECTIVES: To assess the incidence and different types of the mechanical failure of fixation and to evaluate their managements and their influences on the progression of a spinal fusion and to the clinical outcomes. SUMMARY OF LITERATURE REVIEW: Most of the spine surgeons have been experiencing the mechanical failures after instrumentations for a spinal fusion, eden though the incidence is decreasing with a modification of the implants. Reports on this problem are sporadic in conjunction with the other topics, rarely focusing on their management and their influences on the final outcomes. MATERIALS AND METHODS: 338 consecutive patients who had a lateral fusion in the lumbar region with an instrumentation of pedicle screws and rods, mostly with decompression, were reviewed to analyse the fixation failures of instrumentation after surgery. RESULTS: There were 26 patients (7.7%) who had the fixation failures of instrumentation, in terms of loosening around the pedicle screws in 18 patients (5.3%), the breakage of the pedicle screws in fide patients (1.5%), and the migration of a rod in three patients (0.9%). They were managed by prolonged use of brace and ergonomic back cares. Even with the fixation failures, 19 patients (73.1%) disclosed solid union uneventfully, but one patient had re-operation to obtain solid fusion. The final outcomes were satisfactory in 22 patients (84.6%), including four of six patients who had pseudoarthrosis. CONCLUSIONS: The fixation failure of instrumentation after a spinal fusion in lumbar region was not rare, but the progression of a spinal fusion usually quite well achieved and the final outcomes were not so bad, even with the implant failures and pseudoarthrosi s. Except for the persistently symptomatic pseudoarthrosis, only a prolonged use of brace and the ergonomic back cares are recommended for symptomatic patients.
Braces ; Decompression ; Humans ; Incidence ; Lumbosacral Region* ; Pseudarthrosis ; Retrospective Studies ; Spinal Fusion* ; Spine

No abstract available.

No abstract available.
Meningitis

No abstract available.
Child* ; Humans

No abstract available.
Anus, Imperforate* ; Bronchi* ; Esophageal Atresia*

No abstract available.
Erythema Nodosum* ; Erythema* ; Yersinia pseudotuberculosis* ; Yersinia*

No abstract available.
Yersinia pseudotuberculosis* ; Yersinia*

BACKGROUND: Radiofrequency (RF) lesioning is one of the most frequently used neurolytic techniques for the relief of pain. Technical advances enables one to make a more reliable and reproducible lesion production. If the size at different parameters is known, the maximal effects and reduction of the side effects could be achieved. However, its size can not be measured systematically using thermocouple (TC) electrodes. 'Differential selection of pain fibers' was proposed but there was not any neuropathologic evidence. We studied pathologic changes produced with various sizes and shapes of electrodes using different parameters. METHODS: Using fresh egg white, RF lesions were produced by four different electrodes at 65, 70, 75, 80 and 90degreesC. At each temperature, Photographs were taken at 10, 20, 30, 40, 50, 60, 90 and 120 seconds. Using the sciatic nerve of the rats, we performed RF lesioning utilizing two different electrodes at 70, 80 and 90degreesC and dissected them 1, 7, and 30 days after treatment. The pathologic changes of lesions were studied and analyzed by applying a quantitative experimental scoring system on the light and electron microscopy (LM and EM). RESULTS: The lesion size increased with a higher temperature and larger electrode. Among the electrodes with the same thickness, the lesion size with the longer electrode was larger than the shorter one. In a histopathologic study, there were significant changes with time, but no significant changes with different electrode and temperature. On electron microscope (EM), large myelinated fibers were relatively intact on RF lesion of 80degreesC after 1 day. 7 days after treatment, there were significant inflammatory cell infiltration and axonal regeneration. At 30 days after the same treatment, there were relatively large amount of small myelinated fibers and unmyelinated fibers. CONCLUSIONS: We measured the lesions systematically with different parameters expecting the result can be used as the reference for the RF lesion. There were no histopathologic differences on LM at different electrodes and temperatures. But we found the evidence of 'differential selection of pain fibers' with 22 gauge electrode at 80degreesC. And also we found the axonal regeneration as early as 1 week later. We learned the neuropathic pain can be induced by pathologic changes, such as bleb formation, inflammatory cell infiltration and predominance of small myelinated and unmyelinated fibers.
Animals ; Axons ; Blister ; Egg White ; Electrodes ; Microscopy, Electron ; Myelin Sheath ; Neuralgia ; Peripheral Nerves* ; Rats ; Regeneration ; Sciatic Nerve