Knowledge is ever increasing on spinal anatomy and histopathology and the possible physiological mechanisms by which pain may be generated and experienced. Therefore, in this text an introductory chapter summarizes possible pain sources based on known anatomical principles. Because spinal pain syndromes can be complex, there often is a tendency for clinicians to incorrectly label patients as being ‘neurotic’, or when patients are involved in litigation they may be considered to have litigation ‘neurosis’ as a motive. However, it should be remembered that it is not always possible to diagnose a patient’s spinal pain condition because of many factors such as the limitations of imaging procedures and the specificity and sensitivity of laboratory tests. Therefore, patients should not be considered as malingerers unless there are very strong grounds for doing so. Imaging frequently only provides shadows of the truth and laboratory tests can be misleading, so it is imperative to take a careful history and to perform a thorough physical examination followed, as indicated, by appropriate imaging and laboratory procedures.
During the last few years of a 37-year career specializing in spinal pain syndromes, interesting challenging spinal pain syndrome cases have been collected, 100 of which are presented in this text. In some of the cases presented, gross anatomy and pathology, as well as some histopathology specimens, obtained from postmortem material, with changes similar to the clinical cases presented, are used to illustrate how such conditions in patients may cause spinal pain syndromes and provide a basis upon which to recommend treatment options.
In some cases patients merely wanted reassurance, based upon a thorough evaluation leading to a likely explanation for their chronic pain syndrome(s), rather than requesting treatment. The importance of providing adequate, albeit time consuming, psychological assurance should not be underestimated. Obviously, it is important to consider a particular pain syndrome in great detail while not forgetting that psychology must be taken into account for each patient, as symptoms and signs should not be isolated from the patient as a whole being.
The cases begin with the most frequently involved spinal level (lumbar spine) and conclude with the least frequently involved spinal level (thoracic spine).
The cases represent what actually takes place in day-today clinical practice and illustrate some of the various shortcomings of health care providers.
It should be noted that it is the responsibility of the treating clinician, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for their individual patients.
Finally, all clinical professionals may make errors of judgement in the diagnosis and management of patients. Therefore, it is not the intention of this text to criticize any particular profession but rather to draw to the attention of health practitioners from various backgrounds what actually takes place in the health care domain in the hope that clinicians, and students embarking upon a health care career, will glean some insight into the possible difficulties that may arise with respect to individual cases.
Multidisciplinary cooperation is essential if clinicians fromdifferent backgrounds are to best serve individuals with spinal pain syndromes and the possible sequelae of such syndromes – no one profession has all the answers to manage challenging acute and chronic spinal pain syndrome patients.
General introduction
Whiplash injuries
Section I LUMBAR SPINE CASES
- Introduction
- Case 1 L5–S1 posterior central intervertebral disc protrusion not abutting adjacent nerve roots
- Case 2 L5–S1 posterior central intervertebral disc protrusion abutting adjacent nerve roots
- Case 3 L5–S1 posterior left paracentral intervertebral disc protrusion
- Case 4 CT versus MRI for lumbar spine intervertebral disc protrusion
- Case 5 L4 retrolisthesis with associated intervertebral disc protrusion
- Case 6 Carcinoma of the pancreas
- Case 7 Sacroiliac joint dysfunction
- Case 8 Sacroiliac joint dysfunction and perineal pain
- Case 9 Ewing’s sarcoma
- Case 10 Abdominal aorta aneurysm
- Case 11 Small aortic aneurysm
- Case 12 Minor internal disc disruption
- Case 13 Major internal disc disruption
- Case 14 L4 discectomy
- Case 15 Lumbosacral metastasis
- Case 16 Lytic L5 Grade 1 spondylolisthesis of long standing
- Case 17 Lytic L5 Grade 1 spondylolisthesis in a young man
- Case 18 Lumbosacral intervertebral disc protrusion
- Case 19 Adolescent tethered cord syndrome
- Case 20 Adult tethered cord syndrome
- Case 21 Lumbar neuroma
- Case 22 Sacral Tarlov cyst
- Case 23 Zygapophysial joint synovial cyst
- Case 24 L5–S1 posterior left paracentral intervertebral disc protrusion with a probable epidural haematoma
- Case 25 Re-absorption of intervertebral disc material
- Case 26 L5–S1 intervertebral disc protrusion
- Case 27 Leg length inequality
- Case 28 Scanogram versus erect posture X-ray examination for evaluating leg length inequality
- Case 29 Seropositive inflammatory arthropathy Case 30 Lumbar vertebral body compression fracture
- Case 31 Lumbar intervertebral disc symptoms aggravated by spinal manipulation
- Case 32 Cauda equina syndrome
- Case 33 Perineural fibrosis
- Case 34 Intervertebral disc dysfunction
- Case 35 Discitis and osteomyelitis
- Case 36 L4 and L5 posterior intervertebral disc protrusions
- Case 37 Failed low back surgery
- Case 38 Incorrect laminectomy level for lumbar intervertebral disc bulge
- Case 39 Chronic low back pain with an incidental finding
- Case 40 Multiple level intervertebral disc degeneration
- Case 41 Lumbar osteoporotic fractures
- Case 42 L3–4 far lateral intervertebral disc protrusion
- Case 43 Lumbar perineural ‘block’ injection
- Case 44 Intervertebral disc protrusion into the intervertebral canal
- Case 45 Sacral fracture
- Case 46 Low back pain and left sided sciatica
- Case 47 Low back and unilateral buttock pain
- Case 48 L4–5 and L5–S1 degenerative intervertebral disc replacement with Charite´ artificial discs
Section II CERVICAL SPINE CASES
- Introduction
- Case 49 Post motor vehicle accident CT versus MRI investigations
- Case 50 C5–6 posterolateral intervertebral disc protrusion
- Case 51 Post motor vehicle accident intervertebral disc injuries
- Case 52 Post motor vehicle accident soft tissue injuries
- Case 53 Vertebral artery tortuosity
- Case 54 Vertebral artery dissection
- Case 55 Post-manipulation stroke
- Case 56 Brain injury
- Case 57 Intervertebral disc protrusion
- Case 58 Failed Cloward procedure
- Case 59 Persisting symptoms following Cloward procedure
- Case 60 Cloward revision surgery
- Case 61 Uncovertebral joint osteoarthrosis
- Case 62 Hangman’s fracture of C2 vertebra
- Case 63 Cervical cord myelopathy
- Case 64 Advanced osteoarthrosis in the cervical spine
- Case 65 Cervical cord ependymoma
- Case 66 Cervical, lumbar, and thoracic spine injuries, as well as a foot injury, following a motorcycle accident
- Case 67 Cervical ribs
- Case 68 Block vertebrae
- Case 69 Cerebellar tonsil ectopia
- Case 70 Chiari I malformation
- Case 71 Cervical spine plain X-rays versus MRI
- Case 72 Cervical and thoracic spine injuries resulting in biomechanical disturbances and pain
- Case 73 C3 lamina fracture
- Case 74 C5 facet fracture
- Case 75 Fractures of the C6 and C7 spinous processes and of the C7 inferior articular processes
- Case 76 Cervico-thoracic junction and upper thoracic spine aches
- Case 77 Osseous anomalies
- Case 78 C7–T1 posterior central intervertebral disc protrusion
- Case 79 Hyperflexion injury
- Case 80 Neck pain, headaches and facial injuries
Section III THORACIC SPINE CASES
- Introduction
- Case 81 T9–10 intervertebral disc herniation
- Case 82 T7–8 intervertebral disc posterior protrusion
- Case 83 Pancoast’s tumour
- Case 84 Zygapophysial joint facet fracture
- Case 85 Osteoporosis
- Case 86 T10–11 intervertebral disc posterior protrusion
- Case 87 Burst fracture
- Case 88 Thoracic vertebral body fracture
- Case 89 T6–7 intervertebral disc posterior protrusion
- Case 90 Spinal cord syrinx
- Case 91 Extradural cystic lesion
- Case 92 Post-traumatic anterior longitudinal ligament calcification
- Case 93 Neurofibroma
- Case 94 Posterior central osteophyte encroaching upon the dural tube
- Case 95 T4 and T6 vertebral body fractures
- Case 96 T7 vertebral body fracture
- Case 97 Spinal canal cyst
- Case 98 Scheuermann’s disease – or is it?
- Case 99 T6 intervertebral disc anterior protrusion and posterior bulge
- Case 100 T5–6 and T11–12 intervertebral disc posterior protrusions
- Questions and answers
- Conclusion
- Definitions and abbreviations
Book Details
- Hardcover: 440 pages
- Publisher: Churchill Livingstone; 2nd edition (2010)
- Language: English
- ISBN-10: 0443067163
- ISBN-13: 978-0443067167