Asunto(s)
Cateterismo , Ventriculostomía/métodos , Ventrículos Cerebrales/anatomía & histología , Ventrículos Cerebrales/diagnóstico por imagen , Ventrículos Cerebrales/cirugía , Endoscopios , Tecnología de Fibra Óptica , Humanos , Procedimientos Neuroquirúrgicos , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler TranscranealRESUMEN
OBJECTIVE: Cases of chronic noncancer pain are both the most frequent and the most difficult that the spine care professional is called upon to treat. We use this case to illustrate the potential effectiveness of repeat positional upright, weight-bearing magnetic resonance (MR) imaging to diagnose disorders and to detect changes in disorders. CLINICAL FEATURES: We present the case of a 35-year-old man referred to our neurosurgical clinic with complaints of chronic, noncancer lower back pain and right-greater-than-left sciatica. Traditional recumbent MR imaging had revealed degenerative disk disease at L5-S1 and a 2.2-mm (grade 1) degenerative spondylolisthesis. The patient had not improved after more than a year of conservative treatments and, moreover, had been prescribed opiates for pain management that were potentially masking changes in his condition. INTERVENTION AND OUTCOMES: After referral to our clinic, we ordered repeat lumbar MR imaging in an upright weight-bearing position (sitting) 14 months after the patient's recumbent MR imaging. The weight-bearing MR imaging revealed a 9.13-mm (grade 1) degenerative spondylolisthesis at L5-S1. The patient underwent arthrodesis. His leg pain and back were significantly and clinically improved. CONCLUSION: When patients with noncancer, lower back pain worsen, fail to improve, or require opiates to manage their pain, updated clinical diagnosis including repeat positional imaging may be an effective diagnostic strategy.
Asunto(s)
Quiropráctica/métodos , Dolor de la Región Lumbar , Imagen por Resonancia Magnética/métodos , Adulto , Causalidad , Enfermedad Crónica , Discitis/complicaciones , Discitis/diagnóstico , Discitis/cirugía , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia , Vértebras Lumbares , Masculino , Examen Físico , Postura , Sacro , Ciática/diagnóstico , Ciática/etiología , Fusión Vertebral , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico , Espondilolistesis/cirugía , Insuficiencia del Tratamiento , Soporte de PesoRESUMEN
Diagnosis of tethered cord syndrome (TCS) is complicated because anatomical information is not adequate for this task. For example, recent studies have shown that the combination of an elongated cord and a thick filum terminale, demonstrated by MRI or at operation, is no longer an essential feature for the diagnosis of TCS. For TCS diagnosis, emphasis should rather be on its characteristic symptomatology and accentuated by postural changes, since TCS is a functional disorder of the lumbosacral spinal cord. In this report, the authors present the list of signs and symptoms pertinent to TCS in adult and late teenage patients to serve as a diagnostic means.