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The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 9 | Pages 1292 - 1294
1 Sep 2012
Dabasia H Rahim N Marshall R

Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause


The Journal of Bone & Joint Surgery British Volume
Vol. 31-B, Issue 3 | Pages 325 - 355
1 Aug 1949
Boyd AM Ratcliffe AH Jepson RP James GWH

1. A description is given of historical discoveries relating to intermittent claudication. Various theories that have been advanced are discussed. A hypothesis, based on the work of Lewis, is elaborated. 2. A classification of obliterative arterial disease is outlined. The three groups that are distinguished are: primary thrombosis of the popliteal artery; juvenile obliterative arteritis; and senile obliterative arteritis. 3. The methods adopted for assessment of the severity of disease, including study of the clinical features, arteriographic findings, results of novocain infiltration and examination of the patient on a walking machine, are reported. 4. Methods of treatment by Buerger's exercises, contrast baths, intermittent venous occlusion and suction pressure; by lumbar ganglionectomy ant paravertebral block with phenol; by vitamin E (α-tocopherol) therapy; by treatment with thiouracil antistin; by internal popliteal myoneurectomy and division of the external popliteal and posterior tibial nerves; and by tenotomy of the tendo Achillis, are discussed. 5. It is concluded that tenotomy of the tendo Achillis should replace myoneurectomy in Type 3 cases where the blood supply is so far reduced that vascular stability cannot be achieved, and that it might apply in Type 2 cases in which there is persistent pain at a steady level. 6. The results of treatment in 276 patients with intermittent claudication are recorded


The Journal of Bone & Joint Surgery British Volume
Vol. 31-B, Issue 3 | Pages 321 - 322
1 Aug 1949
Ross JP


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 37 - 44
1 Jun 2019
Liu N Goodman SB Lachiewicz PF Wood KB

Aims. Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. Materials and Methods. Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining. Results. Responses were received from 51 hip surgeons (46%) and 37 spine surgeons (37%). The percentages of hip surgeons recommending ‘hip first’ differed significantly among scenarios: 59% for scenario 1; 73% for scenario 2; 47% for scenario 3; 47% for scenario 4; and 10% for scenario 5 (p < 0.001). The percentages of spine surgeons recommending ‘hip first’ were 49% for scenario 1; 70% for scenario 2; 19% for scenario 3; 78% for scenario 4; and 0% for scenario 5. There were significant differences between the groups for scenarios 3 (more hip surgeons recommended ‘hip first’; p = 0.012) and 4 (more hip surgeons recommended ‘spine first’; p = 0.006). Conclusion. In patients with coexistent OA of the hip and degenerative disorders of the spine, the question of ‘hip or spinal surgery first’ elicits relatively consistent answers in some clinical scenarios, but remains controversial in others, even for experienced surgeons. The nature of neurological symptoms can influence surgeons’ decision-making. Cite this article: Bone Joint J 2019;101-B(6 Supple B):37–44


Bone & Joint 360
Vol. 4, Issue 2 | Pages 23 - 25
1 Apr 2015

The April 2015 Spine Roundup360 looks at: Hyperostotic spine in injury; App based back pain control; Interspinous process devices should be avoided in claudication; Robot assisted pedicle screws: fad or advance?; Vancomycin antibiotic power in spinal surgery; What to do with that burst fracture?; Increasing complexity of spinal fractures in major trauma pathways; Vitamin D and spinal fractures


Bone & Joint 360
Vol. 2, Issue 1 | Pages 27 - 30
1 Feb 2013

The February 2013 Spine Roundup. 360 . looks at: complications with anterior decompression and fusion; lumbar claudication and peripheral vascular disease; increasing cervical instability in rheumatoids; kyphoplasty; cervical stenosis; exercise or fusion for chronic lower back pain; lumbar disc arthroplasty and adjacent level changes; and obese disc prolapses


Bone & Joint Open
Vol. 4, Issue 8 | Pages 573 - 579
8 Aug 2023
Beresford-Cleary NJA Silman A Thakar C Gardner A Harding I Cooper C Cook J Rothenfluh DA

Aims

Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted.

Methods

As part of the SpInOuT-F study, a pilot randomized trial was carried out across five NHS hospitals. Patients were randomized to either spinal decompression alone or spinal decompression plus instrumented fusion. Patient-reported outcome measures were collected at baseline and three months. The intended sample size was 60 patients.


The Bone & Joint Journal
Vol. 104-B, Issue 12 | Pages 1281 - 1283
1 Dec 2022
Azizpour K Birch NC Peul WC


The Bone & Joint Journal
Vol. 106-B, Issue 8 | Pages 842 - 848
1 Aug 2024
Kriechling P Whitefield R Makaram NS Brown IDM Mackenzie SP Robinson CM

Aims

Vascular compromise due to arterial injury is a rare but serious complication of a proximal humeral fracture. The aims of this study were to report its incidence in a large urban population, and to identify clinical and radiological factors which are associated with this complication. We also evaluated the results of the use of our protocol for the management of these injuries.

Methods

A total of 3,497 adult patients with a proximal humeral fracture were managed between January 2015 and December 2022 in a single tertiary trauma centre. Their mean age was 66.7 years (18 to 103) and 2,510 (72%) were female. We compared the demographic data, clinical features, and configuration of those whose fracture was complicated by vascular compromise with those of the remaining patients. The incidence of vascular compromise was calculated from national population data, and predictive factors for its occurrence were investigated using univariate analysis.


Bone & Joint Research
Vol. 12, Issue 6 | Pages 387 - 396
26 Jun 2023
Xu J Si H Zeng Y Wu Y Zhang S Shen B

Aims

Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease.

Methods

We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes.


The Bone & Joint Journal
Vol. 106-B, Issue 1 | Pages 53 - 61
1 Jan 2024
Buckland AJ Huynh NV Menezes CM Cheng I Kwon B Protopsaltis T Braly BA Thomas JA

Aims

The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique.

Methods

This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively.


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 3 | Pages 606 - 618
1 Aug 1968
Schatzker J Pennal GF

1. The syndrome of spinal stenosis is due to compression of the cauda equina from structural narrowing of the lumbar spinal canal. 2. Patients with this syndrome present symptoms of cauda equina claudication or of unremitting bizarre back pain and sciatica. 3. The compression of the cauda equina is always posterior and postero-lateral and is caused by narrowing of the lateral recesses and of the dorso-ventral diameter of the spinal canal. 4. The diagnosis can be made only by myelography. The only form of successful relief of the nerve root compression in spinal stenosis is adequate lateral and longitudinal decompression


Bone & Joint 360
Vol. 10, Issue 4 | Pages 34 - 37
1 Aug 2021


Bone & Joint 360
Vol. 11, Issue 1 | Pages 36 - 38
1 Feb 2022


The Journal of Bone & Joint Surgery British Volume
Vol. 48-B, Issue 4 | Pages 765 - 769
1 Nov 1966
Kessel L Rang M

Symptoms due to a supracondylar spur of the humerus, although rare, are common enough to make it the subject of routine examination of a patient with pain and disturbance of sensibility of the hand. It can mimic the carpal tunnel syndrome; it may produce ulnar nerve symptoms. Irritation or compression of either the brachial artery or, if there is a high division of it, the ulnar artery, may cause episodes of ischaemic pain in the forearm. The clinical features of a supracondylar spur causing symptoms are: symptoms of median nerve compression; forearm claudication; a palpable spur about two inches above the medial epicondyle; and disappearance of the radial or ulnar pulse on full extension and supination of the forearm


The Journal of Bone & Joint Surgery British Volume
Vol. 59-B, Issue 2 | Pages 181 - 188
1 May 1977
Verbiest H

Between 1948 and 1975 147 patients were treated surgically for developmental stenosis of the lumbar vertebral canal, measurement of the mid-sagittal diameters in the whole area of stenosis being performed in 116 patients. Ninety-two of these patients were followed up for periods varying between one and twenty years. About two-thirds were completely relieved fo symptoms and signs. Sciatica and intermittent claudication were more frequently cured than radicular deficit and lumbago, the latter being the most frequent persisting symptom. A permanent neural deficit as a result of the surgical procedure was noted in two cases. A detailed presentation of the technique, complications and results is given


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 3 | Pages 595 - 605
1 Aug 1968
Jones RAC Thomson JLG

The syndromes associated with a narrow lumbar spinal canal are described and discussed. In thirteen cases two main groups were evident, the larger group having mainly backache and root pain, the smaller group having intermittent claudication. A method of recognising the narrow spinal canal on plain radiographs is described, and a comparison made with normal controls. The findings at operation are reported and the importance is emphasised of making a wide laminectomy for decompression. Our thanks are due to the neurosurgeons of the South-West Neurosurgical Unit, Mr G. L. Alexander, Mr D. G. Phillips and Mr A. Hulme, who kindly allowed us full use of their clinical notes. We would also like to thank Mr G. Banham for the reproductions, Mr E. Turnbull for the drawing and the secretarial staff for their patient co-operation


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 6 | Pages 938 - 944
1 Nov 1996
Tandon V Williamson JB Cowie RA Wraith JE

Bone-marrow transplantation has increased the survival of patients with mucopolysaccharidosis-I. We describe the spinal problems and their management in 12 patients with this disorder who have been followed up for a mean of 4.5 years since transplantation. High lumbar kyphosis was seen in ten patients which was associated with thoracic scoliosis in one. Isolated thoracic scoliosis was seen in another. One patient did not have any significant problems in the thoracic or lumbar spine but had odontoid hypoplasia, which was also seen in three other children. Four of the eight patients in whom MRI of the cervical spine had been performed had abnormal soft tissue around the tip of the odontoid. Neurological problems were seen in two patients. In one it was caused by cord compression in the lower dorsal spine 9.5 years after posterior spinal fusion for progressive kyphosis, and in the other by angular kyphosis with thecal indentation in the high thoracic spine associated with symptoms of spinal claudication


Bone & Joint 360
Vol. 10, Issue 3 | Pages 24 - 26
1 Jun 2021


The Bone & Joint Journal
Vol. 102-B, Issue 8 | Pages 1062 - 1071
1 Aug 2020
Cheung JPY Fong HK Cheung PWH

Aims

To determine the effectiveness of prone traction radiographs in predicting postoperative slip distance, slip angle, changes in disc height, and lordosis after surgery for degenerative spondylolisthesis of the lumbar spine.

Methods

A total of 63 consecutive patients with a degenerative spondylolisthesis and preoperative prone traction radiographs obtained since 2010 were studied. Slip distance, slip angle, disc height, segmental lordosis, and global lordosis (L1 to S1) were measured on preoperative lateral standing radiographs, flexion-extension lateral radiographs, prone traction lateral radiographs, and postoperative lateral standing radiographs. Patients were divided into two groups: posterolateral fusion or posterolateral fusion with interbody fusion.