On the issue of evaluation of vertebrogenic pathology in professional drivers at the stage of outpatient visit

Truck drivers represent one of numerous occupational groups employed in many economic sectors. Their work is characterized by a complex of adverse occupational factors. The greatest risk for the development of musculoskeletal diseases, including vertebral pathology, is associated with vibration, adverse environment, and work stress. Analysis of the state of health in 65 male drivers from trucking industry is carried out on the basis of results of outpatient examination. It included medical history, assessment of the severity of pain according to a visual analog scale, and instrumental methods of diagnosis. Vertebrogenic diseases of the cervical spine (cervicalgia, cervicobrachialgia) were detected according to the results of examination in 73.8% of drivers and diseases of the lumbosacral region (low back pain, lumbar ischialgia, radiculopathy) in 89.2% of drivers. Increase in the length of service negatively affects the course of the disease, leading to an increase in neurologic impairment from the reflex stage in the group of people with work experience of up to 9 years to the stage of radicular compression in the group with work experience of more than 20 years. Presented data indicate the need to develop a set of targeted measures of sanitary and hygienic and therapeutic and preventive nature.

Treatment for radicular compression experience of 926 cases in Bolivia [abstract]

PURPOSE: The present study aims to demonstrate the advantage of treating the radicular compression with the minimally invasive approach such as the discolysis with Ozone Therapy, rather than the surgical approach that we know has complications such as the spine fail back syndrome. This study shows the experience in Bolivia shows from August 2004 to August 2016. MATERIAL AND METHODS: Were treated 926 patients with radicular compression at cervical, thoracic and lumbar level 569 males and 357 females First were performed intra discal injections, the discolysis, of ozone at 30 mcgr/mL followed by 15 or 20 paravertebral injections at 20 mcgr/mL. RESULTS: Among the 926 patients with radicular compression were observed that sensory and motor dysfunction were completely abolished in 611 patients (66%) improved in 176 patients (19%) and with poor results and the dysfunction remained unchanged in 139 patients 15% some of them underwent surgical treatment. DISCUSSION: The discolysis with Ozone is a minimally invasive approach is atraumatic and safety and with this method avoids complications such as spine fail back syndrome, which in USA statistics are reported in 15% to 20%. CONCLUSION: With the treatment of ozone therapy is possible to obtain excellent and good results in 85 % of the cases. Ozone is a useful alternative the effectiveness using this minimal invasive method can avoid complications like spine fail back syndrome.

Endoscopic transforaminal lumbar microdiscectomy. A retrospective analysis of 180 clinical cases

The authors performed retrospective analysis of 180 clinical cases of surgical treatment of lumbar herniated discs in patients who underwent endoscopic transforaminal microdiscectomy. This technique allows minimally invasive insertion of the endoscope into the spinal canal under local anaesthesia to decompress the nerve root by removing hernial protrusion under visual control. However, this technique is not universal and cannot be applied to all patients. Considerable practical experience has shown that the surgeon may encounter certain technical difficulties in cases of cranial or caudal sequester migration and in some cases when the access at L5–S1 level is complicated due to the high standing of the iliac crest. However, if there are correct indications, this technique allows to solve the problem of radicular compression syndrome in a short time.

Disc Herniation and Cyst Gas: A Rare Association Causing Radicular Compression

Introduction Intraspinal gas is a common clinical finding, but an epidural gas pseudocyst in association with lateral disc herniation compressing a nerve root is an exceptional observation. Case Report A 49-year-old man was admitted to our department presenting with sciatica. The neurological examination demonstrated moderate lumbar pain without neurological deficit. A lumbosacral computed tomography showed the presence of degenerated disc herniation and epidural gas collection. Discussion The pathological association between the cyst and the hernia is probably due to the migration of gas pumped from the intervertebral space through a breaking point or lower in the annulus fibrosis, involving its contiguity with the herniated disc. Conclusion An association between a disc herniation and a gas pseudocyst can be a cause of sciatica.

Primary Spinal Epidural Lymphoma As a Cause of Spontaneous Spinal Anterior Syndrome: A Case Report and Literature Review

Background Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Phantom Radiculitis Effectively Treated by Fluoroscopically Guided Transforaminal Epidural Steroid Injections

Lower back and extremity pain in the amputee patient can be challenging to classify and treat. Radicular compression in a patient with lower limb amputation may present as or be superimposed upon phantom limb pain, creating diagnostic difficulties. Both patients and physicians classically find it difficult to discern phantom sensation from phantom limb pain and stump pain; radicular compression is often not considered. Many studies have shown back pain to be a significant cause of pain in lower limb amputees, but sciatica has been rarely reported in amputees. We present a case of L4/5 radiculitis in an above-knee amputee presenting as phantom radiculitis. Our patient is a 67 year old gentleman with new onset 10/10 pain in a phantom extremity superimposed upon a 40 year history of previously stable phantom limb pain. MRI showed a central disc herniation at L4/5 with compression of the traversing left L4 nerve root. Two fluoroscopically guided left transforaminal epidural steroid injections at the level of the L4 and L5 spinal nerve roots totally alleviated his new onset pain. At one year post injection, his phantom radiculitis pain was completely gone, though his underlying phantom limb pain remained. Lumbar radiculitis in lower extremity amputee patients may be difficult to differentiate from baseline phantom limb pain. When conservative techniques fail, fluoroscopically guided spinal nerve injection may be valuable in determining the etiology of lower extremity pain. Our experience supports the notion that epidural steroid injections can effectively treat phantom lumbar radiculitis in lower extremity amputees. Key words: amputee, phantom pain, phantom sensation, phantom radiculitis, disc herniation, interlaminar, transforaminal, epidural steroid injection