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Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Unilateral facet joint dislocation occurs from a flexion/distraction injury with a rotatory component. It is a stable form of facet joint dislocation (cf. with highly unstable bilateral facet joint dislocation). The naked facet sign is seen involving one facet joint on CT, and on plain radiograph there is often an overlapping appearance to the facet joints. Mild anterolisthesis and widening of the interspinous space at the level of injury is a common finding. Up to 30% of patients have a neurological deficit.
Fundamental Concepts in the Diagnosis of Low Back Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
The structural causes of radiculopathy include protrusion or frank rupture of an intervertebral disc, inflammation due to material derived from the herniated disc, intervertebral foraminal stenosis, osteophytes, and rarely, infection. Narrowing of the intervertebral foramen may be due to trauma and degeneration. Slippage of one vertebral body on another may result in nerve root entrapment and radicular symptoms. Spondylolisthesis occurs when one vertebra moves either anteriorly or posteriorly (anterolisthesis or retrolisthesis, respectively) and may be congenital, associated with spondylolysis (fracture of the pars interarticularis), or acquired, related to degenerative changes.
Sacral insufficiency fracture after lumbosacral decompression and fusion
Published in Baylor University Medical Center Proceedings, 2022
Brendan M. Holderread, Caleb P. Shin, Ishaq Y. Syed, Ioannis Avramis, James M. Rizkalla
Meredith et al4 recommended iliosacral fixation as prophylaxis when considering the risk of SIF, emphasizing the importance of pelvic incidence. (High pelvic incidence increases the risk of sacral fracture after lumbosacral fusion.) Buell et al7 recommended beginning management conservatively, with indications for revision surgery including pain refractory to nonoperative management, presence of a neurological deficit, nonunion with anterolisthesis, L5–S1 pseudoarthrosis, and misalignment of the spinopelvic axis. When considering surgical planning, the authors also recommended iliac screws. They stated that patients at increased risk of SIF identified preoperatively may receive prophylactic iliac screws at the initial surgery. Of the four operative cases in this series, none received prophylactic lumbopelvic fixation or iliac screws as part of salvage therapy. Two patients developed infection as a result of revision surgery and had complicated courses as a result. The two surgical cases without infection were managed with lumbopelvic fixation and returned to ambulate at their baseline. The patients managed nonoperatively with lumbar bracing, bone stimulator, or standard postoperative rehabilitation were all ambulating at their baseline with no symptoms within a year of their revision surgery.
Dupilumab use in dermatologic conditions beyond atopic dermatitis – a systematic review
Published in Journal of Dermatological Treatment, 2021
Aleksi J. Hendricks, Gil Yosipovitch, Vivian Y. Shi
Common etiologies of chronic anogenital pruritus include ACD (frequently due to soaps or hygiene products) and fungal or bacterial infection, exacerbated by friction and occlusion. Additional etiologies include lumbosacral spinal injury, stenosis or arthritis. Patch testing can aid in identification of potential irritants and allergenic culprits. Management is challenging because trigger avoidance is often difficult and topical anti-inflammatory anesthetic agents have limited efficacy in ameliorating itch (21). In a 62-year-old man with L5–S1 anterolisthesis and chronic pruritic papular anogenital eruption refractory to topical corticosteroids, antifungals, oral antihistamines and MMF, dupilumab led to near complete resolution of anogenital itch and dermatitis after only 1 month with response maintained at 1-year follow-up (22).
Risk factors related to adjacent segment degeneration: retrospective observational cohort study and survivorship analysis of adjacent unfused segments
Published in British Journal of Neurosurgery, 2019
Jose Ramirez-Villaescusa, Jesús López-Torres Hidalgo, Antonio Martin-Benlloch, David Ruiz-Picazo, Francisco Gomar-Sancho
The radiological results that were considered as criteria of ASD were: (1) A loss in global pre-operative disc height was observed in 159 adjacent unfused segments in 112 patients (42.6%); (2) Anterior or posterior slippage (anterolisthesis or retrolisthesis) at end of follow-up was observed in 33 patients (12.5%), 28 of them had retrolisthesis (in the first superior disc in 20 patients, and in the second and third superior discs in 8 patients), and 5 of them had anterolisthesis; (3) Rotation of superior vertebral segments not included in the fusion was found in 36 patients (13.6%), being grade I in 24 patients, grade II in 11 patients, and grade III in one; (4) Radiographic disc degeneration was observed in 107 discs of 72 patients, with degeneration being most frequent in the first superior disc: presence of radiographic grade 2 and 3 degeneration was observed at end of follow-up in 48 discs of 35 patients (13.6%); (5) severe degeneration of grades IV and V evaluated by MR was observed in 46 discs of 32 patients (43.8% of patients with pre and postoperative MR) (Table 2).