By Henry Vernon Crock M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)
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Extra resources for Practice of Spinal Surgery
Sample text
Clinical Features 37 Conversely, some patients actually gain weight, due to their enforced physical inactivity. d) Neurological Signs Abnormal neurological signs in the limbs are uncommon, though complaints of weakness, clumsiness, and sympathetic nervous system disturbances as described above, are often made. e) Psychiatric Disturbances The psychological responses to this form of disc injury are partly predictable. These patients are usually incapacitated for many months before the diagnosis is established.
I) For example, in isolated disc resorption, retrolisthesis of L5 on Sl may occur, aggravating the tendency for the development of spinal nerve root canal stenosis which occurs commonly in this condition (Fig. 32). ii) Retrolisthesis of one lumbar vertebra on another often occurs in association with disc resorptive changes in the first mobile segment above sacralization anomalies in the lower lumbar spine. iii) Unilateral facet osteoarthritis may occur at a single level, most commonly at the lumbo-sacral junction, where it can produce unilateral sciatica (Figs.
In cases where there is an associated unilateral sciatica, a sequestrum of necrotic vertebral end-plate cartilage will usually be present. The protruding fragment should be removed and the vertebral end-plate cartilage remnants curetted and extracted from the disc space. At the same time bilateral nerve root canal decompression should be performed. If, at the time of nerve root canal decompression, marked vertebral instability is noted at the site and the patient's symptoms have included the complaint of intractable back pain, then spinal fusion should be carried out.