By Henry Vernon Crock A.O., M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)
"... i'd suggest this e-book for an in-depth research of the lumbar backbone and its degenerative states ... super worthwhile for the resident early in trainings as she or he makes an attempt to correlate the advanced anatomy of the lumbosacral sector with linked pathological states ...” magazine of Neurosurgery
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Extra info for A Short Practice of Spinal Surgery
Circumferential tears between adjacent rings of the annulus ~ibrosus or radial tears in these fibres, short of complete extension to the outer annular layers, can be demonstrated radiographically by CT discography (Fig. 1). After many years of clinical observation, the conclusion is inescapable that in certain individuals these changes in the discs are associated with biological dynamics which lead to a disabling syndrome, precipitated by trauma and further aggravated by repeated minor trauma. The relationships observed in these patients between the degree of their physical activity and the onset of their pain with profound fatigue and lassitude are striking.
Good physical therapists will stop treatment, recognizing that they are simply aggravating their patients' problems by continuing exercises. On purely clinical grounds it seems reasonable to conclude that there must be an increase in "noxious fluid exchanges" across the vertebral end-plates in these patients, varying with degrees of their physical activity. 1. CT discogram from a female patient aged 18 years showing internal disc disruption at LS/SI Studies of fluid exchanges within the intervertebral disc and across the vertebral end-plates have, to date, failed to raise awareness of their potential clinical significance, Ghosh (1988).
76% had pain in one or both legs, and SO% complained of paraesthesiae. Only 8% reported exacerbation of their pain on coughing, but 18% gave a history of increasing leg pain or paraesthesiae on walking distances up to SOO yards (root claudication). Some patients had weakness and occasional dragging of the feet or difficulty in standing, but these symptoms settled on resting, usually by sitting. 94% had lumbar tenderness, but only 8 patients had reduced lumbar movement as defined by Moll and Wright (1976).
A Short Practice of Spinal Surgery by Henry Vernon Crock A.O., M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)