J Comput Assist Tomogr. 1990 Jul-Aug;14(4):574-80.

Three-dimensional CT imaging in postsurgical "failed back" syndrome.

Zinreich SJ1, Long DM, Davis R, Quinn CB, McAfee PC, Wang H.

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One hundred consecutive patients with postsurgical “failed back” syndrome (PSFBS) without fusion and 100 patients with PSFBS with fusion were evaluated with direct CT, two-dimensional (2D) multiplanar, and three-dimensional (3D) imaging. In the patients with and without fusion, 3D images were found to best display the following: the surgical procedure and its extent, lateral neural foraminal narrowing, and fractures of the posterior elements. The 3D images enabled optimal demonstration of fusion: solidity, pseudarthrosis, incorporation of transverse processes and facet joints, and transitional syndrome. In the patients without fusion, 3D images provided improved appraisal of surgical results in 31%; it showed additional fracture(s) in 9%, better displayed lateral neural foraminal narrowing in 42%, and showed additional posterior element fractures in 11% as compared to axial and 2D multiplanar reconstructed (MPR) scans. Three-dimensional imaging uncovered incomplete fusion in 17%, transitional syndrome in 13%, and pseudarthrosis in 6%. Thus, the 3D imaging provided additional information over the direct axial and MPR images (2D images) in 56 of 100 patients without fusion and 76 of 100 patients with fusion. At our institution, this imaging modality is now routinely performed in this patient population.

January–February, 1993 Volume 34, Issue 1, Pages 90–96

 J Spinal Disord. 2000 Oct;13(5):438-43. 

Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI.

Sandhu HS1,Sanchez-Caso LP,Parvataneni HKCammisa FP JrGirardi FPGhelman B.

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Provocative discography is a controversial diagnostic tool for pathologic discs. Modic has identified vertebral endplate signal changes on magnetic resonance imaging (MRI) that are thought to signify advanced discogenic degeneration. These two distinct diagnostic tools are examined to determine if there is association between them. Fifty-three consecutive patients who underwent both investigations were retrospectively reviewed. In discs that had negative T1 MRI findings, 28.2% of patients had concordant pain and 17.3% had discordant pain. In discs with positive T1 MRI findings, 34.8% of patients had concordant pain and 17.4% had discordant pain. 79.5% and 74.4% of levels with patient concordant pain on discography had no endplate changes on T1- and T2 weighted MR images, respectively (compared with 84.5% and 81.7%, respectively, for levels with no patient pain on discography). Our data showed no significant relationship between these distinct diagnostic tools. Further investigation of their relative roles in this application is recommended.

Dellon, AL, Andronian, E, Rosson, GD, CRPS of the upper or lower extremity: surgical treatment outcomes, J. Brachial Plex Peripher Nerve Inj, Feb 20: 4 (1):1, 2009

ABSTRACT: The hypothesis is explored that CRPS I (the “new” RSD) persists due to undiagnosed injured joint afferents, cutaneous neuromas or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II (the “new” causalgia). An IRB-approved, retrospective chart review on a series of 100 consecutive patients with “RSD” identified 40 upper and 30 lower extremity patients for surgery based upon their history, physical examination, neurosensory testing, and nerve blocks. Based upon decreased pain medication usage, and recovery of function, outcome in the upper extremity, at a mean of 27.9 months follow-up (range of 9 to 81 months), gave the results that were excellent in 40% (16 of 40 patients), good in 40% (16 of 40 patients) and failure 20% (8 of 40 patients). In the lower extremity, at a mean of 23.0 months follow-up (range of 9 to 69 months) the results were excellent in 47% (14 of 30 patients), good in 33% (10 of 30 patients) and failure 20% (6 of 30 patients). It is concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and therefore, similar to a patient with CRPS II, they can be treated successfully with an appropriate peripheral nerve surgical strategy.