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T-1-rho (T1ρ) magnetic resonance imaging (MRI) and disc height ratio (DHR) are potential biomarkers of degenerative disk disease (DDD) related to biochemical composition and morphology of the intervertebral disk (IVD), respectively. To objectively detect DDD at an early stage, the hypothesis was tested that the average T1ρ relaxation time of the nucleus pulposus (NP) correlates with the disk height of degenerate IVDs, measured by MRI. Studies were performed on a 3-T Siemens Tim Trio clinical MRI scanner (Siemens Healthcare, Malvern, Pennsylvania, United States) on patients being treated for low back pain whose disks were categorized into (1) painful and (2) nonpainful subgroups based on provocative diskography and (3) age-matched healthy controls. Painful disks presented both low DHR and T1ρ values, nonpainful disks measured the highest DHR and extended to a higher range of T1ρ, and control disks presented a midrange DHR with the highest T1ρ values. T1ρ MRI evaluated in the NP of IVDs may be useful to establish a threshold (120 milliseconds here) above which indicates a healthy disk, and disks measuring low NP T1ρ (50 to 120 milliseconds here) would require disk height analysis to further categorize the disk. Combining T1ρ MRI and disk height analysis may hold promise in predicting painful disks without provocative diskography, and predictive models should be developed.

Study Design: Single-arm, prospective clinical trial., Objective: To evaluate back pain severity, physical function, and quality of life outcomes in highly selected patients with lumbar discogenic pain treated with intradiscal electrothermal therapy (IDET)., Summary of Background Data: Degeneration and disruption of the intervertebral disc can be the source of severe low back pain and the associated physical dysfunction. IDET is a minimally invasive treatment option in the continuum of care between conservative nonoperative management and spinal surgery., Methods: Using magnetic resonance imaging, pressure-controlled discography, and postdiscogram computed tomography findings, 56 patients with lumbar discogenic pain were identified, underwent IDET treatment and followed for 20.5+/-4.4 months, on average. Outcomes included assessments of back pain severity by visual analog scale, sitting, standing, and walking tolerances, and health-related quality of life using the SF-36., Results: Mean pain severity scores (visual analog scale) improved from 6.1+/-1.8 pretreatment to 2.4+/-2.6 at final follow-up (P=0.0001). Mean tolerance times (minutes) improved from 40.9+/-40.6 to 84.5+/-54.4, 46.8+/-42.9 to 84.4+/-54.2, and 39.2+/-39.6 to 77.9+/-50.8 between baseline and final follow-up for sitting, standing, and walking, respectively (P=0.0001 for all comparisons). Seven of 8 quality of life domains showed significant (P=0.0001 for all comparisons) improvement over baseline. Forty-two patients (75%) were classified as a treatment success by virtue of a >or=2-point improvement in pain severity or a >or=10-point improvement in either the physical functioning or bodily pain domain of the SF-36., Conclusions: The findings of this study suggest that durable clinical improvements can be realized after IDET in highly selected patients with mild disc degeneration, confirmatory imaging evidence of annular disruption, and concordant pain provocation by low pressure discography.

Background: It is hypothesized that injury or degeneration of osteoligamentous spinal structures would require compensation by trunk musculature and alterations in motor control to maintain spine stability. While, biomechanical modeling has supported this hypothesis, studies of muscle recruitment patterns in chronic low back pain patients both with and without significant osteoligamentous damage have been limited. This study utilized a non-randomized case-control design to investigate trunk muscle recruitment patterns around the neutral spine position between subgroups of patients with chronic mechanical low back pain and asymptomatic controls., Methods: Twenty subjects with chronic low back pain attributed to clinical lumbar instability were matched to 20 asymptomatic controls. In addition 12 patients with non-specific chronic low back pain were studied. Surface EMG from five trunk muscles was analyzed to determine activation levels and patterns of recruitment during a standing reach under two different loading conditions., Findings: The chronic low back pain group with symptoms attributed to clinical instability demonstrated significantly higher activation levels of the external oblique and rectus abdominus muscles and lower abdominal synergist ratios than the control group. No significant differences were found between patient subgroups., Interpretation: While these data demonstrate altered muscle recruitment patterns in patients with chronic low back pain, the changes are not consistent with Panjabi's theory suggesting that these alterations are driven by passive subsystem damage. However, the higher activation of global abdominal musculature and altered synergist patterns may represent a motor control pattern that has consequences for continued dysfunction and chronic pain.

The authors report our experience on 19 cases of discitis developed after operations for herniated lumbar disc. Because of the negativity of the neuroradiological studies in the acute stage, the recognition of the typical syndrome (severe back pain, spasm of the paravertebral lumbar muscles, limited spinal motility, fever) beginning 3-30 days post-operatively and the study of some laboratory tests (elevated Erythrocyte sedimentation rate (ESR) and midly to moderately elevated white blood cells (WBC) are very important for diagnosis. The first radiographic findings (disc space narrowing, ecc.) are detectable only 4 to 6 weeks after the first symptoms; other X-ray findings are not seen post-operatively before 6 months-2 years. The CT-scan is diagnostic of discitis only when the following three specific signs are present: a) anterior paravertebral soft tissue swelling with obliteration of paravertebral fat planes; b) fragmentation or erosion of vertebral end plates; c) paravertebral fluid collection (abscess). In our experience a period of immobilization of the spine with a plaster body jackets and the use of adequate antibiotic therapy are the more effective treatment. Undoubtedly the discits are the results of an infection that must be prevented adhering to the aseptic principles not only during surgery but also during the procedures performed in the radiology suite.

An open technique of cerebral four-vessel angiography via femoral artery "in vivo" of the rabbit is described. This method allows a good visualization of extracranial and intracranial circulation without direct damage to the cerebral vessels.

The use and the abuse of the antibiotics are certainly a subject of great concern, particularly for the increasing incidence of multiresistant bacteria. Since these resistant organisms may be sensitive to cephalosporin, we have tested the effectiveness of a new cephalosporin, ceftazidime, in the treatment of resistant infection in spinal cord injured patients. A randomized study of ceftazidime versus amikacin was carried out on twenty patients. The preliminary results are presented.