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Background The nerve root sedimentation sign is a magnetic resonance (MR) sign, shown to be present in central lumbar spinal stenosis. The lack of sedimentation of the nerve roots to the dorsal part of the dural sac is consistent with the positive nerve root sedimentation sign. Purpose To validate the reliability of the nerve root sedimentation sign in diagnosis of different grades of lumbar spinal canal stenosis. Material and Methods This study was a retrospective review of 101 consecutive MR imaging (MRI) studies obtained on patients with clinically suspected lumbar canal stenosis. Based on the minimum anteroposterior (AP) diameter of the dural sac the study sample was classified into two groups: a group with morphological lumbar spinal stenosis; and the group of patients free from stenosis (AP > 12 mm). Patients with stenosis were further subclassified based on its severity: severe stenosis (AP ≤ 10 mm); and moderate stenosis (AP > 10 mm to ≤ 12 mm). Results Positive sedimentation sign was identified in 81% of patients with severe lumbar spinal stenosis and 14% of patients with moderate stenosis. No patients without lumbar spinal stenosis had a positive nerve root sedimentation sign. Of patients with a positive nerve root sedimentation sign, 89% presented with neurological claudication. Conclusion The nerve root sedimentation is a useful tool for identification of patients with both severe clinical and morphological lumbar spinal stenosis; however, its performance in the diagnosis of patients with moderate morphological spinal stenosis is poor.

Computed tomography is a modern technique producing high quality image of scanned organs. It plays a significant role in diagnostic work-up on orthopedics wards. This paper presents an analysis of management of two cases of Hawkins type I talar neck fracture with ankle joint rotation. In both patients, the diagnosis was based on conventional radiographs of the ankle joint in two projections and was subsequently verified with CT scans. The findings of a CT scan of the talus had a significant impact on further treatment and physiotherapy. Non-surgical treatment consisting in immobilization with a short leg cast combined with medication and magnetic field therapy produced a positive therapeutic outcome. A follow-up CT scan of the talus revealed bone union with remodelling in both patients. The functional outcome according to the AOFAS scale should be regarded good. Computed tomography is the radiological modality for detecting talar neck fractures and determining the presence of displacement. Follow-up CT scans evaluate the natural process of bone healing, which is crucial for treatment decisions regarding weight-bearing status. A correct diagnosis based on CT helps to prevent the development of necrosis and posttraumatic (secondary) degenerative changes as well as advanced physical disability, especially among youn­ger patients, in whom the injury is most common, consequently helping to avoid a long and costly treatment.

Summary An osseous Bankart lesion is commonly seen in patients with an anterior shoulder dislocation. It is defined as a detachment of the anteroinferior labrum associated with a glenoid rim fracture. Radiological studies are crucial not only for detecting glenoid bone defects but also for measuring the amount of bone loss. The precise quantification of the bony defect is crucial for the therapeutic desicion-making and clinical outcomes. Although we know that major glenoid bone loss requires surgical intervention, none of the studies performed so far answered the question what size of the defect should be an indication for open surgery procedures. Moreover, there is still no consensus on the exact percentage of glenoid loss that results in a higher risk of re-dislocations. In our opinion, there is a strong need for a consensus on universally accepted measuring techniques of the glenoid defect as well as on algorithms with validated glenoid bone loss threshold values for therapeutic decision-making. In this study, we review the techniques described so far in the literature and try to assess if any of these techniques should be treated as a leading method of detecting and quantifying osseous glenoid lesions.

Snapping hip syndrome is an audible or palpable snap in a hip joint during movement which may be accompanied by pain or locking. It is typically seen in young athletes performing activities requiring repeated extreme movements of the hip. It may also follow a physical trauma, intramuscular injections or surgeries. There are two main forms of snapping hip: extra- or intra-articular. Extra-articular snapping hip is elicited by an abnormal movement of specific tendons and is divided into two forms: internal and external. The internal form of snapping hip syndrome is attributed to an abrupt movement of an iliopsoas tendon against an iliopectineal eminence. Radiograph results in patients with this form of snapping tend to be normal. Dynamic ultrasound is the gold standard diagnostic technique in both forms of extra-articular snapping hip syndrome. The objective of the following text is to describe a step-by-step dynamic ultrasonography examination in internal extra-articular snapping hip syndrome in accordance to the proposed checklist protocol. To evaluate abrupt movement of an involved tendon, the patient needs to perform specific provocation tests during the examination. With its real-time imaging capabilities, dynamic ultrasonography detects the exact mechanism of the abnormal tendon friction during hip movement in a noninvasive way. It also allows for a diagnosis of additional hip tissue changes which may be causing the pain.

Introduction. The association between changes in magnetic resonance imaging (MRI) and clinical symptoms in patients with low back pain (LBP) is unclear. Aim. To evaluate correlations between combined MRI findings of the lumbar spine (LS) and pain intensity, depressive and anxiety symptoms and quality of life in patients with LBP. Material and methods. 200 subjects (93 men and 107 women; mean age 51.42 ± 13.21 years) with LBP referred for MRI were enrolled in the study. All patients completed the Hospital Anxiety and Depression Scale (HADS), Quality of Life Scales (EQ-5D, EQ-VAS) and the Visual Analogue Scale (VAS). MRI scans were assessed according to a scoring system prepared by the authors, and the total MRI score was calculated. Results. The mean total MRI score was 11.59 ± 6.73 points (range 0–50 points) and was higher in men than in women (p = 0.015). A correlation was observed between total MRI score and age (p < 0.001) and between total MRI score and BMI (p = 0.005). An association was found between total MRI score and EQ-5D (p = 0.012) and HADS-D results (p = 0.003). VAS and HADS-A results did not correlate with MRI score. When multivariate analysis was done, the total MRI score was only significantly related to age and BMI, and association between the total MRI score and EQ-5D or HADS-D results was not confirmed. Decreased quality of life was associated with increased intensity of pain and depressive and anxiety symptoms. Conclusions. Combined MRI changes in LS do not correlate with pain intensity, depressive and anxiety syndromes or quality of life in patients with LBP.

Introduction: Literature data concerning the association between the back pain syndrome and the quality of sexual life are rare, especially in the Polish literature. There are also no reports on the association between magnetic resonance (MRI) results and sexual satisfaction in patients with low back pain (L-S). The aim: To assess the association between the severity of degenerative-discopathic changes in the MRI of L-S spine and the quality of sexual life in patients with low back pain.Materials and methods: The study involved 200 patients (107 women and 93 men), referred for MRI of the L-S spine due to the back pain syndrome. The assessment of satisfaction with sexual life at present and before the disease was made by the self-constructed questionnaire and with the use of the Question No. 8 of the Oswestry Questionnaire (ODI). In addition, the VAS (Visual Analogue Scale) was used. MRIs were analyzed based on the author's scoring scale, assessing selected radiological changes at levels L1-S1. The total score was in the range of 0-50 points.Results: There was a statistically significant decrease in the quality of sexual life (8.9 points vs 6.3 points) (0.001). Back pain did not affect sexual life only in 36.9% of respondents. 26.5% patients were sexually inactive, 7.5% of them declared that pain was the reason for this. There was no statistically significant correlation between the intensity of radiological changes and satisfaction with sexual life.Conclusions: Back pain affects the patients' sexual life. There was no association between the severity of degenerative-discopathic changes assessed in the MRI and the quality of sexual life in patients with L-S back pain syndrome.

Degenerative spine disease is a serious social problem. In most cases, it causes pain and neurological symptoms. Most patients are therefore referred for magnetic resonance imaging (MRI). The article discusses the relationship between back pain and magnetic resonance changes. The signification of some of the radiological symptoms remains controversial. Some of them are markers of acute pain, others may be clinically insignificant, occurring with age. Authors presents some of the magnetic resonance alterations and based on the latest articles discusses their clinical significance. The issues of performing routine, control MRI examination due to chronic back pain and the incidence of new radiological findings were also discussed.

Summary Background The right aortic arch with mirror-image of branching arteries without coexisting congenital heart disease is a very rare anomaly. Case Report We report a case of the right-sided aortic arch with aplasia of the left brachiocephalic trunk in a 64-year-old women, presenting difference in systolic blood pressure between upper extremities. The history of the patient and angio-CT findings were described and visualized with images. Conclusions The knowledge of vascular variations is important for the clinical and therapeutic aspects.

BACKGROUND Successful treatment of chronic occlusion of inferior vena cava (IVC) and iliocaval confluence with angioplasty and stent implantation is very rare. CASE REPORT We present a case of a 59-year-old patient with iatrogenic occlusion of IVC following L3/L4 discectomy. The wall of the ventral IVC was ruptured during the operation. RESULTS The torn wall was treated by patch angioplasty, resulting in a permanent IVC occlusion, as confirmed by angiography. Iatrogenic permanent occlusion of IVC was successfully treated with recanalization and implantation of a non-covered aortic stent.

Background This study is an outcome evaluation of the Drug-Eluting-Bead-Chemoembolization (DEB TACE) compared to conventional TACE (cTACE) with Cisplation and Lipiodol in patients with hepatocellular carcinoma (HCC) and Child-Pugh A Cirrhosis. Material/methods A comparison of interventional therapy with either cTACE or DEB-TACE of 22 patients each with unresectable HCC and Child-Pugh A Cirrhosis was carried out. A comparison of therapy-associated complications, tumour response rates and mean survival was performed. Tumour response was evaluated in accordance with the European Association for the Study of the Liver (EASL) response criteria by two radiologists in consensus reading. Results The choice of TACE procedure (DEB TACE/cTACE) had no significant impact on therapy-associated complications. Objective Response (OR, complete response + partial response) for DEB-TACE was 22.7%; a further 68.2% was stable disease (SD). The respective response rates for the cTACE were OR 22.7 and SD 31.8%. Thus disease control was not significantly increased for DEB TACE (p=0.066). After DEB-TACE mean survival was significantly prolonged with 651 ± 76 days vs. 414 ± 43 days for cTACE (p=0.01). Conclusions Associated with a similar safety profile and an at least comparable tumour response, the DEB-TACE is a method of treatment for HCC that has the potential to improve mean survival compared to cTACE with Cisplatin/Lipiodol.

Even though heterotopic ossification (HO) is most often asymptomatic in patients after total hip replacement (THR), it remains a serious problem in orthopaedics as it is observed in nearly all operated patients.The article presents a pre- and post-operative retrospective analysis of heterotopic ossification based on radiographic evidence. The study involved 77 patients below forty years old who underwent THR due to degenerative changes. Heterotopic ossification was evaluated using Brooker's basic four-grade scale.Heterotopic ossification was diagnosed more often in women. The study confirmed once again that non-steroidal anti-inflammatory drug (NSAID) prophylaxis reduces the risk of ossification. We propose that the hydroxyapatite coating of implants may also contribute to a higher incidence of heterotopic ossification in operated patients.A history of surgical procedures and a lack of NSAID prophylaxis contributed to heterotopic ossification in the region of the replaced hip joint in the study group.

The case of a massive pelvis chondroma in a 15-year-old male is described. The patient was previously treated operatively due to multiple chondro-osseous exostoses. An extensive chondrous tumour was detected in the patient's pelvis and abdomen during a follow-up visit. This was accompanied by symptoms of intestinal obstruction and impaired micturition. CT scans showed an extensive tumour filling the entire minor pelvic cavity and proximal femur with impression and infiltration of the femoral blood vessels, and displacement of both ureters, colon and urinary bladder causing urinary retention. The tumour caused severe disturbances of anatomical relations leading to dysfunction of the urinary and gastrointestinal systems. After appropriate preparation, the patient underwent surgery by a multidisciplinary team comprising an orthopaedic surgeon, a general surgeon and a urologist. After laparotomy and exposure of the retroperitoneal space, a giant (about 3.5 dm3) chondro-osseous tumour was resected. After 5 weeks another operation was made and another tumour, greater than an adult man's fist, was removed from the medial aspect of the right hip. The postoperative course was uncomplicated, the patient felt immediate relief as regards the urinary and gastrointestinal disturbances. His locomotion became noticeably better. A histological examination confirmed the preliminary diagnoses of a chondroma and a chondro-osseous lesion. Outpatient follow-up and additional work-up (ultrasound, CT) showed resolution of urine retention with an appropriate urinary bladder position and tumour-free minor pelvis cavity and proximal femur.

Heterotopic ossification (HO) is defined as pathological bone formation in soft tissues, for example in muscles, where physiologically there is no osseous tissue present. It is one of the most common complications of total hip joint replacement surgery. A wide variety of risk factors for heterotopic ossification have been identified to date. Almost 90% of total hip arthroplasty patients are at high risk for HO. There are two primary methods of preventing heterotopic ossification: pharmacotherapy with NSAIDs (non steroid anti-inflammatory drugs) and radiotherapy. Symptomatic heterotopic ossifications are treated by extracorporeal shock wave therapy (ESWT) and surgery, followed by NSAID pharmacotherapy or radiotherapy. The arterioles adjacent to areas of heterotopic ossification are usually embolized prior to the operation. This article describes the state of the art in the prevention and treatment of heterotopic ossifications based on the available literature.

Cervical spine injuries are common and essential diagnostic problem. Diagnostic imaging is necessary for proper and effective treatment. Helical computed tomography (CT) and plain radiography are the basic diagnostic methods in cervical spine injuries. The purpose of this work was the comparison of CT examination of the upper cervical spine (CI-C2) with patients' clinical state. Twenty four patients (17 men and 7 women) were introduced into the study. The most common cause of cervical spine injuries were car accidents (48.5%). CT examination was performed in all patients. Six patients (25%) had multilevel injury, localized at C1-C2 level and in the lower part of cervical spine. The main pathology diagnosed by CT in the studied group was rotatory subluxation (66.6%). Eight patients (33.3%), with rotatory subluxation did not present any abnormalities in neurological examination performed immediately after the admission to the hospital. C1 and/or C2 fractures were diagnosed in 11 patients (45.8%), in some cases (in 3 patients - 12.5%) they were accompanied by rotatory subluxations. CT examination is the basic technique of diagnostic imaging in a case of cervical spine injuries. It enables quick, accurate and precise evaluation of bone structures and surrounding soft tissues. CT also enables multiplanar imaging and 3-dimentional imaging.

The Sprengel's deformity is a congenital anomaly of the shoulder girdle with an elevation of the scapula and limitation of movement of the shoulder. Sprengel's deformity is frequently associated with cervical spine malformations such as: spinal synostosis, spina bifida and an abnormal omovertebral fibrous, cartilaginous or osseus connection. The diagnosis of Sprengel's deformity is based on a clinical examination and radiological procedures. In every case of Sprengel's deformity plain radiography and computed tomography should be performed. Three-dimensional (3D) reconstructions allow to visualize precise topography and spatial proportions of examined bone structures. 3D reconstruction also enables an optional rotation of visualized bone structures in order to clarify the anatomical abnormalities and to plan surgical treatment.