Degenerative spondylolisthesis

The clinical and pathological findings in a group of 260 homosexual men comprising 10% of a private proctologic practice are reviewed. A clinical pattern of anorectal and colon diseases encountered with unusual frequency in these homosexual patients is termed the gay bowel syndrome. The clinical diagnoses in decreasing order of frequency include condyloma acuminata, hemorrhoids, nonspecific proctitis, anal fistula, perirectal abscess, anal fissure, amebiasis, benign polyps, viral hepatitis, gonorrhea, syphilis, anorectal trauma and foreign bodies, shigellosis, rectal ulcers and lymphogranuloma venereum. 60 anorectal and sigmoid biopsies from 51 patients failed to disclose evidence of specific infection other than condyloma acuminata. Of 21 patients with biopsy diagnosis of nonspecific proctitis, 8 had a specific infection which was detected by other means,--5 cases of shigellosis and one case each of gonorrheal proctitis, amebiasis and lymphogranuloma venereum. In evaluating proctologic problems in the gay male, all of the known sexually transmitted diseases should be considered. Shigellosis, amebiasis and viral hepatitis should be included. Microbiological evaluation is essential. Concurrent infections with 2 or more pathogens should be anticipated. Chlamydia trachomatis, an important cause of nonspecific urethritis in the general population, is high on the list of possible causes of the nonspecific proctitis present in 31 of the 260 patients.     

SPECT evaluation of lumbar spondylolysis and spondylolisthesis

Fifty patients with back pain and radiologically diagnosed spondylolysis were evaluated by a single-photon emission computed tomography (SPECT bone scanning). These patients were separated into three groups according to the degree of spondylolisthesis accompanying the spondylolysis. The data obtained from the study indicate that in acute spondylolysis, the SPECT scan is positive at the pars interarticularis. As the spondylolysis becomes chronic, the SPECT scan tends to revert toward normal even though healing of the spondylolysis has not occurred. As spondylolisthesis develops and progresses, the SPECT scan again becomes positive. The positivity, however, is more anterior and more diffuse. The authors propose that SPECT scanning in spondylolysis is not a positive or negative process, but rather varies with the time and stability of the spondylolytic spine.     

Treatment of spondylolysis and spondylolisthesis in children and adolescents

The treatment of spondylolysis and spondylolisthesis in children depends on the severity of clinical symptoms, pathologic anatomy, and prognosis. Simple spondylolysis can be cured by immobilization alone in selected cases, or by surgery when it remains symptomatic and resistant to nonoperative treatment. The majority of cases are asymptomatic and require no treatment. Spondylolisthesis is classified into 2 types based on the magnitude of the lumbosacral angle: spondylolisthesis with a horizontal sacrum (lumbosacral angle > or = 100 degrees), which seldom requires surgical treatment, usually responds to orthotic management, and generally shows little progression; spondylolisthesis with a vertical sacrum (lumbosacral angle < 100 degrees) which is always progressive, can produce neurologic impairment and cosmetic and functional disability, and requires surgical treatment. In 17 cases the author has reduced the latter deformity by gradual traction in hyperextension followed by cast immobilization, then stabilized the reduction by posterolateral fusion performed through the cast without instrumentation and without opening the spinal canal. When the lumbosacral angle is not improved to 100 degrees or more by hyperextension and traction, an anterior console interbody fusion is added before the posterolateral fusion.     

Spondylolysis associated with Arnold-Chiari malformation and syringomyelia. A report of two cases

STUDY DESIGN: This is a report of two cases. OBJECTIVE: To document the occurrence and association of spondylolysis and Arnold-Chiari malformation Type I. SUMMARY OF BACKGROUND DATA: The association of spinal dysraphism has been reported with Arnold-Chiari Type II, but not with Arnold-Chiari Type I. METHODS: The senior author was involved in the care of these patients. All medical records, laboratory and radiologic investigations, and related literature were reviewed. RESULTS: The presence of cephalic and caudal neuropore maldevelopment may be present in various combinations. The presence of spondylolysis, with or without spina bifida occulta, associated with Arnold-Chiari malformation type I and syringohydromyelia, is demonstrated. CONCLUSIONS: In some patients, the presence of spondylolysis may represent a congenital anomaly and may be associated with cephalic neuropore maldevelopment, such as cerebromedullary malformation syndrome (i.e., Arnold-Chiari malformation Type I).     

Diabetes mellitus and sports

The adolescent with insulin-dependent diabetes mellitus (IDDM) can safely participate in sports activities without interference from the disease. To ensure safe and successful participation, clinicians must appreciate how diabetes may alter the physiologic adaptation to strenuous exercise and how an individualized self-care plan can empower the adolescent with IDDM to effectively manage meal planning, blood glucose testing, and insulin injections. Various types of insulin, insulin schedules, and insulin delivery devices that may suit a wide variety of training and activity regimens are described.     

The cardiovascular system and sports

The article deals with the athlete's heart syndrome as well as the views on this phenomenon throughout this century. The basic diagnostic procedures for heart examination as a part of general medical examination are listed. The authors confront the position recommendations of American and European authors for determining eligibility for competition in athletes with cardiovascular abnormalities.     

Posterolateral fusion for radicular pain in isthmic spondylolisthesis

Reported is the outcome for 25 patients in whom spondylolisthesis with radicular pain was treated by posterolateral fusion alone (Group A). These outcomes are compared with those obtained in 23 other patients with the same symptomatology and spondylolisthesis treated by root release and posterolateral fusion (Group B). Most patients had Grade I or II isthmic spondylolisthesis. Results were assessed functionally and radiographically with an average followup of 32 months. Posterolateral fusion in situ provided excellent or good results in 88% of patients according to the modified classification of Stauffer and Coventry. In Group A, radicular pain at exertion disappeared in 92% of patients, and radicular pain at rest disappeared in 88%. In Group B, radicular pain at exertion disappeared in 65% of patients, and radicular pain at rest disappeared in 70%. There was no significant statistical difference between the 2 groups. Resection of the loose lamina and root decompression do not seem to be mandatory. The overall fusion rate was 81%. Instrumentation in case of instability and the use of allografts are advised.     

Paradoxical motion in spondylolisthesis due to two-segment instability

We report here a paradoxical motion in unstable spondylolytic spondylolisthesis: a more forward displacement of the L5 vertebral body on the sacrum on the standing extension view than on the standing flexion view. An axial loading through the inferior articular process of the posteriorly displaced L4 on extension appears to be the cause, while the instability in the two contiguous segments may be an important contributing factor.     

Injury pattern in a sports club with its own sports physician

As the first Danish athletic association, TST-79 in 1995 appointed a permanent sports doctor for use by all its members. We publish the results of the first year. Seventeen percent of all handball players and 11% of all football players were seen in the consultation. The athletes were between 10 and 69 years old. Seventy-eight percent of the injured athletes could be diagnosed, instructed and, if necessary, treated after one consultation. Eight percent were sent for further examination at a hospital. Ultrasound examinations were necessary for establishing the diagnosis in 10% of the injured athletes. Some of the injuries were serious, and would probably not have been seen if the athletes did not have the possibility of consulting a sports doctor. This would increase the risk of chronic injury. It is suggested that a permanent arrangement with a sports doctor is an economically reasonable investment.     

Assessing agreement between measurements recorded on a ratio scale in sports medicine and sports science

In the literature, it is usual to find women and younger subjects reporting higher levels of dental anxiety than men and older subjects. Fear of pain was found to be the most important predictor of dental anxiety and issues of control were also related to such anxiety. Therefore, it was predicted that gender and age differences would be reflected in attitudes to pain and control. Subjects were randomly selected from the voters' list in metropolitan Toronto and mailed a questionnaire with a request for cooperation in a study of their thoughts, feelings, and behaviour regarding dental treatment. The questionnaire included demographic data, measures of dental anxiety and painful experiences as well as the Pain Anxiety Symptoms Scale and the Iowa Dental Control Index. The results supported the main predictions. In addition, attitudes to pain and control were found to be complex phenomena with characteristic gender differences.     

Tobacco, youth, and sports

Cigarette smoking constitutes the single largest threat to the health and longevity of American youth. Each year, almost 400,000 people die prematurely from tobacco-related diseases. Moreover, 90% of adult smokers began using tobacco before their eighteenth birthday, and each day 3,000 children and adolescents begin smoking. Smokeless tobacco use is less prevalent than cigarette smoking but has similar deleterious health effects and is often also glamorized by sports figures. This article examines the relationship between tobacco and sports and offers specific steps that physicians (specifically orthopedic surgeons and sports medicine physicians, who interact with athletes at sporting events and in schools as well as at the clinic) can take to help prevent or minimize tobacco use. Although sports have been used by the tobacco industry to promote tobacco products to young people, the authors suggest new ways to prevent its success.     

Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with chronic back pain and previously asymptomatic low-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: The role of previously asymptomatic low-grade isthmic spondylolisthesis in chronic adult low back pain is unclear. Operative intervention in this setting is controversial. METHODS: Twenty-four consecutive adult patients with chronic low back pain and low-grade isthmic spondylolisthesis first detected during routine work-up of new onset low back pain underwent spinal fusion with or without decompression. The influence of active worker's compensation or litigation claims, radicular pain, concomitant laminectomy, age, gender, fusion to L4, intervertebral disc bulge, and pseudarthrosis were investigated. RESULTS: All 13 patients involved in worker's compensation claims or pending litigation had fair or poor results. Nine of 11 patients without such issues had good or excellent results. Although the strong association of worker's compensation with poor results made it difficult to assess the importance of other risk factors, the data suggest that good results may be more likely in patients with radiculopathy who undergo laminectomy. CONCLUSIONS: This investigation, although limited by a number of factors including small sample size and retrospective, unblinded review, suggests that active worker's compensation and litigation issues are associated strongly with poor results of operative management for chronic low back pain in adult patients with low-grade spondylolisthesis.     

Sacrospinalis muscle-pedicle bone graft in posterolateral fusion for spondylolisthesis

From 1984 to 1995, 68 ankylosed elbows and 11 which were unstable after trauma were replaced in India by Baksi sloppy hinge prostheses. The mean age of the patients was 28.6 years (17 to 70) and the mean follow-up 9.6 years (2 to 13.5). Of the 68 ankylosed elbows, 59 (87%) regained a mean arc of painless movement of 88.5 degrees (27 to 115). The mean improvement of supination was 24 degrees and of pronation 16.5 degrees . There were 54 good results (80%), eight fair and three poor. There were two complete failures due to infection, and one due to a broken humeral stem. Of the 11 unstable elbows, the nine with good results had a mean arc of 125 degrees (15 to 140) of painless stable movement, with a mean improvement in supination of 26 degrees and of pronation of 19.5 degrees . There was one fair result and one failure due to loosening with subsequent late infection. There were significant complications in 14 cases with infection in seven and aseptic loosening in four. Patients with loosening or late removal of the prosthesis often retained reasonably stable elbow movement because periprosthetic fibrosis had connected the approximated bone ends, and muscle balance had been restored.     

Microdecompression and uninstrumented single-level fusion for spinal canal stenosis with degenerative spondylolisthesis

STUDY DESIGN: A retrospective review was completed on 21 patients who had a "least invasive" (one or two level) microdecompression and uninstrumented single-segment lumbar fusion for spinal canal stenosis with degenerative spondylolisthesis. OBJECTIVE: To determine whether a "least invasive" approach to lumbar spinal canal stenosis and degenerative spondylolisthesis would yield acceptable results. SUMMARY OF BACKGROUND DATA: The prevailing surgical technique for symptomatic spinal canal stenosis with degenerative spondylolisthesis is a wide midline decompression and instrumented fusion. METHODS: On an average of 38 months postoperatively, 21 patients were personally assessed on four scores: 1) their overall satisfaction with the outcome of surgery, 2) an analog back and leg pain scale, 3) a functional evaluation scale, and 4) Ferguson (upshot) anterior-posterior lumbosacral and lateral flexion-extension radiographs. RESULTS: The overall satisfactory outcome on all four scales was 16 (76%) of 21. Twenty of twenty-one patients had relief of their claudicant leg pain; the overall fusion rate was 18 (86%) of 21. Two of three patients with a pseudarthrosis had a successful outcome on the patient-oriented outcome (1, 2, and 3) scales (excluding the radiograph scale), and one was a failure. One patient with a solid fusion was a failure because of continuing back pain. One patient with a solid fusion was a failure because of continuing leg pain. The overall satisfactory outcome on the nonradiographic scales was 18 of 21, for an 86% patient satisfaction rate. CONCLUSIONS: In this retrospective study, a "least invasive" surgical approach to lumbar degenerative spondylolisthesis with spinal canal stenosis causing claudicant leg pain produced acceptable results.     

Athlete age and sports physical examination findings

BACKGROUND: Interscholastic and intercollegiate athletes commonly visit physician offices to have sports participation examinations (PPEs). Few data exist, however, to help determine the age range for which such examinations are reasonable. The purpose of this study was to determine the percentage of athletes with significant findings on sports PPEs among junior high school, high school, and college-age athletes. METHODS: Analyses were made of 937 consecutive PPEs that were performed by primary care physicians using a standardized form. Subjects were interscholastic athletes of junior high, high school, and college age. Significant findings were defined as those that resulted in any recommendation, ie, change in management, by the examining physician. RESULTS: The incidence of significant findings was 3.4% for the junior high school athletes, 15.4% for high school athletes, and 33.9% for college athletes (P < .001). The overall percentage of athletes disqualified from participating in any sport, which was 1.7%, did not differ significantly across age levels. CONCLUSIONS: In this sample, college and high school athletes were much more likely than junior high school athletes to have significant findings on sports. PPEs. These data cast uncertainty on the necessity of annual PPEs to screen athletes of junior high school age.