By Henry Vernon Crock M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)
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Additional info for Practice of Spinal Surgery
A micro-photograph (x 60 approximately) showing the capillary bed in the vertebral end-plate cartilage in the lower lumbar ragion in an adult dog. Note the drainage of these capillaries directly into the marrow spaces of the vertebral bodies. This is almost certainly the pathway for the passage of substances from a damaged "avascular" disc into the patient's immune system. (Prepared by Drs. H. V. Crock and M. S. 6. A photo micrograph (x 20 approximately) to show the distribution of capillaries in the vertebral end-plate cartilages at the anterior disc margin in the lower lumbar disc of an adult dog.
The acute reaction is usually short-lived, responds to conservative anti-psychotic treatment readily and seldom needs intensive psychiatric or physical treatment. "Given that patients, suffering from this syndrome, are probably prone individuals of whom there is no dearth in the normal community, it could be fairly said that even with a mild whiplash injury to the neck, a state of depression follows. ii) Reaction to Prolonged Disease "With more serious disc disease-particularly of the cervical spine-one finds the second typical syndrome, characterized by irritability, intolerance to noise, periods of severe depression, headaches starting at the back of the head, going over the front of the head and often causing blurring of the vision, a gross degree of introspection which is again probably a factor of a true depressive illness, reduced sexual function, in both male and female and extending particularly in the male to the state of complete impotence, dizziness often postural in type and frequently directly related to the intensity of the headache; pain in the limbs not corresponding to the anatomical areas of sensory supply but notably consistent over a great number of patients, a poor memory and reduced concentration.
Gross disc disruption is shown. 9a and b. Lateral X-rays of the lumbar spine to show the plain film appearance and the gross disc disruption at three levels demonstrated by discography Many authorities have tended to play down the importance of discography when their personal experience of it is small (Epstein, 1969; De Palma and Rothman, 1970). T. scanning may be used with greater effect (Collis, 1963). The indications for discography are: (1) in suspected cases of internal disc disruption assessed on the clinical syndrome; (2) in suspected cases of internal disc disruption in patients who have had failed "laminectomies"; (3) as a supplementary test following negative myelography; (4) in some cases of spondylolisthesis to determine if adjacent discs are disrupted; and (5) to plan the level and extent of spinal fusion in lumbar spondylosis.
Practice of Spinal Surgery by Henry Vernon Crock M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)