Jerrold H. Mink

Early experience with automated percutaneous lumbar discectomy in the treatment of lumbar disc herniation.

Seventeen patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy employing local anesthetic in an outpatient setting. Operative technique included (1) intravenous sedation and single-dose antibiotics, (2) prone oblique patient positioning for initial needle placement, and (3) postdiscectomy interspace lavage with bupivacaine hydrochloride. There were no postoperative complications and the procedure was well-tolerated by all patients. Although results have thus far been less successful than previously reported, with improved patient selection by means of routine magnetic resonance imaging (or computed tomographic discography in select cases), success rates (nine of 17 patients) might approach those achieved by chemonucleolysis. The successful response of four patients with so-called midline L4-L5 discs has been particularly encouraging, and it may be that percutaneous lumbar discectomy will be an effective and a reasonable treatment alternative for this particular subgroup of patients.

The cervical spine: radiologist's perspective

This article provides an essential curriculum in cervical spine radiology. It discusses the uses of plain radiographs, MR imaging, computed tomography (CT), and CT myelography, in addition to the methodologies of discography, epidural injections under visualization, and facet and nerve root injections. It explains how radiographic images of the cervical spine can differentiate tumors, inflammation, recent or prior trauma, and the range of discal, arthritic, neural, and vascular cervical pathologies and, just as importantly, when they cannot.

Effect of a newly designed patellar realignment brace on patellofemoral relationships

The effect of applying a newly developed patellar realignment brace to a patient with lateral subluxation of the patella was evaluated using active movement, loaded kinematic magnetic resonance (MR) imaging. The brace corrected the lateral displacement of the patella as shown on the kinematic MR imaging study. The patient underwent physical rehabilitation in conjunction with the use of the patellar realignment brace and has had resolution of her painful symptoms for the past 4 months.

Tendon injuries of the lower extremity: Magnetic resonance assessment

MR is rapidly establishing itself as a premiere imaging modality for the assessment of musculoskeletal trauma. Its utility in the evaluation of the menisci and ligaments of the knee is well known, but there is far less known about the use of MR for evaluation of the tendons. MR, by virtue of its unmatched soft tissue resolution capability, can determine not only the contour of an affected tendon, but the tendon sheath and internal signal alterations that accompany tendonitis, partial and complete ruptures. Injuries to the Achilles tendon are well known to the athlete and the imager alike; however, abnormalities of the posterior tibial tendon, peroneal tendon, and flexor hallucis longus also result in significant clinical symptoms, as well as imaging abnormalities.

Articular disorders of the knee

In no musculoskeletal area has the marked growth and expansion of interest in the application of magnetic resonance imaging (MRI) been more evident than in assessment of articular disorders of the knee.1–27 The high accuracy of the method, coupled with its noninvasive nature and lack of operator dependence, has allowed MRI to challenge and indeed rapidly replace arthrography in many institutions. In addition to evaluation of meniscal and ligamentous abnormalities, MRI has demonstrated a markedly expanded diagnostic capacity to include a wide spectrum of abnormalities that may previously have escaped early detection with the use of arthrography or arthroscopy. It is anticipated that future technologic advances will further the diagnostic efficacy of the technique and its ultimate contribution to patient management. This article is based on our experience with more than 3,500 MR examinations of the knee. The discussion will emphasize salient aspects of technique, normal and pathologic anatomy, and potential pitfalls in interpretation of the examination. The accuracy of the method and its relation to other diagnostic techniques will be addressed.