OKOJ, Volume 1, No. 11

L5-S1 Disc Degeneration

Disk degeneration is a ubiquitous process found in almost everyone by the seventh decade. Fortunately, the majority of patients have either no symptoms or symptoms that are mild or resolve with time. The small proportion of patients with symptoms related to disk degeneration, however, make up a significant proportion of those seeking care in the spine surgeon's office. Management of the symptoms should begin with a focused history and physical examination. Nonoperative management is the mainstay for most degenerative conditions of the lumbar spine. Surgical therapy for degenerative conditions of the lumbar spine should be well designed to address the underlying pathology and meet the goals of the surgeon and patient.

This article reviews the pathophysiology and clinical presentaion of L5-S1 disc degeneration, as well as surgical and nonsurgical treament options. Three surgical techniques are reviewed in detail, including anterior lumbar interbody fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion. Video is available.

    • Keywords:
    • low back pain

    • spondylosis

    • discogenic low back pain

    • disk herniation

    • degenerative spondylolisthesis

    • spinal stenosis

    • degenerative scoliosis

    • degenerative disk disease

    • myelography

    • anterior lumbar interbody fusion

    • ALIF

    • posterior lumbar interbody fusion

    • PLIF

    • transforaminal lumbar interbody fusion

    • TLIF

    • Subspecialty:
    • Spine

Septic Hip

Few orthopedic problems elicit as much anxiety in the on-call physician as that of a possible septic hip in a child. The differential diagnosis is extensive and a ruined hip can result if appropriate treatment is delayed. Although it is not rare, the incidence is not known; 50 percent of cases occur in children younger than 3 years of age. The patient history is often critical in diagnosing a septic hip in a child. Joint aspirate and culture is the most critical test in evaluating an irritable hip. Nonsurgical treatment of hip sepsis has two components: serial aspiration and antibiotic treatment.

The pathophysiology and etiology of septic hip in children is reviewed extensively, and nonsurgical and surgical management considerations and options are discussed in detail. Video is available.

    • Keywords:
    • hip joint

    • septic arthritis

    • joint infection

    • hip infection

    • septic joint

    • bacterial arthritis

    • suppurative arthritis

    • acute septic arthritis

    • pyogenic arthritis

    • gonococcal arthritis

    • Haemophilus influenzae type b

    • H influenzae type b

    • Staphylococcus aureus

    • S aureus

    • bone scan

    • scintigraphy

    • joint aspiration

    • culture

    • arthrotomy

    • arthroscopy

    • Subspecialty:
    • Pediatric Orthopaedics