Spinal Stenosis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

SPINAL STENOSIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Spinal Stenosis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84076-8 1. Spinal Stenosis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on spinal stenosis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON SPINAL STENOSIS ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Spinal Stenosis.............................................................................. 5 The National Library of Medicine: PubMed ................................................................................ 13 CHAPTER 2. NUTRITION AND SPINAL STENOSIS ............................................................................ 57 Overview...................................................................................................................................... 57 Finding Nutrition Studies on Spinal Stenosis............................................................................. 57 Federal Resources on Nutrition ................................................................................................... 59 Additional Web Resources ........................................................................................................... 59 CHAPTER 3. ALTERNATIVE MEDICINE AND SPINAL STENOSIS ...................................................... 61 Overview...................................................................................................................................... 61 National Center for Complementary and Alternative Medicine.................................................. 61 Additional Web Resources ........................................................................................................... 66 General References ....................................................................................................................... 68 CHAPTER 4. DISSERTATIONS ON SPINAL STENOSIS ........................................................................ 69 Overview...................................................................................................................................... 69 Dissertations on Spinal Stenosis.................................................................................................. 69 Keeping Current .......................................................................................................................... 69 CHAPTER 5. CLINICAL TRIALS AND SPINAL STENOSIS................................................................... 71 Overview...................................................................................................................................... 71 Recent Trials on Spinal Stenosis.................................................................................................. 71 Keeping Current on Clinical Trials ............................................................................................. 76 CHAPTER 6. PATENTS ON SPINAL STENOSIS ................................................................................... 79 Overview...................................................................................................................................... 79 Patents on Spinal Stenosis........................................................................................................... 79 Patent Applications on Spinal Stenosis ....................................................................................... 82 Keeping Current .......................................................................................................................... 84 CHAPTER 7. BOOKS ON SPINAL STENOSIS ...................................................................................... 85 Overview...................................................................................................................................... 85 Book Summaries: Online Booksellers........................................................................................... 85 The National Library of Medicine Book Index ............................................................................. 86 Chapters on Spinal Stenosis......................................................................................................... 86 CHAPTER 8. MULTIMEDIA ON SPINAL STENOSIS............................................................................ 89 Overview...................................................................................................................................... 89 Bibliography: Multimedia on Spinal Stenosis ............................................................................. 89 CHAPTER 9. PERIODICALS AND NEWS ON SPINAL STENOSIS ......................................................... 91 Overview...................................................................................................................................... 91 News Services and Press Releases................................................................................................ 91 Newsletter Articles ...................................................................................................................... 92 Academic Periodicals covering Spinal Stenosis ........................................................................... 93 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 97 Overview...................................................................................................................................... 97 NIH Guidelines............................................................................................................................ 97 NIH Databases............................................................................................................................. 99 Other Commercial Databases..................................................................................................... 101 APPENDIX B. PATIENT RESOURCES ............................................................................................... 103 Overview.................................................................................................................................... 103 Patient Guideline Sources.......................................................................................................... 103 Finding Associations.................................................................................................................. 108

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APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 111 Overview.................................................................................................................................... 111 Preparation................................................................................................................................. 111 Finding a Local Medical Library................................................................................................ 111 Medical Libraries in the U.S. and Canada ................................................................................. 111 ONLINE GLOSSARIES................................................................................................................ 117 Online Dictionary Directories ................................................................................................... 118 SPINAL STENOSIS DICTIONARY........................................................................................... 121 INDEX .............................................................................................................................................. 153

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with spinal stenosis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about spinal stenosis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to spinal stenosis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on spinal stenosis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to spinal stenosis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on spinal stenosis. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON SPINAL STENOSIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on spinal stenosis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and spinal stenosis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “spinal stenosis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Lumbar Spinal Stenosis: Clinical Presentation and Management Source: Clinical Geriatrics. 4(12):33-42. November 1996. Summary: This article reviews the clinical presentation of lumbar spinal stenosis (LSS), an approach to diagnosis, and current treatment methods with a special emphasis on the management of the geriatric patient population. It explains that LSS is a frequent problem in older people and is usually due to degenerative changes that occur as the skeleton ages, changes that result in nerve root compression. Patients usually present with leg pain or weakness, or both. Pain is usually exacerbated by standing or walking and is not relieved until the patient resumes a sitting or flexed posture. In mild cases, patients respond to conservative measures, including prescribing nonsteroidal antiinflammatory drugs to control the back pain and training patients to do activities in the flexed position such as using a walker to facilitate walking. Also, about 90 percent of

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patients are significantly helped through surgery with infrequent postoperative complications. 5 tables, and 27 references. •

Spinal Stenosis: Making the Diagnosis, Offering Relief Source: Journal of Musculoskeletal Medicine. 13(8): 46-48,52,57-58; August 1996. Summary: This journal article for health professionals, the sixth in a special series of articles on diagnosis and management of back pain and other spinal problems, explains how changes in spinal anatomy lead to lumbar spinal stenosis and produce associated symptoms. Changes that lead to degenerative lumbar stenosis include formation of osteophytes around the vertebrae and facet joints and hypertrophy of the vertebrae and apophyseal joints. The article also discusses spinal stenosis in terms of symptoms, physical examination findings, diagnostic studies, and management options. Neurogenic claudication is the hallmark symptom of spinal stenosis. Pain characteristically occurs after walking or standing and is alleviated by sitting. Symptoms also tend to decrease with lumbar flexion. Pain during palpation of the spine, Lasegue's sign, and nerve root signs may be present or absent. Roentgenograms and other imaging studies show the extent of stenosis, but findings do not necessarily correlate with symptoms. Electrodiagnostic studies may provide objective neurophysiologic information. The cornerstone of conservative management is exercise. Patients who do not respond or are severely affected often benefit from surgery. 16 references, 3 figures, and 2 tables. (AA-M).

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Nonoperative Treatment for Lumbar Disc Herniation With Radiculopathy and for Lumbar Spinal Stenosis Source: Current Opinion in Orthopedics. 10(2): 137-141. April 1999. Summary: This journal article provides health professionals with information on nonoperative treatment for lumbar disk herniation with radiculopathy and for lumber spinal stenosis, focusing on randomized controlled trials assessing the efficacy of nonoperative interventions for treatment of lumbar radiculopathy with herniated nucleus pulposus (HNP) and spinal stenosis and on studies possibly affecting the management of the nonoperative approaches. Once a patient is diagnosed with lumbar radiculopathy and HNP or lumber spinal stenosis, the patient is likely to receive a course of nonoperative treatment. In most cases, these patients have improvement of their symptoms over time and do not need an operative intervention. These treatments include bed rest, medications, physical therapy, and epidural steroid injections. Short term bed rest with early mobilization is recommended for most patients with back pain. Although physical therapy is often recommended, there is a lack of evidence demonstrating its efficacy in either condition. Epidural steroid injections may provide some relief, if only temporary, for patients with lumbar radiculopathy with HNP; however, results and expectations are limited for the use of these injections in patients with spinal stenosis. There may be a role for spinal manipulation in nonspecific low back pain, but there is no study that supports the use of this modality in lumbar disk herniation. In light of these options, the patient and the surgeon must have realistic expectations and goals. The ability to predict which patients are likely to fail conservative treatment and which nonoperative intervention would best relieve the pain and decrease the length of disability is key to optimizing therapy. 39 references. (AA-M).

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Arthritis 101: Spinal Stenosis Source: Arthritis Today. 13(6): 32. November-December 1999.

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Summary: This journal article provides people who have arthritis with information on the cause and treatment of spinal stenosis. This painful condition is the cause of back pain in many people over 50 who have osteoarthritis (OA). Changes to the spine caused by OA lead to bony overgrowth of the vertebrae. In some people, this bony overgrowth causes the spinal column to narrow and press on the nerves housed within it, resulting in spinal stenosis. Treatment consists of taking nonsteroidal anti-inflammatory drugs to relieve pain or undergoing physical therapy. If these measures fail, surgery may be recommended. The simplest and most common surgery for spinal stenosis is laminectomy. Another surgical option is spinal fusion. 1 figure. •

Sciatica: Verifying the Diagnosis, Offering Relief Source: Journal of Musculoskeletal Medicine. 15(1): 51-59. January 1998. Summary: This journal article, the second in a special series on back pain, provides health professionals with information on diagnosing and treating sciatica. Sciatica is pain that radiates along the course of one or more of the roots of the sciatic nerve to a point below the knee. One or both legs may be involved. The article offers a detailed approach to taking the history and performing the physical examination. The history focuses on eliciting symptoms of sciatica and back pain, finding out when the pain began, and documenting the progression. The examination includes a gross assessment as well as a sensory and motor evaluation targeted at areas supplied by sciatic nerve components. Provocative tests detect neural irritability. Of these, the bowstring sign may be more sensitive than the straight leg raising test. Common causes of sciatica include herniated disc, spinal stenosis, and spondylolisthesis. Magnetic resonance imaging and myelography can confirm these diagnoses. No reproducible scientific evidence indicates that any specific treatments, including corticosteroids and chiropractic manipulation, can predictably alter the long-term clinical course of sciatica. Management is directed at reducing pain without the prolonged use of narcotic medication. 4 figures, 4 tables, and 9 references. (AA-M).

Federally Funded Research on Spinal Stenosis The U.S. Government supports a variety of research studies relating to spinal stenosis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to spinal stenosis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore spinal stenosis. The following is typical of the type of information found when searching the CRISP database for spinal stenosis: 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Project Title: ASSESS & IMPROVE THE QUALITY OF CARE FOR LOW BACK PAIN Principal Investigator & Institution: Birkmeyer, Nancy J.; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: As reflected in the-topic of this proposal, the applicant has two main career goals: (I) to evaluate the quality of surgical and non-surgical treatment for low back pain; and (2). to reduce variation in treatment practices and improve the outcomes of treatment for these conditions. This five-year project combines the use of outcomes research and continuous quality improvement techniques to close the gap between knowledge gained through outcomes research and clinical practices to improve outcomes for patients with low back pain. Despite its frequency and related costs, little is known about the quality of care for spinal disorders. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trials (SPORT) presents a unique opportunity to study, compare, and improve outcomes for patients undergoing treatment for three surgically treatable spine conditions: herniated disc, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions that is being conducted at II U.S. medical centers and expects to enroll approximately 3000 patients. The overall goals of this proposal are to evaluate and improve the quality of care for low back pain through a comparative study of the structure, process, and outcomes of care at medical centers participating in SPORT. Specifically, this proposal has three research objectives: 1. To characterize clinical practices. We plan a detailed study of variability in structures and processes of care for patients with low back pain at the sites participating in SPORT. 2. To assess outcomes of care. After developing and validating methods for risk-adjustment, we will evaluate and compare quality of care for low back pain across the II sites participating in SPORT. Outcomes, to be assessed in both surgically and non-surgically treated patients, will include functional health status, clinical outcomes, patient satisfaction, and cost. 3. To link clinical practices and outcomes. Using statistical models to account for random variation in the setting of hierarchical data structures, we will examine associations between clinical structure, process, and outcomes to identify high-leverage areas for improvement. Improving clinical care can not occur in the vacuum of a research laboratory. At each step of this project, we will feedback data to clinicians at the participating medical centers and work with them to develop a focused quality improvement agenda that is designed to improve patient outcomes by reducing variability in clinical practices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL DECISION MAKING IN LOW BACK PAIN Principal Investigator & Institution: Lurie, Jon D.; Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The applicant has the broad career goal of improving the diagnostic evaluation, treatment recommendations, and health outcomes for patients with low back pain. In this project he proposes to extend his prior training in outcomes research, technology assessment, medical decision-making, and biostatistics. These advanced quantitative skills will be used to identify optimal treatment strategies for subgroups of low back pain patients defined on the basis of

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clinical and radiologic features. Low back pain is one of the most prevalent and costly health problems in the industrial world. Back surgery is nearly always elective, yet the rates of spine surgery in the US have increased dramatically in the past 10 years and show marked geographic variation. Both the First and Second International Forums for Primary Care Research on Low Back Pain chose the identification of important clinical subgroups of low back pain patients based on characteristics, imaging studies and other factors as their number one research priority. The data and infrastructure provided by the recently initiated Spine Patient Outcomes Research Trial (SPORT) presents a unique opportunity to study the predictors of outcome for patients with herniated discs, spinal stenosis, and degenerative spondylolisthesis. SPORT is a set of clinical trials designed to compare the effectiveness of surgical and non-surgical approaches to the treatment of these conditions; it is being conducted at I I U.S. medical centers and expects to enroll approximately 3000 patients. Extensive clinical, functional status, quality of life, and imaging data will allow for an unprecedented ability to identify optimal treatment approaches for these patients. This five-year project combines the use of outcomes research and decision analytic techniques to better understand the predictors of outcome with surgery and non-surgical treatment. After a period of additional training in decision in mdeling and biostatistics, the applicant will work closely with the Principal Investigator and Co-Principal vestigators of SPORT to accomplish two specific research objectives: To identify patient subgroups, defined by clinical and radiographic features at baseline, that are predictive of good/bad outcome with surgical/nonsurgical treatment among patients with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis with associated stenosis. To develop decision analytic models for specific patient subgroups, which also accommodate individual patient preference and quality of life data, for the purpose of identifying optimal treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF LUMBAR SPINE SURGERY: RATES AND TRENDS Principal Investigator & Institution: Deyo, Richard A.; Professor; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Spine surgery rates in the United States exceed those in most developed countries by at least twofold. Furthermore, they increased 55 % during the 1980's. Wide geographic variations in surgical rates may imply professional uncertainty about optimal indications. Recent technical changes in spine surgery, including new spinal implants and a shift towards ambulatory surgery, may affect surgical rates and reoperation rates. The goals of this project are to examine whether surgical rates continue to rise, and if the introduction of interbody fusion cages resulted in acceleration of surgery rates: to examine surgical rates among the elderly and for spinal stenosis in particular to examine whether reoperation rates are increasing over time; and to determine if certain surgical procedures are associated with unusually high rates of reoperation. The analyses will make use of existing survey and administrative data. We will use a previously validated algorithm for identifying patients with lumbar spine surgery from automated data, as well as a previously validated comorbidity index. National rates of surgery will be examined using the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project, both available from the National Technical Information Service, Examination of rates and trends among elderly patients, and especially for spinal stenosis, will make use of these national databases and of

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Medicare claims data for selected years. The analysis of reoperation rates will depend largely on a Washington State hospital discharge registry which will provide data from 1987 through 2000. Reoperation rates will also be examined using Medicare claims data. Finally, we hope to examine the growth of ambulatory disc surgery, which became increasingly popular after 1994. Although previously available surveys of ambulatory surgery are no longer available, we will have an opportunity to examine the growth of the ambulatory surgery using Medicare claims data, and some state ambulatory surgery databases. This series of analyses is important because it will help to clarify factors associated with changes in surgical rates. It will also help to assess the impacts of recent technical and practice innovations. Reoperation is generally regarded as an unfavorable outcome of lumbar spine surgery, and rising reoperation rates would be alarming. Thus, rates and trends in the use of spinal surgery and repeat operations may help identify high priorities for research, suggest areas requiring a more consistent therapeutic approach, and indicate possible problems in quality of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOW BACK PAIN--A MULTICENTER RANDOMIZED TRIAL Principal Investigator & Institution: Weinstein, James N.; Professor; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 04-JUL-1999; Project End 31-MAY-2004 Summary: Low back pain is considered one of the most widely experienced health problems in the U.S. and the world. This condition is second only to the common cold as the condition for which patients most frequently see a physician or suffer days lost from work. Estimated costs to those who are severely disabled from low back pain range from 30-70 billion dollars annually. Rates of spinal surgery in the U.S. have increased sharply over time, and 15-fold geographic variation in rates of these surgeries has been documented. In many cases the rates of surgery appear to be determined by where one lives and who one sees. Despite these trends, there is little evidence proving the effectiveness/efficacy of these therapies over non-operative management. This study will use the unique resource of the National Spine Network to conduct multicentered, randomized, controlled trials for the three most common diagnostic groups for which spine surgery is performed: lumbar intervertebral disc herniation (IDH), spinal stenosis (SpS) and spinal stenosis secondary to degenerative spondylolithesis (DS). The trials will compare the most commonly used standard surgical treatments to the most commonly used standard non-operative treatments. The study will be conducted at 16 sites throughout the United States. The primary endpoints of the study will be changes in general health-related quality of life as measured by the SF-36 health status questionnaire and spine-related disability as measured by the Oswestry Low Back Pain questionnaire. Secondary endpoints will include patient satisfaction with treatment, resource utilization for estimation of cost, and utility for current health for estimation of quality-adjusted life years (QALYs). The latter two endpoints will be used to complete a formal cost-effectiveness evaluation. Patients will be followed a minimum of 24 months with visits scheduled at 3, 6, 12, and 24 months. Data on all endpoints will be collected at each study visit. If possible, extended follow-up visits will be scheduled at 36 and 48 months. We anticipate that a total of 1450 subjects will be enrolled and randomly allocated. An additional observational cohort will be tracked to assess health and resource outcomes. Data from the RCT and observational cohorts will be integrated to formally estimate the cost-effectiveness of operative versus non-operative interventions for IDH, SpS, and DS. Based on this trial we will, for the first time, have scientific

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evidence as to the relative effectiveness/efficacy of surgical versus non-surgical treatment for these three common lumbar spine conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAINE LUMBAR SPINE STUDY Principal Investigator & Institution: Keller, Robert B.; Executive Director; Maine Medical Assessment Foundation Manchester, Me 043510249 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-JUL-2002 Summary: This proposed follow-up study is a competitive renewal of the Maine Lumbar Spine Study (MLSS). The MLSS, initially funded as part of the Low Back Pain PORT, enrolled over 600 patients with either sciatica or spinal stenosis in 1990/92. Patients were recruited through community-based physicians (orthopedists, neurosurgeons, and occupational medicine) for this observational study. The main goal was to compare patient-centered outcomes for patients who underwent surgery vs. those who did not. After extensive baseline data collection, patients have been resurveyed every year, with a good retention rate of approximately 80% of the surviving cohort at 8 years. The study has so far published 11 peer-reviewed papers with results of up to 5 years of follow-up. Data covering 8 years of follow-up have already been collected, years 9 and 10 are in process, and funding is requested to complete the 10 years of follow-up for all retained participants and to perform additional analyses. This application requests continued funding for 18 months, at a reduced level. The PI is based in Maine, which is the location of the cohort, and is now a consultant for the applicant organization. Subcontracts with MGH (Dr. Atlas), and the University of Washington (Dr. Deyo) are proposed, to continue collaborative efforts with investigators who have been involved with MLSS since its inception. Dr. Singer (MGH) is also proposed as a consultant, but not through the MGH subcontract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROPHYSIOLOGY HYPERALGESIA

OF

PAIN

ADAPTATION

AND

Principal Investigator & Institution: La Motte, Robert H.; Professor; Anesthesiology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-JUL-1978; Project End 31-MAR-2003 Summary: (Adapted From The Applicant's Abstract): When primary neurons are injured in humans and experimental animals, hyperalgesia can develop to heating or, more commonly, to mechanical stroking and indentation of cutaneous territory of the nerve. In rat with such injuries, the somata of certain dorsal root ganglion neurons (DRGs) becomes hyperexcitable and exhibit various patterns of abnormal ectopic discharge. However, the functional properties of these neurons are unknown, as they are typically severed from their peripheral receptors in most animal models. Furthermore, little is known of the capacities of normal or injured sensory neurons to transduce the stimuli that evoke neuropathic sensations due, in part, to the lack of control over stimulus properties and cutaneous delivery. We propose to address these issues with a new model of neuropathic pain in rats that have a chronic compression of the lumbar DRG ('CCD') similar to the compression that might occur in humans as a consequence of an acutely herniated lumbar disc, spinal stenosis, tumor or other injury or disease of the spine. In the rat, CCD produces severe cutaneous hyperalgesia; this hyperalgesia will be measured using new methodology including the stroking of textured surfaces with controlled geometry across the skin. A large population of

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neurons become hyperexcitable and express patterns of ectopic discharge similar to those of axotomized neurons. A novel feature of CCD is that the neurons are intact. Also, we propose a novel method of recording intracellularly from visualized, chambered DRG neurons in vivo to measure simultaneously, for the first time, the functional properties of the peripheral receptors and the membrane properties of the somata of neuropathic DRG neurons; these neurons can be labeled and histochemically identified. With extracellular recording from dorsal root in vivo, and with a skin nerve preparation that allows separate measures of tensile and compressional stress applied to the skin, we will determine how ectopic discharge affects sensory transmission and whether the hyperexcitability of the somata is reflected in the sensitization of their peripheral receptors. Results will provide new information on the functional properties of DRG neurons contributing to neuropathic pain caused by nerve injuries or by certain injuries or disorders of the spine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARASPINAL MUSCLE DENERVATION AND SYMPTOMS IN LUMBAR SS Principal Investigator & Institution: Haig, Andrew J.; Phys Med and Rehabilitation; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Objectives: The clinical syndrome of spinal stenosis is a significant problem for older Americans. Although stenosis causes neurogenic claudication, spinal canal size does not accurately predict the severity of symptoms. A pilot study shows that paraspinal muscle denervation relates to spinal canal size in symptomatic persons. It is possible that paraspinal denervation is a more accurate marker for the clinical syndrome than anatomical imaging. Other research shows that paraspinal denervation in a particular distribution also occurs in younger asymptomatic persons, and denervation increases with age. It is possible that paraspinal denervation causes subtle hypermobility and contributes to Kirkaldy-Willis's degenerative cascade of facet hypertrophy and canal stenosis. Specific Aims: 1. To assess whether paraspinal EMG scores or MRI measurements of stenosis relate best with the clinical syndrome in older persons. 2. To assess whether paraspinal EMG scores predict future symptoms of stenosis and future symptom severity in older persons with and without spinal stenosis. 3. To assess whether change in clinical status relates better to change in paraspinal EMG scores or change in MRI measurement of stenosis. 4. To assess the rate of denervation of the paraspinal muscles in older persons with and without back symptoms. Research Design: Blinded longitudinal study. Methods: Five groups of 30 subjects older than 55 years old, including: asymptomatic persons (healthy persons without low back pain) from the community, persons with lock back pain (LBP) but no stenosis on MRI, persons with stenosis symptoms with mild, moderate, and severe radiographic findings. An experienced neuroradiologist will measure spinal canal size and assign subjects to appropriate categories. A patient questionnaire, physical examination, a walking tolerance test with long latency nerve conduction studies (F- and H- waves) before and after walking, a 7-day pedometer test, and a measure of the flexion-relaxation phenomenon will be administered to the subjects. An unblinded examiner will perform one aspect of the MiniPM paraspinal EMG technique to acclimatize the patient, then a blinded examiner will perform the entire MiniPM, one extremity EMG, sensory and motor nerve conduction studies. Subjects will repeat the

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test battery (MRI, EMG, and clinical evaluation) approximately 18 months later. Appropriate statistics will test each of the four hypotheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RANDOMIZED CLINICAL TRIAL: TREATMENT FOR SPINAL STENOSIS Principal Investigator & Institution: Delitto, Anthony; Associate Professor & Chair; Physical Therapy; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: Lumbar spinal stenosis is a frequently-encountered condition, particularly in the elderly, which can lead to significant pain and functional limitations. The prevalence of this condition is growing as the population continues to age. Substantial controversy presently exists regarding the management of lumbar spinal stenosis. Surgery has traditionally been the treatment of choice, although a trial of non-surgical care is typically recommended prior to surgery. The most effective means of non- surgical treatment has not been identified, although a 'standard' regimen has been developed. There is presently no evidence in the literature regarding the relative effectiveness of surgical versus non-surgical treatment of lumbar spinal stenosis, or the efficacy of the standard non-surgical treatment approach. This randomized clinical trial proposes to compare surgical versus non-surgical treatment of lumbar spinal stenosis. The results of this study should help to clarify which treatment strategies are the most effective for patients with lumbar spinal stenosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SAFETY OF LUMBAR FUSION SURGERY FOR CHRONIC BACK PAIN Principal Investigator & Institution: Mirza, Sohail K.; Associate Orthopaedics/Sports Medicine; University of Washington Seattle, Wa 98195

Professor;

Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Although I have been successful as a spine surgeon in an academic environment, building a respected clinical practice and completing spine biomechanics research for competitively funded projects, I realize that clinical research most directly addresses my motivation for choosing an academic career, and that highquality clinical research is complex, requiring a long-term commitment and specialized skills. I am in an excellent environment to develop these skills, with supportive colleagues and a supportive chairman. I have developed a five-year training schedule, with the first three years devoted to obtaining an MPH degree. A team of three outstanding individuals has committed to working with me for the next five years and guiding my career development. My immediate goal is to gain practical clinical research experience by conducting a five-year prospective study with this team of experienced and highly respected researchers. My long-term career goals are to help identify spine patient populations more concretely, measure end-results of spinal disorders in general, and define outcomes for treated and untreated back pain and whiplash injuries in particular. Research Project: The use of surgery for back pain is rapidly growing; data on its safety and outcomes are sorely needed. We propose a prospective cohort study to measure the frequency of complications in lumbar fusion surgery, variation in rates of specific serious complications with different types of lumbar fusion, clinical and functional consequences for specific types of complications, and patient or treatment

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characteristics that predict particularly severe complications. Over a two-year interval, we propose to enroll 1000 patients choosing fusion surgery for treatment of disc degeneration, spondylolisthesis, spinal stenosis, and adult degenerative scoliosis. We will follow these patients for two years, measure predictor patient and treatment characteristics, and measure consequences with clinical and functional outcomes. Accumulating data will be stored in an existing central database. The analysis will use appropriate univariate and multivariate techniques to address the study questions. This study will provide data on the relative benefits and risks of lumbar fusion surgery in treating back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAFETY-SENSING INDEPENDENCE-ENHANCING WHEELCHAIR Principal Investigator & Institution: Kennedy, William P.; Activmedia Robotics, Llc 44 Concord St Peterborough, Nh 03458 Timing: Fiscal Year 2003; Project Start 09-APR-2002; Project End 30-NOV-2004 Summary: (provided by applicant): Serious wheelchair accidents have risen to almost 37,000 per year. Users of power chairs are three times as likely to have accidents as users of manual chairs! Many people can neither walk nor successfully navigate a wheelchair, e.g., many with MS, quadraplegia, spinal stenosis, visual and other impairments. The Safety Sensing Independence-Enhancing Wheelchair (SIW) has the potential to reduce accident rates dramatically. Moreover, it could enable as many as 88,000 more nonambulatory Americans to successfully use wheelchairs. During Phase I, we built SIW and safety sensor prototypes that met or exceeded all our goals. In Phase II, we will develop a research prototype of SIW with additional functionality. We will complete development of the 2 modes of assisted control: Assistive and One-Click. Manual Mode, in which the wheelchair operates like an ordinary power chair, was integrated in Phase I. For Assistive Mode, we will add redundant sensors to improve the SIW's ability to avoid obstacles at both head and body height. In One-Click mode, those needing the most assistance can travel to destinations, with a single click of an input device, as demonstrated in Phase I. During Phase II, we will continue to extend the capabilities of the localization and navigational algorithms using fuller modeling so that fine-tuning the wheelchair's position will become easier. During Phase II we will also finish development of the new lightweight more economical Safety Sensor tested successfully for head and stair sensing in Phase I. We will develop a Universal SIW User Interface to be compatible with nearly any type of input device, as recommended by Phase I feedback from Crotched Mountain Rehabilitation Center (CMRC) and from our 3.5 hour invited demonstration of the Phase I prototype at RESNA 2002. We will also integrate and test various types of seating, as recommended. We will plan assessment, build 3 more prototypes, and conduct lab, field and clinical trials in conjunction with CMRC during Phase II. The results of these trials will be used to design further independent trials and to prepare for the approval process in Phase III. Once SIW technologies are proven, ordinary chairs that allow users to accidentally drive down stairs will be considered highly unsafe. Moreover, allowing individuals to remain immobile, with no control over their own location, will be considered inhumane when the SIW is available to provide mobility at their command. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STUDY OF CHEMOGENIC LOW BACK PAIN Principal Investigator & Institution: Zhang, Junming; Anesthesiology; University of Arkansas Med Scis Ltl Rock 4301 W Markham St Little Rock, Ar 72205

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Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2004 Summary: (adapted from applicant's abstract): The overall goal of our research is to better understand the etiology and mechanisms of low back pain and sciatica. Clinical studies indicate that degenerative changes and traumatic injuries of the spine are often associated with mechanical compression and chemical irritation of dorsal root ganglia (DRG). DRG neurons can be exposed to inflammatory cytokines that are released from a herniated nucleus pulposus (HNP) or synthesized inside the ganglion in response to injury. However, the specific role of cytokines and cytokine-induced inflammation in the generation of spontaneous activity and enhancement of neuronal excitability is still unknown. We hypothesize that DRG neurons may develop hyperexcitability in response to peripheral nerve or ganglion injury such that the release of inflammatory cytokines from the injured neurons, the macrophages, the glial cells or the HNP activate hyperexcitable DRG neurons and lead to pain. Using a new animal model of neuropathic pain, involving compression of the L5 lumbar ganglion with a hollow stainless steel rod, we will test our hypothesis via 3 Specific Aims. SA1. Determine whether elevated release/synthesis of cytokines enhances the excitability of normal DRG neurons. SA2. Determine if endogenous inflammatory cytokines contribute to the generation and maintenance of spontaneous activity in compressed DRG neurons and if exogenous cytokines enhance this activity. SA3. Determine whether cytokines contribute to the development and maintenance of cutaneous hypersensitivity in CCD rats. A novel feature of our animal model is that the inserted rod allows local delivery of cytokines to the compressed ganglion in vivo. With this model, we will study how cytokines affect the excitability of DRG neurons and correlate these effects to behavioral measures of hyperalgesia and allodynia. If a relationship between specific cytokines and the sensory hyperexcitability responsible for neuropathic pain is identified, then new therapeutic approaches involving pharmacological modulation of cytokine release or synthesis could be developed to control pain in individuals with an acutely herniated lumbar disc, spinal stenosis, tumor, or other injury or disease of the spine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with spinal stenosis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “spinal stenosis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for spinal stenosis (hyperlinks lead to article summaries):

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A 50-year-old woman with disabling spinal stenosis, 1 year later. Author(s): Daley J, Delbanco T, Walzen J. Source: Jama : the Journal of the American Medical Association. 1996 July 3; 276(1): 66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8667542&dopt=Abstract

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A 50-year-old woman with disabling spinal stenosis. Author(s): Garfin SR. Source: Jama : the Journal of the American Medical Association. 1995 December 27; 274(24): 1949-54. Erratum In: Jama 1996 April 24; 275(16): 1232. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8568991&dopt=Abstract

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A 50-year-old woman with spinal stenosis. Author(s): Mazanec D, Drucker Y. Source: Jama : the Journal of the American Medical Association. 1996 May 8; 275(18): 1401; Author Reply 1401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8618363&dopt=Abstract

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A 50-year-old woman with spinal stenosis. Author(s): Levy CE, Clinchot DM, Bowyer BL, Pease WS. Source: Jama : the Journal of the American Medical Association. 1996 May 8; 275(18): 1400-1; Author Reply 1401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8618362&dopt=Abstract

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A biomechanical evaluation of internal lumbar laminoplasty: the preservation of spinal stability during laminectomy for degenerative spinal stenosis. Author(s): Efstathiou P, Moskovich R, Casar R, Magnisalis E. Source: Bull Hosp Jt Dis. 1996; 55(1): 7-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8771346&dopt=Abstract

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A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. Author(s): Yukawa Y, Lenke LG, Tenhula J, Bridwell KH, Riew KD, Blanke K. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 November; 84A(11): 1954-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12429755&dopt=Abstract

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A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis. Author(s): Cornefjord M, Byrod G, Brisby H, Rydevik B. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2000 December; 9(6): 563-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11189928&dopt=Abstract

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A new multiple malformation syndrome of Mullerian dysgenesis and conductive hearing loss with facial hypoplasia, bilateral forearm deformity, brachydactyly, spinal stenosis and scoliosis. Author(s): Kumar D, Masel JP. Source: Clinical Genetics. 1997 July; 52(1): 30-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9272710&dopt=Abstract

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A nonsurgical treatment approach for patients with lumbar spinal stenosis. Author(s): Fritz JM, Erhard RE, Vignovic M. Source: Physical Therapy. 1997 September; 77(9): 962-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9291953&dopt=Abstract

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A physiological approach to the evaluation of lumbosacral spinal stenosis. Author(s): Kraft GH. Source: Phys Med Rehabil Clin N Am. 1998 May; 9(2): 381-9, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9894123&dopt=Abstract

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A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings. Author(s): Jonsson B, Annertz M, Sjoberg C, Stromqvist B. Source: Spine. 1997 December 15; 22(24): 2932-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9431629&dopt=Abstract

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A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up by an independent observer. Author(s): Jonsson B, Annertz M, Sjoberg C, Stromqvist B. Source: Spine. 1997 December 15; 22(24): 2938-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9431630&dopt=Abstract

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A prospective study on CT scan outcomes after conservative decompression surgery for lumbar spinal stenosis. Author(s): Gunzburg R, Keller TS, Szpalski M, Vandeputte K, Spratt KF. Source: Journal of Spinal Disorders & Techniques. 2003 June; 16(3): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792340&dopt=Abstract

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A rare cause of cervical spinal stenosis: posterior arch hypoplasia in a bipartite atlas. Author(s): Atasoy C, Fitoz S, Karan B, Erden I, Akyar S. Source: Neuroradiology. 2002 March; 44(3): 253-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942383&dopt=Abstract

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Achondroplasia and hypochondroplasia. Clinical variation and spinal stenosis. Author(s): Wynne-Davies R, Walsh WK, Gormley J. Source: The Journal of Bone and Joint Surgery. British Volume. 1981; 63B(4): 508-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7298674&dopt=Abstract

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Acquired lumbar spinal stenosis. Author(s): Jane JA Sr, Jane JA Jr, Helm GA, Kallmes DF, Shaffrey CI, Chadduck JB, DiPierro CG. Source: Clin Neurosurg. 1996; 43: 275-99. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9247811&dopt=Abstract

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Acromegaly and spinal stenosis. Case report. Author(s): Epstein N, Whelan M, Benjamin V. Source: Journal of Neurosurgery. 1982 January; 56(1): 145-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7054412&dopt=Abstract

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Acute cauda equina syndrome after total knee arthroplasty as a result of epidural anesthesia and spinal stenosis. Author(s): Stambough JL, Stambough JB, Evans S. Source: The Journal of Arthroplasty. 2000 April; 15(3): 375-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10794236&dopt=Abstract

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Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis. Author(s): Young WF, Baron E. Source: Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia. 2001 March; 8(2): 129-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11484662&dopt=Abstract

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Aeolus myth: chronic obstructive lung disease and nocturnal lumbosacral pain in association with lumbar spinal stenosis and pulmonary hypertension. Author(s): LaBan MM, Kucway EJ. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 September; 82(9): 660-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960906&dopt=Abstract

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Amyloid deposits of immunohistochemically different classes in the ligamentum flavum in biopsies from patients with herniated discs or lumbar spinal stenosis. Author(s): Gies U, Linke RP, Schachenmayr W. Source: Clin Neuropathol. 1996 January-February; 15(1): 54-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8998858&dopt=Abstract

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An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. Author(s): Ciol MA, Deyo RA, Howell E, Kreif S. Source: Journal of the American Geriatrics Society. 1996 March; 44(3): 285-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8600197&dopt=Abstract

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An endoscopic curved Kerrison rongeur for spinal stenosis surgery. Author(s): Frank EH, Martin J, Hsu FP. Source: Minimally Invasive Neurosurgery : Min. 2002 December; 45(4): 254-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12494364&dopt=Abstract

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An endoscopic dural retractor for spinal stenosis surgery. Author(s): Frank EH, Hsu FP. Source: Minimally Invasive Neurosurgery : Min. 2002 September; 45(3): 136-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353158&dopt=Abstract

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Application of spatial modulation of magnetization to cervical spinal stenosis for evaluation of the hydrodynamic changes occurring in cerebrospinal fluid. Author(s): Lee KH, Chung TS, Jeon TJ, Kim YH, Chien D, Laub G. Source: Korean Journal of Radiology : Official Journal of the Korean Radiological Society. 2000 January-March; 1(1): 11-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11752923&dopt=Abstract

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Appropriateness of indications for surgery of lumbar disc hernia and spinal stenosis. Author(s): Larequi-Lauber T, Vader JP, Burnand B, Brook RH, Kosecoff J, Sloutskis D, Fankhauser H, Berney J, de Tribolet N, Paccaud F. Source: Spine. 1997 January 15; 22(2): 203-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9122803&dopt=Abstract

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Assessment of neuroforaminal decompression in degenerative spinal stenosis. Author(s): Gill TJ, Mason MD. Source: Clinical Orthopaedics and Related Research. 1998 March; (348): 135-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9553545&dopt=Abstract

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Assessment of trunk function in single and multi-level spinal stenosis: a prospective clinical trial. Author(s): Keller TS, Szpalski M, Gunzburg R, Spratt KF. Source: Clinical Biomechanics (Bristol, Avon). 2003 March; 18(3): 173-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12620779&dopt=Abstract

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Associations between spinal deformity and outcomes after decompression for spinal stenosis. Author(s): Frazier DD, Lipson SJ, Fossel AH, Katz JN. Source: Spine. 1997 September 1; 22(17): 2025-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9306534&dopt=Abstract

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Axial loading of the spine during CT and MR in patients with suspected lumbar spinal stenosis. Author(s): Danielson BI, Willen J, Gaulitz A, Niklason T, Hansson TH. Source: Acta Radiologica (Stockholm, Sweden : 1987). 1998 November; 39(6): 604-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9817029&dopt=Abstract

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Bicycle sign in spinal stenosis. Author(s): Dixon AS. Source: Lancet. 1982 October 9; 2(8302): 825. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126698&dopt=Abstract

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Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. Author(s): Palmer S, Turner R, Palmer R. Source: Journal of Neurosurgery. 2002 September; 97(2 Suppl): 213-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12296681&dopt=Abstract

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Bilateral hand pain. Congenital cervical spinal stenosis with an associated herniated disc. Author(s): Phillips WC Jr, Strauss AJ, Kattapuram SV. Source: Del Med J. 1986 August; 58(8): 559-64. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3758437&dopt=Abstract

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Bilateral partial laminectomy: a treatment for lumbar spinal stenosis and midline disc herniation. Author(s): Eule JM, Breeze R, Kindt GW. Source: Surgical Neurology. 1999 October; 52(4): 329-37; Discussion 337-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10555837&dopt=Abstract

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Bilateral synovial cysts creating spinal stenosis: CT diagnosis. Author(s): Conrad MR, Pitkethly DT. Source: Journal of Computer Assisted Tomography. 1987 January-February; 11(1): 196-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3805420&dopt=Abstract

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Bone mineral content and bone mass in patients with spinal stenosis. Author(s): Johnsson KE, Nilsson BE. Source: Clinical Orthopaedics and Related Research. 1984 June; (186): 240-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6723152&dopt=Abstract

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Bone regrowth after surgical decompression for lumbar spinal stenosis. Author(s): Postacchini F, Cinotti G. Source: The Journal of Bone and Joint Surgery. British Volume. 1992 November; 74(6): 862-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1447247&dopt=Abstract

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Buschke-Ollendorff syndrome, otosclerosis, and congenital spinal stenosis. Author(s): Schnur RE, Grace K, Herzberg A. Source: Pediatric Dermatology. 1994 March; 11(1): 31-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8170846&dopt=Abstract

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Cardiac risk stratification of patients with symptomatic spinal stenosis. Author(s): Faciszewski T, Jensen R, Rokey R, Berg R. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 110-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249155&dopt=Abstract

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Case report: renal osteodystrophy in association with spinal stenosis in achondroplasia. Author(s): Ong JS, McKenna MJ, Lorigan JG, Watson A, Freaney R. Source: Ir J Med Sci. 1996 July-September; 165(3): 155-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8824015&dopt=Abstract

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Causes and management of unstable degenerative spinal stenosis. Author(s): Fellrath RF Jr, Hanley EN Jr. Source: J South Orthop Assoc. 1996 Fall; 5(3): 221-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8884710&dopt=Abstract

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Central spinal stenosis due to pseudogout. Author(s): Dehais J. Source: The Journal of Bone and Joint Surgery. British Volume. 1995 March; 77(2): 335. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7706364&dopt=Abstract

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Central spinal stenosis due to pseudogout: a case report. Author(s): Sadique T, Bradley JG, Jackson AM. Source: The Journal of Bone and Joint Surgery. British Volume. 1994 July; 76(4): 672-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8027163&dopt=Abstract

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Cervical neurofibroma and generalised spinal stenosis in von Recklinghausen disease. Author(s): Vancoillie P, Veiga-Pires JA. Source: Lancet. 1979 December 8; 2(8154): 1246-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=92659&dopt=Abstract

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Cervical spinal stenosis and sports-related cervical cord neurapraxia in children. Author(s): Boockvar JA, Durham SR, Sun PP. Source: Spine. 2001 December 15; 26(24): 2709-12; Discussion 2713. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740359&dopt=Abstract

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Cervical spinal stenosis and stingers in collegiate football players. Author(s): Meyer SA, Schulte KR, Callaghan JJ, Albright JP, Powell JW, Crowley ET, elKhoury GY. Source: The American Journal of Sports Medicine. 1994 March-April; 22(2): 158-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8198181&dopt=Abstract

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Cervical spinal stenosis and stingers in collegiate football players. Author(s): Drez D Jr. Source: The American Journal of Sports Medicine. 1994 September-October; 22(5): 727. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7810802&dopt=Abstract

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Cervical spinal stenosis with cord neurapraxia and transient quadriplegia. Author(s): Torg JS. Source: Sports Medicine (Auckland, N.Z.). 1995 December; 20(6): 429-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8614762&dopt=Abstract

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Cervical spinal stenosis with cord neurapraxia: evaluations and decisions regarding participation in athletics. Author(s): Torg JS. Source: Curr Sports Med Rep. 2002 February; 1(1): 43-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831646&dopt=Abstract

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Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. Author(s): Mayr MT, Subach BR, Comey CH, Rodts GE, Haid RW Jr. Source: Journal of Neurosurgery. 2002 January; 96(1 Suppl): 10-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11795694&dopt=Abstract

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Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Author(s): Takahashi K, Kagechika K, Takino T, Matsui T, Miyazaki T, Shima I. Source: Spine. 1995 December 15; 20(24): 2746-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8747254&dopt=Abstract

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Chiropractic management of a patient with lumbar spinal stenosis. Author(s): Snow GJ. Source: Journal of Manipulative and Physiological Therapeutics. 2001 May; 24(4): 300-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353943&dopt=Abstract

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Chronic inflammatory demyelinating polyneuropathy mimicking a lumbar spinal stenosis syndrome. Author(s): Ginsberg L, Platts AD, Thomas PK. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1995 August; 59(2): 189-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7629539&dopt=Abstract

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Clinical and psychofunctional measures of conservative decompression surgery for lumbar spinal stenosis: a prospective cohort study. Author(s): Gunzburg R, Keller TS, Szpalski M, Vandeputte K, Spratt KF. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2003 April; 12(2): 197-204. Epub 2002 November 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709858&dopt=Abstract

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Clinical and roentgenographic results of decompression for lumbar spinal stenosis. Author(s): McCullen GM, Bernini PM, Bernstein SH, Tosteson TD. Source: Journal of Spinal Disorders. 1994 October; 7(5): 380-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7819637&dopt=Abstract

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Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Author(s): Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein JN, Fossel AH, Lew RA, Liang MH. Source: Spine. 1995 May 15; 20(10): 1155-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7638658&dopt=Abstract

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Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. Author(s): Fox MW, Onofrio BM, Onofrio BM, Hanssen AD. Source: Journal of Neurosurgery. 1996 November; 85(5): 793-802. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8893716&dopt=Abstract

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Clinical recording of pressure on the spinal cord and cauda equina. Part 2: position changes in pressure on the cauda equina in central lumbar spinal stenosis. Author(s): Magnaes B. Source: Journal of Neurosurgery. 1982 July; 57(1): 57-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7086500&dopt=Abstract

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Clinical symptoms and surgical outcome in lumbar spinal stenosis patients with neuropathic bladder. Author(s): Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Fujiuchi Y, Matsui H, Kimura T. Source: Journal of Spinal Disorders. 2001 October; 14(5): 404-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11586140&dopt=Abstract

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Comparison of CT myelography performed in the prone and supine positions in the detection of cervical spinal stenosis. Author(s): Blease Graham C 3rd, Wippold FJ 2nd, Bae KT, Pilgram TK, Shaibani A, Kido DK. Source: Clinical Radiology. 2001 January; 56(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11162695&dopt=Abstract

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Comparison of surgical procedures for degenerative lumbar spinal stenosis: a metaanalysis of the literature from 1975 to 1995. Author(s): Niggemeyer O, Strauss JM, Schulitz KP. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 1997; 6(6): 423-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9455673&dopt=Abstract

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Computed tomography after laminectomy for lumbar spinal stenosis. Patients' pain patterns, walking capacity, and subjective disability had no correlation with computed tomography findings. Author(s): Herno A, Airaksinen O, Saari T. Source: Spine. 1994 September 1; 19(17): 1975-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7997932&dopt=Abstract

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Computed tomography findings 4 years after surgical management of lumbar spinal stenosis. No correlation with clinical outcome. Author(s): Herno A, Airaksinen O, Saari T, Pitkanen M, Manninen H, Suomalainen O. Source: Spine. 1999 November 1; 24(21): 2234-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10562990&dopt=Abstract

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Computed tomography in degenerative spinal stenosis. Author(s): McAfee PC, Ullrich CG, Yuan HA, Sherry RG, Lockwood RC. Source: Clinical Orthopaedics and Related Research. 1981 November-December; (161): 221-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7307385&dopt=Abstract

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Computerized tomography in dorsal spinal stenosis. Report of three cases. Author(s): Yamamoto I, Kageyama N, Nakamura K, Takahashi T. Source: Acta Neurochirurgica. 1980; 53(3-4): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6775501&dopt=Abstract

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Conservative management of lumbar spinal stenosis. Identifying patients likely to do well without surgery. Author(s): Nagler W, Hausen HS. Source: Postgraduate Medicine. 1998 April; 103(4): 69-71, 76, 81-3 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9553588&dopt=Abstract

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Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. Author(s): Kuntz KM, Snider RK, Weinstein JN, Pope MH, Katz JN. Source: Spine. 2000 May 1; 25(9): 1132-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10788859&dopt=Abstract

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Current concepts review. The treatment of spinal stenosis. Author(s): Grabias S. Source: The Journal of Bone and Joint Surgery. American Volume. 1980 March; 62(2): 308-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6987238&dopt=Abstract

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Decompression for degenerative spondylolisthesis and spinal stenosis at L4-5. The effects on facet joint morphology. Author(s): Grobler LJ, Robertson PA, Novotny JE, Ahern JW. Source: Spine. 1993 September 1; 18(11): 1475-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8235819&dopt=Abstract

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Decompression for lateral lumbar spinal stenosis. Results and impact on sick leave and working conditions. Author(s): Jonsson B, Stromqvist B. Source: Spine. 1994 November 1; 19(21): 2381-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7846588&dopt=Abstract

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Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis. Author(s): Hansraj KK, O'Leary PF, Cammisa FP Jr, Hall JC, Fras CI, Cohen MS, Dorey FJ. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 18-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249164&dopt=Abstract

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Decompressive laminectomy for spinal stenosis. Author(s): Harrington JF. Source: Journal of Neurosurgery. 1998 April; 88(4): 790-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9525735&dopt=Abstract

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Decompressive surgery for typical lumbar spinal stenosis. Author(s): Hansraj KK, Cammisa FP Jr, O'Leary PF, Crockett HC, Fras CI, Cohen MS, Dorey FJ. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 10-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249153&dopt=Abstract

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Degenerative lumbar spinal stenosis. Author(s): Shiloni E, Wald U, Robin GC, Floman Y. Source: Isr J Med Sci. 1980 September-October; 16(9-10): 692-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7429807&dopt=Abstract

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Degenerative lumbar spinal stenosis. Author(s): Spivak JM. Source: The Journal of Bone and Joint Surgery. American Volume. 1998 July; 80(7): 105366. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9698011&dopt=Abstract

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Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. Author(s): Grob D, Humke T, Dvorak J. Source: The Journal of Bone and Joint Surgery. American Volume. 1995 July; 77(7): 103641. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7608225&dopt=Abstract

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Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Author(s): Katz JN, Dalgas M, Stucki G, Katz NP, Bayley J, Fossel AH, Chang LC, Lipson SJ. Source: Arthritis and Rheumatism. 1995 September; 38(9): 1236-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7575718&dopt=Abstract

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Degenerative lumbar spinal stenosis. Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion. Author(s): Rompe JD, Eysel P, Zollner J, Nafe B, Heine J. Source: Neurosurgical Review. 1999 October; 22(2-3): 102-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10547007&dopt=Abstract

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Degenerative lumbar spinal stenosis: results of operative treatment. Author(s): Surin V, Hedelin E, Smith L. Source: Acta Orthopaedica Scandinavica. 1982 February; 53(1): 79-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6461161&dopt=Abstract

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Degenerative lumbar spondylolisthesis with spinal stenosis, a prospective study comparing decompression with decompression and intertransverse process arthrodesis: a critical analysis. Author(s): Vaccaro AR, Garfin SR. Source: Spine. 1997 February 15; 22(4): 368-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9055361&dopt=Abstract

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Dermatomal somatosensory-evoked potentials in the evaluation of lumbosacral spinal stenosis. Author(s): Kraft GH. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 71-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622483&dopt=Abstract

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Developmental lumbar spinal stenosis. Pathology and surgical treatment. Author(s): Lee CK, Hansen HT, Weiss AB. Source: Spine. 1978 September; 3(3): 246-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=715553&dopt=Abstract

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Diagnosis and treatment of spinal stenosis. Author(s): Walters BC, Friehs GM. Source: Medicine and Health, Rhode Island. 1998 May; 81(5): 174-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9617095&dopt=Abstract

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Diagnosis of lumbar spinal stenosis. Author(s): Katz JN, Dalgas M, Stucki G, Lipson SJ. Source: Rheumatic Diseases Clinics of North America. 1994 May; 20(2): 471-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8016421&dopt=Abstract

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Diagnostic value of electrical stimulation of lumbosacral roots in lumbar spinal stenosis. Author(s): Zileli B, Ertekin C, Zileli M, Yunten N. Source: Acta Neurologica Scandinavica. 2002 March; 105(3): 221-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11886368&dopt=Abstract

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Differential diagnostics in patients with mild lumbar spinal stenosis: the contributions and limits of various tests. Author(s): Adamova B, Vohanka S, Dusek L. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2003 April; 12(2): 190-6. Epub 2002 December 21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709857&dopt=Abstract

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Distraction laminoplasty for decompression of lumbar spinal stenosis. Author(s): O'Leary PF, McCance SE. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 26-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249174&dopt=Abstract

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Does additional discectomy and the degree of dural sac compression influence the outcome of decompressive surgery for lumbar spinal stenosis? Author(s): Aliashkevich AF, Kristof RA, Schramm J, Brechtelsbauer D. Source: Acta Neurochirurgica. 1999; 141(12): 1273-9; Discussion 1279-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10672297&dopt=Abstract

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Does the cervical canal to body ratio predict spinal stenosis? Author(s): Moskovich R, Shott S, Zhang ZH. Source: Bull Hosp Jt Dis. 1996; 55(2): 61-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8879738&dopt=Abstract

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Editorial: Lumbar spinal stenosis. Author(s): Kirkaldy-Willis WH, McIvor GW. Source: Clinical Orthopaedics and Related Research. 1976 March-April; (115): 2-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1253483&dopt=Abstract

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Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study. Author(s): Rivest C, Katz JN, Ferrante FM, Jamison RN. Source: Arthritis Care and Research : the Official Journal of the Arthritis Health Professions Association. 1998 August; 11(4): 291-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9791328&dopt=Abstract

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Electrodiagnostic challenges in the evaluation of lumbar spinal stenosis. Author(s): Plastaras CT. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 57-69. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622482&dopt=Abstract

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Electromyography in the diagnosis of lumbar spinal stenosis. Author(s): Seppalainen AM, Alaranta H, Soini J. Source: Electromyogr Clin Neurophysiol. 1981 January; 21(1): 55-66. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7215284&dopt=Abstract

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Epidemiology of spinal stenosis. Author(s): Martinelli TA, Wiesel SW. Source: Instr Course Lect. 1992; 41: 179-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1588062&dopt=Abstract

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Epidural injection in the treatment of spinal stenosis. Author(s): Hoogmartens M, Morelle P. Source: Acta Orthop Belg. 1987; 53(3): 409-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3442227&dopt=Abstract

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Epidural pressure measurements. Relationship between epidural pressure and posture in patients with lumbar spinal stenosis. Author(s): Takahashi K, Miyazaki T, Takino T, Matsui T, Tomita K. Source: Spine. 1995 March 15; 20(6): 650-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7604339&dopt=Abstract

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Epidural venography in the diagnosis of lumbar spinal stenosis. Author(s): Bestawros OA, Vreeland OH, Goldman ML. Source: Radiology. 1979 May; 131(2): 423-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=441332&dopt=Abstract

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Epidural venous stasis in spinal stenosis. CT appearance. Author(s): Kaiser MC, Capesius P, Roilgen A, Sandt G, Poos D, Gratia G. Source: Neuroradiology. 1984; 26(6): 435-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6504311&dopt=Abstract

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Examination findings and self-reported walking capacity in patients with lumbar spinal stenosis. Author(s): Iversen MD, Katz JN. Source: Physical Therapy. 2001 July; 81(7): 1296-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11444993&dopt=Abstract

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Exercise provoked faecal incontinence in spinal stenosis. Author(s): Foster OJ, Harrison MJ, Crockard HA. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1987 March; 50(3): 362-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3559621&dopt=Abstract

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Exercise-induced myokymia with congenital spinal stenosis. Author(s): Colachis SC 3rd, Bobulski RJ. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1991 October; 70(5): 255-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1910650&dopt=Abstract

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Expansive laminoplasty for lumbar spinal stenosis. Author(s): Tsuji H, Itoh T, Sekido H, Yamada H, Katoh Y, Makiyama N, Yamagami T. Source: International Orthopaedics. 1990; 14(3): 309-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2279841&dopt=Abstract

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Expansive lumbar laminoplasty for degenerative spinal stenosis in patients below 70 years of age. Author(s): Matsui H, Kanamori M, Ishihara H, Hirano N, Tsuji H. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 1997; 6(3): 191-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9258638&dopt=Abstract

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Extended laminectomy for spinal stenosis in achondroplasia. Author(s): Streeten E, Uematsu S, Hurko O, Kopits S, Murphy E, Pyeritz R. Source: Basic Life Sci. 1988; 48: 261-73. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3240261&dopt=Abstract

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Extradural “plumboma”. A rare cause of acquired spinal stenosis. Author(s): Staniforth P, Watt I. Source: The British Journal of Radiology. 1982 October; 55(658): 772-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7127029&dopt=Abstract

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Factors in the development of the spinal stenosis syndrome. Author(s): Naylor A. Source: The Journal of Bone and Joint Surgery. British Volume. 1979 August; 61-B(3): 306-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=479253&dopt=Abstract

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Factors influencing the outcome of degenerative lumbar spinal stenosis. Author(s): Mariconda M, Zanforlino G, Celestino GA, Brancaleone S, Fava R, Milano C. Source: Journal of Spinal Disorders. 2000 April; 13(2): 131-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10780688&dopt=Abstract

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Factors influencing the outcome of operative treatment for lumbar spinal stenosis. Author(s): Lehto MU, Honkanen P. Source: Acta Neurochirurgica. 1995; 137(1-2): 25-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8748863&dopt=Abstract

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Familial lumbar spinal stenosis with acute disc herniations. Case reports of four brothers. Author(s): Varughese G, Quartey GR. Source: Journal of Neurosurgery. 1979 August; 51(2): 234-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=448432&dopt=Abstract

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Fibrous spinal stenosis. A report on 850 myelograms with a water-soluble contrast medium. Author(s): De Villiers PD, Booysen EL. Source: Clinical Orthopaedics and Related Research. 1976 March-April; (115): 140-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1253477&dopt=Abstract

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Flexed sitting maneuver for complete lumbar myelography in patients with severe spinal stenosis and apparent block. Author(s): Kapila A, Chakeres DW. Source: Radiology. 1986 July; 160(1): 265-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3715042&dopt=Abstract

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Focal dystonia in spinal stenosis. Author(s): Al-Kawi MZ. Source: Archives of Neurology. 1987 July; 44(7): 692-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3593056&dopt=Abstract

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Functional cervical spinal stenosis: a contraindication to participation in contact sports. Author(s): Cantu RC. Source: Medicine and Science in Sports and Exercise. 1993 March; 25(3): 316-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8455444&dopt=Abstract

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Functional deficits of central sensory and motor pathways in patients with cervical spinal stenosis: a study of SEPs and EMG responses to non-invasive brain stimulation. Author(s): Masur H, Elger CE, Render K, Fahrendorf G, Ludolph AC. Source: Electroencephalography and Clinical Neurophysiology. 1989 NovemberDecember; 74(6): 450-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2480225&dopt=Abstract

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Functional mobility performance in an elderly population with lumbar spinal stenosis. Author(s): Whitehurst M, Brown LE, Eidelson SG, D'angelo A. Source: Archives of Physical Medicine and Rehabilitation. 2001 April; 82(4): 464-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11295005&dopt=Abstract

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Functional myelography with metrizamide in the diagnosis of lumbar spinal stenosis. Author(s): Sortland O, Magnaes B, Hauge T. Source: Acta Radiologica. Supplementum. 1977; 355: 42-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=299686&dopt=Abstract

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Functional outcome study of patients after surgical decompression for lumbar spinal stenosis: effects of concomitant pathology. Author(s): Mofidi A, O'Connor D, El-Abed K, McCabe JP. Source: Journal of Spinal Disorders & Techniques. 2002 October; 15(5): 377-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394661&dopt=Abstract

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Functional rehabilitation for degenerative lumbar spinal stenosis. Author(s): Rittenberg JD, Ross AE. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 111-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622486&dopt=Abstract

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Fusion for spinal stenosis: a personal view. Author(s): Eisenstein S. Source: The Journal of Bone and Joint Surgery. British Volume. 2002 January; 84(1): 9-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11837840&dopt=Abstract

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Genetics clinics of The Johns Hopkins Hospital. Surgical intervention in achondroplasia. Cervical and lumbar laminectomy for spinal stenosis in achondroplasia. Author(s): Pyeritz RE, Sack GH Jr, Udvarhelyi GB. Source: Johns Hopkins Med J. 1980 May; 146(5): 203-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7382243&dopt=Abstract

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Histology of the ligamentum flavum in patients with degenerative lumbar spinal stenosis. Author(s): Schrader PK, Grob D, Rahn BA, Cordey J, Dvorak J. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 1999; 8(4): 323-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10483836&dopt=Abstract

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Hyperostotic lumbar spinal stenosis. A review of 12 surgically treated cases with roentgenographic survey of ossification of the yellow ligament at the lumbar spine. Author(s): Kurihara A, Tanaka Y, Tsumura N, Iwasaki Y. Source: Spine. 1988 November; 13(11): 1308-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3144759&dopt=Abstract

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Hypophosphataemic vitamin D-resistant rickets--a cause of spinal stenosis in adults. Author(s): Masel JP, Cartwright DW, Latham SC. Source: Australasian Radiology. 1981 November; 25(3): 264-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6284105&dopt=Abstract

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Imaging lumbar spinal stenosis. Author(s): Schonstrom N, Willen J. Source: Radiologic Clinics of North America. 2001 January; 39(1): 31-53, V. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11221505&dopt=Abstract

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Imaging of spinal stenosis. Author(s): Richmond BJ, Ghodadra T. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 41-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622481&dopt=Abstract

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Impaired lumbar movement perception in association with postural stability and motor- and somatosensory-evoked potentials in lumbar spinal stenosis. Author(s): Leinonen V, Maatta S, Taimela S, Herno A, Kankaanpaa M, Partanen J, Kansanen M, Hanninen O, Airaksinen O. Source: Spine. 2002 May 1; 27(9): 975-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979174&dopt=Abstract

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Incidence of cervical spinal stenosis in professional and rookie football players. Author(s): Odor JM, Watkins RG, Dillin WH, Dennis S, Saberi M. Source: The American Journal of Sports Medicine. 1990 September-October; 18(5): 507-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2252092&dopt=Abstract

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Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Author(s): Yone K, Sakou T, Kawauchi Y, Yamaguchi M, Yanase M. Source: Spine. 1996 January 15; 21(2): 242-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8720411&dopt=Abstract

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Intermittent claudication due to spinal stenosis in a vascular surgical practice. Author(s): Stansby G, Evans G, Shieff C, Hamilton G. Source: Journal of the Royal College of Surgeons of Edinburgh. 1994 April; 39(2): 83-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7520074&dopt=Abstract

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Intermittent parasympathetic symptoms in lumbar spinal stenosis. Author(s): Willen JG, Griffiths ER, Mastaglia FL, Beaver R. Source: Journal of Spinal Disorders. 1989 June; 2(2): 109-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2520061&dopt=Abstract

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Intermittent priapism associated with lumbar spinal stenosis. Author(s): Baba H, Furusawa N, Tanaka Y, Imura S, Tomita K. Source: International Orthopaedics. 1994 June; 18(3): 150-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7927963&dopt=Abstract

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Intermittent priapism in spinal stenosis. Author(s): Hidalgo Ovejero AM, Garcia Mata S, Sauras Herranz MA, Maravi Petri E, Martinez Grande M. Source: Acta Orthop Belg. 1991; 57(2): 192-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1872164&dopt=Abstract

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Internal decompression for multiple levels of lumbar spinal stenosis: a technical note. Author(s): Lin PM. Source: Neurosurgery. 1982 October; 11(4): 546-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7145072&dopt=Abstract

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Intradural spinal tumors and spinal stenosis. Report of two cases. Author(s): McGuire RA, Brown MD, Green BA. Source: Spine. 1987 December; 12(10): 1062-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2964729&dopt=Abstract

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Intraspinal synovial cyst simulating spinal stenosis. A case report. Author(s): Baum JA, Hanley EN Jr. Source: Spine. 1986 June; 11(5): 487-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3750088&dopt=Abstract

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Inverse laminoplasty for the treatment of lumbar spinal stenosis. Author(s): Yucesoy K, Ozer E. Source: Spine. 2002 July 1; 27(13): E316-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131752&dopt=Abstract

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Klippel-Feil syndrome associated with spinal stenosis. A case report. Author(s): Prusick VR, Samberg LC, Wesolowski DP. Source: The Journal of Bone and Joint Surgery. American Volume. 1985 January; 67(1): 161-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3968098&dopt=Abstract

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Laron syndrome abnormalities: spinal stenosis, os odontoideum, degenerative changes of the atlanto-odontoid joint, and small oropharynx. Author(s): Kornreich L, Horev G, Schwarz M, Karmazyn B, Laron Z. Source: Ajnr. American Journal of Neuroradiology. 2002 April; 23(4): 625-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11950656&dopt=Abstract

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Long-term clinical and magnetic resonance imaging follow-up assessment of patients with lumbar spinal stenosis after laminectomy. Author(s): Herno A, Partanen K, Talaslahti T, Kaukanen E, Turunen V, Suomalainen O, Airaksinen O. Source: Spine. 1999 August 1; 24(15): 1533-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10457572&dopt=Abstract

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Lumbar epidural steroid injections in the patient with lumbar spinal stenosis. Author(s): Botwin KP, Gruber RD. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 121-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622487&dopt=Abstract

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Lumbar facets--spinal stenosis and intermittent claudication: a mini review. Author(s): Sutro CJ. Source: Bull Hosp Joint Dis. 1979; 40: 13-37. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=162322&dopt=Abstract

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Lumbar spinal stenosis assessment with computed tomography, magnetic resonance imaging, and myelography. Author(s): Saint-Louis LA. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 122-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249157&dopt=Abstract

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Lumbar spinal stenosis causing congenital clubfoot. Author(s): Ng YT, Mancias P, Butler IJ. Source: Journal of Child Neurology. 2002 January; 17(1): 72-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11913580&dopt=Abstract

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Lumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies. Author(s): Storm PB, Chou D, Tamargo RJ. Source: Phys Med Rehabil Clin N Am. 2002 August; 13(3): 713-33, Ix. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380555&dopt=Abstract

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Lumbar spinal stenosis. Author(s): Binder DK, Schmidt MH, Weinstein PR. Source: Seminars in Neurology. 2002 June; 22(2): 157-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524561&dopt=Abstract

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Lumbar spinal stenosis. Author(s): Critchley EM. Source: British Medical Journal (Clinical Research Ed.). 1982 May 29; 284(6329): 1588-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6805616&dopt=Abstract

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Lumbar spinal stenosis. Author(s): Chouteau RM. Source: J Am Osteopath Assoc. 1980 September; 80(1): 105-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7419450&dopt=Abstract

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Lumbar spinal stenosis. A cause of continued pain and disability in patients after total hip arthroplasty. Author(s): Bohl WR, Steffee AD. Source: Spine. 1979 March-April; 4(2): 168-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=264032&dopt=Abstract

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Lumbar spinal stenosis. Treatment strategies and indications for surgery. Author(s): Sengupta DK, Herkowitz HN. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 281-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914268&dopt=Abstract

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Lumbar spinal stenosis: a prospective review of evaluation and treatment utilizing a new “back analysis form”. Author(s): Scafuri RL, Weinstein JN. Source: Proc Inst Med Chic. 1981 July-September; 34(3): 79-82. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7301825&dopt=Abstract

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Lumbar spinal stenosis: a review of biomechanical studies. Author(s): Dai L, Xu Y. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 1998 March; 13(1): 56-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11717927&dopt=Abstract

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Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Author(s): Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Source: Spine. 2000 June 1; 25(11): 1424-35; Discussion 1435-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10828926&dopt=Abstract

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Lumbar spinal stenosis: experience at a community hospital. Author(s): Echeverria T, Lockwood RC. Source: N Y State J Med. 1979 May; 79(6): 872-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=286188&dopt=Abstract

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Lumbar spinal stenosis: studies on 8 cases. Author(s): Chen PQ, Yang CH. Source: Taiwan Yi Xue Hui Za Zhi. 1978 March; 77(3): 352-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=275459&dopt=Abstract

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Lumbar spinal stenosis: surgical considerations. Author(s): Nasca RJ. Source: J South Orthop Assoc. 2002 Fall; 11(3): 127-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12539936&dopt=Abstract

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Lumbar spinal stenosis: the clinical spectrum and the results of operation. Author(s): Getty CJ. Source: The Journal of Bone and Joint Surgery. British Volume. 1980 November; 62-B(4): 481-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6448861&dopt=Abstract

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Lumbar spinal stenosis: treatment options. Author(s): Truumees E, Herkowitz HN. Source: Instr Course Lect. 2001; 50: 153-61. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372310&dopt=Abstract

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Management of iatrogenic spinal stenosis complicating placement of a fusion cage. A case report. Author(s): Glassman SD, Johnson JR, Raque G, Puno RM, Dimar JR. Source: Spine. 1996 October 15; 21(20): 2383-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8915077&dopt=Abstract

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Management of lumbar spinal stenosis. Author(s): Postacchini F. Source: The Journal of Bone and Joint Surgery. British Volume. 1996 January; 78(1): 15464. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8898152&dopt=Abstract

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Manual therapy for lumbar spinal stenosis: a comprehensive physical therapy approach. Author(s): Rademeyer I. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 103-10, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622485&dopt=Abstract

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Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. Author(s): Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Source: Journal of Neurosurgery. 1995 July; 83(1): 27-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7782845&dopt=Abstract

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Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Author(s): Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. Source: Spine. 1996 April 1; 21(7): 796-803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8779009&dopt=Abstract

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Measurements of epidural pressures that occur during walking in patients with or without spinal stenosis. Author(s): Blau WS, Arora S, Dogra S. Source: Spine. 1997 May 1; 22(9): 1045-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9152459&dopt=Abstract

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Metabolic changes in the cerebrospinal fluid of patients with lumbar disc herniation or spinal stenosis. Author(s): Garseth M, Sonnewald U, White LR, Rod M, Nygaard O, Zwart JA. Source: Journal of Neuroscience Research. 2002 September 1; 69(5): 692-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12210836&dopt=Abstract

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Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. Author(s): Waikakul W, Waikakul S. Source: J Med Assoc Thai. 2000 August; 83(8): 825-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10998833&dopt=Abstract

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Metrizamide myelography and epidural venography. Their role in the diagnosis of lumbar disc herniation and spinal stenosis. Author(s): Herkowitz HN, Wiesel SW, Booth RE Jr, Rothman RH. Source: Spine. 1982 January-February; 7(1): 55-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7071662&dopt=Abstract

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Microscopic laminotomies for degenerative lumbar spinal stenosis. Author(s): Tsai RY, Yang RS, Bray RS Jr. Source: Journal of Spinal Disorders. 1998 October; 11(5): 389-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9811098&dopt=Abstract

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Microsurgical decompression without laminectomy in lumbar spinal stenosis. Author(s): Nystrom B, Weber H, Amundsen T. Source: Upsala Journal of Medical Sciences. 2001; 106(2): 123-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11888068&dopt=Abstract

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Microsurgical techniques in lumbar spinal stenosis. Author(s): Riew KD, Rhee J. Source: Instr Course Lect. 2002; 51: 247-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12064110&dopt=Abstract

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Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Author(s): Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K. Source: Spine. 2000 July 15; 25(14): 1754-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10888941&dopt=Abstract

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Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: analysis of clinical and radiographic data. Author(s): Shaffrey CI, Wiggins GC, Piccirilli CB, Young JN, Lovell LR. Source: Journal of Neurosurgery. 1999 April; 90(4 Suppl): 170-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10199245&dopt=Abstract

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Motor and somatosensory conduction time between the cortex and the Erb point in patients suffering from cervical spinal stenosis and tumour. Author(s): Szekely G Jr, Csecsei GI. Source: Neurobiology (Bp). 1997; 5(4): 441-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9591279&dopt=Abstract

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Motor conduction alterations in patients with lumbar spinal stenosis following the onset of neurogenic claudication. Author(s): Baramki HG, Steffen T, Schondorf R, Aebi M. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 1999; 8(5): 411-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10552326&dopt=Abstract

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Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. Author(s): Guigui P, Benoist M, Delecourt C, Delhoume J, Deburge A. Source: Journal of Spinal Disorders. 1998 August; 11(4): 283-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9726295&dopt=Abstract

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Multilevel lumbar laminotomies for focal spinal stenosis: case report. Author(s): Aryanpur J, Ducker T. Source: Neurosurgery. 1988 July; 23(1): 111-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2971890&dopt=Abstract

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Multilevel osteochondroma of the lumbar spine presenting as spinal stenosis. Author(s): Royster RM, Kujawa P, Dryer RF. Source: Spine. 1991 August; 16(8): 992-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1948388&dopt=Abstract

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Multiplanar computerized tomography in the normal spine and in the diagnosis of spinal stenosis. A gross anatomic-computerized tomographic correlation. Author(s): Lancourt JE, Glenn WV Jr, Wiltse LL. Source: Spine. 1979 July-August; 4(4): 379-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=483045&dopt=Abstract

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Nerve root ischemia and pain secondary to spinal stenosis syndrome: technical and clinical considerations. Author(s): Foreman SM. Source: Journal of Manipulative and Physiological Therapeutics. 1985 June; 8(2): 81-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4009071&dopt=Abstract

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Neural arch resection for lumbar spinal stenosis. Author(s): Rosomoff HL. Source: Clinical Orthopaedics and Related Research. 1981 January-February; (154): 83-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7471592&dopt=Abstract

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Neurogenic claudication (spinal stenosis). Author(s): Stephens MM, O'Connell D, McManus F. Source: Ir Med J. 1984 August; 77(8): 235-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6480323&dopt=Abstract

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Neurogenic intermittent claudication related to spinal stenosis. Author(s): Chung CT, Chou CS, Ho YJ, Lee SK. Source: Zhonghua Yi Xue Za Zhi (Taipei). 2000 November; 63(11): 809-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11155757&dopt=Abstract

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Neurogenic positional pedal neuritis. Common pedal manifestations of spinal stenosis. Author(s): Goldman SM. Source: Journal of the American Podiatric Medical Association. 2003 May-June; 93(3): 174-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756307&dopt=Abstract

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Neurophysiologic investigation of patients with spinal stenosis. Author(s): Johnsson KE, Rosen I, Uden A. Source: Spine. 1987 June; 12(5): 483-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2820066&dopt=Abstract

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New techniques for decompression of lumbar spinal stenosis. Author(s): Ray CD. Source: Neurosurgery. 1982 May; 10(5): 587-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6212772&dopt=Abstract

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Night pain associated with diminished cardiopulmonary compliance. A concomitant of lumbar spinal stenosis and degenerative spondylolisthesis. Author(s): LaBan MM, Wesolowski DP. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1988 August; 67(4): 155-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3401361&dopt=Abstract

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Nonoperative management of lumbar spinal stenosis. Author(s): DuPriest CM. Source: Journal of Manipulative and Physiological Therapeutics. 1993 July-August; 16(6): 411-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8409789&dopt=Abstract

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Nonoperative treatment for lumbar spinal stenosis. Author(s): Simotas AC. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 153-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249160&dopt=Abstract

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Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis. Author(s): Simotas AC, Dorey FJ, Hansraj KK, Cammisa F Jr. Source: Spine. 2000 January 15; 25(2): 197-203; Discussions 203-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10685483&dopt=Abstract

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Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Author(s): Whitman JM, Flynn TW, Fritz JM. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 77-101, Vi-Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622484&dopt=Abstract

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Normal cervical spine morphometry and cervical spinal stenosis in asymptomatic professional football players. Plain film radiography, multiplanar computed tomography, and magnetic resonance imaging. Author(s): Herzog RJ, Wiens JJ, Dillingham MF, Sontag MJ. Source: Spine. 1991 June; 16(6 Suppl): S178-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1862411&dopt=Abstract

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Obliterative arachnoiditis complicating lumbar spinal stenosis. Author(s): Epstein JA, Epstein BS, Lavine LS, Rosenthal AD, Decker RE, Carras R. Source: Journal of Neurosurgery. 1978 February; 48(2): 252-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=624974&dopt=Abstract

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Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients. Author(s): Fredman B, Arinzon Z, Zohar E, Shabat S, Jedeikin R, Fidelman ZG, Gepstein R. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002 December; 11(6): 571-4. Epub 2002 September 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12522715&dopt=Abstract

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Observer variability in assessing lumbar spinal stenosis severity on magnetic resonance imaging and its relation to cross-sectional spinal canal area. Author(s): Speciale AC, Pietrobon R, Urban CW, Richardson WJ, Helms CA, Major N, Enterline D, Hey L, Haglund M, Turner DA. Source: Spine. 2002 May 15; 27(10): 1082-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12004176&dopt=Abstract

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Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading. Author(s): Nowicki BH, Haughton VM, Schmidt TA, Lim TH, An HS, Riley LH 3rd, Yu L, Hong JW. Source: Ajnr. American Journal of Neuroradiology. 1996 October; 17(9): 1605-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8896609&dopt=Abstract

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Occult lumbar spinal stenosis. Author(s): Choudhury AR, Taylor JC. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1977 May; 40(5): 506-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=894321&dopt=Abstract

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Ossification of the posterior longitudinal ligaments: a cause of spinal stenosis syndrome. Author(s): Foreman SM. Source: Journal of Manipulative and Physiological Therapeutics. 1985 December; 8(4): 251-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3935747&dopt=Abstract

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Our experience with lumbar spinal stenosis in Singapore. Author(s): Nather A, Thomas E. Source: Ann Acad Med Singapore. 1985 January; 14(1): 49-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4004128&dopt=Abstract

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Outcome after laminectomy for lumbar spinal stenosis. Part I: Clinical correlations. Author(s): Tuite GF, Stern JD, Doran SE, Papadopoulos SM, McGillicuddy JE, Oyedijo DI, Grube SV, Lundquist C, Gilmer HS, Schork MA, et al. Source: Journal of Neurosurgery. 1994 November; 81(5): 699-706. Erratum In: J Neurosurg 1995 May; 82(5): 912. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7755690&dopt=Abstract

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Outcome after laminectomy for lumbar spinal stenosis. Part II: Radiographic changes and clinical correlations. Author(s): Tuite GF, Doran SE, Stern JD, McGillicuddy JE, Papadopoulos SM, Lundquist CA, Oyedijo DI, Grube SV, Gilmer HS, Schork MA, et al. Source: Journal of Neurosurgery. 1994 November; 81(5): 707-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7931616&dopt=Abstract

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Oxalosis: cause of degenerative spinal stenosis. A case report and review of the literature. Author(s): Knight RQ, Taddonio RF, Smith FB, Weseley S, Pecker HM. Source: Orthopedics. 1988 June; 11(6): 955-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3290875&dopt=Abstract

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Pamidronate treatment of the neurologic sequelae of pagetic spinal stenosis. Author(s): Wallace E, Wong J, Reid IR. Source: Archives of Internal Medicine. 1995 September 11; 155(16): 1813-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7654117&dopt=Abstract

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Paraplegia following post-traumatic thoracic spinal stenosis: a case report. Author(s): Farooq MT, Chao T, Bennett M. Source: Archives of Physical Medicine and Rehabilitation. 1996 January; 77(1): 84-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8554481&dopt=Abstract

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Paraplegia from operating position and spinal stenosis in non-spinal surgery: a case report. Author(s): Wilkes LL. Source: Clinical Orthopaedics and Related Research. 1980 January-February; (146): 1489. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7371243&dopt=Abstract

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Paraspinal muscle denervation, paradoxically good lumbar endurance, and an abnormal flexion-extension cycle in lumbar spinal stenosis. Author(s): Leinonen V, Maatta S, Taimela S, Herno A, Kankaanpaa M, Partanen J, Hanninen O, Airaksinen O. Source: Spine. 2003 February 15; 28(4): 324-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590204&dopt=Abstract

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Partial pediculectomy in the treatment of lumbar spinal stenosis: technical note. Author(s): Sheehan JM, Helm GA, Kallmes DF, Bogaev CA, Jane JA. Source: Neurosurgery. 1997 July; 41(1): 308-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9218325&dopt=Abstract

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Pathogenesis of lumbar spinal stenosis pain: why does an asymptomatic stenotic patient flare? Author(s): Akuthota V, Lento P, Sowa G. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 17-28, V. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622479&dopt=Abstract

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Pathophysiology of spinal stenosis. Author(s): Mirkovic S, Garfin SR, Rydevik B, Lipson SJ. Source: Instr Course Lect. 1992; 41: 165-77. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1588061&dopt=Abstract

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Percutaneous laser disc decompression in spinal stenosis. Author(s): Choy DS, Ngeow J. Source: Journal of Clinical Laser Medicine & Surgery. 1998 April; 16(2): 123-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9663104&dopt=Abstract

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Percutaneous stimulation of the cauda equina. A new diagnostic method in spinal stenosis. Author(s): Williamson JB. Source: Spine. 1991 April; 16(4): 460-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2047919&dopt=Abstract

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Pituitary gigantism with cervical spinal stenosis. Author(s): Efird TA, Genant HK, Wilson CB. Source: Ajr. American Journal of Roentgenology. 1980 January; 134(1): 171-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6766014&dopt=Abstract

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Positionally dependent spinal stenosis: correlation of upright flexion-extension myelography and computed tomographic myelography. Author(s): Zander DR, Lander PH. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 1998 August; 49(4): 256-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9709684&dopt=Abstract

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Postoperative bone re-growth in lumbar spinal stenosis. A multivariate analysis of 48 patients. Author(s): Chen Q, Baba H, Kamitani K, Furusawa N, Imura S. Source: Spine. 1994 October 1; 19(19): 2144-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7809745&dopt=Abstract

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Post-traumatic progressive cervical myelopathy in patient with congenital spinal stenosis. Author(s): Ducker TB. Source: Journal of Spinal Disorders. 1996 February; 9(1): 76; Discussion 77-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8727461&dopt=Abstract

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Posttraumatic spinal stenosis of the lumbar spine: report of a case caused by hyperextension injury; review of literature. Author(s): Hasue M, Kikuchi S, Inoue K, Miura H. Source: Spine. 1980 May-June; 5(3): 259-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7394665&dopt=Abstract

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Pre- and postoperative factors associated with return to work following surgery for lumbar spinal stenosis. Author(s): Herno A, Airaksinen O, Saari T, Svomalainen O. Source: American Journal of Industrial Medicine. 1996 October; 30(4): 473-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8892553&dopt=Abstract

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Precise and limited decompression for lumbar spinal stenosis. Author(s): Caspar W, Papavero L, Sayler MK, Harkey HL. Source: Acta Neurochirurgica. 1994; 131(1-2): 130-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7709775&dopt=Abstract

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Predictors of surgical outcome in degenerative lumbar spinal stenosis. Author(s): Katz JN, Stucki G, Lipson SJ, Fossel AH, Grobler LJ, Weinstein JN. Source: Spine. 1999 November 1; 24(21): 2229-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10562989&dopt=Abstract

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Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. Author(s): Fritz JM, Erhard RE, Delitto A, Welch WC, Nowakowski PE. Source: Journal of Spinal Disorders. 1997 October; 10(5): 410-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9355058&dopt=Abstract

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Prospective functional evaluation of the surgical treatment of neurogenic claudication in patients with lumbar spinal stenosis. Author(s): Tenhula J, Lenke LG, Bridwell KH, Gupta P, Riew D. Source: Journal of Spinal Disorders. 2000 August; 13(4): 276-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10941885&dopt=Abstract

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Pseudohypoparathyroidism-associated spinal stenosis. Author(s): Okada K, Iida K, Sakusabe N, Saitoh H, Abe E, Sato K. Source: Spine. 1994 May 15; 19(10): 1186-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8059279&dopt=Abstract

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Qualitative assessment of cervical spinal stenosis: observer variability on CT and MR images. Author(s): Stafira JS, Sonnad JR, Yuh WT, Huard DR, Acker RE, Nguyen DL, Maley JE, Ramji FG, Li WB, Loftus CM. Source: Ajnr. American Journal of Neuroradiology. 2003 April; 24(4): 766-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695220&dopt=Abstract

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Quality of life before and after microsurgical decompression in lumbar spinal stenosis. Author(s): Schillberg B, Nystrom B. Source: Journal of Spinal Disorders. 2000 June; 13(3): 237-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10872762&dopt=Abstract

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Quantitative analysis of transforming growth factor-beta 1 in ligamentum flavum of lumbar spinal stenosis and disc herniation. Author(s): Park JB, Chang H, Lee JK. Source: Spine. 2001 November 1; 26(21): E492-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11679833&dopt=Abstract

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Questions & answers. I'm a 79-year-old man with spinal stenosis. I was recently diagnosed with Paget's disease. Are these conditions related, and what are the best treatments? Author(s): Kippel J. Source: Health News. 2003 October; 9(10): 16. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14619778&dopt=Abstract

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Radiologic imaging in spinal stenosis. Author(s): Herzog RJ. Source: Instr Course Lect. 2001; 50: 137-44. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372308&dopt=Abstract

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Radiology of spinal stenosis. Author(s): McCall IW. Source: Acta Orthop Scand Suppl. 1993; 251: 59-60. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8451988&dopt=Abstract

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Rationale for spinal fusion in lumbar spinal stenosis. Author(s): Nasca RJ. Source: Spine. 1989 April; 14(4): 451-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2718051&dopt=Abstract

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Recurrent articular spondylolisthesis: common cause of vertebral instabilities, root pain, sciatica, and ultimately spinal stenosis. Early detection and blocking of specific dislocations. Author(s): Milgram JE. Source: Bull Hosp Jt Dis Orthop Inst. 1986 Spring; 46(1): 47-51. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3015295&dopt=Abstract

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Recurrent spinal stenosis caused by tophaceous gout: a case report and review of literature. Author(s): Ko PJ, Huang TJ, Liao YS, Hsueh S, Hsu RW. Source: Changgeng Yi Xue Za Zhi. 1996 September; 19(3): 272-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8921648&dopt=Abstract

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Redefining cervical spinal stenosis using MRI. Author(s): Pavlov H, Torg JS. Source: Medicine and Science in Sports and Exercise. 1993 September; 25(9): 1082-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8231779&dopt=Abstract

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Redundant nerve roots in patients with degenerative lumbar spinal stenosis. Author(s): Tsuji H, Tamaki T, Itoh T, Yamada H, Motoe T, Tatezaki S, Noguchi T, Takano H. Source: Spine. 1985 January-February; 10(1): 72-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3983705&dopt=Abstract

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Rehabilitation outcome of individuals with nontraumatic myelopathy resulting from spinal stenosis. Author(s): McKinley WO, Tellis AA, Cifu DX, Johnson MA, Kubal WS, Keyser-Marcus L, Musgrove JJ. Source: J Spinal Cord Med. 1998 April; 21(2): 131-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9697089&dopt=Abstract

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Relationship between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. Author(s): Keller RB, Atlas SJ, Soule DN, Singer DE, Deyo RA. Source: The Journal of Bone and Joint Surgery. American Volume. 1999 June; 81(6): 75262. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10391540&dopt=Abstract

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Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. Author(s): Stucki G, Liang MH, Fossel AH, Katz JN. Source: Journal of Clinical Epidemiology. 1995 November; 48(11): 1369-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7490600&dopt=Abstract

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Reliability in grading the severity of lumbar spinal stenosis. Author(s): Drew R, Bhandari M, Kulkarni AV, Louw D, Reddy K, Dunlop B. Source: Journal of Spinal Disorders. 2000 June; 13(3): 253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10872765&dopt=Abstract

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Restless legs syndrome associated with diminished cardiopulmonary compliance and lumbar spinal stenosis--a motor concomitant of “Vesper's curse”. Author(s): LaBan MM, Viola SL, Femminineo AF, Taylor RS. Source: Archives of Physical Medicine and Rehabilitation. 1990 May; 71(6): 384-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2334280&dopt=Abstract

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Results of decompression for lumbar spinal stenosis. Author(s): Paine KW. Source: Clinical Orthopaedics and Related Research. 1976 March-April; (115): 96-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1253504&dopt=Abstract

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Results of expansive laminoplasty for lumbar spinal stenosis in active manual workers. Author(s): Matsui H, Tsuji H, Sekido H, Hirano N, Katoh Y, Makiyama N. Source: Spine. 1992 March; 17(3 Suppl): S37-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1566183&dopt=Abstract

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Results of surgery for lumbar spinal stenosis in patients aged 80 years or more. A retrospective study of thirty-four cases. Author(s): Ishac R, Alhayek G, Fournier D, Mercier P, Guy G. Source: Rev Rhum Engl Ed. 1996 March; 63(3): 196-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8731237&dopt=Abstract

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Results of surgery for spinal stenosis adjacent to previous lumbar fusion. Author(s): Phillips FM, Carlson GD, Bohlman HH, Hughes SS. Source: Journal of Spinal Disorders. 2000 October; 13(5): 432-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11052354&dopt=Abstract

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Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes. Author(s): Shapiro GS, Taira G, Boachie-Adjei O. Source: Spine. 2003 February 15; 28(4): 358-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590210&dopt=Abstract

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Reversible prolongation of motor conduction time after transcranial magnetic brain stimulation after neurogenic claudication in spinal stenosis. Author(s): Lang E, Hilz MJ, Erxleben H, Ernst M, Neundorfer B, Liebig K. Source: Spine. 2002 October 15; 27(20): 2284-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394909&dopt=Abstract

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Rheumatoid arthritis contributing to lumbar spinal stenosis. Neurogenic intermittent claudication. Author(s): Magnaes B, Hauge T. Source: Scandinavian Journal of Rheumatology. 1978; 7(4): 215-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=734379&dopt=Abstract

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Role of computed tomography and myelography in the diagnosis of central spinal stenosis. Author(s): Bolender NF, Schonstrom NS, Spengler DM. Source: The Journal of Bone and Joint Surgery. American Volume. 1985 February; 67(2): 240-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3968115&dopt=Abstract

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Severe underestimation of lumbar spinal stenosis by supine imaging. Author(s): Coulier B, Devyver B, Ghosez JP. Source: Clinical Radiology. 2003 February; 58(2): 167-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623050&dopt=Abstract

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Simian stance: a sign of spinal stenosis. Author(s): Simkin PA. Source: Lancet. 1982 September 18; 2(8299): 652-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6125787&dopt=Abstract

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Spinal stenosis vs traumatic spinal cord injury: a rehabilitation outcome comparison. Author(s): Mckinley WO, Tewksbury MA, Mujteba NM. Source: J Spinal Cord Med. 2002 Spring; 25(1): 28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939463&dopt=Abstract

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Spinal stenosis. Author(s): Garfin SR, Rauschning W. Source: Instr Course Lect. 2001; 50: 145-52. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372309&dopt=Abstract

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Spinal stenosis. Author(s): Garfin SR, Herkowitz HN, Mirkovic S. Source: Instr Course Lect. 2000; 49: 361-74. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10829189&dopt=Abstract

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Spinal stenosis: a review of 23 cases. Author(s): Black KA, McCormick C, Owen ET, Vaughan R. Source: The Journal of Rheumatology. 1982 July-August; 9(4): 573-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7131455&dopt=Abstract

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Spinal stenosis: history and physical examination. Author(s): Thomas SA. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 29-39. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622480&dopt=Abstract

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Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Author(s): Ragab AA, Fye MA, Bohlman HH. Source: Spine. 2003 February 15; 28(4): 348-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590208&dopt=Abstract

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Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Author(s): Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Source: Spine. 2000 March 1; 25(5): 556-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10749631&dopt=Abstract

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Surgical management of lumbar degenerative spinal stenosis with spondylolisthesis via posterior reduction with minimal laminectomy. Author(s): Bednar DA. Source: Journal of Spinal Disorders & Techniques. 2002 April; 15(2): 105-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927818&dopt=Abstract

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Surgical management of lumbar spinal stenosis. Author(s): Postacchini F. Source: Spine. 1999 May 15; 24(10): 1043-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10332799&dopt=Abstract

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Surgical management of spinal stenosis. Author(s): Zak PJ. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 143-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622488&dopt=Abstract

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Surgical management of spinal stenosis: a comparison of immediate and long term outcome in two geriatric patient populations. Author(s): Arinzon ZH, Fredman B, Zohar E, Shabat S, Feldman JS, Jedeikin R, Gepstein RJ. Source: Archives of Gerontology and Geriatrics. 2003 May-June; 36(3): 273-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12849082&dopt=Abstract

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Surgical therapy for lumbar spinal stenosis: evaluation of 300 cases. Author(s): Cirak B, Alptekin M, Palaoglu S, Ozcan OE, Ozgen T. Source: Neurosurgical Review. 2001 July; 24(2-3): 80-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11485243&dopt=Abstract

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Surgical treatment for thoracic spinal stenosis. Author(s): Chang UK, Choe WJ, Chung CK, Kim HJ. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2001 July; 39(7): 362-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11464309&dopt=Abstract

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Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. Author(s): Vitaz TW, Raque GH, Shields CB, Glassman SD. Source: Journal of Neurosurgery. 1999 October; 91(2 Suppl): 181-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10505502&dopt=Abstract

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Surgical treatment of lumbar spinal stenosis. Five-year follow-up. Author(s): Jolles BM, Porchet F, Theumann N. Source: The Journal of Bone and Joint Surgery. British Volume. 2001 September; 83(7): 949-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11603533&dopt=Abstract

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Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Author(s): Simmons ED. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 45-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249179&dopt=Abstract

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Surgical treatment of thoracic spinal stenosis: a 2- to 9-year follow-up. Author(s): Palumbo MA, Hilibrand AS, Hart RA, Bohlman HH. Source: Spine. 2001 March 1; 26(5): 558-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11242384&dopt=Abstract

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Symptomatic congenital spinal stenosis in a child. Author(s): Dauser RC, Chandler WF. Source: Neurosurgery. 1982 July; 11(1 Pt 1): 61-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7110570&dopt=Abstract

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Tandem spinal stenosis: clinical diagnosis and surgical treatment. Author(s): Hsieh CH, Huang TJ, Hsu RW. Source: Changgeng Yi Xue Za Zhi. 1998 December; 21(4): 429-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10074729&dopt=Abstract

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Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Author(s): Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Source: Mayo Clinic Proceedings. 2000 October; 75(10): 1002-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11040847&dopt=Abstract

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The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Author(s): Herno A, Saari T, Suomalainen O, Airaksinen O. Source: Spine. 1999 May 15; 24(10): 1010-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10332794&dopt=Abstract

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The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis. Author(s): Kramer R, Wild A, Haak H, Borowski S, Krauspe R. Source: Biomed Tech (Berl). 2002 June; 47(6): 159-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12149803&dopt=Abstract

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The effectiveness of lumbosacral corset in symptomatic degenerative lumbar spinal stenosis. Author(s): Prateepavanich P, Thanapipatsiri S, Santisatisakul P, Somshevita P, Charoensak T. Source: J Med Assoc Thai. 2001 April; 84(4): 572-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11460971&dopt=Abstract

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The imaging of lumbar spinal stenosis. Author(s): Saifuddin A. Source: Clinical Radiology. 2000 August; 55(8): 581-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10964728&dopt=Abstract

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The lateral recess syndrome. A variant of spinal stenosis. Author(s): Ciric I, Mikhael MA, Tarkington JA, Vick NA. Source: Journal of Neurosurgery. 1980 October; 53(4): 433-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7420163&dopt=Abstract

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The long-term results of surgical treatment for spinal stenosis in the elderly. Author(s): Hee HT, Wong HK. Source: Singapore Med J. 2003 April; 44(4): 175-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12952028&dopt=Abstract

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The natural history of lumbar degenerative spinal stenosis. Author(s): Benoist M. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 October; 69(5): 450-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477228&dopt=Abstract

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The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Author(s): Iversen MD, Daltroy LH, Fossel AH, Katz JN. Source: Patient Education and Counseling. 1998 June; 34(2): 169-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9731176&dopt=Abstract

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The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Author(s): Pratt RK, Fairbank JC, Virr A. Source: Spine. 2002 January 1; 27(1): 84-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11805642&dopt=Abstract

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The roentgenographic manifestations and clinical features of lumbar spinal stenosis with special emphasis on the superior articular process. Author(s): Chynn KY, Altman I, Shaw WI, Finby N. Source: Neuroradiology. 1978; 16: 378-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=745720&dopt=Abstract

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The stenosis ratio: a new tool for the diagnosis of degenerative spinal stenosis. Author(s): Laurencin CT, Lipson SJ, Senatus P, Botchwey E, Jones TR, Koris M, Hunter J. Source: International Journal of Surgical Investigation. 1999; 1(2): 127-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11341632&dopt=Abstract

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The surgical outcome of degenerative lumbar spinal stenosis. Author(s): Razak MA, Ong KP, Hyzan Y. Source: Med J Malaysia. 1998 September; 53 Suppl A: 12-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10968178&dopt=Abstract

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The syndrome of lumbar spinal stenosis and its surgical treatment. Author(s): Hubschmann OR, Weisbrot FJ. Source: J Med Soc N J. 1981 May; 78(5): 351-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6457157&dopt=Abstract

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Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Author(s): Bodack MP, Monteiro M. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 144-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249159&dopt=Abstract

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Three-question depression screener used for lumbar disc herniations and spinal stenosis. Author(s): Levy HI, Hanscom B, Boden SD. Source: Spine. 2002 June 1; 27(11): 1232-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045523&dopt=Abstract

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Transient lumbosacral polyradiculopathy after prostatectomy: association with spinal stenosis. Author(s): Ahearn GS, Bedlack RS, Price DT, Robertson CN, Morgenlander JC. Source: Southern Medical Journal. 1999 August; 92(8): 809-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10456722&dopt=Abstract

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Traumatic myelopathy in patients with cervical spinal stenosis without fracture or dislocation: methods of diagnosis, management, and prognosis. Author(s): Epstein N, Epstein JA, Benjamin V, Ransohoff J. Source: Spine. 1980 November-December; 5(6): 489-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7466456&dopt=Abstract

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Treatment of spinal stenosis and fixed sagittal imbalance. Author(s): Bridwell KH, Lenke LG, Lewis SJ. Source: Clinical Orthopaedics and Related Research. 2001 March; (384): 35-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11249178&dopt=Abstract

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Ultrasound measurements of the spinal canal in spinal stenosis. Author(s): Davies P. Source: British Medical Journal (Clinical Research Ed.). 1982 September 25; 285(6345): 893-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6811059&dopt=Abstract

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Understanding spinal stenosis. Author(s): Best JT. Source: Orthopaedic Nursing / National Association of Orthopaedic Nurses. 2002 MayJune; 21(3): 48-54; Quiz 54-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12101938&dopt=Abstract

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Unilateral fenestration in the treatment of lumbar spinal stenosis. Author(s): Mackay DC, Wheelwright EF. Source: British Journal of Neurosurgery. 1998 December; 12(6): 556-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10070466&dopt=Abstract

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Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. Author(s): Mariconda M, Fava R, Gatto A, Longo C, Milano C. Source: Journal of Spinal Disorders & Techniques. 2002 February; 15(1): 39-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11891449&dopt=Abstract

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Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations. Author(s): Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM. Source: Acta Neurochirurgica. 1997; 139(5): 392-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9204106&dopt=Abstract

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Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Author(s): Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM. Source: Acta Neurochirurgica. 1997; 139(5): 397-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9204107&dopt=Abstract

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Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature. Author(s): Radu AS, Menkes CJ. Source: Rev Rhum Engl Ed. 1998 May; 65(5): 337-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9636953&dopt=Abstract

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Urodynamic evaluation of patients with spinal stenosis. Author(s): Smith AY, Woodside JR. Source: Urology. 1988 November; 32(5): 474-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3188319&dopt=Abstract

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Use of the exercise treadmill to measure baseline functional status and surgical outcome in patients with severe lumbar spinal stenosis. Author(s): Deen HG, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM. Source: Spine. 1998 January 15; 23(2): 244-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9474733&dopt=Abstract

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Usefulness of Posner's definition of spinal instability for selection of surgical treatment for lumbar spinal stenosis. Author(s): Yone K, Sakou T. Source: Journal of Spinal Disorders. 1999 February; 12(1): 40-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10078948&dopt=Abstract

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Value of magnetic resonance myelography in the diagnosis of disc herniation and spinal stenosis. Author(s): Pui MH, Husen YA. Source: Australasian Radiology. 2000 August; 44(3): 281-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10974720&dopt=Abstract

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Vascular and neural pathology of lumbosacral spinal stenosis. Author(s): Watanabe R, Parke WW. Source: Journal of Neurosurgery. 1986 January; 64(1): 64-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3941352&dopt=Abstract

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Vertebral slipping after decompression for spinal stenosis. Author(s): Jonsson B. Source: Acta Orthop Scand Suppl. 1993; 251: 76-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8451995&dopt=Abstract

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Voiding dysfunction and urodynamic findings in patients with cervical spondylotic spinal stenosis compared with severity of the disease. Author(s): Tammela TL, Heiskari MJ, Lukkarinen OA. Source: British Journal of Urology. 1992 August; 70(2): 144-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1393436&dopt=Abstract

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Voiding dysfunction and urodynamic findings in patients with lumbar spinal stenosis and the effect of decompressive laminectomy. Author(s): Hellstrom PA, Tammela TL, Niinimaki TJ. Source: Scandinavian Journal of Urology and Nephrology. 1995 June; 29(2): 167-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7569794&dopt=Abstract

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When is spinal fusion warranted in degenerative lumbar spinal stenosis? Author(s): Brunon J, Chazal J, Chirossel JP, Houteville JP, Lagarrigue J, Legars D, Moreau JJ, Perrin G, Tremoulet M. Source: Rev Rhum Engl Ed. 1996 January; 63(1): 44-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9064109&dopt=Abstract

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CHAPTER 2. NUTRITION AND SPINAL STENOSIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and spinal stenosis.

Finding Nutrition Studies on Spinal Stenosis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “spinal stenosis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “spinal stenosis” (or a synonym): •

Calcitonin treatment in lumbar spinal stenosis: clinical observations. Author(s): Invalid Foundation Orthopaedic Hospital, Helsinki, Finland. Source: Eskola, A Alaranta, H Pohjolainen, T Soini, J Tallroth, K Slatis, P Calcif-TissueInt. 1989 December; 45(6): 372-4 0171-967X

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Congenital spinal stenosis in beef calves in western Canada. Author(s): Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada. Source: Doige, C E Townsend, H G Janzen, E D McGowan, M Vet-Pathol. 1990 Jan; 27(1): 16-25 0300-9858

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Epidural injection in the treatment of spinal stenosis. Source: Hoogmartens, M Morelle, P Acta-Orthop-Belg. 1987; 53(3): 409-11 0001-6462

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Lumbar canal stenosis: start with nonsurgical therapy. Author(s): Spine Center, Department of Rheumatic and Immunologic Disease, The Cleveland Clinic Foundation, Ohio 44195, USA. [email protected] Source: Mazanec, D J Podichetty, V K Hsia, A Cleve-Clin-J-Med. 2002 November; 69(11): 909-17 0891-1150

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Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Author(s): Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, University of Istanbul, Turkey. Source: Onel, D Sari, H Donmez, C Spine. 1993 February; 18(2): 291-8 0362-2436

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Metabolic changes in the cerebrospinal fluid of patients with lumbar disc herniation or spinal stenosis. Author(s): Department of Clinical Neurosciences, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. [email protected] Source: Garseth, M Sonnewald, U White, L R Rod, M Nygaard, O Zwart, J A J-NeurosciRes. 2002 September 1; 69(5): 692-5 0360-4012

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Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. Author(s): Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Source: Waikakul, W Waikakul, S J-Med-Assoc-Thai. 2000 August; 83(8): 825-31 01252208

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Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature. Author(s): Department of Rheumatology, School of Medicine of the Sao Paulo University, Brazil. Source: Radu, A S Menkes, C J Rev-Rhum-Engl-Ed. 1998 May; 65(5): 337-45 1169-8446

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to spinal stenosis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Food and Diet Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND SPINAL STENOSIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to spinal stenosis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to spinal stenosis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “spinal stenosis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to spinal stenosis: •

A hypothesis introducing a new calculation for discal reduction emphasis on stentotic factors and manipulative treatment. Author(s): Church CP, Dailey EJ, Henry JR, Goeser CD. Source: Journal of Manipulative and Physiological Therapeutics. 1989 April; 12(2): 151-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2715739&dopt=Abstract

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A review of radiographic differential diagnosis of common degenerative spinal disorders. Author(s): Foreman SM. Source: Journal of Manipulative and Physiological Therapeutics. 1985 March; 8(1): 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3989397&dopt=Abstract

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A single case report of healing through specific martial art therapy: comparison of MRI to clinical resolution in severe cervical stenosis: a case report. Author(s): Massey PB, Kisling GM. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 1999 February; 5(1): 75-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10100033&dopt=Abstract

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An 83-year-old woman with chronic illness and strong religious beliefs. Author(s): Koenig HG. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 487-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132980&dopt=Abstract

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Charcot-Marie-Tooth disease. Author(s): Martel J, Mierau D, Donat J. Source: Journal of Manipulative and Physiological Therapeutics. 1995 March-April; 18(3): 168-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7790797&dopt=Abstract

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Chiropractic management of a patient with lumbar spinal stenosis. Author(s): Snow GJ. Source: Journal of Manipulative and Physiological Therapeutics. 2001 May; 24(4): 300-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353943&dopt=Abstract

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Chondromyxoid fibroma of bone presenting as chronic back pain. Author(s): Schmidt RG, Reddy CS, Applegate TD, Ghabra M. Source: Journal of Manipulative and Physiological Therapeutics. 1998 October; 21(8): 564-7. Erratum In: J Manipulative Physiol Ther 1999 February; 22(2): 122. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9798185&dopt=Abstract

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Chronic inflammatory granuloma mimics clinical manifestations of lumbar spinal stenosis after acupuncture: a case report. Author(s): Ha KY, Kim YH. Source: Spine. 2003 June 1; 28(11): E217-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782998&dopt=Abstract

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Delay in the diagnosis and treatment of primary bone sarcoma of the pelvis. Author(s): Wurtz LD, Peabody TD, Simon MA. Source: The Journal of Bone and Joint Surgery. American Volume. 1999 March; 81(3): 317-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10199269&dopt=Abstract

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Drug therapy for back pain. Which drugs help which patients? Author(s): Deyo RA. Source: Spine. 1996 December 15; 21(24): 2840-9; Discussion 2849-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9112708&dopt=Abstract

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Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Author(s): Borenstein DG. Source: Current Opinion in Rheumatology. 2001 March; 13(2): 128-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11224737&dopt=Abstract

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From the Electrodiagnostics Lab. Author(s): Leppanen RE. Source: The Spine Journal : Official Journal of the North American Spine Society. 2003 March-April; 3(2): 174. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14589235&dopt=Abstract

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Intravascular lymphoma presenting with cauda equina syndrome: treated with CHOP and rituxan. Author(s): Davis TS. Source: Leukemia & Lymphoma. 2003 May; 44(5): 887-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802932&dopt=Abstract

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Lateral recess syndrome: diagnosis and chiropractic management. Author(s): Ben-Eliyahu DJ, Rutili MM, Przybysz JA. Source: Journal of Manipulative and Physiological Therapeutics. 1983 March; 6(1): 25-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6222128&dopt=Abstract

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Low back disorders: conservative management. Author(s): Fast A. Source: Archives of Physical Medicine and Rehabilitation. 1988 October; 69(10): 880-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2972268&dopt=Abstract

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Mechanisms of neurovascular compression within the spinal and intervertebral canals. Author(s): Giles LG. Source: Journal of Manipulative and Physiological Therapeutics. 2000 February; 23(2): 107-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10714537&dopt=Abstract

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Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. Author(s): Waikakul W, Waikakul S.

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Source: J Med Assoc Thai. 2000 August; 83(8): 825-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10998833&dopt=Abstract •

Multilevel spinal stenosis: a case report. Author(s): Buehler MT, Marquart D. Source: Journal of Manipulative and Physiological Therapeutics. 1986 June; 9(2): 135-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3734637&dopt=Abstract

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Nerve root ischemia and pain secondary to spinal stenosis syndrome: technical and clinical considerations. Author(s): Foreman SM. Source: Journal of Manipulative and Physiological Therapeutics. 1985 June; 8(2): 81-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4009071&dopt=Abstract

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Nonoperative management of lumbar spinal stenosis. Author(s): DuPriest CM. Source: Journal of Manipulative and Physiological Therapeutics. 1993 July-August; 16(6): 411-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8409789&dopt=Abstract

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Ossification of the posterior longitudinal ligaments: a cause of spinal stenosis syndrome. Author(s): Foreman SM. Source: Journal of Manipulative and Physiological Therapeutics. 1985 December; 8(4): 251-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3935747&dopt=Abstract

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Percutaneous stimulation of the cauda equina. A new diagnostic method in spinal stenosis. Author(s): Williamson JB. Source: Spine. 1991 April; 16(4): 460-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2047919&dopt=Abstract

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Plain film assessment of spinal stenosis: method comparison with lumbar CT. Author(s): Meyer JJ. Source: Journal of Manipulative and Physiological Therapeutics. 1990 June; 13(5): 288. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2376723&dopt=Abstract

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Plain film assessment of spinal stenosis: method comparison with lumbar CT. Author(s): Dailey EJ, Buehler MT.

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Source: Journal of Manipulative and Physiological Therapeutics. 1989 June; 12(3): 192-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2664062&dopt=Abstract •

Postmyelographic cauda equina syndrome in an asymptomatic acquired spinal stenosis of a young acromegalic. Author(s): Woo CC. Source: Journal of Manipulative and Physiological Therapeutics. 1988 April; 11(2): 11823. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3385339&dopt=Abstract

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Spinal manipulative therapy for low back pain. Author(s): Swenson R, Haldeman S. Source: J Am Acad Orthop Surg. 2003 July-August; 11(4): 228-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889861&dopt=Abstract

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The effects of compression on the physiology of nerve roots. Author(s): Rydevik BL. Source: Journal of Manipulative and Physiological Therapeutics. 1992 January; 15(1): 626. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1740654&dopt=Abstract

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The lack of prognostic value of computerized tomography imaging examinations in patients with chronic non-progressive back pain. Author(s): Elkayam O, Avrahami E, Yaron M. Source: Rheumatology International. 1996; 16(1): 19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8783418&dopt=Abstract

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The myelon in cervical spinal canal stenosis: imaging by X-ray and MRI. Author(s): Haupts M, Haan J, Uhlenbrock D. Source: Neurosurgical Review. 1987; 10(2): 123-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3502361&dopt=Abstract

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Unilateral intermittent claudication of the left lower extremity. Author(s): Downs SE. Source: Journal of Manipulative and Physiological Therapeutics. 1988 August; 11(4): 322-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3171415&dopt=Abstract

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to spinal stenosis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Sciatica Source: Integrative Medicine Communications; www.drkoop.com

•

Alternative Therapy Acupuncture Source: Integrative Medicine Communications; www.drkoop.com Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Chiropractic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,681,00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705,00.html Massage Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,716,00.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730,00.html Trager Approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html •

Chinese Medicine Xiatianwu Alternative names: Decumbent Corydalis Rhizome; Rhizoma Corydalis Decumbentis Source: Chinese Materia Medica

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Herbs and Supplements Ananas Comosus Source: Integrative Medicine Communications; www.drkoop.com Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.drkoop.com Bromelainum Source: Integrative Medicine Communications; www.drkoop.com Elecampane Source: Prima Communications, Inc.www.personalhealthzone.com Rosemary Alternative names: Rosmarinus officinalis Source: Integrative Medicine Communications; www.drkoop.com

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Rosemary Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Rosmarinus Officinalis Source: Integrative Medicine Communications; www.drkoop.com St. John’s Wort Alternative names: Hypericum perforatum Source: Healthnotes, Inc.; www.healthnotes.com St. John's Wort Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Tribulus Puncture Alternative names: Puncture Vine, Goathead; Tribulus terrestris L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON SPINAL STENOSIS Overview In this chapter, we will give you a bibliography on recent dissertations relating to spinal stenosis. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “spinal stenosis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on spinal stenosis, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Spinal Stenosis ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to spinal stenosis. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Changing Views of Health: Spinal Stenosis and Its Impact on Well-being by Tatarek, Nancy Elizabeth; Phd from The Ohio State University, 1999, 363 pages http://wwwlib.umi.com/dissertations/fullcit/9941444

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND SPINAL STENOSIS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning spinal stenosis.

Recent Trials on Spinal Stenosis The following is a list of recent trials dedicated to spinal stenosis.5 Further information on a trial is available at the Web site indicated. •

Effect of Antidepressants on Back Pain Condition(s): Back Pain; Sciatica Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service Purpose - Excerpt: The purpose of this study is to determine whether different types of antidepressant medicines relieve back pain that has lasted at least six months on a daily basis. Study participants will be assigned to treatment with either a antidepressant acting on the serotonin system in the brain (fluoxetine), one acting on the noradrenoline system (desipramine, or to a control medication not expected to relieve pain (benztropine). Each participant will be seen at least nine times during their 12 weeks on medication. This is a phase 2/3, outpatient study. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00018200

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Magnets in the Treatment of Sciatica Condition(s): Low Back Pain; Sciatica Study Status: This study is currently recruiting patients.

5

These are listed at www.ClinicalTrials.gov.

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Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: This 19-week study will evaluate magnets of very low power to treat sciatica (also referred to as lumbago, sciatica, or lumbar radicular pain). Some evidence suggests that magnets can alleviate pain associated with muscle, bone, and nerve problems. Individuals between 30 and 70 years of age who have had sciatica (sharp, shooting pains in the leg) daily for at least 3 months may be eligible for this study. The pain must be moderate to severe, occur on a daily basis, and be due to either disc problems or degeneration of the spine. Patients with pain in the buttock or posterior thigh without sciatica may also qualify if they have irritation of the lumbar (lower spine) nerve roots or if imaging studies such as magnetic resonance imaging (MRI) reveal a disc compressing the lumbar nerves on the same side as the pain. Candidates will be screened with a medical history, physical and neurological examinations, blood tests, pain evaluation, collection of demographic information, and possibly MRI. They will fill out questionnaires regarding pain, daily function, and psychological well being. The study has two phases, consisting of four 2-week periods in phase 1 and two 5-week periods in phase 2. - Phase 1: During two of the 2-week periods, subjects wear an elastic binder back support device with magnets sewn into them - one with the magnets aligned in the direction of the spine; the other with the magnets placed across the spine. During another period, subjects wear a dummy device that looks like a real magnet but has no actual magnetic force; in another, they wear no device at all. The magnets are worn at least 12 hours a day. - Phase 2: The subject wears the preferred magnet (real or sham) from phase 1 during one of these 5-week periods, and a dummy device during the other. Participants who did not find any of the magnets helpful in phase 1 may continue, nevertheless, with phase 2 and be assigned a magnet and sham device by the investigators. Participants may continue taking their regular pain medicines throughout the study's duration. They will keep a pain log during both phases, rating their pain on a scale of 0 to 10, and a record of side effects experienced with each period of the study. They will also keep a record of procedures, such as injections and manipulations, they undergo during the study to control pain flare-ups. Clinic visits will be scheduled as follows: - Visit 1: for screening and baseline studies before starting phase 1; participants may also come to the clinic after each 2-week period in phase 1 to exchange devices, or the devices may be mailed to the participant - Visit 2: at the end of phase 1 for an interview about the magnet treatments and to indicate the preferred treatment - Visit 3: at the end of the first phase 2 5-week period for a brief neurological examination, interview regarding treatment satisfaction and side effects, and completion of questionnaires - Visit 4: at the end of the second phase 2 5-week period for the same procedures as visit 2 During each visit, participants will have sensory testing, in which a pin is placed on the surface of the skin. This test does not cause any discomfort. At the end of the study, participants will be given the device that helped them, if any. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044109 •

Pain Treatment for Sciatica Condition(s): Radiculopathy; Sciatica Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR)

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Purpose - Excerpt: This study will test the effectiveness of two drugs-nortriptyline and MS Contin (a type of morphine)-to treat pain caused by lumbar radiculopathy, or sciatica. Sciatica results from damage to the lumbar nerve roots, typically causing back pain and sharp, shooting pain down one or both legs. Although sciatica is common, there are no good treatments for it. Tricyclic antidepressants, such as nortriptyline, and opioids, such as morphine, have been effective in treating other kinds of pain from nerve damage. Patients between 18 and 65 years of age who have had sciatica pain daily for at least 3 months may be eligible for this study. Participants will provide a medical history and occupational and other social information. They will undergo a neurological examination, routine blood tests and an electrocardiogram and will fill out three questionnaires providing information on daily functioning and psychological wellbeing. This "cross-over" study consists of several parts, including a baseline study and four different treatment regimens. During each part, patients keep a daily log in which they rate their pain, record other procedures they undergo, such as injections and manipulations, and record medication side effects. In the first week of the study, patients remain on their current medications. Any antidepressants or opioids are stopped gradually before starting the drug trials. After the first week, patients go through the following four drug trials in random order: 1. Nortriptyline and inert placebo-Patients take nortriptyline in doses ranging from 25 mg. to 100 mg. and an inert placebo for morphine. (An inert placebo is a dummy pill; it looks like the test drug but has no active ingredient.) 2. MS Contin (morphine) and inert placebo-Patients take MS Contin in doses ranging from 30 mg. to 90 mg. and an inert placebo for nortriptyline. 3. Nortriptyline and MS Contin-Patients take MS Contin and nortriptyline in the same dose ranges as for each drug alone. 4. Active placebo and inactive placebo-Patients take an active placebo-in this case benztropine-and an inert placebo. An active placebo is a drug that does not work for the problem being studied but whose side effects are like those of the test drug-in this case, slight sleepiness or dry mouth. Benztropine is given at one-third the recommended dosage. For each drug regimen, the medication dose is increased gradually over 5 weeks until the maximum tolerated dose is reached. At the end of each regimen, patients are taken off the study drugs over a 12-day tapering period and are off drugs completely for another 2 days. Patients are seen by a doctor or nurse at the 7-week point in each study period. After all the drug trials are finished, patients repeat the questionnaires they filled out at the beginning of the study. Patients and their doctors will be informed of the medications that were effective in each individual's care. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00009672 •

Spine Patient Outcomes Research Degenerative Spondylolisthesis with Spinal Stenosis Condition(s): Spondylolisthesis; Spinal Stenosis; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The

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purpose is to learn which of two commonly prescribed treatments-surgery and nonsurgical therapy-works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work. In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) caused by degenerative spondylolisthesis (a condition in which one vertebra, or spinal bone, slips forward on another) with either surgery or nonsurgical methods. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000409 •

Spine Patient Outcomes Research Spinal Stenosis Condition(s): Spinal Stenosis; Low Back Pain Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute for Occupational Safety and Health (NIOSH/CDC); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This study tests the effectiveness of different treatments for the three most commonly diagnosed conditions of the lower backbone (lumbar spine). The purpose is to learn which of two commonly prescribed treatments (surgery and nonsurgical therapy) works better for specific types of low back pain. Low back pain is one of the most widely experienced health problems in the United States and the world. It is the second most frequent condition, after the common cold, for which people see a doctor or lose days from work. In this part of the study, we will treat patients with spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) with a type of surgery known as posterior decompressive laminectomy or with nonsurgical methods. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000411

•

Surgical versus Nonsurgical Treatment for Spinal Stenosis Condition(s): Spinal Stenosis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: Lumbar spinal stenosis (a narrowing of spaces in the backbone that results in pressure on the spinal cord and/or nerve roots) is a condition that occurs frequently, particularly in the elderly. This condition can lead to significant pain and limit a person's ability to function. Moreover, doctors disagree about the best way to treat people with lumbar spinal stenosis. In this study we will compare surgical

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treatment of lumbar spinal stenosis with nonsurgical treatment using physical therapy. The results of this study should help clarify which treatment strategies are the most effective for patients with lumbar spinal stenosis. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00022776 •

Topiramate in the Treatment of Sciatica Condition(s): Sciatica Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: This study will test the effectiveness of topiramate to treat pain caused by lumbar radiculopathy, or sciatica. Sciatica results from damage to the lumbar nerve roots, typically causing back pain and sharp, shooting pain down one or both legs. Although sciatica is common, there are no good treatments for it. Topiramate belongs to a group of medications commonly used to treat pain caused by nerve damage. Patients between 18 and 75 years of age who have had sciatica pain daily for at least 3 months may be eligible for this study. (This is taken from the first paragraph of the Qualification Criteria in the consent form. The inclusion criteria on page 6 of the protocol say "low back pain of 3 months duration or longer present at least 5 out of 7 days a week" and signs and symptoms of lumbar radiculopathy. Which is correct?) Participants will provide a medical history, as well as occupational and social information. They will undergo a standard neurological examination, including a test of cognitive (thinking) abilities, muscular function, reflexes and a sensory examination. The latter involves testing with a pin placed on the surface of the skin. Participants will also have routine blood tests and will fill out questionnaires on their daily functioning and psychological well being. Additional procedures may include magnetic resonance imaging (MRI) scans and possible referral to a psychiatrist for evaluation of depression or emotional difficulties. This "cross-over" study consists of two parts. In one part, patients will receive topiramate and in the other, an active placebo. An active placebo is a drug that does not work for the problem being studied but whose side effects are like those of the test drug. Diphenhydramine (Benadryl) is the active placebo used in this study. Diphenhydramine is an allergy medication with very mild side effects, such as drowsiness. During both parts of the study-topiramate and placebo-patients will keep a daily log in which they rate their pain, record other procedures they undergo, such as injections and manipulations, and record medication side effects. In the first week of the study, patients will remain on their current medications and record pain levels once a day. After the first week, they will begin taking the study drugs-either topiramate in increasing doses ranging from 50 to 400 mg. or diphenhydramine in doses ranging from 6.25 to 50 mg. The drug doses will be increased gradually over 4 weeks to minimize possible side effects. Increases will continue until the maximum tolerated dose is reached. Patients will continue on the highest tolerated dose for two weeks and then be tapered off gradually over 12 days. They will remain off drugs completely for a 2-day washout period and then begin the next treatment. Those who took topiramate for the first part will take diphenhydramine for the second part and vice versa. A study nurse will call patients twice a week throughout the study to check for problems and answer questions. A physician will see patients 6 weeks after the start of each treatment. During

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the last visit, at the end of the study, patients will repeat the questionnaires they filled out at the beginning of the study. Patients and their doctors will be informed of the medications that were effective in each individual's care. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00011804

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “spinal stenosis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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•

For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON SPINAL STENOSIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.6 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “spinal stenosis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on spinal stenosis, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Spinal Stenosis By performing a patent search focusing on spinal stenosis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 6Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on spinal stenosis: •

Facet arthroplasty devices and methods Inventor(s): Reiley; Mark A (Piedmont, CA) Assignee(s): Archus Orthopedics Inc. (Redmond, WA) Patent Number: 6,610,091 Date filed: October 20, 2000 Abstract: Devices and surgical methods treat various types of adult spinal pathologies, such as degenerative spondylolisthesis, spinal stenosis, degenerative lumbar scoliosis, and kypho-scoliosis. Various types of spinal joint replacement prostheses, surgical procedures for performing spinal joint replacements, and surgical instruments are used to perform the surgical procedures. Excerpt(s): The present invention generally relates to devices and surgical methods for the treatment of various types of spinal pathologies. More specifically, the present invention is directed to several different types of spinal joint replacement prostheses, surgical procedures for performing spinal joint replacements, and surgical instruments which may be used to perform the surgical procedures. Back pain is a common human ailment. In fact, approximately 50% of persons who are over 60 years old suffer from lower back pain. Although many incidences of back pain are due to sprains or muscle strains which tend to be self-limited, some back pain is the result of more chronic fibromuscular, osteoarthritic, or ankylosing spondolytic processes of the lumbosacral area. Particularly in the population of over 50 year olds, and most commonly in women, degenerative spine diseases such as degenerative spondylolisthesis and spinal stenosis occurs in a high percentage of the population. Iida, et al, 1989. Degenerative changes of the adult spine have traditionally been determined to be the result of the interrelationship of the three joint complex; the disk and the two facet joints. Degenerative changes in the disc lead to arthritic changes in the facet joint and vice versa. See Farfan and Sullivan, 1967; see also Farfan, 1969; see also Farfan, 1980. Web site: http://www.delphion.com/details?pn=US06610091__

•

Method of treating chronic pain associated with muscle spasms, tendonitis and sciatica Inventor(s): Joseph; William K. (241 Central Park West, #7C, New York, NY 10024) Assignee(s): none reported Patent Number: 6,048,881 Date filed: February 1, 1999 Abstract: The invention is a method of treating chronic pain associated with muscle spasms, tendonitis and sciatica comprising administering to a human patient an effective amount of niacin. Excerpt(s): The present invention relates to a method for treating chronic pain associated with muscle spasms, tendonitis and sciatica by administering to a human patient an effective amount of niacin. Chronic pain associated with conditions such as muscle spasms, tendonitis and sciatica is not only very painful to the individual, but is usually

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very difficult to treat. Inadequate treatment of chronic pain can be debilitating to humans. Muscle spasms are violent, involuntary contractions of a muscle or a group of muscles. They affect a large segment of the population and are often very painful. The pain resulting from muscle spasms often is chronic, i.e. lasts for one day or even longer. By contrast, the pain associated with leg cramps, which usually radiates from the calf, and can last from a few seconds up to ten minutes. See for example, Weiner et al., JAMA 244:2332-2333 (1980). Web site: http://www.delphion.com/details?pn=US06048881__ •

Support pillow for pregnant women, obese people, people who suffer from various forms of back pain and people who suffer from sleep apnea, snoring and sciatica Inventor(s): Friedman; Loretta (9269 Shore Rd., Apt. B1, Brooklyn, NY 11209) Assignee(s): none reported Patent Number: 6,044,505 Date filed: August 27, 1998 Abstract: A pillow (10) for pregnant, over weight, back-pain suffering, sleep apnea suffering, and sciatica suffering persons lying in a prone position, is provided. The pillow has an aperture (90) extending through it, and is sized for receipt of a portion of the abdomen of the user. The aperture is defined by at least first (20), second (30) and third (40) support structures, and is of a substantially uniform thickness (T). The first support structure extends substantially traversely across the lower-chest and upperabdominal regions of the user, the second support structure extends along a first sideabdominal region of the user to end proximate to the person's pelvic region, and the third support structure extends along a second side-abdominal region of the user to also end proximate to the pelvic region of the user. Excerpt(s): This invention relates to the field of pillows, and more particularly, to the field of abdominal support pillows for pregnant women, over weight people and otherwise regular people who suffer from back pain. Citizens of the United States spend eleven percent of the nation's gross national product on hospital and medical care. The United States has more doctors and hospitals that nearly any other industrialized nation, and yet the United Nations World Health Organization continually rates the population of the United States as having one of the lowest general health indexes in the world. The symptoms of bad health and poor physical condition are the end result of the body's inability to function properly. Currently, if you are a pregnant woman, an obese person, an athlete, an individual who suffers from back pain, sleep apnea, snoring or sciatica, your ability to lay on your stomach is greatly diminished. The posture that is assumed during pregnancy, or in the obese, creates hyper-extension in the low back region, causing jamming of the thoracolumbar facets, posterior narrowing of the disc space and myospasms in the erector spinae muscles. Sciatica, and lower back pain, are usually caused by misalignment of bones, nerve interference and vertebral subluxation. Web site: http://www.delphion.com/details?pn=US06044505__

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Volumetric measurement device and method in lateral recess and foraminal spinal stenosis Inventor(s): Simmons, Jr.; Edward D. (59 S. Woodside La., Williamsville, NY 14221) Assignee(s): none reported Patent Number: 6,102,930 Date filed: May 15, 1998 Abstract: A device for accurately determining the lateral recess and foraminal volume prior to and following spinal decompression procedures to assess adequacy of the decompression. The device comprises an inflatable tipped catheter connected to calibration instruments that will correspondingly give volume of inflation of the tip of the catheter which is placed in the lateral recess or nerve root foramen. The readings can be used to determine the extent of the decompression and objectively quantify the extent of such decompression. Excerpt(s): This invention relates generally to the art of medical diagnostic instruments and methods of using the same, and more particularly to a new and improved device and method for more accurately determining the lateral recess and foraminal volume prior to and following spinal decompression procedures. In degenerative conditions of the spine narrowing of the nerve root, narrowing of the lateral recess and foramen, with nerve root compression, can occur due to loss of disc space height, subluxation, facet joint hypertrophy, osteophyte formation, and ligamentum flavum hypertrophy along with other causes. The ultimate loss in volume through the lateral recess and foramen results in compression of the nerve root structures. This gives rise to symptoms of radicular pain and dysfunction in the lower extremities. Surgical treatment for this involves decompression and removal of bony and soft tissue elements that are compressing the nerve in the lateral recess and foramen. Presently probes are commonly used to assess adequacy of decompression. The present invention provides a device that can more accurately determine the lateral recess and foraminal volume prior to and following decompression to assess the degree of compression and the adequacy of the decompression. The device of the present invention comprises an inflatable tipped catheter connected to calibration instruments that will correspondingly give volume of inflation of the tip of the catheter which is placed in the lateral recess or nerve root foramen. The readings can be used to determine the extent of the decompression and more objectively quantify the extent of such decompression. Web site: http://www.delphion.com/details?pn=US06102930__

Patent Applications on Spinal Stenosis As of December 2000, U.S. patent applications are open to public viewing.7 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to spinal stenosis:

7

This has been a common practice outside the United States prior to December 2000.

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•

Methods for treating spinal stenosis by pedicle distraction Inventor(s): Bloemer, Wilhelm; (Unteruhldingen-Muehlhofen, DE), Marnay, Thierry; (Montpellier, FR) Correspondence: Law Office OF Barry R Lipsitz; 755 Main Street; Monroe; CT; 06468; US Patent Application Number: 20030212400 Date filed: March 11, 2003 Abstract: The invention provides methods for treating spinal stenosis by pedicle distraction. The vertebral segment is cut so that the pedicles are separated from the main portion of the vertebral segment. After being cut, each pedicle is separated from the main portion and fixed at a distance from the main portion using screws. For example, two-component compression screws or stenosis screws may be used to fix the pedicles from the main portion. The screws may be inserted through bores drilled into the vertebral segment. The bores are preferably drilled prior to the cutting. As a result of fixing the cut portion at a distance from the main portion, there will be a gap between the main portion and the two pedicles, thereby enlarging the cross-section of the spinal column. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/363,854, filed Mar. 12, 2002, the entire disclosure of which is hereby incorporated by reference. The present invention relates generally to correcting spinal defects. More specifically, the present invention relates to methods for alleviating spinal stenosis by enlarging the cross-section of the spinal canal in a vertebral or spinal segment by pedicle distraction. If the cross section of the spinal canal is too small, a condition called "lumbar spinal stenosis" exists and results in trauma to the nerves running through the spinal canal. Such stenosis can be due to degenerative effects of the vertebral material. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Spine distraction implant and method Inventor(s): Fallin, T. Wade; (Hyde Park, UT), Hsu, Ken Y.; (San Francisco, CA), Klyce, Henry A.; (Piedmont, CA), Zucherman, James F.; (San Francisco, CA) Correspondence: Sheldon R. Meyer; Fliesler, Dubb, Meyer & Lovejoy Llp; Suite 400; Four Embarcadero Center; San Francisco; CA; 94111-4156; US Patent Application Number: 20010007073 Date filed: January 4, 2001 Abstract: A spine distraction implant alleviates pain associated with spinal stenosis and facet arthropathy by expanding the volume in the spine canal and/or neural foramen. The implant provides a spinal extension stop while allowing freedom of spinal flexion. Excerpt(s): As the present society ages, it is anticipated that there will be an increase in adverse spinal conditions which are characteristic of older people. By way of example, with aging comes increases in spinal stenosis (including but not limited to central canal and lateral stenosis), the thickening of the bones which make up the spinal column and facet arthropathy. Spinal stenosis is characterized by a reduction in the available space for the passage of blood vessels and nerves. Pain associated with such stenosis can be relieved by medication and/or surgery. Of course, it is desirable to eliminate the need for major surgery for all individuals and in particular for the elderly. Accordingly, there needs to be developed procedures and implants for alleviating such condition which are

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minimally invasive, can be tolerated by the elderly and can be performed preferably on an outpatient basis. The present invention is directed to providing a minimally invasive implant and method for alleviating discomfort associated with the spinal column. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with spinal stenosis, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “spinal stenosis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on spinal stenosis. You can also use this procedure to view pending patent applications concerning spinal stenosis. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON SPINAL STENOSIS Overview This chapter provides bibliographic book references relating to spinal stenosis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on spinal stenosis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “spinal stenosis” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “spinal stenosis” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “spinal stenosis” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Lumbar Spinal Stenosis by Marek Szpalski (Editor), Robert Gunzburg (Editor); ISBN: 0781723809; http://www.amazon.com/exec/obidos/ASIN/0781723809/icongroupinterna

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Lumbar Spinal Stenosis by Franco Postacchini, Wolfgang Rauschning; ISBN: 0387821112; http://www.amazon.com/exec/obidos/ASIN/0387821112/icongroupinterna

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Lumbar Spinal Stenosis by Gunnar B.J. Andersson, Thomas W. McNeill; ISBN: 0801600901; http://www.amazon.com/exec/obidos/ASIN/0801600901/icongroupinterna

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Spinal Stenosis by Nixon (1991); ISBN: 0713145250; http://www.amazon.com/exec/obidos/ASIN/0713145250/icongroupinterna

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The Official Patient's Sourcebook on Spinal Stenosis by James N. Parker (Editor), Philip M. Parker (Editor); ISBN: 0597831947; http://www.amazon.com/exec/obidos/ASIN/0597831947/icongroupinterna

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Treatment of Degenerative Lumbar Spinal Stenosis by Ecri (2001); ISBN: 1587630516; http://www.amazon.com/exec/obidos/ASIN/1587630516/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “spinal stenosis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 •

Computed tomography and plain radiography of the lumbar spine: in low back pain, sciatica, spinal stenosis and after disc surgery Author: Ilkko, Eero.; Year: 1989; Oulu: Dept. of Diagnostic Radiology, University of Oulu, 1989; ISBN: 9514227301

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Degenerative lumbar spinal stenosis treatment Author: ECRI (Organization). Health Technology Assessment Information Service.; Year: 2001; Plymouth Meeting, PA: ECRI, c2001

•

The spectrum of spinal stenosis Author: Holder, John C.; Year: 1988; Chicago: Year Book Medical Publishers, c1985

Chapters on Spinal Stenosis In order to find chapters that specifically relate to spinal stenosis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and spinal stenosis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “spinal stenosis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on spinal stenosis: •

Chapter 8-C: Musculoskeletal Signs and Symptoms: Disorders of the Low Back and Neck Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 165-173.

8

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This chapter provides health professionals with information on disorders of the low back and neck. Axial skeletal pain is associated with various mechanical and medical disorders. Mechanical disorders are caused by overuse, trauma, or physical deformity of an anatomic structure. Medical disorders responsible for spinal pain are associated with constitutional symptoms, disease in other organ systems, and inflammatory or infiltrative disease of the axial skeleton. Most people who have low back or neck pain have a mechanical reason for their pain. The initial evaluation of patients with spinal pain focuses on separating people with mechanical disorders from those with systemic illnesses. The initial diagnostic evaluation includes taking a medical history and performing physical and neurologic examinations. Plain radiographs and laboratory tests are usually not needed for most patients. Symptoms that help identify systemic illnesses in people who have spinal pain include fever or weight loss, pain with recumbency, morning stiffness, localized bone pain, or visceral pain. Mechanical disorders of the lumbosacral spine are the most common causes of low back pain. These disorders include muscle strain, herniated nucleus pulposus, osteoarthritis, lumbar spinal stenosis, spondylolisthesis, and adult scoliosis. Mechanical disorders of the cervical spine are less common than lumbar spine disorders and tend to be less debilitating. Causes of cervical spine pain include neck strain, cervical disc herniation, cervical spondylosis, myelopathy, and whiplash. The chapter describes the clinical features, diagnosis, and treatment of these mechanical causes of back and neck pain. 3 figures, 5 tables, and 27 references. •

Section Eight: Spine Source: in Greene, W.B., Ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS). 2001. p. 518-576. Contact: Available from American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, IL 60018-4262. (800) 626-6726 (toll-free) or (847) 823-7186. Fax (800) 823-8025 (toll-free) or (847) 823-8025. E-mail: [email protected]. Website: www.aaos.org. PRICE: $105.00 for nonmembers; $90.00 AAOS members; $80.00 for residents; plus shipping and handling. ISBN 0892032170. Summary: This section of a book on musculoskeletal care provides health professionals with information on common conditions affecting the spine, including acute and chronic or repetitive injuries and degenerative, inflammatory, or idiopathic conditions. The section begins with information on the principles of evaluating and examining a patient presenting with a back complaint, focusing on inspection, palpation, range of motion, muscle testing, and special testing. This is followed by descriptions of cauda equina syndrome; cervical radiculopathy, spondylosis, and sprain; fracture of the cervical, thoracic, and lumbar spine; low back sprain; lumbar degenerative disk disease; lumbar herniated disk; lumbar spinal stenosis; metastatic disease; scoliosis in adults; and degenerative and isthmic spondylolisthesis. Information includes synonyms for and red flags associated with each condition; the definition, clinical symptoms, diagnosis, differential diagnosis, adverse outcomes, and treatment of the condition; diagnostic tests; and adverse treatment outcomes. Other topics include orthotic devices for the cervical, thoracic, and lumbar regions. 66 figures and 4 tables.

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CHAPTER 8. MULTIMEDIA ON SPINAL STENOSIS Overview In this chapter, we show you how to keep current on multimedia sources of information on spinal stenosis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Bibliography: Multimedia on Spinal Stenosis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in spinal stenosis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on spinal stenosis: •

Conservative management of lumbar spinal stenosis [videorecording] Source: Willibald Nagler, Elisabeth Lachmann; Year: 2000; Format: Videorecording; Secaucus, NJ: Network for Continuing Medical Education, c2000

•

Spinal stenosis [slide] Source: American Academy of Orthopaedic Surgeons; Year: 1976; Format: Slide; [Chicago]: The Academy, [1976]

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CHAPTER 9. PERIODICALS AND NEWS ON SPINAL STENOSIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover spinal stenosis.

News Services and Press Releases One of the simplest ways of tracking press releases on spinal stenosis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “spinal stenosis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to spinal stenosis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “spinal stenosis” (or synonyms). The following was recently listed in this archive for spinal stenosis: •

Surgery Effective In Selected Patients With Sciatica And Spinal Stenosis Source: Reuters Medical News Date: August 22, 1996

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “spinal stenosis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “spinal stenosis” (or synonyms). If you know the name of a company that is relevant to spinal stenosis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “spinal stenosis” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly

Periodicals and News

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to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “spinal stenosis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on spinal stenosis: •

Spinal Stenosis: Low Back Pain May be Degenerative Disease Source: Mayo Clinic Women's Health Source. 5(12): 6. December 2001. Contact: Available from Mayo Clinic Women's Health Source. 200 First Street SW, Rochester, MN 55905. (800) 876-8633 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article presents information on spinal stenosis to patients with low back pain. Spinal stenosis is a narrowing of the spinal canal, most often caused by osteoarthritis, resulting in back and lower leg pain. Symptoms may include pain, numbness, or tingling. Diagnosing spinal stenosis may require magenetic resonance imaging, computerized tomography, or myelography. Treatment depends upon the severity and cause of the problem and includes physical therapy, NSAIDs, and bracing. In severe cases surgery to relieve compression on the spine is performed.

•

Spinal Stenosis: Severity Determines Treatment Plan Source: Mayo Clinic Health Letter. 19(6): 1-3. June 2001. Contact: Available from Mayo Clinic Health Letter. 200 First Street, SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. E-mail: [email protected]. Summary: This newsletter article provides people who have spinal stenosis with information on the causes, symptoms, diagnosis, and management of this spinal condition. People who have spinal stenosis have a narrowing of the spinal canal. When the narrowing compresses nerves, pain can result. Spinal stenosis, which usually affects people 60 or older, is generally caused by backbone changes related to osteoarthritis, but it can occur in younger people born with a narrowed spinal canal or following spinal injury. The signs and symptoms of spinal stenosis tend to appear over time, and they generally worsen with walking and standing. Diagnosis is based on the medical history, a physical examination, and diagnostic imaging techniques such as magnetic resonance imaging and computerized tomography scans. Treatment decisions are based on the severity of the narrowing. Nonsurgical treatments for mild stenosis include dynamic lumbar stabilization and pain medications such as nonsteroidal antiinflammatory drugs, antiseizure medications, and tricyclic antidepressants. Surgery to treat spinal stenosis enlarges the area of the spinal canal at the point where the nerves are being compressed. Surgical procedures used to treat spinal stenosis are decompressive lumbar laminectomy, laminotomy, or spinal fusion. 1 figure.

Academic Periodicals covering Spinal Stenosis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to spinal stenosis. In addition to these sources, you can search for articles covering spinal stenosis that have been published by any of the periodicals listed in previous chapters. To find the latest studies

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published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “spinal stenosis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 2583 20 419 1 5 3028

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “spinal stenosis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on spinal stenosis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to spinal stenosis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to spinal stenosis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “spinal stenosis”:

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•

Guides on spinal stenosis Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html

•

Other guides Back Injuries http://www.nlm.nih.gov/medlineplus/backinjuries.html Peripheral Nerve Disorders http://www.nlm.nih.gov/medlineplus/peripheralnervedisorders.html Sciatica http://www.nlm.nih.gov/medlineplus/sciatica.html Scoliosis http://www.nlm.nih.gov/medlineplus/scoliosis.html Slipped Disk http://www.nlm.nih.gov/medlineplus/slippeddisk.html Spinal Cord Injuries http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html Spinal Diseases http://www.nlm.nih.gov/medlineplus/spinaldiseases.html

Within the health topic page dedicated to spinal stenosis, the following was listed: •

General/Overviews Spinal Stenosis Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=128&topcategory=Spine

•

Diagnosis/Symptoms MR Imaging (MRI)-Musculoskeletal Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/mr_musculoskeletal.htm Myelogram http://www.nlm.nih.gov/medlineplus/tutorials/myelogramloader.html

•

Treatment Back Surgery: When Is It a Good Idea? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00305

•

Specific Conditions/Aspects Cauda Equina Syndrome Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=285&%3Btopcatego

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ry=Spine Cervical Spine Source: American Association of Neurological Surgeons, Congress of Neurological Surgeons http://www.neurosurgery.org/pubpages/patres/cervspnbroch.html False Claudication (Pseudoclaudication) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01278 Lumbar Spinal Canal Stenosis: A Common Cause of Back and Leg Pain Source: American Academy of Family Physicians http://familydoctor.org/256.xml •

Organizations American Academy of Orthopaedic Surgeons http://www.aaos.org/ National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on spinal stenosis. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Questions and Answers About Spinal Stenosis Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1999. 14 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail: [email protected]. Website: www.niams.nih.gov. PRICE: 1 to 25 copies free. Order Number: AR-189 QA (fact sheet), or AR-189L QA (large print). Summary: This fact sheet uses a question and answer format to provide people who have spinal stenosis with information on its causes, symptoms, diagnosis, and treatment. Spinal stenosis is a narrowing of spaces in the spine that results in pressure

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on the spinal cord or nerve roots. Narrowing usually occurs in one or more of the following areas: the canal in the center of the spinal column through which the spinal cord and nerve roots run, the canals at the base or roots of nerves branching out from the spinal cord, or the openings between vertebrae through which nerves leave the spine and go to other parts of the body. People who are over age 50 are most commonly affected. The structures of the spine most often involved include intervertebral disks, facet joints, intervertebral foramen, lamina, ligaments, pedicles, spinal cord and nerve roots, synovium, and vertebral arch. Narrowing of the canal may be inherited or acquired. Acquired conditions that cause spinal stenosis include degenerative conditions such as osteoarthritis, rheumatoid arthritis, tumors of the spine, trauma, Paget's disease of bone, and fluorosis. Spinal stenosis symptoms include numbness, weakness, cramping, or general pain in the legs; abnormal bowel and bladder function; and foot disorders. Diagnosis involves obtaining a medical history, performing a physical examination, and obtaining laboratory tests and X rays or other imaging tests. Nonsurgical treatments include nonsteroidal anti-inflammatory drugs, analgesics, corticosteroid injections, restricted activity, physical therapy, and a lumbar brace or corset. Surgery may be considered during the first 3 months of treatment if a patient experiences numbness or weakness that interferes with walking, impaired bowel or bladder function, and other neurological problems. The National Institute of Arthritis and Musculoskeletal and Skin Diseases currently supports several research projects on spinal stenosis. The fact sheet also includes a list of additional sources of information. 3 figures. •

Lumbar Spinal Stenosis Source: LaGrange, IL: North American Spine Society (NASS). 2001. 8 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Sets of 25 for $15.00 (members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color patient education brochure uses a question and answer format to provide people who have lumbar spinal stenosis with information on this condition. Spinal stenosis is a narrowing of the spinal canal. It may not cause symptoms, but, when present, symptoms may include pain or numbness in the back or legs or cramping in the legs. Symptoms are often worse with prolonged standing or walking. Diagnosis is based on the medical history, physical examination, and diagnostic imaging studies. Nonsurgical treatments are usually tried at first. These include antiinflammatory medications such as nonsteroidal antiinflammatory drugs, physical therapy, exercise, and spinal injections. Surgery is reserved for patients whose pain cannot be relieved by nonsurgical methods and those who develop progressive leg weakness or bowel and bladder problems. Lumbar decompression surgery, or laminectomy, is the technique used to open up the bony canal. Spinal fusion surgery may be needed in addition to decompression if the vertebrae shift or slip in relation to each other. Postoperative rehabilitation may be needed to help patients return to normal activities. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site

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located at http://www.guideline.gov/ by using the keyword “spinal stenosis” (or synonyms). The following was recently posted: •

Low back pain or sciatica in the primary care setting Source: Department of Defense - Federal Government Agency [U.S.]; 1999 May; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2578&nbr=1804&a mp;string=sciatica Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Questions and Answers about Spinal Stenosis Summary: Spinal stenosis is a narrowing of spaces in the spine (backbone) that results in pressure on the spinal cord and/or nerve roots. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6761 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to spinal stenosis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to spinal stenosis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with spinal stenosis. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about spinal stenosis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “spinal stenosis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “spinal stenosis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “spinal stenosis” (or synonyms) into the “For

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these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “spinal stenosis” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on spinal stenosis: •

Basic Guidelines for Spinal Stenosis Spinal stenosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000441.htm

•

Signs & Symptoms for Spinal Stenosis Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Decreased sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Lack of sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Leg pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003182.htm

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Neck pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Spinal Stenosis CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm EMG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm Spinal CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003787.htm Spine MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003792.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm X-ray of the spine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003806.htm

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Background Topics for Spinal Stenosis Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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SPINAL STENOSIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allograft: An organ or tissue transplant between two humans. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH]

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Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Aqueous: Having to do with water. [NIH]

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Art Therapy: The use of art as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arthropathy: Any joint disease. [EU] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Articular: Of or pertaining to a joint. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autosuggestion: Suggestion coming from the subject himself. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Benztropine: A centrally active muscarinic antagonist that has been used in the symptomatic treatment of Parkinson's disease. Benztropine also inhibits the uptake of dopamine. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic

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engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after

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treatment. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Claudication: Limping or lameness. [EU] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clubfoot: A deformed foot in which the foot is plantarflexed, inverted and adducted. [NIH] Coenzymes: Substances that are necessary for the action or enhancement of action of an enzyme. Many vitamins are coenzymes. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be

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used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine.

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Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices.

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The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Diagnosis, Differential: Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH]

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Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysgenesis: Defective development. [EU] Dystonia: Disordered tonicity of muscle. [EU] Ectopic: Pertaining to or characterized by ectopia. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the

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latter being a high-energy biproduct of nuclear decay. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exercise Tolerance: The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an exercise test. [NIH]

Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Facial: Of or pertaining to the face. [EU]

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Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibroma: A benign tumor of fibrous or fully developed connective tissue. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Flexor: Muscles which flex a joint. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluorosis: Discoloration of the tooth enamel due to fluorine. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a

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aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Geriatric: Pertaining to the treatment of the aged. [EU] Gigantism: The condition of abnormal overgrowth or excessive size of the whole body or any of its parts. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]

Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

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Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypesthesia: Absent or reduced sensitivity to cutaneous stimulation. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue

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(thymus or bone marrow). [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH]

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Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lesion: An area of abnormal tissue change. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligamentum Flavum: The paired bands of yellow elastic tissue that connect adjoining laminae of the vertebrae. With the laminae, it forms the posterior wall of the spinal canal and helps hold the body erect. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside

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diameter) and used in transferring microorganisms. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbago: Pain in the lumbar region. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Maximum Tolerated Dose: The highest dose level eliciting signs of toxicity without having major effects on survival relative to the test in which it is used. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with

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application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metrizamide: A solute for density gradient centrifugation offering higher maximum solution density without the problems of increased viscosity. It is also used as a resorbable, non-ionic contrast medium. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH]

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Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Muscle Denervation: The resection or removal of the innervation of a muscle or muscle tissue. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuritis: A general term indicating inflammation of a peripheral or cranial nerve. Clinical manifestation may include pain; paresthesias; paresis; or hypesthesia. [NIH] Neurofibroma: A fibrous tumor, usually benign, arising from the nerve sheath or the endoneurium. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU]

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Neuromuscular Diseases: A general term encompassing lower motor neuron disease; peripheral nervous system diseases; and certain muscular diseases. Manifestations include muscle weakness; fasciculation; muscle atrophy; spasm; myokymia; muscle hypertonia, myalgias, and musclehypotonia. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nortriptyline: A metabolite of amitryptyline that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occupational Medicine: Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic cup: The white, cup-like area in the center of the optic disc. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the

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suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oropharynx: Oral part of the pharynx. [NIH] Orthotic Devices: Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. [NIH] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteochondroma: A cartilage-capped benign tumor that often appears as a stalk on the surface of bone. It is probably a developmental malformation rather than a true neoplasm and is usually found in the metaphysis of the distal femur, proximal tibia, or proximal humerus. Osteochondroma is the most common of benign bone tumors. [NIH] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH]

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Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pedicle: Embryonic link between the optic vesicle or optic cup and the forebrain or diencephalon, which becomes the optic nerve. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected

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to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Polyradiculopathy: Disease or injury involving multiple spinal nerve roots. Polyradiculitis refers to inflammation of multiple spinal nerve roots. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Postural: Pertaining to posture or position. [EU] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU]

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Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root.

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[NIH]

Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal Osteodystrophy: Decalcification of bone due to hyperparathyroidism secondary to chronic kidney disease. [NIH] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which

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restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed

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pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or

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cartilage. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU]

148 Spinal Stenosis

Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Cyst: A nodular, tumorlike lesion in or about a tendon sheath or joint capsule, especially of the hands, wrists, or feet. It is not a true cyst as it lacks an epithelial wall, and it does not communicate with the underlying synovial space. The lesion represents a focal accumulation of mucin in the dermis of the dorsal aspect of the distal phalanges or, less often, other portions of the extremities. [NIH]

Dictionary 149

Systemic: Affecting the entire body. [NIH] Tendonitis: Inflammation of tendons attached to the biceps muscle, i. e. the main flexor muscle of the upper arm. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonicity: The normal state of muscular tension. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series.

150 Spinal Stenosis

[NIH]

Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Wheelchairs: Chairs mounted on wheels and designed to be propelled by the occupant. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

Dictionary 151

153

INDEX A Abdomen, 81, 121, 124, 134, 135, 148, 149 Abdominal, 81, 121, 140 Adjunctive Therapy, 121, 123 Adjustment, 6, 121 Adjuvant, 37, 58, 63, 121 Adrenal Cortex, 121, 127, 142 Adverse Effect, 121, 146 Affinity, 121, 128, 147 Airway, 121, 147 Algorithms, 12, 121, 124 Alkaloid, 121, 137 Allergen, 121, 146 Allograft, 20, 121 Alternative medicine, 92, 121 Ampulla, 121, 130 Anal, 7, 122, 131, 135, 138 Analgesic, 122, 137, 139 Anatomical, 10, 54, 122, 130, 134 Androgens, 121, 122, 127 Anesthesia, 16, 121, 122 Animal model, 9, 13, 122 Antiallergic, 122, 127 Antibacterial, 122, 147 Antibiotic, 122, 147 Antibody, 121, 122, 126, 133, 134, 136, 146 Antidepressant, 71, 122, 131 Antiemetic, 122, 128 Antigen, 121, 122, 126, 133, 134, 136, 146 Anti-inflammatory, 5, 106, 122, 127, 132 Anti-Inflammatory Agents, 122, 127 Antineoplastic, 122, 127 Antitussive, 122, 128, 139 Anus, 122, 124 Aperture, 81, 122 Apnea, 122 Aponeurosis, 122, 132 Aqueous, 122, 123 Art Therapy, 62, 123 Arterial, 123, 132, 133, 143 Arteries, 123, 124, 127, 137, 143 Arterioles, 123, 124 Arthropathy, 83, 123 Arthroplasty, 16, 34, 80, 123 Articular, 46, 52, 123, 135, 140 Asymptomatic, 10, 40, 43, 65, 123 Atypical, 123, 139 Auditory, 123, 130

Autosuggestion, 123, 133 B Back Pain, 3, 4, 5, 6, 8, 10, 11, 62, 63, 65, 71, 73, 74, 75, 80, 81, 107, 123 Bacteria, 122, 123, 131, 147, 150 Basal Ganglia, 123, 124, 131 Base, 106, 123, 128, 135 Bed Rest, 4, 123 Benign, 123, 131, 138, 140 Benign tumor, 123, 131, 140 Benztropine, 71, 73, 123 Bilateral, 15, 18, 54, 123, 140 Bile, 123, 131, 135, 148 Biochemical, 123, 140, 146 Biomechanics, 11, 17, 123 Biotechnology, 13, 86, 92, 99, 123 Bladder, 22, 106, 124, 131, 134, 138, 143, 145, 150 Blood Platelets, 124, 146 Blood pressure, 124, 132, 133, 143, 147 Blood vessel, 83, 124, 135, 147, 148, 149, 150 Bone scan, 124, 145 Bowel, 106, 122, 124, 128, 134, 148 Bowel Movement, 124, 128, 148 Brain Diseases, 124, 143 Brain Stem, 124, 143 Branch, 115, 124, 141, 147, 149 Bulbar, 124, 143 C Calculi, 124, 132 Carbohydrate, 124, 127, 132 Carcinogenic, 124, 148 Cardiac, 19, 124, 130, 138, 148 Cardiopulmonary, 39, 47, 124 Cardiovascular, 124, 130, 146 Case report, 16, 19, 29, 32, 33, 36, 38, 42, 46, 62, 64, 124 Case series, 40, 124 Cauda Equina, 16, 22, 34, 43, 63, 64, 65, 87, 104, 125, 146 Caudal, 125, 128, 142 Cell, 123, 125, 126, 127, 128, 130, 131, 133, 136, 137, 138, 142, 144 Central Nervous System, 124, 125, 130, 131, 132, 137, 140, 146 Centrifugation, 125, 137 Cerebral, 123, 124, 125, 130

154 Spinal Stenosis

Cerebrospinal, 17, 36, 58, 125 Cerebrospinal fluid, 17, 36, 58, 125 Cervix, 125, 131 Character, 125, 128, 143 Chiropractic, 5, 21, 62, 63, 66, 125 Cholesterol, 123, 125, 148 Chronic, 9, 16, 21, 62, 65, 80, 87, 118, 123, 125, 129, 134, 135, 136, 144 Claudication, 4, 10, 14, 32, 33, 38, 39, 44, 48, 65, 105, 125 Clinical trial, 5, 6, 7, 12, 17, 71, 76, 99, 125, 127, 143, 144 Cloning, 124, 125 Clubfoot, 34, 125 Coenzymes, 125, 139 Cofactor, 125, 143 Collapse, 125, 147 Comorbidity, 7, 125 Complement, 126, 146 Complementary and alternative medicine, 61, 68, 126 Complementary medicine, 61, 126 Computational Biology, 99, 126 Computed tomography, 22, 23, 33, 40, 48, 86, 126, 127, 145 Computerized axial tomography, 126, 127, 145 Computerized tomography, 23, 38, 65, 93, 126 Concomitant, 21, 30, 39, 47, 127 Conduction, 10, 38, 48, 127 Connective Tissue, 127, 131, 132, 136, 145 Consciousness, 122, 127, 143 Constitutional, 87, 127 Constriction, 127, 135 Consumption, 127, 128, 130 Contraindications, ii, 127 Control group, 127, 142 Coronary, 127, 137 Coronary Thrombosis, 127, 137 Cortex, 38, 124, 127, 130 Corticosteroid, 106, 127 Cranial, 127, 138, 139, 141, 143 Curative, 127, 139, 145, 149 Cutaneous, 9, 13, 127, 133 Cyst, 127, 148 Cytokine, 13, 127 D Data Collection, 9, 127 Databases, Bibliographic, 99, 128 Decompression Sickness, 128 Dendrites, 128, 139

Density, 125, 128, 137, 147 Desipramine, 71, 128 Developed Countries, 7, 128 Diagnosis, Differential, 87, 128 Diagnostic Imaging, 93, 106, 128 Diagnostic procedure, 79, 92, 128 Diencephalon, 128, 141 Digestion, 123, 124, 128, 134, 135, 148 Digestive system, 77, 128 Diphenhydramine, 75, 128 Direct, iii, 129, 142, 144 Disease Progression, 129, 144 Dislocation, 53, 129, 147 Distal, 129, 140, 143, 148 Dopamine, 123, 129 Dorsal, 9, 13, 23, 129, 142, 147, 148 Dorsum, 129, 132 Drive, ii, vi, 12, 57, 129 Drug Interactions, 129 Drug Tolerance, 129, 149 Duodenum, 123, 129, 130, 148 Dysgenesis, 15, 129 Dystonia, 29, 129 E Ectopic, 9, 129 Efficacy, 4, 8, 11, 40, 129, 149 Elective, 7, 129 Electrocardiogram, 73, 129 Electrolyte, 127, 129, 137, 147 Electrons, 123, 129, 134, 143 Enamel, 130, 131 Endoscope, 130 Endoscopic, 17, 130 Environmental Health, 98, 100, 130 Epidural, 4, 16, 21, 26, 27, 33, 36, 37, 58, 130 Epithelial, 130, 148 Erection, 130, 142 Erythrocytes, 130, 146 Esophagus, 128, 130, 141, 148 Evoke, 9, 130, 148 Evoked Potentials, 25, 31, 130 Excitability, 13, 130, 138 Exercise Test, 130 Exercise Tolerance, 36, 130 Exogenous, 13, 130 Extracellular, 10, 127, 130, 147 Extremity, 10, 65, 130, 140, 146 Eye Movements, 130, 143 F Facial, 15, 130 Faecal, 28, 131

Index 155

Family Planning, 99, 131 Fat, 127, 131, 132, 145, 147 Feces, 131, 148 Femur, 131, 140 Fibroma, 62, 131 Fixation, 131, 146 Flexion, 4, 10, 42, 43, 83, 131 Flexor, 131, 149 Fluorine, 131 Fluorosis, 106, 131 Fluoxetine, 71, 131 Fold, 8, 131 Foramen, 82, 83, 106, 131, 133 Forearm, 15, 124, 131 Fundus, 131 G Gallbladder, 121, 128, 131 Ganglia, 13, 131, 138, 141, 147, 148 Ganglion, 9, 13, 131, 139 Gas, 128, 131, 132, 133, 150 Gastrointestinal, 132, 146 Gastrointestinal tract, 132, 146 Gene, 86, 124, 132 Geriatric, 3, 40, 50, 132 Gigantism, 43, 132 Gland, 121, 132, 136, 140, 141, 143, 146, 148 Glucocorticoids, 121, 127, 132 Gonadal, 132, 148 Gout, 46, 132 Governing Board, 132, 142 Grade, 132 Grading, 47, 132 Granuloma, 62, 132 Growth, 8, 43, 45, 122, 123, 132, 136, 138, 142, 150 H Health Status, 6, 8, 47, 132 Hemorrhage, 132, 148 Hemostasis, 132, 146 Heredity, 132, 133 Hernia, 17, 133 Herniated, 4, 5, 6, 7, 9, 13, 16, 18, 26, 87, 133 Histamine, 128, 133 Homologous, 133, 146 Hormonal, 127, 133 Hormone, 127, 133, 140, 142, 145 Hydrogen, 123, 124, 133, 137 Hyperalgesia, 9, 13, 133 Hypersensitivity, 13, 121, 128, 133, 145, 146

Hypertension, 133 Hypertrophy, 4, 10, 82, 133 Hyperuricemia, 132, 133 Hypesthesia, 133, 138 Hypnotic, 128, 133 Hypoplasia, 15, 133 I Iatrogenic, 36, 133 Id, 59, 66, 104, 105, 107, 114, 116, 133 Idiopathic, 48, 87, 133 Immune response, 121, 122, 127, 133, 146 Immunization, 133, 146 Immunology, 121, 134 Impairment, 134, 136 In vitro, 134 In vivo, 10, 13, 134 Incision, 134, 143 Incontinence, 28, 134 Indicative, 85, 134, 141, 150 Infancy, 134, 145 Infarction, 127, 134, 137 Infection, 134, 136, 139, 145 Inflammation, 13, 122, 134, 138, 142, 145, 149 Innervation, 134, 138, 141, 146, 149 Intermittent, 32, 33, 39, 48, 65, 134, 135 Intervertebral, 7, 8, 63, 106, 133, 134, 136, 143, 146 Intervertebral Disk Displacement, 134, 136, 143, 146 Intestine, 124, 129, 133, 134, 135 Intrathecal, 51, 134 Invasive, 17, 30, 84, 134, 136 Involuntary, 81, 134, 138 Ions, 123, 129, 133, 134, 137 Ischemia, 38, 64, 135 J Joint, 14, 16, 19, 23, 24, 28, 30, 33, 35, 36, 46, 48, 50, 52, 62, 80, 82, 123, 128, 131, 135, 136, 140, 147, 148 Joint Capsule, 135, 148 K Kb, 98, 135 Kidney Disease, 77, 98, 135, 144 L Labyrinth, 135, 140 Large Intestine, 128, 134, 135, 144 Latency, 10, 135 Lesion, 132, 135, 143, 148 Library Services, 114, 135 Ligament, 31, 135, 143, 147 Ligamentum Flavum, 16, 31, 45, 82, 135

156 Spinal Stenosis

Liver, 121, 123, 128, 131, 132, 135, 145 Liver scan, 135, 145 Localization, 12, 135 Localized, 87, 131, 134, 135, 138, 142 Longitudinal study, 10, 135 Long-Term Care, 11, 135 Loop, 133, 135 Low Back Pain, 4, 6, 8, 9, 10, 13, 48, 60, 63, 65, 66, 71, 73, 74, 75, 86, 87, 93, 136 Lumbago, 72, 136 Luxation, 129, 136 Lymph, 125, 136 Lymph node, 125, 136 Lymphoid, 136 Lymphoma, 63, 136 M Magnetic Resonance Imaging, 33, 40, 41, 72, 75, 93, 136, 145 Malformation, 15, 136, 140 Malignant, 122, 136, 138, 145 Maximum Tolerated Dose, 73, 75, 129, 136 Medial, 136, 145, 149 Mediator, 136, 146 Medical Records, 136, 145 MEDLINE, 99, 136 Membrane, 10, 126, 130, 135, 136, 140, 145 Mental Disorders, 77, 136 Mental Health, iv, 5, 77, 98, 100, 136, 139 Meta-Analysis, 22, 136 Metabolic disorder, 132, 137 Metabolite, 137, 139 Metastasis, 137 Metastatic, 87, 137 Metrizamide, 30, 37, 137 MI, 118, 137 Mineralocorticoids, 121, 127, 137 Mobility, 12, 30, 137 Mobilization, 4, 137 Modeling, 12, 137 Modification, 137, 143 Molecular, 99, 101, 123, 126, 137, 144, 150 Molecular Structure, 137, 150 Molecule, 122, 123, 126, 137, 144 Mononuclear, 132, 137 Morphine, 73, 137, 138, 139 Morphology, 23, 137 Motility, 137, 146 Motor Activity, 137, 143 Motor nerve, 10, 137, 141 Mucinous, 132, 137 Multivariate Analysis, 43, 138 Muscle Denervation, 10, 42, 138

Muscular Diseases, 138, 139, 143 Myelography, 5, 22, 29, 30, 33, 37, 43, 48, 55, 93, 138 Myocardium, 137, 138 N Narcosis, 138 Narcotic, 5, 137, 138 NCI, 1, 76, 97, 138 Neck Pain, 87, 138 Necrosis, 134, 137, 138 Need, 3, 4, 83, 86, 92, 108, 138, 149 Neoplasm, 138, 140, 145, 150 Neoplastic, 136, 138 Nerve, 3, 4, 5, 9, 10, 13, 38, 46, 64, 65, 72, 73, 74, 75, 81, 82, 104, 106, 107, 122, 125, 128, 131, 133, 134, 136, 137, 138, 139, 141, 142, 143, 146, 147, 148, 149 Nervous System, 125, 136, 138, 139, 141, 148 Neural, 5, 39, 41, 55, 83, 128, 138 Neuritis, 39, 138 Neurofibroma, 20, 138 Neurogenic, 4, 10, 14, 38, 39, 44, 48, 138 Neurologic, 16, 42, 87, 138 Neuromuscular, 138, 139, 143 Neuromuscular Diseases, 139, 143 Neuronal, 13, 138, 139 Neurons, 9, 13, 128, 131, 139, 147, 148 Neuropathy, 139, 146 Niacin, 80, 139, 150 Norepinephrine, 128, 129, 139 Nortriptyline, 73, 139 Nuclear, 123, 130, 131, 138, 139 Nuclei, 129, 136, 139 Nucleus, 4, 13, 87, 134, 137, 139, 143 O Observational study, 9, 139 Occupational Medicine, 9, 139 Opium, 137, 139 Optic cup, 139, 141 Optic Nerve, 139, 141, 145 Oropharynx, 33, 140 Orthotic Devices, 87, 140 Ossicles, 140 Ossification, 31, 41, 64, 140, 145 Osteoarthritis, 5, 87, 93, 106, 140 Osteochondroma, 38, 140 Otosclerosis, 19, 140 Outpatient, 71, 84, 140 P Palate, 140, 147, 150 Palliative, 140, 149

Index 157

Palpation, 4, 87, 140 Pancreas, 121, 128, 140 Paralysis, 124, 140, 143 Parathyroid, 140, 145 Parathyroid Glands, 140, 145 Paresis, 138, 140 Paresthesias, 138, 140 Pathologic, 124, 127, 133, 141, 142, 147 Pathologies, 80, 141 Patient Education, 52, 105, 106, 112, 114, 119, 141 Patient Satisfaction, 6, 8, 21, 141 Pedicle, 83, 141 Pelvic, 81, 141, 143 Penis, 141, 142 Perception, 31, 141 Perforation, 122, 131, 141 Peripheral Nervous System, 139, 141, 143 Peripheral Nervous System Diseases, 139, 141, 143 Peroneal Nerve, 141, 146 Pharmacologic, 122, 141, 149 Pharynx, 140, 141 Physical Examination, 4, 5, 10, 24, 49, 93, 106, 141 Physical Therapy, 4, 5, 11, 15, 27, 36, 40, 75, 93, 106, 141 Physiologic, 41, 128, 141, 144 Physiology, 65, 141 Pilot study, 10, 141 Pituitary Gland, 127, 141 Plants, 121, 137, 139, 142, 145 Plexus, 142, 146 Polyradiculopathy, 53, 142 Posterior, 15, 41, 49, 64, 72, 74, 81, 122, 123, 129, 135, 138, 140, 142, 146, 150 Postoperative, 4, 43, 44, 106, 142 Postoperative Complications, 4, 142 Post-traumatic, 42, 44, 142 Postural, 31, 142 Potentiates, 128, 142 Practicability, 142, 149 Practice Guidelines, 100, 106, 142 Prevalence, 11, 142 Priapism, 32, 142 Primary endpoint, 8, 142 Progesterone, 142, 148 Progression, 5, 122, 142 Progressive, 44, 65, 106, 129, 132, 138, 140, 142, 150 Prone, 22, 81, 143 Prone Position, 81, 143

Prospective study, 11, 15, 25, 26, 135, 143 Prostate, 143, 149 Prostatectomy, 53, 143 Protein S, 86, 124, 143 Protocol, 75, 143 Proximal, 129, 140, 143 Pruritus, 128, 143 Public Policy, 99, 143 Pulmonary, 16, 124, 127, 130, 143 Pulmonary hypertension, 16, 143 Pulposus, 4, 13, 87, 134, 143 Q Quadriplegia, 20, 143 Quality of Life, 7, 8, 143 R Radiation, 143, 144, 145, 150 Radicular, 72, 82, 143 Radiculopathy, 4, 72, 73, 75, 87, 143, 146 Radioactive, 124, 133, 135, 139, 144, 145 Radiography, 40, 86, 144 Radiological, 17, 21, 104, 144 Radiology, 17, 22, 27, 28, 29, 31, 45, 48, 52, 55, 86, 104, 144 Randomized, 4, 8, 11, 129, 144 Randomized clinical trial, 11, 144 Randomized Controlled Trials, 4, 144 Receptor, 122, 129, 130, 144, 146 Receptors, Serotonin, 144, 146 Rectum, 122, 124, 128, 132, 134, 135, 143, 144 Recurrence, 144 Refer, 1, 126, 131, 135, 144 Refraction, 144, 147 Regimen, 11, 73, 129, 144 Reliability, 47, 52, 144 Renal Osteodystrophy, 19, 144 Reoperation, 7, 144 Resection, 39, 138, 144, 149 Restoration, 141, 144 Retina, 139, 145 Retractor, 17, 18, 145 Retropubic, 143, 145 Retrospective, 38, 47, 54, 58, 145 Retrospective study, 38, 47, 54, 58, 145 Rheumatism, 24, 145 Rheumatoid, 48, 106, 145 Rheumatoid arthritis, 48, 106, 145 Rickets, 31, 145 Risk factor, 143, 145 Rod, 13, 36, 58, 145 S Sagittal, 53, 145

158 Spinal Stenosis

Salivary, 128, 145 Salivary glands, 128, 145 Saponins, 145, 148 Sarcoma, 62, 145 Scans, 75, 93, 145 Sciatic Nerve, 5, 141, 146, 149 Sciatica, 5, 9, 13, 46, 66, 71, 72, 73, 75, 80, 81, 86, 91, 104, 107, 146 Scoliosis, 12, 15, 48, 50, 80, 87, 104, 146 Screening, 72, 125, 146 Secretion, 127, 132, 133, 137, 146 Sedative, 128, 146 Sensibility, 133, 146 Sensitization, 10, 146 Sensor, 12, 146 Sensory loss, 143, 146 Serotonin, 71, 128, 131, 144, 146, 150 Shock, 146, 149 Side effect, 72, 73, 75, 121, 133, 146, 149 Signs and Symptoms, 75, 86, 93, 146 Skeletal, 87, 122, 138, 146 Skeleton, 3, 87, 131, 135, 146 Sleep apnea, 81, 147 Smooth muscle, 133, 137, 138, 147 Snoring, 81, 147 Social Environment, 143, 147 Sodium, 132, 137, 147 Soft tissue, 82, 146, 147 Sound wave, 127, 147 Specialist, 108, 147 Spectrum, 35, 86, 147 Spinal Cord Diseases, 143, 147 Spinal Cord Injuries, 104, 143, 147 Spinal Nerve Roots, 142, 143, 146, 147 Spondylolisthesis, 5, 6, 7, 12, 23, 25, 39, 46, 49, 73, 74, 80, 87, 147 Sprains and Strains, 136, 147 Stabilization, 93, 147 Staging, 145, 148 Stasis, 27, 148 Steel, 13, 148 Steroid, 4, 26, 33, 145, 148 Stimulus, 9, 129, 130, 134, 135, 140, 148, 149 Stomach, 81, 121, 128, 130, 131, 132, 133, 141, 148 Stool, 134, 135, 148 Stress, 10, 145, 148 Stroke, 77, 98, 148 Stupor, 138, 148 Supine, 22, 48, 148 Supine Position, 22, 148

Suppression, 127, 148 Surgical Instruments, 80, 148 Sympathetic Nervous System, 139, 148 Symptomatic, 10, 19, 36, 51, 123, 148 Symptomatic treatment, 123, 148 Synovial, 18, 32, 135, 148 Synovial Cyst, 18, 32, 148 Systemic, 87, 124, 134, 149 T Tendonitis, 80, 149 Therapeutics, 21, 38, 40, 41, 61, 62, 63, 64, 65, 149 Thigh, 72, 149 Thoracic, 16, 42, 50, 51, 87, 123, 149 Thorax, 121, 136, 149 Threshold, 130, 133, 149 Thrombosis, 143, 148, 149 Tibial Nerve, 146, 149 Tin, 93, 149 Tolerance, 10, 149 Tomography, 18, 22, 149 Tonicity, 129, 149 Toxic, iv, 139, 149 Toxicity, 129, 136, 149 Toxicology, 100, 149 Trace element, 131, 149 Transfection, 124, 149 Transurethral, 143, 149 Transurethral Resection of Prostate, 143, 149 Trauma, 83, 87, 106, 138, 149 Treatment Outcome, 87, 149 Tricyclic, 73, 93, 128, 150 Tryptophan, 146, 150 Tumour, 38, 131, 150 U Unconscious, 133, 150 Uric, 132, 133, 150 Urinary, 124, 134, 143, 145, 150 Urine, 124, 134, 150 Urodynamic, 55, 56, 150 Uterus, 125, 131, 142, 150 Uvula, 147, 150 V Vaccine, 121, 143, 150 Vascular, 32, 55, 134, 147, 150 VE, 27, 37, 150 Veins, 124, 142, 150 Venous, 27, 143, 150 Ventricles, 125, 150 Venules, 124, 150 Vertebrae, 4, 5, 106, 134, 135, 147, 150

Index 159

Vertebral, 46, 55, 81, 83, 106, 150 Veterinary Medicine, 58, 99, 150 Visceral, 87, 150 Viscosity, 137, 150 Vivo, 10, 150 Volition, 134, 150

W Wheelchairs, 12, 150 X Xenograft, 122, 150 X-ray, 65, 118, 126, 138, 139, 144, 145, 150

160 Spinal Stenosis