Neurosurgery

associated with the facet joints can be seen on the CT scan.

The presence of degenerative change in the cervical spine does not always correlate with the presence of symptoms and often does not specify the location of the pain generator in a situation where the patient has more than one level of degenerative change. The challenge to the physician is to correlate the patient's symptomatology with the imaging findings. In the presence of a neurologic deficit from spinal cord compression or isolated nerve root compression, a focus of spinal cord or nerve root compression which conforms to the distribution of the neurological deficit is usually sufficient to establish a correlation between the clinical and imaging findings. In other cases, ancillary testing and diagnostic procedures may be required to obtain a clinical pathological correlate. Electrophysiological testing and diagnostic nerve root and facet blocks and diskography may be helpful in assessing the origin of a patient's pain.

Electrophysiological testing can be effective in identifying the origin of arm pain. A peripheral entrapment neuropathy, brachial plexus abnormality or a radiculopathy should be distinguishable on an EMG/nerve conduction study. The EMG/nerve conduction study can assist in identifying the precise nerve root involved in a patient with radicular pain and deficit, although this should be apparent by the clinical assessment. Also, the EMG/nerve conduction study can be helpful in identifying the origin of proximal arm pain, which could either be radicular or a referred phenomenon from the cervical spondylosis [2].

The percutaneous injection of steroids and/or local anesthetics can be of diagnostic and, in some cases, therapeutic benefit [3]. Selective injections blocking conductivity through nerve roots or the facet joint can determine if the specific structure injected is contributing to axial and/or appendicular pain. The techniques should be performed under fluoroscopy to optimize the specificity of the procedure. Despite safeguards and meticulous technique, the procedure is not completely specific and sensitive.

Diskography is a controversial diagnostic technique to evaluate the presence of pain of diskogenic origin. The concept of diskogenic pain is also controversial. Innervation of the annulus and the endplates provides a substrate

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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