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Sample records for posterior-lateral lumbar interbody

  1. Percutaneous posterior-lateral lumbar interbody fusion for degenerative disc disease using a B-Twin expandable spinal spacer

    OpenAIRE

    Xiao, Lizu; Xiong, Donglin; Zhang, Qiang; Jian, Jin; Zheng, Husan; Luo, Yuhui; Dai, Juanli; Zhang, Deren

    2009-01-01

    Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated by follow-up more than 1 year. 12 cases with chronic low back pain and compressive radiculopathy due to DDD refractory were sel...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... lumbar laminectomy transforaminal lumbar interbody fusion. Surgeons take bone off the spine to make more room for ... re taking off the middle part of her bone as well. We’ve done this TLIF approach ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... a procedure in terms of the instruments we use. When we think about doing an interbody fusion, ... from the front, though we are going to use a type of a spacer put in from ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... pain, or classic sciatica, due to compression of one or more nerves in the spinal canal. Now, ... for sciatica due to a herniated disc. Now, one might as why we’re doing an interbody ...

  5. Contralateral radiculopathy after transforaminal lumbar interbody fusion

    OpenAIRE

    Hunt, Travis; Shen, Francis H.; Shaffrey, Christopher I.; Arlet, Vincent

    2007-01-01

    Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative spondylolisthesis and degenerative disc disease. Opposite side radiculopathy after the TLIF procedure has been recognized in this institution but has not been addressed in the literature. We present a case of opposite side radiculopathy after the TLIF procedure. We believe that this complication is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased l...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... left, that is the approach for the transforaminal lumber interbody fusion. Now, different today is that we’re doing a full laminectomy. Because this patient has severe stenosis, we’re taking off the middle part of ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... watching audience to know that is one true emergency in lumbar surgery: it’s called cauda equina syndrome, ... the hospital in that time. So there are emergencies, but the answer is patients don’t have ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... will demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy ... a 67-year-old female who has significant back and leg pain, worse with standing and walking, ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy transforaminal ... old female who has significant back and leg pain, worse with standing and walking, and it’s been ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going to be on the air ... of a laminectomy and TLIF for stenosis and scoliosis, which is what this patient has. So let’s ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... will demonstrate a surgical procedure to treat lower back pain. The procedure is called a lumbar laminectomy transforaminal ... collapse of those disc spaces. Now, axial low back pain, which many patients complain of with back disorders, ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... questions as possible. Today we’re performing a lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going to be on ... and walking, and it’s been refractory to medical therapies. She has the diagnosis called spinal stenosis, which is a narrowing of the spine, and ...

  13. Transforaminal lumbar interbody fusion (TLIF): Assessment of clinical and radiological outcome

    Scientific Electronic Library Online (English)

    MJD, Jacobsohn; RN, Dunn.

    Full Text Available AIM: To assess the complications and outcome of patients who underwent transforaminal lumbar interbody fusion (TLIF) with an interbody cage. METHODS: Fifty-two consecutive patients were reviewed retrospectively. Clinical and radiological data were collected and analysed. Thirty-three female and 19 m [...] ale patients underwent the procedure with a mean age of 45.7 years (12-76 years). Eight cases were revision surgery. The primary pathology was a lytic listhesis in 20 patients, degenerative disc disease in 17, adjacent segment disease following a previous fusion in eight, degenerative listhesis in four, a congenital abnormality (L5 hemivertebrae and segmentation failure L2-4) in two, and a neuromuscular scoliosis in one patient. The mean blood loss was 610 ml and mean operative time 170 minutes. Mean stay in ICU or high care was 1 day, and mean hospital stay was 7.8 days. All patients operated since 2005 were evaluated pre- and post-op using the following scoring systems: EQ 5D, Visual Analogue Scale (VAS), Roland Morris scale and Oswestry Disability Index (ODI). RESULTS: There were no intra-operative complications. One patient developed a cauda equina syndrome 48 hours postoperatively when he was mobilised. This resolved completely following evacuation of the haematoma. In one case there was instrumentation failure with a rod screw disarticulation which led to failure of the posterior construct. There were statistically significant improvements in all clinical scores except the EQ 5D. Fusion could be assessed in 47 patients. Anterior interbody fusion was achieved in 95.3% of cases and posterior lateral fusion was achieved in 83.7%. CONCLUSION: Transforaminal lumbar interbody fusion is a safe and effective option to achieve circumferential fusion. It is technically challenging and the surgeon needs to be proficient in the technique to avoid catastrophic complications. Clinical scoring confirmed that our patients did benefit significantly in terms of pain and overall health status.

  14. Anterior Lumbar Interbody Implants: Importance of the Interdevice Distance

    OpenAIRE

    Schuler, Thomas C.; Martin, Marcus M.; Copay, Anne G.; Subach, Brian R.

    2011-01-01

    Object. The implantation of interbody fusion cages allows for the restoration of disc height and the enlargement of the neuroforaminal space. The purpose of this study was to compare the extent of subsidence occurring after conventional cage placement compared to a novel wider cage placement technique. Methods. This study is a retrospective evaluation of radiographs of patients who underwent stand-alone single level anterior lumbar interbody fusion with lordotic titanium cages and rhBMP-...

  15. Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint

    Directory of Open Access Journals (Sweden)

    Wei Lu, Yan-Hao Li, Xiao-Feng He

    2010-03-01

    Full Text Available AIM: To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS: Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography. Second injections were performed 5 d after the initial injection. All patients were followed up for 6-18 mo. A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS: Successful puncture was obtained in all patients. The overall efficacy was 91.4%; the outcome was the excellent in 37 cases (63.8%, good in 16 cases (27.6% and fair/poor in 5 cases (8.6% according to the Macnab criteria. No severe complications were found throughout this study.CONCLUSION: Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.

  16. Finite element analysis of minimal invasive transforaminal lumbar interbody fusion.

    Science.gov (United States)

    Zhao, Chuncheng; Wang, Xinhu; Chen, Changchun; Kang, Yanzhong

    2014-09-01

    The purpose of our study is to develop and validate three-dimensional finite element models of transforaminal lumbar interbody fusion, and explore the most appropriate method of fixation and fusion by comparing biomechanical characteristics of different fixation method. We developed four fusion models: bilateral pedicle screws fixation with a single cage insertion model (A), bilateral pedicle screws fixation with two cages insertion model (B), unilateral pedicle screws fixation with a single cage insertion model (C), and unilateral pedicle screws fixation with two cages insertion model (D); the models were subjected to different forces including anterior bending, posterior extension, left bending, right bending, rotation, and axial compressive. The von Mises stress of the fusion segments on the pedicle screw and cages was recorded. Angular variation and stress of pedicle screw and cage were compared. There were differences of Von Mises peak stress among four models, but were within the range of maximum force. The angular variation in A, B, C, and D decreased significantly compared with normal. There was no significant difference of angular variation between A and B, and C and D. Bilateral pedicle screws fixation had more superior biomechanics than unilateral pedicle screws fixation. In conclusion, the lumbar interbody fusion models were established using varying fixation methods, and the results verified that unilateral pedicle screws fixation with a single cage could meet the stability demand in minimal invasive transforaminal interbody fusion. PMID:24782059

  17. A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

    OpenAIRE

    McCarthy, M. J.H.; Ng, L; Vermeersch, G.; D Chan

    2012-01-01

    Aim?To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion.

  18. A minimally invasive posterior lumbar interbody fusion using percutaneous long arm pedicle screw system for degenerative lumbar disease

    OpenAIRE

    He, Er-xing; Cui, Ji-hao; Yin, Zhi-xun; Li, Chuang; Tang, Cheng; He, Yi-qian; Liu, Cheng-wei

    2014-01-01

    The aim of this study is to evaluate the therapeutic efficacy of patients with lumbar degeneration and instability treated with percutaneous pedicle screw fixation and minimally invasive lumbar interbody fusion. Twenty-one patients were selected in our hospital from November, 2012 to March, 2013. The patients with an average age 55.62 years, including 8 vertebral spondylolisthesis, 4 lumbar intervertebral disc herniation, and 9 lumbar spinal canal stenosis cases. All the patients were managed...

  19. TLIF: transforaminal lumbar interbody fusion TLIF: artrodese intersomática lombar transforaminal

    Directory of Open Access Journals (Sweden)

    Nicandro Figueiredo

    2004-09-01

    Full Text Available Transforaminal lumbar interbody fusion (TLIF is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indication for interbody fusion and posterior decompression. The main advantage of TLIF is that it allows the complete removal of the intervertebral disc through the vertebral foramen, decompression of the spinal canal and vertebral foramen with minimum risk of neural lesion, due to the access being lateral to the nerve roots. In this study, we describe the first 24 cases of TLIF that we have done, wich shows to be very safe and efficient in our serie, with an relief of pain in 83.3% of patients, great improvements in the life quality in 75% of cases and satisfaction with the surgery in 79.1% of patients.Artrodese lombar intersomática transforaminal (TLIF é uma técnica relativamente nova de artrodese lombar intersomática via transforaminal posterior, indicada principalmente nos casos de doença discal degenerativa, espondilolistese (grau I e II e reoperação para hérnia discal, especialmente quando existe indicação para fusão intersomática e descompressão posterior. A maior vantagem do TLIF é que ele permite remoção completa do disco através do forame, descompressão do canal e neuroforame, com mínimo risco de lesão neural, uma vez que o acesso é lateral aos nervos. Em nosso estudo, descrevemos os primeiros 24 casos de TLIF que realizamos, que se mostrou como cirurgia segura e eficiente em nossa série, com alívio da dor em 83,3% dos pacientes, melhora na qualidade de vida em 75% dos casos e satisfação com a cirurgia em 79,1% dos pacientes.

  20. TLIF: transforaminal lumbar interbody fusion / TLIF: artrodese intersomática lombar transforaminal

    Scientific Electronic Library Online (English)

    Nicandro, Figueiredo; Johnny Wesley G., Martins; Alfredo A., Arruda; Alexandre R., Serra; Marco Antônio A., Figueiredo; Rodrigo C., Diniz; Alessandro A., Cavicchioli.

    2004-09-01

    Full Text Available Artrodese lombar intersomática transforaminal (TLIF) é uma técnica relativamente nova de artrodese lombar intersomática via transforaminal posterior, indicada principalmente nos casos de doença discal degenerativa, espondilolistese (grau I e II) e reoperação para hérnia discal, especialmente quando [...] existe indicação para fusão intersomática e descompressão posterior. A maior vantagem do TLIF é que ele permite remoção completa do disco através do forame, descompressão do canal e neuroforame, com mínimo risco de lesão neural, uma vez que o acesso é lateral aos nervos. Em nosso estudo, descrevemos os primeiros 24 casos de TLIF que realizamos, que se mostrou como cirurgia segura e eficiente em nossa série, com alívio da dor em 83,3% dos pacientes, melhora na qualidade de vida em 75% dos casos e satisfação com a cirurgia em 79,1% dos pacientes. Abstract in english Transforaminal lumbar interbody fusion (TLIF) is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indica [...] tion for interbody fusion and posterior decompression. The main advantage of TLIF is that it allows the complete removal of the intervertebral disc through the vertebral foramen, decompression of the spinal canal and vertebral foramen with minimum risk of neural lesion, due to the access being lateral to the nerve roots. In this study, we describe the first 24 cases of TLIF that we have done, wich shows to be very safe and efficient in our serie, with an relief of pain in 83.3% of patients, great improvements in the life quality in 75% of cases and satisfaction with the surgery in 79.1% of patients.

  1. Surgical outcome of posterior lumbar interbody fusion with pedicle screw fixation for lumbar spondylolisthesis

    International Nuclear Information System (INIS)

    Problems of lumbar spondylolisthesis treatment are many surgical tactics, elderly patient, osteoporosis, complications and recurrence of the symptoms. PLIF (posterior lumbar interbody fusion) and PS (pedicle screw) fixation technique for lumbar spondylolisthesis provide good patient satisfaction. Good outcome has been reported by only laminectomy alone, but patient satisfaction becomes worse year after year. The role of instrumentation for lumbar spondylolisthesis is decompression of the nerve root, correction of lumbar pathologies, bony fusion and early mobilization. We show our surgical technique and long term outcome of PLIF with PS for lumbar spondylolisthesis. Three hundred and fifty cases of lumbar spondylolisthesis were operated on in Department of Neurosurgery, Fujita Health University during the period of from December 1992 to August 2008. Patient background: age 16-84 years old (mean 62.5), Gender: male 153, female 197. Follow-up period 1-180 months (mean 61.2). Degenerative: 255, Isthmic: 63, Dysplastic: 10, Fracture: 5 and scoliosis 16 cases. Surgical procedure was PS with interbody fusion cage: 331, Hybrid cage (titanium cage with hydroxyapatite) 314, PS with Cerabone: 2 and PS with autograft: 17. CT was done to evaluate bony fusion postoperatively. Post operative improvements by JOA (Japan Orthopedic Association) score is 11.4 before surgery, 24.1 (post op. within 2 years), 25.4 (post op. 2-5 years), 25.0 (post op. 5-10 years) and 22.4 (post op. 10-15 yep. 5-10 years) and 22.4 (post op. 10-15 years). Significant improvements were observed in %Slip and Slip angle but no remarkable change was observed in lumbar lordotic angle by postoperative X-ray evaluation. No root injury, and systemic complication except 4 cases of cerebrospinal fluid (CSF) leakage during surgery. Two cases were reoperated in whom cage with autograft migration due to pseudoarthrosis. Two cases had to undergo screw and cage system removal due to infection. Two cases of adjacent level stenosis had to undergo operation 10 tears after surgery in this study. Rigid fixation (PLIF+PS) technique for lumbar spondylolisthesis provide good surgical result for over 15 years. Minimum invasive surgery is popular but this technique achieved good satisfaction for patient and prevent malpractice. (author)

  2. Set screw fracture with cage dislocation after two-level transforaminal lumbar interbody fusion (TLIF): a case report

    OpenAIRE

    Leute, Philip Jf; Hammad, Ahmed; Hoffmann, Isabel; Hoppe, Sebastian; Klinger, Hans-michael; Lakemeier, Stefan

    2015-01-01

    Abstract Introduction Transforaminal lumbar interbody fusion is a popular procedure used to achieve spondylodesis in patients with degenerative lumbar spinal diseases. We present a rare case of a patient with a set screw fracture with cage dislocation after an open transforaminal lumbar interbody fusion procedure. To the best of our knowledge, this case is the first of its kind to be reported. Case presentation A 44-year-old Caucasian woman attended a follow-up appointment at our hospital 3 m...

  3. Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion

    OpenAIRE

    Schleicher, Philipp; Gerlach, R.; Schär, B.; Cain, C. M. J.; Achatz, W.; Pflugmacher, R.; Haas, N. P.; Kandziora, F

    2008-01-01

    Segmental instability in degenerative disc disease is often treated with anterior lumbar interbody fusion (ALIF). Current techniques require an additional posterior approach to achieve sufficient stability. The test device is an implant which consists of a PEEK-body and an integrated anterior titanium plate hosting four diverging locking screws. The test device avoids posterior fixation by enhancing stability via the locking screws. The test device was compared to an already established stand...

  4. Large volume inside the cage leading incomplete interbody bone fusion and residual back pain after posterior lumbar interbody fusion.

    Science.gov (United States)

    Takeuchi, Mikinobu; Kamiya, Mitsuhiro; Wakao, Norimitsu; Hirasawa, Atsuhiko; Kawanami, Katsuhisa; Osuka, Koji; Takayasu, Masakazu

    2015-07-01

    The purpose of this study is to compare intervertebral bone fusion and clinical outcomes in L4-5 posterior lumbar interbody fusion (PLIF) using the same posterior instrumentation with four combinations of one of three types of interbody cage with one of two bone grafts, iliac and local or only local. In 67 patients who underwent L4-5 PLIF, 19 patients had the Brantigan cage and iliac and local bone graft, 18 with the TELAMON C cage and iliac and local bone graft, 16 with the TELAMON C cage and local bone graft (TL), and 14 with the OIC PEEK cage and local bone graft. Clinical assessments were based on Japanese Orthopaedic Association (JOA) scores and on the visual analogue scale (VAS). The bone fusion assessments were based on radiography and CT scans according to the Brantigan, Steffee, and Fraser criteria. More than 2 years after surgery, these assessments were made. In the results, the fusion outcome for the group receiving TL was significantly less than those for the other three groups. In TL, multivariate logistic regression analysis showed that the inside volume of the cage of ?2.0 mL was the only significant factor for incomplete fusion. Moreover, the VAS (low back pain) score was significantly higher for TL than for the other three groups. In conclusions, we believe that the large volume inside the cage (?2.0 mL) with local bone graft may lead incomplete interbody bone fusion and residual postsurgical low back pain after PLIF. PMID:25666390

  5. Development of a 4-axis load cell used for lumbar interbody load measurements.

    Science.gov (United States)

    Demetropoulos, Constantine K; Morgan, Craig R; Sengupta, Dilip K; Herkowitz, Harry N

    2009-09-01

    Numerous studies have assessed lumbar interbody fusion, but little data from direct interbody load measurements exists. This manuscript describes an interbody fusion cage with integrated 4-axis load cell that can simulate implant heights of 13, 15, 17, 19 and 21 mm. The calibrated load cell was accurate to within 7.9% for point compressive loads over the central 8 mm x 8 mm region, but up to 26.8% for eccentric loads on the outer 16 mm x 16 mm rim of the device (although typically errors were less than half). Anterior-posterior shear and lateral shear loads did not affect compressive load measurement (<1.0% and <3.5%, respectively). Moments calculated from 4 load sensing corner pillars demonstrated errors below 2.3% in lateral bending and 2.1% in flexion-extension. Although this device does not have the accuracy of other much larger corpectomy implants, it incorporates four channels of load and simulates multiple implant heights, making for a favorable comparison in this restricted space. This device has immediate use in cadaveric testing, providing data previously not attainable, and serves as a novel technological step towards an implantable interbody device with multi-axis load sensing capability. As per the authors' knowledge, no such device has previously been described. PMID:19447666

  6. The Effect of the Retroperitoneal Transpsoas Minimally Invasive Lateral Interbody Fusion on Segmental and Regional Lumbar Lordosis

    OpenAIRE

    Le, Tien V.; Vivas, Andrew C.; Dakwar, Elias; Baaj, Ali A.; Uribe, Juan S.

    2012-01-01

    Background. The minimally invasive lateral interbody fusion (MIS LIF) in the lumbar spine can correct coronal Cobb angles, but the effect on sagittal plane correction is unclear. Methods. A retrospective review of thirty-five patients with lumbar degenerative disease who underwent MIS LIF without supplemental posterior instrumentation was undertaken to study the radiographic effect on the restoration of segmental and regional lumbar lordosis using the Cobb angles on pre- and postoperative rad...

  7. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery

    OpenAIRE

    Moo Sung Kang; Jeong Yoon Park; Kyung Hyun Kim; Sung Uk Kuh; Dong Kyu Chin; Keun Su Kim; Yong Eun Cho

    2014-01-01

    Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle scr...

  8. Treatment of multilevel degenerative lumbar spinal stenosis with spondylolisthesis using a combination of microendoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion

    OpenAIRE

    Wu, Han; Yu, Wei-dong; Jiang, Rui; Gao, Zhong-li

    2012-01-01

    Degenerative lumbar spinal stenosis (DLSS) has become increasingly common and is characterized by multilevel disc herniation and lumbar spondylolisthesis, which are difficult to treat. The current study aimed to evaluate the short-term clinical outcomes and value of the combined use of microendoscopic discectomy (MED) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of multilevel DLSS with spondylolisthesis, and to compare the combination with traditio...

  9. AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

    Directory of Open Access Journals (Sweden)

    Rapp SM

    2011-08-01

    Full Text Available Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF system is a minimally invasive fusion device that accesses the lumbar (L4–S1 intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.Keywords: AxiaLIF, fusion, lumbar, minimally invasive, presacral

  10. Clinical outcomes of single-level lumbar artificial disc replacement compared with transforaminal lumbar interbody fusion in an Asian population

    Science.gov (United States)

    Lee, Wei Ting; Liu, Gabriel; Thambiah, Joseph; Wong, Hee Kit

    2015-01-01

    INTRODUCTION The objective of this study was to examine the clinical outcome of single-level lumbar artificial disc replacement (ADR) compared to that of transforaminal lumbar interbody fusion (TLIF) for the treatment of symptomatic degenerative disc disease (DDD) in an Asian population. METHODS This was a retrospective review of 74 patients who had surgery performed for discogenic lower backs that involved only the L4/5 and L5/S1 levels. All the patients had lumbar DDD without radiculopathy or spondylolithesis, and concordant pain with discogram at the pathological level. The patients were divided into two groups – those who underwent ADR and those who underwent TLIF. RESULTS A trend suggesting that the ADR group had better perioperative outcomes (less blood loss, shorter operating time, shorter hospital stay and shorter time to ambulation) than the TLIF group was observed. However, a trend indicating that surgical-approach-related complications occurred more frequently in the ADR group than the TLIF group was also observed. The rate of revision surgery was comparable between the two groups. CONCLUSION Our findings suggest that for the treatment of discogenic lower back pain, lumbar ADR has better perioperative outcomes and a similar revision rate when compared with TLIF. However, the use of ADR was associated with a higher incidence of surgical-approach-related complications. More studies with bigger cohort sizes and longer follow-up periods are needed to determine the long-term efficacy and safety of ADR in lumbar DDD. PMID:25917472

  11. Excessive distraction of lumbar disc space induces early degeneration of the adjacent segment after posterior lumbar interbody fusion (PLIF)

    International Nuclear Information System (INIS)

    Posterior lumbar interbody fusion (PLIF) for lumbar spondylolisthesis usually results in an excellent outcome, but the problem of so-called adjacent segment disease (ASD) remains unresolved. ASD at L3/4 was investigated in 85 patients with LA spondylolisthesis treated by L4/5 PLIF with uniform pedicle screws and interbody cages who had been followed up for more than two years (mean, 38.8±17.1 months). The patients were divided into three groups according to the final outcome: a group without ASD (n=58), a group with radiological ASD (n=14), and a group with clinical ASD (n=13). Eleven patients in the third group were reoperated to treat L3/4 lesions. L4-5 disc height distraction by cage insertion in the three groups was 3.1 mm, 4.4 mm, and 6.2 mm, respectively, and the latter two values were significantly higher than the first value. Excessive distraction of the L4/5 disc space proved to be a significant risk factor for radiological and clinical ASD at L3/4. (author)

  12. Surgeons' Exposure to Radiation in Single- and Multi-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion; A Prospective Study

    OpenAIRE

    Funao, Haruki; Ishii, Ken; Momoshima, Suketaka; Iwanami, Akio; Hosogane, Naobumi; Watanabe, Kota; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2014-01-01

    Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level ...

  13. Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion.

    Science.gov (United States)

    Bevevino, Adam J; Kang, Daniel G; Lehman, Ronald A; Van Blarcum, Gregory S; Wagner, Scott C; Gwinn, David E

    2014-10-01

    The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be established. Omitting a PLF significantly reduces overall surface area available for achieving a solid arthrodesis, however it decreases the soft tissue dissection and costs of additional bone graft. The authors sought to perform a meta-analysis to establish the fusion rate of MIS TLIF performed without attempting a PLF. We performed an extensive Medline and Ovid database search through December 2010 revealing 39 articles. Inclusion criteria necessitated that a one or two level TLIF procedure was performed through a paramedian MIS approach with bilateral posterior pedicle screw instrumentation and without posterolateral bone grafting. CT scan verified fusion rates were mandatory for inclusion. Seven studies (case series and case-controls) met inclusion criteria with a total of 408 patients who underwent MIS TLIF as described above. The mean age was 50.7 years and 56.6% of patients were female. A total of 78.9% of patients underwent single level TLIF. Average radiographic follow-up was 15.6 months. All patients had local autologous interbody bone grafting harvested from the pars interarticularis and facet joint of the approach side. Either polyetheretherketone (PEEK) or allograft interbody cages were used in all patients. Overall fusion rate, confirmed by bridging trabecular interbody bone on CT scan, was 94.7%. This meta-analysis suggests that MIS TLIF performed with interbody bone grafting alone has similar fusion rates to MIS or open TLIF performed with interbody supplemented with posterolateral bone grafting and fusion. PMID:24913928

  14. Biomechanical comparison of two different concepts for stand alone anterior lumbar interbody fusion.

    Science.gov (United States)

    Schleicher, Philipp; Gerlach, R; Schär, B; Cain, C M J; Achatz, W; Pflugmacher, R; Haas, N P; Kandziora, F

    2008-12-01

    Segmental instability in degenerative disc disease is often treated with anterior lumbar interbody fusion (ALIF). Current techniques require an additional posterior approach to achieve sufficient stability. The test device is an implant which consists of a PEEK-body and an integrated anterior titanium plate hosting four diverging locking screws. The test device avoids posterior fixation by enhancing stability via the locking screws. The test device was compared to an already established stand alone interbody implant in a human cadaveric three-dimensional stiffness test. In the biomechanical test, the L4/5 motion segment of 16 human cadaveric lumbar spines were isolated and divided into two test groups. Tests were performed in flexion, extension, right and left lateral bending, right and left axial rotation. Each specimen was tested in native state first, then a discectomy was performed and either of the test implants was applied. Finite element analysis (FE) was also performed to investigate load and stress distribution within the implant in several loading conditions. The FE models simulated two load cases. These were flexion and extension with a moment of 5 Nm. The biomechanical testing revealed a greater stiffness in lateral bending for the SynFix-LR compared to the established implant. Both implants showed a significantly higher stiffness in all loading directions compared to the native segment. In flexion loading, the PEEK component takes on most of the load, whereas the majority of the extension load is put on the screws and the screw-plate junction. Clinical investigation of the test device seems reasonable based on the good results reported here. PMID:18841399

  15. Axial lumbar interbody fusion: a 6-year single-center experience

    Directory of Open Access Journals (Sweden)

    Zeilstra DJ

    2013-08-01

    Full Text Available Dick J Zeilstra,1 Larry E Miller,2,3 Jon E Block3 1Bergman Clinics, Naarden and NedSpine, Ede, The Netherlands; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USA Introduction: The aim of this study is to report our 6-year single-center experience with L5–S1 axial lumbar interbody fusion (AxiaLIF. Methods: A total of 131 patients with symptomatic degenerative disc disease refractory to nonsurgical treatment were treated with AxiaLIF at L5–S1, and were followed for a minimum of 1 year (mean: 21 months. Main outcomes included back and leg pain severity, Oswestry Disability Index score, working status, analgesic medication use, patient satisfaction, and complications. Computed tomography was used to determine postoperative fusion status. Results: No intraoperative complications, including vascular, neural, urologic, or bowel injuries, were reported. Back and leg pain severity decreased by 51% and 42%, respectively, during the follow-up period (both P < 0.001. Back function scores improved 50% compared to baseline. Clinical success, defined as improvement ?30%, was 67% for back pain severity, 65% for leg pain severity, and 71% for back function. The employment rate increased from 47% before surgery to 64% at final follow-up (P < 0.001. Less than one in four patients regularly used analgesic medications postsurgery. Patient satisfaction with the AxiaLIF procedure was 83%. The fusion rate was 87.8% at final follow-up. During follow-up, 17 (13.0% patients underwent 18 reoperations on the lumbar spine, including pedicle screw fixation (n = 10, total disc replacement of an uninvolved level (n = 3, facet screw fixation (n = 3, facet screw removal (n = 1, and interbody fusion at L4–L5 (n = 1. Eight (6.1% reoperations were at the index level. Conclusion: Single-level AxiaLIF is a safe and effective means to achieve lumbosacral fusion in patients with symptomatic degenerative disc disease. Keywords: AxiaLIF, interbody, fusion, lumbosacral, minimally invasive, presacral

  16. A novel synthetic material for spinal fusion: a prospective clinical trial of porous bioactive titanium metal for lumbar interbody fusion

    OpenAIRE

    Fujibayashi, Shunsuke; Takemoto, Mitsuru; Neo, Masashi; Matsushita, Tomiharu; Kokubo, Tadashi; Doi,Kenji; Ito, Tatsuya; Shimizu, Akira; Nakamura, Takashi

    2011-01-01

    The objective of this study was to establish the efficacy and safety of porous bioactive titanium metal for use in a spinal fusion device, based on a prospective human clinical trial. A high-strength spinal interbody fusion device was manufactured from porous titanium metal. A bioactive surface was produced by simple chemical and thermal treatment. Five patients with unstable lumbar spine disease were treated surgically using this device in a clinical trial approved by our Ethics Review Commi...

  17. Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis

    OpenAIRE

    Oh, Hyeong Seok; Lee, Sang-ho; Hong, Soon-woo

    2013-01-01

    Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks p...

  18. Biomechanical evaluation of three surgical scenarios of posterior lumbar interbody fusion by finite element analysis

    Directory of Open Access Journals (Sweden)

    Xiao Zhitao

    2012-06-01

    Full Text Available Abstract Background For the treatment of low back pain, the following three scenarios of posterior lumbar interbody fusion (PLIF were usually used, i.e., PLIF procedure with autogenous iliac bone (PAIB model, PLIF with cages made of PEEK (PCP model or titanium (Ti (PCT model materiel. But the benefits or adverse effects among the three surgical scenarios were still not fully understood. Method Finite element analysis (FEA, as an efficient tool for the analysis of lumbar diseases, was used to establish a three-dimensional nonlinear L1-S1 FE model (intact model with the ligaments of solid elements. Then it was modified to simulate the three scenarios of PLIF. 10?Nm moments with 400?N preload were applied to the upper L1 vertebral body under the loading conditions of extension, flexion, lateral bending and torsion, respectively. Results Different mechanical parameters were calculated to evaluate the differences among the three surgical models. The lowest stresses on the bone grafts and the greatest stresses on endplate were found in the PCT model. The PCP model obtained considerable stresses on the bone grafts and less stresses on ligaments. But the changes of stresses on the adjacent discs and endplate were minimal in the PAIB model. Conclusions The PCT model was inferior to the other two models. Both the PCP and PAIB models had their own relative merits. The findings provide theoretical basis for the choice of a suitable surgical scenario for different patients.

  19. Minimally invasive presacral approach for revision of an Axial Lumbar Interbody Fusion rod due to fall-related lumbosacral instability: a case report

    Directory of Open Access Journals (Sweden)

    Cohen Anders

    2011-09-01

    Full Text Available Abstract Introduction The purpose of this study was to describe procedural details of a minimally invasive presacral approach for revision of an L5-S1 Axial Lumbar Interbody Fusion rod. Case presentation A 70-year-old Caucasian man presented to our facility with marked thoracolumbar scoliosis, osteoarthritic changes characterized by high-grade osteophytes, and significant intervertebral disc collapse and calcification. Our patient required crutches during ambulation and reported intractable axial and radicular pain. Multi-level reconstruction of L1-4 was accomplished with extreme lateral interbody fusion, although focal lumbosacral symptoms persisted due to disc space collapse at L5-S1. Lumbosacral interbody distraction and stabilization was achieved four weeks later with the Axial Lumbar Interbody Fusion System (TranS1 Inc., Wilmington, NC, USA and rod implantation via an axial presacral approach. Despite symptom resolution following this procedure, our patient suffered a fall six weeks postoperatively with direct sacral impaction resulting in symptom recurrence and loss of L5-S1 distraction. Following seven months of unsuccessful conservative care, a revision of the Axial Lumbar Interbody Fusion rod was performed that utilized the same presacral approach and used a larger diameter implant. Minimal adhesions were encountered upon presacral re-entry. A precise operative trajectory to the base of the previously implanted rod was achieved using fluoroscopic guidance. Surgical removal of the implant was successful with minimal bone resection required. A larger diameter Axial Lumbar Interbody Fusion rod was then implanted and joint distraction was re-established. The radicular symptoms resolved following revision surgery and our patient was ambulating without assistance on post-operative day one. No adverse events were reported. Conclusions The Axial Lumbar Interbody Fusion distraction rod may be revised and replaced with a larger diameter rod using the same presacral approach.

  20. Diagnostic method for lumbar foraminal stenosis based on the clinical results of transforaminal lumbar interbody fusion (TLIF). Utility of the foraminal stenosis score

    International Nuclear Information System (INIS)

    In this study we analyzed 73 cases treated by transforaminal lumbar interbody fusion (TLIF) for lumbar foraminal stenosis or central canal stenosis and foraminal stenosis, and based on the perioperative findings and outcome of treatment, we considered the diagnostic procedure for lumbar foraminal stenosis in the future. In 25 cases (34.2%) cases there was actually no clear perioperative evidence of foraminal stenosis. We compared the preoperative clinical and imaging findings in the group with perioperative findings and the group without perioperative findings performed a multiple logistic regression analysis to identify factors associated with foraminal stenosis. We also calculated the odds ratio for the perioperative findings and proposed a foraminal stenosis scoring system. (author)

  1. Application of tridimensional intravertebral bone graft combined with AxiaLIF technique in lumbar interbody fusion

    Directory of Open Access Journals (Sweden)

    Xiangdong Duan

    2009-05-01

    Full Text Available "nLumbar interbody fusion techniques are becoming more and more minimally invasive. AxiaLIF technique can be used in low back pain caused by degenerative disc disease or minor spondylolisthesis, but there are risks for fusion failure. Intravertebral bone graft is performed in painful osteoporotic or posttraumatic vertebral compression fractures (VCFs. Until now, no attempt has been made to apply intravertebral bone graft with AxiaLIF technique."nSo first, we hypothesize a novel method for tridimensional intravertebral bone graft with a special designed bone grafting instrument and describe it vividly. The special instrument would mainly consist of a hollow tube and a rod, the distal parts of them would be shape into 45o slope, so the direction of grafting would be decided by the slope. By rotating the tube we can deliver cancellous bone granules in one plane, but by retreating the tube we can perform tridimensional intravertebral bone graft. Second, intravertebral bone graft is supposed to be performed combined with AxiaLIF technique in order to create biologic vertebral reconstruction and raise fusion rate. We believe this is the first description of such a method, future clinical studies are needed to validate these hypotheses.

  2. BMP-2-induced Neuroforaminal Bone Growth in the Setting of a Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    Science.gov (United States)

    Ahn, Junyoung; Tabaraee, Ehsan; Singh, Kern

    2015-06-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has become a popular alternative to traditional methods of lumbar decompression and fusion. When compared with the open technique, the minimally invasive approach can result in decreased pain and blood loss as well as a shorter length of hospitalization. However, the narrower working channel through the tubular retractor increases the difficulty of decortication and bone grafting. Therefore, recombinant human bone morphogenetic proteins (rhBMP-2) is often utilized (although this is off-label) to create a more favorable interbody fusion environment. Recently, the use of rhBMP-2 has been associated with excessive bone growth in an MIS-TLIF. If this bone growth compresses the neighboring neural structures, patients may present with either new or recurrent radicular pain. Computed tomographic (CT) imaging can demonstrate heterotopic bone growth extending from the disk space into either the ipsilateral neuroforamen or lateral recess, which may result in the compression of the exiting or traversing root, respectively. The purpose of this article and the accompanying video is to demonstrate a technique for defining and resecting rhBMP-2-induced heterotopic bone growth following a previous MIS-TLIF. PMID:25978140

  3. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders : a randomized clinical trial with 2-year follow-up

    DEFF Research Database (Denmark)

    HØy, Kristian; Bünger, Cody

    2013-01-01

    PURPOSE: The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. METHODS: Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. RESULTS: The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p 

  4. Effects on clinical outcomes of grafts and spacers used in transforaminal lumbar interbody fusion: a critical review.

    Science.gov (United States)

    Heida, Kenneth; Ebraheim, Molly; Siddiqui, Saaid; Liu, Jiayong

    2013-02-01

    Transforaminal lumbar interbody fusion (TLIF) is a relatively new and popular spinal fusion technique that has proven very useful since its introduction. To date, fusion rates for different combinations of modalities and materials have not been thoroughly compared and assessed. In this review of published reports, 29 papers met criteria for assessing fusion rates for three different interbody spacers and four different combinations of bone grafts and extenders. The spacers included Capstone, polyether ether ketones and Telamon cages, and the grafting materials reviewed were locally harvested bone, iliac crest bone with local, local bone plus recombinant human bone morphogenetic protein 2 and a mixture of local and allograft bone. Of these, it was found that only the Capstone cage and locally harvested bone achieved statistically significant higher fusion rates (96.46% ± 2.89% and 97.07% ± 1.94% respectively) than the other modalities and materials studied. Oswestry Disability Index scores and visual pain scales were also examined as indicators of overall improvement after using each spacer and graft; the Telamon cage and local bone mixed with rhBMP-2 stood out as conferring statistically significant greater improvements according to these two scales. Our findings are that Capstone and locally harvested bone alone are relatively superior in terms of fusion rates. PMID:23420741

  5. Posterior interbody spondylodesis with cage in the system of lumbar osteochondrosis treatment

    OpenAIRE

    Khusniddin Nuraliev

    2012-01-01

    Titanic cage in combination with autobone can be used successfully for the different types of interbody spondilodesis additionally to the other known implants. Owing to the holes located in the corpus of titanic cage there is contact between autobone and osseous tissue of the adjacent vertebrae. The favaourable conditions have been created for formation of bone-metallic spondylodesis. The application of titanium cage has reduced traumatic effect of operation and has not required additional us...

  6. AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

    OpenAIRE

    Sm, Rapp; Le, Miller; Je, Block

    2011-01-01

    Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, post...

  7. Intraspinal metalloma causing lumbar stenosis after interbody fusion with cylindrical titanium cages.

    Science.gov (United States)

    Fernández-Baíllo, Nicomedes; Sánchez Marquez, José Miguel; Conde Gallego, Esther; Martín Esteban, Ana

    2012-12-01

    Intraspinal metallomas are rare. The authors present a case after implantation of two titanium threaded interbody cages at the L4L5 level, without posterior instrumentation. To their knowledge this is the first case due to intervertebral cages. The lack of additional instrumentation had probably allowed the cages to make contact. Subsequently, friction generated wear debris, which led to the formation of a granuloma, responsible for compression of the dural sac. Intraspinal metallosis should be kept in mind as an infrequent cause of delayed neurological symptoms after spinal surgery with metallic instrumentation. PMID:23409582

  8. Posterior interbody spondylodesis with cage in the system of lumbar osteochondrosis treatment

    Directory of Open Access Journals (Sweden)

    Khusniddin Nuraliev

    2012-10-01

    Full Text Available Titanic cage in combination with autobone can be used successfully for the different types of interbody spondilodesis additionally to the other known implants. Owing to the holes located in the corpus of titanic cage there is contact between autobone and osseous tissue of the adjacent vertebrae. The favaourable conditions have been created for formation of bone-metallic spondylodesis. The application of titanium cage has reduced traumatic effect of operation and has not required additional use of autobone tissue from the iliac crest.

  9. Fusão intersomática lombar transforaminal: experiência de uma instituição / Transforaminal lumbar interbody fusion: a single-center experience / Fusión intersomática lumbar transforaminal: la experiencia de una institución

    Scientific Electronic Library Online (English)

    Vinicius de Meldau, Benites; Eduardo Augusto, Iunes; Alexandre José dos Reis, Elias; Rodrigo Miziara, Yunes; Franz Jooji, Onishi; Sérgio, Cavalheiro.

    2012-12-01

    Full Text Available OBJETIVO: Relatar a experiência inicial de um serviço de referência em cirurgia da coluna em São Paulo, Brasil com a técnica de fusão intersomática lombar transforaminal (TLIF) nas suas mais variadas indicações. MÉTODOS: Avaliamos retrospectivamente os dados gravados em prontuário de 25 pacientes qu [...] e foram submetidos à cirurgia com a técnica de TLIF no ano de 2011. Um paciente foi excluído porque não consideramos que a TLIF foi a principal técnica empregada. As indicações incluíram nove casos de hérnia de disco lombar, sete espondilolisteses, quatro cirurgias de revisão, sendo duas por pseudoartrose e duas por lombalgias e, finalmente, quatro pacientes com estenose espinhal lombar. RESULTADOS: Todos os pacientes referiram melhora da dor e/ou claudicação neurológica em comparação com o estado pré-operatório. Apenas cinco pacientes continuaram usando alguma medicação analgésica. Cinco pacientes apresentaram alguma complicação, mas somente duas delas estão relacionadas diretamente com o procedimento. CONCLUSÕES: Trata-se de uma técnica segura, possível de ser realizada em todos os níveis da coluna lombar e aplicável a grande parte das doenças que acometem essa região da coluna. Abstract in spanish OBJETIVO: Relatar la experiencia de un servicio de referencia en cirugía de la columna en São Paulo, Brasil con la técnica de fusión intersomática lumbar transforaminal (TLIF) en sus más variables indicaciones. MÉTODOS: Valoramos retrospectivamente el historial médico de 25 pacientes que fueron some [...] tidos a la cirugía con la técnica de TLIF en el año de 2011. Un paciente fue excluido porque no consideramos que la TLIF fue la principal técnica empleada. Las indicaciones incluyeron nueve casos de hernia de disco lumbar, siete espondilolistesis, cuatro cirugías de revisión siendo dos por pseudoartrosis y dos por lumbalgias y, finalmente, cuatro pacientes con estenosis espinal. RESULTADOS: Todos los pacientes presentaron mejora del dolor y/o claudicación neurogénicas en comparación con el status preoperatorio. Solamente cinco pacientes continuaron usando alguna medicación analgésica. Cinco pacientes presentaran alguna complicación, pero sólo dos de ellas están relacionadas directamente al procedimiento. CONCLUSIONES: Es una técnica segura, posible de ser realizada en todos los niveles de la columna lumbar y es aplicable a la mayoría de las enfermedades que afectan a esta región de la columna. Abstract in english OBJECTIVE: Describe the early results and experience from a reference center in spine surgery in São Paulo, Brazil with transforaminal lumbar interbody fusion (TLIF) technique in its various indications. METHODS: We retrospectively reviewed the medical records of 25 patients who underwent surgery wi [...] th TLIF technique in 2011. One patient was excluded because we considered that TLIF was not the most important technique used. The indications were 9 lumbar disc herniations, 7 spondylolistheses, 4 revision surgeries of which 2 were for pseudoarthroses and 2 for low back pain, and finally, 4 lumbar spinal stenoses. RESULTS: All the patients reported low back pain and/or neurologic claudication improvement when comparing to preoperative status. Only five patients continued using analgesics. Five patients presented some complication, but only two of them were related to the procedure. CONCLUSIONS: TLIF is a safe technique which can be performed at any lumbar level of the lumbar spine and is applicable to the majority of diseases that affect this region.

  10. Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation. A minimum 3-year follow-up study

    International Nuclear Information System (INIS)

    The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.1deg, 39.2deg, and 32.6deg to 32.9deg, 44.5deg, and 36.6deg, respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery. (author)or fusion surgery. (author)

  11. Stand-alone minimally invasive lateral lumbar interbody fusion: multicenter clinical outcomes.

    Science.gov (United States)

    Ahmadian, Amir; Bach, Konrad; Bolinger, Bryan; Malham, Gregory M; Okonkwo, David O; Kanter, Adam S; Uribe, Juan S

    2015-04-01

    Stand-alone minimally invasive lateral transpsoas interbody fusion (MIS-LIF), without posterior instrumentation, is feasible because the technique does not necessitate the disruption of the stabilizing elements. The objectives of this study are to evaluate the efficacy and clinical outcomes of patients who underwent stand-alone lateral interbody fusion. A multicenter chart review was conducted to identify patients who underwent stand-alone MIS-LIF between 2008 and 2012. Patients were classified by spinal pathology (degenerative disc disease [DDD], spondylolisthesis [SL] and adult degenerative scoliosis [ADS]). Routine clinical follow-up was scheduled at 3, 6, and12 months. Outcome measures included hospital length of stay, fusion rates, neurologic complications, integrity of construct and clinical outcome questionnaires (Visual Analog Scale [VAS] and Oswestry Disability Index [ODI]). A total of 59 patients met the inclusion criteria. The average age was 60 years (range 31-86 years). Spinal pathologies treated were DDD in 37 (63%), SL in four (7%) and ADS in 18 (30%) patients. Fusion rate was 93% of patients (95% of levels) at 12 months. Two patients required re-operation. Mean hospital stay and follow-up were 3.3days (range 1-10) and 14.6 months, respectively. The mean preoperative VAS and ODI were 69.1 and 51.8, respectively. VAS improved to 37.8 (p<0.0005). ODI improved to 31.8 (p<0.0005). Seventy percent of patients had grade 0 subsidence while 30% had grade I and grade II subsidence. Stand-alone MIS-LIF is viable option in a carefully selected patient population for both single and multilevel disease and shows significant improvement in health related quality of life. PMID:25684343

  12. Lateral Lumbar Interbody Fusion for the Correction of Spondylolisthesis and Adult Degenerative Scoliosis in High-Risk Patients: Early Radiographic Results and Complications

    Science.gov (United States)

    Waddell, Brad; Briski, David; Qadir, Rabah; Godoy, Gustavo; Houston, Allison Howard; Rudman, Ernest; Zavatsky, Joseph

    2014-01-01

    Background Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients. Methods We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion. Results Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon. Conclusion Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates. PMID:24688329

  13. Perioperative Surgical Complications and Learning Curve Associated with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Single-Institute Experience

    Science.gov (United States)

    Lee, Soo Bin; Seok, Sang Ok; Jo, Byung Woo; Ha, Joong Won

    2015-01-01

    Background As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). Methods We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. Results Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). Conclusions We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure. PMID:25729524

  14. The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF

    Directory of Open Access Journals (Sweden)

    Birkenmaier Christof

    2010-09-01

    Full Text Available Abstract Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted. Trial Registration Clinical Trials NCT00810433

  15. Clinical and radiographic outcomes with L4–S1 axial lumbar interbody fusion (AxiaLIF and posterior instrumentation: a multicenter study

    Directory of Open Access Journals (Sweden)

    Tobler WD

    2013-09-01

    Full Text Available William D Tobler,1 Miguel A Melgar,2 Thomas J Raley,3 Neel Anand,4 Larry E Miller,5 Richard J Nasca6 1Department of Neurosurgery, University of Cincinnati College of Medicine, Mayfield Clinic, and The Christ Hospital, Cincinnati, OH, USA; 2Department of Neurosurgery, Tulane University, New Orleans, LA, USA; 3Advanced Spine and Pain, Arlington, VA, USA; 4Spine Trauma, Minimally Invasive Spine Surgery Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 5Miller Scientific Consulting, Inc, Arden, NC, USA; 6Orthopaedic and Spine Surgery, Wilmington, NC, USA Introduction: Previous studies have confirmed the benefits and limitations of the presacral retroperitoneal approach for L5–S1 interbody fusion. The purpose of this study was to determine the safety and effectiveness of the minimally invasive axial lumbar interbody approach (AxiaLIF for L4–S1 fusion. Methods: In this retrospective series, 52 patients from four clinical sites underwent L4–S1 interbody fusion with the AxiaLIF two-level system with minimum 2-year clinical and radiographic follow-up (range: 24–51 months. Outcomes included back pain severity (on a 10-point scale, the Oswestry Disability Index (ODI, and Odom's criteria. Flexion and extension radiographs, as well as computed tomography scans, were evaluated to determine fusion status. Longitudinal outcomes were assessed with repeated measures analysis of variance. Results: Mean subject age was 52 ± 11 years and the male:female ratio was 1:1. Patients sustained no intraoperative bowel or vascular injury, deep infection, or neurologic complication. Median procedural blood loss was 220 cc and median length of hospital stay was 3 days. At 2-year follow-up, mean back pain had improved 56%, from 7.7 ± 1.6 at baseline to 3.4 ± 2.7 (P < 0.001. Back pain clinical success (ie, ?30% improvement from baseline was achieved in 39 (75% patients at 2 years. Mean ODI scores improved 42%, from 60% ± 16% at baseline to 35% ± 27% at 2 years (P < 0.001. ODI clinical success (ie, ?30% improvement from baseline was achieved in 26 (50% patients. At final follow-up, 45 (87% patients were rated as good or excellent, five as fair, and two as poor by Odom's criteria. Interbody fusion observed on imaging was achieved in 97 (93% of 104 treated interspaces. During follow-up, five patients underwent reoperation on the lumbar spine, including facet screw removal (two, laminectomy (two, and transforaminal lumbar interbody fusion (one. Conclusion: The AxiaLIF two-level device is a safe, effective treatment adjunct for patients with L4–S1 disc pathology resistant to conservative treatments. Keywords: AxiaLIF, axial presacral fusion, interbody, outcomes, two-level fusion

  16. Effects of lordotic angle of a cage on sagittal alignment and clinical outcome in one level posterior lumbar interbody fusion with pedicle screw fixation.

    Science.gov (United States)

    Lee, Ji-Ho; Lee, Dong-Oh; Lee, Jae Hyup; Shim, Hee Jong

    2015-01-01

    This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF). We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK) cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups. PMID:25685795

  17. Avaliação clínica radiológica da artrodese lombar transforaminal aberta versus minimamente invasiva / Clinical and radiological evaluation of open transforaminal lumbar interbody fusion versus minimally invasive / Evaluación clínica radiológica de la artrodesis lumbar transforaminal abierta versus mínimamente invasiva

    Scientific Electronic Library Online (English)

    Cristiano Magalhães, Menezes; Roberto Sakamoto, Falcon; Marcos Antônio, Ferreira Júnior; Johmeson, Alencar.

    2009-09-01

    Full Text Available OBJETIVO: a proposta deste trabalho é comparar os resultados clínicos e radiológicos dos pacientes submetidos à artrodese transforaminal aberta e minimamente invasiva. MÉTODOS: quarenta e cinco pacientes foram submetidos à artrodese lombar transforaminal pelo Grupo de Cirurgia Espinhal do Hospital L [...] ifecenter/Ortopédico de Belo Horizonte, no período de Dezembro de 2005 a Maio de 2007, sendo 15 no grupo de artrodese aberta e 30 pacientes do grupo de artrodese minimamente invasiva (MIS). As indicações para a artrodese intersomática foram: doença degenerativa do disco, associada ou não a hérnia de disco ou estenose do canal; espondilolistese de baixo grau espondilolítica ou degenerativa; e síndrome pós-laminectomia/discectomia. As variáveis analisadas foram: tempo de cirurgia, tempo de internação hospitalar, necessidade de hemotransfusão, escala analógica visual de dor (VAS) lombar e dos membros inferiores, Oswestry, índice de consolidação da artrodese e retorno ao trabalho. RESULTADOS: o seguimento mínimo foi de 24 meses. Havia oito homens e sete mulheres no Grupo Aberto e 17 homens e 13 mulheres no Grupo MIS. O tempo cirúrgico médio foi de 222 minutos e 221 minutos, respectivamente. Houve melhora significativa da VAS e Oswestry no pós-operatório em ambos os grupos. O tempo de internação hospitalar variou de 3,3 dias para o Grupo Aberto e 1,8 dias para o Grupo MIS. O índice de fusão obtido foi de 93,3% em ambos os grupos. Houve necessidade de hemotransfusão em três pacientes no Grupo Aberto (20%) e nenhum caso MIS. CONCLUSÕES: a transforaminal lumbar interbody fusion (TLIF) minimamente invasiva apresenta resultados similares em longo prazo quando comparado à TLIF aberta, com os benefícios adicionais de menor morbidade pós-operatória, menor período de internação e reabilitação precoce. Abstract in spanish OBJETIVO: la propuesta de este trabajo es comparar los resultados clínicos y radiológicos de los pacientes sometidos a la artrodesis transforaminal abierta y mínimamente invasiva. MÉTODOS: cuarenta y cinco pacientes fueron sometidos a la artrodesis lumbar transforaminal por el Grupo de Cirugía Espin [...] al del Hospital Lifecenter/Ortopédico de Belo Horizonte, en el periodo de Diciembre de 2005 a Mayo de 2007, siendo 15 en el grupo de artrodesis abierta y 30 pacientes del grupo de artrodesis mínimamente invasiva (MIS). Las indicaciones para la artrodesis intersomática fueron: enfermedad degenerativa de disco, asociada o no a hernia de disco o estenosis del canal; espondilolistesis de bajo grado espondilolítica o degenerativa; y síndrome post-laminectomía/discectomía. Las variables analizadas fueron: tiempo de cirugía, tiempo de internación hospitalar, necesidad de hemotransfusión, escala analógica visual de dolor (VAS) lumbar y de los miembros inferiores, Oswestry, índice de consolidación de la artrodesis y regreso al trabajo. RESULTADOS: el seguimiento mínimo fue de 24 meses. Fueron ocho hombres y siete mujeres en el Grupo Abierto y 17 hombres y 13 mujeres en el Grupo MIS. El tiempo quirúrgico promedio fue de 222 minutos y 221 minutos, respectivamente. Hubo mejora significativa del VAS y Oswestry en el postoperatorio en ambos grupos. El tiempo de internación hospitalar varió de 3.3 días para el Grupo Abierto y 1.8 días para el Grupo MIS. El índice de fusión obtenido fue de 93.3% en ambos grupos. Hubo necesidad de hemotransfusión en tres pacientes en el Grupo Abierto (20%) y ningún caso MIS. CONCLUSIONES: la TLIF mínimamente invasiva presenta resultados similares a largo plazo cuando comparada con TLIF abierta, con los beneficios adicionales de menor morbilidad postoperatoria, menor periodo de internación y rehabilitación precoz. Abstract in english OBJECTIVE: the aim of this article is to compare the clinical and radiological results of patients who underwent open and minimally invasive transforaminal lumbar interbody fusion. METHODS: forty-five patients underwent transforaminal lumbar interbody fusion by the Department

  18. Avaliação clínica radiológica da artrodese lombar transforaminal aberta versus minimamente invasiva Evaluación clínica radiológica de la artrodesis lumbar transforaminal abierta versus mínimamente invasiva Clinical and radiological evaluation of open transforaminal lumbar interbody fusion versus minimally invasive

    Directory of Open Access Journals (Sweden)

    Cristiano Magalhães Menezes

    2009-09-01

    Full Text Available OBJETIVO: a proposta deste trabalho é comparar os resultados clínicos e radiológicos dos pacientes submetidos à artrodese transforaminal aberta e minimamente invasiva. MÉTODOS: quarenta e cinco pacientes foram submetidos à artrodese lombar transforaminal pelo Grupo de Cirurgia Espinhal do Hospital Lifecenter/Ortopédico de Belo Horizonte, no período de Dezembro de 2005 a Maio de 2007, sendo 15 no grupo de artrodese aberta e 30 pacientes do grupo de artrodese minimamente invasiva (MIS. As indicações para a artrodese intersomática foram: doença degenerativa do disco, associada ou não a hérnia de disco ou estenose do canal; espondilolistese de baixo grau espondilolítica ou degenerativa; e síndrome pós-laminectomia/discectomia. As variáveis analisadas foram: tempo de cirurgia, tempo de internação hospitalar, necessidade de hemotransfusão, escala analógica visual de dor (VAS lombar e dos membros inferiores, Oswestry, índice de consolidação da artrodese e retorno ao trabalho. RESULTADOS: o seguimento mínimo foi de 24 meses. Havia oito homens e sete mulheres no Grupo Aberto e 17 homens e 13 mulheres no Grupo MIS. O tempo cirúrgico médio foi de 222 minutos e 221 minutos, respectivamente. Houve melhora significativa da VAS e Oswestry no pós-operatório em ambos os grupos. O tempo de internação hospitalar variou de 3,3 dias para o Grupo Aberto e 1,8 dias para o Grupo MIS. O índice de fusão obtido foi de 93,3% em ambos os grupos. Houve necessidade de hemotransfusão em três pacientes no Grupo Aberto (20% e nenhum caso MIS. CONCLUSÕES: a transforaminal lumbar interbody fusion (TLIF minimamente invasiva apresenta resultados similares em longo prazo quando comparado à TLIF aberta, com os benefícios adicionais de menor morbidade pós-operatória, menor período de internação e reabilitação precoce.OBJETIVO: la propuesta de este trabajo es comparar los resultados clínicos y radiológicos de los pacientes sometidos a la artrodesis transforaminal abierta y mínimamente invasiva. MÉTODOS: cuarenta y cinco pacientes fueron sometidos a la artrodesis lumbar transforaminal por el Grupo de Cirugía Espinal del Hospital Lifecenter/Ortopédico de Belo Horizonte, en el periodo de Diciembre de 2005 a Mayo de 2007, siendo 15 en el grupo de artrodesis abierta y 30 pacientes del grupo de artrodesis mínimamente invasiva (MIS. Las indicaciones para la artrodesis intersomática fueron: enfermedad degenerativa de disco, asociada o no a hernia de disco o estenosis del canal; espondilolistesis de bajo grado espondilolítica o degenerativa; y síndrome post-laminectomía/discectomía. Las variables analizadas fueron: tiempo de cirugía, tiempo de internación hospitalar, necesidad de hemotransfusión, escala analógica visual de dolor (VAS lumbar y de los miembros inferiores, Oswestry, índice de consolidación de la artrodesis y regreso al trabajo. RESULTADOS: el seguimiento mínimo fue de 24 meses. Fueron ocho hombres y siete mujeres en el Grupo Abierto y 17 hombres y 13 mujeres en el Grupo MIS. El tiempo quirúrgico promedio fue de 222 minutos y 221 minutos, respectivamente. Hubo mejora significativa del VAS y Oswestry en el postoperatorio en ambos grupos. El tiempo de internación hospitalar varió de 3.3 días para el Grupo Abierto y 1.8 días para el Grupo MIS. El índice de fusión obtenido fue de 93.3% en ambos grupos. Hubo necesidad de hemotransfusión en tres pacientes en el Grupo Abierto (20% y ningún caso MIS. CONCLUSIONES: la TLIF mínimamente invasiva presenta resultados similares a largo plazo cuando comparada con TLIF abierta, con los beneficios adicionales de menor morbilidad postoperatoria, menor periodo de internación y rehabilitación precoz.OBJECTIVE: the aim of this article is to compare the clinical and radiological results of patients who underwent open and minimally invasive transforaminal lumbar interbody fusion. METHODS: forty-five patients underwent transforaminal lumbar interbody fusion by the Department of Spine Surgery of Hospital Lifecenter/Ortopédico, between D

  19. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion : cost-utility evaluation along side an RCT with a 2-year follow-up

    DEFF Research Database (Denmark)

    Christensen, A; HØy, K

    2014-01-01

    PURPOSE: Long-lasting low back pain is an increasing problem, and for some patients surgery is the final option for improvement. Several techniques for spinal fusion are available and the optimal technique remains uncertain. The objective of this study was to assess the cost-effectiveness and cost-utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. METHODS: 100 Patients were randomized to TLIF or PLF (51/49) and followed for 2 years. Cost data were acquired from national registers, and outcomes were measured using the Oswestry Disability Index and SF-6D questionnaires. Conventional cost-effectiveness methodology was employed to estimate net benefit and to illustrate cost-effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped confidence intervals. RESULTS: Results showed no statistically significant difference in either cost or effects although a tendency for the TLIF regimen being more costly on bed days (2,554) and production loss (1,915) was observed. The probability that TLIF would be cost-effective did not exceed 30 % for any threshold of willingness to pay per quality-adjusted life year. Sensitivity analysis was conducted and supported the statistical model for handling of missing data. CONCLUSION: TLIF does not seem to be a relevant alternative to PLF from a socioeconomic, societal point of view.

  20. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion: cost-utility evaluation along side an RCT with a 2-year follow-up

    DEFF Research Database (Denmark)

    Christensen, Ann Demant; Hoy, K.

    2014-01-01

    Long-lasting low back pain is an increasing problem, and for some patients surgery is the final option for improvement. Several techniques for spinal fusion are available and the optimal technique remains uncertain. The objective of this study was to assess the cost-effectiveness and cost-utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. 100 Patients were randomized to TLIF or PLF (51/49) and followed for 2 years. Cost data were acquired from national registers, and outcomes were measured using the Oswestry Disability Index and SF-6D questionnaires. Conventional cost-effectiveness methodology was employed to estimate net benefit and to illustrate cost-effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped confidence intervals. Results showed no statistically significant difference in either cost or effects although a tendency for the TLIF regimen being more costly on bed days (a,not sign2,554) and production loss (a,not sign1,915) was observed. The probability that TLIF would be cost-effective did not exceed 30 % for any threshold of willingness to pay per quality-adjusted life year. Sensitivity analysis was conducted and supported the statistical model for handling of missing data. TLIF does not seem to be a relevant alternative to PLF from a socioeconomic, societal point of view.

  1. Novel Pedicle Screw and Plate System Provides Superior Stability in Unilateral Fixation for Minimally Invasive Transforaminal Lumbar Interbody Fusion: An In Vitro Biomechanical Study

    Science.gov (United States)

    Zhu, Qingan; Zhou, Yue; Li, Changqing; Liu, Huan; Huang, Zhiping; Shang, Jin

    2015-01-01

    Purpose This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body. Methods Seven fresh calf lumbar spines (L3-L6) were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM) was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB). After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR); unilateral pedicle screw and plate (UP); UR and transfacet pedicle screw (TFS); UP and TFS; UP and UR. Results All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP) reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR). The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs. Conclusions The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF. PMID:25807513

  2. K-Wire fracture during minimally invasive transforaminal lumbar interbody fusion: Report of six cases and recommendations for avoidance and management

    Science.gov (United States)

    Scheer, Justin K.; Harvey, Michael J.; Dahdaleh, Nader S.; Smith, Zachary A.; Fessler, Richard G.

    2014-01-01

    Background: Although rare, minimally invasive spine techniques do have the risk of intraoperative device failure. Kirschner wire (K-wire) fractures during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have not been previously reported. This report focuses on the incidence of k-wire fractures following MI-TLIF and describes techniques to help avoid and treat these fractures when they occur. Methods: Inclusion criteria: (i) patients underwent 1, 2, or 3 level MI-TLIF over a 10-year period and (ii) had a k-wire fracture leading to a retained fragment. Exclusion criteria included: >10° coronal curves, significant sagittal malalignment, infection, and preoperative instrumentation failure. Results: Of 513 patients undergoing MI-TLIF, 6 (1.2%) sustained k-wire fracture (3 males, 3 females, mean age 43 ± 13 years). Complications included k-wire fracture alone (4 patients), cerebrospinal fluid (CSF) leak (1 patient), and both ileus and revision for hardware removal (1 patient). All six patients went home postoperatively. The mean follow-up duration was 27.7 ± 37.4 months. All retained k-wire fragments were located in the vertebral bodies at the tip of the pedicle screws; none breached the anterior cortex of the vertebral bodies. None of the k-wires migrated at final follow-up 7.8 years (93.7 months) postoperatively. Furthermore, no complications were attributed to retained k-wires. Conclusions: K-wire fractures during MI-TLIF are rare (incidence of 1.2%) and retained k-wire segments led to no postoperative complications (e.g. no migration). PMID:25593770

  3. Anterior lumbar interbody fusion with carbon fiber cage loaded with bioceramics and platelet-rich plasma. An experimental study on pigs

    DEFF Research Database (Denmark)

    Li, Haisheng; Zou, Xuenong

    2004-01-01

    Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (beta-TCP) and PRP may enhance spinal fusion in a controlled animal study. Ten Danish Landrace pigs were used as a spinal fusion model. Immediately prior to the surgery, 55 ml blood was collected from each pig for processing PRP. Three-level anterior lumbar interbody fusion was performed with carbon fiber cages and staples on each pig. Autogenous bone graft, beta-TCP, and beta-TCP loaded with PRP were randomly assigned to each level. Pigs were killed at the end of the third month. Fusion was evaluated by radiographs, CT scanning, and histomorphometric analysis. All ten pigs survived the surgery. Platelet concentration increased 4.4-fold after processing. Radiograph examination showed 70% (7/10) fusion rate in the autograft level. All the levels with beta-TCP+PRP showed partial fusion, while beta-TCP alone levels had six partial fusions and four non-fusions ( P=0.08). CT evaluation of fusion rate demonstrated fusion in 50% (5/10) of the autograft levels. Only partial fusion was seen at beta-TCP levels and beta-TCP+PRP levels. Histomorphometric evaluation found no difference between beta-TCP and beta-TCP+PRP levels on new bone volume, remaining beta-TCP particles, and bone marrow and fibrous tissue volume, while the same parameters differ significantly when compared with autogenous bone graft levels. We concluded from our results in pigs that the PRP of the concentration we used did not improve the bone-forming capacity of beta-TCP biomaterial in anterior spine fusion. Both beta-TCP and beta-TCP+PRP had poorer radiological and histological outcomes than that of autograft after 3 months.

  4. Biomechanical comparison of a new stand-alone anterior lumbar interbody fusion cage with established fixation techniques – a three-dimensional finite element analysis

    Directory of Open Access Journals (Sweden)

    Hsieh Pang-Hsing

    2008-06-01

    Full Text Available Abstract Background Initial promise of a stand-alone interbody fusion cage to treat chronic back pain and restore disc height has not been realized. In some instances, a posterior spinal fixation has been used to enhance stability and increase fusion rate. In this manuscript, a new stand-alone cage is compared with conventional fixation methods based on the finite element analysis, with a focus on investigating cage-bone interface mechanics and stress distribution on the adjacent tissues. Methods Three trapezoid 8° interbody fusion cage models (dual paralleled cages, a single large cage, or a two-part cage consisting of a trapezoid box and threaded cylinder were created with or without pedicle screws fixation to investigate the relative importance of the screws on the spinal segmental response. The contact stress on the facet joint, slip displacement of the cage on the endplate, and rotational angle of the upper vertebra were measured under different loading conditions. Results Simulation results demonstrated less facet stress and slip displacement with the maximal contact on the cage-bone interface. A stand-alone two-part cage had good slip behavior under compression, flexion, extension, lateral bending and torsion, as compared with the other two interbody cages, even with the additional posterior fixation. However, the two-part cage had the lowest rotational angles under flexion and torsion, but had no differences under extension and lateral bending. Conclusion The biomechanical benefit of a stand-alone two-part fusion cage can be justified. This device provided the stability required for interbody fusion, which supports clinical trials of the cage as an alternative to circumferential fixations.

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... do do it for degenerative disc disease, though much less commonly; scoliosis, as in this patient; a pseudoarthrosis ... advance in spinal surgery, the advantage is it’s much less of an operation. The operation you’re seeing ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... bone on one side of the spine. If pathology is only on one side of the spine, ... your diagnosis is. We think for this particular pathology and problem that—which is not a simple ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the operation for you. I’m going to go through the thought process of performing the operation ... look at your screen, I’m going to go through some pictures for you and a slide ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... then fuse the surrounding vertebrae across the disc space. For many patients, this allows them to return to normal activities and an improved quality of life. You may participate in the program by sending ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... legs and give power to your legs. The blue square you see on the left is the ... back out so he can get a little light in here for a second. You can see ... MD: You can’t really see it. The light’s not great. But we did get it—we ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the screen. Physicians may take a post-assessment survey at the end of the program for CME ... the screen. Physicians may take a post-assessment survey at the end of the program for CME ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... marker, that’s where we start to do our work above. And you can see on the lateral ... you this animation, to show you how these work. If you use just a straight instrument, you ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the spreader where the metal instrument is, the big hole. 00:25:29 JAMES S. HARROP, MD: Here’s ... 54 TODD ALBERT, MD: Yeah, that makes a big difference for that exiting nerve root. And you’ ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... do so, it releases the dura, or the tube of nerves, so we can move it away and show ... patient. We have had no problems during the surgery. Our monitoring has been good, so we know her nerves have been good. Her decompression looks great. So ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... ALBERT, MD: I would start with an 8 trial, Ron, and see if that won’t do ... J. ALBERT, MD: Do you have that 8 trial? 00:25:45 JAMES S. HARROP, MD: Do you ... the hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... neurogenic claudication, or spinal stenosis, feel better with sitting and bending over, where vascular claudication will only ... A patient with spinal stenosis is usually fine sitting and can ride a bike all day. Also ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... to make more room for the spinal canal, free the nerve roots, and then fuse the surrounding ... in the middle of the foramen. It’s completely free, looks very relaxed. 00:28:31 TODD J. ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... and then he tries to put it as ant—as anterior, or toward the front of the ... at the beginning of the talk, there’s minimally invasive, maximally invasive, and front-and-back versus back ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... another; we do do it for degenerative disc disease, though much less commonly; scoliosis, as in this ... ll see what we—how we made a skin incision. And this is called the fascia you ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... surrounding vertebrae across the disc space. For many patients, this allows them to return to normal activities ... table continuing to operate. We’ve prepared the patient by exposing them to this point, exposing their ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... of spinal stenosis are called neurogenic claudication. That means weakness and symptoms when walking, and it has ... so we’ve gone for other materials and means for avoiding fusion. In this patient, since we’ ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... MD: Yeah, that’s actually a good picture. Somebody’s head’s in the way now. 00:42:31 JAMES S. ... left. 00:44:08 JAMES S. HARROP, MD: The head turner. 00:44:18 ASSISTANT: L3 on the ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... when you walk downhill or when a lady wears high heels or when they arch their back. ... question—how long does the patient have to wear a brace? We typically brace patients after this ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... precursor molecule to making bone. It derives the cells, it brings the cells from the tissues and the blood to the ... analogous process to healing of a fracture, where cells will come into the area, blood cells, basic ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... at the transverse processes so that the high-speed burr that they’re using is unseating the ... hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... Branigans ready? Do you have an 8 Branigan? I think an 8 Branigan. Jim, they’re going to ... interspace. He’s already prepared the m-plates. Jim, I think maybe after we do that we should probably— ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... m better when I’m at the grocery store bending over a shopping cart,” so flexing the ... pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first on ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... scoliosis. We’re going to be on the air for the next hour, but we’ve been ... nerve that exits in that area that’s been compressed, and worse when the patient is walking. Now, ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... advantages of the TLIF: we resect a certain amount of bone on one side of the spine. ... depending on what we call the threshold, the amount of voltage that we read in the lower ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... more room for the spinal canal, free the nerve roots, and then fuse the surrounding vertebrae across ... a patient who cannot walk well because her nerves are pinched. Every time she stands and walks, ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... degeneration and spinal arthritis. So the spine becomes sloppy, the tissues grow into the spinal canal and ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... more nerves in the spinal canal. Now, typically acute onset leg pain where a patient has not ... that—and very important— that they keep, in terms of good spine health, that they keep in ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... their spine, which is somewhat involved: taking the muscles off their spine and preparing some sites where ... get going, and that’ll help with her muscle pain. And then we will get them doing ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... going to see that osteotome—which is the sharp instrument—you’re going to see it cutting ... of special instruments called curettes, which are cups, sharp cups, that we scrape along the sides of ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... types of cages available for the spine and spacers when we take out the disc space to ... are threaded and go in with distraction plugs; spacers are placed more frequently from the front, though ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the spine makes them better. Now, the other component of this patient’s problem is degenerative scoliosis, and ... we go off air. This is just some data, and important, when people say, “Why do you ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... have to scream it out. And when we test these, you’ll see they stick a needle in the skin. We have to do a ground to make a full circle. 00:43:36 ASSISTANT: How do these heights look to you? 00:43:42 JAMES S. HARROP, ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... spinous ligament. And we’re pointing out the facet joint, the facet joint and the—and the lamina. And the area where we’re going to perform an osteotomy. And you can see we try to take ... so that we remove the inferior facet. So there you see some of the things ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... Jim—we put in some markers before the webcast started and took some x-rays to insure ... group that’s put this— helped us put this webcast together. I want to thank our patron, who ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... up, does amazing things for the nerve that exits in that area that’s been compressed, and worse ... to open up the area where that nerve exits. So Dr. Harrop will help take away the ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... at the transverse processes so that the high-speed burr that they’re using is unseating the ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... through a spine, a cadaver spine. The lateral recess is what’s the area called with the two ... re feeling throughout the—what’s called the lateral recess, correct? 00:32:22 JAMES S. HARROP, MD: Correct. ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the operation is exposure, instrumentation, neural decompression, or opening up the nerve roots, and then we do ... us: we can do it in the front, opening a patient in the front, called an anterior ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... L5 lamina, the L5 pedicle here, and the L5 nerve root coming around the pedicle. This is her side ... inaudible]. Go around them. These are the nerve roots—the L5 nerve root. And here we really exposed the ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... survey at the end of the program for CME credit. 00:00:55 TODD J. ALBERT, MD: ... much. That’s terrific. So I want to remind CME viewers that they can receive CME credit by ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... worse with standing and walking, and it’s been refractory to medical therapies. She has the diagnosis called ... the idea of the X-Stop is to block spinal extension. And there’s other devices like this ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... worse with standing and walking, and it’s been refractory to medical therapies. She has the diagnosis called ... up on the right lower area—the carbon fiber cage, similar to what we’re going to ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... replay this webcast anytime. It’s going to be embedded starting tomorrow, I believe, November 16. It will ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... recommended to have this procedure. Is this the latest and best procedure or is there something new ... problem—this is the best and I guess latest procedure. Some might argue that they could do ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... some—what you’re doing? 00:22:17 JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ... of where you are here? 00:22:31 JAMES S. HARROP, MD: Here we are. We actually—skipping ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... going to then ramp up the current and read if they get what’s called an electrical breech, ... the threshold, the amount of voltage that we read in the lower extremity, we will know that ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... correct for a TLIF, the TLIF in this paper, done by Hee and Castro, showed—looking and ... re using is unseating the bone from the top of the transverse process, or what’s called decortication. ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... hour, but we’ve been trying to prepare. It’s a very involved operation with multiple steps, and ... has. So let’s talk about the patient first. It’s a 67-year-old female who has significant ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... of the m-plates to get the disc material out And here you see these special angles— ... instruments and get about 75% of the disc material out, which is plenty to obtain a fusion. ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... fine sitting and can ride a bike all day. Also very commonly, patients with spinal stenosis say, “ ... appropriate patient, and they go home the same day, much like a discectomy is done in the ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... we will have to go to a square rectangular cage on one side, depending on what we ... to be oh-so-careful both in our positioning and how much distraction. In this patient, at ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... around the nerves. That sac is filled with water. I’m sure everyone in our listening audience ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... dots, is L2. We’re going to be putting screws there as well. We’ve already cannulated ... and how we approach doing the discectomy and putting the cage in. What you see here is ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University ... in the program by sending questions at any time; just click the MDirectAccess button on the screen. ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... this bone. And we have a series of special instruments, straight and angled, to take down—to ... the disc out, we need a series of special instruments called curettes, which are cups, sharp cups, ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... to prop the spine open. So the surgical approach we decide for each patient is dependent on ... or junction degeneration. There is a plethora of approaches available to us: we can do it in ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... we’ve got some very good questions. These sound like perhaps patient questions that I think would ... Jim’s microphone. That squeak is titanium; that’s the sound titanium makes when you’re tightening it against ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital ... this procedure minimally invasively and see—get the access and see the nerves in the way that ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... contains all the nerves in a sac of water, the cerebrospinal fluid, and each of those white ... around the nerves. That sac is filled with water. I’m sure everyone in our listening audience ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... they walk uphill or if they ride a bicycle, a patient with vascular claudication, or hardening of ... clicking on the appropriate button, also on your computer screen. You can also—you can replay this ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... a skin incision. And this is called the fascia you see being taken down along the spinous ... around the nerves. That sac is filled with water. I’m sure everyone in our listening audience ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... on the screen. Physicians may take a post-assessment survey at the end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... them—both of the groups did have some issues with persistent radiculopathy. I’ve received another question: “ ... six weeks after surgery, sooner if there’s an issue that we need to take care of, but ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... vascular claudication in patients with hardening of the arteries can have very similar symptoms. And so as ... those with vascular stenosis, or hardening of the arteries in their aorta or their legs. And patients ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... Might want to also add that we did check x-rays before to make sure everything looked ... maybe 3 and 4. You probably want to check those real quick, also, those—So maybe you ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... thecal sac. 00:42:29 TODD ALBERT, MD: Yeah, that’s actually a good picture. Somebody’s head’s in ... MD: Craig, you ready? 00:44:05 CRAIG: Yeah, we’re ready. 00:44:06 ASSISTANT: L2 ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. Todd Albert, professor and vicechairman of orthopedics at Thomas Jefferson University. I’m at the operating room at Thomas Jefferson University ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... you— this is the effect on the nerve roots. And here is a picture through a spine, a cadaver spine. The lateral recess is what’s the area called with the two arrows. That’s supposed to be wide open, and ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... spine to make more room for the spinal canal, free the nerve roots, and then fuse the surrounding vertebrae across the ... And we want to open up her spinal canal, decompress her nerve roots, or open them up, and this is going ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ... the surgery: our spine fellows and all the media crew that was here. They did a great ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... m Dr. Todd Albert, professor and vicechairman of orthopedics at Thomas Jefferson University. I’m at the ... re happy to help, both the neurosurgical and orthopedic department works closely together on spinal problems and ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... we go off air. This is just some data, and important, when people say, “Why do you ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... to normal activities and an improved quality of life. You may participate in the program by sending ... be political for the first time in my life. 00:49:56 TODD ALBERT, MD: Okay, it’s ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the vessels. But vascular claudication in patients with hardening of the arteries can have very similar symptoms. ... and absent in those with vascular stenosis, or hardening of the arteries in their aorta or their ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... that area. It’s a great milieu for fusion healing. And another patient asked, “Can I be treated ... lower complication rates and lower arthrosis, or non-healing rates for the TLIF. So both of them— ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... through some pictures for you and a slide talk here, in terms of a laminectomy and TLIF ... which is what this patient has. So let’s talk about the patient first. It’s a 67-year- ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... the procedure to you. I want to remind all the viewers that you can submit a question ... usually fine sitting and can ride a bike all day. Also very commonly, patients with spinal stenosis ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the back, but as you look into the wound from the top camera, you’ll see it ... that area. It’s a great milieu for fusion healing. And another patient asked, “Can I be treated ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... better. Now, the other component of this patient’s problem is degenerative scoliosis, and that is a curvature ... not—we are not good at fixing this problem with surgery; we do sometimes operate for back ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... right now, and two of our spine fellows, Andrew Wight and David Hannala, are assisting as well. ... pretty good. 00:43:52 TODD ALBERT, MD: Andrew, can you go ahead and test those screws ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... curettes, which are cups, sharp cups, that we scrape along the sides of the m-plates to ... instrument called a chondrotome, a sharp instrument to scrape the mplate and prepare for—to prepare for ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... the top of that picture you see the white, which is the canal, is wide open. And ... water, the cerebrospinal fluid, and each of those white lines with the ball on it shows where ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... then fuse the surrounding vertebrae across the disc space. For many patients, this allows them to return ... also put a cage in the inner vertebral space. So as you look at your screen, I’ ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring the latest medical education to both patients and the healthcare community. 01: ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... and do kind of try to stay as active as possible. That’s why we fixed her, so ... important to rehabilitate her muscles and get her active again, and which many patients will do. This ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... we go off air. This is just some data, and important, when people say, “Why do you not do the front and the back fusion and just do this TLIF?” Well, if the indication is correct for a TLIF, the TLIF in this paper, done by Hee and Castro, showed—looking and ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... have to try to operate on patients within six hours. It’s not always possible because they don’ ... We typically brace patients after this operation for six weeks. We hope to fix her well enough ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... and we’ve been very happy with the fusion. Sometimes in a small percentage of patients, because it’s put in posteriorly, it can create an inflammatory reaction where they do get some leg pain. It ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Science.gov (United States)

    ... and we’ve been very happy with the fusion. Sometimes in a small percentage of patients, because it’s put in posteriorly, it can create an inflammatory reaction where they do get some leg pain. It ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... the left, why don’t you—when you drop that rod in and you get the caps in 3 and 4, let’s do a minimal distraction between 3 and 4 because I think it will really neutralize her out really nicely. And also, if you could show ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... we go off air. This is just some data, and important, when people say, “Why do you ... 54 TODD ALBERT, MD: Yeah, that makes a big difference for that exiting nerve root. And you’ ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... at the operating room at Thomas Jefferson University right now. We’ve been operating for approximately an ... neurosurgery. He’s at the table holding the instrument right now, and two of our spine fellows, Andrew ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... re after, and we do attend to the cost of a procedure in terms of the instruments ... a major operation: it has a blood loss associated with it, it has a large dissection. The ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... you can just run the “Identification of the Anatomy” video now. Thank you. So now the next ... to show you is the identification of the anatomy. After we’ve done that skin incision and ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... the nerve roots. So there’s a lot of squeezing in the nerve roots. You can imagine if someone was grabbing your throat and squeezing and strangling you— this is the effect on ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... and markers, which you’ll see on the field. We have yet to put in the screws. ... of spinal stenosis are called neurogenic claudication. That means weakness and symptoms when walking, and it has ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... 25 TODD J. ALBERT, MD: You get the sense, Jim, at the lower part right below the ... the most slight distraction between maybe 3 and 4. You probably want to check those real quick, ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... is usually caused with no sciatica, or nerve compression; disc degeneration only. And again, it’s less successful ... radicular leg pain, or classic sciatica, due to compression of one or more nerves in the spinal ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... 26:49 TODD J. ALBERT, MD: And our monitoring p—we have monitoring people in the room. They’re a critical ... have had no problems during the surgery. Our monitoring has been good, so we know her nerves ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... on the screen. Physicians may take a post-assessment survey at the end of the program for ... on the screen. Physicians may take a post-assessment survey at the end of the program for ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... successful with surgery. With the appropriate diagnosis and failure of nonoperative treatment 95 to 97% of patients ... we go off air. This is just some data, and important, when people say, “Why do you ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... around the nerves. That sac is filled with water. I’m sure everyone in our listening audience ... latest and best procedure or is there something new on the horizon? I have to say, to ...

  9. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... minimally-disruptive procedure for spine surgery called XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will perform ... known as XLIF. A better term would be extreme lateral interbody fusion. This is a procedure that ...

  10. Hybrid construct for two levels disc disease in lumbar spine

    OpenAIRE

    Aunoble, Stephane; Meyrat, Robert; Al Sawad, Yasser; Tournier, C.; Leijssen, Philip; Le Huec, Jean-charles

    2009-01-01

    Prospective study. To study the validity of Hybrid construction (Anterior Lumbar Interbody Fusion) ALIF at one level and total disc arthroplasty (TDA) at adjacent, for two levels disc disease in lumbar spine as surgical strategy. With growing evidence that fusion constructs in the treatment of degenerative disc disease (DDD) may alter sagittal balance and contribute to undesirable complications in the long-term, total disc arthroplasty (TDA) slowly becomes an accepted treatment option for a s...

  11. Estrogen receptor ESR1 controls cell migration by repressing chemokine receptor CXCR4 in the zebrafish posterior lateral line system

    OpenAIRE

    Gamba, Laurent; Cubedo, Nicolas; Ghysen, Alain; Lutfalla, Georges; Dambly-Chaudière, Christine

    2010-01-01

    The primordium that generates the embryonic posterior lateral line of zebrafish migrates from the head to the tip of the tail along a trail of SDF1-producing cells. This migration critically depends on the presence of the SDF1 receptor CXCR4 in the leading region of the primordium and on the presence of a second SDF1 receptor, CXCR7, in the trailing region of the primordium. Here we show that inactivation of the estrogen receptor ESR1 results in ectopic expression of cxcr4b throughout the pri...

  12. Clinical Outcomes of Extreme Lateral Interbody Fusion in the Treatment of Adult Degenerative Scoliosis

    OpenAIRE

    Caputo, Adam M.; Michael, Keith W.; Chapman, Todd M.; Massey, Gene M.; Howes, Cameron R.; Isaacs, Robert E.; Brown, Christopher R

    2012-01-01

    Introduction. The use of extreme lateral interbody fusion (XLIF) and other lateral access surgery is rapidly increasing in popularity. However, limited data is available regarding its use in scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis treated with XLIF. Methods. Thirty consecutive patients with adult degenerative scoliosis treated by a single surgeon at a major academic institution were followed for an avera...

  13. Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up

    OpenAIRE

    Fritzell, Peter; Berg, Svante; Borgström, Fredrik; Tullberg, Tycho; Tropp, Hans

    2010-01-01

    This randomized controlled health economic study assesses the cost-effectiveness of the concept of total disc replacement (TDR) (Charité/Prodisc/Maverick) when compared with the concept of instrumented lumbar fusion (FUS) [posterior lumbar fusion (PLF) /posterior lumbar interbody fusion (PLIF)]. Social and healthcare perspectives after 2 years are reported. In all, 152 patients were randomized to either TDR (n = 80) or lumbar FUS (n = 72). Cost to society (total mean cost/patient, Swedi...

  14. Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis Estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomática lombar posterior associada com parafuso pedicular em espondilolistese no adulto

    OpenAIRE

    Fernando Luiz Rolemberg Dantas; Mirto Nelso Prandini; Mauro A.T. Ferreira

    2007-01-01

    The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first...

  15. Biomechanical comparison of anterior lumbar screw-plate fixation versus posterior lumbar pedicle screw fixation.

    Science.gov (United States)

    Liu, Lie-hua; Guo, Cong-tao; Zhou, Qiang; Pu, Xiao-bing; Song, Lei; Wang, Hao-ming; Zhao, Chen; Cheng, Shi-ming; Lan, Yang-jun; Liu, Ling

    2014-12-01

    Anterior lumbar interbody fusion (ALIF) followed by posterior pedicle screw fixation (PSF) in a second procedure is mostly used to implement lumbar spine fusion. ALIF followed by anterior lumbar screw-plate has a lot of advantages, but its biomechanical stability requires confirmation. This study evaluated the biomechanical stability of a novel anterior lumbar locked screw-plate (ALLSP) by comparison with posterior lumbar PSF. Twelve fresh human cadaveric lumbar specimens (L4-L5) were assigned to four groups: ALIF+PSF group, ALIF+ALLSP (both fixed) group, ALIF group and an untreated control (both non-fixed) group. The first three groups received implantation of a rectangular titanium cage. Tests under axial compression, flexion, extension, lateral bending, or rotation showed that the fixed groups had significantly stronger stability than the non-fixed groups (P=0.000 for all). The ALIF+ALLSP group had significantly greater axial stiffness under applied axial compression and significantly less angular displacement under rotational forces than the ALIF+PSF group. The angular displacement of the ALIF+ALLSP group was less under flexion than that of the ALIF+PSF, and the angular displacement under lateral bending and extension was greater, but these differences were not statistically significant. In summary, the ALLSP conforms to the anterior lumbar spine and has good biomechanical stability. It is a reliable choice for enhancing the stability of ALIF. PMID:25480589

  16. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... intractable lumbar spondylosis. Anybody that suffers from spine disease from L4 and above could potentially benefit from ... quick shot of our radiograph of the potential disease that can be corrected with this minimal access ...

  17. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... and allow for a fusion without disrupting the rest of the soft tissue. You can see Dr. ... allows bone-to-bone fusion without disturbing the rest of the lumbar anatomy. Again, I mean, as ...

  18. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... The minimally invasive XLIF procedure takes a unique approach with a side entry. This allows the surgeon ... that can be corrected with this minimal access approach to the lumbar spine. So that's the way ...

  19. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... severe facet disease. These are all stages of arthritis. And it will happen to anybody. It will ... suffering from severe lumbar spondylosis. Again, spondylosis means arthritis, which results in pain, nerve damage, and all ...

  20. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... there, we just get access to the disk space and perform the fusion. And that's all done ... are placed to allow exposure to the disc space. This patient is suffering from severe lumbar spondylosis. ...

  1. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... on the lumbar plexus. And with the NeuroVision monitoring on the screen, we are obtaining the numbers ... are changing. Now we can see on the monitoring, you have 9, so it's telling me that ...

  2. [Lumbar spondylosis].

    Science.gov (United States)

    Seichi, Atsushi

    2014-10-01

    Lumbar spondylosis is a chronic, noninflammatory disease caused by degeneration of lumbar disc and/or facet joints. The etiology of lumbar spondylosis is multifactorial. Patients with lumbar spondylosis complain of a broad variety of symptoms including discomfort in the low back lesion, whereas some of them have radiating leg pain or neurologenic intermittent claudication (lumbar spinal stenosis). The majority of patients with spondylosis and stenosis of the lumbosacral spine can be treated nonsurgically. Nonsteroidal anti-inflammatory drugs and COX-2 inhibitors are helpful in controlling symptoms. Prostaglandin, epidural injection, and transforaminal injection are also helpful for leg pain and intermittent claudication. Operative therapy for spinal stenosis or spondylolisthesis is reserved for patients who are totally incapacitated by their condition. PMID:25509797

  3. Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

    OpenAIRE

    Putzier, Michael; Strube, Patrick; Funk, Julia F.; Gross, Christian; Mo?nig, Hans-joachim; Perka, Carsten; Pruss, Axel

    2009-01-01

    The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant donor site morbidity after iliac crest grafting the need exists for alternative grafts with a comparable outcome. Forty patients with degenerative spinal disease were treated with a monosegmental spondylodesis (ventrally, 1 PEEK-cage; dorsally, a scre...

  4. Biomechanics of Lateral Interbody Spacers: Going Wider for Going Stiffer

    OpenAIRE

    Pimenta, Luiz; Turner, Alexander W. L.; Dooley, Zachary A.; Parikh, Rachit D.; Peterson, Mark D.

    2012-01-01

    This study investigates the biomechanical stability of a large interbody spacer inserted by a lateral approach and compares the biomechanical differences with the more conventional transforaminal interbody fusion (TLIF), with and without supplemental pedicle screw (PS) fixation. Twenty-four L2-L3 functional spinal units (FSUs) were tested with three interbody cage options: (i) 18?mm XLIF cage, (ii) 26?mm XLIF cage, and (iii) 11?mm TLIF cage. Each spacer was tested without supplemental f...

  5. External transpedicular fixation test of the lumbar spine correlates with the outcome of subsequent lumbar fusion.

    Science.gov (United States)

    Soini, J; Slätis, P; Kannisto, M; Sandelin, J

    1993-08-01

    External transpedicular fixation was applied to the lower lumbar spine in a prospective study on 42 patients with chronic low back pain combined with suspected instability of the lumbar segments; the diagnosis was failed disk surgery, spondylolisthesis, and degenerative disk disease. The aim was to realign the involved segments, to restore disk height, and to record changes in pain and performance during the external fixation test. Pain was recorded on a visual analog scale, and performance was assessed using the Oswestry disability score. As independent observer assessed the test and treatment results. Twenty-nine patients experienced relief of pain and performed better in the fixator; they were subjected to anterior interbody fusion, the external frame being kept as a stabilizing device for an additional four months. Twenty-two patients have had follow-up evaluations for two years. One and two years after successful lumbar fusion, significantly (p < 0.02) better pain and performance scores were recorded; the results of lumbar fusion corresponded to the preoperative fixation test. A temporary external fixation test may be a useful procedure in patients considered for subsequent spondylodesis. PMID:8339515

  6. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty.

    Science.gov (United States)

    Jackson, Keith L; Hire, Justin M; Jacobs, Jeremy M; Key, Charles C; DeVine, John G

    2015-06-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO. PMID:26097664

  7. Lumbar spine CT scan

    Science.gov (United States)

    CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... Koh DM, Roditi G. Intravascular contrast media for radiology, CT, and MRI. In: Adam A, Dixon AK, ...

  8. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    Scientific Electronic Library Online (English)

    Tianyong, Hou; Qiang, Zhou; Fei, Dai; Fei, Luo; Qingyi, He; Jinsong, Zhang; Jianzhong, Xu.

    2015-02-01

    Full Text Available OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patient [...] s who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery.

  9. Forelimb amputation-induced reorganization in the ventral posterior lateral nucleus (VPL) provides a substrate for large-scale cortical reorganization in rat forepaw barrel subfield (FBS).

    Science.gov (United States)

    Li, Cheng X; Chappell, Tyson D; Ramshur, John T; Waters, Robert S

    2014-10-01

    In this study, we examined the role of the ventral posterior lateral nucleus (VPL) as a possible substrate for large-scale cortical reorganization in the forepaw barrel subfield (FBS) of primary somatosensory cortex (SI) that follows forelimb amputation. Previously, we reported that, 6 weeks after forelimb amputation in young adult rats, new input from the shoulder becomes expressed throughout the FBS that quite likely has a subcortical origin. Subsequent examination of the cuneate nucleus (CN) 1 to 30 weeks following forelimb amputation showed that CN played an insignificant role in cortical reorganization and led to the present investigation of VPL. As a first step, we used electrophysiological recordings in forelimb intact adult rats (n=8) to map the body representation in VPL with particular emphasis on the forepaw and shoulder representations and showed that VPL was somatotopically organized. We next used stimulation and recording techniques in forelimb intact rats (n=5) and examined the pattern of projection (a) from the forelimb and shoulder to SI, (b) from the forepaw and shoulder to VPL, and (c) from sites in the forepaw and shoulder representation in VPL to forelimb and shoulder sites in SI. The results showed that the projections were narrowly focused and homotopic. Electrophysiological recordings were then used to map the former forepaw representation in forelimb amputated young adult rats (n=5) at 7 to 24 weeks after amputation. At each time period, new input from the shoulder was observed in the deafferented forepaw region in VPL. To determine whether the new shoulder input in the deafferented forepaw VPL projected to a new shoulder site in the deafferented FBS, we examined the thalamocortical pathway in 2 forelimb-amputated rats. Stimulation of a new shoulder site in deafferented FBS antidromically-activated a cell in the former forepaw territory in VPL; however, similar stimulation from a site in the original shoulder representation, outside the deafferented region, in SI did not activate cells in the former forepaw VPL. These results suggest that the new shoulder input in deafferented FBS is relayed from cells in the former forepaw region in VPL. In the last step, we used anatomical tracing and stimulation and recording techniques in forelimb intact rats (n=9) to examine the cuneothalamic pathway from shoulder and forepaw receptive field zones in CN to determine whether projections from the shoulder zone might provide a possible source of shoulder input to forepaw VPL. Injection of biotinylated dextran amine (BDA) into physiologically identified shoulder responsive sites in CN densely labeled axon terminals in the shoulder representation in VPL, but also gave off small collateral branches into forepaw VPL. In addition, microstimulation delivered to forepaw VPL antidromically-activated cells in shoulder receptive field sites in CN. These results suggest that forepaw VPL also receives input from shoulder receptive sites in CN that are latent or subthreshold in forelimb intact rats. However, we speculate that following amputation these latent shoulder inputs become expressed, possibly as a down-regulation of GABA inhibition from the reticular nucleus (RTN). These results, taken together, suggest that VPL provides a substrate for large-scale cortical reorganization that follows forelimb amputation. PMID:25058605

  10. The finite element modeling and analysis of human lumbar segment herniation

    Directory of Open Access Journals (Sweden)

    HUANG Ju-ying

    2012-08-01

    Full Text Available Objective To study the biomechanical character of intervertebral disc in different loadings of axial compression, flexion, lateral bending, extension, rotation to develop the finite element (FE of human lumbar L3-5 segment. Methods According to CT radiological data of a healthy adult, the vertebra and intervertebral disc of lumbar L3-5 segment were respectively reconstructed by Mimics 10.0 software and Geomagic 10.0 software. The FE model of L3-5 segment was reconstructed, and intact disc and herniated lumbar disc were created by adding the lumbar attaching ligaments into the simulating model and changing the corresponding material properties after the disc was extruded in Ansys software. The biomechanical characteristics of two models were simulated under the five loadings of axial compression, flexion, lateral bending, extension and rotation by FE method. Results After the L3, 4 lumbar disc was extruded, the stress distribution on the disc and the ability of load transfer were changed. The stress was concentrated in the posterior lateral of annulus fibrous. Conclusion After the disc was extruded, the load-bearing capacity decreased.

  11. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... Lumbar surgery, particularly from the micro-lumbar discectomy style, it is a very common procedure. Many patients ... muscles and get them functioning back into normal style. So I do not routinely send patients to ...

  12. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a very common problem that presents ... up? Once the patient goes through an initial treatment modality, there is no ... of the lumbar spine. Okay. If they can’t have an ...

  13. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... have been around for a while, but the learning curve is quite steep. It takes some specialized ... a bony spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a very ...

  14. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... These are patients that usually can walk long distances before having to sit down, and they love ... MRI is by far the gold standard for evaluation of the lumbar spine. Okay. If they can’ ...

  15. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... inside the MRI. But MRI is really the gold standard for diagnosing these types of conditions. What ... test, and an MRI is by far the gold standard for evaluation of the lumbar spine. Okay. ...

  16. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... a bony spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a very ... a little bit more. I mean with conservative management, people think about taking the non-steroidal anti- ...

  17. Lumbar paraspinal compartment syndrome

    OpenAIRE

    Nathan, Senthil T.; Roberts, Craig S.; Deliberato, David

    2011-01-01

    The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics, aetiology, types, diagnosis, clinical features, and treatment. This was an Institutional Review Board-exempt study performed at a Level 1 trauma center. A PubMed search was conducted with the title query: lumbar paraspinal compartment syndrome. Eleven articles met our search criteria. Three of the patients with acute paraspina...

  18. Structural and mechanical evaluations of a topology optimized titanium interbody fusion cage fabricated by selective laser melting process.

    Science.gov (United States)

    Lin, Chia-Ying; Wirtz, Tobias; LaMarca, Frank; Hollister, Scott J

    2007-11-01

    A topology optimized lumbar interbody fusion cage was made of Ti-Al6-V4 alloy by the rapid prototyping process of selective laser melting (SLM) to reproduce designed microstructure features. Radiographic characterizations and the mechanical properties were investigated to determine how the structural characteristics of the fabricated cage were reproduced from design characteristics using micro-computed tomography scanning. The mechanical modulus of the designed cage was also measured to compare with tantalum, a widely used porous metal. The designed microstructures can be clearly seen in the micrographs of the micro-CT and scanning electron microscopy examinations, showing the SLM process can reproduce intricate microscopic features from the original designs. No imaging artifacts from micro-CT were found. The average compressive modulus of the tested caged was 2.97+/-0.90 GPa, which is comparable with the reported porous tantalum modulus of 3 GPa and falls between that of cortical bone (15 GPa) and trabecular bone (0.1-0.5 GPa). The new porous Ti-6Al-4V optimal-structure cage fabricated by SLM process gave consistent mechanical properties without artifactual distortion in the imaging modalities and thus it can be a promising alternative as a porous implant for spine fusion. PMID:17415762

  19. Current strategies for the restoration of adequate lordosis during lumbar fusion.

    Science.gov (United States)

    Barrey, Cédric; Darnis, Alice

    2015-01-18

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

  20. Lumbar corsets can decrease lumbar motion in golf swing.

    Science.gov (United States)

    Hashimoto, Koji; Miyamoto, Kei; Yanagawa, Takashi; Hattori, Ryo; Aoki, Takaaki; Matsuoka, Toshio; Ohno, Takatoshi; Shimizu, Katsuji

    2013-01-01

    Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K.), full golf swings were monitored without a corset (WOC), with a soft corset (SC), and with a hard corset (HC), with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity) in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt) were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38°) or HC (28°) than under WOC (44°) conditions (p swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC. Key pointsRotational and extension forces on the lumbar spine may cause golf-related low back painWearing lumbar corsets during a golf swing can effectively decrease lumbar extension and rotation angles and angular velocity.Wearing lumbar corsets increased the rotational motion of the hip joint while reducing the rotation of the lumbar spine. PMID:24149729

  1. QUANTIFICATION OF LUMBAR ENDURANCE ON A BACKUP LUMBAR EXTENSION DYNAMOMETER

    Directory of Open Access Journals (Sweden)

    Staci M. Hager

    2006-12-01

    Full Text Available We evaluated the reliability of static and dynamic lumbar muscle endurance measurements on a BackUP lumbar extension dynamometer. Sixteen healthy participants (8 male; 8 female volunteered for this investigation. Fifty percent of each participant's body weight was calculated to determine the weight load utilized for the static (holding time and dynamic (repetitions lumbar extension endurance tests. Four separate tests (2 static, 2 dynamic were conducted with at least a 24-hour rest period between tests. Test-retest intraclass correlations were shown to be high (static lumbar endurance, ICC = 0.92 (p < 0.0005; dynamic lumbar endurance, ICC = 0.93 (p < 0.0005 for both of the performed tests. Our results demonstrated that static and dynamic lumbar endurance can be assessed reliably on a BackUP lumbar extension dynamometer.

  2. Lumbar disc replacement: update.

    Science.gov (United States)

    Heider, F C; Mayer, H M; Siepe, C J

    2015-06-01

    Over the last decades, fusion of lumbar spinal motion segments has represented the mainstay of treatment of lumbar degenerative conditions which failed to respond adequately to conservative therapy. Increasing demands and expectations from patients as well as the necessity to avoid fusion related negative side effects such as adjacent level disc degeneration, considerable complication and reoperation rates, cranial facet joint violations, pseudarthrosis and others led to the development of motion preserving technologies such as total lumbar disc replacement (TDR). The first and rudimentary attempts to preserve motion of lumbar motion segments can be dated back to the early 1950s. Over the past two to three decades, a variety of new implants with different motion characteristics have been developed and introduced into the market. Despite of the extensive knowledge which has been gained in this field of research, insurers in the United States have refused to reimburse surgeons due to fear of late complications and reoperations as well as unknown secondary costs, which led to a global decline in the numbers of TDR procedures. The current literature review intends to provide a concise summary of the adequate indications for TDR as well as outcome determining factors and delineate the role of TDR in the currently available armamentarium for the treatment of low back pain (LBP) resulting from degenerative disc disease (DDD) without instabilities or deformities. PMID:25649068

  3. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... we need to be able to release the pressure whether it’s a disc herniation or whether it is a bony spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a very common problem that presents as we age, in which our canal becomes compressed like a ...

  4. Quantification of Lumbar Endurance on a Backup Lumbar Extension Dynamometer

    OpenAIRE

    Hager, Staci M.; Udermann, Brian E; David M. Reineke; Gibson, Mark H; Mayer, John M.; Steven R. Murray

    2006-01-01

    We evaluated the reliability of static and dynamic lumbar muscle endurance measurements on a BackUP lumbar extension dynamometer. Sixteen healthy participants (8 male; 8 female) volunteered for this investigation. Fifty percent of each participant's body weight was calculated to determine the weight load utilized for the static (holding time) and dynamic (repetitions) lumbar extension endurance tests. Four separate tests (2 static, 2 dynamic) were conducted with at least a 24-hour rest period...

  5. IMAGENOLOGIA DEL DOLOR LUMBAR

    Directory of Open Access Journals (Sweden)

    Cristian Matus Y

    2003-01-01

    Full Text Available EL dolor lumbar es un síntoma de consulta frecuente, con ribetes de problema de Salud Pública. El imagenólogo tiene un papel crucial tanto en el diagnóstico como en el tratamiento de este problema. La comprensión de la clínica, la fisiopatología, la patología y las distintas alternativas terapéuticas permitirá un estudio imagenológico dirigido que aportará información complementaria y orientará hacia tratamientos más adecuados. La categorización de los distintos cuadros clínicos y técnicas orientadas a la búsqueda de patología especifica permitirá hacer aproximaciones etiologicas de los diversos cuadros que pueden dar origen al dolor lumbar.The low back pain is a common cause of consultation and may be considered a public health problem. The imaging physician has an important role in the diagnoses and treatment. The understanding of the clinical aspects, physiology, pathology and different options of treatment will permit a tailored imaging examination. This will result in useful clinical information and the correct treatment for the patients.

  6. Medline Plus

    Full Text Available ... Doctors Hospital, Coral Gables, FL, 11/27/2012) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion ( ... Tumors (Hartford Hospital, Hartford, CT, 6/21/2007) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion ( ...

  7. Medline Plus

    Full Text Available ... Hospital, Coral Gables, FL, 11/27/2012) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ... Hartford Hospital, Hartford, CT, 6/21/2007) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ...

  8. LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

    Directory of Open Access Journals (Sweden)

    Koji Hashimoto

    2013-03-01

    Full Text Available Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K., full golf swings were monitored without a corset (WOC, with a soft corset (SC, and with a hard corset (HC, with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38° or HC (28° than under WOC (44° conditions (p < 0.05. The maximum angular velocity after impact was significantly smaller under HC (94°/sec than under SC (177°/sec and WOC (191° /sec conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC

  9. Use of coral grafts in anterior interbody fusion of the rabbit spine.

    Science.gov (United States)

    Tho, K S; Krishnamoorthy, S

    1996-11-01

    The search for suitable bone graft substitutes has been made necessary by the problems encountered when using autogenous sources. Coral grafts have been used for the past two decades in various fields of surgery with reported good results. The aim of this study was to determine the efficacy of coral graft (Biocoral in anterior interbody fusion of rabbit spine. Fourteen rabbits underwent surgical anterior interbody fusion with autogenous, coral and Kiel grafts. At three months there was evidence of new bone formation at the graft-bone interface but no signs of osteointegration of the coral graft. The coral graft was also inert and did not evoke in any inflammatory reactions. Radiological examinations did not reveal any signs of fusion at three months. Kiel grafts only evoked a fibrous reaction. Autogenous rib grafts used has solid interbody fusion at two months as evidenced from both radiological and histological studies. PMID:9055010

  10. Lumbar spinal stenosis

    International Nuclear Information System (INIS)

    Lumbar spinal stenosis is a condition of polyetiologic origin. It is defined as narrowing of the spinal canal, the nerve root canals or the intervertebral canals. For clinical, diagnostic and therapeutic reasons it may be divided into two main types: central and lateral stenosis with obstruction of the lateral recesses. Plain radiographs may be suggestive in central or generalized narrowing only. Diagnosis is confirmed by additional investigations, i.e. myelography and CT. Lumbar myelography allows definitive diagnosis of central spinal stenosis. However, validity regarding visualization of the lateral recesses is limited and a decision on the nature of the obstruction, bony or soft tissue, cannot be made. In contrast, CT does support information on the bony outline of the lateral recess as related to the facet and soft tissue structures in particular. Treatment of choice should be conservative-supportive if clinical symptoms permit. Surgery is indicated when there is intolerable pain, progressive muscle weakness or sphincter dysfunction. Surgery seeks to attain complete decompression of neural elements, if instability is present or imminent spinal fusion has to be considered. Shape, size and configuration of the spinal canal have to be determined prior to any surgical approach. CT fulfills these requirements most admirably. (orig.)

  11. The imaging of lumbar spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Butt, S. [Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP (United Kingdom); Saifuddin, A. [Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP (United Kingdom) and Institute of Orthopaedics and Musculo-Skeletal Sciences, University College, London (United Kingdom)]. E-mail: asaifuddin@aol.com

    2005-05-01

    Lumbar spondylolisthesis is a common finding on plain radiographs. The condition has a variety of causes which can be differentiated on the basis of imaging findings. As the treatment is dependent upon the type of spondylolisthesis, it is important for the radiologist to be aware of these features. We present a pictorial review of the imaging features of lumbar spondylolisthesis and explain the differentiating points between different groups of this disorder. The relative merits of the different imaging techniques in assessing lumbar spondylolisthesis are discussed.

  12. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review.

    Science.gov (United States)

    Bonaldi, G; Brembilla, C; Cianfoni, A

    2015-05-01

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications. PMID:24906245

  13. Lumbar myelography with iohexol

    International Nuclear Information System (INIS)

    Since 1983 iohexol has been routinely used for myelography in our hospital and 1 650 myelographies have been performed. The first 331 patients with lumbar myelography were included in a follow-up study. Headache was observed in 26 per cent, nausea in 12 per cent and vertigo in 6 per cent of the patients, a frequency very similar to that observed in an earlier study of side effects following spinal puncture. Severe reactions were not seen. Three patients had radicular symptoms and 3 patients had minor mental symptoms possibly caused by the contrast medium. It is concluded that most side effects are related to the spinal puncture and that iohexol probably can be used with safety in out-patients. (orig.)

  14. Lumbar epidural venography

    International Nuclear Information System (INIS)

    Myelography is widely used for radiological diagnosis of herniated lumbar disc. But the diagnostic accuracy is only about 84% with range of 67 to 100% with many cases of false negative and equivocal cases. In cases of extreme lateral disc herniation and short cul de sac or wide epidural space, even quite a large disc herniation cannot be detected on myelography. But with epidural venography these defects of myelography can easily be overcome. 52 cases of epidural venography were performed in department of Radiology of Capital Armed Forces General Hospital during the 20 months from May 1979 to December 1980. And the findings were compared with those of myelography and operative results. The results are as follows; 1. Of 52 cases, satisfactory opacification was obtained in 48 cases (92.3%). 2. Single vein injection was adequate for satisfactory opacification in 40 cases (76.9%). 3. There were 2 cases of retroperitoneal extravasation of contrast media, but the patient recovered without difficulty. 4. Of 24 cases operated, the venographic finding was confirmed in 21 cases (87.5%) and of the 48 cases adequately opacified, there were only 3 cases of confirmed diagnostic error and so the error rate is only 6.25%. 5. Abnormal findings of myelography were exactly reproduced on epidural venography and many cases with equivocal or normal myelographic findings were accurately diagnosed with epidural venography. 6. In cases of total block, epidural venography was very useful for e epidural venography was very useful for evaluation of the caudal portion. So lumbar epidural venography is very useful not only as an adjunctive method to myelography, but also as the first diagnostic procedure for herniated disc, for the procedure is simple and the diagnostic accuracy is very high

  15. Lumbar spondylolysis: a review

    International Nuclear Information System (INIS)

    Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presenceand sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its epidemiology, pathogenesis, and general treatment guidelines, as well as a detailed review and discussion of the imaging principles for the diagnosis and follow-up of this condition. (orig.)

  16. Lumbar spondylolysis: a review

    Energy Technology Data Exchange (ETDEWEB)

    Leone, Antonio; Magarelli, Nicola; Bonomo, Lorenzo [Dept. of Bioimaging and Radiological Sciences, Catholic Univ., Rome (Italy); Cianfoni, Alessandro [Dept. of Radiology and Radiological Sciences, Medical Univ. of South Carolina, Charleston (United States); Cerase, Alfonso [General Hospital, Unit Neuroimaging and Neurointervention (NINT), Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena (Italy)

    2011-06-15

    Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its epidemiology, pathogenesis, and general treatment guidelines, as well as a detailed review and discussion of the imaging principles for the diagnosis and follow-up of this condition. (orig.)

  17. Lumbar peritoneal shunt

    Directory of Open Access Journals (Sweden)

    Yadav Yad

    2010-01-01

    Full Text Available A lumbar peritoneal (LP shunt is a technique of cerebrospinal fluid (CSF diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension, normal pressure hydrocephalus, spinal and cranial CSF leaks, pseudomeningoceles, slit ventricle syndrome, growing skull fractures which are difficult to treat by conventional methods (when dural defect extends deep in the cranial base or across venous sinuses and in recurrent cases after conventional surgery, raised intracranial pressure following chronic meningitis, persistent bulging of craniotomy site after operations for intracranial tumors or head trauma, syringomyelia and failed endoscopic third ventriculostomy with a patent stoma. In spite of the large number of indications of this shunt and being reasonably good, safe, and effective, very few reports about the LP shunt exist in the literature. This procedure did not get its due importance due to some initial negative reports. This review article is based on search on Google and PubMed. This article is aimed to review indications, complications, results, and comparison of the LP shunt with the commonly practiced ventriculoperitoneal (VP shunt. Shunt blocks, infections, CSF leaks, overdrainage and acquired Chiari malformation (ACM are some of the complications of the LP shunt. Early diagnosis of overdrainage complications and ACM as well as timely appropriate treatment especially by programmable shunts could decrease morbidity. Majority of recent reports suggest that a LP shunt is a better alternative to the VP shunt in communicating hydrocephalus. It has an advantage over the VP shunt of being completely extracranial and can be used under conditions other than hydrocephalus when the ventricles are normal sized or chinked. More publications are required to establish its usefulness in the treatment of wide variety of indications.

  18. Emergency Lumbar Puncture in Adults

    OpenAIRE

    Macdonald, R. Loughlin; Bernstein, Mark

    1989-01-01

    Three patients who had lumbar punctures performed in the presence of undiagnosed intracranial space-occupying lesions are described. Neurologic deterioration was precipitated in one and continued in another; neurologic status was unchanged in the third patient. The use of lumbar puncture in adults in the emergency setting is discussed in light of the accepted indications and contra-indications, available data on complication rates, and regional availability of cranial computed tomography. We ...

  19. PA lumbar spines: a future concept

    International Nuclear Information System (INIS)

    The article presents results of a comparison of two possible lumbar spine projections used in a sample of 20 male and 20 female patients, with regard to dose reduction in lumbar spine radiography. (UK)

  20. Quistes sinoviales lumbares

    Scientific Electronic Library Online (English)

    Abraham, Krivoy; Jaime, Krivoy; Mauricio, Krivoy.

    2003-12-01

    Full Text Available Se presentan siete casos con quistes sinoviales cuyas edades oscilaron entre 43 y 81 años. Se estudiaron 4 casos masculinos y 3 femeninos. La evolución varió entre 1 mes y 10 años. La presentación clínica fue de 2 casos de lumbociática bilateral, 1 caso de síndrome de cola de caballo, 2 casos de cla [...] udicación neurogénica y lumbociática bilateral, 1 caso de lumbocruralgia y 1 caso de ciática unilateral. El examen de mayor contribución diagnóstica fue la resonancia magnética lumbar que aunado a los otros estudios reafirmaron el diagnóstico. Todos los pacientes fueron sometidos a tratamientos conservadores y fisioterapia sin resultados por lo que la sanción quirúrgica fue indispensable con resultados satisfactorios. Todos los casos se incorporaron a su vida social y laboral. Abstract in english Seven cases of synovial cyst were presented. The duration of symptoms were between 1 month and 10 years. Four cases were male and 3 female. Variation of age were between 43 and 81 years. Patient symptoms were: bilateral leg pain 2 cases; bilateral leg pain with neurogenic claudication: 2 cases. One [...] case with cauda equina syndrome. One case with unilateral leg pain and one case with lumbocrural pain. The best diagnosis test was magnetic resonance image. Other tests improved details of the cysts. All patients received conservative therapy with no relieve of symptoms. Surgery was necessary in all patient with complete recovery in the social and laboral fields.

  1. NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS

    Directory of Open Access Journals (Sweden)

    Ville Leinonen

    2004-03-01

    Full Text Available Impaired motor and sensory functions have been associated with low back pain (LBP. This includes disturbances in a wide range of sensorimotor control e.g. sensory dysfunctions, impaired postural responses and psychomotor control. However, the physiological mechanisms, clinical relevance and characteristics of these findings in different spinal pathologies require further clarification. The purposes of this study were to investigate postural control, lumbar muscle function, movement perception and associations between these findings in healthy volunteers (n=35, patients with lumbar disc herniation (n=20 and lumbar spinal stenosis (LSS, n=26. Paraspinal muscle responses for sudden upper limb loading and muscle activation during flexion-extension movement and the lumbar endurance test were measured by surface electromyography (EMG. Postural stability was measured on a force platform during two- and one-footed standing. Lumbar movement perception was assessed in a motorised trunk rotation unit in the seated position. In addition, measurements of motor-(MEP and somatosensory evoked potentials (SEP and needle EMG examination of lumbar multifidus muscles were performed in the LSS patients. Clinical and questionnaire data were also recorded. A short latency paraspinal muscle response (~50 ms for sudden upper limb loading was observed. The latency of the response was shortened by expectation (p=0.017. The response latency for unexpected loading was similar in healthy persons and disc herniation patients but the latency was not shortened by expectation in the patients (p = 0.014. Also impaired postural control (p < 0.05 and lumbar movement perception (p = 0.012 were observed in disc herniation patients. The impaired lumbar movement perception (p=0.054 and anticipatory muscle activation (p = 0.043 tended to be restored after successful surgery but postural control had still not recovered after 3 months of follow-up. The majority of LSS patients were unable to sense a rotational movement in the lumbar area and thus had clearly impaired lumbar movement perception (p = 0.006. Abnormal MEPs had only inconsistent and SEPs showed no associations with impaired movement perception and postural stability in LSS. Abnormal needle EMG findings and flexion-extension activation of paraspinal muscles were frequently observed in LSS patients. Lumbar paraspinal muscle endurance was better than in previously evaluated healthy subjects and chronic LBP patients (p < 0.001. The results demonstrated clearly impaired lumbar sensory and motor function in sciatica and LSS patients. The pure reflex activation of paraspinal muscles was not affected in sciatica but a difference was found in the premotoneuronal response control. The impaired proprioceptive functions and premotoneuronal response control seem to recover at least partially but the maintenance of postural stability is a complex activity which does not seem to recover automatically in operated sciatica patients at least in three months follow-up. Paraspinal muscle denervation and dysfunction were clearly detectable in LSS but lumbar paraspinal muscle endurance was unexpectedly good.

  2. Lumbar Corsets Can Decrease Lumbar Motion in Golf Swing

    OpenAIRE

    Koji Hashimoto; Kei Miyamoto; Takashi Yanagawa; Ryo Hattori; Takaaki Aoki; Toshio Matsuoka; Takatoshi Ohno; Katsuji Shimizu

    2013-01-01

    Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K.), full golf swings were monitored without a corset (WOC), with a soft corset (SC), and with a hard corset (HC), wi...

  3. TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion [Corrigendum

    OpenAIRE

    Hardenbrook MA; Miller LE; Block JE

    2013-01-01

    Hardenbrook MA, Miller LE, Block JE. Medical Devices: Evidence and Research. 2013;6:91–95. On page 94, the disclosure was listed as "LEM and JEB received financial support from TranS1 Inc for assistance with manuscript development. MAH reports no conflict of interest in this work." in error. The disclosure should have been "LEM and JEB received financial support from TranS1 Inc for assistance with manuscript development. MAH receives a royalty for the VEO system, in addition to other pa...

  4. TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion [Corrigendum

    Directory of Open Access Journals (Sweden)

    Hardenbrook MA

    2013-07-01

    Full Text Available Hardenbrook MA, Miller LE, Block JE. Medical Devices: Evidence and Research. 2013;6:91–95. On page 94, the disclosure was listed as "LEM and JEB received financial support from TranS1 Inc for assistance with manuscript development. MAH reports no conflict of interest in this work." in error. The disclosure should have been "LEM and JEB received financial support from TranS1 Inc for assistance with manuscript development. MAH receives a royalty for the VEO system, in addition to other payments for consulting/training work performed."Read original article

  5. Biomechanical evaluation of immediate stability with rectangular versus cylindrical interbody cages in stabilization of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Webb John K

    2002-10-01

    Full Text Available Abstract Background Recent cadaver studies show stability against axial rotation with a cylindrical cage is marginally superior to a rectangular cage. The purpose of this biomechanical study in cadaver spine was to evaluate the stability of a new rectangular titanium cage design, which has teeth similar to the threads of cylindrical cages to engage the endplates. Methods Ten motion segments (five L2-3, five L4-5 were tested. From each cadaver spine, one motion segment was fixed with a pair of cylindrical cages (BAK, Sulzer Medica and the other with paired rectangular cages (Rotafix, Corin Spinal. Each specimen was tested in an unconstrained state, after cage introduction and after additional posterior translaminar screw fixation. The range of motion (ROM in flexion-extension, lateral bending, and rotation was tested in a materials testing machine, with +/- 5 Nm cyclical load over 10 sec per cycle; data from the third cycle was captured for analysis. Results ROM in all directions was significantly reduced (p Conclusions There was no significant difference in immediate stability in any direction between the threaded cylindrical cage and the new design of the rectangular cage with endplate teeth.

  6. The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF)

    OpenAIRE

    Birkenmaier Christof; Suess Olaf; Pfeiffer Michael; Burger Ralf; Schmieder Kirsten; Wegener Bernd

    2010-01-01

    Abstract Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO...

  7. Rate of graft bone filling by transforaminal lumber interbody fusion (TLIF) with mesh cages

    International Nuclear Information System (INIS)

    Compared to posterior lumber interbody fusion (PLIF), the transforaminal lumber interbody fusion (TLIF) procedure has a latent disadvantage in terms of bone grafting because of being a unilateral approach. We calculated the rate of graft bone filling in TLIF cases by postoperative CT and evaluated the clinical results. The rate of filling in the TLIF cases was not significantly less than in the PLIF cases. The results also showed no significant difference between TLIF and PLIF. An adequate amount of bone were grafted into the intervertebral space even by the unilateral TLIF approach, however the procedure is not easy. An incidental dural tear occurred in 1 case each treated by TLIF and PLIF. The exposure of the dural tube increases the risk of epidural bleeding and neural tissue injury. We recommend TLIF for discopathy, foraminal stenosis, and repeat surgery to avoid latent risk. (author)

  8. Clinical, radiological and histological study of the failure of cervical interbody fusions with bone substitutes

    OpenAIRE

    Xie, Youzhuan; Chopin, Daniel; Hardouin, Pierre; Lu, Jianxi

    2006-01-01

    Few histological studies on bone substitutes in human cervical spine are available and the biological processes of bone substitutes are not well documented. The authors studied four failure cases of cervical interbody fusion: two cases with hydroxyapatite (HA), one case with ?-tricalcium phosphate ceramic (?-TCP) and one case with xenograft (bovine bone). Clinical data showed that all the patients experienced neck pain with or without numbness of upper extremity due to fusion failure. Succe...

  9. Hematoma epidural lumbar crónico espontáneo / Chronic spontaneous lumbar epidural hematoma

    Scientific Electronic Library Online (English)

    J.M., Belinchón; J., Campos; J., Merino; J.M., Gallego; C., Barcia.

    2005-12-01

    Full Text Available Presentamos un caso excepcional de estenosis de canal lumbar con síndrome de cola de caballo por un hematoma crónico espontáneo en el espacio epidural L2-L3. Se trata de un varón de 53 años que, sin ninguna clase de antecedente patológico relacionado con el problema actual (traumatismos, punciones l [...] umbares, toma de antiagregantes o anticoagulantes), presenta una colección hemática epidural que va comprimiendo progresivamente la cola de caballo. Las pruebas de imagen mostraron una colección polilobulada, bien delimitada, que se interpretó como quiste sinovial. Tras la cirugía (laminectomía descompresiva y evacuación) se confirmó el diagnóstico con estudio histológico. Tras la operación se recuperó por completo la función neurológica. Abstract in english We report an exceptional case of cauda equina syndrome, caused by a chronic epidural hematoma of the lumbar spine, (L2-L3). A 53 year old man without history of trauma, lumbar punctures or antiagregant medication, suffered from progressive back pain and minor motor deficit in the legs. The etiology, [...] MRI, intraoperative findings and microscopical study are presented and discussed. After surgery there was a complete resolution of the clinical picture.

  10. Provocation Lumbar Diskography at Previously Fused Levels

    OpenAIRE

    Dulai, H. S.; Bartynski, W. S.; Rothfus, W. S.; Gerszten, P. C.

    2010-01-01

    Recurrent or persistent low back pain (LBP) after lumbar fusion can be related to many factors. We reviewed the provocation lumbar diskogram (PLD) features and redo-fusion outcome in our patients evaluated for recurrent/persistent LBP after technically successful fusion. LD was performed in 27 patients with recurrent/persistent LBP after prior successful lumbar surgical fusion (31 fused levels: single-level fusion-23; two-level fusion-4). PLD response and imaging characteristics at fused and ...

  11. Arteriovenous fistula following lumbar laminectomy

    International Nuclear Information System (INIS)

    A case of iatrogenic aortocaval fistula is presented. The fistula arose from lumbar disc surgery. Its presence was immediately suspected on ultrasound and computed tomogram, and was promptly confirmed by angiography. Ultrasound and computed tomogram also precisely define the anatomy between the aorta or its branches and the IVC or its tributaries. Sudden deterioration of the patient's condition necessitated surgical correction of the fistula before the elected date. The successful corrective operation is described

  12. Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery

    Directory of Open Access Journals (Sweden)

    Ding Zi-hai

    2011-04-01

    Full Text Available Abstract Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH data set were prepared and used in the study. Three-dimensional (3D computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP. All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical operations by its relative position to the lumbar plexus. 3D reconstructions of the lumbar plexus based on VCH data provide a virtual morphological basis for anterior lumbar surgery.

  13. Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

    Science.gov (United States)

    Segers, B; Himpens, J; Barroy, J P

    2007-06-01

    The first retroperitoneal lumbar sympathectomy was performed in 1924 by Julio Diez. The classic procedure for sympathectomy is open surgery. We report a unilateral laparoscopic retroperitoneal approach to perform bilateral lumbar sympathectomy. This approach was performed for a 43-year-old man with distal arterial occlusive disease and no indication for direct revascularization. His predominant symptoms were intermittent claudication at 100 metres and cold legs. The patient was placed in a left lateral decubitus position. The optical system was placed first in an intra-abdominal position to check that the trocars were well positioned in the retroperitoneal space. The dissection of retroperitoneum was performed by CO2 insufflation. The inferior vena cava was reclined and the right sympathetic chain was individualized. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. The aorta was isolated on a vessel loop and careful anterior traction allowed a retro-aortic pre-vertebral approach between the lumbar vessels. The left sympathetic chain was dissected. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. PMID:17685269

  14. Osteomielitis vertebral lumbar / Ostéomyélite vertébrale lombaire / Lumbar vertebral osteomyelitis

    Scientific Electronic Library Online (English)

    Hiralio, Collazo Álvarez; Javier, Pacheco López; Lander, García de Rojas; Juan Pablo, Yandún Quiroz.

    2013-06-01

    Full Text Available Se mostró la terapéutica médica y quirúrgica ante un caso con osteomielitis vertebral secundaria a discectomía, mediante el estudio observacional descriptivo en un paciente de 50 años de edad, afecto de hernia discal del 5to. espacio lumbar, a quien se le había practicado discectomía abierta; que in [...] gresó a los 15 días con un cuadro doloroso lumbar e hipertermia de 39 °C.Se hizo una revisión actualizada del tema de osteomielitis vertebral y se expuso la terapéutica quirúrgica y antimicrobiana realizada al paciente. Luego de desbridamientos quirúrgicos seriados demandantes y secuenciales, así como de irrigación continua, se observó la resolución del cuadro infeccioso y del cuadro radicular que presentaba el paciente. En consulta externa se reflejó la negatividad de las investigaciones analíticas de infección a los 4 meses de evolución. Se concluyó que es importante ante los signos clínicos de infección (dolor, fiebre), realizar una tomografía axial computarizada en un paciente con discectomía abierta, para ver la repercusión ósea y operar lo antes posible. La modalidad de desbridamiento secuencial y demandante con una irrigación continua de solución salina fisiológica 0,9 % con antibiótico sensible al microorganismo, da resultados satisfactorios. Abstract in english Surgical and medical therapy was shown in a case of vertebral osteomyelitis secondary to disectomy by means of a descriptive observational study conducted in a 50 years old patient affected by herniation of the fifth lumbar disk that had undergone open disectomy; who was admitted 15 days after this [...] with a painful lumbar manifestation and hyperthermia of 39 °C. An updated review of the topic of vertebral osteomyelitis was made and the surgical and antimicrobial therapy followed in the patient was shown. After demanding sequential serial surgical debridements with continuous irrigation, the resolution of the infectious and radicular manifestation that the patient presented was observed. The negative impacts of the analytical investigations of infection were presented in the outpatient consultation after four months of evolution. It was concluded that, in the presence of clinical signs of infection such as pain and fever, it is important to indicate a CT-scan to a patient who had undergone open disectomy to observe the osseous percussion and operate on as soon as possible. The modality of demanding sequential serial surgical debridement with continuous irrigation with 0.9 % physiological saline solution and a sensitive antibiotic to the microorganism gives satisfactory results.

  15. Intradural hemangiopericytoma of the lumbar spine

    International Nuclear Information System (INIS)

    Hemangiopericytoma is a rare tumor that can affect the lumbar spine; the intradural location is very infrequent. We report a 54-years-old man with lumbociatic pain during a period of several month, with a diagnosis of lumbar intradural hemangiopericytoma. This case report describes the results obtained by RMI and pathology. (author)

  16. Role of femoral ring allograft in anterior interbody fusion of the spine.

    OpenAIRE

    Chotivichit A; Fujita T.; Wong TH; Kostuik JP; Sieber AN

    2001-01-01

    A review was carried out on 59 patients (10 males and 49 females) who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75). The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in ...

  17. Homeopatía y dolor lumbar / Homeopathy and lumbar pain

    Scientific Electronic Library Online (English)

    Eva María, Castro Morillo; Osmany, Ramos Marrero; Maritza Catalina, Lozano Tarifa; Johann, Perdomo Delgado; Evelyn Annie, González Plá.

    2011-02-01

    Full Text Available El dolor lumbar es una causa frecuente que afecta a los pacientes que acuden a consulta, siendo uno de los más incapacitantes. Prevalece en la población adulta, con mayor incidencia en los mayores de 30 años, pudiendo evolucionar por crisis, o ser constante y resultar temporal, permanente o recidiva [...] nte. En su tratamiento se emplean medicamentos alopáticos, modalidades físicas y diferentes técnicas de medicina natural y tradicional con el objetivo de aliviar el dolor, recuperar o mantener la función, así como evitar su recurrencia. Teniendo en cuenta el desarrollo en los últimos tiempos de la homeopatía, se decidió realizar una revisión bibliográfica con el objetivo de identificar los principales medicamentos homeopáticos susceptibles de ser utilizados en esta entidad según criterios actuales. Abstract in english The lumbar pain is a frequent symptom affecting patients assisting the consultation, and it is one of the most incapacitating. It prevails among the adult population, with a higher incidence in those aged more than 30 years. It may lead to crisis, or may be constant and temporal, permanent or recidi [...] vist. Treating it we use allopathic medicines, physical modalities and different traditional and natural medicine techniques with the objective of alleviating pain, recover or maintain the function, and also avoiding its recurrence. Considering the current development of the homeopathy, we decided to make a bibliographic review to identify the main homeopathic medicines that could be used in this entity according to the current criteria.

  18. Foramen Vertebral Lumbar Inconstante en Bos taurus / Inconstant Lumbar Vertebral Foramen in Bos taurus

    Scientific Electronic Library Online (English)

    Martin, Lima; William, Pérez.

    2007-12-01

    Full Text Available En Anatomía Veterinaria la investigación de los forámenes de la columna vertebral es necesaria para expandir nuestro conocimiento de osteología sistemática, y para el estudio de la vascularización de la columna vertebral y de la médula espinal. El objetivo de este trabajo es informar acerca de la pr [...] esencia y características de forámenes inconstantes hallados en las vértebras lumbares bovinas. Quince de 100 (15 %) vértebras lumbares presentaban forámenes. Todos los forámenes estaban localizados en el cuerpo de la vértebra lumbar sobre su cara lateral derecha. Cuatro de estas vértebras eran la lumbar 2 y tres de ellas la lumbar 5 Abstract in english In Veterinary Anatomy the research of the foramina of the vertebral column is necessary for to expand our knowledge of systematic osteology, and for study of the vascularization of the vertebral column and spinal cord. The objective of this work is to inform about presence and characteristics of inc [...] onstant foramina found in bovine lumbar vertebrae. Fifteen of 100 (15 %) of lumbar vertebrae presented foramina. All foramina were found at the body of lumbar vertebrae on their right lateral face. Four of these vertebrae were lumbar 2 and three of them lumbar 5

  19. DOLOR LUMBAR RELACIONADO AL EMBARAZO

    Scientific Electronic Library Online (English)

    Milan, Munjin L; Francisco, llabaca G; Juan, Rojas B.

    Full Text Available El dolor lumbar ha sido considerado la complicación más frecuente del embarazo, a pesar de ello, su etiopatogenia aún es controvertida. La prevalencia en nuestro medio es desconocida, y el tratamiento se basa para muchos médicos solo en el reposo, medida que no tiene sustento en la literatura. En es [...] ta revisión, nos centramos en la historia clínica, terminología, mecanismos fisiológicos teóricamente implicados, factores de riesgo, prevalencia y proponemos un enfoque de tratamiento del dolor lumbar asociado al embarazo Abstract in english The low back pain has been considered the most frequent complication of pregnancy, despite this fact, etiology and pathophysiology is unclear at present time. The prevalence in our country is unknown, and the treatment is based on in rest-periods for the most physicians, instead literature rationali [...] ty. In our research, based in the literature, we focus in the history, terminology, theoretical physiological mechanism, risk factors, prevalence and we propose pathways for treatment of pregnancy-related low back pain

  20. Anterior column realignment following lateral interbody fusion for sagittal deformity correction.

    Science.gov (United States)

    Pimenta, Luiz; Fortti, Fernanda; Oliveira, Leonardo; Marchi, Luis; Jensen, Rubens; Coutinho, Etevaldo; Amaral, Rodrigo

    2015-07-01

    Degenerative and iatrogenic diseases may lead to loss of lordosis or even kyphotic thoracolumbar deformity and sagittal misalignment. Traditional surgery with three-column osteotomies is associated with important neurologic risks and postoperative morbidity. In a novel technique, the lateral transpsoas interbody fusion (LTIF) is complemented with the sacrifice of the anterior longitudinal ligament and anterior portion of the annulus followed by the insertion of a hyperlordotic interbody cage. This is a less invasive lateral technique named anterior column realignment (ACR) and aims to correct sagittal misalignment in adult spinal deformity (ASD), with or without the addition of minor posterior osteotomies. In this article, we provide an account of the evolution to the ACR technique, the literature, and the Brazilian experience in the treatment of adult spinal deformity with this novel advanced application of LTIF. In the presence of ASD, the risk-to-benefit ratio of a surgical correction must be evaluated. Less invasive surgical strategies can be alternatives to treat the deformity and provide better quality of life to the patient. ACR is an advanced application of lateral transpsoas approach, up to date has shown to be reliable and effective when used for ASD, and may minimize complications and morbidity from traditional surgical procedures. Long-term follow-up and comparative studies are needed to evaluate real benefit. PMID:25971442

  1. Lumbar Hernia: An Unusual Presentation of Bear Maul

    OpenAIRE

    Mubashir Ahmad Shah; Aakib Hamid Charag; Adil Pervaiz Shah; Haroon Rashid Zargar

    2013-01-01

    Introduction: Typical lumbar hernias are very rare surgical conditions. Lumbar hernias can be congenital or acquired. About 25% of all lumbar hernias have a traumatic etiology. Case-Report: We here reported a case of a 55-year-old male who was mauled by a bear. The patient developed an atypical lumbar hernia after 6 months of sustaining craniofacial and abdominal trauma. Open hernioplasty, which was a very challenging job, was done in this patient. Conclusion: Post traumatic lumbar hernias ha...

  2. Estenosis espinal lumbar degenerativa / Degenerative spinal lumbar stenosis

    Scientific Electronic Library Online (English)

    Erick Héctor, Hernández González; Antonio, Puente Álvarez; Gretel, Mosquera Betancourt.

    2013-08-01

    Full Text Available Fundamento: el aumento progresivo de la esperanza de vida viene acompañado de una mayor incidencia de las enfermedades degenerativas del raquis como la estenosis espinal. Objetivo: actualizar y sistematizar los conocimientos sobre la estenosis espinal degenerativa del canal espinal lumbar. Método: s [...] e realizó una revisión de la literatura de los último cinco años. Se insistió en la clasificación, patogenia, diagnóstico y tratamiento. Desarrollo: la estenosis espinal degenerativa del canal lumbar es un desorden multifactorial caracterizado por un estrechamiento del canal vertebral, del receso lateral o de los agujeros de conjunción secundaria a hipertrofia degenerativa y progresiva de cualquiera de las estructuras óseas, cartilaginosas o ligamentosas que culmina en una compresión neurológica y vascular. La claudicación neurogéna es de los síntomas más característicos. El diagnóstico se basa en las mediciones realizadas en las imágenes de tomografía axial computarizada y en la resonancia nuclear magnética. Las opciones terapéuticas incluyen el tratamiento conservador y el quirúrgico, con las técnicas descompresivas convencionales y las de mínima invasión, preferidas en la actualidad. Conclusiones: la estenosis espinal degenerativa es una enfermedad multifactorial. El diagnóstico se fundamenta en la sospecha clínica confirmada en los estudios imagenológicos. Para la elección del tratamiento deben tenerse en cuenta factores relacionados con el paciente, con las características de la estenosis y con la disponibilidad de la tecnología. El objetivo de la cirugía se encaminará a descomprimir las estructuras neurovasculares y respetar la estabilidad del raquis para disminuir la morbilidad posoperatoria. Abstract in english Background: the progressive increase of life expectancy came along with a greater incidence of degenerative diseases of the rachis like spinal stenosis. Objective: to systematize and bring the knowledge about degenerative spinal stenosis of the spinal lumbar channel up to date. Method: a review of t [...] he literature from the last five years was made, making emphasis in the classification, pathogeny, diagnosis, and treatment. Development: degenerative spinal stenosis of the lumbar channel is a multifactorial disorder characterized by a narrowing of the vertebral channel, of the lateral recess, or of the secondary intervertebral foramina, conditions commonly observed in degenerative and progressive hypertrophy of any of the cartilaginous, ligamentous, or osseous structures that ends in a neurologic or vascular squeeze. Neurogenic claudication is one of the most characteristic symptoms. The diagnosis is based on measuring made through the images in the computerized axial tomography and in the nuclear magnetic resonance. The therapeutic options include the conservative treatment and the surgical treatment, with conventional decompressing techniques and the techniques of minimal invasion that are the most used nowadays. Conclusions: degenerative spinal stenosis is a multifactorial disease. The diagnosis is based on the clinical suspicion confirmed through imagenology studies. Some factors related to the patient, to the characteristics of the stenosis, and to the availability of the technology should be taken into consideration for choosing the treatment. The objective of the surgery will be aimed at decompressing the neurovascular structures and keeping the stability of the rachis in order to reduce the postoperative morbidity.

  3. Gonadal dose reduction in lumbar spine radiography

    International Nuclear Information System (INIS)

    Different ways to minimize the gonadal dose in lumbar spine radiography have been studied. Two hundred and fifty lumbar spine radiographs were reviewed to assess the clinical need for lateral L5/S1 projection. Modern film/screen combinations and gonadal shielding of externally scattered radiation play a major role in the reduction of the genetic dose. The number of exposures should be minimized. Our results show that two projections, anteroposterior (AP) and lateral, appear to be sufficient in routine radiography of the lumbar spine. (orig.)

  4. Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

    OpenAIRE

    y?lmaz, tevfik; Turan, Yahya; Gül?en, ?smail; Dalbayrak, Sedat

    2014-01-01

    Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompre...

  5. Nursing care for patients receiving percutaneous lumbar discectomy and intradiscal electrothermal treatment for lumbar disc herniation

    International Nuclear Information System (INIS)

    Objective: To summarize the nursing experience in caring patients with lumbar intervertebral disc herniation who received percutaneous lumbar discectomy (PLD) together with intradiscal electrothermal treatment (IDET) under DSA guidance. Methods: The perioperative nursing care measures carried out in 126 patients with lumbar intervertebral disc herniation who underwent PLD and IDET were retrospectively analyzed. Results: Successful treatment of PLD and IDET was accomplished in 112 cases. Under comprehensive and scientific nursing care and observation, no serious complications occurred. Conclusion: Scientific and proper nursing care is a strong guarantee for a successful surgery and a better recovery in treating lumbar intervertebral disc herniation with PLD and IDET under DSA guidance. (authors)

  6. Migrating lumbar facet joint cysts

    International Nuclear Information System (INIS)

    The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2-L4 spinous process. Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints. (orig.)

  7. Partial Facetectomy for Lumbar Foraminal Stenosis

    OpenAIRE

    Kang, Kevin; Rodriguez-olaverri, Juan Carlos; Schwab, Frank; Hashem, Jenifer; Razi, Afshin; Farcy, Jean Pierre

    2014-01-01

    Background. Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms. Methods. Partial facetectomy...

  8. Fem Modelling of Lumbar Vertebra System

    Directory of Open Access Journals (Sweden)

    Rimantas Ka?ianauskas

    2014-02-01

    Full Text Available The article presents modeling of human lumbar vertebra and it‘sdeformation analysis using finite elements method. The problemof tissue degradation is raised. Using the computer aided modelingwith SolidWorks software the models of lumbar vertebra(L1 and vertebra system L1-L4 were created. The article containssocial and medical problem analysis, description of modelingmethods and the results of deformation test for one vertebramodel and for model of 4 vertebras (L1-L4.

  9. Posteroanterior versus anteroposterior lumbar spine radiology

    International Nuclear Information System (INIS)

    The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae

  10. Posteroanterior versus anteroposterior lumbar spine radiology

    Energy Technology Data Exchange (ETDEWEB)

    Tsuno, M.M.; Shu, G.J. (Cleveland Chiropractic College, Los Angeles, CA (USA))

    1990-03-01

    The posteroanterior view of the lumbar spine has important features including radiation protection and image quality; these have been studied by various investigators. Investigators have shown that sensitive tissues receive less radiation dosage in the posteroanterior view of the spine for scoliosis screening and intracranial tomography without altering the image quality. This paper emphasizes the importance of the radiation safety aspect of the posteroanterior view and shows the improvement in shape distortion in the lumbar vertebrae.

  11. Septic arthritis of a lumbar facet joint

    International Nuclear Information System (INIS)

    Septic arthritis of the posterior lumbar joints is extremely rare. The clinical picture of the unusual site of infection can easily lead to confusion with spondylo-discitis which is more common. We report a case of a 50-year-old women with Staphylococcus aureus septic arthritis of the left L5-S1 lumbar facet joint. CT scan was helpful to establish the diagnosis and to guide the percutaneous needle biopsy. (authors)

  12. Design concepts in lumbar total disc arthroplasty

    OpenAIRE

    Galbusera, Fabio; Bellini, Chiara M.; Zweig, Thomas; Ferguson, Stephen; Raimondi, Manuela T.; Lamartina, Claudio; Brayda-bruno, Marco; Fornari, Maurizio

    2008-01-01

    The implantation of lumbar disc prostheses based on different design concepts is widely accepted. This paper reviews currently available literature studies on the biomechanics of TDA in the lumbar spine, and is targeted at the evaluation of possible relationships between the aims of TDA and the geometrical, mechanical and material properties of the various available disc prostheses. Both theoretical and experimental studies were analyzed, by a PUBMED search (performed in February 2007, revise...

  13. Pigmented villonodular synovitis in lumbar spine

    International Nuclear Information System (INIS)

    Pigmented villonodular synovitis (PVNS) very rarely develops in the lumbar spine. We have found no more than 14 cases in the literature, only three of which were studied by magnetic resonance imaging (MRI). We present a case of PVNS is a lumbar facet joint. The results of imaging studies (including CT myelography and MRI) are described and discussed, and a review of the literature is provided. (Author) 9 refs

  14. Lumbar facet syndrome - Lumbar facet joint injection and low back pain

    International Nuclear Information System (INIS)

    The authors conducted a retrospective study lo evaluate the effectiveness of injection therapy in the lumbar zygapophysial joints with anesthetics and steroids in patients with persisting low back pain and lumbar facer syndrome. Thirty-seven patients with low back pain who reported immediate relief of their pain after controlled blocks into the facet joints between the fourth and fifth lumbar vertebrae and the fifth lumbar and first sacral vertebrae were evaluated. Outcome was evaluated using the visual analog pain scales. All outcome measures were repeated at eight days and six weeks alter controlled injection. At six-week follow-up examination 83,7% of thirty-seven patients experienced a good response to controlled blocks of the lumbar zygaphyseal (facet) joints. Good result is the pain relief of 50% or more. Fifteen patients experienced a good response with pain relief of eight points or more in the VAS

  15. Chordoma of the lumbar spine: a case report / Cordoma de la columna lumbar: caso clínico

    Scientific Electronic Library Online (English)

    H., Tuna; V., Aydin; M., Bozkurt; A., Attar.

    2005-04-01

    Full Text Available Los cordomas son tumores poco frecuentes que pueden presentarse en cualquier parte de la columna vertebral y en el clivus. Sólo un mínimo porcentaje de estos tumores afectan el área lumbar. En este escrito presentamos un caso de cordoma lumbar y discutimos su presentación clínica, radiológica y las [...] opciones de tratamiento. Abstract in english Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of th [...] is chordoma arising from the lumbar vertebra.

  16. Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion

    OpenAIRE

    Ryu, Stephen I.; Lim, Jesse T.; Kim, Sung-Min; Paterno, Josemaria; Kim, Daniel H

    2006-01-01

    Several choices are available for cervical interbody fusion after anterior cervical discectomy. A recent option is dense cancellous allograft (CS) which is characterized by an open-matrix structure that may promote vascularization and cellular penetration during early osseous integration. However, the biomechanical stability of CS should be comparable to that of the tricortical iliac autograft (AG) and fibular allograft (FA) to be an acceptable alternative to these materials. The purpose of t...

  17. Full-endoscopic technique for anterior cervical discectomy and interbody fusion: 5-year follow-up results of 67 cases

    OpenAIRE

    Yao, Nuzhao; Wang, Cheng; Wang, Wenjun; Wang, Lushan

    2010-01-01

    With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362–368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique w...

  18. Descompressão intradiscal lombar percutânea para tratamento de dor discogênica / Percutaneous lumbar disc decompression for treatment of discogenic pain / Descompresión percutánea de disco lumbar para tratar el dolor discogénico

    Scientific Electronic Library Online (English)

    Jonas Lenzi de, Araujo; Pedro Grein, Del Santoro; Henrique, Motizuki; Xavier, Soler i Graells; Ed Marcelo, Zaninelli; Marcel Luiz, Benato.

    Full Text Available OBJETIVO: Relatar a segurança e os desfechos clínicos de procedimentos de descompressão intradiscal percutânea em pacientes com dor discogênica nos quais houve falha do tratamento conservador. Procedimentos cirúrgicos minimamente invasivos são uma tendência de tratamento. METODOS: Estudo retrospecti [...] vo com descrição dos desfechos clínicos de pacientes tratados com NucleoplastyTM e DeKompressorTM, com seguimento de 5 anos. RESULTADOS: Trinta e quatro (n = 34) pacientes foram submetidos a descompressão intradiscal com seguimento mínimo de 5 anos, 21 obtiveram resolução do quadro álgico, 8 foram submetidos a artrodese intersomática lombar, um foi submetido a discectomia cirúrgica e 4 apresentam dor lombar residual. Não ocorreram eventos adversos. CONCLUSÃO: Foi demonstrada a mesma segurança obtida em outros trabalhos que também avaliaram o uso da zona triangular de segurança para procedimentos percutâneos. O índice de sucesso com o procedimento percutâneo assemelha-se a outros estudos mais recentes publicados em uma metanálise. A realização de estudos comparativos, prospectivos e controlados será útil para definir melhor a efetividade dos procedimentos percutâneos. Abstract in spanish OBJETIVO: Informe de la seguridad y los resultados clínicos de los procedimientos de descompresión intradiscal percutánea en pacientes con dolor de origen discal que fracasó el tratamiento conservador. Tratamientos quirúrgicos mínimamente invasivos son una tendencia está OK. METODOS: Estudio retrosp [...] ectivo que describe los resultados clínicos de los pacientes tratados con NucleoplastyTM y DeKompressorTM, con un seguimiento de 5 años. RESULTADOS: Treinta y cuatro (n = 34) pacientes fueron sometidos a descompresión intradiscal y evaluados por período de 5 años, 21 tuvieron la resolución del dolor, 8 se sometieron a artrodesis lumbar intersomática, un paciente fue sometido a una discectomía quirúrgica y 4 tienen dolor lumbar residual. No hubo eventos adversos. CONCLUSIÓN: Se ha demostrado el mismo grado de seguridad alcanzado en otros estudios que también evaluaron el uso de la zona triangular de seguridad para procedimientos percutáneos. La tasa de éxito con el procedimiento percutáneo es similar a otros estudios publicados en un reciente meta-análisis. Los estudios comparativos, prospectivos y controlados serán útiles para definir mejor la eficacia de los procedimientos percutaneous. Abstract in english OBJECTIVE: Report safety and clinical outcomes of percutaneous intradiscal decompression procedures in patients with discogenic pain that failed conservative treatment. Minimally invasive surgical treatments are a trend. METHODS: A retrospective study describing the clinical outcomes of patients tre [...] ated with NucleoplastyTM and DeKompressorTM, with follow up of 5 years. RESULTS: Thirty-four (n=34) patients underwent intradiscal decompression with a follow-up period of 5 years, 21 had resolution of pain, eight underwent lumbar interbody arthrodesis, one underwent surgical discectomy and 4 had residual back pain. There were no adverse events. CONCLUSION: It was demonstrated the same safety obtained in other studies that also evaluated the use of triangular safety zone for percutaneous procedures. The success rate with the percutaneous procedure is similar to other studies published in a recent meta-analysis. The comparative studies, prospective and controlled will be useful to better define the effectiveness of percutaneous procedures.

  19. MR-guided lumbar sympathicolysis

    International Nuclear Information System (INIS)

    The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

  20. Tractography of lumbar nerve roots: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Balbi, Vincent; Budzik, Jean-Francois; Thuc, Vianney le; Cotten, Anne [Hopital Roger Salengro, Service de Radiologie et d' Imagerie musculo-squelettique, Lille Cedex (France); Duhamel, Alain [Universite de Lille 2, UDSL, Lille (France); Bera-Louville, Anne [Service de Rhumatologie, Hopital Roger Salengro, Lille (France)

    2011-06-15

    The aims of this preliminary study were to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and fibre tracking (FT) of the lumbar nerve roots, and to assess potential differences in the DTI parameters of the lumbar nerves between healthy volunteers and patients suffering from disc herniation. Nineteen patients with unilateral sciatica related to posterolateral or foraminal disc herniation and 19 healthy volunteers were enrolled in this study. DTI with tractography of the L5 or S1 nerves was performed. Mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated from tractography images. FA and MD values could be obtained from DTI-FT images in all controls and patients. The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (p=0.0001) and of the nerve roots of volunteers (p=0.0001). MD was significantly higher in compressed nerve roots than in the contralateral nerve root (p=0.0002) and in the nerve roots of volunteers (p=0.04). DTI with tractography of the lumbar nerves is possible. Significant changes in diffusion parameters were found in the compressed lumbar nerves. (orig.)

  1. Dolor lumbar agudo: mecanismos, enfoque y tratamiento

    Directory of Open Access Journals (Sweden)

    Marco Tulio Mahecha Toro

    2009-10-01

    Full Text Available El dolor lumbar agudo tiene un gran impacto socioeconómico a nivel mundial, esto lo constituye en un problema de salud pública. En nuestro país su ocurrencia es muy similar a la de otras latitudes. A lo largo de la historia se ha considerado como un “precio” que debemos pagar los mamíferos bipedestres de importante longevidad. Comparte sus mecanismos fisiopatológicos con los otros tipos de dolor agudo. Sin embargo, en la gran mayoría de los casos, implica un reto determinar su origen patológico estructural exacto. El adecuado enfoque del paciente con lumbalgia aguda, garantiza su adecuado tratamiento. Su diagnóstico requiere de una evaluación clínica exhaustiva, con el fin de clasificarlo en uno de estos tres grupos: dolor lumbar potencialmente asociado a radiculopatía (irradiado, dolor lumbar potencialmente asociado a condición específica (específico o dolor lumbar no específico (simple. Los estudios imagenológicos deben limitarse a los pacientes que tienen signos de alarma, aquellos que no se encuentran en el grupo de lumbalgia inespecífica. La evidencia actual sugiere que el tratamiento farmacológico con Antiinflamatorios no Esteroideos (AINEs y Acetaminofen debe ser el de primera línea en dolor lumbar agudo. Su pronóstico es benigno en la mayoría de los casos.

  2. Economic impact of minimally invasive lumbar surgery

    Science.gov (United States)

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  3. Lumbar hernia associated with chronic obstructive pulmonary disease (COPD)

    OpenAIRE

    Xu, Tao; Zhang, Shuwei; Wang, Huaying; Yu, Wanjun

    2013-01-01

    Lumbar hernias are very rare posterolateral abdominal wall hernias, and they are spontaneous in most adult patients. Here we report two cases of spontaneous lumbar hernias associated with chronic obstructive pulmonary disease (COPD). Some factors such as chronic cough, poor nutritional status and old age in patients with COPD would contribute to lumbar hernia.

  4. Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis: anterior interbody fusion versus expansive laminoplasty

    International Nuclear Information System (INIS)

    Background: there have been many reports about newly developed degenerative changes in the adjacent segments after anterior interbody fusion. It is a controversial issue whether the adjacent-segment disease in patients treated by anterior interbody fusion is the result of progressive cervical spondylosis at the adjacent levels or is caused by the arthrodesis. The aim of this study is to clarify the difference in postoperative effect an the adjacent segments between anterior interbody fusion and expansive laminoplasty. Method: this study included 14 patients who underwent pre- and postoperative MR images at 6 and 12 months. Seven patients underwent cervical interbody fusion and the other 7 patients underwent expansive laminoplasty. Disc degeneration was evaluated semi-quantitatively by calculating the degenerative index (DI) that is a ratio of the intensity in the disc to that in the upper cervical cord. Findings: in the anterior interbody fusion group, the adjacent disc intensities decreased within 12 months (F = 20.42; P < 0.01). The pre-operative mean DI was 0.59 ± 0.16. The post-operative mean DIs were 0.56 ± 0.16 at 6 months and 0.47 ± 0.16 at 12 months. In the expansive laminoplasty group, the signal intensities of both the adjacent discs and the discs within the range of laminoplasty had no serial changes during the same period (F = 2.67; P = 0.09 and F = 0.15; P = 0.87 respectively). Interpretation. Anterior interbody fusion had a significant influence on thusion had a significant influence on the adjacent discs even as soon as 12 months after surgery, but laminoplasty had no influence on them during the same period. (author)

  5. Interlaminar decompression in lumbar canal stenosis.

    Directory of Open Access Journals (Sweden)

    Patond K

    1999-10-01

    Full Text Available Opinion is still divided over a standard surgical procedure to decompress lumbar canal stenosis. Both, laminectomy with or without facetectomy and foraminotomy and interlaminar fenestration have been advocated. In the present communication interlaminar decompression in lumbar canal stenosis has been discussed. Sixteen consecutive patients (7 males and 9 females with clinical, neurological and radiological features of lumbar canal stenosis were treated by interlaminar (fenestration decompression. The age of onset of symptoms ranged between 22-57 years. Adjoining lamina around interlaminar space of involved segment along with ligamentum flavum and part of facet joint (undercutting facetectomy, extending laterally (foraminotomy were removed at single or multiple levels. Follow-up response (93.7% over a period of two and half years showed the results as good in 73.3% and fair in 26.7% of cases, with uniformly uneventful post-operative period.

  6. Side effects after lumbar iohexol myelography

    International Nuclear Information System (INIS)

    Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i.e. anxiety or depression) and pain became less frequent with age. This pattern is similar to that reported after lumbar puncture. Young women without definite clinical signs of nerve root lesions probably have the greatest risk of experiencing side effects after iohexol lumbar myelography. (orig.)

  7. Image quality in conventional lumbar spine radiography

    International Nuclear Information System (INIS)

    Conventional radiography contributes for the majority of examinations in radiology departments. Based on the European Commission Quality Criteria we evaluated the effects on image quality when applying the new post-processing tool Diamond View (Siemens AG Medical Solutions, Germany) to conventional lumbar spine radiographs. 100 digital image pairs in two directions in two planes of lumbar spine radiographs were prospectively evaluated by two radiologists. Statistical analysis was performed with a p-value < .05 considered as significant. Images were evaluated on basis of the modified imaging Quality Criteria by the Commission of the European Communities, rated on a five-point scale. Statistical analysis showed an overall tendency for improved image quality of Diamond View (DV) for all criteria. Significant differences could be found in most of the criteria. Additional phantom analyses supported the advantage of DV. In conclusion DV improves image quality in conventional lumbar spine radiographs.

  8. Adjacent Instability after Instrumented Lumbar Fusion.

    Directory of Open Access Journals (Sweden)

    Wen-Jer Chen

    2003-11-01

    Full Text Available The invention of pedicle screw instrumentation has greatly improved outcomes ofspinal fusion, which has become the treatment of choice for lumbar spondylolisthesis. Asresearchers accumulate experience, both theoretical and clinical advances are continuallybeing reported. A review of the literature and the experience of the authors show that thedevelopment of adjacent instability, as in the breakdown of a neighboring unfixed motionsegment, is a common consequence of an instrumented lumbar spine. This article reviewsthe risk factors and surgical treatment of adjacent instability. The authors believe that properpreoperative planning and complete surgical procedures are imperative to prevent adjacentinstability. For those who need revision surgery, meticulous surgical techniques can achievesatisfactory results.

  9. Lumbar vertebral pedicles: radiologic anatomy and pathology

    International Nuclear Information System (INIS)

    With the advancement of high-resolution computed tomography (CT) scanning the spine has added new knowledge to the various conditions affecting the pedicles. We wish to review the entire spectrum of pedicular lesions: the embryology, normal anatomy, normal variants, pitfalls, congenital anomalies, and pathological conditions are discussed. Different imaging modalities involving CT, isotope bone scanning, and Magnetic Resonance Imaging (MRI) are used to complement plain films of the lumbar spine. This subject review is an excellent source for future reference to lumbar pedicular lesions. 27 references

  10. Lumbar vertebral pedicles: radiologic anatomy and pathology.

    Science.gov (United States)

    Patel, N P; Kumar, R; Kinkhabwala, M; Wengrover, S I

    1988-01-01

    With the advancement of high-resolution computed tomography (CT) scanning the spine has added new knowledge to the various conditions affecting the pedicles. We wish to review the entire spectrum of pedicular lesions: the embryology, normal anatomy, normal variants, pitfalls, congenital anomalies, and pathological conditions are discussed. Different imaging modalities involving CT, isotope bone scanning, and Magnetic Resonance Imaging (MRI) are used to complement plain films of the lumbar spine. This subject review is an excellent source for future reference to lumbar pedicular lesions. PMID:3293918

  11. How frequent is chronic lumbar arachnoiditis following intrathecal Myodil?

    Science.gov (United States)

    Hughes, D G; Isherwood, I

    1992-09-01

    Chronic lumbar arachnoiditis has numerous causes, including the introduction of contrast media into the lumbar subarachnoid space. The oily contrast medium Myodil (iophendylate) is often cited but the true incidence of symptomatic lumbar arachnoiditis due solely to the presence of Myodil is unknown. A retrospective review of 98 patients in whom Myodil was introduced by ventriculography or cisternography, i.e. remote from the lumbar spine, revealed no cases of chronic lumbar arachnoiditis. All patients were monitored closely for periods ranging from 1 to 28 years. We conclude that, in these circumstances, it is rare for Myodil to produce symptomatic arachnoiditis. PMID:1393409

  12. General practitioners' willingness to request plain lumbar spine radiographic examinations

    International Nuclear Information System (INIS)

    Objectives: To examine general practitioners' attitudes to plain lumbar spine radiographic examinations. Design: A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation. Setting: Finland. Subjects: Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group). Results: The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks. Conclusions: General practitioners commonly use plain lumbaral practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination

  13. Foramen Vertebral Lumbar Inconstante en Bos taurus Inconstant Lumbar Vertebral Foramen in Bos taurus

    OpenAIRE

    Martin Lima; William Pérez

    2007-01-01

    En Anatomía Veterinaria la investigación de los forámenes de la columna vertebral es necesaria para expandir nuestro conocimiento de osteología sistemática, y para el estudio de la vascularización de la columna vertebral y de la médula espinal. El objetivo de este trabajo es informar acerca de la presencia y características de forámenes inconstantes hallados en las vértebras lumbares bovinas. Quince de 100 (15 %) vértebras lumbares presentaban forámenes. Todos los forámenes estab...

  14. Effect of Laminectomy on Stability of Lumbar Spine Effect of Laminectomy on Stability of Lumbar Spine

    Directory of Open Access Journals (Sweden)

    Petr Tichy

    2009-12-01

    Full Text Available The paper aims at the presentation of the lumbar spine finite element model used in a study of segmental kinematics including the tissue loading. Lumbar spine FE-model consisting of the three lumbar vertebras, two disc (including annulus and nucleus and vast variety of ligaments. The primary model objective is its verification by experimental test data obtained from cadaver spine segments. A confirmed model was used for a study of various range of laminectomy effect. On this model we simulate a various loading states witch can spine segment arrive at under physiologic conditions (compression, flexion, extension and lateral bending. FE-model could predict the laminectomy impact on the operation approach. The paper aims at the presentation of the lumbar spine finite element model used in a study of segmental kinematics including the tissue loading. Lumbar spine FE-model consisting of the three lumbar vertebras, two disc (including annulus and nucleus and vast variety of ligaments. The primary model objective is its verification by experimental test data obtained from cadaver spine segments. A confirmed model was used for a study of various range of laminectomy effect. On this model we simulate a various loading states witch can spine segment arrive at under physiologic conditions (compression, flexion, extension and lateral bending. FE-model could predict the laminectomy impact on the operation approach.

  15. Computer tomography assisted stereotactic percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Authors presents experiences and results of prospective study of 54 patients operated by technique of computer tomography assisted stereotactic percutaneous lumbar discectomy. New stereotactic instrumentation for percutaneous discectomy is introduced, which was designed by authors. There were no significant per-operative complications in the study group and a good postoperative clinical outcome was achieved. (authors)

  16. [Lumbar pain and bilateral adrenal masses].

    Science.gov (United States)

    García, Elena; Sánchez, Raquel; Martínez, Guillermo; Bernal, Carmen; Calatayud, M; Partida, M; Hawkins, Federico

    2009-05-01

    Many problems may arise when defining whether adrenal lesions are primary to the adrenal glands or represent other tissue, whether they are benign or malignant and whether they are functioning or nonfunctioning. Adrenal imaging complements the clinical and hormonal evaluation of these patients. We present a patient with lumbar pain and bilateral adrenal masses. PMID:19627747

  17. Iliac Arteriovenous Fistula Complicating Lumbar Laminectomy

    OpenAIRE

    Chiariello, Luigi; Marino, Benedetto; Nigri, Antonio; Macrina, Francesco; Ruvolo, Giovanni; Sinatra, Riccardo

    1983-01-01

    An iliac arteriovenous fistula may rarely complicate lumbar laminectomy, particularly at the L4-L5 level. We present such a complication in a 45-year-old man who presented in our institution with a postlaminectomy iliac arteriovenous fistula and severe congestive heart failure. Repair of the fistulous orifice and tubular reconstruction of the iliac artery were successfully performed.

  18. Interexaminer reliability of lumbar segmental mobility tests.

    Science.gov (United States)

    Johansson, Fredrik

    2006-11-01

    The purpose of this study was to investigate the interexaminer reliability of segmental mobility tests for the lumbar flexion and extension movement. Available reliability studies are rare and investigate total segmental mobility through several tests, making the understanding of the effect of each test more difficult. There is also a risk of creating a test situation that has less resemblance to the work situation of physiotherapists if two physiotherapists who have trained and coordinated their manual techniques together in advance are studied. Three physiotherapists with step 2 of the Swedish orthopaedic manual therapy education (OMT) performed one segmental mobility test for lumbar flexion and one for lumbar extension on twenty subjects. They were not permitted to obtain additional information, apart from a standing inspection without movements. The physiotherapists had not worked together, nor did they have a chance to coordinate their manual techniques prior to the examinations. The results showed no interexaminer reliability and suggest that future research is essential if a conclusion about lumbar intersegmental mobility tests is to be reached. PMID:16844402

  19. A case of inferior lumbar hernia

    Directory of Open Access Journals (Sweden)

    Vidhyasagar M. Sharma

    2013-02-01

    Full Text Available In this article we report a case of inferior lumbar hernia. The patient underwent preperitoneal meshplasty. The patient is well on follow up with no recurrence. The relevant literature has been reviewed and management discussed in brief. [Int J Res Med Sci 2013; 1(1.000: 33-35

  20. Role of femoral ring allograft in anterior interbody fusion of the spine.

    Directory of Open Access Journals (Sweden)

    Chotivichit A

    2001-12-01

    Full Text Available A review was carried out on 59 patients (10 males and 49 females who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75. The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in 3, pseudarthrosis after posterior laminectomy and fusion in 35, congenital scoliosis in 3, scoliosis in 2 and paralytic scoliosis due to multiple sclerosis in one. The distribution of levels fused was T12-L1 in 6, L1-2 in 12, L2-3 in 17, L3-4 in 22, L4-5 in 35 and L5-S1 in 39. The remaining 10 levels were in the lower thoracic areas (T7-T12. The operations were performed as anterior fusion alone in 13 patients, one-stage anterior and posterior fusion in 26 patients and two-stage surgery in 20 patients. Anterior instrumentation was used in all 141 levels. At average follow-up (33.7 months there was no significant change in allograft angles (average = 1.6 degrees . Fusion of the allograft was classified by Bridwell's grading system. At 24 months of the follow up, 97 % of the allografts were in grade I (fully incorporated and 3% were in grade II (partially incorporated. Compared to 12 months follow-up only 76.2% of the grafts were in grade I, 28 % were in grade II and 0.8% were in grade III. Two patients had deep posterior infections which required further surgery (without resorption of the allograft anteriorly. One patient had a screw migration anteriorly which required removal. Three patients had persistence of radiolucent line at one of the vertebral end plates - graft interfaces but no subsidence of the graft or pain. In conclusion, the femoral ring allograft appeared to benefit the anterior interbody fusion in complex spinal surgery.

  1. Artrodesis cervical mediante fusión intersomática con hueso autólogo versus espaciador intersomático en discopatía cervical / Cervical arthrodesis by means of interbody fusion with autologous bone and/or interbody spacer for cervical disc disease

    Scientific Electronic Library Online (English)

    JJ, Salvatori-Rubí; AJ, Montiel-Jarquín; RG, Barragán-Hervella; OS, García-Díaz; A, Pacheco-Espinosa; MA, Sánchez-Durán; MI, Domínguez-Cid; MS, Romero-Figueroa; M, García-Carrasco.

    2014-10-01

    Full Text Available El objetivo de este estudio fue comparar los resultados de la artrodesis cervical mediante fusión intersomática con hueso autólogo y/o espaciador intersomático en discopatía cervical. Material y métodos: Estudio comparativo transversal en 49 pacientes tratados quirúrgicamente con artrodesis anterior [...] , en el período Enero 2011 a Diciembre 2011; revisión del expediente clínico. Resultados: Incluimos 49 pacientes de los cuales 20 (40.8%) fueron hombres y 29 (59.2%) mujeres; el diagnóstico en todos fue patología discal (hernia cervical) con uno o dos niveles de afectación; el tiempo quirúrgico promedio fue 69.12, mínimo 53 - máximo 110, ± 19.61 minutos para artrodesis cervical con injerto y promedio 61.18, mínimo 50 - máximo 96.00, ± 11.38 minutos para artrodesis cervical con espaciador intersomático (p = 0.00 t de Student); las características sociodemográficas, clínicas y complicaciones se muestran. Los pacientes operados con ambas técnicas tuvieron una adecuada integración radiológica, p = 0.015 consideramos estadísticamente significativa una p ? a 0.05, ?². Conclusiones: La integración ósea es buena tanto con la aplicación de caja intersomática como con la aplicación de injerto autólogo de cresta iliaca, en pacientes con patología discal cervical. Abstract in english The purpose of this study was to compare the results of cervical arthrodesis performed through interbody fusion with autologous bone and/or interbody spacer for cervical disc disease. Material and methods: Comparative cross-sectional study that included 49 patients who underwent surgery for anterior [...] arthrodesis between January and December 2011, whose clinical records were reviewed. Results: We included 49 patients: 20 (40.8%) males and 29 (59.2%) females. All of them were diagnosed with disc disease (cervical disc herniation) involving one or two levels. Mean operative time was 69.12, with a minimum of 53 and a maximum of 110 ± 19.61 minutes for cervical arthrodesis with a graft. Mean operative time was 61.18 with a minimum of 50 and a maximum of 96.00 ± 11.38 minutes for cervical arthrodesis with an interbody spacer (p = 0.00, Student t test). Patient sociodemographic and clinical characteristics and complications are shown. Patients in whom both surgical techniques were used had appropriate radiological integration, with p = 0.015, considering p ? a 0.05 as significant, ?2. Conclusions: In patients with cervical disc disease bone integration is appropriate with the use of either an interbody cage or an autologous iliac crest graft.

  2. MRI of transforaminal lumbar interbody fusion: imaging appearance with and without the use of human recombinant bone morphogenetic protein-2 (rhBMP-2)

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Michael G.; Goldberg, Judd M.; Gaskin, Cree M.; Barr, Michelle S.; Alford, Bennett [University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Patrie, James T. [University of Virginia, Department of Public Health Sciences, Charlottesville, VA (United States); Shen, Francis H. [University of Virginia, Department of Orthopedic Surgery, Charlottesville, VA (United States)

    2014-09-15

    To describe the vertebral endplate and intervertebral disc space MRI appearance following TLIF, with and without the use of rhBMP-2, and to determine if the appearance is concerning for discitis/osteomyelitis. After institutional review board approval, 116 TLIF assessments performed on 75 patients with rhBMP-2 were retrospectively and independently reviewed by five radiologists and compared to 73 TLIF assessments performed on 45 patients without rhBMP-2. MRIs were evaluated for endplate signal, disc space enhancement, disc space fluid, and abnormal paraspinal soft tissue. Endplate edema-like signal was reported when T1-weighted hypointensity, T2-weighted hyperintensity, and endplate enhancement were present. Subjective concern for discitis/osteomyelitis on MRI was graded on a five-point scale. Generalized estimating equation binomial regression model analysis was performed with findings correlated with rhBMP-2 use, TLIF level, graft type, and days between TLIF and MRI. The rhBMP-2 group demonstrated endplate edema-like signal (OR 5.66; 95 % CI [1.58, 20.24], p = 0.008) and disc space enhancement (OR 2.40; 95 % CI [1.20, 4.80], p = 0.013) more often after adjusting for the TLIF level, graft type, and the number of days following TLIF. Both groups had a similar temporal distribution for endplate edema-like signal but disc space enhancement peaked earlier in the rhBMP-2 group. Disc space fluid was only present in the rhBMP-2 group. Neither group demonstrated abnormal paraspinal soft tissue and discitis/osteomyelitis was not considered likely in any patient. Endplate edema-like signal and disc space enhancement were significantly more frequent and disc space enhancement developed more rapidly following TLIF when rhBMP-2 was utilized. The concern for discitis/osteomyelitis was similar and minimal in both groups. (orig.)

  3. MRI of transforaminal lumbar interbody fusion: imaging appearance with and without the use of human recombinant bone morphogenetic protein-2 (rhBMP-2)

    International Nuclear Information System (INIS)

    To describe the vertebral endplate and intervertebral disc space MRI appearance following TLIF, with and without the use of rhBMP-2, and to determine if the appearance is concerning for discitis/osteomyelitis. After institutional review board approval, 116 TLIF assessments performed on 75 patients with rhBMP-2 were retrospectively and independently reviewed by five radiologists and compared to 73 TLIF assessments performed on 45 patients without rhBMP-2. MRIs were evaluated for endplate signal, disc space enhancement, disc space fluid, and abnormal paraspinal soft tissue. Endplate edema-like signal was reported when T1-weighted hypointensity, T2-weighted hyperintensity, and endplate enhancement were present. Subjective concern for discitis/osteomyelitis on MRI was graded on a five-point scale. Generalized estimating equation binomial regression model analysis was performed with findings correlated with rhBMP-2 use, TLIF level, graft type, and days between TLIF and MRI. The rhBMP-2 group demonstrated endplate edema-like signal (OR 5.66; 95 % CI [1.58, 20.24], p = 0.008) and disc space enhancement (OR 2.40; 95 % CI [1.20, 4.80], p = 0.013) more often after adjusting for the TLIF level, graft type, and the number of days following TLIF. Both groups had a similar temporal distribution for endplate edema-like signal but disc space enhancement peaked earlier in the rhBMP-2 group. Disc space fluid was only present in the rhBMP-2 group. Neither group demonstrated abnormal paraspinal soft tissue and discitis/osteomyelitis was not considered likely in any patient. Endplate edema-like signal and disc space enhancement were significantly more frequent and disc space enhancement developed more rapidly following TLIF when rhBMP-2 was utilized. The concern for discitis/osteomyelitis was similar and minimal in both groups. (orig.)

  4. Medline Plus

    Full Text Available ... Eastside Hospital, Greenville, SC, 07/10/2012) Spinal Stenosis Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson ... University, Portland, OR, 4/20/2011) Stereotactic Radiation Therapy for Brain ... Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson ...

  5. Medline Plus

    Full Text Available ... Doctors Hospital, Coral Gables, FL, 11/27/2012) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ... Tumors (Hartford Hospital, Hartford, CT, 6/21/2007) Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas ...

  6. AVULSION TRAUMÁTICA RADICULAR LUMBAR: CASO CLÍNICO DE INTERÉS / TRAUMATIC LUMBAR NERVE ROOT AVULSION

    Scientific Electronic Library Online (English)

    Miguel Ángel, Lecaros L; Francisco, Ilabaca G; Patricio, Melero D; Ratko, Yurac B; Bartolomé, Marré P; Víctor, Amagada V; Alejandro, Urzúa B; Milan, Munjin L.

    Full Text Available La avulsión traumática de una raíz lumbo-sacra es una lesión poco frecuente que se presenta en asociación con fracturas lumbares y pélvicas o luxaciones de cadera. Se describe un caso clínico de avulsión traumática de la raíz lumbar L1 derecha, en un paciente de 63 años, víctima de un accidente de a [...] lta energía, quien no presentó lesiones asociadas. La resonancia magnética mostró un pseudomeningocele traumático de Ll y el estudio con gadolinio intratecal permitió confirmar el diagnóstico y evaluar la extensión. Luego de 7 meses de evolución, el paciente retornó a sus actividades laborales con mínimas molestias Abstract in english Traumatic lumbosacral nerve root avulsion it's an infrequent injury that appears in association with pelvic and lumbar fractures or hip dislocations. We describe a clinical case of traumatic avulsion at the LI lumbar root in a patient victim of an accident of high energy, without associate injuries. [...] Magnetic resonance demonstrated traumatic pseudomenin-gocele at the LI lumbar root. The use of intrathecal gadolinium allowed us to confirm diagnosis and evaluate extension. Seven months later, patient returns to its labour activities with minimum pain

  7. Characteristics of PMHS Lumbar Motion Segments in Lateral Shear.

    Science.gov (United States)

    Sundararajan, Srini; Prasad, Priya; Rouhana, Stephen W; Demetropoulos, Constantine K; Yang, King H; King, Albert I; Nolte, Lutz P

    2005-11-01

    The purpose of this study was to determine the characteristics of eighteen lumbar spine motion segments subjected to lateral shear forces under quasi-static (0.5 mm/s) and dynamic (500 mm/s) test conditions. The quasi-static test was also performed on the lumbar spine of a side impact anthropomorphic test device, the EuroSID-2 (ES-2). In the quasi-static tests, the maximum force before disc-endplate separation in the PMHS lumbar motion segments was 1850 +/- 612 N, while the average linear stiffness of PMHS lumbar motion segments was 323 +/- 126 N/mm. There was a statistically significant difference between the quasi-static (1850 +/- 612 N) and dynamic (2616 +/- 1151 N) maximum shear forces. The ES-2 lumbar spine (149 N/mm) was more compliant than the PMHS lumbar segments under the quasi-static test condition. PMID:17096282

  8. Importance of greenstick lamina fractures in low lumbar burst fractures

    OpenAIRE

    Ozturk, C.; Ersozlu, S.; AYDINLI, U.

    2006-01-01

    Lumbar burst fractures (L3–L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina frac...

  9. Oriental Medical Treatment of Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2003-12-01

    Full Text Available Lumbar spinal stenosis results from the progressive combined narrowing of the central spinal canal, the neurorecesses, and the neuroforaminal canals. In the absence of prior surgery, tumor, or infection, the spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposis posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins, or a combination of two or more of the above factors. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or other neurologic compromise causes distress. In one case, we administrated oriental medical treatment with acupuncture treatment and herb-medicine. Oriental medical treatment showed desirable effect on lumbar spinal stenosis.

  10. Lumbar spinal stenosis: therapeutic options review.

    Science.gov (United States)

    Costandi, Shrif; Chopko, Bohdan; Mekhail, Mena; Dews, Teresa; Mekhail, Nagy

    2015-01-01

    Lumbar spinal stenosis (LSS) functionally impacts significant numbers of Americans per year. Current estimates place the number of Americans suffering from senescent lumbar spinal stenosis at 400,000. The prevalence of this disorder in patients ranging from 60 to 69 years of age is very high. Forty-seven percent of this age group have mild to moderate stenosis, and 19.7% have severe stenosis. As the baby boomer generation gets older, 10,000 individuals attain the age of 65 years every day in United States. LSS is becoming very common and will be a major healthcare issue as the population ages. Although LSS is not life threatening, it can cause substantial disability with limitations to performing daily activities, and thus, the associated negative impact on quality of life (QOL). This article reviews the pathophysiology and current treatment options for LSS, focusing on evidence-based treatment options. PMID:24725422

  11. CT recognition of lateral lumbar disk herniation

    International Nuclear Information System (INIS)

    Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

  12. Spontaneous Disappearance of Lumbar Synovial Cyst

    Directory of Open Access Journals (Sweden)

    A. Celal IPLIKCIOGLU

    2012-03-01

    Full Text Available Objective: In our case study, we represent that lumbar synovial cysts can disappear spontaneously, therefore conservative treatment techniques could be used before planning for invasive methods.Methods: A synovial cyst is detected with magnetic resonance imaging (MRI in a patient with lumbar region and sciatic nerve pain. Conservative treatment methods are used.Results: Symptoms improved with medication two months after the initial presentation of the patient. A year later MR images demonstrated that the cyst has disappeared. Four year follow up revealed that the lesion did not recur.Conclusion: Synovial cyst for which methods of treatment is listed in the literature, is rare. It is also stated in the literature that lesion can regress spontaneously. A chance for a conservative treatment should be given to the patient.

  13. Synovial chondromatosis in a lumbar apophyseal joint

    International Nuclear Information System (INIS)

    A 31-year-old woman presented with painful swelling in the right paravertebral region that h[ been present for 2 years. R[iography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue. (orig.)

  14. Oriental Medical Treatment of Lumbar Spinal Stenosis

    OpenAIRE

    Hae-Yeon Lee; Tae-Hun Lee; Jung-Han Park; Hyun-Seok Cho; Jae-Jun Lee; Dong-Joo Bae; Kyung-Hwan Kong; Tae-Hyun Baik

    2003-01-01

    Lumbar spinal stenosis results from the progressive combined narrowing of the central spinal canal, the neurorecesses, and the neuroforaminal canals. In the absence of prior surgery, tumor, or infection, the spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposis posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral...

  15. Expansive laminoplasty for lumbar intradural lipoma

    OpenAIRE

    Matsui, H.; Kanamori, M.; Miaki, K.

    1997-01-01

    We evaluated the pre- and postoperative neurological state of 3 patients with lumbar intradural lipoma. Total resection of the lipoma in the cauda equina was impossible, and partial resection and expansive laminoplasty was carried out. Subsequent neural involvement may depend on the duration of symptoms rather than the extent of resection. Expansive laminoplasty is appropriate in these circumstances since decompression is combined with spinal stabilization.

  16. Lumbar myelography in 79 dogs, using different puncture sites

    International Nuclear Information System (INIS)

    Lumbar myelography was performed in 79 dogs either before spinal surgery or as part of an investigation of neurological disease. In small dogs the site of the puncture was between L1 and L5, avoiding the lumbosacral intumescence, whereas in large dogs the site was between T13 and L2. It was found that a lumbar puncture cranial to the lumbar intumescence was easier and caused no problems. The lumbar puncture was unsuccessful in three obese dogs. In 72 per cent of the cases the myelogram revealed a lesion, and the main cause of a non-diagnostic myelogram was epidural leakage

  17. X-Ray parameters of lumbar spine

    Directory of Open Access Journals (Sweden)

    Otabek Ablyazov

    2012-05-01

    Full Text Available Knowledge of anatomic spinal structures, especially its relation-ship to the functions performed, is necessary to form a correct diagnosis. The anatomical structure of the vertebrae varies de-pending on the level of the spinal segment. Normal anatomical parameters, derived from bone structures of the spine, are roughly determined by X-ray method.This paper presents the results of the survey radiography of the lumbar spine in a straight line and lateral projections in 30 individ-uals without pathology spine, aged 21-60 years with frequently observed lumbar spinal stenosis stenosis. Applying X-ray method there were studied shape, height, and the contours of the vertebral bodies and intervertebral disc in the front (interpedicular and sagittal planes; there were measured dimensions of the lumbar canal and foramen holes in the same planes. Using X-ray method can fully identify the bone parameters of vertebral column. How-ever, the informativity of the method depends on knowledge of radiologist about topographic anatomical features of spine.

  18. Skin to posterior lumbar epidural space distance

    International Nuclear Information System (INIS)

    To measure the clinically relevant skin to posterior lumbar epidural space distance in adult surgical patients and to correlate this distance with the patient physical factors to construct a model for the prediction of this distance using the correlation. The study was carried out in 100 patients divided into three groups, who were scheduled for different surgical procedures. Group-I consisted of female patients scheduled for lower segment caesarian section (L.S.C.S); group-II adult non-pregnant females undergoing elective surgery and group-III adult males undergoing different surgical procedures. Epidural anaesthesia was given, using loss of resistance (LOR) technique, and skin to posterior epidural space was measured. The mean skin to posterior lumbar epidural space distance was found to be 3.8 +- 0.5 cm in group-I, 3.76 +- 0.7 cm in group- II and 4.0 +- 0.5 cm in group-III. Skin to posterior epidural space distance correlates best with weight of the patient. Posterior lumbar skin to epidural space distance has been found to be less than what is normal in rest of the world. These results may be used as a guideline for performing successful epidural blocks in Pakistani population. A reliable model using patient physical factors to predict skin to posterior epidural space distance could not be constructed. (author)

  19. Morphometric analysis of lumbar pedicles in degenerative lumbar scoliosis with a cobb angle ?30 degrees

    International Nuclear Information System (INIS)

    The purpose of our study was to assess the asymmetry of lumbar pedicle morphology in degenerative lumbar scoliosis by analyzing the images obtained by multiplanar reconstruction computed tomography (MPR-CT). Eleven patients (88 pedicles) with a Cobb angle ?30 deg who underwent preoperative MPR-CT were the subjects of our study. The morphometric parameters of each pedicle inside the curves were measured. Transverse pedicle width and minimum pedicle diameter on the concave side were significantly smaller than on the convex side, and the axial angle on the concave side was significantly larger than on the convex side. These differences were most evident at L4. We speculated that these asymmetrical changes in the lumbar pedicles were attributable to the remodeling caused by axial load imbalance and the limited space available for pedicles on the concave side. Surgeons should keep these differences in mind and pay attention to screw size and direction when inserting pedicle screws on the concave side. (author)

  20. Lumbar and iliac artery aneurysms in Menkes' disease: endovascular cover stent treatment of the lumbar artery aneurysm.

    Science.gov (United States)

    Adaletli, Ibrahim; Omeroglu, Alp; Kurugoglu, Sebuh; Elicevik, Mehmet; Cantasdemir, Murat; Numan, Furuzan

    2005-10-01

    We report lumbar and iliac artery aneurysms in a 3-month-old boy with Menkes' disease. The iliac artery aneurysm thrombosed spontaneously, documented by follow-up colour Doppler sonography. The lumbar artery aneurysm was successfully treated using a cover stent. There was no filling of the lumbar artery aneurysm and no stenosis of the cover stent during the 9-month follow-up. PMID:15891878

  1. Lumbar and iliac artery aneurysms in Menkes' disease: endovascular cover stent treatment of the lumbar artery aneurysm

    International Nuclear Information System (INIS)

    We report lumbar and iliac artery aneurysms in a 3-month-old boy with Menkes' disease. The iliac artery aneurysm thrombosed spontaneously, documented by follow-up colour Doppler sonography. The lumbar artery aneurysm was successfully treated using a cover stent. There was no filling of the lumbar artery aneurysm and no stenosis of the cover stent during the 9-month follow-up. (orig.)

  2. MRI Evaluation of Lumbar Disc Degenerative Disease

    Science.gov (United States)

    Patel, Rupal; Mehta, Chetan; Patel, Narrotam

    2015-01-01

    Introduction: Lower back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 40 y. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. Aims and Objective: To evaluate the characterization, extent, and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: Cross-sectional and observational study. Materials and Methods: A total 109 patients of the lumbar disc degeneration with age group between 17 to 80 y were diagnosed & studied on 1.5 Tesla Magnetic Resonance Imaging machine. MRI findings like lumbar lordosis, Schmorl’s nodes, decreased disc height, disc annular tear, disc herniation, disc bulge, disc protrusion and disc extrusion were observed. Narrowing of the spinal canal, lateral recess and neural foramen with compression of nerve roots observed. Ligamentum flavum thickening and facetal arthropathy was observed. Result: Males were more commonly affected in Degenerative Spinal Disease & most of the patients show loss of lumbar lordosis. Decreased disc height was common at L5-S1 level. More than one disc involvement was seen per person. L4 – L5 disc was the most commonly involved. Annular disc tear, disc herniation, disc extrusion, narrowing of spinal canal, narrowing of lateral recess, compression of neural foramen, ligamentum flavum thickening and facetal arthropathy was common at the L4 –L5 disc level. Disc buldge was common at L3 – L4 & L4 – L5 disc level. Posterior osteophytes are common at L3 - L4 & L5 –S1 disc level. L1- L2 disc involvement and spondylolisthesis are less common. Conclusion: Lumbar disc degeneration is the most common cause of low back pain. Plain radiograph can be helpful in visualizing gross anatomic changes in the intervertebral disc. But, MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. PMID:26023617

  3. Nervio Femoral Accesorio: Una Variación del Plexo Lumbar / Accessory Femoral Nerve: a Variation of Lumbar Plexus

    Scientific Electronic Library Online (English)

    E, Olave; J. J, Cabezas; A, Soto; O, Binvignat.

    2013-12-01

    Full Text Available Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un ne [...] rvio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Abstract in english Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. Duri [...] ng routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

  4. False aneurysm of a lumbar artery following vertebral biopsy

    OpenAIRE

    Stevens, K. J.; Gregson, R. H.; Kerslake, R. W.

    1997-01-01

    Vertebral body biopsy is regarded as a simple and relatively safe technique, with a low complication rate. We report the case of an 80-year-old man who developed a false aneurysm of a lumbar artery following biopsy of the fourth lumbar vertebra./p

  5. Abdominal aortic pseudoaneurysm caused by lumbar discectomy: case report

    International Nuclear Information System (INIS)

    Vascular injuries which occur during lumbar disk surgery, although rare, can give rise to potentially fatal complications which may be overlooked due to a broad range of clinical manifestations, and which surgeons and radiologists should be aware of. We report a recently encountered case of pseudoaneurysm of the abdominal aorta after lumbar disc surgery, and review the associated literature

  6. Complex radiodiagnosis of the lumbar spine spinal canal stenosis

    International Nuclear Information System (INIS)

    Ultrasound study was done in 67 patients with osteochondrosis of the lumbar spine revealed by x-ray study, magnetic resonance imaging and computed tomography. Ultrasound technique is highly informative in visualizing location, direction, size of the hernia in lumbar osteochondrosis and stenosis of spinal canal

  7. Finite element analysis of the spondylolysis in lumbar spine.

    Science.gov (United States)

    Wang, Jung-Pin; Zhong, Zheng-Cheng; Cheng, Cheng-Kung; Chen, Chen-Sheng; Yu, Chung-hung; Chang, Ting-Kuo; Wei, Shun-Hwa

    2006-01-01

    Spondylolysis is a fracture of the bone lamina in the pars interarticularis and has a high risk of developing spondylolisthesis, as well as traction on the spinal cord and nerve root, leading to spinal disorders or low back pain when the lumbar spine is subjected to high external forces. Previous studies mostly investigated the mechanical changes of the endplate in spondylolysis. However, little attention has been focused on the entire structural changes that occur in spondylolysis. Therefore, the purpose of this study was to evaluate the biomechanical changes in posterior ligaments, disc, endplate, and pars interarticularis between the intact lumbar spine and spondylolysis. A total of three finite element models, namely the intact L2-L4 lumbar spine, lumbar spine with unilateral pars defect and with bilateral pars defect were established using a software ANSYS 6.0. A loading of 10 N.m in flexion, extension, left torsion, right torsion, left lateral bending, and right lateral bending respectively were imposed on the superior surface of the L2 body. The bottom of the L4 vertebral body was completely constrained. The finite element models estimated that the lumbar spine with a unilateral pars defect was able to maintain spinal stability as the intact lumbar spine, but the contralateral pars experienced greater stress. For the lumbar spine with a bilateral pars defect, the rotation angle, the vertebral body displacement, the disc stress, and the endplate stress, was increased more when compared to the intact lumbar spine under extension or torsion. PMID:17075165

  8. Lumbar hernia - a case report and review of the literature

    International Nuclear Information System (INIS)

    The authors present a case of lumbar hernia of inferior right space (Petit's triangle), classified as acquired hernia and diagnosed by clinical history and computed tomography. Lumbar hernia are quite rare. Authors have done a literature review of this disease. (author)

  9. Lumbar artery pseudoaneurysm following percutaneous nephrolithotripsy: Treatment by transcatheter embolization

    OpenAIRE

    Tummala, Venkat; Nanavati, Kunal I.; Yrizarry, Joes M.; Scagnelli, Thomas

    2008-01-01

    Vascular complications from percutaneous nephrostomy/nephrolithotripsy (PCN/PCNL) mostly involve the kidneys. Lumbar artery pseudoaneurysms from PCN and PCNL are a rare occurrence. We report a case of lumbar artery pseudoaneurysm following PCNL. This was treated successfully by transcatheter embolization.

  10. CT features and clinical significance of lumbar articular facet syndrome

    International Nuclear Information System (INIS)

    Objective: To discuss the CT features and its clinical significance of lumbar articular facet syndrome. Methods: Based on CT findings and clinical data of lumbar articular facet, 51 cases with lumbar articular facet syndrome and 11 normal young adults were analyzed and compared retrospectively. Results: The CT findings of lumbar articular facet syndrome were: (1)hyperostosis and hypertrophy of articular process; (2)the narrowing space of inter-articular facet; (3)vacuum sign in articular facet; (4)coarse and osteosclerosis of articular facet; (5)partial dislocation of articular facet; (6)calcification in peri-articular facet; (7)complications including disc bulge, discprotrusion, vacuum sign in disc, hypertrophy and calcification of ligamentum flavum. Conclusion: CT features of lumbar articular facet syndrome are multifarious, which should be analyzed in all respects. . (authors)

  11. Hernia discal lumbar: algunos aspectos del diagnóstico

    Scientific Electronic Library Online (English)

    Rafael, Rivero Torres; Roger, Álvarez Fiallo.

    2004-06-01

    Full Text Available Se realizó un estudio descriptivo y transversal de 133 pacientes con diagnóstico de hernia discal lumbar L4-L5 y L5-S1, para evaluar algunos aspectos del diagnóstico. Más de las 2/3 partes correspondió al sexo masculino, para una relación aproximada de 3:1. En uno y otro sexos los grupos de edades m [...] ás afectados fueron 30-39 y 40-49 años. El síntoma más frecuente fue la lumbalgia (64,7 %); 71 pacientes evolucionaron durante más de un año con los síntomas, 42 entre 6 meses y un año y solo 20 por menos de 6 meses, y en 86 pacientes (63,2 %) en el momento del diagnóstico se comprobaron signos de compresión prolongada. La electromiografía ocupó el lugar cimero en cuanto a positividad de los estudios electrofisiológicos, 74,4 %. Se concluye que el diagnóstico de la enfermedad es tardío y condiciona alteraciones electrofisiológicas de compresión prolongada de mal pronóstico para la rehabilitación. Abstract in english A cross-sectional descriptive study of 133 patients diagnosed with lumbar disc herniation L4-L5 and L5-S1 to evaluate some aspects of the diagnosis. More than two thirds were males for an approximate ratio 3:1. The most affected age groups were 30-39 and 40-49 years in both sexes. The most frequent [...] symptom was lumbar pain (64,7 %); 71 patients progressed with the symptoms for over a year, 42 patients kept symptoms from 6 to 12 months and only 20 kept symptoms for less than 6 months. At the time of diagnosis, signs of prolonged compression were conformed in 86 patients (63,2 %). Electromyography held the first place as far as positive electrophysiological studies are concerned (74,4 %). It was concluded that diagnosis of disease was late and determined electrophysiological alterations of prolonged compression that can not be solved with rehabilitation.

  12. Hernia discal lumbar: algunos aspectos del diagnóstico

    Directory of Open Access Journals (Sweden)

    Rafael Rivero Torres

    2004-06-01

    Full Text Available Se realizó un estudio descriptivo y transversal de 133 pacientes con diagnóstico de hernia discal lumbar L4-L5 y L5-S1, para evaluar algunos aspectos del diagnóstico. Más de las 2/3 partes correspondió al sexo masculino, para una relación aproximada de 3:1. En uno y otro sexos los grupos de edades más afectados fueron 30-39 y 40-49 años. El síntoma más frecuente fue la lumbalgia (64,7 %; 71 pacientes evolucionaron durante más de un año con los síntomas, 42 entre 6 meses y un año y solo 20 por menos de 6 meses, y en 86 pacientes (63,2 % en el momento del diagnóstico se comprobaron signos de compresión prolongada. La electromiografía ocupó el lugar cimero en cuanto a positividad de los estudios electrofisiológicos, 74,4 %. Se concluye que el diagnóstico de la enfermedad es tardío y condiciona alteraciones electrofisiológicas de compresión prolongada de mal pronóstico para la rehabilitación.A cross-sectional descriptive study of 133 patients diagnosed with lumbar disc herniation L4-L5 and L5-S1 to evaluate some aspects of the diagnosis. More than two thirds were males for an approximate ratio 3:1. The most affected age groups were 30-39 and 40-49 years in both sexes. The most frequent symptom was lumbar pain (64,7 %; 71 patients progressed with the symptoms for over a year, 42 patients kept symptoms from 6 to 12 months and only 20 kept symptoms for less than 6 months. At the time of diagnosis, signs of prolonged compression were conformed in 86 patients (63,2 %. Electromyography held the first place as far as positive electrophysiological studies are concerned (74,4 %. It was concluded that diagnosis of disease was late and determined electrophysiological alterations of prolonged compression that can not be solved with rehabilitation.

  13. Limbus lumbar and sacral vertebral fractures.

    Science.gov (United States)

    Mendez, Jorge S; Huete, Isidro L; Tagle, Patricio M

    2002-03-01

    We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases. PMID:11877896

  14. Lumbar spine degenerative disease : effect on bone mineral density measurements in the lumbar spine and femoral neck

    Energy Technology Data Exchange (ETDEWEB)

    Juhng, Seon Kwan [Wonkwang Univ. School of Medicine, Iksan (Korea, Republic of); Koplyay, Peter; Jeffrey Carr, J.; Lenchik, Leon [Wake Forest Univ. School of Medicine, Winston-salem (United States)

    2001-04-01

    To determine the effect of degenerative disease of the lumbar spine on bone mineral density in the lumbar spine and femoral neck. We reviewed radiographs and dual energy x-ray absorptiometry scans of the lumbar spine and hip in 305 Caucasian women with suspected osteoporosis. One hundred and eight-six patient remained after excluding women less than 40 years of age (n=18) and those with hip osteoarthritis, scoliosis, lumbar spine fractures, lumbar spinal instrumentation, hip arthroplasty, metabolic bone disease other than osteoporosis, or medications known to influence bone metabolism (n=101). On the basis of lumbar spine radiographs, those with absent/mild degenerative disease were assigned to the control group and those with moderate/severe degenerative disease to the degenerative group. Spine radiographs were evaluated for degenerative disease by two radiologists working independently; discrepant evaluations were resolved by consensus. Lumbar spine and femoral neck bone mineral density was compared between the two groups. Forty-five (24%) of 186 women were assigned to the degenerative group and 141 (76%) to the control group. IN the degenerative group, mean bone mineral density measured 1.075g/cm? in the spine and 0.788g/cm{sup 2} in the femoral neck, while for controls the corresponding figures were 0.989g/cm{sup 2} and 0.765g/cm{sup 2}. Adjusted for age, weight and height by means of analysis of variance, degenerative disease of the lumbar spine was a significant predictor of increased bone mineral density in the spine (p=0.0001) and femoral neck (p=0.0287). Our results indicate a positive relationship between degenerative disease of the lumbar spine and bone mineral density in the lumbar spine and femoral neck, and suggest that degenerative disease in that region, which leads to an intrinsic increase in bone mineral density in the femoral neck, may be a good negative predictor of osteoporotic hip fractures.

  15. Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

    OpenAIRE

    Wilke, H. - J.; Kettler, A; L Claes

    2000-01-01

    Interbody fusion cages are small hollow implants that are inserted into the intervertebral space to restore physiological disc height and to allow bony fusion. They sometimes cause clinical complications due to instability, subsidence or dislocation. These are basic biomechanical parameters, which influence strongly the quality of a fusion device; however, only few data about these parameters are available. Therefore, the purpose of the present study was to investigate the primary stabilizing...

  16. The vertebral interbody grafting site’s low concentration in osteogenic progenitors can greatly benefit from addition of iliac crest bone marrow

    OpenAIRE

    Romih, Mostafa; Dele?crin, Joe?l; Heymann, Dominique; Passuti, Norbert

    2005-01-01

    The ability of bone substitutes to promote bone fusion is contigent upon the presence of osteoinductive factors in the bone environment at the fusion site. Osteoblast progenitor cells are among these environmental osteoinductive factors, and one of the most abundant and available sources of osteoblastic cells is the bone marrow. As far as biological conditions are concerned, the vertebral interbody space appears as a favorable site for fusion, as it is surrounded by spongy bone, theoretically...

  17. General versus epidural anesthesia for lumbar microdiscectomy.

    Science.gov (United States)

    Ulutas, Murat; Secer, Mehmet; Taskapilioglu, Ozgur; Karadas, Soner; Akyilmaz, Ahmet Aykut; Baydilek, Yunus; Kocamer, Betul; Ozboz, Ayse; Boyaci, Suat

    2015-08-01

    This study was a retrospective analysis of 850 lumbar microdiscectomy (LMD) under epidural anesthesia (EA; n=573) or general anesthesia (GA; n=277) performed by the same surgeon and paid by invoice to the Social Security Institution of the Turkish Republic between April 2003 and May 2013. Although GA is the most frequently used method of anesthesia during LMD, the choice of regional anesthetia (epidural, spinal or a combination of these) differs between surgeons and anesthetists. Studies have reported that EA in surgery for lumbar disc herniation may be more reliable than GA, as it enables the surgeon to communicate with the patient during surgery, but few studies have compared the costs of these two anesthetic methods in LMD. We found that EA patient costs were significantly lower than GA patient costs (p0.05). The anesthetic method used during LMD affected the complication rate, cost and efficiency of operating room use. We suggest that EA is an anesthetic method that can contribute to health care cost savings and enable LMD to be completed with less nerve root manipulation and more comfort, efficacy, reliability and cost efficiency without affecting the success rate of the surgical procedure. PMID:26067543

  18. Computed Tomography of the lumbar facet joints

    International Nuclear Information System (INIS)

    The lumbar facet disease is a frequently overlooked cause of sciatic pain, but the lumbar facet joints are well-recognized source of low back pain and radiating leg pain which can be confused with sciatica due to herniated disc. We measured the angulation of the facet joints on axial spine CT films in 149 cases which contains 41 normal group and 108 abnormal group and studied the relationship between the angulation and degeneration of the facets, the asymmetry of each sided facets and facet degeneration, the asymmetry and disc protrusion, and the asymmetry and annular bulging of the disc. The results were as follows: 1. Facet angulation in abnormal group were more sagittally oriented than the normal group. 2. The angulation of right facet was more sagittally oriented than the left in L4-5 level of abnormal group. 3. Degeneration of facet joints occur asymmetrically, and the more facet joint degenerates, the more it orients sagittally, particularly in L4-5. 4. Asymmetry in facet joint degeneration and unilateral disc protrusion of L5-SI level is greater than the normal group

  19. Repair of the spondylolysis in lumbar spine

    International Nuclear Information System (INIS)

    The objective is to present the surgical experience in the repair of the spondylolysis in lumbar spine. Background: Spodylolysis is an important cause of low back pain in young adults and is responsible for high grade of incapacity. Classically, patients with surgical indications with Spondylolysis have been treated with vertebral arthrodesis arthrodesis, with the following functional lost of the intervened segment and biomechanical overload of the upper contiguous segment. There are not previous reports about repairing of lysis in national literature and international references in this technique are scarce. Materials and methods: Eight patients within 2002-2004 were operated, a direct repairing of the lyses by in situ, fusion and interfragmental osteosynthesis with AO 3.5 mm titanium cortical screws with autogenous bone grafts was achieved. The casuistic was analyzed depending on clinical presentation, consolidation, mobility and vitality of the disc in imaginology studies. Results: During the follow-up a firm fusion in all cases, mobility and vitality preservation of the L5-S1 intervertebral disc was detected. There was neither infection nor neurological deficit. Recommendations: Repairing of spondylolysis in lumbar column, in young symptomatic patients without or with mild lystesis (grade I) and without associated disc damage, is a safe surgical technique

  20. MRI manifestations of lumbar active inflammation in ankylosing spondylitis

    International Nuclear Information System (INIS)

    Objective: To study the MRI manifestations of lumbar active inflammation in ankylosing spondylitis (AS), and its relationship with CT grade of sacroiliitis. Methods: 64 cases of AS accepted lumbar MR scan with sagittal STIR/SPIR and T1-weighted fat suppressed sequences after administration of GD-DTPA. MR manifestations of lumbar active inflammation including active spondylitis, spondylodiskitis, arthritis of the facet joints and enthesitis were studied. Spondylitis was especially analyzed by Berlin method. 40 cases accepted CT scan of sacroiliac joints simultaneously, classed by modified New York criteria. Correlation: analysis was made between lumbar involvement and Berlin method. Results: There were 42 cases of active spondylitis, 6 of spondylodiskitis, 37 of arthritis of the facet joints, 32 of enthesitis in all 64 cases. The positive rate of lumbar involvement in AS was 85.9%. Positive rate of Spondylitis was 65.6%. L1/2 was 34.4%, which accounted for the most in all lumbar vertebral units, but there was not statistically significance between L1/2 and other Vertebral Units (P>0.05). The mean score of L5/S1 was 1.23, which was the highest in vertebral units involved, and there was statistically significance between L5/S1 and T12/L1, L1/2, L2/ 3 (P0.05) between lumbar active inflammation and the CT grades of sacroiliitis. Conclusions: Lumbar involvement of AS is common, mostly manifested as spondylitis, common, mostly manifested as spondylitis, arthritis of the facet joints and enthesitis, with spondylodiskitis the least. In spondylitis, L1/2 is the most. There maybe no correlation between lumbar involvement and degree of spondylitis and grade of sacroiliitis. (authors)

  1. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    International Nuclear Information System (INIS)

    Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

  2. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2009-12-15

    Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

  3. Termocoagulación facetaria lumbar: Experiencia en 252 pacientes / Thermocoagulation of lumbar facet joints: Experience in 252 patients

    Scientific Electronic Library Online (English)

    J. E., Martínez-Suárez; L., Camblor; S., Salva; W. A. de, Jongh.

    2005-10-01

    Full Text Available Se presentan 252 pacientes con el diagnóstico de dolor lumbar facetario a los que se le realizó la técnica quirúrgica de termocoagulación percutánea de la faceta articular. Nuestro propósito principal fue aliviar el dolor en estos pacientes, evaluamos la eficacia de la técnica con un 74,7% de result [...] ados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor. Abstract in english Two hundred fifty two patients with diagnosis of lumbar facet joint pain underwent the surgical technique of percutaneous thermocoagulation of the facet joint. Our major aim was to relief pain in those patients. We assess the effectiveness of the technique, with 74.7% of surgical success, and we als [...] o describe different aspects such as: age, sex, causes and segmentary pain topography.

  4. Termocoagulación facetaria lumbar: Experiencia en 252 pacientes Thermocoagulation of lumbar facet joints: Experience in 252 patients

    Directory of Open Access Journals (Sweden)

    J. E. Martínez-Suárez

    2005-10-01

    Full Text Available Se presentan 252 pacientes con el diagnóstico de dolor lumbar facetario a los que se le realizó la técnica quirúrgica de termocoagulación percutánea de la faceta articular. Nuestro propósito principal fue aliviar el dolor en estos pacientes, evaluamos la eficacia de la técnica con un 74,7% de resultados quirúrgicos satisfactorios, así como la descripción de diferentes aspectos como: edad, sexo, causas y la topografía segmentaria del dolor.Two hundred fifty two patients with diagnosis of lumbar facet joint pain underwent the surgical technique of percutaneous thermocoagulation of the facet joint. Our major aim was to relief pain in those patients. We assess the effectiveness of the technique, with 74.7% of surgical success, and we also describe different aspects such as: age, sex, causes and segmentary pain topography.

  5. Vía lumbar para plastrón apendicular abscedado Lumbar route use for abscess appendicular plastron

    Directory of Open Access Journals (Sweden)

    Luis Pita Armenteros

    2010-06-01

    Full Text Available Se presenta el caso de una paciente de 32 años de edad, con evolución tórpida desde el inicio de su enfermedad. Se intervino quirúrgicamente por presentar un plastrón apendicular abscedado. A pesar de que requirió 2 intervenciones, aparecieron signos flogísticos en la región lumbar derecha. Se practicó una lumbotomía y en la cavidad del absceso en el retroperitoneo se dejó un catéter para clisis de goteo rápido durante el posoperatorio. Luego se destechó dicha cavidad para cierre por segunda intención.This is a case presentation of a woman aged 32 with a torpid course from the onset of her disease. She was operated on due to an abscess appendicular plastron. Despite two surgical interventions there were weak signs in right lumbar zone. A lumbotomy was performed and in abscess cavity in retroperitoneum an indwelling catheter was placed for fast dripping clysis during the postoperative period. Then, this cavity was roofed off for second-look closure.

  6. Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. Technical note.

    Science.gov (United States)

    Watanabe, Kota; Hosoya, Toshihiko; Shiraishi, Tateru; Matsumoto, Morio; Chiba, Kazuhiro; Toyama, Yoshiaki

    2005-11-01

    In conventional laminectomy for lumbar canal stenosis (LCS), intraoperative damage of posterior supporting structures can lead to irreversible atrophy of paraspinal muscles. In 2001, the authors developed a new procedure for lumbar laminectomy, the lumbar spinous process-splitting laminectomy (LSPSL). In this new procedure, the spinous process is split longitudinally in the middle and then divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successfully decompressing nerve tissues, each half of the split spinous process is reapproximated using a strong suture. Thus, the supra- and interspinous ligaments are preserved, as is the spinous process, and damage to the paraspinal muscles is minimal. Eighteen patients with LCS underwent surgery in which this new technique was used. Twenty patients in whom conventional laminectomy was undertaken were chosen as controls. At 2 years, the clinical outcomes (as determined using the Japanese Orthopaedic Association [JOA] scores and recovery rate) and the rate of measured magnetic resonance imaging-documented paravertebral muscle atrophy were evaluated and compared between the two groups. The mean JOA score recovery rates were 67.6 and 59.2%, respectively, for patients treated with LSPSL and conventional laminectomy; the mean rates of paravertebral muscle atrophy were 5.3 and 23.9%, respectively (p = 0.0005). Preservation of posterior supporting structures and satisfactory recovery rate after 2 years indicated that this technique can be a useful alternative to conventional decompression surgery for lumbar canal stenosis. PMID:16302638

  7. Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias / Spinal lumbar stenosis: An update

    Scientific Electronic Library Online (English)

    Marcelo, Molina; Pablo, Wagner; Mauricio, Campos.

    1488-14-01

    Full Text Available [...] Abstract in english Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging di [...] scs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI). Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease.

  8. Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias Spinal lumbar stenosis: An update

    Directory of Open Access Journals (Sweden)

    Marcelo Molina

    2011-11-01

    Full Text Available Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging discs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI. Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease.

  9. Anatomy of Lumbar Interspinous Ligaments: Attachment, Thickness, Fibre Orientation and Biomechanical Importance Anatomía de los Ligamentos Interespinosos Lumbares: Inserción, Grosor, Orientación de las fibras e Importancia Biomecánica

    OpenAIRE

    Niladri Kumar Mahato

    2013-01-01

    Literature related to the study of interspinous ligament in the lumbar region is sparse. Very few studies have elucidated the fibre orientation of this ligament at different lumbar levels. Male (19) and female (6) cadavers were dissected to expose the interspinous ligaments beneath all the lumbar vertebrae. Fibre attachments and directions were observed at all lumbar interspinous spaces. Thicknesses of the ligaments were measured at all levels. Interspinous ligament fibres were found to be or...

  10. Comparación entre Dos Métodos Utilizados para Medir la Curva Lumbar Comparison of Two Method for Measuring the Lumbar Curve

    Directory of Open Access Journals (Sweden)

    F. T. A Yuing

    2010-06-01

    Full Text Available Las alteraciones posturales tales como hiperlordosis, aumento de la cifosis, cifolordosis y escoliosis en columna, producen complicaciones a nivel músculo-esquelético y articular. Debido a esto, es que en el último tiempo ha aumentado el número de atenciones kinésicas por patologías de la columna lumbar, he aquí la importancia de un test clínico que cuente con la confiabilidad necesaria para determinar la curvatura lumbar. El objetivo de este estudio es determinar si existen diferencias en los resultados entre los dos métodos utilizados para medir la curva lumbar: el test clínico de las flechas sagitales y el ángulo de la columna lumbar mediante radiografías. En una muestra de 32 pacientes de edad promedio 44,93 (+/- 12,67 años evaluados en el Servicio de Kinesiología del Centro Médico Megasalud de Viña del Mar entre los meses de Marzo y Agosto del 2008. El procedimiento utilizado fue el examen clínico, en el cual se usó una plomada que va desde C7, pasando por la línea ínterglútea. En el plano sagital se mide la curvatura lumbar a nivel de L3. Para la medición del ángulo de la curvatura lumbar se utilizó una radiografía proyección lateral en la cual se proyectan las mesetas superior de L1 e inferior de L5 para la conformación del ángulo lumbar y su posterior medición. El resultado obtenido por medio del examen clínico entre el test de las flechas sagitales y las radiografías del ángulo de la lordosis lumbar para un índice de concordancia de Kappa, fue mayor o igual a un 95%. De esta manera, se obtuvo que el test de las flechas sagitales es una herramienta válida para la pesquisa de patologías lumbares, al igual que la radiografía, con una marcada diferencia en el costo económico entre ambas.The altered posture, such as hiperlordosis, increase in kyphosis, and scoliosis in cifolordosis column complications occur at the muscular, skeletal and articulate. Because of this, is that in recent times to increase the number of benefits for kinesics pathologies of the lumbar spine, and here the importance of a clinical test that has the confidence necessary to determine lumbar curvature. The objective of the study seeks to determine whether there are differences in outcomes between the two methods used to measure the lumbar curve, the test of the arrows sagitales and the angle of the lumbar spine using x-rays in patients greater than or equal to 21 years, as assessed the service kinesiology of Centro Médico Megasalud of Viña del Mar, between the months of March and August 2008. The procedure used was by means of physical examination, which uses a plumb line that runs from C7 through inter gluteal line in the sagittal plane was measured at the lumbar curvature of L3 and compared with the measurement of the angle curvature of the lumbar measured by radiographic position in bipedal in a side view in 32 adults, measures of kinesiology at the service of the Medical Center Megasalud of Viña del Mar, Chile. The result obtained by means of physical examination between the test of the arrows sagitales versus the angle of the lumbar lordosis measured by X-rays, reached a record of correlation between the two diagnostic tests greater than or equal to 95%. In conclusion we can say that the test of the arrows sagitales is a valid tool for the investigation of lumbar pathologies, like radiography, with a marked difference in cost between the two.

  11. Sciatica caused by lumbar epidural gas

    Science.gov (United States)

    Belfquih, Hatim; El Mostarchid, Brahim; Akhaddar, Ali; Gazzaz, Miloudi; Boucetta, Mohammed

    2014-01-01

    Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. The clinical features are similar to those of common sciatica. CT is very useful in the detection of epidural gas accumulation and nerve root compression. We report a case of symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbo-sacral radiculopathy. A 45-year-old woman suffered from sciatica for 9 months. The condition worsened in recent days. Computed tomography (CT) demonstrated intradiscal vacuum phenomenon, and accumulation of gas in the lumbar epidural space compressing the dural sac and S1 nerve root. After evacuation of the gas, her pain resolved without recurrence. PMID:25422680

  12. [Lumbar disc herniation--diagnosis and treatment].

    Science.gov (United States)

    Corniola, M-V; Tessitore, E; Schaller, K; Gautschi, O P

    2014-12-10

    A lumbar disc herniation (LDH) is a condition frequently encountered in primary care medicine. It may give rise to a compression of one or more nerve roots, which can lead to a nerve root irritation, a so-called radiculopathy, with or without a sensorimotor deficit. The majority of LDHs can be supported by means of a conservative treatment consisting of physical therapy, ergotherapy, analgetics, anti-inflammatory therapy or corticosteroids, which may be eventually administered by infiltrations. If a clinico-radiological correlation is present and moderate neurological deficit appears suddenly, if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during four to six months, surgery is then recommended. PMID:25632633

  13. Upright positional MRI of the lumbar spine

    International Nuclear Information System (INIS)

    Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples

  14. Hérnia discal lombar Lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Luis Roberto Vialle

    2010-01-01

    Full Text Available A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas. O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo.Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3% of the population, and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks. Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less, where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence in the long term.

  15. Hérnia discal lombar / Lumbar disc herniation

    Scientific Electronic Library Online (English)

    Luis Roberto, Vialle; Emiliano Neves, Vialle; Juan Esteban Suárez, Henao; Gustavo, Giraldo.

    Full Text Available A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população) e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática [...] pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas). O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo. Abstract in english Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3% of the population), and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progress [...] ive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks). Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less), where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence in the long term.

  16. 3-dimensional reconstructions of computer tomograms of the lumbar spine

    International Nuclear Information System (INIS)

    In this study, 50 patients were examined by a Siemens 'Somatom Plus'; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondyloarthrosis, with narrowing of the invertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondyloarthrosis with narrowing of the root canals and of the spinal canal. This method of axial CT is superior to conventional radiography of the lumbar spine in the usual two planes. (orig./GDG)

  17. Does myodil introduced for ventriculography lead to symptomatic lumbar arachnoiditis?

    Science.gov (United States)

    Hill, C A; Hunter, J V; Moseley, I F; Kendall, B E

    1992-12-01

    Although there is a substantial body of evidence implicating Myodil or Pantopaque as a cause of lumbar arachnoiditis, assessment of the clinically based evidence is complicated by the additional potentially causative factors present in a high proportion of cases. These include pre-existing spinal pathology, traumatic lumbar puncture and surgery. The aim of this retrospective study was to attempt to ascertain whether Myodil introduced via ventricular catheter was associated with subsequent development of symptomatic lumbar arachnoiditis. In 222 patients in whom clinical records were reviewed there was no excess of back pain following ventriculography compared to the general population. Myodil ventriculography does not appear to be a major cause of symptomatic lumbar arachnoiditis. Several unavoidable problems with the methodology of this study are discussed. PMID:1286419

  18. Bias in the physical examination of patients with lumbar radiculopathy

    OpenAIRE

    Katz Jeffrey N; Hunter David J; Suri Pradeep; Li Ling; Rainville James

    2010-01-01

    Abstract Background No prior studies have examined systematic bias in the musculoskeletal physical examination. The objective of this study was to assess the effects of bias due to prior knowledge of lumbar spine magnetic resonance imaging findings (MRI) on perceived diagnostic accuracy of the physical examination for lumbar radiculopathy. Methods This was a cross-sectional comparison of the performance characteristics of the physical examination with blinding to MRI results (the 'independent...

  19. Arterio-venous fistula following a lumbar disc surgery

    OpenAIRE

    Mulaudzi, Thanyani; Sikhosana, Mbokeleng

    2011-01-01

    Vascular complications during posterior lumbar disc surgery are rare and its presentation with varicose veins is even rarer. A 23 year-old male patient presented with large varicose veins in right lower limb. He underwent a posterior lumbar spine discectomy surgery. He noticed mild swelling of the distal third right lower limb 3 months after index surgery and reported 6 months later when he developed varicose veins. Duplex Doppler confirmed varicose veins of the long saphenous vein and its tr...

  20. Computed tomography in the diagnosis of the lumbar disc herniation

    International Nuclear Information System (INIS)

    In this study, effectiveness of computed tomography (CT) in diagnosing lumbar disc herniation was evaluated. Twenty CT examinations which were interpreted as positive for a herniated disc, and were comfirmed by myelography, were reviewed. In 19 patients, CT demonstrated posterior protrusion of the disc but in one normal disc. Three typical cases were described. This study suggests that CT accurately demonstrates lumbar disc herniation. (author)

  1. Chronic inflammatory demyelinating polyneuropathy mimicking a lumbar spinal stenosis syndrome.

    OpenAIRE

    Ginsberg, L.; Platts, A. D.; Thomas, P. K.

    1995-01-01

    A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) established by biopsy developed cauda equina symptoms due to swelling of the nerve roots in the lumbar spinal canal. Magnetic resonance imaging of the lumbar spine showed profoundly thickened nerve roots from the level of the conus medullaris, filling the caudal thecal sac. Immunosuppressant treatment produced partial clinical and radiological resolution. This case shows that spinal compressive syndromes may occur in acqu...

  2. Factors predicting the outcome following treatment for lumbar spondylolysis

    OpenAIRE

    Debnath, Ujjwal Kanti

    2010-01-01

    Abstract of Study 1 Study design A non –randomised continuous retrospective cross sectional and observational study Objective 1) To evaluate the results of nonoperative treatment of symptomatic lumbar pars stress injuries or spondylolysis in sporting as well as non sporting individuals 2) To determine the factors responsible for non-operative method of managing symptomatic lumbar spondylolysis in young population 3) To evaluate the outcome in different types of...

  3. Human lumbar apophyseal joint damage and intervertebral disc degeneration.

    OpenAIRE

    Swanepoel, M W; Adams, L M; Smeathers, J E

    1995-01-01

    OBJECTIVES--To record the extent and location of lumbar apophyseal cartilage damage, and to ascertain if the extent of damage is correlated with the grade of disc degeneration, age, or both. METHODS--The extent and location of fibrillated areas of the apophyseal cartilage of the joint surfaces of 29 lumbar motion segments were examined using computer aided image processing of Indian ink stained areas, and degeneration of the associated intervertebral discs graded using the method of Nachemson...

  4. Five years’ experience of retroperitoneal lumbar and thoracolumbar surgery

    OpenAIRE

    Hovorka, I.; De Peretti, F.; Damon, F.; Arcamone, H.; Argenson, C.

    2000-01-01

    Retroperitoneal videoscopic spine surgery has been developed in our department since 1994. It has been used not only at the lumbar, but also at the thoracolumbar and lumbosacral level. Thirty-eight patients have been operated on. We have performed 12 thoracolumbar approaches, 23 lumbar approaches, and 3 retroperitoneal lumbosacral approaches. In every case, a video-assisted technique has been employed. These techniques have been used for anterior grafting in 18 cases of fracture, for corporec...

  5. Pathological changes in the lumbar spine of boars.

    OpenAIRE

    Doige, C. E.

    1980-01-01

    Lumbar vertebral columns from 73 boars were examined for pathological changes. While pathological changes were minimal at five months of age, several animals aged seven to 18 months of age had facet asymmetry and large osteophytes surrounding lumbar facets. In the adult group 36% had degeneration of intervertebral discs and 28% had ventrolateral vertebral osteophytes. Lesions characterized by irregular areas of cavitation in the annulus and adjacent vertebral epiphyses were also observed. Of ...

  6. Short fusion versus long fusion for degenerative lumbar scoliosis

    OpenAIRE

    Cho, Kyu-Jung; Suk, Se-Il; Park, Seung-Rim; Kim, Jin-Hyok; Kim, Sung-Soo; Lee, Tong-Joo; MD; Lee, Jeong-Joon; Lee, Jong-Min

    2008-01-01

    The extent of fusion for degenerative lumbar scoliosis has not yet been determined. The purpose of this study was to compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. Fifty patients (mean age 65.5 ± 5.1 years) undergoing decompression and fusion with pedicle screw instrumentation were evaluated. Short fusion was defined as fusion within the deformity, not exceeding the end vertebra. Long fusion was defined as fusion extended above the upper end vert...

  7. Differential involvement of the dorsal and lumbar spine in osteoporosis.

    OpenAIRE

    Bhambhani, M.; Crisp, A. J.; Compston, J. E.

    1992-01-01

    The presence of normal bone density values in the lumbar spine is often assumed to exclude osteoporosis. Eleven cases are reported in which normal lumbar spine bone density and radiology were associated with one or more dorsal spine fractures; the diagnosis was postmenopausal osteoporosis in eight patients and corticosteroid induced osteoporosis in three. These findings suggest that spinal osteoporosis may sometimes be a focal disorder and emphasise the need for dorsal spine radiology in addi...

  8. Lumbar facet anatomy changes in spondylolysis: a comparative skeletal study

    OpenAIRE

    Masharawi, Youssef; Dar, Gali; Peleg, Smadar; Steinberg, Nili; Alperovitch-najenson, Dvora; Salame, Khalil; Hershkovitz, Israel

    2007-01-01

    Opinions differ as to the exact mechanism responsible for spondylolysis (SP) and whether individuals with specific morphological characteristics of the lumbar vertebral neural arch are predisposed to SP. The aim of our study was to reveal the association between SP and the architecture of lumbar articular facets and the inter-facet region. Methods: Using a Microscribe three-dimensional apparatus (Immersion Co., San Jose, CA, USA), length, width and depth of all articular facets and all inter-...

  9. Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study

    Directory of Open Access Journals (Sweden)

    Endres Stefan

    2011-11-01

    Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients in the tranexamic acid group and nine in the control group because of postoperative anemia. Complications associated with the administration of tranexamic acid, e.g. renal failure, deep vein thrombosis or pulmonary embolism did not occur. Conclusions This study suggests a less blood loss when administering tranexamic acid in posterior lumbar spine surgery as demonstrated by the higher postoperative hemoglobin concentration and the less blood loss. But given the relatively small volume of blood loss in the patients of this study it is underpowered to show a difference in transfusion rates.

  10. Single photon emission computed tomography in lumbar degenerative spondylolisthesis

    International Nuclear Information System (INIS)

    Analysis of single photon emission computed tomographic images and plain X-ray films of the lumbar vertebrae was performed in 15 patients with lumbar spondylosis and 15 patients with lumbar degenerative spondylolisthesis. The facet joint and osteophyte images were observed in particular, and the slipping ratio of spondylolisthetic vertebrae was determined. The slipping ratio of degenerative spondylolisthesis ranged from 11.8 % to 22.3 %. Hot uptake of 99mTc-HMDP by both L4-5 facet joints was significantly greater in the patients with degenerative spondylolisthesis than in those with lumbar spondylosis. The hot uptake by the osteophytes in lumbar spondylosis was nearly uniform among the three inferior segments, L3-4, L4-5 and L5-S, but was localized to the spondylolisthetic vertebrae, L4-5, or L5-S, in the patients with spondylolisthesis. Half of the osteophytes with hot uptake were assigned to the 3rd degree of Nathan's grading. It was suggested that stress was localized to the slipping vertebrae and their facet joints in patients with lumbar degenerative spondylolisthesis. (author)

  11. In vivo morphological features of human lumbar discs.

    Science.gov (United States)

    Zhong, Weiye; Driscoll, Sean J; Wu, Minfei; Wang, Shaobai; Liu, Zhan; Cha, Thomas D; Wood, Kirkham B; Li, Guoan

    2014-12-01

    Recent biomechanics studies have revealed distinct kinematic behavior of different lumbar segments. The mechanisms behind these segment-specific biomechanical features are unknown. This study investigated the in vivo geometric characteristics of human lumbar intervertebral discs. Magnetic resonance images of the lumbar spine of 41 young Chinese individuals were acquired. Disc geometry in the sagittal plane was measured for each subject, including the dimensions of the discs, nucleus pulposus (NP), and annulus fibrosus (AF). Segmental lordosis was also measured using the Cobb method.In general, the disc length increased from upper to lower lumbar levels, except that the L4/5 and L5/S1 discs had similar lengths. The L4/5 NP had a height of 8.6±1.3?mm, which was significantly higher than all other levels (Pdisc length, which was significantly less than the NP of the L5/S1 segment (72.4%) (Pdisc length, which was significantly greater than that of the posterior AF (15.6%) (Pdisc, respectively). The height to length (H/L) ratio of the L4/5 NP was 0.45±0.06, which was significantly greater than all other segments (Pdiscs were similar, the geometry of the AF and NP showed segment-dependent properties. These data may provide insight into the understanding of segment-specific biomechanics in the lower lumbar spine. The data could also provide baseline knowledge for the development of segment-specific surgical treatments of lumbar diseases. PMID:25526494

  12. Ruling out Piriformis Syndrome before Diagnosing Lumbar Radiculopathy

    Directory of Open Access Journals (Sweden)

    Chi-Chien Niu

    2009-04-01

    Full Text Available Background: Piriformis syndrome (PS, a rare cause of sciatica, is usually diagnosed onlyafter excluding all other possibilities. But this principle is being challengedbecause of the number of patients with PS who have had ineffective lumbardecompressive surgery after positive findings on image study.Methods: From 2001 to 2004, twelve patients with piriformis syndrome diagnosed byphysical examination were retrospectively enrolled in this study. Indicatorsof piriformis syndrome include a positive Freiberg sign and local tendernessover the piriformis tendon. All patients received local injection of triamcinoloneacetonide and lidocaine into the piriformis tendon. The course ofdiagnosis and treatment was reviewed retrospectively from patient recordsand patient recollections.Results: Of seven (58.3% patients who had positive findings on computed tomography(CT or magnetic resonance imaging (MRI studies of the lumbar spine,four had previously undergone unsuccessful lumbar surgeries but wereresponsive to local injection and three received the injection first. Two ofthose three required no lumbar discectomy thereafter. However, one patientsubsequently underwent lumbar decompression surgery because of failedresponse to the local injection. Three patients had negative CT or MRI findings,and two received no CT or MRI study. According to our diagnosticflowchart for PS, further lumbar surgery was unnecessary for eleven of thetwelve patients at follow-up.Conclusions: According to experience in this series, a Freiberg test and local injectionshould be performed first to rule out PS in patients with unilateral sciatica. Ifsymptoms are relieved by local injection and further physical therapy for PS,unnecessary lumbar surgery can be avoided.

  13. Comparación entre Dos Métodos Utilizados para Medir la Curva Lumbar / Comparison of Two Method for Measuring the Lumbar Curve

    Scientific Electronic Library Online (English)

    F. T. A, Yuing; A. F, Almagià; P. J, Lizana; R. F. J, Rodríguez; D. M, Ivanovic; G. O, Binvignat; L. R, Gallardo; C. F, Nieto; S. A, Verdejo.

    2010-06-01

    Full Text Available Las alteraciones posturales tales como hiperlordosis, aumento de la cifosis, cifolordosis y escoliosis en columna, producen complicaciones a nivel músculo-esquelético y articular. Debido a esto, es que en el último tiempo ha aumentado el número de atenciones kinésicas por patologías de la columna lu [...] mbar, he aquí la importancia de un test clínico que cuente con la confiabilidad necesaria para determinar la curvatura lumbar. El objetivo de este estudio es determinar si existen diferencias en los resultados entre los dos métodos utilizados para medir la curva lumbar: el test clínico de las flechas sagitales y el ángulo de la columna lumbar mediante radiografías. En una muestra de 32 pacientes de edad promedio 44,93 (+/- 12,67 años) evaluados en el Servicio de Kinesiología del Centro Médico Megasalud de Viña del Mar entre los meses de Marzo y Agosto del 2008. El procedimiento utilizado fue el examen clínico, en el cual se usó una plomada que va desde C7, pasando por la línea ínterglútea. En el plano sagital se mide la curvatura lumbar a nivel de L3. Para la medición del ángulo de la curvatura lumbar se utilizó una radiografía proyección lateral en la cual se proyectan las mesetas superior de L1 e inferior de L5 para la conformación del ángulo lumbar y su posterior medición. El resultado obtenido por medio del examen clínico entre el test de las flechas sagitales y las radiografías del ángulo de la lordosis lumbar para un índice de concordancia de Kappa, fue mayor o igual a un 95%. De esta manera, se obtuvo que el test de las flechas sagitales es una herramienta válida para la pesquisa de patologías lumbares, al igual que la radiografía, con una marcada diferencia en el costo económico entre ambas. Abstract in english The altered posture, such as hiperlordosis, increase in kyphosis, and scoliosis in cifolordosis column complications occur at the muscular, skeletal and articulate. Because of this, is that in recent times to increase the number of benefits for kinesics pathologies of the lumbar spine, and here the [...] importance of a clinical test that has the confidence necessary to determine lumbar curvature. The objective of the study seeks to determine whether there are differences in outcomes between the two methods used to measure the lumbar curve, the test of the arrows sagitales and the angle of the lumbar spine using x-rays in patients greater than or equal to 21 years, as assessed the service kinesiology of Centro Médico Megasalud of Viña del Mar, between the months of March and August 2008. The procedure used was by means of physical examination, which uses a plumb line that runs from C7 through inter gluteal line in the sagittal plane was measured at the lumbar curvature of L3 and compared with the measurement of the angle curvature of the lumbar measured by radiographic position in bipedal in a side view in 32 adults, measures of kinesiology at the service of the Medical Center Megasalud of Viña del Mar, Chile. The result obtained by means of physical examination between the test of the arrows sagitales versus the angle of the lumbar lordosis measured by X-rays, reached a record of correlation between the two diagnostic tests greater than or equal to 95%. In conclusion we can say that the test of the arrows sagitales is a valid tool for the investigation of lumbar pathologies, like radiography, with a marked difference in cost between the two.

  14. Transforaminal epidural steroid injection via a preganglionic approach for lumbar spinal stenosis and lumbar discogenic pain with radiculopathy

    OpenAIRE

    Kabatas Serdar; Cansever Tufan; Yilmaz Cem; Kocyigit Ozgen; Coskun Evrim; Demircay Emre; Akar Aykan; Caner Hakan

    2010-01-01

    Background: Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (CLBP) with various degrees of success. Aim: We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs) via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. Materials and Methods: We analyzed the data of 40 patients (February 2008 and April 2009) with...

  15. Comparación entre Dos Métodos Utilizados para Medir la Curva Lumbar Comparison of Two Method for Measuring the Lumbar Curve

    OpenAIRE

    Yuing, F. T. A.; Almagia?, A. F.; Lizana, P. J.; Rodri?guez, R. F. J.; Ivanovic, D. M.; Binvignat, G. O.; Gallardo, L. R.; Nieto, C. F.; Verdejo, S. A.

    2010-01-01

    Las alteraciones posturales tales como hiperlordosis, aumento de la cifosis, cifolordosis y escoliosis en columna, producen complicaciones a nivel músculo-esquelético y articular. Debido a esto, es que en el último tiempo ha aumentado el número de atenciones kinésicas por patologías de la columna lumbar, he aquí la importancia de un test clínico que cuente con la confiabilidad necesaria para determinar la curvatura lumbar. El objetivo de este estudio es determinar si existen diferenci...

  16. Outcome after surgical treatment for lumbar spinal stenosis: the lumbar extension test is not a predictive factor

    DEFF Research Database (Denmark)

    Westergaard, Lars; Hauerberg, John

    2009-01-01

    STUDY DESIGN: A prospective clinical study. OBJECTIVES: To investigate the predictive value of the lumbar extension test for outcome after surgical treatment of lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: Studies have indicated that aggravation of the symptoms from LSS by extension of the lumbar spine has predictive value for the outcome after decompression. The aim of this study was to investigate this theory in a larger group of patients. METHODS: One hundred forty-six consecutive patients surgically treated for LSS were included in the study. The clinical condition was recorded before surgery and at 3, 6, 12, and 24 months after surgery using 3 different scoring systems: Swiss Spinal Stenosis Questionnaire, Neurogenic Claudication Outcome Score, and Oswestry Disability Index. The group of patients with preoperative aggravation of the symptoms by the lumbar extension test, (positive extension test), was compared with the group of patients without aggravation by the test, (negative extension test). RESULTS: Before surgery, patients with a positive extension test scored significantly worse on all disability scoring systems than patients with a negative test. However, the extension test itself had no prognostic value for the overall outcome after lumbar decompression. Using regression models with the 2-year Oswestry Disability Index as dependent variable, only before surgery self-reported health and age were found to have prognostic significance. CONCLUSION: The lumbar extension test has no predictive value for the outcome after surgical treatment of LSS.

  17. Biomechanical effect of altered lumbar lordosis on intervertebral lumbar joints during the golf swing: a simulation study.

    Science.gov (United States)

    Bae, Tae Soo; Cho, Woong; Kim, Kwon Hee; Chae, Soo Won

    2014-11-01

    Although the lumbar spine region is the most common site of injury in golfers, little research has been done on intervertebral loads in relation to the anatomical-morphological differences in the region. This study aimed to examine the biomechanical effects of anatomical-morphological differences in the lumbar lordosis on the lumbar spinal joints during a golf swing. The golf swing motions of ten professional golfers were analyzed. Using a subject-specific 3D musculoskeletal system model, inverse dynamic analyses were performed to compare the intervertebral load, the load on the lumbar spine, and the load in each swing phase. In the intervertebral load, the value was the highest at the L5-S1 and gradually decreased toward the T12. In each lumbar spine model, the load value was the greatest on the kypholordosis (KPL) followed by normal lordosis (NRL), hypolordosis (HPL), and excessive lordosis (EXL) before the impact phase. However, results after the follow-through (FT) phase were shown in reverse order. Finally, the load in each swing phase was greatest during the FT phase in all the lumbar spine models. The findings can be utilized in the training and rehabilitation of golfers to help reduce the risk of injury by considering individual anatomical-morphological characteristics. PMID:25162173

  18. ABSCESO EPIDURAL LUMBAR POST HERNIA DISCAL TRAUMÁTICA: CASO CLÍNICO Lumbar epidural abscess secondary to traumatic disk herniation: A case report

    Directory of Open Access Journals (Sweden)

    Carlos Sajama l

    2009-01-01

    Full Text Available Se presenta el caso de un hombre de 42 años con historia de trauma y compresión axial de la columna lumbar que originó una hernia de núcleo pulposo a nivel lumbar, demostrada mediante resonancia magnética. Al cuarto dta de evolución aparece fiebre y alteraciones de laboratorio concordantes con infección, sin signos de compromiso neurológico. El hemocultivo resulta positivo para staphylococcus aureus. La resonancia magnética demuestra presencia de absceso espinal lumbar, que impresiona secundario a hematoma epidural infectado. El paciente es tratado médicamente, con antibioticoterapia que incluye inicial mente ceftriaxona/ metronidazol/ gentamicina y posteriormente cloxacilina/cefazotina, con buena evolución, completando 6 semanas por vta endovenosa y 4 vta oral. Su evolución fue favorable, siendo dado de alta en buenas condiciones y sin déficit neurológico.We report the case of a 42-year-old male patient presenting with trauma history and lumbar spine axial compression which caused a herniated nucleus pulposus at lumbar level, revealed through MRI. After a four-day evolution period, fever and laboratory alterations indicative otan infectious process appear without signs of neurologic involvement. Hemoculture was positive for Staphylococcus aureus and MRI showed the presence of a lumbar spinal abscess secondary to infected epidural hematoma. The patient was treated with antibiotics, being given ceftriaxone, metronidazol, and gentamicin as an initial theraphy switched subsecuently to cloxaciline and cefazoline, He showed a favourable evolution, completing a six-week period of endovenous treatment plus fourweeks receiving oral therapy The patient was discharged in good condition with no neurologic deficit.

  19. Comparison of lumbar repositioning error according to different lumbar angles in a flexion pattern (FP) subgroup of patients with non-specific chronic low back pain.

    Science.gov (United States)

    Noh, Kyung-Hee; Oh, Jae-Seop; Yoo, Won-Gyu

    2015-01-01

    [Purpose] This study determined the change in lumbar position sense according to lumbar angles in a flexion pattern (FP) subgroup of patients with non-specific chronic low back pain (NCSLBP). [Subjects] Thirteen subjects with FP low back pain participated. [Methods] The lumbar repositioning error (RE) of subjects was measured between a neutral starting position and re-position phases at three angles, in sitting and standing upright positions. [Results] Lumbar RE was significantly greater during lumbar flexion at a 30° angle in the sitting position than in the other tasks. [Conclusion] In the flexion-related subgroup, the lumbar RE measurement may be a more sensitive evaluation method using a lumbar flexion angle of 30° while in the sitting position, compared with other angles in sitting or standing positions. PMID:25642094

  20. Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

    Directory of Open Access Journals (Sweden)

    Manchikanti L

    2012-08-01

    Full Text Available Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati,1 Ramsin Benyamin3,41Pain Management Center of Paducah, Paducah, KY; 2University of Louisville, Louisville, KY; 3Millennium Pain Center, Bloomington, IL; 4University of Illinois, Urbana-Champaign, IL, USAAbstract: Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures, the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source.Keywords: lumbar disc herniation, axial or discogenic pain, lumbar interlaminar epidural injections, local anesthetic, steroids, controlled comparative local anesthetic blocks, NCT00681447

  1. Resultados de cirugía de la estenosis degenerativa del canal vertebral lumbar / Surgical results of degenerative lumbar spinal canal stenosis

    Scientific Electronic Library Online (English)

    Erick Héctor, Hernández González; Antonio, Puentes Álvarez; Gretell, Mosquera Betancourt.

    2013-04-01

    Full Text Available Fundamento: la estenosis lumbar es el estrechamiento del canal vertebral, el receso lateral o del canal de la raíz, de causa congénita o adquirida. Su prevalencia en Cuba está por el orden del 6 % de la población y es una de las principales causas de dolor lumbar o lumbociático de los pacientes mayo [...] res de 40 años. Objetivo: caracterizar los resultados del tratamiento quirúrgico de la estenosis degenerativa del canal vertebral lumbar en el Hospital Universitario Provincial Amalia Simoni de Camagüey. Método: se realizó un estudio prospectivo y descriptivo en el período comprendido entre enero de 2009 a septiembre de 2011, en una muestra no probabilística de 27 pacientes seleccionados según criterios de inclusión y exclusión. Se emplearon técnicas de estadística descriptiva para el análisis de los datos. Resultados: mayor incidencia en el sexo masculino, en las edades comprendidas entre 60-69 años. Las estenosis monosegmentarias fueron las más frecuentes, con mayor afectación del cuarto y quinto segmento lumbar. Luego de aplicadas las técnicas quirúrgicas los pacientes estudiados mejoraron de discapacidad a limitación funcional mínima en el grupo de descompresión pura y a moderada en el grupo de descompresión más estabilización. El dolor posquirúrgico se presentó como la principal complicación, seguido de la infección de la herida quirúrgica. Conclusiones: el tratamiento quirúrgico de la estenosis degenerativa del canal lumbar mejora el estado clínico de los pacientes con poca morbilidad asociada Abstract in english Background: lumbar spinal stenosis is the narrowing of the spinal canal, lateral recess and root canal, of congenital or acquired cause. Its prevalence in Cuba is about 6 % of the population and it is one of the main causes of lumbar or sciatic pain in adults over 40 years. Objective: to characteriz [...] e the results of the surgical treatment in degenerative lumbar spinal stenosis at the University Hospital Amalia Simoni in Camagüey. Method: a prospective and descriptive study was conducted from January 2009 to September 2011 in a non-probabilistic sample of 27 patients selected according to inclusion and exclusion criteria. For data analysis, descriptive statistics techniques were used. Results: a greater incidence in males between 60-69 years old was obtained. Monosegmentary stenoses were more frequent and the fourth and fifth lumbar segment the most affected. After surgical techniques were applied, the studied patients improved from disability to minimal functional limitation in the group of pure decompression and moderate functional limitation in the group of decompression and stabilization. Postoperative pain and infection of surgical wound were the most common complications. Conclusions: the surgical treatment of degenerative lumbar spinal stenosis improved the clinical status of patients with low comorbidity

  2. Computed tomography in lumbar degenerative disease

    International Nuclear Information System (INIS)

    We reported the 18 patients which underwent surgical exploration and reviewed these CT findings. Method All CT scans were obtained on Somatom II, high resolution CT scanner, with the patient in the supine position. A lateral localizer image (Topogram) was used to select the appropriate intervertebral disk space. The slice thickness was 4 mm. Results 1) CT findings in lumbar degenerative diseases include bony canal stenosis (central canal stenosis, narrowed lateral recess), soft tissue abnormalities (herniated nucleus pulposus, bulging annulus, hypertrophy and/or ossification of ligamentum flavum, no delineation of nerve root in lateral recess), and spinal instability (spondylolisthesis, vacuum phenomenon). 2) The above three factors contribute to narrowing of spinal canal. 3) No delineation of nerve root or soft tissue replacement of epidural fat in lateral recess suggests that the nerve root may be compressed by some factors. 4) Herniated nucleus pulposus may cause nerve root compression with or without canal stenosis. Conclusion This study revealed that the CT findings correlated closely with the surgical findings and the site of nerve root compression could be determined. (author)

  3. Vía lumbar para plastrón apendicular abscedado / Lumbar route use for abscess appendicular plastron

    Scientific Electronic Library Online (English)

    Luis, Pita Armenteros; Joel, González Salcedo; Emilio, Pérez Jomarrón; Ignacio, Morales Díaz.

    2010-06-01

    Full Text Available Se presenta el caso de una paciente de 32 años de edad, con evolución tórpida desde el inicio de su enfermedad. Se intervino quirúrgicamente por presentar un plastrón apendicular abscedado. A pesar de que requirió 2 intervenciones, aparecieron signos flogísticos en la región lumbar derecha. Se pract [...] icó una lumbotomía y en la cavidad del absceso en el retroperitoneo se dejó un catéter para clisis de goteo rápido durante el posoperatorio. Luego se destechó dicha cavidad para cierre por segunda intención. Abstract in english This is a case presentation of a woman aged 32 with a torpid course from the onset of her disease. She was operated on due to an abscess appendicular plastron. Despite two surgical interventions there were weak signs in right lumbar zone. A lumbotomy was performed and in abscess cavity in retroperit [...] oneum an indwelling catheter was placed for fast dripping clysis during the postoperative period. Then, this cavity was roofed off for second-look closure.

  4. REHABILITATION THERAPY VERSUS DRUG THERAPY IN PATIENTS WITH LUMBAR DISC DEGENERATION

    OpenAIRE

    Broscatean, Emanuela-flavia; Dogaru, Gabriela

    2013-01-01

    Lumbar disc degeneration is a disorder whose clinical manifestations are represented by episodic pain in the lumbar spine, without lumbar blockage and minor muscle contraction. Because lumbalgia caused by lumbar disc degeneration is not always very high intensity pain, the easiest to apply treatment is drug therapy. The aim of this study was to analyze the potential role of rehabilitation treatment in the recovery of patients and the prevention of complications compared to drug therapy alone....

  5. Endoscopic lumbar sympathectomy for women: effect on compensatory sweat

    Scientific Electronic Library Online (English)

    Marcelo de Paula, Loureiro; José Ribas Milanez de, Campos; Paulo, Kauffman; Fábio Biscegli, Jatene; Sheila, Weigmann; Aline, Fontana.

    Full Text Available INTRODUCTION: Plantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new min [...] imally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20%) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3%). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p

  6. Short-term alendronate treatment does not maintain a residual effect on spinal fusion with interbody devices and bone graft after treatment withdrawal : an experimental study on spinal fusion in pigs

    DEFF Research Database (Denmark)

    Huang, Baoding; Zou, Xuenong

    2013-01-01

    Whether alendronate treatment has a residual effect on bone ingrowth into porous biomaterial in humans or experimental animals after treatment withdrawal is still unknown. The purpose of this study was to investigate bone ingrowth into porous tantalum and carbon fiber interbody implants after discontinuing alendronate treatment in experimental spinal fusion in pigs.

  7. CT scanning versus myelography in the diagnosis of lumbar stenosis

    International Nuclear Information System (INIS)

    To assess the diagnostic accuracy of CT scanning in lumbar stenosis, twenty-nine patients in whom water-soluble myelography showed degenerative bony encroachment or suggested developmental narrowing of the spinal canal were scanned at all lumbar levels, and CT images were compared with myelographic findings. In developmental stenosis computerised tomography was found to be less accurate than water-soluble myelography, whereas in most cases of degenerative stenosis CT findings correlated well with myelographic patterns. An intermediate accuracy index was found in combined stenosis. In central degenerative encroachment of the spinal canal surgical treatment may be undertaken on the basis of CT findings. In the preoperative evaluation of the other types of lumbar stenosis CT scanning with 8-mm thick slices represents a useful adjunct to myelography, but cannot replace this investigation. (orig.)

  8. CT-guided epidural steroid injections in lumbar spinal stenosis

    International Nuclear Information System (INIS)

    Objective: To identify the short and long-term therapeutic benefits of CT-guided transforaminal epidural steroid injections in lumbar spinal stenosis. Methods: Thirty six patients with lumbar spinal stenosis shown by CT underwent CT-guided transforaminal epidural steroid injections because of irresponsible to conservative treatment. Patients were evaluated by visual analogue scale (VAS) before the initial injection, at 2 weeks and 1 year after the injection. Results: All patients were followed up for 2 weeks and 1 year. 19 (52.8%) patients had successful short-term outcome, and 15(41.6%) had long-term outcome. 15(41.6%) patients satisfied with the short-term result and 12(33.3%) were satisfactory with the long-term result. Conclusions: CT-guided transforaminal epidural steroid injection may reduce the pain and improve the quality of life in some patients with lumbar spinal stenosis. (authors)

  9. Lumbar disc herniation in a 9-year-old child

    Scientific Electronic Library Online (English)

    M, Lukhele; Z, Mayet; B, Dube.

    Full Text Available Lumbar disc herniation is very uncommon in children under the age of 10 years. We report on a lumbar disc herniation in a 9 year old. The patient presented with spontaneous onset of back pain and right leg pain which had failed to respond to 6 months of conservative treatment at a primary health car [...] e facility. Examination revealed severe lumbar back muscle spasm, listing of the spine to the left and a positive straight leg raising test on the right. The child had weakness of the right big toe extension. Magnetic resonance imaging (MRI) confirmed a disc prolapsed at L4L5 compressing the traversing right nerve root of L5. A standard discectomy followed by rehabilitation was performed after a further 2 weeks of observation. The muscle spasm and listing together with the right big toe motor weakness disappeared post operation. At 3 months follow-up he was back into his school activities.

  10. A Case of Epidural Lipomatosis With Lumbar Canal Stenosis

    Directory of Open Access Journals (Sweden)

    A. Celal IPLIKCIOGLU

    2012-06-01

    Full Text Available Objective: Idiopathic symptomatic spinal epidural lipomatosis is not a common clinical condition. There are a few cases reported in the literature discussing the magnetic resonance imaging (MRI findings of epidural lipomatosis. Characteristic imaging findings of this clinical condition is represented.Methods: Evaluation of epidural fat and thecal sac is ideal with MRI. Involved vertebra level is seen optimal as well. Literature suggests decompressive surgery with fat debulking for symptomatic relief for patients with neurological deficits diagnosed with epidural lipomatosis and lumbar canal stenosis if conservative therapy fails to respond.Results: A severe case of spinal epidural lipomatosis with lumbar canal stenosis is presented. Characteristic MRI and CT findings of lumbar canal degeneration, dural sac compression, deformity and significant fat deposition are demonstrated.Conclusion: Epidural lipomatosis may cause neurological complications and deficits such as neurogenic claudication or radicular symptoms. Weight reduction should be attempted for symptomatic relief. Symptoms and neurological findings should determine therapeutic paradigm.

  11. Electrodiagnosis in Lumbar Spinal Stenosis: A Review

    Directory of Open Access Journals (Sweden)

    Stephen K?shner

    2010-06-01

    Full Text Available Lumbar spinal stenosis (LSS is a narrowing of the spinal canal and/or the neuroforamina through which the spinal cord roots enter and exit. The symptoms of LSS usually begin over the course of several months and include neurogenic claudication. This is characterized by low back pain that radiates down one or both legs producing pain or weakness. LSS can be quite debilitating and can have a profound negative effect on one’s activities of daily living and overall quality of life. Imaging studies, such as computed tomography (CT and magnetic resonance imaging (MRI are routinely performed in the work-up of suspected LSS. In recent years, there has been much controversy over the actual clinical usefulness of these studies. When compared to electrodiagnostic studies, CT and MRI have been shown to have increased false negative and false positive rates. Electrodiagnostic studies show dynamic physiological neural function and has become a valuable tool in LSS. This information can be used to determine the location and severity of LSS, differentiate LSS from other conditions, and monitor the progression. Electrodiagnostic techniques such as somatosensory evoked potentials, dermatomal somatosensory evoked potentials (DSEPs, and paraspinal mapping (PM increase both the sensitivity and specificity in diagnosing LSS. DSEPs provide useful information on multi-level, multiple rootlet disease. PM reflects the physiology of nerve roots and has been found to be superior to extremity needle EMG. Electrodiagnostic techniques are becoming the standard in the diagnosis and therapeutic decisions for LSS and other related diseases.Turk J Phys Med Rehab 2010;56:75-80.

  12. Lumbo-Costo-Vertebral Syndrome with Congenital Lumbar Hernia

    Directory of Open Access Journals (Sweden)

    Lucky Gupta

    2014-02-01

    Full Text Available Lumbo-costo-vertebral syndrome (LCVS is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

  13. Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

    Science.gov (United States)

    Gupta, Lucky; Mala, Tariq Ahmed; Gupta, Rahul; Malla, Shahid Amin

    2014-01-01

    Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done. PMID:24834386

  14. Spontaneous ligamentum flavum hematoma in the lumbar spine

    International Nuclear Information System (INIS)

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  15. Application of percutaneous endoscopic RF/holmium laser lumbar discectomy in the lumbar disc herniation (attach 160 cases reported)

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy of endoscopic discectomy for the lumbar disc herniation and to determine the prognostic factors affecting surgical outcome. Methods: In the group of 160 cases, posterolateral and trans-interlaminar endoscopic Ho: YAG laser and radio frequency-assisted disc excisions were performed under local anesthesia. Results: In 160 patients with post-surgical follow-up period was 15 months on average (7 ? 24 months). Based on the MacNab criteria, there were 117 cases in which result was excellent, in 19 cases good, in 12 cases fair, and in 12 cases poor, and successful rate was 85%. Conclusion: Percutaneous endoscopy lumbar discectomy is effective for recurrent disc herniation in the selected. In applies in particular to the traditional open surgery of lumbar disc herniation in patients with recurrent. (authors)

  16. Imaging Characterization Lumbar Disk Hernia in Operated patients. Caracterización por imaginología de la hernia discal lumbar en pacientes operados.

    Directory of Open Access Journals (Sweden)

    Félix Dueñas Ros

    2009-07-01

    Full Text Available Background: The details of lumbar disk hernia are specifically described in imaging studies, which leads to very specific diagnosis contributing to its appropriate treatment. Objective: To characterize through imaging studies the lumbar disk hernia in operated patients. Methods: Descriptive observational, correlational, retrospective study of a series of cases, carried out in the University Hospital “Dr. Gustavo Aldereguía Lima” of Cienfuegos, from 2000 to 2005, including all the patients who required imaging studies for a suspect of lumbar disk hernia, who received surgical treatment in that institution. The available imaging means were used: spine simple radiography in lumbar area, myelography and computerized axial tomography. Results: Males were more affected by lumbar disk hernia. The most common sings observed through spine simple radiography in lumbar area were: decrease of the intervertebral space and arthrosic changes in the vertebral bodies. Myelography was performed in six patients and three of them were positive. The most common kind of hernia according with their localization was the lateral, and according with the amount of herniated material, the protruded hernia. The most affected spaces were: L5- S1 and L4-L5. The patients of the third and fourth decade of life were the most affected, with a prevalence of the protruded hernia in the L5-S1 y L4 -L5 spaces. Conclusions: The imaging studies contributed to a correct characterization of lumbar disk hernia.
    Fundamento: La imaginología describe con mucha precisión los detalles de la hernia discal lumbar  y propicia diagnósticos muy certeros que favorecen su correcto tratamiento. Objetivo:  Caracterizar por imaginología la hernia discal lumbar en pacientes operados. Método: Estudio descriptivo, observacional, correlacional y retrospectivo de una serie de casos, realizado en el Hospital Provincial  Universitario “Dr. Gustavo Aldereguía Lima” de Cienfuegos, del 2000 al 2005, que incluyó todos los pacientes a los que se les realizaron estudios imaginológicos por sospecha de hernia discal lumbar, quienes recibieron intervención quirúrgica en dicha institución. Se emplearon los medios de imágenes disponibles: radiografías simples de columna en región lumbosacra, la mielografía y la tomografía axial computarizada. Resultados: El sexo masculino fue el más afectado por hernia discal lumbar. Los signos indirectos más observados en radiografías simples de región lumbosacra fueron: la disminución del espacio intervertebral y cambios artrósicos a nivel de cuerpos vertebrales. Se les realizó mielografías a 6 pacientes y en 3 de ellos fueron positivas. En localización, el tipo de hernia más representado fue la lateral y de acuerdo a la cantidad de material herniado, las hernias protuidas. Los espacios más afectados fueron L5-S1 y L4-L5. Los pacientes de la tercera y la cuarta décadas de la vida son los más afectados por esta entidad, con predominio en ellos de la hernia protuida y más frecuencia a nivel de los espacios L5-S1 y L4 -L5. Conclusiones: Los estudios imaginológicos realizados contribuyeron a una correcta caracterización de la hernia discal lumbar.


  17. ABSCESO EPIDURAL LUMBAR POST HERNIA DISCAL TRAUMÁTICA: CASO CLÍNICO / Lumbar epidural abscess secondary to traumatic disk herniation: A case report

    Scientific Electronic Library Online (English)

    Carlos, Sajama l; Milán, Munjin L; Bartolomé, Marré P; Víctor, Arriagada V; Alejandro, Urzúa B.

    Full Text Available Se presenta el caso de un hombre de 42 años con historia de trauma y compresión axial de la columna lumbar que originó una hernia de núcleo pulposo a nivel lumbar, demostrada mediante resonancia magnética. Al cuarto dta de evolución aparece fiebre y alteraciones de laboratorio concordantes con infec [...] ción, sin signos de compromiso neurológico. El hemocultivo resulta positivo para staphylococcus aureus. La resonancia magnética demuestra presencia de absceso espinal lumbar, que impresiona secundario a hematoma epidural infectado. El paciente es tratado médicamente, con antibioticoterapia que incluye inicial mente ceftriaxona/ metronidazol/ gentamicina y posteriormente cloxacilina/cefazotina, con buena evolución, completando 6 semanas por vta endovenosa y 4 vta oral. Su evolución fue favorable, siendo dado de alta en buenas condiciones y sin déficit neurológico. Abstract in english We report the case of a 42-year-old male patient presenting with trauma history and lumbar spine axial compression which caused a herniated nucleus pulposus at lumbar level, revealed through MRI. After a four-day evolution period, fever and laboratory alterations indicative otan infectious process a [...] ppear without signs of neurologic involvement. Hemoculture was positive for Staphylococcus aureus and MRI showed the presence of a lumbar spinal abscess secondary to infected epidural hematoma. The patient was treated with antibiotics, being given ceftriaxone, metronidazol, and gentamicin as an initial theraphy switched subsecuently to cloxaciline and cefazoline, He showed a favourable evolution, completing a six-week period of endovenous treatment plus fourweeks receiving oral therapy The patient was discharged in good condition with no neurologic deficit.

  18. Fibroma desmoplásico de la columna lumbar / Fibrome desmoplasique au niveau lombaire / Desmoplastic fibroma of lumbar spine

    Scientific Electronic Library Online (English)

    Raúl, Candebat Rubio; Raúl Rodulfo, Candebat Candebat; Orestes Mauri, Pérez; Madelín, Sosa Carrasco; Rodrigo, Rajadel Alzuri; Alina, Delgado Rosales.

    2012-06-01

    Full Text Available Introducción: el fibroma desmoplásico fue definido por la Organización Mundial de la Salud en 2002 como un tumor benigno, raro, compuesto por células fusiformes, con mínima atipia celular y abundante producción de colágeno. Es considerado por muchos autores como benignos localmente agresivos, pero q [...] ue rara vez hacen metástasis. Objetivo: presentar un caso raro de fibroma desmoplásico en la columna lumbar y discutir el diagnóstico y tratamiento de esta afección. Descripción: se presentó un paciente de 20 años de edad con cuadro doloroso en la columna lumbar. Se hizo una radiografía simple observándose imagen osteolítica de la apófisis espinosa de L3, se decidió efectuar biopsia abierta incisional que determinó un fibroma desmoplásico óseo. Se aplicó tratamiento quirúrgico con bordes amplios de la lesión, mediante abordaje combinado anterior y posterior. La reconstrucción se realizó con tornillos pediculares, placa anterior e injerto autólogo de peroné. Resultados: después de la cirugía el dolor desapareció y la función neurológica resultó normal. Hubo complicaciones relacionadas con el injerto óseo e infección del sitio quirúrgico. El paciente en un seguimiento de 3 meses no tuvo recidiva. Conclusión: el fibroma desmoplásico óseo, descrito también como quiste desmoide óseo, es un tumor muy infrecuente y de difícil diagnóstico, el cual debe ser considerado entre los diagnósticos diferenciales de los tumores de la columna vertebral. Una confirmación histológica siempre es requerida. La resección en bloque de la lesión puede ser curativa seguida de la reconstrucción para preservar la estabilidad espinal. Abstract in english Introduction: the desmoplastic fibroma was defined by WHO in 2000 as a benign tumor, rare, composed by fusiform cells with a minimal cellular atypia and an abundant collagen production. Many authors consider it as locally aggressive and benign tumors but rarely to metastasize. Objective: to present [...] a rare case of desmoplastic fibroma in lumbar spine and to discuss the diagnosis and treatment of this affection. Description: this is the case of a patient aged 20 presenting with a painful picture in lumbar spine. A simple radiography was taken showing an osteolytic image of spinal apophysis of L3 and an open incisional biopsy determining a bone desmoplastic fibroma. Surgical treatment was applied with wide edges of injury by anterior and posterior combined approach. In repair process we used pedicular screws, anterior plate and autologous peroneal graft. Results: after surgery pain disappeared and the neurologic function became normal. There were complications related to the bone graft and infection in surgical site. During a 3-month follow-up patient had not relapse. Conclusion: the bone desmoplastic fibroma also known as bone desmoid cyst is a very infrequent tumor and of difficult diagnosis, which must to be considered among the differential diagnoses of spinal column tumors. Always it is necessary a histological confirmation. The block resection of injury must to be curative followed by the repair to preserve the spinal stability.

  19. Long-term outcomes and quality of lift after percutaneous lumbar discectomy for lumbar disc herniation

    International Nuclear Information System (INIS)

    Objective: To assess the long-term outcomes as well as the living quality of the patients with lumbar disc herniation (LDH) after the treatment of percutaneous lumbar discectomy (PLD), and to discuss the influential factors related to the long-term effectiveness. Methods: During the period of January 2000 to March 2002, PLD was performed in 129 patients with LDH. By using self-evaluation questionnaires of Oswestry disability index(ODI), Short Form-36(SF-36) and Japanese Orthopaedic Association(JOA) through letter or telephone interviews as well as the patients' initial medical records, the related clinical data were collected. Statistical analysis was conducted by using Wilcoxon's rank sum test, Chi-square test. Results: One hundred and eight patients (83.7%) were able to be followed up and 104 effective ques-tionnaires were collected. The mean follow-up time was (6.64±0.67) years, the excellent rate(ODI score, 0-20%) was 71.15%. The average scores of the JOA and SF-36 was 23.66±5.72 and 75.88±25.57, respectively. The scores of quality of life were obviously improved in all follow-up subscales. Conventional operations were carried out subsequently in 9 patients as they failed to respond to PLD. No complications related to PLD occurred in this study. The age,course of the disease and the patient's condition at the time of discharge might bear a relationship to long-term effectiveness. Conclusion: PLD is a safe and minimally-invasive technique for the treatment of LDasive technique for the treatment of LDH with quick and reliable effect. PLD can dramatically improve the quality of life. Many factors,such as the age, course of the disease and the patient's condition at the time of discharge,can affect the long-term outcomes. (authors)

  20. Bloqueo epidural lumbar continuo para espasmos vesicales incoercibles / Continuous lumbar epidural uncontrollable bladder spasms

    Scientific Electronic Library Online (English)

    C., López Carballo; S., Vázquez del Valle; M., Garrido García; J., Pico Veloso; R., Valle Yáñez; M. J., Bermúdez López; F. J., Pardo-Sobrino López.

    2013-04-01

    Full Text Available Presentamos un caso clínico de espasmos vesicales por hiperactividad del detrusor de la vejiga, desencadenados por lavado vesical continuo aplicado en un paciente con hematuria, en el contexto de hipertrofia benigna de próstata. Los espasmos llegaron a ser refractarios a tratamiento sistémico con an [...] timuscarínicos, espasmolíticos y opioides. Se optó por la colocación de un catéter epidural lumbar para infusión continua de anestésicos locales y opioides como terapia analgésica alternativa, que no solo proporcionó un aceptable grado de confort, sino que permitió el mantenimiento del sondaje uretral y el lavado vesical continuo. Realizamos una revisión bibliográfica sobre el uso del bloqueo epidural de la neurotransmisión de las aferencias sensitivas vesicales en dolor de origen disfuncional vesical, y analizamos algunas de la teorías publicadas sobre la fisiopatología y génesis de dolor en estos trastornos vesicales, con la intención de interpretar las peculiaridades y complejidad del dolor en el cuadro del caso presentado. Abstract in english We present a clinical case of bladder spasms due to detrusor overactitivity, triggered by continuous vesicoclysis therapy, which was applied in a patient with benign prostatic hypertrophy-related hematuria. Bladder spasms turned out to be refractory to combined antimuscarinic, spasmolytic and system [...] ic opioid therapies. Implantation of a lumbar epidural catheter was chosen for continuous epidural infusion of local anesthetics and opioid drugs as an alternate analgesic therapy, which provided the patient an optimum comfort, but let urethral indwelling catheterization and the maintenance of continuous vesicoclysis therapy as well. We reviewed scientific literature concerning bladder-afferent neurotransmission blockade at epidural level for dysfunctional bladder pain therapy, and discussed several published theories about pain physiopathology and origin in those cases of dysfunctional bladder disturbance, with the aim to interpret the peculiarity and complexity of the described clinical case.

  1. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    

  2. Supernumerary neuromasts in the posterior lateral line of zebrafish lacking peripheral glia

    OpenAIRE

    López-Schier, Hernán; Hudspeth, A. J.

    2005-01-01

    The lateral line and its associated sensory nerves develop from cephalic epithelial thickenings called neurogenic placodes. In the zebrafish, the transcription factor neurogenin 1 is essential for the generation of the sensory ganglion from the placode, but is dispensable for the migration of the primordium and the initial development of neuromasts. We find that inactivation of the gene encoding neurogenin 1 leads to the development of over twice the normal number of neuromasts along the post...

  3. CT of postoperative lumbar disk herniation

    International Nuclear Information System (INIS)

    Results are reported of a multicenter analytic-statistical CT study on 128 postoperative lumbar herniated disk (HD) disk (HD) cases (50 at L4-L5, 64 at L5-S1, 2 at L3-L4, 12 multiple). CT was performed from 10 days to 204 months (47,7 months of mean) after surgery, in 51 patients without and in 77 with intravenous contrast medium (42 in bolus, 35 in perfusion). In 59 cases (38%) a recurrent hernia was found, and in 8% a new hernia. In 81% of patients epidural fibrous scars were demonstrated, in a rough 50% of cases associated with recurrent/new hernia: posterior fibrosis was found in 81% of cases, while unilaterally, bilaterally, or anteriorly extended fibroses were present in 20%, in 4,7%, and in 29% of cases respectively. In 72% of the patients injected with contrast medium, various kinds of fibrosis contrast enhancement were detected. In 8% neither fibrosis nor recurrent herniation was found. In 22% of cases lateral and/or central bony canal stenosis was present, in 26% vacuum disk, in 9% intracanalar calcifications, in 39% and in 19,5% dural sac stretching and compression respectively. In 5 cases a pseudomeningocele was found, and in 3 only a postoperative diskitis. Fibrosis is an almost inevitable postoperative consequence (4 out of 5 cases); it can be demonstrated by CT with high sensitivity and good specificity. A series of diagnostic criteria, such as the post-contrast media reaction, allow fibrosis to be discriminated from recurrent hernia. However, the possi from recurrent hernia. However, the possible association must be kept in mind of both diseases and/or of included roots in the scar. Myelography is hardly ever able to supply furthere resolutive diagnostic elements, while Myelo-CT sometimes more useful. The importance of bone changes is questionable, with the exception of evident cases of canal stenosis, also because in most cases the radiologist cannot count on a preoperative CT study. Furthermore, the correlation between CT and clinical findings (possible asymptomatic fibrosis) is often difficult, which gives way to contrasting therapeutic attitudes

  4. Capabilities of ultrasound diagnosis in lumbar spine pathology

    International Nuclear Information System (INIS)

    The capabilities of radiodiagnosis (x-ray, CT, and ultrasound) in diagnosis of degenerative disk disease (DDD) of the lumbar spine (LS) were studied. The performed study have shown that ultrasound study in DDD allows easy and more accurate calculation of the VC area at the disk level. Besides, the use of Doppler ultrasound allows revealing the cause of compression syndrome in every case

  5. Computer aided measurement of biomechanical characteristics of cadaverous lumbar spines.

    Czech Academy of Sciences Publication Activity Database

    Barton?k, L.; Keprt, Ji?í; Charamza, J.; Hrabálek, L.

    2004-01-01

    Ro?. 2, ?. 3 (2004), s. 504-510. ISSN 1644-3608 R&D Projects: GA MŠk LN00A015 Institutional research plan: CEZ:AV0Z1010921 Keywords : lumbar spine * force gauges * specle interferometry * fast Fourier transform PACS Subject RIV: BH - Optics, Masers, Lasers Impact factor: 0.375, year: 2004

  6. Hemilaminoplasty for the treatment of lumbar disc herniation.

    Science.gov (United States)

    Xinyu, Liu; Yanping, Zheng; Jianmin, Li; Liangtai, Gong

    2009-10-01

    The aim of this study was to evaluate the clinical outcome of the hemilaminoplasty technique for the treatment of lumbar disc herniation (LDH). Forty-three cases of single-level LDH underwent a discectomy and hemilaminoplasty procedure. The preoperative JOA score and VAS of lower back and leg pain were 10.4+/-1.3, 7.8+/-2.1, and 8.6+/-1.7, respectively. The Cobb angle of lumbar sagittal alignment was 10.1+/-2.0. Twenty-five patients who agreed to lumbar discectomy through fenestration were enrolled as the control group. The postoperative JOA score and VAS of low back and leg pain of the hemilaminoplasty group were 19.4+/-1.3, 1.4+/-0.4, and 2.1+/-0.5, respectively. The Cobb angle was 29.2+/-1.9 degrees. There was no epidural scar observed in any of the patients. The Cobb angle of the hemilaminoplasty group was higher than that of the control group (p < 0.05), while the VAS was significantly lower (p < 0.05). Hemilaminoplasty is a useful method to improve clinical outcome, prevent epidural scar, and preserve the normal alignment of lumbar spine. PMID:18636258

  7. Intraosseous schwannoma with ancient change on the lumbar spine.

    Science.gov (United States)

    Youn, Boram; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

    2012-08-01

    A 65-year-old male was admitted for progressive lower back pain. The preoperative revealed an osteolytic expansile mass with a sclerotic margin involving the right lamina and pedicle of L2. The histopathology revealed an ancient schwannoma. We report a rare case of an intraosseous ancient schwannoma involving lumbar vertebra along with its imaging findings and surgical aspects. PMID:22463813

  8. A radiological study on lumbar disc herniation in Korean

    International Nuclear Information System (INIS)

    Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

  9. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    Directory of Open Access Journals (Sweden)

    Sandén Bengt

    2009-07-01

    Full Text Available Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI. Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.

  10. Physiologic predictors of lumbar spine bone mass in neonates.

    Science.gov (United States)

    Koo, W W; Hockman, E M

    2000-10-01

    Dual energy x-ray absorptiometry (DXA) of the lumbar spine (LS) was measured in 201 singleton infants with birth weights from 1152 to 3970 g and gestational ages from 27 to 42 wk. All infants were well and studied at a mean (+/-SD) of 2.1 (+/-1.6) days after birth. There were 75 Caucasian (46 males, 29 females) and 126 African American infants (58 males, 68 females). Scan acquisition of the first to fourth lumbar vertebrae was performed with a single beam whole body scanner (Hologic QDR 1000/W densitometer, Hologic Inc, Waltham, MA, U.S.A.) using the infant spine mode. Scan analysis was performed with software version 4.57Q and consistent region of interest. The SD of difference for duplicate LS scans is infant's length appears to be the best determinant of LS area and accounts for about 75% of the variance in LS area. Race, gender or season has little or no effect on LS bone mass. There was progressive increase in BMC and area from first to fourth lumbar vertebra but BMD was significantly higher only at the fourth lumbar vertebra. We conclude that DXA LS can be performed even in small preterm infants. Its excellent precision, low radiation exposure and rapid scan acquisition offers promise as a useful tool for widespread use in pediatrics. Our data may be used as a basis for further studies in physiologic and pathologic situations that may affect bone mineralization in infants. PMID:11004239

  11. Lateral disc herniation following percutaneous lumbar discectomy : A case report

    OpenAIRE

    Matsui, H.; Aoki, M.; Kanamori, M.

    1997-01-01

    A case of lateral disc herniation in the lumbar spine which occurred soon after percutaneous discectomy is described. This is a rare complication, but in this patient it appeared that the extrusion occurred through the hole in the annulus made at the first operation.

  12. Idiopathic Intracranial Hypertension in Pregnancy Treated with Serial Lumbar Punctures

    OpenAIRE

    Manasi Badve; Mcconnell, Matthew J.; Tanmay Shah; Ondecko-ligda, Kristin M.; Poutous, George W.; Vallejo, Manuel C.

    2011-01-01

    Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure with normal CSF composi-tion and no evidence of hydrocephalus or mass lesion. We describe the anesthetic management of a parturient with IIH who required multiple lumbar punctures during pregnancy and delivery secondary to worsening neurological symp-toms.

  13. Lumbar muscle electromyographic dynamic topography during flexion-extension.

    Science.gov (United States)

    Hu, Yong; Siu, Stanley H F; Mak, Joseph N F; Luk, Keith D K

    2010-04-01

    The objective of this study is to introduce dynamic topography of surface electromyography (SEMG) to visualize lumbar muscle myoelectric activity and provides a new view to analyze muscle activity in vivo. A total of 20 healthy male subjects and 15 males LBP were enrolled. An electrode-array was applied to the lumbar region to collect SEMG. The root mean square (RMS) value was calculated for each channel, and then a 160x120 matrix was constructed using a linear cubic spline interpolation of each scan to create a 2-D color topographic image. Along a definite interval of action, a series of RMS topography matrices was concatenated as a function of position and time, to form a dynamic topographical video of lumbar muscle activity. Relative area (RA), relative width (RW), relative height (RH) and Width-to-Height Ratio (W/H) were chosen as the four quantitative parameters in measuring topographic features. Normal RMS dynamic topography was found to have a consistent, symmetric pattern with a high intensity area in the paraspinal area. LBP patients had a different RMS dynamic topography, with an asymmetric, broad, or disorganized distribution. Quantitative SEMG features were found significantly different between normal control and LBP. After physiotherapy rehabilitation, the dynamic topography images of LBP tended towards the normal pattern. There are obvious differences in lumbar muscle coordination between healthy subjects and LBP patients. The dynamic topography allows the continuous visualization of the distribution of surface EMG signals and the coordination of muscular contractions. PMID:19540776

  14. GRAVITATIONAL THERAPY IN COMPLEX TREATMENT OF LUMBAR OSTEOCHONDROSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    I.E. Poverennova

    2009-03-01

    Full Text Available A new technique- gravitational therapy- has been used in complex therapy of patients with lumbar osteochondrosis. The substantiation of application of gravitational therapy in case of this pathology is presented. Indications and contraindications to the treatment, technical parameters of procedure are pointed out. Treatment results are considered in comparison with traditional therapy.

  15. Lumbar arachnoiditis as the differential diagnosis of chronic spine problems

    International Nuclear Information System (INIS)

    Lumbar epiduro-arachnoiditis is an infectious disaese of the three mengial layers. It is often caused by surgical interventions on the spine. In this survey etiologic factors, clinical symptoms and radiological findings are compared. The radiologic classification of Delamater is described by three clinical cases. The diagnostic value of different procedures such as myelography, postmyelographic computed tomography and MR imaging is evaluated. (orig.)

  16. Laparoscopic surgery for treatment of incisional lumbar hernia

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-08-01

    Full Text Available OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

  17. Laparoscopic surgery for treatment of incisional lumbar hernia

    Scientific Electronic Library Online (English)

    M., Tobias-Machado; Freddy J., Rincon; Marco T., Lasmar; Joao P., Zambon; Roberto V., Juliano; Eric R., Wroclawski.

    2005-08-01

    Full Text Available OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We [...] used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

  18. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study.

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    STUDY DESIGN: A cross-sectional epidemiological survey of 4151 participants of the Copenhagen Osteoarthritis Study. OBJECTIVE: To identify prevalences and individual risk factors for degenerative lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: The Copenhagen Osteoarthritis Study has registered health parameters since 1976. In 1993, standardized, lateral radiographs of the lumbar spine were recorded. There were 1533 men and 2618 women. METHODS: Statistical correlations were made between degenerative spondylolisthesis, and physical, occupational, and general epidemiological data. RESULTS: A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0.001), and between BMI in 1993 and both L4 and L5 olisthesis were found (L4: P = 0.003; L5: P = 0.006). Lumbar lordosis was associated with degenerative spondylolisthesis in women. Occupational exposures to daily lifting or smoking were not associated with degenerative spondylolisthesis. Degenerative spondylolisthesis was associated with increased age in both sexes (L4: P < 0.001; L5: P < 0.001). CONCLUSIONS: BMI longitudinally and at index evaluations, age, and angle of lordosis were significantly associated with degenerative spondylolisthesis in women. In men, no individual risk factors for degenerative spondylolisthesis were found, save increased age. Udgivelsesdato: 2007-Jan-1

  19. Endoscopic lumbar sympathectomy for women: effect on compensatory sweat

    Directory of Open Access Journals (Sweden)

    Marcelo de Paula Loureiro

    2008-01-01

    Full Text Available INTRODUCTION: Plantar hyperhidrosis is present in 50% of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60% of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A or no surgical intervention (Group B - control groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20% experienced prolonged pain (more than ten days. Eight patients suffered from worsened compensatory sweating (53.3%. In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison beyond that of the control group (p<0.05, inter-group comparison. Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05. These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal regions after the procedure (p<0.05. CONCLUSIONS: The endoscopic retroperitoneal lumbar sympathectomy diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis. However, about half of the patients develop increased compensatory hyperhidrosis in other areas of the body.

  20. Lumbar disc arthroplasty: indications, biomechanics, types, and radiological criteria

    International Nuclear Information System (INIS)

    Lumbar total disc replacement (TDR) was developed to treat a painful degenerative lumbar motion segment while avoiding the disadvantages of fusion surgery, such as adjacent segment instabilities. Early clinical results with TDR have shown a significant reduction in low back pain and a significant improvement in disability scores. When compared to fusion, the results with TDR tend to be superior in the short-term follow-up and initial rehabilitation is faster. The radiological assessment is an integral part of the preoperative work-up. Plain X-rays of the lumbar spine should be complemented by flexion - extension views in order to assess residual segmental mobility. Computed tomography is used to exclude osteoarthritis of the zygapophyseal joints, Baastrup's disease (kissing spines) and other sources of low back pain. Magnetic resonance imaging is useful to exclude substantial disc protrusions; it allows for the detection of disc dehydration and bone marrow edema in the case of activated spondylochondrosis. If osteoporosis is suspected, an osteodensitometry of the lumbar spine should be performed. Postoperative plain X-rays should include antero-posterior and lateral views as well as flexion - extension views in the later postoperative course. Measurements should determine the disc space height in the lateral view, the segmental and total lumbar lordosis as well as the segmental mobility in the flexion - extension views. The ideal position of a TDR is exactly central ieal position of a TDR is exactly central in the ap-view and close to the dorsal border of the vertebral endplates in the lateral view. Malpositioning may cause segmental hyperlordosis and unbalanced loading of the endplates with the risk of implant subsidence and migration. (orig.)

  1. Spontaneous disappearance of lumbar disk herniation within 3 months.

    Science.gov (United States)

    Nozawa, Satoshi; Nozawa, Asae; Kojima, Hisashi; Shimizu, Katsuji

    2009-11-01

    Although spontaneous regression of disk herniation is a well-known phenomenon, the time taken for the condition to resolve has not been detailed in previous studies. This article describes a case of vanishing lumbar disk herniation in a 33-year-old man. The patient experienced sudden severe lumbar pain while lifting a 240-kg weight while attempting a Donkey Calf Raise during muscle training. The pain persisted despite the use of a lumbar corset and nonsteroidal anti-inflammatory drugs. Twelve days after onset, sensory disturbance appeared in the right L5 dermatome, and a manual muscle test of the right anterior tibial muscle revealed level 3. The pain gradually spread over the right lower extremity and the indistinct lumbago changed to localized back pain at the L4/5 vertebral level. Magnetic resonance imaging (MRI) of the lumbar spine 12 days after onset revealed a large disk herniation at L4/5. T2-weighted images demonstrated the herniated disk with a sequestrated disk fragment, which compressed the right L5 nerve root. Over the following month, his pain gradually diminished and he was able to resume his muscle-building program. Follow-up MRI 3 months after the lumbar injury showed complete disappearance of the extruded disk material. This is the first reported case of disk herniation that disappeared within only 3 months, as previous reports have reported that a minimum 30-week period was needed. Clinical awareness of the possibility that disk herniation may resolve within a relatively short time may aid both correct informed consent and treatment. PMID:19902881

  2. El infarto renal en la valoración de dolores lumbares / Renal infarction in the evaluation of lumbar pain

    Scientific Electronic Library Online (English)

    Alfonso, Barbagelata López; Patricia, Lado Lema; Jóse, Lorenzo; Cristina, Barbagelata López; Andrés, Rodríguez Alonso; German, Suárez Pascual; Alfonso, González Blanco.

    2008-06-01

    Full Text Available Objetivo: Presentamos un caso clínico de dolor cólico hacia fosa lumbar ocasionado por infarto renal en un paciente joven sin antecedentes de riesgo tromboembólicos conocidos. Métodos: Existen procesos poco habituales que se deben incluir en el diagnóstico diferencial del dolor cólico lumbar. Realiz [...] amos una revisión en el conocimiento actual. Resultado/Conclusiones: La mayor dificultad para el diagnóstico de esta patología radica en su sospecha clínica, que es clara si existen factores de riesgo cardiovascular. La aparición en un escenario no habitual, hace necesario recurrir a indicadores complementarios como la leucocitosis y la elevación de la LDH. Su confirmación se realiza mediante tomografía computada, RMN, gammagrafía o arteriografía. Su tratamiento necesita medidas trombolíticas, anticoagulantes y/o antiagregantes. Abstract in english Objective: We report the case of a young patient without known cardiovascular risk factors, complaining of lumbar colic pain due to renal infarction. Methods: Differential diagnosis of lumbar colic pain must include some rare events. We performed a review of the current knowledge on the topic. Resul [...] ts/Conclusion: The increasing difficulty in the diagnosis of these pathology lies on its clinical suspect, which can be clear when having cardiovascular risk factors. Its diagnosis, on a rare scenario, needs leucocytosis and LDH rising as suspicious indicators. Computed tomography, MRI, radionuclids and arteriography may confirm diagnosis. Treatment is based on thrombolytic therapy, anticoagulants and antiagregants.

  3. Consentimiento informado en la punción lumbar. Una propuesta para su ejecución / Consent in the lumbar puncture. A proposal for execution

    Scientific Electronic Library Online (English)

    Ivonne, Martín Hernández.

    2013-12-01

    Full Text Available La punción lumbar es un procedimiento invasivo, no exento de riesgos y para hacerlo es necesario solicitar el consentimiento informado del paciente o de un familiar. En este trabajo se aportan elementos éticos y prácticos necesarios para la realización de un correcto consentimiento informado en los [...] pacientes a quienes se practica este proceder. Se propone un modelo de consentimiento informado para este fin que incluye información sobre: la explicación del procedimiento, contraindicaciones, complicaciones y cuidados después del procedimiento. Se resalta que el consentimiento informado para la punción lumbar, más que una exigencia institucional o legal, constituye una exigencia ética para el médico y un derecho exigible por parte de los pacientes por lo que urge instituirlo como práctica sistemática. Abstract in english Lumbar puncture is an invasive procedure, not exempt of risks and to do so it is necessary to request the consent of the patient or a family member. This paper provides practical and ethical elements necessary to carry out a proper informed consent in patients to whom this procedure is practiced. Pr [...] oposes a model of informed consent for this purpose which includes information on: the explanation of the procedure, contraindications, complications and care after the procedure. It highlights that informed consent for lumbar puncture, rather than a legal, or institutional requirement constitutes an enforceable right by patients and an ethical requirement for medical by which urges to establish it as a systematic practice.

  4. Tratamiento de la radiculopatía lumbar con radiofrecuencia pulsada / Treatment of lumbar radiculopathy with pulsed radiofrequency

    Scientific Electronic Library Online (English)

    D., Abejón; C., Delgado; C., Nieto; M. L., Fuentes; S., García del Valle; J., Gómez-Arnau; E., Reig.

    2004-09-01

    Full Text Available Objectivos: Valorar la eficacia y los efectos secundarios derivados del tratamiento con radiofrecuencia pulsada en pacientes diagnosticados de radiculopatía lumbar. Material y métodos: Se realiza un estudio observacional prospectivo. Se realizan 20 radiofrecuencias en modo pulsado en 17 pacientes co [...] nsecutivos con diagnóstico de radiculopatía confirmado mediante electromiografía y clínica congruente desde enero de 2001 hasta enero del 2002. En todos los pacientes antes de efectuar la radiofrecuencia pulsada se realiza un bloqueo radicular selectivo que ha de reducir a sintomatología de los pacientes en al menos el 50% para que se considere positivo. Se evalúa, mediante una escala analógica visual, la intensidad del dolor en cinco momentos. En la visita inicial, al mes del tratamiento, a los 2 meses, a los 3 meses y a los 6 meses. La capacidad funcional del paciente se evalúa, mediante el test de Lattinen, en la visita inicial, a los 3 y 6 meses. Se valora la eficacia de la técnica mediante la escala de Likert de 7 puntos, así como la reducción del tratamiento en el periodo de estudio y la existencia de complicaciones. Para comparar los valores de la EVA a lo largo del periodo de estudio se realiza el test de Friedman no paramétrico para datos apareados de muestras múltiples aplicando un contraste de una sola cola. Se considera significación estadística cuando el valor de p es Abstract in english Objectives: To assess the effectiveness and side effects derived from the treatment with pulsed radiofrequency in patients diagnosed of lumbar radiculopathy. Material and methods: A prospective observational study was performed. Twenty pulsed radiofrequencies were performed in 17 consecutive patient [...] s with diagnosis of radioculopathy confirmed by electromyography and congruent clinical manifestations from January 2001 to January 2002. In all the patients and prior to the pulsed radiofrequency, a selective radicular blockade was performed. This blockade had to reduce patient symptomatology in at least 50% to be considered positive. Pain severity was assessed using a visual analogical scale at 5 different points in time: at the initial visit, at one month of treatment, at 2 months, at 3 months and at 6 months. The functional capacity of the patient was assessed using the Lattinen's test at the initial visit, at 3 months and at 6 months. The effectiveness of the technique was assessed using the 7-point Likert's scale, as well as the reduction of the treatment during the study period and the presence of complications. In order to compare the VAS scores obtained during the study period, a non-parametric Friedman's test was performed for paired data from multiple samples, applying a single-tailed contrast. A p-value

  5. Traumatismo raquimedular torácico y lumbar / Traumatisme rachimédullaire thoracique et lombaire / Thoracic and lumbar spinomedullary traumatism

    Scientific Electronic Library Online (English)

    Hiralio, Collazo Álvarez; Juan, Imbert Palmero; Stephen Yecc, Collazo MarÍn; Noelia Margarita, Boada Salas.

    2002-12-01

    Full Text Available Se realizó un estudio observacional descriptivo en 65 pacientes con trauma raquimedular torácico y lumbar, atendidos en los Servicios de Ortopedia y Traumatología y de Neurocirugía del Hospital General Provincial Docente “Roberto Rodríguez Fernández” de Morón de enero/1988 a enero/2001, con el objet [...] ivo de valorar los resultados en la determinación de la estabilidad espinal segmentaria con la técnica de Luque I y distribución de los pacientes de acuerdo con las variables de complicaciones, edad, sexo, tipo de injerto óseo, topografía lesional y clasificación neurológica de Frankel. Hubo 23,07 % de complicaciones posquirúrgicas y tres fallecidos (4,61 %). Los materiales de osteosíntesis empleados fueron clavo de Kunstcher, pin de Rush de 5 mm y varillas de acero inoxidable de 6 mm. El injerto óseo autógeno se empleó en el 64,61 %; el mecanismo de producción predominante fue el accidente del tránsito (54,46 %). Los resultados finales fueron buenos en el 88,70 %, regulares en el 4,83 % y malos en el 6,45 %. Abstract in english An observational and descriptive study was carried out among 65 patients with thoracic and lumbar spinomedullary trauma that received medical attention at the Services of Orthopedics, Traumatology and Neurosurgery of "Roberto Rodríguez Fernández" Provincial General Teaching Hospital, in Morón, from [...] January, 1988, to January, 2001, in order to evaluate the results in the determination of spinal segmentary stability by Luque I technique and the patients’ distribution, according to variables of complications, age, sex, type of bone graft, injury topography and Frankel’s neurological classification. There were 23.07 % of postsurgical complications and 3 deaths (4.61 %). The osteosynthesis materials used were Kunstcher’s nail, Rush’s pin of 5 mm and stainless steel rods of 6 mm. The autogenous bone graft was used in 64.61 %. The prevailing mechanism of production was the car crash (54.46 %). The final results were good in 88.70 %, fair in 4.83 % and bad in 6.45 %

  6. Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report / Hematoma lumbar epidural postpunción lumbar: influencia de dosis altas de LMWH y cirugía diferida

    Scientific Electronic Library Online (English)

    D., Gurkanlar; C., Acikbas; G.K., Cengiz; R., Tuncer.

    2007-02-01

    Full Text Available El hematoma espinal epidural (HEE) es una complicación conocida en la cirugía espinal, pero la incidencia del HEE que da lugar a déficit neurológico es muy rara (0.1%). Los pacientes que necesitan intervenciones en varios niveles lumbares y/o que tienen una coagulopatía preoperatoria tienen un riesg [...] o significativamente mayor de desarrollar un hematoma epidural. La introducción de dosis altas de heparina de bajo peso molecular (HBPM), (30 mgrs. dos veces al día) aumentan la incidencia de hematomas neuroaxiales. La cirugía llevada a cabo dentro de las 8 horas da lugar a un recuperación buena o parcial de la función neurológica. Nuestro paciente fue tratada con dosis altas de HBPM y desarrolló un déficit neurológico debido a un HEE, después de una punción lumbar. Fue operada al cabo de seis días y se recuperó parcialmente de su déficit después de la intervención. La administración actual de dosis altas de HBPM puede dar lugar a HEE, incluso después de una punción lumbar, que se hizo en pocos intentos. Aunque la cirugía realizada en las primeras 8 horas produce una recuperación buena o parcial, la laminectomía y evacuación del hematoma llevada a cabo después de tres días también puede dar lugar a buenos resultados. Abstract in english Spinal epidural hematoma (SEH) is a known complication of spinal surgery, but the incidence of post-surgical SEHs that result in neurologic deficits is extremely rare (0.1%). Patients that require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk [...] of developing an epidural hematoma. The introduction of higher dose of low molecular weight heparin (LMWH) twice daily 30 mg regimen) increased the reported incidence of neuroaxial hematomas. Surgery performed within 8 hours makes good or partial recovery of neurologic function. Our patient was also started on higher dose of LMWH and developed neurological deficits due to a SEH following lumbar puncture. She underwent operation after six days and she had a mild recovery following the operation. Current administration of high doses of LMWH can cause SEH even after a lumbar puncture, which was performed without multiple attempts. Although surgery performed within 8 hours makes good or partial recovery of neurologic function, laminectomy and epidural hematoma evacuation performed after three days can also have successful results.

  7. Percutaneous fusion of lumbar facet with bone allograft / Fusión facetaria lumbar por vía percutánea con aloinjerto óseo / Fusão de faceta lombar por via percutânea com aloenxerto ósseo

    Scientific Electronic Library Online (English)

    Félix Dolorit, Verdecia; Hiram Martinez, Medina.

    2015-03-01

    Full Text Available OBJETIVO: Avaliar a evolução dos casos tratados com a fusão de faceta por via percutânea com aloenxerto ósseo na doença facetária lombar. MÉTODO: Entre 2010 e 2014, 100 pacientes (59 mulheres e 41 homens) com diagnóstico de doença facetária lombar foram submetidos à cirurgia. RESULTADOS: A fusão de [...] faceta lombar com aloenxerto ósseo mostra bons resultados clínicos, é realizada em ambulatório, apresenta complicações mínimas e incorporação rápida do paciente às atividades da vida diária. CONCLUSÕES: A fusão facetária percutânea com aloenxerto ósseo parece ser um tratamento eficaz para a doença de faceta lombar. Abstract in spanish OBJETIVO: Valorar la evolución de los casos tratados con fusión facetaria por vía percutánea con aloinjerto óseo en la enfermedad facetaria lumbar. MÉTODO: Entre los años 2010 y 2014 se intervinieron 100 pacientes (59 mujeres y 41 hombres) con diagnóstico de enfermedad facetaria lumbar. RESULTADOS: [...] La fusión facetaria lumbar con aloinjerto óseo muestra buenos resultados clínicos, se realiza de forma ambulatoria, presenta mínimas complicaciones y una rápida incorporación del paciente a sus actividades diarias. CONCLUSIONES: La fusión facetaria lumbar con aloinjerto óseo parece ser un tratamiento eficaz para la enfermedad facetaria lumbar. Abstract in english OBJECTIVE: To assess the evolution of the cases treated with percutaneous facet fusion with bone allograft in lumbar facet disease. METHOD: Between 2010 and 2014, 100 patients (59 women and 41 men) diagnosed with lumbar facet disease underwent surgery. RESULTS: The lumbar facet fusion with bone all [...] ograft shows good clinical results, is performed on an outpatient basis, and presents minimal complications and rapid incorporation of the patient to the activities of daily living. CONCLUSIONS: The lumbar facet fusion with bone allograft appears to be an effective treatment for lumbar facet disease.

  8. Efectos del vendaje neuromuscular sobre la flexibilidad del raquis lumbar / Effects of kinesio taping on lumbar rachis flexibility

    Scientific Electronic Library Online (English)

    A.M., Labrador-Cerrato; P., Ortega Sánchez-Diezma; G., Lanzas Melendo; C., Gutiérrez-Ortega.

    2015-03-01

    Full Text Available Introducción: El vendaje neuromuscular es una técnica que produce una estimulación muy selectiva sobre la piel a través de la aplicación de unas vendas elásticas especiales con el fin de lograr cambios propioceptivos, aumento o inhibición del tono muscular y mitigación de algias, entre otros. Objeti [...] vos: Comprobar si la aplicación del vendaje neuromuscular permite aumentar la flexión del raquis lumbar comparándola con otras técnicas de vendaje placebo (esparadrapo rígido convencional; Omniplaste®-E); observar la concordancia entre la prueba sit-and-reach y el test de Schober en la valoración de la ganancia de flexión lumbar. Material y métodos: Estudio piloto experimental a triple ciego. Se distribuyeron aleatoriamente 45 sujetos sanos de 20-55 años en tres grupos: 1) esparadrapo convencional; 2) Omniplaste®-E; 3) vendaje neuromuscular. En todos los participantes se evaluó la flexión del raquis lumbar mediante la prueba sit-and-reach y el test de Schober antes y después de la intervención siguiendo el mismo protocolo. Resultados: Considerado un intervalo de confianza del 95% y grado de significación estadística p Abstract in english Introduction: Kinesio taping is a technique that produces a very selective stimulation through skin by means of specific elastic strips application aiming to achieve proprioceptive changes, increase or inhibition of muscle activity and pain mitigation, among others. Aims: The present work was focuse [...] d on checking whether kinesio taping increases lumbar rachis flexion compared with other placebo taping techniques such as conventional tape or Omniplaste®-E elastic tape. Furthermore, it was led to observe the correspondence between the sit-and-reach and Schober tests when assessing the increase of lumbar flexion. Material and methods: Experimental, triple-blind randomized controlled pilot trial, where 45 healthy 20-55 year-aged participants were randomly distributed into three groups: 1) conventional taping; 2) Omniplaste®-E; 3) kinesio taping. Flexion of lumbar rachis was evaluated using both sit-and-reach and Schober tests before and after the intervention following the same procedure in all subjects. Results: Considered 95 % as confidence interval and level of significant difference of p

  9. Primary and revision lumbar discectomy: A three-year review from one center

    OpenAIRE

    Acharya K; Senthil Nathan T; Kumar J; Menon K

    2008-01-01

    Background: Despite variations in technique, the results of primary and revision lumbar discectomy have been good. The aim of this study was to retrospectively review cases of primary and revision lumbar discectomy performed in our institute over a three-year period. Materials and Methods: The case records of 273 patients who underwent lumbar discectomy between January 2001-2004 and fulfilled our inclusion and exclusion criteria were reviewed. Of these, 259 were primary discectomies and 14...

  10. Stabilising effect of dynamic interspinous spacers in degenerative low-grade lumbar instability

    OpenAIRE

    Holinka, Johannes; Krepler, Petra; Matzner, Michael; Grohs, Josef G.

    2010-01-01

    The aim of the study was to investigate the stabilising effect of dynamic interspinous spacers (IS) in combination with interlaminar decompression in degenerative low-grade lumbar instability with lumbar spinal stenosis and to compare its clinical effect to patients with lumbar spinal stenosis in stable segments treated by interlaminar decompression only. Fifty consecutive patients with a minimum age of 60 years were scheduled for interlaminar decompression for clinically and radiologically ...

  11. Unilateral Laminotomy For Decompression of Lumbar Stenosis is Effective and Safe: A Prospective Randomized Comparative Study

    OpenAIRE

    Gurelik, Mustafa; Bozkina, Cemal; Kars, Zafer; Karadag, Ozen; Ozum, Unal; Bayrakli, Fatih

    2012-01-01

    Objective: The purpose of this study is to determine the efficacy and safety of unilateral laminotomy for decompression of lumbar stenosis (LS). Although minimally invasive procedures are gaining increasing popularity in the treatment of spinal disorders, minimally invasive techniques are not standard in the surgical treatment of lumbar stenosis yet.Methods: Fifty-two consecutive patients with lumbar stenosis were randomized to two treatment groups (unilateral laminotomy for decompression-Gro...

  12. The conservative surgical treatment of lumbar spinal stenosis in the elderly

    OpenAIRE

    Gunzburg, Robert; Szpalski, Marek

    2003-01-01

    Canal stenosis is now the most common indication for lumbar spine surgery in elderly subjects. Degenerative disc disease is by far the most common cause of lumbar spinal stenosis. It is generally accepted that surgery is indicated if a well-conducted conservative management fails. A meta-analysis of the literature showed on average that 64% of surgically treated patients for lumbar spinal stenosis were reported to have good-to-excellent outcomes. In recent years, however, a ...

  13. Magnetic resonance imaging of canine degenerative lumbar spine diseases

    International Nuclear Information System (INIS)

    Degenerative lumbar spine diseases, i.e., sacrolumbar stenosis, intervertebral disk degeneration and protrusion and spondylosis deformans of the canine lumbar spine were studied in eleven canine patients and three healthy controls using radiography and 0.02 T and 0.04 T low field magnetic resonance imaging. The T1 and T2 weighted images were obtained in sagittal and transverse planes. The loss of hydration of nucleus pulposus, taken as a sign of degeneration in the intervertebral disks, could be evaluated in both T1 and T2 weighted images. As a noninvasive method magnetic resonance imaging gave more exact information about the condition of intervertebral disks than did radiography. Sacrolumbar stenosis and compression of the spinal cord or cauda equina and surrounding tissue could be evaluated without contrast medium

  14. Spontaneous epidural hematoma at lumbar facet joint: a case report

    International Nuclear Information System (INIS)

    Spontaneous epidural hematomas (SEHs) of the lumbar spine are rare. The pathogenesis is not entirely clear, but several reports have suggested that bleeding originating in the venous epidural plexus is the cause. This is the second report of a SEH thought to be the result of facet joint hemorrhage with no previous synovial cyst formation. A magnetic resonance image revealed a mass beginning in the left epidural space and continuing through to the left L5-S1 facet joint. Surgically, the epidural hematoma, which was covered by a very thin translucent membrane, was visualized directly. A histopathological examination revealed the wall of the epidural hematoma to be composed of very thin fibrous connective tissue with no synovium lining. The purpose of this study was to report a case of an epidural hematoma originated from lumbar facet joint, diagnosed by radiological examination, and to present a review of the subject literature

  15. Lumbar posterior marginal intra-osseous cartilaginous node

    Energy Technology Data Exchange (ETDEWEB)

    Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

    1986-03-01

    This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed.

  16. Lumbar posterior marginal intra-osseous cartilaginous node

    International Nuclear Information System (INIS)

    This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed. (orig.)

  17. Lumbar posterior marginal intra-osseous cartilaginous node.

    Science.gov (United States)

    Laredo, J D; Bard, M; Chretien, J; Kahn, M F

    1986-01-01

    This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed. PMID:3704673

  18. The treatment of lumbar disc herniation: a comparison between percutaneous lumbar diskectomy combined with ozone and percutaneous lumbar diskectomy combined with collagenase

    International Nuclear Information System (INIS)

    Objective: To evaluate the short-term curative effect and the incidence of postoperative adverse events of percutaneous lumbar diskectomy (PLD) combined with ozone or PLD combined with collagenase in treating lumbar disk herniation. Methods: A total of 223 patients with lumbar disk herniation were enrolled in this study. Patients in the study group (n=108) were treated with PLD combined with ozone, while patients in the control group (n=115) were treated with PLD combined with collagenase. The short-term effectiveness and the incidence of postoperative adverse events were documented. The results were analyzed and compared between the two groups. Results: In the study group, the excellent and good therapeutic results were achieved in 85.18% of the patients (n=92) and the occurrence of adverse events was 5.56%, while in the control group, the excellent and good therapeutic results were achieved in 80.00% of the patients (n=92) and the occurrence of adverse events was 13.04%. No significant difference in the short-term effectiveness existed between the two groups (Pearson Chi-Square =1.038, P=0.308). And the difference in the occurrence of postoperative adverse events was not significant between the two groups (Pearson Chi-Square =3.661, P=0.056). No disc infection occurred in the study group. Conclusion: The short-term curative effect of PLD combined with ozone is not significantly different from that of PLD combined with collagenase. In order to maintain decompression within the disc for a long period and to reduce the incidence of postoperative adverse events PLD combined with ozone ablation is an effective complementary treatment. (authors)

  19. Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

    OpenAIRE

    Omidi-kashani, Farzad; Hasankhani, Ebrahim Ghayem; Ashjazadeh, Amir

    2014-01-01

    Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy wi...

  20. Degenerative lumbar stenosis: update Estenose lombar degenerativa: atualização

    OpenAIRE

    Joaquim, Andrei F.; Sansur, Charles A.; Hamilton, David K.; Shaffrey, Christopher I.

    2009-01-01

    We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe...

  1. Diagnosis and conservative management of degenerative lumbar spondylolisthesis

    OpenAIRE

    Kalichman, Leonid; Hunter, David J.

    2007-01-01

    Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over the one below due to degenerative changes in the spine. Lumbar DS is a major cause of spinal canal stenosis and is often related to low back and leg pain. We reviewed the symptoms, prognosis and conservative treatments for symptoms associated with DS. PubMed and MEDLINE databases (1950–2007) were searched for the key words “spondylolisthesis”, “pseudospondylolisthesis”, “degenerative ...

  2. LumbSten: the lumbar spinal stenosis outcome study

    OpenAIRE

    Min Kan; Porchet François; Hodler Jürg; Brunner Florian; Held Ulrike; Nydegger Alexander; Steurer Johann; Mannion Anne F; Michel Beat

    2010-01-01

    Abstract Background Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. For patients with moderate or severe symptoms different conservative and surgical treatment modalities are recommended, but knowledge about the effectiveness, in particular of the conservative treatments, is scarce. There is some evidence that surgery improves outcome in about two thirds of the patients. The aims of this study are to derive and validate a prognostic prediction aid to e...

  3. Lumbar disc herniation at high levels : MRI and clinical findings

    International Nuclear Information System (INIS)

    To assess the frequency, location, associated MR findings, and clinical symptoms of the high level lumbar disc herniation(HLDH). A total of 1076 patients with lunbar disc herniation were retrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms of frequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. The prevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in 14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to 72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated disc herniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variable involvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14 patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6 patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) with HLDH(n=41), there was a previous history of trauma. Patients with HLDH showed a relatively high incidence of associated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl's node, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous l patients with HLDH there was a previous history of trauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relatively nonspecific and their incidence was low

  4. Acute Lumbar Burst Fracture Treated by Minimally Invasive Lateral Corpectomy

    OpenAIRE

    Rodrigo Amaral; Luis Marchi; Leonardo Oliveira; Thiago Coutinho; Luiz Pimenta

    2013-01-01

    Burst fractures in acute spinal traumas are a difficult problem to solve. Different approaches and techniques have been utilized, but with high incidence of morbidity and mortality, besides unsatisfactory clinical and radiological results. Mini-open approaches recently emerged and have been shown to be safe and effective in the treatment of several spinal conditions. Here we report a case of acute lumbar burst fracture at L2 treated by minimally invasive true lateral approach posteriorly inst...

  5. Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

    OpenAIRE

    Schulte, Tobias L.; Schubert, Tim; Winter, Corinna; Brandes, Mirko; Hackenberg, Lars; Wassmann, Hansdetlef; Liem, Dennis; Rosenbaum, Dieter; Bullmann, Viola

    2010-01-01

    Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated ...

  6. Comparison of Spinal and General Anesthesia in Lumbar Disc Surgery

    OpenAIRE

    Inci KARA; Jale Bengu CELIK; Bahar OC; Seza APILLIO?ULLARI; Hakan KARABAGLI

    2011-01-01

    Aim: The purpose of this study was to compare the perioperative advantage and disadvantage between general (GA) and spinal anesthesia (SA).Material and Methods: Sixty patients (randomize GA,n=30, SA,n=30) undergoing lumbar disc surgery were enrolled. Patients were matched for demographic data, perioperative physiological changes, pain score, amount of blood loss, surgeon ‘satisfaction, perioperative complications and length of stay in hospital.Results: Intraoperatively and postoperatively, th...

  7. A radiological study on lumbar disc herniation in Korean

    Energy Technology Data Exchange (ETDEWEB)

    Seol, Hae Young; Park, In Sik; Suh, Won Hyuk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

    1979-12-15

    Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

  8. Material Properties of the Human Lumbar Facet Joint Capsule

    OpenAIRE

    Little, Jesse S.; Khalsa, Partap S

    2005-01-01

    The human facet joint capsule is one of the structures in the lumbar spine that constrains motions of vertebrae during global spine loading (e.g., physiological flexion). Computational models of the spine have not been able to include accurate nonlinear and viscoelastic material properties, as they have not previously been measured. Capsules were tested using a uniaxial ramp-hold protocol or a haversine displacement protocol using a commercially available materials testing device. Plane strai...

  9. Fracture of posterior margin of lumbar vertebral body

    Directory of Open Access Journals (Sweden)

    Krishnan Ajay

    2005-01-01

    Full Text Available Background: Avulsion or fracture of posterior ring apophysis of lumbar vertebra is not a common clinical entity and is missed often. These fractures are mostly traumatic lesions typically seen in adolescents and young adults, because fusion in this area is not complete until the age of 18 to 25 years. These fractures are occult on plain radiographs and are frequently missed due to unfamiliarity with the entity. But, CT scanning and MR imaging shows characteristic picture. Methods: We had 21 cases of fracture of posterior margin of a lumbar vertebral body from 1991 to 2002. Fracture in all patients were classified according to CT imaging, into the three types described by Takata et al. Out of these, 8 patients were of type I, 4 patients of type II and 9 patients of type III respectively. Focal deficit / muscle weakness was present in only three patients. No fractures of type IV (Epstein et al was found. Twelve patients were treated conservatively and 9 patients were treated by posterior decompression with total laminectomy and removal of retropulsed fragment and discectomy. Results: The mean follow-up period was of 42 months. Conventional radiography could locate the fracture in only 6 cases and CT scan was required in all cases for stamping the diagnosis and classification. Though it is uncommon, high index of suspicion is required to diagnose it, in especially adolescent patients. All the 21 patients had good outcome following the management. Conclusion: Avulsion or fracture of posterior margin of lumbar vertebral body is not so rare entity. In children and young adults diagnosed as having lumbar disc herniation, this lesion may be the proper diagnosis. These fractures need to be accurately diagnosed because as compared to simple disc herniations these fractures require more extensive exposure and resection to relieve the nerve impingent.

  10. Methods of predicting vertebral body fractures of the lumbar spine

    OpenAIRE

    Sisodia, Gurudattsingh B.

    2013-01-01

    Lumbar vertebral body (VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density (BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models f...

  11. Incidental durotomy in lumbar spine surgery: incidence and management

    OpenAIRE

    Tafazal, Suhayl I.; Sell, Philip J.

    2004-01-01

    There is increasing awareness of the need to inform patients of common complications that occur during surgical procedures. During lumbar spine surgery, incidental tear of the dural sac and subsequent cerebrospinal fluid leak is possibly the most frequently occurring complication. There is no consensus in the literature about the rate of dural tears in spine surgery. We have undertaken this study to evaluate the incidence of dural tears among spine surgeons in the United Kingdom for commonly ...

  12. Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy

    OpenAIRE

    Cho, Sung-min; Rhee, Woo-tack; Lee, Sang-youl; Lee, Sang-bok

    2010-01-01

    Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral scia...

  13. Restless Leg Syndrome and Sleep Quality in Lumbar Radiculopathy Patients

    OpenAIRE

    Kocabicak, Ersoy; Murat TERZI; Akpinar, Kursad; Paksoy, Kemal; Cebeci, Ibrahim; Iyigun, Omer

    2014-01-01

    Background. To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative treatment. Methods. The present study included 66 lumbar radiculopathy patients, who were resistant to conservative treatment and had indication of surgery. Five different questionnaires were performed to assess depression (the Beck Depr...

  14. Role of computed tomography in detection of lumbar disc prolapse

    International Nuclear Information System (INIS)

    To determine the sensitivity of CT scan in diagnosing lumbar disc prolapse. Study Design: Validation Study. Place and Duration of Study: Combined Military Hospital Multan. From August 2009 to July 2010. Patients and Methods: Patients with clinical suspicion of lumbar disc prolapsed were referred from Neurosurgical OPD for CT scan of lumbar spine. The target CT finding was disc prolapse with compression of dural sac or narrowing of lateral recess / neuroforamina. Patients were divided into positive and negative cases on basis of detective of target finding by CT. All positive cased underwent surgery. Negative cases were first treated conservatively and only patients with persistent symptoms underwent surgery. The findings of CT as index test were compared with operative findings as gold reference standard. Results: Total 61 cases were included in study, 51 positive cases and 10 negative cases. Mean age of patients was 44.6 years. There were 42 males and 19 females. Positive cases after surgery showed 48 true positive and 3 false positive cases. Two negative cases showed persistent symptoms, underwent surgery and found positive for target finding (false negatives. Eight negative cases became symptom free after conservative treatment. These CT negative cases turning asymptomatic were ethically not feasible for surgery so assumed as true negative. The above data of 61 cases was computed in 2x2 table to calculate sensitivity (96%) and positive predictive value (94%) of CT scan in diagnosing lumbar disc prolapse. Conclusion: CT scan is having highly sensitivity and positive predictive value in detecting lumber disc prolapsed. It is reliable imaging modality in this regard. (author)

  15. Extradural chondroma presenting as lumbar mass with compressive neuropathy

    OpenAIRE

    Pace, Jonathan; Lozen, Andrew M.; Wang, Marjorie C.; Cochran, Elizabeth J.

    2014-01-01

    The identification of a soft tissue chondroma within the spine represents a rarity and is typically not included within the differential diagnosis for patients with sensory complaints of the leg. The authors describe 46-year-old female presenting with 3-week history of decreased sensation and paresthesias of the left leg. Magnetic resonance imaging of the lumbar spine demonstrated an L3 extradural soft tissue mass. She underwent an uncomplicated excision through an L3 laminectomy and exhibite...

  16. Lumbar Disc Herniation in Tae Kwon Do Athletic Child

    OpenAIRE

    Kim, Sung Hoon; Kim, Hyeun Sung; Kim, Seok Won

    2010-01-01

    Lumbar disc herniation is extremely uncommon in children below 10 years of age. A 7-year-old boy is reported who presented with low back pain and left leg radiating pain. The pain started seven days prior to presentation and was attributed to performing the jumping kick without any previous warm-up. Magnetic resonance imaging revealed a posterolateral disc herniation at the L3-4 level and multiple degenerative changes. The patient received conservative treatment including limitation of sports...

  17. On lumbar spinal stenosis and disc herniation surgery

    OpenAIRE

    Jansson, Karl-a?ke

    2005-01-01

    Patients with spinal stenosis and disc herniation are most common in spine surgery. Few population based studies of these patients have been made and no studies of their health related quality of life (HRQOL) by the EQ-5D has been published. The aim of this thesis is to analyse incidence, readmission, reoperation and mortality in Swedish patients operated on spinal stenosis or disc herniation in the lumbar spine during 19871999 and report the EQ-5D outcome data between 2001-...

  18. The NEtherlands Cervical Kinematics (NECK Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study

    Directory of Open Access Journals (Sweden)

    van den Akker Elske

    2010-06-01

    Full Text Available Abstract Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial. Trial Registration Netherlands Trial Register NTR1289

  19. Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

    International Nuclear Information System (INIS)

    'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7±8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2±8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

  20. Lumbar microdiscectomy: a historical perspective and current technical considerations.

    Science.gov (United States)

    Koebbe, Christopher J; Maroon, Joseph C; Abla, Adnan; El-Kadi, Hikmat; Bost, Jeffery

    2002-08-15

    A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome. A modification of the lumbar microdiscectomy technique is described including patient positioning in the lateral position as well as minimal disc space and nerve root manipulation. In their experience performing more than 3000 microdiscectomies, the authors have produced good-to-excellent clinical results in nearly 90% of patients, with the majority returning to work within 1 month. The complication rate of dural tears, discitis, or root injury has been less than 2%, with a reoperation rate of 5%. The authors believe that lumbar microdiscectomy remains the gold standard with which all other discectomy techniques must be compared. PMID:15916400

  1. Unusual case of camptocormia triggered by lumbar-disc herniation.

    Science.gov (United States)

    Duman, Iltekin; Baklaci, Korhan; Tan, Arif Kenan; Kalyon, Tunc Alp

    2008-04-01

    A 21-year-old male patient with low back pain and marked forward bending was presented. The exaggerated lumbar flexion was preventing him to stand in erect posture but disappeared while lying. The symptoms had begun after he had lifted a heavy object. Straight-leg-raising test could not be performed properly because of the exaggerated pain. The light-touch sense was decreased on L5 and S1 dermatomes. There was no loss of muscle strength. The deep-tendon reflexes were normal. Plain graph showed mild narrowing in the L4-5 and L5-S1 intervertebral spaces. Lumbar magnetic resonance imaging revealed disc protrusions in L4-5 and L5-S1 levels. During his stay in the department, the patient was given tizanidine and tramadol, and physical therapy was performed. A paravertebral intramuscular injection with lidocaine was applied. Moreover, the patient was referred to psychiatrist for evaluation regarding his medical history of conversive seizures and possible efforts for secondary gain. No response was obtained from all the treatments. The final diagnosis was camptocormia triggered by lumbar-disc herniation. He was applied supportive psychotherapy, psychoeducation regarding secondary gain, strong suggestions to improve posture, positive reinforcement, and behavioral therapy. His postural abnormality resolved and disappeared completely with mild pain. PMID:18087763

  2. Evaluation of 60 cases of surgically treated lumbar spinal stenosis

    Directory of Open Access Journals (Sweden)

    Kemal YUCESOY

    2003-06-01

    Full Text Available In this retrospective study, 60 patients who are operated due to lumbar spinal stenosis are evaluated in respect to age, sex, symptoms of the disease, radiological findings, surgical procedures and clinical results. Clinical evaluation was done using Oswestry low back pain disability questionary. Of patients 31 were male, 29 were female, in a range of 15-84 years-old. Majority of patients were between 40-60 years-old. Radiologically all patients were evaluated with anteroposterior, lateral and dynamic plain radiographies, magnetic resonance imaging and last 11 patients were evaluated with additional magnetic resonance myelography also. Most frequent lumbar level was L4-5 level, cause of the stenosis was congenital in four patients and degenerative in the remaining. Two surgical procedures were applied, laminectomy and foraminotomies in 43 patients and inverse laminoplasty in 17 patients. In 11 patients dural laceration complicated the operations but no patient developed cerebrospinal fluid fistula postoperatively. No neurological progression of present neorogical findings was observed. Clinically preoperative mean score of Oswestry was 41.1 and decreased to 11.3 postoperatively. During the follow up of 33 months, three patients were operated due to stenosis at the different levels and posterior spinal instrumentation was performed in four patients because of iatrogenic spondylolisthesis.In conclusion, lumbar spinal stenosis can be treated surgically by laminectomy successfully and inverse laminoplasty is preferred in young patients.

  3. LumbSten: The lumbar spinal stenosis outcome study

    Directory of Open Access Journals (Sweden)

    Min Kan

    2010-11-01

    Full Text Available Abstract Background Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. For patients with moderate or severe symptoms different conservative and surgical treatment modalities are recommended, but knowledge about the effectiveness, in particular of the conservative treatments, is scarce. There is some evidence that surgery improves outcome in about two thirds of the patients. The aims of this study are to derive and validate a prognostic prediction aid to estimate the probability of clinically relevant improvement after surgery and to gain more knowledge about the future course of patients treated by conservative treatment modalities. Methods/Design This is a prospective, multi-centre cohort study within four hospitals of Zurich, Switzerland. We will enroll patients with neurogenic claudication and lumbar spinal stenosis verified by Computer Tomography or Magnetic Resonance Imaging. Participating in the study will have no influence on treatment modality. Clinical data, including relevant prognostic data, will be collected at baseline and the Swiss Spinal Stenosis Questionnaire will be used to quantify severity of symptoms, physical function characteristics, and patient's satisfaction after treatment (primary outcome. Data on outcome will be collected 6 weeks, and 6, 12, 24 and 36 months after inclusion in the study. Applying multivariable statistical methods, a prediction rule to estimate the course after surgery will be derived. Discussion The ultimate goal of the study is to facilitate optimal, knowledge based and individualized treatment recommendations for patients with symptomatic lumbar spinal stenosis.

  4. Assessment of lumbar spinal canal stenosis by magnetic resonance phlebography

    International Nuclear Information System (INIS)

    There is evidence to suggest that cauda equina intermittent claudication is caused by local circulatory disturbances in the cauda equina as well as compression of the cauda equina. We evaluated the role of magnetic resonance phlebography (MRP) in identifying circulatory disturbances of the vertebral venous system in patients with lumbar spinal canal stenosis. Extensive filling defects of the anterior internal vertebral venous plexus were evident in patients with lumbar spinal canal stenosis (n=53), whereas only milder abnormalities were noted in patients with other lumber diseases (n=16) and none in normal subjects (n=13). The extent of the defect on MRP correlated with the time at which intermittent claudication appeared. In patients with lumber spinal canal stenosis, extensive defects of the internal vertebral venous plexus on MRP were noted in the neutral spine position, but the defect diminished with anterior flexion of the spine. This phenomenon correlated closely with the time at which intermittent claudication appeared. Our results highlight the importance of MRP for assessing the underlying mechanism of cauda equina intermittent claudication in patients with lumbar spinal canal stenosis and suggest that congestive venous ischemia is involved in the development of intermittent claudication in these patients. (author)

  5. Interlaminar fenestration in lumbar canal stenosis- a retrospective study

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    Gupta Puneet

    2005-01-01

    Full Text Available Background: Degenerative lumbar canal stenosis is a multifaceted problem presenting as backache and neurological claudication. Methods: In fifteen patients of acquired degenerative lumbar canal stenosis multi level interlaminar fenestration with discectomy, if required, was carried out. Retrospective analysis was done to assess the out come by assessing the relief in backache and neurological claudication. Results: The mean age of patients was 50.4 years and average duration of neurological claudication was nine months. Diagnosis of the degenerative lumbar canal stenosis was made by clinical examination and confirmed by radiological and MRI measurement of cross section area of neural canal. Interlaminar fenestration was done at four levels and three levels in six patients each while it was done at two levels in remaining three patients. None of the patients reported immediate or late onset of backache or restriction of spinal movements, indicating spinal in stability. None of the patients had neurological claudication in the postoperative period. Conclusion: Retrospective analysis suggests that multiple interlaminar fenestrations done in moderate spinal stenosis provides adequate neurological decompression besides maintaining spinal stability.

  6. Measurements of the normal adult lumbar spinal canal.

    Science.gov (United States)

    Janjua, M Z; Muhammad, F

    1989-10-01

    To assess the normal dimensions of the lumbar spinal canal, 100 normal healthy subjects of either sex between 25 and 45 years age were x-rayed for lumber vertebral column in both posteroanterior and lateral views and the canal was measured by Jones and Thomson method. The lumbar spinal canal showed constant dimensions in both sexes in all age groups when studied separately in the male and female subjects. However, no change in relative dimensions was observed between 25 and 45 years. The canal showed gradual decrease in measurement from L1 to L5 vertebral levels in both sexes but relative width of the canal was more in the females than in the males of the same age group. The normal values of the canal to vertebral body ratio (C/B) varies between 1:2.0 and 1:5.0. The ratio 1:2.0 indicates a wider canal whereas any ratio beyond 1:5.0 would be conclusive of stenosis of the lumbar vertebral canal. PMID:2513423

  7. The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome

    International Nuclear Information System (INIS)

    To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms. We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris. In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants. The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

  8. Percutaneous treatment of cervical and lumbar herniated disc.

    Science.gov (United States)

    Kelekis, A; Filippiadis, D K

    2015-05-01

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4-6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75-94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine. PMID:24673977

  9. Lumbar CT findings of patients with low back pain

    International Nuclear Information System (INIS)

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  10. Lumbar stenosis: clinical case / Estenose lombar: caso clínico

    Scientific Electronic Library Online (English)

    Pedro, Sá; Pedro, Marques; Bruno, Alpoim; Elisa, Rodrigues; António, Félix; Luís, Silva; Miguel, Leal.

    2014-07-01

    Full Text Available A estenose lombar é uma patologia cada vez mais frequente, que acompanha o aumento da esperança média de vida e que comporta custos elevados para a nossa sociedade. Apresenta inúmeras causas, entre as quais destacam-se a degenerativa, a neoplásica e a traumática. A maioria dos pacientes responde bem [...] à terapêutica conservadora. O tratamento cirúrgico está reservado para aqueles doentes que apresentem sintomatologia após a implementação de medidas conservadoras. É apresentado um caso de estenose grave da coluna lombar em vários níveis, numa doente do sexo feminino com antecedentes patológicos/cirúrgicos da coluna lombar, na qual foram aplicadas duas técnicas distintas de descompressão, no mesmo ato cirúrgico. Abstract in english Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservativ [...] e therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

  11. The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome

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    Moon, Tae Yong; Baik, Seong Kug [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan(Korea, Republic of); Lee, In Sook [Dept. of Radiology and Medical Research Institite, Pusan National University Hosptal, Pusan (Korea, Republic of)

    2011-05-15

    To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms. We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris. In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants. The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

  12. Ganglioneuroma coincidente con una extrusión discal lumbar / Ganglioneuroma coinciding with a lumbar disk herniation

    Scientific Electronic Library Online (English)

    J.V., Martínez-Quiñones; F., Consolini; J., Aso-Escario; M., Domínguez-Páez; R., Arregui.

    2011-10-01

    Full Text Available Introducción. Los ganglioneuromas o gangliomas son tumores de los ganglios simpáticos que contienen células de la cresta neural, pudiendo aparecer en cualquier parte del organismo. Son generalmente benignos, más frecuente entre los 10 y los 40 años, pueden secretar hormonas y, en ocasiones, asociars [...] e a trastornos genéticos, como la neurofibromatosis tipo I. Objetivo. Revisar la literatura científica relacionada con el tema y presentar un caso tratado en nuestro servicio. Discusión. La sintomatología de estas lesiones depende de su ubicación y de las sustancias vasoactivas que puedan secretar. A pesar de que son tumores benignos en su mayoría, en ocasiones pueden metastatizar. Las pruebas de imagen y de laboratorio son inespecíficas, por lo que el diagnóstico definitivo es anatomopatológico. En los casos sintomáticos el tratamiento de elección es la resección quirúrgica. Conclusión. La asociación de un ganglioneuroma y de una hernia discal lumbar es algo excepcional. El tratamiento requiere su resección quirúrgica. Abstract in english Introduction. Ganglioneuromas or gangliomas are tumours of the sympathetic ganglia that contain cells of the neural crest, so they can appear in all body localizations. They are generally benign, more frequent between 10 and 40 years, may secrete hormones and, sometimes, Neurofibromatosis type I and [...] other genetic disorders can be associated. Objective. To review the scientific literature related to the topic and to present a case treated in our service. Discussion. The symptoms depend on location and vasoactive secreted hormones. In spite of that, they are generally benign tumours, although sometimes they can spread out. Since laboratory and image test are of limited usefulness, the conclusive diagnosis is anatomopathologic. In symptomatic patients the best procedure is surgical revoming. Conclusión. Ganglioneuroma and disk herniation association constitute an excepcional disorder. Its treatment implies surgery resection.

  13. TAHU MENGHAMBAT KEHILANGAN TULANG LUMBAR TIKUS BETINA OVARIEKTOMI [Tofu Attenuates Lumbar Bone Loss of Ovariectomized Female Rats

    Directory of Open Access Journals (Sweden)

    Suyanto Pawiroharsono 4

    2002-12-01

    Full Text Available The objectives of this research were to examine the efeects of feed containing soybean tofu and tempeh on lumbar bone density and mass of ovariectomized female rats. Twenty four 17 weeks-old Sprague-Dawley rats were randomly assigned to four group, i.e.: (1 non-ovariectomized rats fed casein based diet (NonOvx, (2 ovariectomized rats fed casein based diet (OvxC, (3 ovariectomized rats fed diet containing soybean tofu (OvxH, and (4 ovariectomized rats fed diet containing soybean tempeh (OvxT; in three block based on their body weight. The result show that body weight gram of ovariectomized rats was greater than nonovariectomized. Ovariectomy caused atrophy of the uterus, and resulted in higher serum calcium level. The lower lumbar vertebrae density of ovariectomized rats was observed and the decrease was prevented by tofu.

  14. Tratamiento de la radiculopatía lumbar con radiofrecuencia pulsada Treatment of lumbar radiculopathy with pulsed radiofrequency

    Directory of Open Access Journals (Sweden)

    D. Abejón

    2004-09-01

    Full Text Available Objectivos: Valorar la eficacia y los efectos secundarios derivados del tratamiento con radiofrecuencia pulsada en pacientes diagnosticados de radiculopatía lumbar. Material y métodos: Se realiza un estudio observacional prospectivo. Se realizan 20 radiofrecuencias en modo pulsado en 17 pacientes consecutivos con diagnóstico de radiculopatía confirmado mediante electromiografía y clínica congruente desde enero de 2001 hasta enero del 2002. En todos los pacientes antes de efectuar la radiofrecuencia pulsada se realiza un bloqueo radicular selectivo que ha de reducir a sintomatología de los pacientes en al menos el 50% para que se considere positivo. Se evalúa, mediante una escala analógica visual, la intensidad del dolor en cinco momentos. En la visita inicial, al mes del tratamiento, a los 2 meses, a los 3 meses y a los 6 meses. La capacidad funcional del paciente se evalúa, mediante el test de Lattinen, en la visita inicial, a los 3 y 6 meses. Se valora la eficacia de la técnica mediante la escala de Likert de 7 puntos, así como la reducción del tratamiento en el periodo de estudio y la existencia de complicaciones. Para comparar los valores de la EVA a lo largo del periodo de estudio se realiza el test de Friedman no paramétrico para datos apareados de muestras múltiples aplicando un contraste de una sola cola. Se considera significación estadística cuando el valor de p es Objectives: To assess the effectiveness and side effects derived from the treatment with pulsed radiofrequency in patients diagnosed of lumbar radiculopathy. Material and methods: A prospective observational study was performed. Twenty pulsed radiofrequencies were performed in 17 consecutive patients with diagnosis of radioculopathy confirmed by electromyography and congruent clinical manifestations from January 2001 to January 2002. In all the patients and prior to the pulsed radiofrequency, a selective radicular blockade was performed. This blockade had to reduce patient symptomatology in at least 50% to be considered positive. Pain severity was assessed using a visual analogical scale at 5 different points in time: at the initial visit, at one month of treatment, at 2 months, at 3 months and at 6 months. The functional capacity of the patient was assessed using the Lattinen's test at the initial visit, at 3 months and at 6 months. The effectiveness of the technique was assessed using the 7-point Likert's scale, as well as the reduction of the treatment during the study period and the presence of complications. In order to compare the VAS scores obtained during the study period, a non-parametric Friedman's test was performed for paired data from multiple samples, applying a single-tailed contrast. A p-value < 0.05 was considered statistically significant. Results: The average age was 53.46 years (34-73, 7 women and 10 men, with an average time of evolution of 52.9 months (300-2. The average initial VAS score was 8 (10-4 with an average Lattinen index of 12.7 (15-9. Nine patients were receiving treatment with class I drugs, 6 with class 2 drugs and 2 with class 3 drugs. Root location was distributed as follows: 6 patients had affected the L5 root, 3 the S1 root, 1 the L2 root, 2 the L4 root and 4 the L5+S1 root. The average VAS score was reduced to 3.5 (2-7 at 1 month, to 3,3 (1-7 at 2 months, to 3.5 (0-7 at 3 months and to 3.8 (0-7 at 6 months. The Lattinen index was reduced to 6 at 3 months and was of 6.5 at 6 months. An statistically significant reduction of the VAS score was observed (p<0.001 in all the cases. Nine patients reduced their consumption of medication. There were no complications among the patients of this series. Conclusions: Pulsed radiofrequency seems to be a safe and promising technique for lumbar radicular pathologies, given its satisfactory results and the absence of side effects.

  15. Dolor lumbar por estreptoquinasa recombinante: Presentación de un caso / Lumbar pain caused by recombinant streptokinase: A case presentation

    Scientific Electronic Library Online (English)

    María Julia, Cigales Reyes.

    2009-08-01

    Full Text Available La Heberkinasa® (estreptoquinasa recombinante), es un trombolítico utilizado en el tratamiento del infarto agudo del miocardio, presentada en forma de liofilizado en bulbos estériles, de conocidos y probados efectos de reperfusión coronaria y reducción del tamaño del infarto, además de otras aplicac [...] iones como en la trombosis venosa profunda, trombosis de acceso vascular permanente de pacientes con insuficiencia renal crónica terminal tratados por hemodiálisis periódicas, disfunción de prótesis valvulares cardíacas por trombos y en el tromboembolismo pulmonar; se asocian reacciones adversas durante el tratamiento, frecuentes y menos frecuentes, dentro de las que se encuentra el dolor lumbar. Se presenta a una paciente con el diagnóstico de un infarto agudo del miocardio, de cara diafragmática, a quien se le aplicó la trombolisis con Heberkinasa y durante esta presentó dolor lumbar agudo, intenso, que cedió con la reducción de goteo de la infusión y esta se pudo continuar sin más problemas. Abstract in english The Heberkinase® (recombinant streptokinase) is a thrombolytic agent used in treatment of acute myocardial infarction, presented as sterile bulbs, of known and proved effects of coronary reperfusion and reduction of infarction dimension, besides of other applications e.g. the deep venous thrombosis, [...] permanent vascular access thrombosis in patients presenting with terminal chronic renal insufficiency treated by periodical hemodialysis, dysfunction of cardiac vascular prostheses by thrombi, and in case of pulmonary thromboembolism; there are adverse reactions associated during treatment, frequent and less frequent including those of lumbar pain. Authors present a case of a woman diagnosed with acute myocardial infarction of diaphragmatic side undergoing thrombolysis with Heberkinase, and during it she had intense and acute lumbar pain improving with reduction of dripping infusion without subsequent problems.

  16. Dolor lumbar por estreptoquinasa recombinante: Presentación de un caso Lumbar pain caused by recombinant streptokinase: A case presentation

    Directory of Open Access Journals (Sweden)

    María Julia Cigales Reyes

    2009-08-01

    Full Text Available La Heberkinasa® (estreptoquinasa recombinante, es un trombolítico utilizado en el tratamiento del infarto agudo del miocardio, presentada en forma de liofilizado en bulbos estériles, de conocidos y probados efectos de reperfusión coronaria y reducción del tamaño del infarto, además de otras aplicaciones como en la trombosis venosa profunda, trombosis de acceso vascular permanente de pacientes con insuficiencia renal crónica terminal tratados por hemodiálisis periódicas, disfunción de prótesis valvulares cardíacas por trombos y en el tromboembolismo pulmonar; se asocian reacciones adversas durante el tratamiento, frecuentes y menos frecuentes, dentro de las que se encuentra el dolor lumbar. Se presenta a una paciente con el diagnóstico de un infarto agudo del miocardio, de cara diafragmática, a quien se le aplicó la trombolisis con Heberkinasa y durante esta presentó dolor lumbar agudo, intenso, que cedió con la reducción de goteo de la infusión y esta se pudo continuar sin más problemas.The Heberkinase® (recombinant streptokinase is a thrombolytic agent used in treatment of acute myocardial infarction, presented as sterile bulbs, of known and proved effects of coronary reperfusion and reduction of infarction dimension, besides of other applications e.g. the deep venous thrombosis, permanent vascular access thrombosis in patients presenting with terminal chronic renal insufficiency treated by periodical hemodialysis, dysfunction of cardiac vascular prostheses by thrombi, and in case of pulmonary thromboembolism; there are adverse reactions associated during treatment, frequent and less frequent including those of lumbar pain. Authors present a case of a woman diagnosed with acute myocardial infarction of diaphragmatic side undergoing thrombolysis with Heberkinase, and during it she had intense and acute lumbar pain improving with reduction of dripping infusion without subsequent problems.

  17. Análisis de las complicaciones de la cirugía de la hernia discal lumbar / Analysis of the lumbar discectomy complications

    Scientific Electronic Library Online (English)

    P.A., Hernández-Pérez; H., Prinzo-Yamurri.

    2005-10-01

    Full Text Available Objetivo. Examinar los casos de hernia discal lumbar operados entre los años 1997 y 2002, realizando un análisis de las complicaciones quirúrgicas, a la vez que se realiza una revisión de la literatura en relación con el tema. Material y métodos. Se revisaron las historias clínicas de 64 pacientes c [...] on diagnóstico de compresión radicular lumbar por hernia discal, sometidos a tratamiento quirúrgico, analizándose un total de 73 cirugías, incluyendo 9 reintervenciones realizadas en el período de tiempo definido al inicio. Resultados. Se presentaron complicaciones en 7 procedimientos (9.6%): 2 infecciones profundas, 1 caso de desgarro de la duramadre reparado, 2 casos de fístula de líquido cefalorraquídeo (LCR), 1 pseudomeningocele, y 1 caso de lesión de la raíz L5. Conclusiones. Las complicaciones que se presentaron con mayor frecuencia fueron los desgarros de la duramadre y las infecciones, resultados que coinciden con las series internacionales publicadas. Abstract in english Objective. To analyze the complications in a series of patients operated on for lumbar disc herniations between 1997 and 2002. Methods. The records of 64 patients with the diagnosis of lumbar radicular compression by disc herniation who underwent 73 surgical procedures were analyzed. The patients wi [...] th radicular pain without disc herniation were excluded. Results. Complications occurring in 7 cases (9.6 %) were 2 deep infections, 1 dural tear which was repaired, 2 cerebrospinal fluid fistulae, 1 pseudomeningocele and 1 lesion of L5 root. Conclusions.- The most frequent complications were dural tear and infection. These observations are similar to those reported in previously published papers.

  18. THE ROLE OF LIGAMENTUM FLAVUM CALCIFICATION AT LUMBAR SPINE CAUSING CAUDA EQUINA SYNDROME AND LUMBAR RADICULOPATHY: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Gajanan

    2013-10-01

    Full Text Available ABSTRACT: The focal calcification or ossification of ligamentum flavum is a rare cau se of thoracic myelopathy and most often occurs among individuals of Japanese descent. It is rare in other ethnic groups and in individuals below the age of 50 year. It is most often described at the lower thoracic level, being uncommon in the lumbar regio n and rare in the cervical region. Here, we present the case of a 40 - year - old Indian female patient who sought medical attention with a six month history of paraesthesia of the lower limbs and progressive difficulty in walking. The clinical profile, togeth er with computed tomography and magnetic resonance imaging of the spine, led to a diagnosis of compressive lumbar myelopathy due to ossification of the ligamentum flavum of lumbar spine. The patient underwent laminectomy and dissection of some of the affec ted ligamentum flavum. After three months of clinical follow - up, the patient had progressed favorably , having no sensory complaints and again becoming ambulatory

  19. Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005-2008

    Science.gov (United States)

    ... at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005–2008 On This Page Key ... either the femur neck or lumbar spine among older adults in the United States population based on these ...

  20. The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm

    OpenAIRE

    Crossley, R. A.; Raza, A.; Adams, W. M.

    2011-01-01

    We present a new MRI finding within the lumbar spine in a series of six patients admitted with CT proven subarachnoid haemorrhage (SAH) where cerebral angiography demonstrated no aneurysm and who had not had a lumbar puncture.

  1. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction.

    Science.gov (United States)

    Chung, Tae-Sub; Yang, Hea-Eun; Ahn, Sung Jun; Park, Jung Hyun

    2015-06-01

    Purpose To assess the morphologic changes in herniated lumbar intervertebral disks and surrounding structures during lumbar traction by using real-time magnetic resonance (MR) imaging. Materials and Methods This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Forty-eight consecutive patients with lumbar disk herniation (13 men and 35 women) were treated with continuous lumbar traction by using a nonmagnetic traction device. Real-time MR imaging of the lumbar spine was performed before the initiation of traction and at 10-minute intervals during 30 minutes of 30 kg of continuous traction. Sagittal and axial MR images were analyzed to determine qualitative changes during lumbar traction. Quantitative changes caused by traction on the lumbar spine were determined by measurement of lumbar vertebral column elongation and the disk reduction ratio. Results Continuous traction on herniated lumbar disks and surrounding structures resulted in change in disk shape, disk reduction with opening in the intervertebral disk, reduction of herniated disk volume, separation of the disk and adjoining nerve root, and widening of the facet joint. Both the mean lumbar vertebral column length (elongation of 1.45% after 30 minutes, P < .001) and the mean disk reduction ratio (8.57%, 15.24%, and 17.94% after 10, 20, and 30 minutes of traction, respectively) increased with time of traction. Conclusion The results of this study demonstrated that the real-time effects of continuous traction on herniated lumbar intervertebral disks and their surrounding structures can be visualized by using MR imaging. (©) RSNA, 2015. PMID:25611735

  2. Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis

    OpenAIRE

    Tafazal, Suhayl I.; Ng, Leslie; Sell, Philip

    2006-01-01

    This is a double blind randomised controlled trial to assess the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. The trial compared the outcome of salmon calcitonin nasal spray to placebo nasal spray in patients with MRI confirmed lumbar spinal stenosis. Lumbar spinal stenosis is one of the commonest conditions encountered by spine surgeons. It more frequently affects elderly patients and lumbar decompression has been used to treat the condition with varia...

  3. Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests

    OpenAIRE

    Mariconda, Massimo; Galasso, Olimpio; Attingenti, Paolo; Federico, Gianluigi; Milano, Carlo

    2009-01-01

    The aim of this retrospective controlled study was to evaluate radiographic degeneration in the lumbar spine of patients who had undergone lumbar discectomy minimum 21 years earlier and its clinical meaning. Indeed, no previous investigation on degenerative changes occurring after lumbar discectomy with a comparable long follow-up has been published. The study participants consisted of 50 patients who had undergone discectomy for lumbar disc herniation. The mean length of follow-up was 25.3?...

  4. A diffusion and T2 relaxation MRI study of the ovine lumbar intervertebral disc under compression in vitro

    International Nuclear Information System (INIS)

    The ovine lumbar intervertebral disc is a useful model for the human lumbar disc. We present preliminary estimates of diffusion coefficients and T2 relaxation times in a pilot MRI study of the ovine lumbar intervertebral disc during uniaxial compression in vitro, and identify factors that hamper the ability to accurately monitor the temporal evolution of the effective diffusion tensor at high spatial resolution

  5. The sitting man. Radiography of lumbar spine and pelvis in sitting position

    International Nuclear Information System (INIS)

    Radiographs of the lumbar spine in sitting and standing positions demonstrate sliding movements of the vertebral bodies to an unexpected extent, as a sign of the instability of the lumbar spine. These observations suggest some ideas for the construction of chairs. (orig.)

  6. Traumatic lumbar artery pseudoaneurysm: the role of CT angiography in diagnosis and treatment.

    Science.gov (United States)

    Ceyhan, Meltem; Belet, Umit; Aslan, Serdar; Ayyildiz, Suat; Göl, Kamil

    2010-06-01

    Pseudoaneurysm of lumbar artery is a rare and late complication of penetrating trauma. We report the Doppler ultrasonography and multidetector computed tomography angiography findings and endovascular embolization treatment of a pseudoaneurysm of lumbar artery in a 14-year-old girl following a gunshot wound. PMID:19838988

  7. Comparison of chronic low-back pain patients hip range of motion with lumbar instability.

    Science.gov (United States)

    Lee, Sang Wk; Kim, Suhn Yeop

    2015-02-01

    [Purpose] The purpose of this study was to compare differences in hip range of motion between a lumbar stability group and a lumbar instability group of patients with chronic low-back pain. [Subjects] Sixty-nine patients with chronic low-back pain were divided into two groups: a lumbar stability group (n=39) and a lumbar instability group (n=30). [Methods] The patients were assessed using a goniometer to evaluate the hip range of motion at pre-test. Data were analyzed using SPSS 18.0 software for Windows. The experimental data were analyzed using one-way ANOVA, repeated one-way ANOVA, and the t-test, and a significance level of 0.05. [Results] The limitation of hip range of motion of the lumbar instability group was significantly greater than that of the lumbar stability group. [Conclusion] The chronic low-back pain patients showed greater limitation of hip range of motion than healthy persons, and among them, those who had lumbar instability showed greater limitation than those with lumbar stability. PMID:25729165

  8. Sagittal Lumbar Spine Position During Standing, Walking, and Running at Various Gradients

    OpenAIRE

    Levine, David; Colston, Marisa A.; Whittle, Michael W; Pharo, Elizabeth C; Marcellin-Little, Denis J

    2007-01-01

    Context: Motion in the lumbar spine during certain physical activities may exceed tissue homeostasis, leading to low back pain. Previous authors have assessed sagittal motion of the lumbar spine during walking; however, limited attention has been focused on changes in spine position with walking or running on different surface gradients.

  9. Diagnostic possibilities of thermal imaging in neurologic manifestations of lumbar osteochondrosis in different stages of treatment

    Science.gov (United States)

    Kolesov, S. N.; Fedosenko, T. S.

    1993-11-01

    On the basis of thermal imaging examinations of 2000 patients suffering lumbar osteochondrosis of the vertebral region, and using their methods, the authors describe the specifics of the thermal images of the lumbar region and the lower extremities in various clinical manifestations of the reflex and radicular syndromes.

  10. Evaluation of the Etoricoxib-Mediated Pain-Relieving Effect in Patients Undergoing Lumbar Fusion Procedures for Degenerative Lumbar Scoliosis: A Prospective Randomized, Double-Blind Controlled Study.

    Science.gov (United States)

    Shi, Yongxiang; Wang, Ping; Hu, Xinlei; Ye, Zhaoming

    2014-11-13

    This randomized, double-blind study was carried out to evaluate the effectiveness of etoricoxib in controlling the pain during lumbar fusion surgery of the degenerative lumbar scoliosis patients. We found that perioperative use of etoricoxib produced a significant reduction in the degree of pain compared to the patients treated with placebo. Etoricoxib eased the pain and helped to manage the discomfort of lumbar fusion surgery. In addition, etoricoxib was well tolerated as it caused no serious adverse reaction, suggesting a safe profile. Etoricoxib also appeared to ensure and promote the positive effect of surgery, however, insignificantly. Thus, the results suggest that etoricoxib was effective in safely managing the pain during the lumbar fusion surgery and recovery thereafter. PMID:25391889

  11. Hernia lumbar de Grynfelt-Lesshaft: A propósito de 2 casos

    Directory of Open Access Journals (Sweden)

    Jesús Alberto Rondón Espino

    2002-08-01

    Full Text Available Las hernias lumbares son sumamentes raras, y se reportan en pocas ocasiones. Las hernias que se producen a través del espacio lumbar superior o de Grynfelt-Lesshaft, por ser éste más constante y de mayor tamaño, suelen aparecer con más frecuencia que las que se producen a través del triángulo de Petit. Se reportan 2 pacientes diagnosticados y tratados quirúrgicamente a causa de esta afecciónLumbar hernias are extremely -+rare and they are occasionally reported. The hernias occurred through the superior lumbar space or triangle of Grynfeltt-Lesshaft, which is more constant and larger, appear more often than those developed through the lumbar triangle of Petit. 2 patients who were diagnosed and surgically treated due to this affection are reported

  12. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM IN PATIENTS WITH LUMBAR RADICULOPATHY (L5 / S1 NERVE ROOT IN LUMBAR DISC HERNIATION

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    Sahiba Yadav

    2014-10-01

    Full Text Available Background: Various manual therapy techniques are known to treat discogenic pain. Research is limited and controversial in the effectiveness of manual therapy for treatment of lumbar radiculopathy due to lumbar disc disease. In manual therapy, Mulligan has described spinal mobilisation with leg movement technique, for improvement in lumbar lesion resulting in pain and other signs below knee. Purpose of the study: To find out if Mulligan’s Spinal Mobilisation with Leg Movement technique (SMWLM in conjunction with conventional treatment is better than conventional treatment alone in improving leg pain intensity (VAS, localization of leg pain (body diagram by Donelson, back specific disability (RMQ in patients with lumbar radiculopathy (L5/ S1 nerve root in lumbar disc herniation. Methods: The study is a randomized controlled trial performed on 30 patients with lumbar radiculopathy. Both the groups received back extension exercises, hot pack, precautions and ergonomic advice. The experimental group received SMWLM technique in addition to the conventional treatment. Outcomes included leg pain intensity, Roland Morris Questionnaire and body diagram by Donelson. Results: There was significant improvement in VAS (p=0.000, body diagram (p=0.000 for experimental group and p=0.003 for conventional group and Roland Morris Questionnaire score (p=0.000 within the groups. Between group analysis showed significant improvement in VAS (p=0.000, body diagram score (p=0.000. Although there was significant improvement in Roland Morris Questionnaire score within the groups but there no significant difference between the group (p=0.070. Conclusion: Spinal Mobilization with Leg Movement technique in addition to conventional physical therapy produced significant improvement in leg pain intensity, location of pain and back specific disability in patients with lumbar radiculopathy in lumbar disc herniation.

  13. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis

    OpenAIRE

    Tsutsumimoto, Takahiro; Shimogata, Mitsuhiko; Yoshimura, Yasuo; Misawa, Hiromichi

    2008-01-01

    It has been reported that in patients undergoing posterolateral lumbar fusion (PLF), the fusion status is not related to the short-term operative results. To determine whether the fusion status influences the long-term operative results of PLF, we retrospectively examined the surgical outcomes of uninstrumented PLF for a minimum of 8 years (average, 9.5 years), by comparing cases exhibiting union with those exhibiting nonunion. Uninstrumented PLF was performed for the treatment of lumbar ca...

  14. The role of cumulative physical work load in lumbar spine disease: risk factors for lumbar osteochondrosis and spondylosis associated with chronic complaints

    OpenAIRE

    Seidler, A.; Bolm-audorff, U.; Heiskel, H.; Henkel, N.; Roth-kuver, B.; Kaiser, U.; Bickeboller, R.; Willingstorfer, W.; Beck, W.; Elsner, G.

    2001-01-01

    OBJECTIVES—To investigate the relation with a case-control study between symptomatic osteochondrosis or spondylosis of the lumbar spine and cumulative occupational exposure to lifting or carrying and to working postures with extreme forward bending.?METHODS—From two practices and four clinics were recruited 229 male patients with radiographically confirmed osteochondrosis or spondylosis of the lumbar spine associated with chronic complaints. Of these 135 had additionally had acute lum...

  15. Asymmetry of the multifidus muscle in lumbar radicular nerve compression

    Energy Technology Data Exchange (ETDEWEB)

    Farshad, Mazda; Gerber, Christian; Farshad-Amacker, Nadja A.; Dietrich, Tobias J.; Laufer-Molnar, Viviane; Min, Kan [Balgrist University Hospital, University of Zuerich, Zuerich (Switzerland)

    2014-01-15

    The multifidus muscle is the only paraspinal lumbar muscle that is innervated by a single nerve root. This study aimes to evaluate if the asymmetry of the multifidus muscle is related to the severity of compression of the nerve root or the duration of radiculopathy. MRI scans of 79 patients with symptomatic single level, unilateral, lumbar radiculopathy were reviewed for this retrospective case series with a nested case-control study. The cross-sectional area (CSA) of the multifidus muscle and the perpendicular distance of the multifidus to the lamina (MLD) were measured bilaterally by two radiologists and set into relation to the severity of nerve compression, duration of radiculopathy and probability of an indication for surgical decompression. In 67 recessal and 12 foraminal symptomatic nerve root compressions, neither the MLD ratio (severe 1.19 ± 0.55 vs less severe nerve compression: 1.12 ± 0.30, p = 0.664) nor the CSA ratio (severe 1 ± 0.16 vs less severe 0.98 ± 0.13, p = 0.577) nor the duration of symptoms significantly correlated with the degree of nerve compression. MR measurements of multifidus were not different in patients with (n = 20) and those without (n = 59) clinical muscle weakness in the extremity caused by nerve root compression. A MLD >1.5 was, however, associated with the probability of an indication for surgical decompression (OR 3, specificity 92 %, PPV 73 %). Asymmetry of the multifidus muscle correlates with neither the severity nor the duration of nerve root compression in the lumbar spine. Severe asymmetry with substantial multifidus atrophy seems associated with the probability of an indication of surgical decompression. (orig.)

  16. Asymmetry of the multifidus muscle in lumbar radicular nerve compression

    International Nuclear Information System (INIS)

    The multifidus muscle is the only paraspinal lumbar muscle that is innervated by a single nerve root. This study aimes to evaluate if the asymmetry of the multifidus muscle is related to the severity of compression of the nerve root or the duration of radiculopathy. MRI scans of 79 patients with symptomatic single level, unilateral, lumbar radiculopathy were reviewed for this retrospective case series with a nested case-control study. The cross-sectional area (CSA) of the multifidus muscle and the perpendicular distance of the multifidus to the lamina (MLD) were measured bilaterally by two radiologists and set into relation to the severity of nerve compression, duration of radiculopathy and probability of an indication for surgical decompression. In 67 recessal and 12 foraminal symptomatic nerve root compressions, neither the MLD ratio (severe 1.19 ± 0.55 vs less severe nerve compression: 1.12 ± 0.30, p = 0.664) nor the CSA ratio (severe 1 ± 0.16 vs less severe 0.98 ± 0.13, p = 0.577) nor the duration of symptoms significantly correlated with the degree of nerve compression. MR measurements of multifidus were not different in patients with (n = 20) and those without (n = 59) clinical muscle weakness in the extremity caused by nerve root compression. A MLD >1.5 was, however, associated with the probability of an indication for surgical decompression (OR 3, specificity 92 %, PPV 73 %). Asymmetry of the multifidus muscle correlates with neither the severity nor the duration of nerve root compression in the lumbar spine. Severe asymmetry with substantial multifidus atrophy seems associated with the probability of an indication of surgical decompression. (orig.)

  17. Postural stability disorders in rural patients with lumbar spinal stenosis

    Directory of Open Access Journals (Sweden)

    Aleksandra Truszczy?ska

    2014-03-01

    Full Text Available Introduction. Hard work in farming may lead to lumbar spinal stenosis, and consequently, to pain. The pain and neurological disorders may lead to disability and postural disorders. Objective. The aim of the presented study was to analyse postural stability and its correlation with functional disability of patients with lumbar spinal stenosis living in rural areas. Materials and methods. The study population consisted of 30 rural patients with lumbar spinal stenosis; mean age: 51.40 (±12.92; mean BMI: 28.60 (±3.77. The control group consisted of 30 rural inhabitants without spinal disorders. Postural stability was tested on the Biodex Balance System. The patients were also evaluated according to the ODI, the Rolland- Morris disability questionnaire, and VAS. Results. The mean results of the patients studied were as follows: 49.37 (±17.39 according to ODI, 15 (±6.19 according to the Rolland-Morris disability scale, and pain intensity of 7 (±1.93 according to the VAS. The following statistically significant differences were found: the mean balance index result was 1.8 (±1.88 and 0.64 (±0.41 in the control group. The mean centre of mass deviation in the A/P plane was 1.39 (±1.88 and 0.46 (±0.41 in the control group. The mean centre of mass deviation in the M/L plane was 0.8 (±0.51 and 0.32 (±0.22 in the control group. The balance in the studied population correlated significantly with the Rolland-Morris disability questionnaire and the VAS. Conclusions: 1 Serious disability was found in rural patients with spinal stenosis. There was a statistically significant correlation between the disability and postural stability disorders. 2 Most of the patients (84% were overweight. 3 Postural stability disorders were statistically significant for both the stability index and the A/P plane deviation.

  18. MR guided percutaneous laser lumbar disk hernia ablation

    International Nuclear Information System (INIS)

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  19. The diagnostic utility of resistive MRI for lumbar disc hernias

    Energy Technology Data Exchange (ETDEWEB)

    Sakaida, Hiroshi; Hanakita, Junya; Suwa, Hideyuki; Nishihara, Kiyoshi; Nishi, Shogo; Ohta, Fumito; Iihara, Kouji (Shizuoka General Hospital, Shizuoka (Japan))

    1990-04-01

    The diagnostic utility of the 0.1 tesla resistive magnetic resonance imaging (MRI) system was studied for 78 lumbar disc hernias in surgically treated 70 patients. Myelographic appearance of the lumbar disc hernias fell into the following three categories: (1) medial type, compressing the thecal sac; (2) mediolateral type, compressing both the nerve root and thecal sac; and (3) lateral type, compressing the nerve root. MRI was performed in low-flip angle (LF) and saturation-recovery (SR) radiofrequency-pulse sequences for the midline and paramedian sagittal sections, respectively. A transverse section was found positive when the laterality of the disc hermia was obtained. A coronal section was found positive when high-intensity disc material compresisng the nerve root was recognized. Diagnostic capability of MRI was graded in three scores: Excellent- the optimal information was provided; Fair- some pieces of information was obtained, but not enough for diagnosis; Poor- the information was not helpful for diagnosis in deciding the operative procedure. Of 13 medial disc hernias, 84.6% was positive in the sagittal plane and 88.9% in the transverse plane. MRI was superior to myelography in 9 lesions. Of 38 mediolateral disc hernias, 84.2% were positive in the sagittal plane, 74.2% in the transverse plane, and 26.7% in the coronal plane. MRI was judged as excellent for 17 lesions, fair for 15 lesions, and poor for 6 lesions. Of 27 lateral disc hernias, 55.6% were positive in the sagittal plane, 50.0% in the transverse plane, and 30.0% in the coronal plane. MRI was judged as excellent for 4 lesions, fair for 11 lesions, and poor for 12 lesions. Resistive MRI system was of limited value in diagnosing surgical indication of lateral lumbar disc hernias, especially for small but painful lesions. (N.K.).

  20. Clinical Evaluation of TruFUSE® Lumbar Facet Fusion System

    Directory of Open Access Journals (Sweden)

    Austin S. Amos

    2013-02-01

    Full Text Available Introduction: The TruFUSE lumbar facet fusion system is a unique allograft milled bone dowel used to fuse facet joints. We evaluated subjects undergoing TruFUSE fusion for stable grade I spondylolisthesis and stenosis comparing operative time, length of stay, blood loss and outcome to a similar literature-based cohort of patients undergoing pedicle screw fusion (PSF. Methods: From 2009 to 2011, 41 subjects (17 M,24 F, aver. age 69.5 yr underwent TruFUSE facet fusion along with transverse process bone fusion and laminectomy. Length of stay, operative time, blood loss and outcomes were compared to eight literature-based cohort that analyzed similar parameters following pedicle screw fusion. Results: The 41 subjects’ mean operative time for laminectomy, transverse process fusion and TruFUSE facet fusion was 106 min, with a mean blood loss of145 cm3, and a mean hospital stay of 1.7 days (77% one day. A follow-up at average six months, 33 (80% subjects reported subjective outcomes of “excellent” or “somewhat improved”, four (10% “unchanged” and four (10% “worse”. Flexion and extension radiographs showed 39 of the 41 patients (95% had spinal stability at an average six months post-op and all (100% had signs of early fusion. Discussion: TruFUSE subjects had significantly (p - 19 days range. Mean estimated blood loss (EBL was significantly lower (p 3 compared to321 cm3 and1082 cm3 range for PSF. Subjective outcome and radiographic stability were comparable between groups. Conclusion: This comparison using the TruFUSE lumbar facet fusion system demonstrates improvements in length of stay, surgical blood loss, and operative time in our selected patient population compared to several published lumbar pedicle screw fusion systems outcomes. There may be potential economic benefits as a result of these improvements.

  1. The diagnostic utility of resistive MRI for lumbar disc hernias

    International Nuclear Information System (INIS)

    The diagnostic utility of the 0.1 tesla resistive magnetic resonance imaging (MRI) system was studied for 78 lumbar disc hernias in surgically treated 70 patients. Myelographic appearance of the lumbar disc hernias fell into the following three categories: (1) medial type, compressing the thecal sac; (2) mediolateral type, compressing both the nerve root and thecal sac; and (3) lateral type, compressing the nerve root. MRI was performed in low-flip angle (LF) and saturation-recovery (SR) radiofrequency-pulse sequences for the midline and paramedian sagittal sections, respectively. A transverse section was found positive when the laterality of the disc hermia was obtained. A coronal section was found positive when high-intensity disc material compresisng the nerve root was recognized. Diagnostic capability of MRI was graded in three scores: Excellent- the optimal information was provided; Fair- some pieces of information was obtained, but not enough for diagnosis; Poor- the information was not helpful for diagnosis in deciding the operative procedure. Of 13 medial disc hernias, 84.6% was positive in the sagittal plane and 88.9% in the transverse plane. MRI was superior to myelography in 9 lesions. Of 38 mediolateral disc hernias, 84.2% were positive in the sagittal plane, 74.2% in the transverse plane, and 26.7% in the coronal plane. MRI was judged as excellent for 17 lesions, fair for 15 lesions, and poor for 6 lesions. Of 27 lateral disc hernias, 55.6% were positive lateral disc hernias, 55.6% were positive in the sagittal plane, 50.0% in the transverse plane, and 30.0% in the coronal plane. MRI was judged as excellent for 4 lesions, fair for 11 lesions, and poor for 12 lesions. Resistive MRI system was of limited value in diagnosing surgical indication of lateral lumbar disc hernias, especially for small but painful lesions. (N.K.)

  2. Influence of lumbar curvature and rotation on forward flexibility in idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Feng-Chun Kao

    2014-04-01

    Full Text Available Background: Lumbar spine facet joints are arranged sagittally and mainly provide forward flexibility. Rotation of the lumbar vertebral body and coronal plane deformity may influence the function of lumbar forward flexibility. We hypothesize that the more advanced axial and coronal plane deformity could cause more limitation on forward flexibility in patients with idiopathic scoliosis. Methods: Between January 2011 and August 2011, 85 patients with adolescent idiopathic scoliosis were enrolled in this study. The proximal thoracic, major thoracic, thoracolumbar/lumbar (TL/L, and lumbar (L1/L5 curves were measured by Cobb's method. Lumbar apical rotation was graded using the Nash-Moe score. Lumbar forward flexibility was measured using the sit and reach (S and R test. Statistical analysis was performed using one-way analysis of variance (ANOVA, Spearman's and Pearson's correlation coefficients. Results: The mean age was 16.1 ± 2.84 years. The mean proximal thoracic, major thoracic, TL/L, and L1/L5 curves were 17.61° ± 8.92, 25.56° ± 11.61, 26.09° ± 8.6, and 15.10° ± 7.85, respectively. The mean S and R measurement was 25.56 ± 12.33 cm. The magnitude of the TL/L and L1/L5 curves was statistically positively related to vertebral rotation (rs = 0.580 and 0.649, respectively. The correlation between the S and R test and both the TL/L and L1/L5 curves was negative (rp = –0.371 and –0.595, respectively. Besides, the S and R test also demonstrated a significant negative relationship with vertebral rotation (rs = –0.768. Conclusion: In patients with idiopathic scoliosis, spinal deformity can diminish lumbar forward flexibility. Higher lumbar curvature and rotation lead to greater restriction of lumbar flexion.

  3. Synovial cysts of the lumbar spine; diagnosed with magnetic resonance

    International Nuclear Information System (INIS)

    A series of nine cases of synovial cysts of the lumbar spine, diagnosed with magnetic resonance is presented. The cysts were found in patients aged 24 to 73 yrs, most of which had symptoms related with this finding. Some were seen as incidental findings or unrelated to symptoms. The most typical characteristic of these lesions is that of a rounded, ovoid or bilobed image, with close anatomical relation with the facet joints or the ligamentum flavum, that presented with facet joint arthrosis and degenerative spondylolisthesis was significant and useful for diagnosis

  4. Radiologic abnormalities of the thoraco-lumbar spine in athletes

    International Nuclear Information System (INIS)

    A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male nonathletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occured in both athletes and non-athletes but were more common among athletes, especially male-gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers. (orig.)

  5. Dumb-bell-type teratoma in the lumbar spine

    International Nuclear Information System (INIS)

    We report a case of a lumbar teratoma in a 50-year-old woman. The teratoma showed a dumb-bell-type expansion at the level of the left L3/4 foramen with massive erosion of the L3 vertebral body. MRI revealed inhomogeneous signal changes in the tumor, which were histologically compatible with a mixture of bone, muscle, fat, and cyst containing sebaceous material. Complete resection of the tumor and spinal arthrodesis with pedicle screw fixation was necessary to obtain stability of the affected spinal segment. (orig.)

  6. Multisegmental pneumatocysts of the lumbar spine mimic osteolytic lesions

    International Nuclear Information System (INIS)

    Circumscribed radiolucencies within the vertebral bones can be due to a variety of changes including benign and malignant tumours or tumour-like lesions. Radiolucencies due to degenerative intraosseous pneumatocyst are very uncommon but have to be taken into the differential diagnosis in well-circumscribed lytic lesions of the vertebral bodies. We describe the first case of multisegmental pneumatocysts in the lumbar spine mimicking osteolytic lesions. On computed tomography, the air-equivalent attenuation values of the lesions and the close vicinity to the degenerated vertebral endplates with vacuum phenomenon led to the correct diagnosis. (orig.)

  7. CT findings of lumbar intervertebral disc: II. Disc herniation (HNP)

    International Nuclear Information System (INIS)

    In lumbar region the epidural fat pad is relatively abundant so that CT can provides sufficient information in diagnosis of lumbar HNP. Many authors have reported on the CT findings of HNP such as focal nodular protrusion of the posterior disc margin, obliteration of epidural fat pad, impingement of dural sac and nerve root, swelling of nerve root, soft tissue density in the spinal canal and calcification of disc. However there was so previous report describing incidence and reliability of the findings. It is the purpose of the present study to survey the frequency, reliability, and limitation of these CT findings. The clinical material was consisted of 30 operatively proven cases of HNP of the lumbar spine. Each lumbar CT scan was reviewed retrospectively and the findings were analysed by two radiologists independently. There were 20 males and 10 females and the mean age was 36.7 years. Involvement of L4-S5 level was 2.3 times more frequent than that of L5-S1 level. Of 30 cases, 22 were unilateral posterolateral types and 8 cases central or unilateral far lateral types. CT findings observed were nodular protrusion of the posterior margin of the disc, obliteration of epidural fat pad, impingement of dural sac or nerve root, soft tissue density in the spinal canal and calcification in the posterior portion of the protruded disc, in order of decreasing frequency. The conclusions are follows: 1. Nodular protrusion of the posterior disc margin accompanied by obliteration r disc margin accompanied by obliteration of epidural fat pad was observed in every case. The former findings was designated as direct sign and the latter indirect. 2. Obliteration of the epidural fat appears to be significant in lateral recesses especially when it occurs unilaterally. This was not true, however, in the centrally located fat pad. 3. Impingement of the dural sac and nerve root were observed in 90% and 67%, respectively, and were very helpful in establishing HNP diagnosis when the direct and indirect signs were equivocal. Metrizamide CT scan facilitated the evaluation of the dural sac and nerve root. 4. Soft tissue density in the spinal canal and calcification in the posterior portion of the protruded disc were demonstrated in only 2% and 1% of the case, respectively.

  8. Rachipagus: A Report of Two Cases - Thoracic and Lumbar

    OpenAIRE

    Sanoussi, Samuila; Rachid, Sani; Sani, Chaibou Maman; Mahamane, Bawa; Addo, Guemou

    2010-01-01

    We present two cases of rachipagus in two male infants and review the literature on this anomaly. These infants were from consanguineous marriages and cases of twins were reported in their families. In the first case it was a limb attached to the lower lumbar region with a rudimentary posterior arch. At the junction there was a lipomeningocele. Anatomical dissection of the limb identified the bones of the lower limb. In the second case, the parasites were joints of the upper limb that were at...

  9. Extradural chondroma presenting as lumbar mass with compressive neuropathy.

    Science.gov (United States)

    Pace, Jonathan; Lozen, Andrew M; Wang, Marjorie C; Cochran, Elizabeth J

    2014-07-01

    The identification of a soft tissue chondroma within the spine represents a rarity and is typically not included within the differential diagnosis for patients with sensory complaints of the leg. The authors describe 46-year-old female presenting with 3-week history of decreased sensation and paresthesias of the left leg. Magnetic resonance imaging of the lumbar spine demonstrated an L3 extradural soft tissue mass. She underwent an uncomplicated excision through an L3 laminectomy and exhibited complete resolution of symptoms. Pathologic examination revealed benign cartilaginous tissue; however, the authors recommend long-term follow-up for such lesions as the potential for malignant transformation is unknown. PMID:25336836

  10. Multivariate prognostic modeling of persistent pain following lumbar discectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2013-03-04

    Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined.

  11. Factores relacionados con la cirugía fallida de hernia discal lumbar / Related factors with the failed surgery of herniated lumbar disc

    Scientific Electronic Library Online (English)

    J., Rodríguez-García; A., Sánchez-Gastaldo; T., Ibáñez-Campos; C., Vázquez-Sousa; M., Cantador-Hornero; J.A., Expósito-Tirado; A., Cayuela-Domínguez; C., Echevarría-Ruiz de Vargas.

    2005-12-01

    Full Text Available Introducción. La cirugía descompresiva de hernia discal es la intervención quirúrgica más frecuente a nivel de la columna lumbar. La cirugía fallida oscila entre un 10 y un 40% de los casos, constituyendo el denominado Síndrome de la Cirugía Raquídea Fracasada (SCRF). La reincorporación laboral a me [...] dio plazo tras la cirugía se sitúa en torno al 70-85%, y existen pocos estudios que analicen la calidad de vida tras la intervención. Los objetivos de este estudio son conocer la incidencia de cirugía fallida de hernia discal lumbar en nuestro medio, identificando aquellos factores que puedan influir en su aparición; y estudiar factores ambientales como la reincorporación laboral y la calidad de vida a medio plazo tras esta cirugía, así como su relación con el éxito o fracaso quirúrgico. Material y métodos. Estudio descriptivo transversal de 117 pacientes intervenidos de hernia discal lumbar durante el primer semestre del 2003 en nuestro hospital. Para valorar la incidencia de cirugía fallida y factores relacionados se han recogido datos clínicos de la Historia Clínica de los pacientes de la muestra. Y, asimismo, se ha entrevistado telefónicamente a 91 de ellos -los que contestaron- para valorar factores no clínicos relacionados con el SCRF, tales como reincorporación laboral, satisfacción con la cirugía, realización de tratamiento rehabilitador y calidad de vida a través del Cuestionario de Salud SF-36. Para el análisis de resultados se ha empleado el programa estadístico SPSS 11.01. Resultados. En una muestra en la que la proporción ente ambos sexos es de 1/1 y la edad media de 45 [35-54] años, con una clínica más frecuente de ciática derecha, de más de 6 meses de evolución, correlacionada con el hallazgo radiológico de hernia L5-S1, un 37,9% ha presentado el SCRF. Aunque es escaso el número de pacientes que en nuestra serie afrontan una reintervención, se ha observado en ellos una incidencia del SCRF notablemente superior (52,2%) a los que se someten a una primera cirugía (32%). Los factores clínicos predictivos de resultados desfavorables en pacientes sometidos a primera cirugía han sido la clínica precirugía de ciática bilateral, el hallazgo de estenosis de canal asociada a hernia discal y la comorbilidad; mientras que los socio-laborales han sido pacientes sin estudios y aquellos que trabajan en los sectores de la conducción, construcción y hostelería. La reincorporación laboral se produjo en el 64 % de los trabajadores activos previamente. Sólo en torno al 10% se encuentran insatisfechos con la opción quirúrgica, relacionándose significativamente tanto esto como las dimensiones de función física, dolor, vitalidad y rol emocional en el SF-36 con el SCRF. Conclusiones. Uno de cada 3 pacientes intervenidos de hernia discal lumbar en nuestro medio presenta cirugía fallida, reincorporándose laboralmente 2 de cada 3 pacientes previamente activos. El paciente con cirugía fallida se encuentra afectado por dolor, hasta el punto de repercutir y limitar las actividades del hogar y las laborales. Además presenta frecuentemente sensación de cansancio o agotamiento, y problemas emocionales que interfieren tanto en las actividades de la vida diaria como en el trabajo. Abstract in english Introduction. The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few [...] studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. Material and methods. A descriptive transversal study of 117 patients operated fo

  12. Transforaminal epidural steroid injection via a preganglionic approach for lumbar spinal stenosis and lumbar discogenic pain with radiculopathy

    Directory of Open Access Journals (Sweden)

    Kabatas Serdar

    2010-01-01

    Full Text Available Background: Epidural steroid injection (ESIs is one of the treatment modalities for chronic low back pain (CLBP with various degrees of success. Aim: We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. Materials and Methods: We analyzed the data of 40 patients (February 2008 and April 2009 with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term, six months (midterm and one year (long term after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS and North American Spine Society (NASS patient satisfaction scores. Results: The mean age of the patients was 59.87 ± 15.06 years (range 30 - 89 years, 25 women. Average follow-up period was 9.22 ± 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P < 0.01, Pearson Correlation Test. Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P < 0.05, linear regression test. At short term evaluation in post treatment (one month, 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8 had a successful long-term outcome at a follow-up of one year. Conclusion: Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores.

  13. Tratamiento microquirúrgico en la hernia discal lumbar / Traitement microchirurgical de la hernie discale lombaire / Microsurgical treatment in herniated lumbar disc

    Scientific Electronic Library Online (English)

    Ángel Jesús, Lacerda Gallardo; Oilen, Hernández Guerra; Julio, Díaz Agramonte.

    1999-12-01

    Full Text Available Se realizó un estudio observacional descriptivo de 35 pacientes operados por hernia discal lumbar, con técnicas de microcirugía, en el período comprendido entre febrero de 1996 y febrero de 1997. De éstos el 68,57 % eran masculinos y 31,43 % femeninos, con una edad promedio para el grupo de 42,11 añ [...] os y un rango de edades comprendido entre 23 y 74 años. Los métodos diagnósticos que influyeron en la decisión quirúrgica fueron la mielografía lumbar con contraste hidrosoluble en el 37,14 % y la TAC en el 34,28 %, mientras que la electromiografía (EMG), la clínica y los rayos X simples fueron menos determinantes, 20 % y 14,29 % respectivamente. Los espacios L5-S1 (57,14 %) y L4-L5 (31,43 %), fueron los más afectados, mientras la combinación de ambos se presentó en el 11,43 %. La complicación más encontrada fue la hernia discal recidivante (8,57 %) y la estadía hospitalaria promedio fue de 2,79 días, el 48,57 % con menos de 24 h (cirugía ambulatoria). Los resultados quirúrgicos a los 6 meses, según la escala de Ebeling fueron satisfactorios en el 97,14 % de los casos con 57,14 % clasificado como bueno; 31,43 % excelente; 8,57 % regular y sólo 2,86 % malo. No existieron casos de fallo de la técnica. Abstract in english An observational descriptive study of 35 patients operated on of herniated lumbar disc by microsurgery techniques from February, 1996, to February, 1997, was conducted. 68.57% of these patients were males and 31.43% were females, with an average age of 42.11 and an age range between 23 and 74. The d [...] iagnostic methods that influenced on the surgical decision were lumbar myelography with hydrosoluble contrast in 37.l4% and CAT in 34.28%, whereas electromyogram (EMG), the clinic and simple X-rays were less determining 20 % and 14.29 %, respectively. The spaces L5-S1 (57.14%) and L4-L5 (31.43%) were the most affected. The combination of both was observed in 11.43%. The most frequent complication was herniated disc (8.57%). Average hospital stay was 2.79 days, 48.57% with less than 24 hours (ambulatory surgery). The surgical results at 6 months according to Ebeling’s scale were satisfactory in 97.l4% of the cases with 57.l4% classified as good; 31.43%, excellent; 8.57%, fair and only 2.86%, poor. The technique did not fail in any of the cases.

  14. Arterio-venous fistula following a lumbar disc surgery.

    Science.gov (United States)

    Mulaudzi, Thanyani V; Sikhosana, Mbokeleng H

    2011-11-01

    Vascular complications during posterior lumbar disc surgery are rare and its presentation with varicose veins is even rarer. A 23 year-old male patient presented with large varicose veins in right lower limb. He underwent a posterior lumbar spine discectomy surgery. He noticed mild swelling of the distal third right lower limb 3 months after index surgery and reported 6 months later when he developed varicose veins. Duplex Doppler confirmed varicose veins of the long saphenous vein and its tributaries with a patent deep venous system. A digital subtraction angiogram demonstrated a large right common iliac artery (CIA) false aneurysm with an arteriovenous fistula between right common iliac vessels. He had a right CIA covered stent insertion with good results. Varicose veins were later managed with sapheno-femoral junction ligation and a below knee long saphenous vein stripping. At six month follow-up the lower limb swelling had completely recovered and duplex ultrasound did not show any recurrence of varicose veins. PMID:22144752

  15. Lumbar spinal loads and muscle activity during a golf swing.

    Science.gov (United States)

    Lim, Young-Tae; Chow, John W; Chae, Woen-Sik

    2012-06-01

    This study estimated the lumbar spinal loads at the L4-L5 level and evaluated electromyographic (EMG) activity of right and left rectus abdominis, external and internal obliques, erector spinae, and latissimus dorsi muscles during a golf swing. Four super VHS camcorders and two force plates were used to obtain three-dimensional (3D) kinematics and kinetics of golf swings performed by five male collegiate golfers. Average EMG levels for different phases of golf swing were determined. An EMG-assisted optimization model was applied to compute the contact forces acting on the L4-L5. The results revealed a mean peak compressive load of over six times the body weight (BW) during the downswing and mean peak anterior and medial shear loads approaching 1.6 and 0.6 BW during the follow-through phases. The peak compressive load estimated in this study was high, but less than the corresponding value (over 8 BW) reported by a previous study. Average EMG levels of different muscles were the highest in the acceleration and follow-through phases, suggesting a likely link between co-contractions of paraspinal muscles and lumbar spinal loads. PMID:22900401

  16. Return-to-work (RTW) of patients after Lumbar Surgery

    Scientific Electronic Library Online (English)

    Herculene, van Staden; René, Kemp; Susan, Beukes.

    Full Text Available BRACKGROUND: Return to work (RTW) after lumbar surgery due to a work-related injury poses a challenge internationally. Work hardening is used as an intervention for acute and chronic lower back pain (CLBP), but it is not necessarily used in post-operative treatments. Method: The RTW rate of an exper [...] imental group (Group A) of unskilled labourers was compared with that of a control group (Group B) of unskilled labourers. Group A received multidisciplinary intervention, including a work hardening programme with ergonomic adaptations, while Group B received only physiotherapy after surgery as a multidisciplinary team was not available. A RTW questionnaire was used as an outcome measure for both groups. During the multidisciplinary intervention, the improvement of pain and functionality of patients from Group A were also evaluated from the pre-operative state to 24 weeks post-operatively with the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) as additional outcome measures. Results: There was a positive tendency to successful RTW after work hardening for Group A, but no statistical significance between Groups A and B. The improvement of pain and functionality in Group A was highly significant from time of surgery to six months post-operatively. Conclusion: Work hardening was found to have a positive tendency towards ensuring RTW for work-injured patients after lumbar surgery, with a highly significant effect on pain and functionality.

  17. Lumbar spine radiology: analysis of the posteroanterior projection

    International Nuclear Information System (INIS)

    The use of the posteroanterior (PA) technique as a means of dose reduction has been used effectively in radiology departments for chest and abdominal examinations. The aim of this investigation was to establish if the PA lumbar spine projection offers any advantages over the traditional anteroposterior (AP) view in terms of radiation dose and image quality. The contribution of tissue displacement to any dose reduction was also evaluated. The first part of the study involved the use of an anthropological phantom where entrance surface and an internal dose were measured for both the PA and AP projections. Entrance surface doses for both projections were then measured on randomly allocated female patients. Resultant image quality was assessed using CEC quality criteria. Anterior to posterior patient diameter was also recorded. The results demonstrated that with the PA compared with the AP projection, reductions of 38.6% (p=0.016) and 38.9% (p=0.02) in patient entrance surface dose and internal phantom dose, respectively. No significant differences in image quality were noted between the two projections. Patient diameter decreased by 1.8 cm with the PA view. The authors conclude that tissue displacement is the main factor for the patient dose reduction and recommend employment of the PA procedure for routine lumbar spine examinations. (orig.)

  18. A generic detailed rigid-body lumbar spine model

    DEFF Research Database (Denmark)

    De Zee, Mark; Hansen, Lone

    2007-01-01

    The objective of this work is to present a musculo-skeletal model of the lumbar spine, which can be shared and lends itself to investigation in many locations by different researchers. This has the potential for greater reproducibility and subsequent improvement of its quality from the combined effort of different research groups. The model is defined in a text-based, declarative, object-oriented language in the AnyBody Modelling System software. Text-based models will facilitate sharing of the models between different research groups. The necessary data for the model has been taken from the literature. The work resulted in a detailed lumbar spine model with seven rigid segments with 18 degrees-of-freedom and 154 muscles. The model is able to produce a maximum extension moment of 238 Nm around L5/S1. Moreover, a comparison was made with in vivo intradiscal pressure measurements of the L4-5 disc available from the literature. The model is based on inverse dynamics, where the redundancy problem is solved using optimization in order to compute the individual muscle forces and joint reactions. With the presented model it is possible to investigate a range of research questions, because the model is relatively easy to share and modify due to the use of a well-defined and self-contained scripting language. Validation is though still necessary for specific cases.

  19. The adaptive changes in muscle coordination following lumbar spinal fusion.

    Science.gov (United States)

    Wang, Ting-Yun; Pao, Jwo-Luen; Yang, Rong-Sen; Jang, Jyh-Shing Roger; Hsu, Wei-Li

    2015-04-01

    Limited back motion and damage of paraspinal muscles after spinal fusion surgery may lead to abnormal compensatory movements of the body. Whether neuromuscular control changes after surgery remains unclear. The purpose of the study was to identify the muscle activation patterns employed before and after lumbar spinal fusion. Nineteen patients having low back pain and undergoing minimally invasive lumbar spinal fusion were evaluated at 1 day before and 1 month after fusion surgery. Nineteen matched healthy participants were recruited as controls. Patients' pain severity and daily activity functioning were recorded. All participants were instructed to perform forward reaching, and the muscle activities were monitored using surface electromyography (EMG) with sensors placed on both sides of their trunk and lower limbs. The muscle activation patterns were identified using the principal component analysis (PCA). All patients had significant improvements in pain intensity and daily activity functioning after surgery, but exhibited an adaptive muscle activation pattern during forward reaching movement compared with the controls. Significant loading coefficients in the dominant movement pattern (reflected in the first principal component) were observed in back muscles for controls whereas in leg muscles for patients, both pre- and postoperatively. Despite substantial improvements in pain intensity and daily activity functioning after surgery, the patients exhibited decreased paraspinal muscle activities and adaptive muscle coordination patterns during forward reaching. They appeared to rely mainly on their leg muscles to compensate for their insufficient paraspinal muscle function. Early intervention focusing on training paraspinal muscles should be considered after spinal fusion surgery. PMID:25625813

  20. Correlations between the cross-sectional area and moment arm length of the erector spinae muscle and the thickness of the psoas major muscle as measured by MRI and the body mass index in lumbar degenerative kyphosis patients

    International Nuclear Information System (INIS)

    Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA and MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age and gender) control group with regard to the CSA, MAL, PT and BMI. The 17 LDK patients were all females [age: 62.5 ± 4.93 years, height: 157 ± 6.19 cm, weight: 55.59 ± 4.7 kg, and BMI: 22.58 ± 2.08 kg/m2]. The control group patients were all female [age: 63.6 ± 2.27 years, height: 156 ± 5.05 cm, weight: 59.65 ± 7.39 kg and BMI: 24.38 ± 2.94 kg/m2]. Spearman's rho kg/m2]. Spearman's rho indicated a positive association between the CSA and BMI (rho = 0.49, ? = 0.046), between the MAL and BMI (rho = 0.808, ? = 0.000) and between the CSA and PT (rho = 0.566, ? = 0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho = 0.67, ? = 0.000, MAL = 0.023CSA + 5.454 in the LDK group; rho = 0.564, ? 0.018, MAL = 0.02CSA + 5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically different mean values (? =0.000) in terms of the CSA and MAL. This study showed that the patients with LDK not only had atrophied erector spinae muscles, but also atrophied psoas major muscles and short MALs, which is harmful because of the increased lower back load in the aged patients. Along with BMI, measurement of the CSA, MAL and PT on the MR images provides an objective assessment of the dimension and severity of the muscle atrophy in the LDK patients