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Sample records for posterior-lateral lumbar interbody

  1. Lateral Lumbar Interbody Fusion

    Science.gov (United States)

    Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-01-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques.

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available LUMBAR LAMINECTOMY AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... to us: we can do it in the front, opening a patient in the front, called an anterior lumbar interbody fusion, or ALIF; ... laparoscopically; minimally invasively; a standalone procedure in the front; or partially front-and-back; or completely front- ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... and especially in this patient, not only is balance to her spine but appropriate balance. And the presence of an interbody cage, which ... to try to do is try to help balance her out. And how we’re going to ...

  5. 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 ...

  6. [Laparoscopic anterior lumbar interbody spinal fusion].

    Science.gov (United States)

    Beglaibter, Nahum; Zamir, Oded; Milgrum, Michael; Askenazi, Eli; Grinbaum, Ronit; Floman, Yzhar; Freund, Herbert

    2003-05-01

    The technique of Laparoscopic Anterior Lumbar Interbody Spinal Fusion (ALIF) has been developed in recent years for treating patients with spondylolisthesis, symptomatic degenerative disc disease and as salvage for failed posterior spinal fusion. The authors have performed 23 laparoscopic ALIF procedures with the close cooperation of spine and laparoscopic surgeons. This collaboration resulted in the successful laparoscopic completion of 87% of our cases. Postoperative length of stay was 2 days and patients required only minimal amounts of oral pain medications. Fourteen patients (70%) achieved excellent long term pain relief while 3 patients subsequently required an additional posterior fusion. There was only one major complication of bleeding from an ileac vein. Our results, similar to the results published by others, demonstrate the feasibility and effectiveness of laparoscopic ALIF. Further proof is still necessary to determine whether this procedure carries significant advantages vis-a-vis the open anterior or retroperitoneal approach. PMID:12803051

  7. 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.

  8. 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.

  9. Outcomes of extended transforaminal lumbar interbody fusion for lumbar spondylosis.

    Science.gov (United States)

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-11-01

    This study aims to assess the results of extended transforaminal lumbar interbody fusion (TLIF) for a two surgeon, single institution series. In total, extended TLIF with bilateral decompression was performed in 57 patients. Pain, American Spinal Injury Association scores, patient demographics, body mass index (BMI), perioperative indices and radiographic measurements were recorded and analysed. The surgeries were performed between February 2011 and January 2014 on 38 women and 19 men. The mean patient age was 62.86years, and the mean BMI was 30.31kg/m(2). In 49 patients, spondylolisthesis was the primary indication. The mean intraoperative time was 284.65min, and this decreased as the series progressed. The median length of stay was 5days (range: 2-9). The surgical complication rate was 19.3%. Two patients died from cardiopulmonary complications. Single level TLIF was performed in 78.9% of the cohort, with L4/5 the most commonly fused level. Significant pain reduction was achieved from a mean (±standard deviation) preoperative visual analogue scale (VAS) of 8.28±1.39 to 1.50±1.05 at 12months postoperatively. No patients deteriorated neurologically. Spondylolisthesis was significantly corrected from a preoperative mean of 6.82mm to 2.80mm postoperatively. Although there is a learning curve associated with the procedure, extended TLIF with bilateral facet joint removal and decompression appeared to be a safe and effective alternative to other fusion techniques, and our results were comparable to other published case series. The stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. PMID:26358199

  10. Complications associated with posterior and transforaminal lumbar interbody fusion.

    Science.gov (United States)

    Chrastil, Jesse; Patel, Alpesh A

    2012-05-01

    Posterior lumbar interbody fusion and transforaminal lumbar interbody fusion are commonly performed to obtain a 360° arthrodesis through a posterior-only approach. These techniques are currently used in the management of spondylolisthesis, degenerative scoliosis, pseudarthrosis, recurrent disk herniation, and chronic low back pain with associated degenerative disk disease. Several adverse events have been described, including intraoperative neurologic injury, implant migration or subsidence, dural tears, infection, heterotopic ossification, BMP-related radiculitis, and osteolysis. Although the use of newer materials (eg, bone morphogenetic proteins) and procedures (eg, minimally invasive surgery) is on the rise, they are associated with unique concerns. Understanding the potential adverse events and steps that can be taken to prevent, detect, and manage complications is critical in patient counseling and perioperative decision making. PMID:22553100

  11. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion

    DEFF Research Database (Denmark)

    Christensen, A; Høy, K; Bünger, C; Helmig, P; Hansen, E S; Andersen, Thomas Borbjerg; Søgaard, Rikke

    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)...

  12. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion

    DEFF Research Database (Denmark)

    Christensen, A; Høy, K; Bünger, C; Helmig, P; Hansen, E S; Andersen, Thomas Borbjerg; Søgaard, Rikke

    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...

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

    OpenAIRE

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

    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.

  14. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders

    DEFF Research Database (Denmark)

    Høy, Kristian; Bünger, Cody; Niederman, Bent; Helmig, Peter; Hansen, Ebbe Stender; Li, Haisheng; Andersen, Thomas

    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 ...

  15. 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.

  16. 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 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)

  17. [The results of decompression and anterior lumbar interbody fusion with the use of interbody cages for the treatment of degenerative lumbar spondylolisthesis].

    Science.gov (United States)

    Luczkiewicz, Piotr; Smoczy?ski, Andrzej; Smoczy?ski, Maciej; Pankowski, Rafa?; Piotrowski, Maciej

    2006-01-01

    In this paper we reviewed 28 patients who had been treated surgically for lumbar degenerative spondylolisthesis. They were operated between 1998-2003. The decompression and anterior lumbar interbody fusion with the use of interbody cages, was performed in all of them. The outcome was assessed using rating system of Prolo and VAPS. The disc height, degree of slippage and segmental lordosis were measured, on the radiographs, before surgery, after 6 weeks and at the time of final follow-up. In all cases spinal fusion was achieved. The disc height, degree of slipage and segmental lordosis were improved and these results were stable in time. A significant decrease in radicular pain and low back pain were seen but the relation between clinical and radiological autcomes was not observed. PMID:17131721

  18. Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion

    OpenAIRE

    Kim, Moon-chan; Chung, Hung-Tae; Cho, Jae-lim; Kim, Dong-jun; Chung, Nam-Su

    2011-01-01

    We retrospectively evaluated 488 percutaneous pedicle screws in 110 consecutive patients that had undergone minimally invasive transforaminal lumbar interbody fusion (MITLIF) to determine the incidence of pedicle screw misplacement and its relevant risk factors. Screw placements were classified based on postoperative computed tomographic findings as “correct”, “cortical encroachment” or as “frank penetration”. Age, gender, body mass index, bone mineral density, diagnosis, operation time, esti...

  19. Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

    OpenAIRE

    Saraph, V; Lerch, C; Walochnik, N.; Bach, C. M.; Krismer, M.; Wimmer, C.

    2004-01-01

    The purpose of the study was to compare conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion (ALIF). Fifty-six consecutive patients with spondylolisthesis, lumbar instability, or failed back syndrome were treated with ALIF between 1991 and 2001. The patients were retrospectively evaluated and divided in two groups: Group 1, consisting 33 patients, was treated with ALIF using the conventional retroperitoneal approach, and Group 2, consisting of 2...

  20. Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability

    Directory of Open Access Journals (Sweden)

    Najmus Sakeb

    2013-01-01

    Conclusions: Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.

  1. MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION IN DEGENERATIVE LUMBAR SPINE DISEASE

    Directory of Open Access Journals (Sweden)

    Pankaj

    2015-12-01

    Full Text Available OBJECTIVE To assess the clinical and radiological outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF and to analyze the surgical outcome for degenerative lumbar spine disease. METHODS A multicenter retrospective analysis of 20 patients who underwent a MI-TLIF by image guidance from 1 January 2012 to April 2015. The study included 13 males and 7 females (Mean age 53 year. CT scan of operating area was done to evaluate the pedicle screw, cage placement and fusion at 6 months post operatively. Oswestry Disability Index (ODI scores and Visual Analogue Scale (VAS were recorded pre-operatively and at 6-month followup. RESULTS Eighteen (90% patients had evidence of fusion at 6 months post operatively with a mean improvement of 34 on the ODI score. Mean length of hospital stay was 4 days. The mean operative time was 170min. One patient developed transient nerve root pain in the postoperative period which was managed conservatively and one patient developed superficial wound infection. There was no case of CSF leak. CONCLUSION MI-TLIF is a safe and effective surgical procedure for management of degenerative lumbar spine disease.

  2. Transforaminal Lumbar Interbody Fusion for Management of Recurrent Lumbar Disc Herniation

    Science.gov (United States)

    2016-01-01

    Study Design Retrospective study. Purpose To study the surgical outcome of transforaminal lumbar interbody fusion (TLIF) combined with trans-pedicular screws fixation for management of selected cases of recurrent lumbar disc herniation. Overview of Literature Recurrent lumbar disc herniation is a major cause of surgical failure, occurring in 5%–11% of cases. The optimal technique for treatment is controversial. Some authors believe that repeated simple discectomy is the treatment of choice, but approach-related complications can be considerable. Other surgeons prefer more removal of posterior elements (as lamina and facet joints) with posterior fusion. Methods The study included 15 patients who presented with symptomatic recurrent lumbar disc herniation who underwent reoperation through posterior trans-pedicular screws and TLIF in our department from April 2008 to May 2010, with a 24-month follow-up. Japanese Orthopedic Association Scale (JOA) was used for low back pain. The results of surgery were also evaluated with the MacNab classification. Results The mean JOA score showed significant improvement, increasing from 9.5 before surgery to 24.0 at the end of follow-up (p<0.001). Clinical outcome was excellent in 7 patients (46% of cases), good in 6 patients (40%) and fair in only 2 patients (14%). There was a significant difference (p<0.05) between patients presenting with recurrent disc at the ipsilateral side and those at the contralateral side. Conclusions In spite of the small number of patients and the short follow-up period, the good clinical and radiological outcome achieved in this study encourage the belief that TLIF is an effective option for the treatment of selected cases of recurrent lumbar disc herniation.

  3. Anterior Lumbar Interbody Fusion as a Salvage Technique for Pseudarthrosis following Posterior Lumbar Fusion Surgery.

    Science.gov (United States)

    Mobbs, Ralph J; Phan, Kevin; Thayaparan, Ganesha K; Rao, Prashanth J

    2016-02-01

    Study Design?Retrospective analysis of prospectively collected observational data. Objective?To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following failed posterior lumbar fusion surgery. Methods?From 2009 to 2013, patient outcome data was collected prospectively over 5 years from 327 patients undergoing ALIF performed by a single surgeon (R.J.M.) with 478 levels performed. Among these, there were 20 cases of failed prior posterior fusion that subsequently underwent ALIF. Visual analog score (VAS), Oswestry Disability Index (ODI), and Short Form 12-item health survey (SF-12) were measured pre- and postoperatively. The verification of fusion was determined by utilizing a fine-cut computed tomography scan at 12-month follow-up. Results?There was a significant difference between the preoperative (7.25?±?0.8) and postoperative (3.1?±?2.1) VAS scores (p?Composite Score (32.18?±?5.5 versus 41.07?±?9.67, p?=?0.0003) and Mental Health Composite Score (36.62?±?12.25 versus 50.89?±?10.86, p?=?0.0001). Overall, 19 patients (95%) achieved successful fusion. Conclusions?Overall, our results suggest that the ALIF procedure results not only in radiographic improvements in bony fusion but in significant improvements in the patient's physical and mental experience of pain secondary to lumbar pseudarthrosis. Future multicenter registry studies and randomized controlled trials should be conducted to confirm the long-term benefit of ALIF as a salvage option for failed posterior lumbar fusion. PMID:26835197

  4. Vertebral osteolytic defect due to cellulose particles derived from gauze fibers after posterior lumbar interbody fusion.

    Science.gov (United States)

    Takenaka, Shota; Mukai, Yoshihiro; Hosono, Noboru; Tateishi, Kosuke; Fuji, Takeshi

    2014-12-01

    Vertebral cystic lesions may be observed in pseudarthroses after lumbar fusion surgery. The authors report a rare case of pseudarthrosis after spinal fusion, accompanied by an expanding vertebral osteolytic defect induced by cellulose particles. A male patient originally presented at the age of 69 years with leg and low-back pain caused by a lumbar isthmic spondylolisthesis. He underwent a posterior lumbar interbody fusion, and his neurological symptoms and pain resolved within a year but recurred 14 months after surgery. Radiological imaging demonstrated a cystic lesion on the inferior endplate of L-5 and the superior endplate of S-1, which rapidly enlarged into a vertebral osteolytic defect. The patient underwent revision surgery, and his low-back pain resolved. A histopathological examination demonstrated foreign body-type multinucleated giant cells, containing 10-?m particles, in the sample collected just below the defect. Micro-Fourier transform infrared spectroscopy revealed that the foreign particles were cellulosic, presumably originating from cotton gauze fibers that had contaminated the interbody cages used during the initial surgery. Vertebral osteolytic defects that occur after interbody fusion are generally presumed to be the result of infection. This case suggests that some instances of vertebral osteolytic defects may be aseptically induced by foreign particles. Hence, this possibility should be carefully considered in such cases, to help prevent contamination of the morselized bone used for autologous grafts by foreign materials, such as gauze fibers. PMID:25259557

  5. POSTERIOR LUMBAR INTERBODY FUSION AND INSTRUMENTED POSTEROLATERAL FUSION IN ADULT SPONDYLOLISTHESIS: ASSESSMENT AND CLINICAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Rajarajan

    2015-11-01

    Full Text Available OBJECTIVE: Aim of this study is to assess and compare the outcomes of posterior lumbar interbody fusion (PLIF and posterolateral fusion (PLF in adult isthmic spondylosthesis. BACKGROUND: Posterolateral fusion has been considered the best method and widely been used for surgical treatment of adult spondylolisthesis.Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation MATERIALS AND METHODS: Thirty six patients with isthmic spondylolisthesis were operated. One group (20 patients had decompression and posterolateral fusion (PLF with a pedicle screw system; other group (16 patients was treated by decompression, posterior lumbar interbody fusion (PLIF and a Pedicle screw system. In both groups adequate decompression was done RESULTS: Seventy seven percent of the patients had a good result with (PLIF and 68 percent with posterolateral fusion (PLF. However there was no statistical difference in cases with low grade slipping, whereas the difference was significant for cases with high grade slipping. Fusion rate was 93% with (PLIF and 68% with (PLF, but without any significant incidence in the functional outcome. 78% has relief of sciatica and neurogenic claudication. CONCLUSION: Based on these findings we found that for high grade spondylolisthesis which requires reduction or if the disc space is still high posterior lumbar inter body fusion is preferable. For low grade spondylolisthesis or if the disc space is narrow posterolateral fusion is preferable. A successful result of fusion operation depends on adequate decompression which relieves radicular symptoms.

  6. 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

  7. Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

    OpenAIRE

    Tsantrizos, A.; Andreou, A; Aebi, M.; Steffen, T

    2000-01-01

    Anterior lumbar interbody fusion (ALIF) cages are expected to reduce segmental mobility. Current ALIF cages have different designs, suggesting differences in initial stability. The objective of this study was to compare the effect of different stand-alone ALIF cage constructs and cage-related features on initial segmental stability. Human multi-segmental specimens were tested intact and with an instrumented L3/4 disc level. Five different ALIF cages (I/F, BAK, TIS, SynCage, and ScrewCage) wer...

  8. 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)

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

    OpenAIRE

    Hardenbrook MA; Miller LE; Block JE

    2013-01-01

    Mitchell A Hardenbrook,1,2 Larry E Miller,3,4 Jon E Block4 1Advanced Spine Institute of Greater Boston, North Billerica, MA, 2Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, MA, 3Miller Scientific Consulting Inc, Arden, NC, 4The Jon Block Group, San Francisco, CA, USA Abstract: Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows dir...

  10. Iatrogenic Baastrup's Syndrome: A Potential Complication Following Anterior Interbody Lumbar Spinal Surgery

    Science.gov (United States)

    Russo, Glenn S.; Castro, Carlos A.

    2015-01-01

    Background Baastrup's Syndrome is a condition that occurs when there is abnormal contact between two adjacent spinous processes resulting in back pain. An alteration in lumbar spinal alignment and/or adjacent segment compensatory motion is thought to be potential causative factors. The objective of this study was to present a case series of what appears to be iatrogenic Baastrup's Syndrome as a mid-to-late term complication following anterior lumbar interbody surgery. Methods A retrospective chart review was performed of all patients undergoing anterior lumbar surgery for either fusion or disc replacement to determine the prevalence of Baastrup's Syndrome. Results Over a 12-year period, 855 patients who had undergone an anterior approach for lumbar spine surgery were identified. Of them 8 patients with evidence of Baastrup's Syndrome were found; this demonstrated a prevalence of 0.9%. Diagnostic injection was a helpful clinical tool in confirming the diagnosis of iatrogenic Baastrup's Syndrome. The partial removal of the impinging spinous processes resulted in excellent clinical relief. Conclusions Iatrogenic Baastrup's Syndrome may be an iatrogenic result of anterior lumbar surgery in small group of patients. Spinous process excision is a suggested treatment option. Further studies are necessary to explore the above phenomenon. This study is a Level 3 retrospective case series. PMID:26767158

  11. Primary investigation of clinical application of percutaneous posterior lumbar interbody fusion

    International Nuclear Information System (INIS)

    Objective: To characterize the feasibility, key technology, indications and clinical outcome of percutaneous lumbar interbody fusion. Methods: Clinical data from 32 cases [16 male, 16 female, age range 31-77 years, average disease duration (5.0±2.0) years] underwent percutaneous nucleotomy and endplate curettage was retrospectively analyzed. After percutaneous nucleotomy and endplate curettage, one expandable spinal spacer B-twin was introduced into the intervertebral space and some allograft cancellous bone implanted around the B-twin. Indications for treatment included degenerative lumbar disc herniation (LDH) with intervertebral distability or I degree spondylolisthesis (21 cases), LDH with intervertebral space collapse (10 cases) and lumbar discogenic pain (1 case). The symptoms and function of all patients were evaluated before, 3 months and 12 months after the operation by clinical outcome judgment criterion of surgical treatment for low back pain formulated by JOA, and the rate of clinical improvement and treatment efficacy were calculated. The JOA scales preoperatively, postoperatively and on the final follow-up was compared using ANOVA in SPSS. The changes before and after surgery with the JOA score and the the rate of clinical improvement between 3 months and 12 months after the operation was also compared using ?2 test. Results: The average operation time 1 hour and blood loss 0.05). Conclusions: Percutaneous posterior lumbar interbody fusion with B-twin expandable fusion cage could lead to satisfactory outcome in the treatment of degenerative disc disease and intervertebral instability, which minimize surgical soft tissue and trauma spinal damage, does not destroy the structure of spinal stability. The long-term outcome, complications and fusion rate need further observing. (authors)

  12. Differences in early osteogenesis and bone micro-architecture in anterior lumbar interbody fusion with rhBMP-2, equine bone protein extract, and autograft

    DEFF Research Database (Denmark)

    Foldager, Casper; Bendtsen, Michael; Nygaard, Jens Vinge; Zou, Xuenong; Bünger, Cody

    2009-01-01

    To investigate the microstructural differences and responsible mechanisms in early bone formation in anterior lumbar interbody fusion (ALIF) in the spine using rhBMP-2 (INFUSE), equine bone protein extract (COLLOSS E) or autograft.

  13. A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions

    Energy Technology Data Exchange (ETDEWEB)

    Mooney, V. (Univ. of California, Irvine (USA))

    1990-07-01

    A randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed on 195 subjects. There were 98 subjects in the active group and 97 subjects in the placebo group. A brace containing equipment to induce an electromagnetic field was applied to patients undergoing interbody fusion in the active group, and a sham brace was used in the control group. In the active group there was a 92% success rate, while the control group had a 65% success rate (P greater than 0.005). The effectiveness of bone graft stimulation with the device is thus established.

  14. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

    OpenAIRE

    Abbushi, Alexander; ?abraja, Mario; Thomale, Ulrich-Wilhelm; Woiciechowsky, Christian; Kroppenstedt, Stefan Nikolaus

    2009-01-01

    In posterior lumbar interbody fusion, cage migrations and lower fusion rates compared to autologous bone graft used in the anterior lumbar interbody fusion procedure are documented. Anatomical and biomechanical data have shown that the cage positioning and cage type seem to play an important role. Therefore, the aim of the present study was to evaluate the impact of cage positioning and cage type on cage migration and fusion. We created a grid system for the endplates to analyze different cag...

  15. Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc

    Science.gov (United States)

    An, Ki-Chan; Kong, Gyu-Min; Park, Dae-Hyun; Youn, Ji-Hong; Lee, Woon-Seong

    2016-01-01

    Study Design Retrospective. Purpose To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. Overview of Literature The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. Methods Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. Results LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). Conclusions No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition.

  16. Cajas intersomáticas lumbares: ¿medios de fusión o solo espaciadores? / Lumbar interbody cages: fusing means or only spacers?

    Scientific Electronic Library Online (English)

    Diego Nicolás, Flores Kanter; Alberto Javier, Jabif; Pablo Nicolás, Ortiz.

    2013-06-01

    Full Text Available Introducción: La fusión quirúrgica de la columna lumbar es un método muy utilizado para el tratamiento de la inestabilidad segmentaria lumbar dolorosa. En la actualidad, las dos técnicas de fusión instrumentada más utilizadas son la fusión posterolateral con tornillos pedicula-res y la fusión circun [...] ferencial mediante asociación de caja intersomática. Si bien hay evidencia de que la asociación de dispositivos intersomáticos aumenta la tasa de fusión, la mayoría de los estudios no discriminan si esta se produce solo de forma posterolateral o si se asocia una fusión anterior. El objetivo de este trabajo es determinar si existe fusión ósea real a nivel de las cajas intersomáticas o si estas actúan solo como espaciadores. Materiales y métodos: Se analizaron 28 pacientes con patología de la columna lumbar sometidos a artrodesis lumbar circunferencial en un solo nivel entre mayo de 2007 y enero de 2012, mediante tomografía computarizada posquirúrgica para valorar la presencia o no de artrodesis anterior. Se efectuó un estudio de valor terapéutico, descriptivo, de observación (nivel de evidencia IV); mediante evaluación estadística se realizó un análisis de frecuencias para describir la proporción de casos con fusión anterior. Resultados: Se detectó una tasa de fusión del 92,86% y falta de fusión radiológica anterior en el 7,14% de los pacientes. Conclusiones: Hay una alta tasa de fusión anterior a nivel de las cajas intersomáticas; de este modo, se demuestra que dichos dispositivos actúan como medios de fusión y no solo como espaciadores. Abstract in english Background: Surgical fusion of the lumbar spine is a frequently used method for the treatment of painful lumbar segmental instability; currently the two instrumented fusion techniques most commonly used are posterolateral fusion with pedicle screws, and circumferential fusion by association of inter [...] body cages. Although evidence shows that the association of intersomatic devices increases the fusion rate, most studies do not discriminate if this fusion occurs only posterolaterally, or an anterior fusion also occurs. The aim of this study is to determine if there is a true bone fusion at the level of interbody cages or if they act only as spacers. Methods: We analyzed 28 patients with lumbar spine pathology surgically treated with one level circumferential lumbar fusion from May 2007 to January 2012, using post-surgical computed tomography, to assess the presence or absence of anterior arthrodesis. A therapeutic value, descriptive, observational study was conducted (evidence level IV); by statistical evaluation, frequency analysis was performed to describe the proportion of cases with anterior fusion. Results: The fusion rate reached 92.86%; while there was no anterior radiological fusion in 7.14% of patients. Conclusions: There is a high rate of anterior fusion at the level of the interbody cages, thus demonstrating that these devices act as fusing means and not only as anterior spacers.

  17. Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity.

    Science.gov (United States)

    Phan, Kevin; Rao, Prashanth J; Scherman, Daniel B; Dandie, Gordon; Mobbs, Ralph J

    2015-11-01

    We conducted a systematic review to assess the safety and clinical and radiological outcomes of the recently introduced, direct or extreme lateral lumbar interbody fusion (XLIF) approach for degenerative spinal deformity disorders. Open fusion and instrumentation has traditionally been the mainstay treatment. However, in recent years, there has been an increasing emphasis on minimally invasive fusion and instrumentation techniques, with the aim of minimizing surgical trauma and blood loss and reducing hospitalization. From six electronic databases, 21 eligible studies were included for review. The pooled weighted average mean of preoperative visual analogue scale (VAS) pain scores was 6.8, compared to a postoperative VAS score of 2.9 (ptreatment of scoliosis, with improved functional VAS and Oswestry disability index outcomes and restored coronal deformity. Future comparative studies are warranted to assess the long term benefits and risks of XLIF compared to anterior and posterior procedures. PMID:26190218

  18. 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

  19. 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...

  20. The in vitro stabilising effect of polyetheretherketone cages versus a titanium cage of similar design for anterior lumbar interbody fusion

    OpenAIRE

    Spruit, M.; Falk, R. G.; Beckmann, L; Steffen, T; Castelein, R. M

    2005-01-01

    This biomechanical study was performed to test the primary segmental in vitro stabilising effect of a standard and large footprint radiolucent poly-ether-ether-ketone (PEEK) box cage versus a titanium box cage for anterior lumbar interbody fusion. Eighteen L2-L3 and sixteen L4-L5 cadaveric motion segments were divided into three groups and received a titanium cage or a radiolucent PEEK cage with standard or large footprint. All specimens were tested in three testing conditions: intact, stand-...

  1. Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion.

    Science.gov (United States)

    Nakashima, Hiroaki; Yukawa, Yasutsugu; Ito, Keigo; Horie, Yumiko; Machino, Masaaki; Kanbara, Shunsuke; Morita, Daigo; Imagama, Shiro; Ishiguro, Naoki; Kato, Fumihiko

    2011-09-01

    Posterior lumbar interbody fusion (PLIF) is a popular procedure for treating lumbar canal stenosis with spinal instability, and several reports concerning fusion assessment methods exist. However, there are currently no definitive criteria for diagnosing a successful interbody fusion in the lumbar spine. We suggested evaluating fusion status using computed tomography (CT) in extension position to detect pseudoarthrosis more precisely. The purpose of this study was to evaluate its usefulness for determining bone union quality after PLIF. Eighty-one patients who underwent PLIF at 97 levels were retrospectively enrolled. The study population included 48 men and 33 women (mean age 58.9 years, range 21-85 years). Patients were followed up for more than 12 months after surgery. The mean follow-up period was 27.6 months (range 14-49 months). Fusion status was evaluated using three ways: flexion-extension radiographs, CT images in flexion and extension position. In the flexion-extension radiographs, mobility of more than 3°, a remaining clear zone, or an uncertain bone connection constituted an incomplete union. For CT images, a remaining clear zone, a gas pattern, or an uncertain bone connection constituted an incomplete union. Flexion-extension radiographs demonstrated a solid fusion in 90.7% of the 97 levels at 10.7 months postoperatively. When fusion was demonstrated on flexion-extension radiographs, the rate of fusion affirmed by flexion CT and extension CT was 87.6 and 69.1% of the levels assessed, respectively. The rate of pseudoarthrosis detected on extension CT images was significantly higher than that on flexion-extension radiographs (P fusion achieved on extension CT was 85.6% at 15.1 months postoperatively. Extension CT could detect pseudoarthrosis more clearly than flexion-extension radiography and flexion CT. The CT images are influenced by body position and dilating anterior disc space in extension CT contributes to detect pseudoarthrodesis. Thus, extension CT was a useful method for assessing fusion status after PLIF. PMID:21380745

  2. 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.

  3. 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.

  4. Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases.

    Science.gov (United States)

    Matsumoto, Tomiya; Okuda, Shinya; Haku, Takamitsu; Maeda, Kazuya; Maeno, Takafumi; Yamashita, Tomoya; Yamasaki, Ryoji; Kuratsu, Shigeyuki; Iwasaki, Motoki

    2015-08-01

    Study Design?Case report. Objective?To present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case Report?We present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. Conclusion?Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex. PMID:26225287

  5. 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.

  6. 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)

  7. The concave versus convex approach for minimally invasive lateral lumbar interbody fusion for thoracolumbar degenerative scoliosis.

    Science.gov (United States)

    Scheer, Justin K; Khanna, Ryan; Lopez, Alejandro J; Fessler, Richard G; Koski, Tyler R; Smith, Zachary A; Dahdaleh, Nader S

    2015-10-01

    We retrospectively reviewed patient charts to compare the approach-related (convex versus concave) neurological complications and magnitude of correction in patients undergoing lateral lumbar interbody fusion (LLIF). It is yet to be quantitatively determined if correction of adult degenerative scoliosis from either side of the curve apex using a LLIF results in a reduction in complications and/or improved corrective ability. The inclusion criteria for this study were patients who underwent a LLIF for adult degenerative thoracolumbar scoliosis and had the LLIF prior to any other supplemental procedures. Patients were grouped based on the approach toward the curve apex concavity (CAVE) or the convexity (VEX). Standard coronal and sagittal radiographic measurements were made. Neurological complications and reoperation indications were also recorded. We included 32 patients for review (CAVE: 17; VEX: 15) with a mean age of 65.5 years±a standard deviation of 10.2, and mean follow-up of 17.0months±15.7. There were eight postoperative neurological complications in eight patients (25.0%), and seven reoperations for six patients (18.8%; CAVE: 4/17 [23.5%]; VEX: 2/15 [13.3%]). The CAVE group had 6/17 neurological complications (35.3%; four ipsilateral and two contralateral to approach side) and VEX had 2/15 (13.3%; one ipsilateral and one bilateral to approach side; p>0.05). All patients significantly improved in the mean regional and segmental Cobb angles (p0.05). There were no significant differences between the groups for any of the radiographic parameters measured (p>0.05). Approaching the curve apex from either the concave or convex side resulted in significant improvements. The concave approach was associated with more postoperative neurological complications. PMID:26164479

  8. Single-level lumbar pyogenic spondylodiscitis treated with mini-open anterior debridement and fusion in combination with posterior percutaneous fixation via a modified anterior lumbar interbody fusion approach.

    Science.gov (United States)

    Lin, Yang; Li, Feng; Chen, Wenjian; Zeng, Heng; Chen, Anmin; Xiong, Wei

    2015-12-01

    OBJECT This study evaluated the efficacy and safety of mini-open anterior debridement and lumbar interbody fusion in combination with posterior percutaneous fixation for single-level lumbar pyogenic spondylodiscitis. METHODS This is a retrospective study. Twenty-two patients with single-level lumbar pyogenic spondylodiscitis underwent mini-open anterior debridement and lumbar interbody fusion in combination with posterior percutaneous fixation via a modified anterior lumbar interbody fusion (ALIF) approach. Patients underwent follow-up for 24 to 38 months. Clinical data, etiological examinations, operative time, intraoperative blood loss, American Spinal Injury Association (ASIA) grade, Japanese Orthopaedic Association (JOA) lumbar function score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), postoperative complications, and the bony fusion rate were recorded. RESULTS The mean operative time was 181.1 ± 22.6 minutes (range 155-240 minutes). The mean intraoperative blood loss was 173.2 ± 70.1 ml (range 100-400 ml). Infection was found in lumbar vertebrae L2-3, L3-4, and L4-5 in 2, 6, and 14 patients, respectively. Bacterial cultures were positive in 15 patients, including 4 with Staphylococcus aureus, 6 with Staphylococcus epidermidis, 4 with Streptococcus, and 1 with Escherichia coli. Postoperative complications included urinary retention, constipation, and numbness in the thigh in 5, 3, and 2 patients, respectively. Compared with before surgery, the VAS scores and ODI were significantly lower at the final follow-up, the JOA scores were significantly higher, and the ASIA grades had improved. All patients achieved good intervertebral bony fusion. CONCLUSIONS Mini-open anterior debridement and lumbar interbody fusion in combination with posterior percutaneous fixation via a modified ALIF approach results in little surgical trauma and intraoperative blood loss, acceptable postoperative complications, and is effective and safe for the treatment of single-level lumbar pyogenic spondylodiscitis. This approach could be an alternative to the conventional open surgery. PMID:26340382

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

    Directory of Open Access Journals (Sweden)

    Hardenbrook MA

    2013-06-01

    Full Text Available Mitchell A Hardenbrook,1,2 Larry E Miller,3,4 Jon E Block4 1Advanced Spine Institute of Greater Boston, North Billerica, MA, 2Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, MA, 3Miller Scientific Consulting Inc, Arden, NC, 4The Jon Block Group, San Francisco, CA, USA Abstract: Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows direct lateral access to the intervertebral disc space while mitigating the complications associated with traditional anterior or posterior approaches. However, a common complication of this procedure is iatrogenic injury to the psoas muscle and surrounding nerves, resulting in postsurgical motor and sensory deficits. The TranS1 VEO system (TranS1 Inc, Raleigh, NC, USA utilizes a novel, minimally invasive transpsoas approach to the lumbar spine that allows direct visualization of the psoas and proximal nerves, potentially minimizing iatrogenic injury risk and resulting clinical morbidity. This paper describes the clinical uses, procedural details, and indications for use of the TranS1 VEO system. Keywords: fusion, lateral, lumbar, minimally invasive, transpsoas, VEO

  10. 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 

  11. Comparison between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis of Clinical Results and Safety Outcomes.

    Science.gov (United States)

    Lin, Yang; Chen, Wenjian; Chen, Anmin; Li, Feng

    2016-01-01

    Objective?A meta-analysis comparing the efficacy and safety of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar diseases. Methods?A literature search of PubMed, Embase, ScienceDirect, OVID, Google scholar, and Cochrane Library databases was conducted to identify relevant articles published before May 2013. Only studies that directly compared the efficacy and safety of minimally invasive and open TLIF in patients with degenerative lumbar diseases were selected. The main outcomes analyzed were the visual analog scale (VAS), Oswestry Disability Index (ODI), complications, and fusion rates. Also evaluated were intraoperative X-ray exposure, intra-postoperative blood loss, operating time, and hospitalization. Results?The selected 14 studies included 494 patients who received minimally invasive TLIF and 500 patients given open TLIF. According to the Methodological Index for Non-Randomized Studies, the quality scores of the studies ranged from 11 to 19. No significant differences in preoperative VAS or ODI scores, operating time, complication rate, or fusion rate were observed between these two procedures. Compared with open TLIF, minimally invasive TLIF was associated with significantly less blood loss, shorter hospitalization, and lower VAS during follow-up assessment. However, minimally invasive TLIF involved significantly more intraoperative X-ray exposure. Conclusion?Although the clinical efficacy, risk of complications and fusion rate were comparable between the two procedures, minimally invasive TLIF resulted in less blood loss, lower follow-up VAS score, and shorter perioperative hospitalization relative to open TLIF. PMID:26091113

  12. 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.; Bunger, C.; Helmig, P.; Hansen, E.; Andersen, T.; Sogaard, R.

    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 ...

  13. Different mechanisms of spinal fusion using equine bone protein extract, rhBMP-2 and autograft during the process of anterior lumbar interbody fusion

    DEFF Research Database (Denmark)

    Zou, Xuenong; Zou, Lijin; Foldager, Casper; Bendtsen, Michael; Feng, Wenzhou; Bünger, Cody

    2008-01-01

    To elucidate the molecular mechanisms of spinal fusion with different graft materials during an anterior lumbar interbody fusion, we examined the gene-expression profiles after implantation of equine bone protein extract, rhBMP-2 and autograft using microarray technology and data analysis, including hierarchical clustering, self-organizing maps (SOM), KEGG pathway and Biological process GO analyses in a porcine model. The results suggest that equine bone protein extract exhibited a more similar ...

  14. Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft

    OpenAIRE

    Hempelmann, Ralf G.; Mater, Eckhardt; Schön, Ralph

    2010-01-01

    The conservative and operative treatment strategies of hematogenous spondylodiscitis in septic patients with multiple risk factors are controversial. The present series demonstrates the outcome of 18 elderly patients (median age, 72 years) with septic hematogenous spondylodiscitis and intraspinal abscess treated with microsurgical decompression and debridement of the infective tissue, followed by posterior stabilization and interbody fusion with iliac crest bone graft in one or two lumbar seg...

  15. 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...

  16. Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

    Science.gov (United States)

    Kuraishi, Shugo; Mukaiyama, Keijiro; Shimizu, Masayuki; Ikegami, Shota; Futatsugi, Toshimasa; Hirabayashi, Hiroki; Ogihara, Nobuhide; Hashidate, Hiroyuki; Tateiwa, Yutaka; Kinoshita, Hisatoshi; Kato, Hiroyuki

    2016-01-01

    Study Design Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis. Purpose To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis. Overview of Literature Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis. Methods Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate. Results JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (pFusion rates of the PLIF and PLF groups had no significant difference. Conclusions The L4–L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF could ameliorate clinical symptoms when local stability is achieved.

  17. 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.

  18. Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better?

    Directory of Open Access Journals (Sweden)

    Q R Abdul

    2011-01-01

    Full Text Available Study design: A prospective clinical study of posterior lumbar interbody fusion in grade I and II degenerative spondylolisthesis was conducted between Mar 2007 and Aug 2008. Purpose: The objective was to assess the clinicoradiological profile of structural v/s nonstructural graft on intervertebral disc height and its consequences on the low back pain (LBP assessed by Visual analog score (VAS score and oswestry disability index (ODI . This study involved 28 patients. Inclusion criteria: Age of 30-70 years, symptomatic patient with disturbed Activities of daily living (ADL, single-level L4/L5 or L5/S1 grade I or grade II degenerative spondylolisthesis. Exclusion criteria: Patients with osteoporosis, recent spondylodiscitis, subchondral sclerosis, visual and cognitive impairment and all other types of spondylolisthesis. All the patients underwent short-segment posterior fixation using CD2 or M8 instrumentation, laminectomy discectomy, reduction and distraction of the involved vertebral space. In 53.5% (n = 15 of the patients, snugly fitted local bone chips were used while in 46.4% (n = 13 of the patients, cage was used. Among the cage group, titanium cage was used in nine (32.1% and PEEK cages were used in four (14.2% patients. In one patient, a unilateral PEEK cage was used. The mean follow-up period was 24 months. Among the 28 patients, 67.8% (n = 19 were females and 32.14% (n = 9 were males. 68.24% (n = 18 had L4/L5 and 35.71% (n = 10 had L5/S1 spondylolisthesis. 39.28% (n = 11 were of grade I and 60.71% (n = 17 were of grade II spondylolisthesis. Conclusions: There was a statistically significant correlation (P < 0.012 and P < 0.027 between the change in disc height achieved and the improvement in VAS score in both the graft group and the cage group. The increment in disc height and VAS score was significantly better in the cage group (2 mm ± SD vis-a-vis 7.2 [88%] than the graft group (1.2 mm ± SD vis-a-vis 5 [62 %].

  19. 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.

  20. 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)

  1. Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series

    Directory of Open Access Journals (Sweden)

    Miller Larry E

    2011-09-01

    Full Text Available Abstract Introduction Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL. Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis.

  2. Building the posterior lateral line system in zebrafish

    OpenAIRE

    Chitnis, Ajay B.; Nogare, Damian Dalle; Matsuda, Miho

    2012-01-01

    The posterior lateral line in zebrafish has emerged as an excellent system to study how a sensory organ system develops. Here we review recent studies that illustrate how interactions between multiple signaling pathways coordinate cell fate, morphogenesis and collective migration of cells in the posterior lateral line primordium. These studies also illustrate how the posterior lateral line system is contributing much more broadly to our understanding of mechanisms operating during the growth,...

  3. 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

  4. Effect of Psychological Status on Outcome of Posterior Lumbar Interbody Fusion Surgery

    Science.gov (United States)

    Lakkol, Sandesh; Budithi, Chakra; Bhatia, Chandra; Krishna, Manoj

    2012-01-01

    Study Design Prospective longitudinal study. Purpose To determine if preoperative psychological status affects outcome in spinal surgery. Overview of Literature Low back pain is known to have a psychosomatic component. Increased bodily awareness (somatization) and depressive symptoms are two factors that may affect outcome. It is possible to measure these components using questionnaires. Methods Patients who underwent posterior interbody fusion (PLIF) surgery were assessed preoperatively and at follow-up using a self-administered questionnaire. The visual analogue scale (VAS) for back and leg pain severity and the Oswestry Disability Index (ODI) were used as outcome measures. The psychological status of patients was classified into one of four groups using the Distress and Risk Assessment Method (DRAM); normal, at-risk, depressed somatic and distressed depressive. Results Preoperative DRAM scores showed 14 had no psychological disturbance (normal), 39 were at-risk, 11 distressed somatic, and 10 distressed depressive. There was no significant difference between the 4 groups in the mean preoperative ODI (analysis of variance, p = 0.426). There was a statistically and clinically significant improvement in the ODI after surgery for all but distressed somatic patients (9.8; range, -5.2 to 24.8; p = 0.177). VAS scores for all groups apart from the distressed somatic showed a statistically and clinically significant improvement. Our results show that preoperative psychological state affects outcome in PLIF surgery. Conclusions Patients who were classified as distressed somatic preoperatively had a less favorable outcome compared to other groups. This group of patients may benefit from formal psychological assessment before undergoing PLIF surgery. PMID:22977697

  5. Clinical Results of a Single Central Interbody Fusion Cage and Transpedicle Screws Fixation for Recurrent Herniated Lumbar Disc and Low-Grade Spondylolisthesis

    Directory of Open Access Journals (Sweden)

    Kuo-Feng Huang

    2003-03-01

    Full Text Available Background: The posterior lumbar interbody fusion (PLIF procedure allows restoration ofthe weight-bearing capacity to a more physiological ventral position andmaintenance of disc space height. However, the procedure can be technicallydifficult and may cause complications. It has always been performed bilaterallywith paired cages; a single central cage has not been commonly used.Methods: Twenty-eight patients who met the interbody fusion criteria from March1999 through November 2001 were included in the study. Surgery was performedfrom the posterior with a single central cage supplemented withtranspedicle screws. The follow-up period ranged from 8 to 39 months with amean of 14.4 months. Clinical outcomes were assessed. Dynamic radiographyfor fusion mass was interpreted by an independent radiologist.Results: Overall, 92.86% of the patients were satisfied with their conditions aftersurgery. Radiography study showed the rate of bony fusion being 82.14%.Fibrous union was noted in five patients. No migration of the cage wasobserved. One patient experienced laceration of the dura without clinicalsequelae. One patient had transient paresthesia and recovered within 2weeks. One patient had transient bladder atony and recovered within 3 days.Overall, the complications were negligible and none of the patients sustaineda motor deficit and permanent complication.Conclusions: The PLIF procedure using a single, central cage combined with bilateralpedicle screws fixation obtained satisfactory outcome within a short-term orlong-term follow-up period. Since the implant-related complications haveseldom been observed, it may be used as an alternative option for recurrentlumbar disc herniation or low grade spondylolisthesis with apparent degenerativedisc disease.

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. Dynamic stabilization for L4-5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up.

    Science.gov (United States)

    Kuo, Chao-Hung; Chang, Peng-Yuan; Wu, Jau-Ching; Chang, Hsuan-Kan; Fay, Li-Yu; Tu, Tsung-Hsi; Cheng, Henrich; Huang, Wen-Cheng

    2016-01-01

    OBJECTIVE In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4-5. METHODS This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4-5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery. RESULTS A total of 86 patients with L4-5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p < 0.001). For both groups, clinical outcomes were significantly improved at 6, 12, 18, and 24 months after surgery compared with preoperative clinical status. Moreover, there were no differences between the 2 groups in clinical outcomes at each evaluation time point. Radiological evaluations were also similar and the complication rates were equally low in both groups. CONCLUSIONS At 32.7 months postoperation, the clinical and radiological outcomes of DDS were similar to those of MI-TLIF for Grade I degenerative spondylolisthesis at L4-5. DDS might be an alternative to standard arthrodesis in mild lumbar spondylolisthesis. However, unlike fusion, dynamic implants have issues of wearing and loosening in the long term. Thus, the comparable results between the 2 groups in this study require longer follow-up to corroborate. PMID:26721577

  11. Artrodesis circunferencial: Plif más tornillos translaminofacetarios / Circumferential fusion: Posterior lumbar interbody fusion (plif) and translaminar facet screw fixation / Artrodese circunferencial: Plif mais parafusos translaminares facetários

    Scientific Electronic Library Online (English)

    Javier Ricardo, Méndez; Nicolás Federico, Maldonado; Enrique Gonzalo, Bovier.

    Full Text Available OBJETIVO: Avaliar o resultado clínico e radiológico de 10 pacientes operados devido a doença degenerativa lombar, nos quais se realizou artrodese intersomática com enxerto ósseo tricortical da crista ilíaca e artrodese póstero-lateral instrumentada com parafusos translaminares facetários. MÉTODOS: F [...] oram avaliados 10 pacientes, quatro homens e seis mulheres, operados pelo mesmo cirurgião entre junho de 2006 e dezembro de 2007. RESULTADOS: Atingiu-se queda significante da incapacidade e da dor (segundo a escala de Oswestry e a escala visual analógica), atingindo-se taxa de artrodese de 100% em um ano de acompanhamento. CONCLUSÕES: Os resultados clínicos e radiológicos deste estudo estabelecem que este procedimento é confiável, de baixo custo e de baixa morbidade, com alta taxa de artrodese e bons resultados clínicos. Abstract in spanish OBJETIVO: Evaluar el resultado clínico y radiológico de 10 pacientes operados por patología degenerativa lumbar, en los que se les realizó artrodesis intersomática con injerto óseo tricortical de cresta ilíaca y artrodesis posterolateral instrumentada con tornillos translaminofacetarios. MÉTODOS: Se [...] evaluaron 10 pacientes, 4 hombres y 6 mujeres operados por el mismo cirujano entre junio de 2006 y diciembre de 2007. RESULTADOS: Se obtuvo un significativo descenso de la discapacidad y del dolor (según las escalas de Oswestry y la escala visual analógica), obteniéndose una tasa de fusión del 100% al año de seguimiento. CONCLUSIONES: Los resultados clínicos y radiológicos de este estudio establecen a éste procedimiento como confiable, de bajo costo y baja morbilidad, con una alta tasa de fusión y buenos resultados clínicos. Abstract in english OBJECTIVE: To evaluate the clinical and radiological results of 10 patients operated for degenerative lumbar disease, by performing tricortical bone graft from the iliac crest and instrumented posterior lateral fusion with translaminar facet screw fixation. METHODS: We evaluated 10 patients, four me [...] n and six women, operated by the same surgeon between June 2006 and December 2007. RESULTS: There was a significant reduction of disability and pain (according to the scale of Oswestry and visual analog scale), reaching fusion rate of 100% in one-year follow-up. CONCLUSIONS: The clinical and radiological results of this study establish that this procedure is reliable, has low cost and low morbidity with a high rate of fusion and good clinical results.

  12. Incidence of microbiological contamination of local bone autograft used in posterior lumbar interbody fusion and its association with postoperative spinal infection.

    Science.gov (United States)

    Lee, Chong-Suh; Kang, Kyung-Chung; Chung, Sung-Soo; Kim, Ki-Tack; Shin, Seong-Kee

    2016-01-01

    OBJECT The aim of this study was to examine the results of microbiological cultures from local bone autografts used in posterior lumbar interbody fusion (PLIF) and to identify their association with postoperative spinal infection. METHODS The authors retrospectively evaluated cases involving 328 patients who had no previous spinal surgeries and underwent PLIF for degenerative diseases with a minimum 1-year follow-up. Local bone was obtained during laminectomy, and microbiological culture was performed immediately prior to bone grafting. The associations between culture results from local bone autografts and postoperative spinal infections were evaluated. RESULTS The contamination rate of local bone was 4.3% (14 of 328 cases). Coagulase-negative Staphylococcus (29%) was the most common contaminant isolated, followed by Streptococcus species and methicillin-sensitive Staphylococcus aureus. Of 14 patients with positive culture results, 5 (35.7%) had postoperative spinal infections and were treated with intravenous antibiotics for a minimum of 4 weeks. One of these 5 patients also underwent reoperation for debridement during this 4-week period. Regardless of the microbiological culture results, the infection rate after PLIF with local bone autograft was 2.4% (8 of 328 cases), with 5 (62.5%) of 8 patients showing positive results on autograft culture. CONCLUSIONS The incidence of contamination of local bone autograft during PLIF was considerable, and positive culture results were significantly associated with postoperative spinal infection. Special attention focused on the preparation of local bone for autograft and its microbiological culture will be helpful for the control of postoperative spinal infection. PMID:26360142

  13. Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbody fusion after decompressive surgery -- a finite element analysis

    Directory of Open Access Journals (Sweden)

    Chen Shih-Hao

    2012-05-01

    Full Text Available Abstract Background Little is known about the biomechanical effectiveness of transforaminal lumbar interbody fusion (TLIF cages in different positioning and various posterior implants used after decompressive surgery. The use of the various implants will induce the kinematic and mechanical changes in range of motion (ROM and stresses at the surgical and adjacent segments. Unilateral pedicle screw with or without supplementary facet screw fixation in the minimally invasive TLIF procedure has not been ascertained to provide adequate stability without the need to expose on the contralateral side. This study used finite element (FE models to investigate biomechanical differences in ROM and stress on the neighboring structures after TLIF cages insertion in conjunction with posterior fixation. Methods A validated finite-element (FE model of L1-S1 was established to implant three types of cages (TLIF with a single moon-shaped cage in the anterior or middle portion of vertebral bodies, and TLIF with a left diagonally placed ogival-shaped cage from the left L4-5 level after unilateral decompressive surgery. Further, the effects of unilateral versus bilateral pedicle screw fixation (UPSF vs. BPSF in each TLIF cage model was compared to analyze parameters, including stresses and ROM on the neighboring annulus, cage-vertebral interface and pedicle screws. Results All the TLIF cages positioned with BPSF showed similar ROM ( Conclusions TLIF surgery is not favored for asymmetrical positioning of a diagonal cage and UPSF used in contralateral axial rotation or lateral bending. Supplementation of a contralateral facet screw is recommended for the TLIF construct.

  14. 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.

  15. Interbody fusion and instrumentation.

    Science.gov (United States)

    Enker, P; Steffee, A D

    1994-03-01

    Fusion indications in adult degenerative disk disease of the lumbosacral spine include isolated disk resorption, primary and secondary instability, recurrent disk herniation, and pseudarthrosis. Common to these indications are variable proportions of biomechanical insufficiency of the motion segment, instability, deformity, and spinal stenosis. Apart from favorable psychosocial and work related variables, satisfactory outcome is dependent on treatment by a combination of diskectomy, decompression, and deformity correction, in addition to fusion. Isolated intertransverse or interbody fusions show variable fusion rates that are increased by concurrent instrumentation. Persistent pseudarthrosis rates and instrumentation failures have prompted circumferential fusion techniques. Posterior lumbar interbody fusion (PLIF) and segmental pedicle-based plate fixation overcome earlier problems with PLIF by allowing for wide decompression and increased exposure for disk space preparation, minimizing neural injury. Pedicle fixation restores segmental stability and minimizes graft retropulsion. Restoration of anterior column support prolongs instrumentation life, and increases fusion rates irrespective of the number of levels fused. Disk space distraction, with the use of instrumentation as a working tool, permits safer decompression of the intraforaminal zone, a common area of stenosis, and single or multilevel deformity correction to restore coronal, axial, and sagittal alignment and spinal balance. Even though the surgical technique is demanding, fusion rates up to 96% and clinical success up to 86% are achieved. PMID:8131360

  16. Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis.

    Science.gov (United States)

    Lee, Chang-Hyun; Jahng, Tae-Ahn; Hyun, Seung-Jae; Kim, Chi Heon; Park, Sung-Bae; Kim, Ki-Jeong; Chung, Chun Kee; Kim, Hyun-Jib; Lee, Soo-Eon

    2016-01-01

    OBJECTIVE The Dynesys, a pedicle-based dynamic stabilization (PDS) system, was introduced to overcome the drawbacks of fusion procedures. Nevertheless, the theoretical advantages of PDS over fusion have not been clearly confirmed. The aim of this study was to compare clinical and radiological outcomes of patients who underwent PDS using the Dynesys system with those who underwent posterior lumbar interbody fusion (PLIF). METHODS The authors searched PubMed, Embase, Web of Science, and the Cochrane Database. Studies that reported outcomes of patients who underwent PDS or PLIF for the treatment of degenerative lumbar spinal disease were included. The primary efficacy end points were perioperative outcomes. The secondary efficacy end points were changes in the Oswestry Disability Index (ODI) and back and leg pain visual analog scale (VAS) scores and in range of motion (ROM) at the treated and adjacent segments. A meta-analysis was performed to calculate weighted mean differences (WMDs), 95% confidence intervals, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 274 retrieved articles, 7 (which involved 506 participants [Dynesys, 250; PLIF, 256]) met the inclusion criteria. The Dynesys group showed a competitive advantage in mean surgery duration (20.73 minutes, 95% CI 8.76-32.70 minutes), blood loss (81.87 ml, 95% CI 45.11-118.63 ml), and length of hospital stay (1.32 days, 95% CI 0.23-2.41 days). Both the Dynesys and PLIF groups experienced improved ODI and VAS scores after 2 years of follow-up. Regarding the ODI and VAS scores, no statistically significant difference was noted according to surgical procedure (ODI: WMD 0.12, 95% CI -3.48 to 3.72; back pain VAS score: WMD -0.15; 95% CI -0.56 to 0.26; leg pain VAS score: WMD -0.07; 95% CI -0.47 to 0.32). The mean ROM at the adjacent segment increased in both groups, and there was no substantial difference between them (WMD 1.13; 95% CI -0.33 to 2.59). Although the United States is the biggest market for Dynesys, no eligible study from the United States was found, and 4 of 8 enrolled studies were performed in China. The results must be interpreted with caution because of publication bias. During Dynesys implantation, surgeons have to decide the length of the spacer and cord pretension. These values are debatable and can vary according to the surgeon's experience and the patient's condition. Differences between the surgical procedures were not considered in this study. CONCLUSIONS Fusion still remains the method of choice for advanced degeneration and gross instability. However, spinal degenerative disease with or without Grade I spondylolisthesis, particularly in patients who require a quicker recovery, will likely constitute the main indication for PDS using the Dynesys system. PMID:26721581

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

    OpenAIRE

    Hsieh Pang-Hsing; Lin Chien-Yu; Tai Ching-Lung; Chen Shih-Hao; Chen Weng-Pin

    2008-01-01

    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. Met...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... cages often are threaded and go in with distraction plugs; spacers are placed more frequently from the ... the spreader and we can do a little distraction. And normally what we would do is do ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... patient is dependent on their diagnosis, but the results, the potential complications which we have to go ... report by Dr. Lowe in 2002 showing good results with a TLIF, and this is just to ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... to your surgeon and say, What are the alternatives? Are there any other ways this can be ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... and squeezing and strangling you— this is the effect on the nerve roots. And here is a ... cartoon that runs on your screen, showing the effect of placing these paddle dilators into the disc ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... beginning of the talk, that helps us prop open the disc space to keep the patient in what we call ... disc spaces, too. The spacer is to prop open the disc space and keep it neutralized to correct the deformity, ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital ... to your surgeon and say, What are the alternatives? Are there any other ways this can be ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... successful with surgery. With the appropriate diagnosis and failure of nonoperative treatment 95 to 97% of patients ... credit. This Internet broadcast represents the hospital’s ongoing efforts to bring the latest medical education to both ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first on ... to two weeks after that visit and begin physical therapy. And usually, I tell patients, after an ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... bore you too much with it, but this cartoon exemplifies the forces on the spine wanting to ... fusion. And here I’ve shown you a cartoon looking at the back of the spine. This ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... to measure the rod and cut it and contour it. And Jim, I would make it a ... important to rehabilitate her muscles and get her active again, and which many patients will do. This ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... spinal surgery, and the ability to obtain a solid fusion if a solid fusion is necessary, what we’re after, and ... contains all the nerves in a sac of water, the cerebrospinal fluid, and each of those white ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the nerves in a sac of water, the cerebrospinal fluid, and each of those white lines with ... has heard—or watching audience has heard—about cerebrospinal fluid. Cerebrospinal fluid is inside it, and he’s ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

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    Full Text Available ... us to do the webcast, and all the people who helped with the surgery: our spine fellows and all the media crew that was here. They did a great job without interrupting our surgery at all or our ...

  13. 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 ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... and go out to your legs and give power to your legs. The blue square you see ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... above. And you can see on the lateral film the same picture. Now, I’m going to ... we’ve got some very good questions. These sound like perhaps patient questions that I think would ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... sitting and bending over, where vascular claudication will only get better when a patient stops. Similarly, a ... with no sciatica, or nerve compression; disc degeneration only. And again, it’s less successful with surgery, as ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the screw that’s where the transverse process is, which is like the wings of the spine. And so what we’re going to do is we’re going to unstrip the bone at the top of that and then lay some bone graft—both the bone we’ve taken out of the patient mixed with some more ...

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    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 ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... successful with surgery. With the appropriate diagnosis and failure of nonoperative treatment 95 to 97% of patients ... cartoon that runs on your screen, showing the effect of placing these paddle dilators into the disc ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... back and leg pain, worse with standing and walking, and it’s been refractory to medical therapies. She ... neurogenic claudication. That means weakness and symptoms when walking, and it has to be differentiated. Physicians who ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... correct her deformity, as it is in an adolescent patient with scoliosis where we try to correct ... end of the program for CME credit. This Internet broadcast represents the hospital’s ongoing efforts to bring ...

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    Full Text Available ... you. I’m going to go through the thought process of performing the operation and then give ... reduce the need for a laminectomy procedure; any thoughts on the efficacy of X-Stop? Okay. This ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... is squeezing in the nerve roots, not the vessels. But vascular claudication in patients with hardening of ... has severe stenosis, we’re taking off the middle part of her bone as well. We’ve ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... see them for decompression. There’s a number of different types of cages available for the spine and spacers ... front, though we are going to use a type of a spacer put in from the back today. And I’ve shown you some pictures of the different cages. The cage that just popped up on ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Science.gov (United States)

    ... the pedicle screw—to make sure the pedicle screw is in the bone. Jim’s putting the cage in now. It’s almost ... going to see we’re going to put bone graft along the back as well, which we’ll show you as Dr. Harrop starts to put the screws in the holes we’ve made, we’ll ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the pedicle screw—to make sure the pedicle screw is in the bone. Jim’s putting the cage in now. It’s almost ... going to see we’re going to put bone graft along the back as well, which we’ll show you as Dr. Harrop starts to put the screws in the holes we’ve made, we’ll ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... months after surgery, six months after surgery, a year after surgery, and then yearly after that. They’ ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... sponge and bone marrow, or sometimes bone morphogenic protein, which is not really approved for use in ... we’re using a material called bone morphogenic protein. Now, I should spend a moment speaking about ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... bleeders. These are called epidural veins, which are around—which are around the dura, or the nerves. And this is ... HARROP, MD: Here we are. We actually—skipping around a little bit. What we did it—I’ ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... So the answer to that question was a long answer, but we won’t be using the ... to help, both the neurosurgical and orthopedic department works closely together on spinal problems and we’re ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... the ball on it shows where the nerves go out at each level. The circles are the pedicles, ... the nerve center where nerves come in and go out to your legs and give power to your ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... their lives, but it’s best that—and very important— that they keep, in terms of good spine health, that they keep in superb condition and keep their back muscles in great condition. You can imagine looking at that wound and ... going to be very important to rehabilitate her muscles and get her active ...

  14. 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 ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... body think that they’re had a spine fracture, they’re had a bone fracture, because the process of bone fusion is the exact analogous process to healing of a fracture, where cells will come into the area, blood ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... that this patient on the right side of her spine was as collapses 2 mm. And the effect of spreading that out, ... weeks. At six weeks, she’ll come for her follow-up, she’ll have x-rays. ... over the next week to two weeks after that visit and begin physical therapy. ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... pain, despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first on a patient before suggesting surgery. But most of the patients that we end ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... to resect, and this is one of the advantages of the TLIF: we resect a certain amount ... this case we will not, which is an advantage for the patient. It’s our number one complaint ...

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... to return to normal activities and an improved quality of life. You may participate in the program ... there’s an issue that we need to take care of, but usually six weeks after surgery, three ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... correct her deformity, as it is in an adolescent patient with scoliosis where we try to correct ... crew that was here. They did a great job without interrupting our surgery at all or our ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... you walk downhill or when a lady wears high heels or when they arch their back. That ... stenosis, it would certainly come back from the high degree of instability. And we see patients like ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... ll see what we—how we made a skin incision. And this is called the fascia you ... down along the spinous processes. And that’s the skin incision. And then we use an instrument called ...

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... to return to normal activities and an improved quality of life. You may participate in the program ... this, their bone—even though this patient’s bone quality isn’t terrific, the bone gets very, very ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... for approximately an hour. I want to introduce my co-surgeon, Dr. Harrop, associate professor of neurosurgery. ... I don’t know if you can see my computer or not—I’m showing you the ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... and go out to your legs and give power to your legs. The blue square you see ... ALBERT, MD: I want to thank the Jefferson media marketing group that’s put this— helped us put ...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  10. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... out to you to answer: “What is the benefit of putting the bone graft in the disc ... grafts as well. But the answer is the benefit is increased fusion rate, and it’s very good ...

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... program for CME credit. 00:00:55 TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. ... JAMES S. HARROP, MD: Absolutely. 00:22:19 TODD J. ALBERT, MD: Okay, good. So what you see— ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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 ...

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... This is an anatomic drawing from a cadaveric model showing you the “NR” is the nerve roots. ... the screw and they’re ramping up the electricity. Okay, we’re good? 00:44:38 ASSISTANT: ...

  14. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... screws there as well. We’ve already cannulated these pedicles, making holes in them and markers, which ... is the canal, is wide open. And at these levels, L3-4 and 4- 5, it’s very ...

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... scoliosis and instability of her spine. So the plan for the operation is exposure, instrumentation, neural decompression, ... there’s an issue that we need to take care of, but usually six weeks after surgery, three ...

  16. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... be putting screws there as well. We’ve already cannulated these pedicles, making holes in them and ... challenge for placing the screws, which we’ve already confronted. Now, here I’ve shown you her ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... 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 she has degenerative scoliosis. And degenerative scoliosis is a curvature of the ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    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’ ...

  19. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... 55 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 ...

  20. 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 ... we go off air. This is just some data, and important, when people say, “Why do you ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... in the program by sending questions at any time; just click the MDirectAccess button on the screen. Physicians may take a post-assessment survey at the end of the program for CME ...

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... TLIF and do our laminectomy. In order to save a step, we started our laminectomy up at ... over two to three spinal levels, we’ll save the bone from the laminectomy. In addition, we’ ...

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... through a slight distraction. Now, there is a negative that comes along with distraction. If you remember ... would take 6 to 7 hours, and there’s negatives associated with that. But it really—to answer ...

  4. 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 ... also put a cage in the inner vertebral space. So as you look at your screen, I’ ...

  5. 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

    Scientific Electronic Library Online (English)

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

    2007-09-01

    Full Text Available O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espon [...] dilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida. Abstract in english 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 t [...] o 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 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

  6. Miniopen Oblique Lateral L5-S1 Interbody Fusion: A Report of 2 Cases

    OpenAIRE

    Keijiro Kanno; Seiji Ohtori; Sumihisa Orita; Kazuyo Yamauchi; Yawara Eguchi; Yasuchika Aoki; Junichi Nakamura; Masayuki Miyagi; Miyako Suzuki; Gou Kubota; Kazuhide Inage; Takeshi Sainoh; Jun Sato; Yasuhiro Shiga; Koki Abe

    2014-01-01

    Extreme lateral interbody fusion (XLIF) has been widely used for minimally invasive anterior lumbar interbody fusion (ALIF), but an approach to L5-S1 is difficult because of the iliac crest. In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion (OLIF) of L5-S1. The patients showed foraminal stenosis between L5 and S1 and severe low back and leg pain. The patients were placed in a lateral decubitus position and underwent OLIF surgery (using a cage a...

  7. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... for spine surgery called XLIF, extreme lateral interbody fusion. Dr. Juan Uribe will perform the procedure. Dr. ... A better term would be extreme lateral interbody fusion. This is a procedure that has been performed ...

  8. Extreme Lateral Interbody Fusion Procedure

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

  9. The VariLift® Interbody Fusion System: expandable, standalone interbody fusion

    Science.gov (United States)

    Emstad, Erik; del Monaco, Diana Cardenas; Fielding, Louis C; Block, Jon E

    2015-01-01

    Intervertebral fusion cages have been in clinical use since the 1990s. Cages offer the benefits of bone graft containment, restored intervertebral and foraminal height, and a more repeatable, stable procedure compared to interbody fusion with graft material alone. Due to concerns regarding postoperative stability, loss of lordosis, and subsidence or migration of the implant, interbody cages are commonly used with supplemental fixation such as pedicle screw systems or anterior plates. While providing additional stability, supplemental fixation techniques increase operative time, exposure, cost, and morbidity. The VariLift® Interbody Fusion System (VariLift® system) has been developed as a standalone solution to provide the benefits of intervertebral fusion cages without the requirement of supplemental fixation. The VariLift® system, FDA-cleared for standalone use in both the cervical and lumbar spine, is implanted in a minimal profile and then expanded in situ to provide segmental stability, restored lordosis, and a large graft chamber. Preclinical testing and analyses have found that the VariLift® System is durable, and reduces stresses that may contribute to subsidence and migration of other standalone interbody cages. Fifteen years of clinical development with the VariLift® system have demonstrated positive clinical outcomes, continued patient maintenance of segmental stability and lordosis, and no evidence of implant migration. The purpose of this report is to describe the VariLift® system, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The VariLift® System represents an improved surgical option for a stable interbody fusion without requiring supplemental fixation. PMID:26060414

  10. In Vivo Magnetic Resonance Imaging Evaluation of Porous Tantalum Interbody Fusion Devices in a Porcine Spinal Arthrodesis Model

    DEFF Research Database (Denmark)

    Zhou, Zhiyu; Wei, Fuxin; Sheng Huang, [Ukendt; Gao, Manman; Li, Haisheng; Stødkilde-Jørgensen, Hans; Lind, Martin; Bünger, Cody; Zou, Xuenong

    2015-01-01

    STUDY DESIGN: Animal experimental study. OBJECTIVE: To investigate the use of magnetic resonance (MR) imaging in the assessment of lumbar interbody fusion using porous tantalum implants in a porcine spinal fusion model. SUMMARY OF BACKGROUND DATA: Porous tantalum has been used successfully as a spinal interbody fusion device. However, to our knowledge, there has been no consensus on the optimal technique for evaluating spinal fusion when using porous tantalum implants. METHODS: Twelve 12-week-ol...

  11. Optimal 3-D conformal treatment planning of posterior lateral supratentorial tumors

    International Nuclear Information System (INIS)

    Purpose/Objective: The ability to treat the brain to greater doses is limited by normal brain tissue tolerance. With the use of 3-dimensional treatment planning dose escalation will result in increased target dose while sparing normal tissue. Treatment of the supratentorial region of the brain presents several unique difficulties due to the changing contour of the calvarium, which are especially noticeable with treatment to the posterior lateral quadrant. The use of a single wedge beam is sub-optimal and a more appropriate solution would employ a two tier wedge arrangement to better conform the isodoses around the target volume. In the past it has only been possible to use a single wedge during treatment with a single port, however, the dynamic wedge presents the opportunity to employ a two tier wedge system by simultaneously using conventional and dynamic wedging. Methods and Materials: An anthropomorphic phantom with a lesion located in the posterior lateral aspect of the brain where the external surface slopes at a maximum was configured. CT generated contours outlined the external surface, normal anatomy, gross tumor, and target volumes. We used the beam's-eye-view projection from the 3D planning system to derive the conformal beams. A standard opposed lateral and posterior oblique wedge pair beam arrangements, were compared to a three field technique (PA, lateral, and vertex) which used both a single wedge arrangement and a two-tier wedge plan. Treatment plans were evaluated by calculating isodose distribution, DVH, TCP, and NTCP. Each beam arrangement was used to treat our phantom with film placed in between the phantom layers at the tumor levels to confirm the accuracy of the 3-D system calculations. Results: The three field, two-tier wedge technique isodose distribution was significantly superior when compared to the standard 2-D plans, and a moderate improvement over the three field, single wedge technique in terms of conforming dose to the tumor and percentage of normal brain tissue spared, when 60.0 Gy covers 100% of the target volume. The percentage of normal brain receiving greater than 45.0 Gy was; 31% for the opposed laterals; 32% for the posterior wedge pair, 19% for the three field, single tier wedge; and 15% for the three field two tier wedge plan. The film dosimetry confirmed the isodose distributions for all beam arrangements to within 5%. Conclusions: Treatment of a posterior or posterior-lateral supratentorial brain lesion present a unique problem in terms of radiation therapy treatment planning due to the rapidly changing contours of the calvarium, resulting in diverging concave anatomical surfaces contained within a single beam port. The use of a multiple field, two tier wedge beam arrangement offers the unique ability to tightly conform the dose in areas of rapidly changing external surfaces while sparing normal tissues

  12. Molecular dissection of the migrating posterior lateral line primordium during early development in zebrafish

    Directory of Open Access Journals (Sweden)

    Villablanca Eduardo J

    2010-12-01

    Full Text Available Abstract Background Development of the posterior lateral line (PLL system in zebrafish involves cell migration, proliferation and differentiation of mechanosensory cells. The PLL forms when cranial placodal cells delaminate and become a coherent, migratory primordium that traverses the length of the fish to form this sensory system. As it migrates, the primordium deposits groups of cells called neuromasts, the specialized organs that contain the mechanosensory hair cells. Therefore the primordium provides both a model for studying collective directional cell migration and the differentiation of sensory cells from multipotent progenitor cells. Results Through the combined use of transgenic fish, Fluorescence Activated Cell Sorting and microarray analysis we identified a repertoire of key genes expressed in the migrating primordium and in differentiated neuromasts. We validated the specific expression in the primordium of a subset of the identified sequences by quantitative RT-PCR, and by in situ hybridization. We also show that interfering with the function of two genes, f11r and cd9b, defects in primordium migration are induced. Finally, pathway construction revealed functional relationships among the genes enriched in the migrating cell population. Conclusions Our results demonstrate that this is a robust approach to globally analyze tissue-specific expression and we predict that many of the genes identified in this study will show critical functions in developmental events involving collective cell migration and possibly in pathological situations such as tumor metastasis.

  13. Miniopen oblique lateral L5-s1 interbody fusion: a report of 2 cases.

    Science.gov (United States)

    Kanno, Keijiro; Ohtori, Seiji; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hiroto; Toyone, Tomoaki; Inoue, Gen; Hanaoka, Eiji; Takahashi, Kazuhisa

    2014-01-01

    Extreme lateral interbody fusion (XLIF) has been widely used for minimally invasive anterior lumbar interbody fusion (ALIF), but an approach to L5-S1 is difficult because of the iliac crest. In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion (OLIF) of L5-S1. The patients showed foraminal stenosis between L5 and S1 and severe low back and leg pain. The patients were placed in a lateral decubitus position and underwent OLIF surgery (using a cage and bone graft from the iliac crest) without posterior decompression. Posterior screws were used in the patients. Pain scores significantly improved after surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. OLIF surgery was minimally invasive and produced good surgical results without complications. PMID:25400963

  14. ISSLS Prize Winner: Positron Emission Tomography and Magnetic Resonance Imaging for Monitoring Interbody Fusion With Equine Bone Protein Extract, Recombinant Human Bone Morphogenetic Protein-2, and Autograft

    DEFF Research Database (Denmark)

    Foldager, Casper; Bendtsen, Michael; Zou, Xuenong; Zou, Lijin; Olsen, Aage; Munk, Ole; Stødkilde-Jørgensen, Hans; Bünger, Cody

    2008-01-01

    STUDY DESIGN.: Prospective and randomized experimental study with anterior lumbar interbody fusion in a porcine model. OBJECTIVE.: To assess the early time-course of spinal fusion with equine bone protein extract (COLLOSS E), recombinant human bone morphogenetic protein-2 (rhBMP-2), and autograft...

  15. More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone

    Science.gov (United States)

    Epstein, Nancy E.

    2016-01-01

    Background: In a recent study entitled: “More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review”, Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability. Methods: In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13–0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion. Results: In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable. Conclusions: The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?

  16. Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF

    Directory of Open Access Journals (Sweden)

    Hey Hwee Weng

    2010-01-01

    Full Text Available Degenerative disease of the lumbar spine is common in ageing populations. It causes disturbing back pain, radicular symptoms and lowers the quality of life. We will focus our discussion on the surgical options of posterior lumbar interbody fusion (PLIF and transforaminal lumbar interbody fusion (TLIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF for lumbar degenerative spinal deformities, which include symptomatic spondylolisthesis and degenerative scoliosis. Through a description of each procedure, we hope to illustrate the potential benefits of TLIF over PLIF. In a retrospective study of 53 ALIF/PLIF patients and 111 TLIF patients we found reduced risk of vessel and nerve injury in TLIF patients due to less exposure of these structures, shortened operative time and reduced intra-operative bleeding. These advantages could be translated to shortened hospital stay, faster recovery period and earlier return to work. The disadvantages of TLIF such as incomplete intervertebral disc and vertebral end-plate removal and potential occult injury to exiting nerve root when under experienced hands are rare. Hence TLIF remains the mainstay of treatment in degenerative deformities of the lumbar spine. However, TLIF being a unilateral transforaminal approach, is unable to decompress the opposite nerve root. This may require contralateral laminotomy, which is a fairly simple procedure.The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF to treat degenerative lumbar spinal deformity is still in its early stages. Although the initial results appear promising, it remains a difficult operative procedure to master with a steep learning curve. In a recent study comparing 29 MI-TLIF patients and 29 open TLIF, MI-TLIF was associated with longer operative time, less blood loss, shorter hospital stay, with no difference in SF-36 scores at six months and two years. Whether it can replace traditional TLIF as the surgery of choice for degenerative lumbar deformity remains unknown and more studies are required to validate the safety and efficiency.

  17. Spine interbody implants: material selection and modification, functionalization and bioactivation of surfaces to improve osseointegration.

    Science.gov (United States)

    Rao, Prashanth J; Pelletier, Matthew H; Walsh, William R; Mobbs, Ralph J

    2014-05-01

    The clinical outcome of lumbar spinal fusion is correlated with achievement of bony fusion. Improving interbody implant bone on-growth and in-growth may enhance fusion, limiting pseudoarthrosis, stress shielding, subsidence and implant failure. Polyetheretherketone (PEEK) and titanium (Ti) are commonly selected for interbody spacer construction. Although these materials have desirable biocompatibility and mechanical properties, they require further modification to support osseointegration. Reports of extensive research on this topic are available in biomaterial-centric published reports; however, there are few clinical studies concerning surface modification of interbody spinal implants. The current article focuses on surface modifications aimed at fostering osseointegration from a clinician's point of view. Surface modification of Ti by creating rougher surfaces, modifying its surface topography (macro and nano), physical and chemical treatment and creating a porous material with high interconnectivity can improve its osseointegrative potential and bioactivity. Coating the surface with osteoconductive materials like hydroxyapatite (HA) can improve osseointegration. Because PEEK spacers are relatively inert, creating a composite by adding Ti or osteoconductive materials like HA can improve osseointegration. In addition, PEEK may be coated with Ti, effectively bio-activating the coating. PMID:24890288

  18. 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 ...

  19. 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 ...

  20. 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 ...

  1. 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. ...

  2. ISSLS Prize Winner: Positron Emission Tomography and Magnetic Resonance Imaging for Monitoring Interbody Fusion With Equine Bone Protein Extract, Recombinant Human Bone Morphogenetic Protein-2, and Autograft

    DEFF Research Database (Denmark)

    Foldager, Casper; Bendtsen, Michael; Zou, Xuenong; Zou, Lijin; Olsen, Aage; Munk, Ole; Stødkilde-Jørgensen, Hans; Bünger, Cody

    2008-01-01

    STUDY DESIGN.: Prospective and randomized experimental study with anterior lumbar interbody fusion in a porcine model. OBJECTIVE.: To assess the early time-course of spinal fusion with equine bone protein extract (COLLOSS E), recombinant human bone morphogenetic protein-2 (rhBMP-2), and autograft using quantitative methods of positron emission tomography (PET)/computed tomography and magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA.: Different growth and differentiation factors are c...

  3. 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 fixatio...

  4. Protecting the genitofemoral nerve during direct/extreme lateral interbody fusion (DLIF/XLIF) procedures.

    Science.gov (United States)

    Jahangiri, Faisal R; Sherman, Jonathan H; Holmberg, Andrea; Louis, Robert; Elias, Jeff; Vega-Bermudez, Francisco

    2010-12-01

    A 77-year-old male presented with a history of severe lower back pain for 10 years with radiculopathy, positive claudication type symptoms in his calf with walking, and severe "burning" in his legs bilaterally with walking. Magnetic resonance imaging (MRI) revealed lumbar stenosis at the L3-L4 and L4-L5 levels. During the direct or extreme lateral interbody fusion (DLIF/XLIF) procedure, bilateral posterior tibial, femoral, and ulnar nerve somatosensory evoked potentials (SSEPs) were recorded with good morphology of waveforms observed. Spontaneous electromyography (S-EMG) and triggered electromyography (T-EMG) were recorded from cremaster and ipsilateral leg muscles. A left lateral retroperitoneal transpsoas approach was used to access the anterior disc space for complete discectomy, distraction, and interbody fusion. T-EMG ranging from 0.05 to 55.0 mA with duration of 200 microsec was used for identification of the genitofemoral nerve using a monopolar stimulator during the approach. The genitofemoral nerve (L1-L2) was identified, and the guidewire was redirected away from the nerve. Post-operatively, the patient reported complete pain relief and displayed no complications from the procedure. Intraoperative SSEPs, S-EMG, and T-EMG were utilized effectively to guide the surgeon's approach in this DLIF thereby preventing any post-operative neurological deficits such as damage to the genitofemoral nerve that could lead to groin pain. PMID:21313792

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

    OpenAIRE

    Putzier, Michael; Strube, Patrick; Funk, Julia F.; Gross, Christian; Mönig, 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...

  6. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study

    Directory of Open Access Journals (Sweden)

    Chung Sung-Soo

    2011-04-01

    Full Text Available Abstract Background Comparatively little is known about the relation between the sagittal vertical axis and clinical outcome in cases of degenerative lumbar spondylolisthesis. The objective of this study was to determine whether lumbar sagittal balance affects clinical outcomes after posterior interbody fusion. This series suggests that consideration of sagittal balance during posterior interbody fusion for degenerative spondylolisthesis can yield high levels of patient satisfaction and restore spinal balance Methods A retrospective study of clinical outcomes and a radiological review was performed on 18 patients with one or two level degenerative spondylolisthesis. Patients were divided into two groups: the patients without improvement in pelvic tilt, postoperatively (Group A; n = 10 and the patients with improvement in pelvic tilt postoperatively (Group B; n = 8. Pre- and postoperative clinical outcome surveys were administered to determine Visual Analogue Pain Scores (VAS and Oswestry disability index (ODI. In addition, we evaluated full spine radiographic films for pelvic tilt (PT, sacral slope (SS, pelvic incidence (PI, thoracic kyphosis (TK, lumbar lordosis (LL, sacrofemoral distance (SFD, and sacro C7 plumb line distance (SC7D Results All 18 patients underwent surgery principally for the relief of radicular leg pain and back pain. In groups A and B, mean preoperative VAS were 6.85 and 6.81, respectively, and these improved to 3.20 and 1.63 at last follow-up. Mean preoperative ODI were 43.2 and 50.4, respectively, and these improved to 23.6 and 18.9 at last follow-up. In spinopelvic parameters, no significant difference was found between preoperative and follow up variables except PT in Group A. However, significant difference was found between the preoperative and follows up values of PT, SS, TK, LL, and SFD/SC7D in Group B. Between parameters of group A and B, there is borderline significance on preoperative PT, preoperative LL and last follow up SS. Correlation analysis revealed the VAS improvements in Group A were significantly related to postoperative lumbar lordosis (Pearson's coefficient = -0.829; p = 0.003. Similarly, ODI improvements were also associated with postoperative lumbar lordosis (Pearson's coefficient = -0.700; p = 0.024. However, in Group B, VAS and ODI improvements were not found to be related to postoperative lumbar lordosis and to spinopelvic parameters. Conclusion In the current series, patients improving PT after fusion were found to achieve good clinical outcomes in degenerative spondylolisthesis. Overall, our findings show that it is important to quantify sagittal spinopelvic parameters and promote sagittal balance when performing lumbar fusion for degenerative spondylolisthesis.

  7. Control of cell migration in the development of the posterior lateral line: antagonistic interactions between the chemokine receptors CXCR4 and CXCR7/RDC1

    Directory of Open Access Journals (Sweden)

    Ghysen Alain

    2007-03-01

    Full Text Available Abstract Background The formation of the posterior lateral line of teleosts depends on the migration of a primordium that originates near the otic vesicle and moves to the tip of the tail. Groups of cells at the trailing edge of the primordium slow down at regular intervals and eventually settle to differentiate as sense organs. The migration of the primordium is driven by the chemokine SDF1 and by its receptor CXCR4, encoded respectively by the genes sdf1a and cxcr4b. cxcr4b is expressed in the migrating cells and is down-regulated in the trailing cells of the primordium. sdf1a is expressed along the path of migration. There is no evidence for a gradient of sdf1a expression, however, and the origin of the directionality of migration is not known. Results Here we document the expression of a second chemokine receptor gene, cxcr7, in the migrating primordium. We show that cxcr7 is highly expressed in the trailing cells of the primordium but not at all in the leading cells, a pattern that is complementary to that of cxcr4b. Even though cxcr7 is not expressed in the cells that lead primordium migration, its inactivation results in impaired migration. The phenotypes of cxcr4b, cxcr7 double morphant embryos suggest, however, that CXCR7 does not contribute to the migratory capabilities of primordium cells. We also show that, in the absence of cxcr4b, expression of cxcr7 becomes ubiquitous in the stalled primordium. Conclusion Our observations suggest that CXCR7 is required to provide directionality to the migration. We propose that directionality is imposed on the primordium as soon as it comes in contact with the stripe of SDF1, and is maintained throughout migration by a negative interaction between the two receptors.

  8. 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

  9. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL

    OpenAIRE

    Cédric Barrey; Gilles Perrin; Sabina Champain

    2013-01-01

    Dynamic systems in the lumbar spine are believed to reduce main fusion drawbacks such as pseudarthrosis, bone rarefaction, and mechanical failure. Compared to fusion achieved with rigid constructs, biomechanical studies underlined some advantages of dynamic instrumentation including increased load sharing between the instrumentation and interbody bone graft and stresses reduction at bone-to-screw interface. These advantages may result in increased fusion rates, limitation of bone rarefaction,...

  10. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review

    OpenAIRE

    Su, I-Chang; Chen, Chang-Mu

    2007-01-01

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. T...

  11. Results of instrumented posterolateral fusion in treatment of lumbar spondylolisthesis with and without segmental kyphosis: A retrospective investigation

    Directory of Open Access Journals (Sweden)

    Szu-Yuan Chen

    2015-06-01

    Full Text Available Background: Treatment by posterolateral fusion (PLF with pedicle-screw instrumentation can be unsuccessful in one-segment and low-grade lumbar spondylolisthesis. Segmental kyphosis, either rigid or dynamic, was hypothesized to be one of the factors interfering with the fusion results. Methods: From 2004 to 2005, 239 patients with single-segment and low-grade spondylolisthesis were recruited and divided into two groups: Group 1 consisting of 129 patients without segmental kyphosis and group 2 consisting of 110 patients with segmental kyphosis. All patients underwent instrumented PLF at the same medical institute, and the average follow-up period was 31 ± 19 months. We obtained plain radiographs of the lumbosacral spine with the anteroposterior view, the lateral view, and the dynamic flexion-extension views before the operation and during the follow-ups. The results of PLF in the two groups were then compared. Results: There was no significant difference in the demographic data of the two groups, except for gender distribution. The osseous fusion rates were 90.7% in group 1 and 68.2% in group 2 (p < 0.001. Conclusion: Instrumented PLF resulted in significantly higher osseous fusion rate in patients without segmental kyphosis than in the patients with segmental kyphosis. For the patients with sagittal imbalance, such as rigid or dynamic kyphosis, pedicle-screw fixation cannot ensure successful PLF. Interbody fusion by the posterior lumbar interbody fusion or transforaminal lumbar interbody fusion technique might help overcome this problem.

  12. Iatrogenic neurologic deficit after lumbar spine surgery: A review.

    Science.gov (United States)

    Ghobrial, George M; Williams, Kim A; Arnold, Paul; Fehlings, Michael; Harrop, James S

    2015-12-01

    Iatrogenic neurologic deficits after lumbar spine surgery are rare complications, but important to recognize and manage. Complications such as radiculopathy, spinal cord compression, motor deficits (i.e. foot drop with L5 radiculopathy), and new onset radiculitis, while uncommon do occur. Attempts at mitigating these complications with the use of neuromonitoring have been successful. Guidance in the literature as to the true rate of iatrogenic neurologic deficit is limited to several case studies and retrospective designed studies describing the management, prevention and treatment of these deficits. The authors review the lumbar spinal surgery literature to examine the incidence of iatrogenic neurologic deficit in the lumbar spinal surgery literature. An advanced MEDLINE search conducted on May 14th, 2015 from January 1, 2004 through May 14, 2015, using the following MeSH search terms "postoperative complications," then subterms "lumbar vertebrae," treatment outcome," "spinal fusion," and "radiculopathy" were included together with "postoperative complications" in a single search. Postoperative complications including radiculopathy, weakness, and spinal cord compression were included. The definition of iatrogenic neurologic complication was limited to post-operative radiculopathy, motor weakness or new onset pain/radiculitis. An advanced MEDLINE search conducted on May 14th, 2015 using all of the above terms together yielded 21 results. After careful evaluation, 11 manuscripts were excluded and 10 were carefully reviewed. The most common indications for surgery were degenerative spondylolisthesis, spondylosis, scoliosis, and lumbar stenosis. In 2783 patients in 12 total studies, there were 56 patients who had reported a postoperative neurologic deficit for a rate of 5.7. The rates of deficits ranged from 0.46% to 17% in the studies used. The average rate of reported neurologic complications within these papers was 9% (range 0.46-24%). Thirty patients of a total of 731 (4.1%) had a new onset neurologic injury after anterior lumber interbody fusion or lateral lumber interbody fusion. Thirty-seven out of 2052 (1.9%) patients had a neurologic injury after posterior decompression and fusion. Screw malposition was responsible for 11 deficits. Spinal surgery for lumbar degenerative disease carries a low but definite rate of neurologic deficits. Despite the introduction of neuromonitoring, these complications still occur. Interpretation of neurologic injury rates for lumbar surgery is limited by the few prospective and cohort-matched controlled studies. Likewise, most injuries were associated with the placement of instrumentation despite the type of approach. PMID:26386902

  13. In Vivo Magnetic Resonance Imaging Evaluation of Porous Tantalum Interbody Fusion Devices in a Porcine Spinal Arthrodesis Model

    DEFF Research Database (Denmark)

    Zhou, Zhiyu; Wei, Fuxin

    2015-01-01

    STUDY DESIGN: Animal experimental study. OBJECTIVE: To investigate the use of magnetic resonance (MR) imaging in the assessment of lumbar interbody fusion using porous tantalum implants in a porcine spinal fusion model. SUMMARY OF BACKGROUND DATA: Porous tantalum has been used successfully as a spinal interbody fusion device. However, to our knowledge, there has been no consensus on the optimal technique for evaluating spinal fusion when using porous tantalum implants. METHODS: Twelve 12-week-old female Danish Landrace pigs underwent 3 levels of anterior lumbar interbody fusion at L2-3, L4-5 and L6-7. One level was fused using a solid porous tantalum cage with pedicle screw fixation. The other two levels were fused using a hollow porous tantalum ring packed with autograft and stabilized anteriorly with staples. Six months postoperatively, T1-weighted, T2-weighted and gadolinium-DTPA contrast-enhanced MRI were obtained on a GE 1.5-T unit. After sacrifice, conventional X-ray and histological examination wereperformed. RESULTS: Eleven pigs went through the experiment without complications. On all the MR sequences, there were significant higher signal intensity bands at the vertebrae-implant interface of non-fused segments compared with that of fused segments as well as the vertebral bone and implants themselves (p<0.001). There was an agreement between histological findings of fibrous tissues surrounding the implants and the high signal intensity band on T1- and T2-weighted MR images respectively(sensitivity 69.6% and 56.5%, specificity 90.7% and 95.3%), both of which were superior to conventional X-ray images(sensitivity 52.2%, specificity 97.7%), especially the T1-weighted MR images. CONCLUSIONS: MR imaging could be an effective and non-invasive way to determine the fusion status of tantalum metal implants. Compared with T2-weighted MR imaging and conventional X-ray, T1-weighted spin-echo MR imaging is more sensitive and specific in detecting nonunion via the lucency between the vertebral body and tantalum metal device.

  14. 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.

  15. 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 ...

  16. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... is joining now. He’s the chief of neurological surgery here at Medical Baptist and the medical director ... to be doing in a few minutes. Lumbar surgery, particularly from the micro-lumbar discectomy style, it ...

  17. Lumbar MRI scan

    Science.gov (United States)

    ... disk ( lumbar radiculopathy ) Narrowing of the spinal column ( spinal stenosis ) Abnormal wearing on the bones and cartilage in ... 44. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med . 2008;358(8):818- ...

  18. 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.

  19. Minimal access spinal technologies (MAST) fusion procedures for the treatment of the degenerative lumbar spine (a part of multicentral prospective study). Case Report.

    Science.gov (United States)

    Khoshab, Hamid A; Sloboda, Tomáš

    2015-01-01

    A prospective multicentral observational study of minimally invasive fusion to treat degenerative lumbar disorders, and to report outcomes of one or two level minimally invasive posterior lumbar interbody fusion (MLIF) for degenerative lumbar disorders in a multi-center 1-year prospective study. We prospectively studied a group of 32 patients, mostly female 24 (75% female), and 8 males (25%). They underwent minimally invasive transforaminal lumbar interbody fusion (mTLIF), 21 of them monosegmental and 11 bisegmental. Patients demographics, intra-operative data and complications were recorded. Time to first ambulation, time to study-defined recovery, surgical duration, blood loss, fluoroscopy time and adverse events were recorded. Visual analogue scale (VAS) of back and legs pain, Oswestry disability index (ODI) and health-related questionnaire (EQ-5D) were assessed preoperatively and at defined time points through 12 months postoperatively. Mean surgical duration, blood loss and intraoperative fluoroscopy time were 125 vs. 175 minutes, 150 vs. 170 ml, and 105 vs. 145 seconds in one- and two-level segments, respectively. Mean preoperative VAS back (6.5) and VAS leg (7.9) scores dropped significantly (p<0.0001) to 3.5 (2.6) and 2.6 (2.0) at discharge (6 weeks). At the end, this is the largest prospective multi-center observational study of MLIF to date, following routine local standard of practice and, MLIF demonstrated favourable clinical results with early and sustained improvement in patient reported outcomes and low major perioperative morbidity. PMID:26313388

  20. Adjacent Segment Instability and Degeneration After Posterior Lumbar Stabilisation

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    Engin Ozar

    2006-01-01

    Full Text Available Objective: In our study, we aimed to research the changes of adjacent segment degeneration in posterior lumbar spinal fusion patients.Material and Method: In this study, lumbar spondylolysthesis operation applied 36 patients were investigated. Posterior stahilisation and fusion were applied to the first group of 26 patients hy using transpedicular screw and to the second group of 10 patients hy using interbody cage. Patients' JOA scales, adjacents segment disc heihts, osteophyte formations, lomher lordosis angles, and lysthesis degrees were evaluated before and after operation.Results: In hoth groups, as bej'ore and and after operation, the clinical healing was detected statistically significant according to JOA scale measurement. Postoperative lomher lordosis angles were increased, upper and lower disc spaces heights nex to the fused segments were decreased, new instability nex to the segment has not heen found and thus these results were not statistically significant.Conclusion: We observed significant clinical improvement in posterior lumhar spinal fusion applied patients in early postoperative period and ur?significant degeneration in adjacent segments.

  1. Is Hydronephrosis a Complication after Anterior Lumbar Surgery?

    Science.gov (United States)

    Parks, Ruth M; Behrbalk, Eyal; Mosharraf, Syed; Müller, Roger M; Boszczyk, Bronek M

    2015-12-01

    Study Design?Prospective follow-up design. Objective?Ureteral injury is a recognized complication following gynecologic surgery and can result in hydronephrosis. Anterior lumbar surgery includes procedures like anterior lumbar interbody fusion (ALIF) and total disk replacement (TDR). Anterior approaches to the spine require mobilization of the great vessels and visceral organs. The vascular supply to the ureter arising from the iliac arteries may be compromised during midline retraction of the ureter, which could theoretically lead to ureter ischemia and stricture with subsequent hydronephrosis formation. Methods?Potential candidates with previous ALIF or TDR via anterior retroperitoneal access between January 2008 and March 2012 were chosen from those operated on by a single surgeon in a university hospital setting (n?=?85). Renal ultrasound evaluation of hydronephrosis was performed on all participants. Simple descriptive and inferential statistics were used to generate results. Results?A total of 37 voluntary participants were recruited (23 male, 14 female subjects; average age 51.8 years). The prevalence of hydronephrosis in our population was 0.0% (95% confidence interval 0 to 8.1%). Conclusions?Retraction of the ureter across the midline in ALIF and TDR does not result in an increase in hydronephrosis and appears to be a safe surgical technique. PMID:26682096

  2. Minimally invasive lateral trans-psoas approach for tuberculosis of lumbar spine

    Directory of Open Access Journals (Sweden)

    Nitin Garg

    2014-01-01

    Full Text Available Anterior, posterolateral and posterior approaches are used for managing lumbar tuberculosis. Minimally invasive methods are being used increasingly for various disorders of the spine. This report presents the utility of lateral trans-psoas approach to the lumbar spine (LS using minimal access techniques, also known as direct lateral lumbar interbody fusion in 2 cases with tuberculosis of LS. Two patients with tuberculosis at L2-3 and L4-5 presented with back pain. Both had destruction and deformity of the vertebral body. The whole procedure comprising debridement and placement of iliac crest graft was performed using tubular retractors and was augmented by posterior fixation using percutaneous transpedicular screws. Both patients recovered well with no significant procedure related morbidity. Post-operative computed tomography scans showed appropriate position of the graft and instrumentation. At follow-up, both patients are ambulant with no progression of the deformity. Minimal access direct lateral transpsoas approach can be used for debridement and reconstruction of ventral column in tuberculous of Lumbar spine. This paper highlights the growing applications of minimal access surgery for spine.

  3. Lumbar stenosis: clinical case

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    Pedro Sá

    2014-08-01

    Full Text Available 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 conservative 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.

  4. Minimally Invasive Lumbar Discectomy

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    Full Text Available ... not improve and we have on the MRI study a demonstrable compression of the nerve, which correlates ... lumbar nerve roots. But without getting some imaging studies, you’re really not going to know for ...

  5. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... Miami’s Baptist Hospital. You’re going to be a seeing a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46-year-old woman who ...

  6. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... end up protruding in the future. So we clean out, to the best of our ability, the ... a bony spur, or whether it’s a degenerative process that lumbar spinal stenosis, which is a very ...

  7. Minimally Invasive Lumbar Discectomy

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    Full Text Available ... minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? 2 Well, the minimally ... think it’s important to stress here that the effectiveness of this procedure is about the same as ...

  8. Minimally Invasive Lumbar Discectomy

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    Full Text Available ... Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today you’ ... much more rapid recovery returning to their routine lives much quicker than the way we used to ...

  9. Ildr1b is essential for semicircular canal development, migration of the posterior lateral line primordium and hearing ability in zebrafish: implications for a role in the recessive hearing impairment DFNB42.

    Science.gov (United States)

    Sang, Qing; Zhang, Junyu; Feng, Ruizhi; Wang, Xu; Li, Qiaoli; Zhao, Xinzhi; Xing, Qinghe; Chen, Weiyu; Du, Jiulin; Sun, Shan; Chai, Renjie; Liu, Dong; Jin, Li; He, Lin; Li, Huawei; Wang, Lei

    2014-12-01

    Immunoglobulin-like domain containing receptor 1 (ILDR1) is a poorly characterized gene that was first identified in lymphoma cells. Recently, ILDR1 has been found to be responsible for autosomal recessive hearing impairment DFNB42. Patients with ILDR1 mutations cause bilateral non-progressive moderate-to-profound sensorineural hearing impairment. However, the etiology and mechanism of ILDR1-related hearing loss remains to be elucidated. In order to uncover the pathology of DFNB42 deafness, we used the morpholino injection technique to establish an ildr1b-morphant zebrafish model. Ildr1b-morphant zebrafish displayed defective hearing and imbalanced swimming, and developmental delays were seen in the semicircular canals of the inner ear. The gene expression profile and real-time PCR revealed down-regulation of atp1b2b (encoding Na(+)/K(+) transporting, beta 2b polypeptide) in ildr1b-morphant zebrafish. We found that injection of atp1b2b mRNA into ildr1b-knockdown zebrafish could rescue the phenotype of developmental delay of the semicircular canals. Moreover, ildr1b-morphant zebrafish had reduced numbers of lateral line neuromasts due to the disruption of lateral line primordium migration. In situ hybridization showed the involvement of attenuated FGF signaling and the chemokine receptor 4b (cxcr4b) and chemokine receptor 7b (cxcr7b) in posterior lateral line primordium of ildr1b-morphant zebrafish. We concluded that Ildr1b is crucial for the development of the inner ear and the lateral line system. This study provides the first evidence for the mechanism of Ildr1b on hearing in vivo and sheds light on the pathology of DFNB42. PMID:24990150

  10. Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis

    Directory of Open Access Journals (Sweden)

    Kee-yong Ha

    2013-01-01

    Full Text Available Background: Degenerative lumbar scoliosis surgery can lead to development of adjacent segment degeneration (ASD after lumbar or thoracolumbar fusion. Its incidence, risk factors, morbidity and correlation between radiological and clinical symptoms of ASD have no consensus. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and certain imperative parameters. Materials and Methods: 98 patients who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative lumbar scoliosis with a minimum 5 year followup were included in the study. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and imperative patient parameters like age at operation, sex, body mass index (BMI, medical comorbidities and bone mineral density (BMD. The radiological parameters taken into consideration were Cobb?s angle, angle type, lumbar lordosis, pelvic incidence, intercristal line, preoperative existence of an ASD on plain radiograph and magnetic resonance imaging (MRI and surgical parameters were number of the fusion level, decompression level, floating OP (interlumbar fusion excluding L5-S1 level and posterolateral lumbar interbody fusion (PLIF. Clinical outcomes were assessed with the Visual Analogue Score (VAS and Oswestry Disability Index (ODI. Results: ASD was present in 44 (44.9% patients at an average period of 48.0 months (range 6-98 months. Factors related to occurrence of ASD were preoperative existence of disc degeneration (as revealed by MRI and age at operation ( P = 0.0001, 0.0364. There were no statistically significant differences between radiological adjacent segment degeneration and clinical results (VAS, P = 0.446; ODI, P = 0.531. Conclusions: Patients over the age of 65 years and with preoperative disc degeneration (as revealed by plain radiograph and MRI were at a higher risk of developing ASD.

  11. Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience.

    Science.gov (United States)

    Nakajima, Hideaki; Uchida, Kenzo; Honjoh, Kazuya; Sakamoto, Takumi; Kitade, Makoto; Baba, Hisatoshi

    2016-01-01

    OBJECT Low lumbar osteoporotic vertebral collapse (OVC) has not been well documented compared with OVC of the thoracolumbar spine. The differences between low lumbar and thoracolumbar lesions should be studied to provide better treatment. The aim of this study was to clarify the clinical and imaging features as well as outcomes of low lumbar OVC and to discuss the appropriate surgical treatment. METHODS Thirty patients (10 men; 20 women; mean age 79.3 ± 4.7 years [range 70-88 years]) with low lumbar OVC affecting levels below L-3 underwent surgical treatment. The clinical symptoms, morphological features of affected vertebra, sagittal spinopelvic alignment, neurological status before and after surgery, and surgical procedures were reviewed at a mean follow-up period of 2.4 years. RESULTS The main clinical symptom was radicular leg pain. Most patients had old compression fractures at the thoracolumbar level. The affected vertebra was flat-type and concave or H-shaped type, not wedge type as often found in thoracolumbar OVC. There were mismatches between pelvic incidence and lumbar lordosis on plain radiographs. On CT and MR images, foraminal stenosis was seen in 18 patients (60%) and canal stenosis in 24 patients (80%). Decompression with short fusion using a posterior approach was performed. Augmentations of vertebroplasty, posterolateral fusion, and posterior lumbar interbody fusion were performed based on the presence/absence of local kyphosis of lumbar spine, cleft formation, and/or intervertebral instability. Although the neurological and visual analog scale scores improved postoperatively, 8 patients (26.7%) developed postoperative complications mainly related to instrumentation failure. In patients with postoperative complications, lumbar spine bone mineral density was significantly low, but the spinopelvic alignment showed no correlation when compared with those without complications. CONCLUSIONS The main types of low lumbar OVC were flat-type and concave type, which resulted in neurological symptoms by retropulsed bony fragments generating foraminal stenosis and/or canal stenosis. For patients with low lumbar OVC, decompression of the foraminal and canal stenosis with short fusion surgery via posterior approach can improve neurological symptoms. Since these patients are elderly with poor bone quality and other complications, treatments for both OVC and osteoporosis should be provided to achieve good clinical outcome. PMID:26384132

  12. Theoretical model of a piezoelectric composite spinal fusion interbody implant.

    Science.gov (United States)

    Tobaben, Nicholas E; Domann, John P; Arnold, Paul M; Friis, Elizabeth A

    2014-04-01

    Failure rates of spinal fusion are high in smokers and diabetics. The authors are investigating the development of a piezoelectric composite biomaterial and interbody device design that could generate clinically relevant levels of electrical stimulation to help improve the rate of fusion for these patients. A lumped parameter model of the piezoelectric composite implant was developed based on a model that has been utilized to successfully predict power generation for piezoceramics. Seven variables (fiber material, matrix material, fiber volume fraction, fiber aspect ratio, implant cross-sectional area, implant thickness, and electrical load resistance) were parametrically analyzed to determine their effects on power generation within reasonable implant constraints. Influences of implant geometry and fiber aspect ratio were independent of material parameters. For a cyclic force of constant magnitude, implant thickness was directly and cross-sectional area inversely proportional to power generation potential. Fiber aspect ratios above 30 yielded maximum power generation potential while volume fractions above 15% showed superior performance. This investigation demonstrates the feasibility of using composite piezoelectric biomaterials in medical implants to generate therapeutic levels of direct current electrical stimulation. The piezoelectric spinal fusion interbody implant shows promise for helping increase success rates of spinal fusion. PMID:23589373

  13. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up.

    Science.gov (United States)

    Wang, Michael Y; Grossman, Jay

    2016-02-01

    OBJECTIVE One of the principal goals of minimally invasive surgery has been to speed postoperative recovery. In this case series, the authors used an endoscopic technique for interbody fusion combined with percutaneous screw fixation to obviate the need for general anesthesia. METHODS The first 10 consecutive patients treated with a minimum of 1 year's follow-up were included in this series. The patients were all treated using endoscopic access through Kambin's triangle to allow for neural decompression, discectomy, endplate preparation, and interbody fusion. This was followed by percutaneous pedicle screw and connecting rod placement using liposomal bupivacaine for long-acting analgesia. No narcotics or regional anesthetics were used during surgery. RESULTS All patients underwent the procedure successfully without conversion to open surgery. The patients' average age was 62.2 ± 9.0 years (range 52-78 years). All patients had severe disc height collapse, and 60% had a Grade I spondylolisthesis. The mean operative time was 113.5 ± 6.3 minutes (range 105-120 minutes), and blood loss was 65 ± 38 ml (range 30-190 ml). The mean length of hospital stay was 1.4 ± 1.3 nights. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that the Oswestry Disability Index improved from 42 ± 11.8 to 13.3 ± 15.1; the 36-Item Short Form Health Survey (SF-36) Physical Component Summary improved from 47.6 ± 3.8 to 49.7 ± 5.4; the SF-36 Mental Component Summary decreased from 47 ± 3.9 to 46.7 ± 3.4; and the EQ-5D improved from 10.7 ± 9.5 to 14.2 ± 1.6. There were no cases of nonunion identified radiographically on follow-up imaging. CONCLUSIONS Endoscopic fusion under conscious sedation may represent a feasible alternative to traditional lumbar spine fusion in select patients. Larger clinical series are necessary to validate that clinical improvements are sustained and that arthrodesis rates are successful when compared with open surgery. This initial experience demonstrates the possible utility of this procedure. PMID:26828882

  14. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... Now let’s talk a little bit about other surgeries. I mean this minimally invasive approach doesn’t only work for just lumbar discs. As we mentioned before, it can even work in the thoracic region and the cervical region. Thoracic is pretty ...

  15. 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

  16. Pseudarthrosis after lumbar spinal fusion: the role of {sup 18}F-fluoride PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Peters, Marloes; Willems, Paul; Jutten, Liesbeth; Arts, Chris; Rhijn, Lodewijk van [Maastricht University Medical Center, Department of Orthopedic Surgery, Postbox 5800, Maastricht (Netherlands); Weijers, Rene; Wierts, Roel; Urbach, Christian; Brans, Boudewijn [Maastricht University Medical Center, Radiology /Nuclear Medicine, Maastricht (Netherlands)

    2015-11-15

    Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of {sup 18}F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. A cohort of 36 patients was retrospectively included in the study after {sup 18}F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) {sup 18}F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following {sup 18}F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. No correlation was found between symptom severity and fusion status. However, {sup 18}F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3). The visual analogue scale and EuroQol results were similar although less pronounced, with only SUV{sub max} between category 1 and 2 being significantly different (p = 0.04). We hypothesize that {sup 18}F-fluoride PET/CT may be able to provide support for the diagnosis of painful pseudarthrosis and could serve as a tool to discriminate between symptomatic and asymptomatic pseudarthrosis for revision surgery, as CT defines the consolidation status and PET pinpoints the 'stress reaction' at the vertebral endplates which significantly correlates with Oswestry Disability Index score. (orig.)

  17. Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT

    International Nuclear Information System (INIS)

    Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of 18F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. A cohort of 36 patients was retrospectively included in the study after 18F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) 18F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following 18F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. No correlation was found between symptom severity and fusion status. However, 18F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3). The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04). We hypothesize that 18F-fluoride PET/CT may be able to provide support for the diagnosis of painful pseudarthrosis and could serve as a tool to discriminate between symptomatic and asymptomatic pseudarthrosis for revision surgery, as CT defines the consolidation status and PET pinpoints the 'stress reaction' at the vertebral endplates which significantly correlates with Oswestry Disability Index score. (orig.)

  18. Comparison of degree of postoperative muscle damage between MIS-TLIF- and PLIF treatment for single-level degenerative lumbar disease

    Directory of Open Access Journals (Sweden)

    Liang ZHOU

    2014-01-01

    Full Text Available Objective?To compare the postoperative muscle damage after either posterior lumbar interbody fusion (PLIF or minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF with the aid of X-Tube system in patients with singlelevel degenerative lumbar spinal disease. Methods?The clinical data of 52 patients (males 28, females 24, aged 54.3±7.8 years with single-level degenerative lumbar spinal disease undergoing MIS-TLIF assisted by the X-Tube system from Oct 2010 to Sep 2011 was analyzed retrospectively. The operative time, intraoperative blood loss, postoperative drainage volume, postoperative bedtime, and serum creatine kinase (CK level 1 day before surgery and 1, 3 and 5 days after surgery were recorded and compared with those of 38 patients (males 20, females 18, aged 51.6±8.6 years with the same disease undergoing conventional open PLIF during the corresponding period. The back pain visual analogue score (VAS, Oswestry disability index (ODI score and imaging examination were performed before operation, after operation and during follow-up duration for each patient. Results?There was no significant difference in the gender, age, clinical diagnosis, lesion location, preoperative CK level, VAS and ODI scores between the two groups (P>0.05. The operative time was longer in MIS-TLIF group than in PLIF group (P0.05. Radiological followup observation revealed good fusion 6 months after operation in all the patients. Conclusion?The X-Tube-assisted MIS-TLIF has several advantages over conventional open PLIF, such as less intraoperative blood loss, milder muscle damage, and lighter back pain. DOI: 10.11855/j.issn.0577-7402.2013.12.04

  19. Lumbar spinal stenosis

    Scientific Electronic Library Online (English)

    JA, Shipley.

    2008-06-01

    Full Text Available Lumbar spinal stenosis is diagnosed by the clinical picture of radiculopathy and / or spinal claudication caused by narrowing of the spinal canal. Anatomical and radiological features correlate poorly with the clinical features, and are of little prognostic value. The natural history is very benign [...] with fluctuating levels and types of symptoms. Indications for surgery must be individualized, but decompression is effective in the short and medium term. Fusion is only indicated in the case of instability.

  20. 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

  1. Lumbar percutaneous discectomy

    International Nuclear Information System (INIS)

    Since November 88, 28 patients with lumbar L5 radiculopathy refractory to conservative care and with a radiologically verified central or mediolateral disc herniation at the level of L4/L5 had had a percutaneous discectomy. A short-term follow-up analysis of at least 2 months taking the clinical and functional status as well as the professional reintegration into account revealed a 64.3% (18/28 patients) satisfactory outcome and a 32.1% (10/28 patients) failure rate. Of the latter 28.6% (8/28 patients) required further open surgery. (orig./GDG)

  2. Osteomielitis vertebral lumbar

    Directory of Open Access Journals (Sweden)

    Hiralio Collazo Álvarez

    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 ingresó 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.

  3. Lumbar spinal stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Galanski, M.; Weidner, A.; Vogelsang, H.

    1982-12-01

    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.

  4. Side effects after diagnostic lumbar puncture and lumbar iohexol myelography

    Energy Technology Data Exchange (ETDEWEB)

    Sand, T.; Stovner, L.J.; Salvesen, R.; Dale, L.

    1987-07-01

    A prospective, controlled study was performed to compare side effect incidences after lumbar iohexol myelography (n=97) and diagnostic lumbar puncture (n=85). No significant side effect incidence differences (iohexol vs. controls) were found regarding number of patients with any side effect (63 vs. 73%), headache (44 vs. 54%), nausea, dizziness, visual, auditory, or psychic symptoms. Early-onset headache occurred significantly more often in the iohexol group (16 vs 5%), while postural headache occurred most frequently after lumbar puncture (25 vs. 41%). These results suggest that apart from the slight early-onset headache, most side effets after lumbar iohexol myelography are related to the puncture per se, not to the contrast agent.

  5. 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 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.)

  6. 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.)

  7. 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.

  8. 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.

  9. 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

  10. Comparative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion.

    Directory of Open Access Journals (Sweden)

    Arai Y

    2002-06-01

    Full Text Available We performed a comparative study of iliac bone graft (the iliac bone group and carbon cage with local bone graft (the cage group in PLIF to evaluate the clinical results of both methods. We examined both groups about the operating time, the estimated blood loss, the operative results using the score rating system of Japanese Orthopaedic Association (JOA score, and the presence of bone union on radiography. The operating time and the estimated blood loss of the cage group were statistically less than those of the iliac bone group. There were no significant differences between both groups about the operative results. The radiographic evaluation on bone union showed that half of the iliac bone group had collapsed union, but all cases of the cage group revealed union without collapse.

  11. Pars Stress Fracture (Lumbar Spondylolysis)

    Science.gov (United States)

    ... Neck and Back) > Pars Stress Fracture Pars Stress Fracture Page Content Pars stress fractures occur in young athletes involved in repetitive bending ... an episode of low back pain Pars stress fracture, also called lumbar spondylolysis, is one of the ...

  12. Radicular interdural lumbar disc herniation

    OpenAIRE

    Akhaddar, Ali; Boulahroud, Omar; Elasri, Abad; Elmostarchid, Brahim; Boucetta, Mohammed

    2009-01-01

    Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between t...

  13. Manejo del síndrome doloroso lumbar Management of lumbar syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Rivas Hernández

    2010-03-01

    Full Text Available Se realizó una revisión bibliográfica del síndrome doloroso lumbar y se seleccionaron los artículos relacionados con este síndrome publicados desde 1991 hasta 2009. Se hizo hincapié en la búsqueda de guías para el manejo del dolor lumbar en la práctica clínica, y sus criterios fueron revisados por el equipo de especialistas en Ortopedia y Traumatología del Servicio de columna vertebral del Hospital Ortopédico Docente "Fructuoso Rodríguez" y adaptados a las condiciones del Sistema Nacional de Salud cubano.A bibliographic review on painful syndrome was made selecting the articles published from 1991 to 2009 related to this syndrome. Authors emphasize in the search of guides for management of lumbar pain in the clinical practice, whose criteria were analyzed by the team Orthopedics and Traumatology team of the spinal column service from the "Fructuoso Rodríguez" Hospital and adjusted to conditions of the Cuban Health System.

  14. 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.

  15. Lumbar artery hemorrhage associated with lumbar fractures: Arteriographic diagnosis and therapy

    International Nuclear Information System (INIS)

    Nine patients who sustained massive lumbar arterial hemorrhage associated with lumbar spinal fractures are described. Pelvic fracture hemorrhage was present in five patients. Spasm and extravasation, a subtle finding on aortography, were usually obvious on lumbar arteriography, often originating from multiple lumbar vessels. Gelfoam embolization controlled bleeding in seven patients. One patient died of exsanguination during embolization; another, not embolized, required 7 units of blood transfusion. Two died of cerebral injury and pulmonary embolism. The authors conclude that lumbar arteriography should be considered during angiography for pelvic fracture when there are lumbar fractures, and life-threatening lumbar artery hemorrhage can be controlled by Gelfoam embolization

  16. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.

    Science.gov (United States)

    Su, I-Chang; Chen, Chang-Mu

    2007-12-01

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done. PMID:17273839

  17. The cause of 2S Diapason screw breakage after internal lumbar fixation: studies of the mechanical and material properties of the implant.

    Science.gov (United States)

    Kolasa, P; Grabarczyk, J; Depczyk, T

    2002-08-30

    In the years 1994-99, unstable fractures of the lumbar spine were surgically treated with interbody fixation in the Department of Neurosurgery at the Nicholas Copernicus Voivodeship Specialized Hospital in ?ód?, using stabilizers manufactured by various companies. Complications in the form of stabilizer breakage were observed in 1 case out of 22. The aim of the present study was to ascertain the reason why the Stryker 2S Diapason screws broke. Tests performed to measure the material and mechanical properties of the implant did not show any signs of material fatigue, nor were any material defects discovered. However, a scanning microscope investigation confirmed the hypothesis that the material had crumbled due to overload. This discovery led to the decision that screws would be mounted in the bodies of the vertebrae in a manner decreasing implant load. PMID:17679886

  18. Lumbar discography: an update.

    Science.gov (United States)

    Anderson, Mark W

    2004-01-01

    Discogenic pain most commonly affects the low back, buttocks, and hips and is thought to be a byproduct of internal disk degeneration. It is postulated that progressive annular breakdown and tearing results in biomechanical and/or biochemical stimulation of the pain fibers that reside in the outer one third of the annulus. Although multiple imaging modalities, most notably MRI, can show morphologic abnormalities of the spine, discography remains the only test that provides physiologic information regarding what role a given intervertebral disk plays in a patient's symptom complex. The controversy surrounding discography is here to stay until more definitive, well-designed studies are performed. In the meantime, there are certain things that can help the discographer maximize the accuracy of the test: 1. Always try to inject one "normal" disk as a "control level." 2. Be alert for factors that are associated with an increased false-positive rate (abnormal non-anatomic pain maps, a history of chronic pain of spinal or nonspinal origin, abnormal psychometric testing, and prior surgery at the injected disk level). In these cases, special attention should be directed to both the patient's verbal and nonverbal cues during disk injection. 3. Do not give any audible clues as to what level is being injected or when the injection is starting or finishing. In this regard, we find it very helpful to have one of our personnel talk with the patient during this portion of the procedure while closely observing the patient for any nonverbal cues regarding their pain response. This distraction is preferable to a silent room where the patient is intensely focused on what is going on with the injections. We also find that music playing during the procedure helps to relax and often distract the patient as well. 4. If the results are equivocal at a level (i.e., you are unable to determine whether or not the patient's pain response was truly concordant), go on to inject another disk level and then come back to reinject more contrast into the disk in question. As radiologists, we tend to focus on the technical aspects of a procedure and the anatomic/morphologic information it provides. However, it cannot be emphasized enough that when performing lumbar discography, the assessment of the patient's pain response during the injection is the most important component of the procedure, and requires not only technical skills, but an understanding of how best to avoid some of the pitfalls that can lead to inaccurate results. PMID:14976837

  19. Lumbar hernia: anatomical route assessed by computed tomography.

    Science.gov (United States)

    Guillem, P; Czarnecki, E; Duval, G; Bounoua, F; Fontaine, C

    2002-02-01

    Lumbar hernia is classically described as arising from the superior (Grynfeltt's) lumbar triangle or the inferior (Jean-Louis Petit's) lumbar triangle. The present anatomical study based on a computed tomography examination performed in a patient with lumbar hernia, has led to the suggestion that lumbar hernias cross the lumbar wall through a musculoaponeurotic tunnel, whose deep and superficial openings are the superior and inferior lumbar triangles, respectively. PMID:12197011

  20. Management of lumbar spinal stenosis.

    Science.gov (United States)

    Lurie, Jon; Tomkins-Lane, Christy

    2016-01-01

    Lumbar spinal stenosis (LSS) affects more than 200?000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality. PMID:26727925

  1. 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 ...

  2. Plexiform Schwannoma of Lumbar Region

    OpenAIRE

    Parihar, Asmita; Verma, Sarika; Suri, Tarun; Agarwal, Anil; Bansal, Kalpana; Gupta, Ruchika

    2015-01-01

    Plexiform schwannoma is an unusual peripheral nerve sheath tumor. It can mimic plexiform neurofibroma. A five-year-old girl presented with painful swelling in left lumbar region. Radiologic investigations showed a multinodular tumor in the subcutaneous plane of lumbosacral region. A complete excision and histopathologic examination revealed a plexiform tumor composed of hypocellular and hypercellular areas with verocay bodies. The tumor cells showed strong positivity for S-100 protein, render...

  3. Physiotherapeutic rehabilitation and lumbar fusion surgery

    OpenAIRE

    Abbott, Allan

    2010-01-01

    Over the last two decades, the economic costs and rates of lumbar fusion surgery for chronic low back pain has risen dramatically in western industrialized countries. Data from the Swedish National Spine Register suggest that 25% of patients experience unimproved pain and up to 40% are not satisfied with the outcome of lumbar fusion surgery. Thus, there is a definite need to optimize the selection and management of patients to improve lumbar fusion outcomes. Aim: To inve...

  4. Lumbar disc excision through fenestration

    Directory of Open Access Journals (Sweden)

    Sangwan S

    2006-01-01

    Full Text Available Background : Lumbar disc herniation often causes sciatica. Many different techniques have been advocated with the aim of least possible damage to other structures while dealing with prolapsed disc surgically in the properly selected and indicated cases. Methods : Twenty six patients with clinical symptoms and signs of prolapsed lumbar intervertebral disc having radiological correlation by MRI study were subjected to disc excision by interlaminar fenestration method. Results : The assessment at follow-up showed excellent results in 17 patients, good in 6 patients, fair in 2 patients and poor in 1 patient. The mean preoperative and postoperative Visual Analogue Scores were 9.34 ±0.84 and 2.19 ±0.84 on scale of 0-10 respectively. These were statistically significant (p value< 0.001, paired t test. No significant complications were recorded. Conclusion : Procedures of interlaminar fenestration and open disc excision under direct vision offers sufficient adequate exposure for lumbar disc excision with a smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results in the centers where recent laser and endoscopy facilities are not available.

  5. Lumbar discoidectomy by minimal incision

    International Nuclear Information System (INIS)

    The objective is to review the experience with the presented technique. Background: Lumbar disc herniation is the most frequent cause of low back pain, becoming a disabling condition. There are multiple surgical procedures to treat lumbar disc herniation; however, review of the literature found similar outcomes within open and percutaneous techniques. Materials and methods: Seventy patients with lumbar disc herniation were operated within 1990 and 2003, 38 years-old of mean age, 6 years 3 months of mean follow-up. Results were evaluated by Spain type, severity of herniation, and presence of neurological deficit, preoperative treatment, and complications and assessment of outcomes according to Ebeling's Scale. Results: 91% of disc herniation were by a physical mechanism. 57% were protruded disc herniation; most common paint type was lumbo-radicular (83%). Disturbances Motor improved in 100% and 69% of sensitive. There were no infections. According to Ebeling's Scale, 94,3% of patients had excellent outcomes, 4.3% well and 1.4% had regular outcomes. Recommendations: The minimally invasive technique is safe and has low incidence of complications, this promotes early clinical recovery and reintegration to daily and laboral activities. Costs are less with this technique than the microsurgical technique because of this does not require of high-technology equipment

  6. 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

  7. 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.

  8. 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.

  9. 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)

  10. Extraspinal abnormalities identified on lumbar spine CT

    International Nuclear Information System (INIS)

    Retrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patient's symptomatology is suggestive of spinal abnormalities. (orig.)

  11. Remote cerebellar hemorrhage after lumbar spinal surgery

    International Nuclear Information System (INIS)

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  12. Post lumbar puncture discitis and vertebral collapse.

    OpenAIRE

    Bhatoe, H. S.; Gill, H. S.; Kumar, N; Biswas, S

    1994-01-01

    Discitis and vertebral collapse are rare but serious complications of lumbar puncture. Clinical profile, management and course of post lumbar puncture discitis in five patients is presented. Such a complication should be kept in mind whenever any invasive procedure is carried out on the spine.

  13. Remote cerebellar hemorrhage after lumbar spinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Cevik, Belma [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: belmac@baskent-ank.edu.tr; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)

    2009-04-15

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  14. 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.

  15. Homeopatía y dolor lumbar Homeopathy and lumbar pain

    Directory of Open Access Journals (Sweden)

    Eva María Castro Morillo

    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 recidivante. 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.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 recidivist. 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.

  16. Postoperative posterior lumbar muscle changes and their relationship to segmental motion preservation or restriction: a randomized prospective study.

    Science.gov (United States)

    Strube, Patrick; Putzier, Michael; Streitparth, Florian; Hoff, Eike K; Hartwig, Tony

    2016-01-01

    OBJECT To date, it remains unclear whether the preservation of segmental motion by total disc replacement (TDR) or motion restriction by stand-alone anterior lumbar interbody fusion (ALIF) have an influence on postoperative degeneration of the posterior paraspinal muscles or the associated clinical results. Therefore, the purpose of the present prospective randomized study was to evaluate the clinical parameters and 3D quantitative radiological changes in the paraspinal muscles of the lumbar spine in surgically treated segments and superior adjacent segments after ALIF and TDR. METHODS A total of 50 patients with chronic low-back pain caused by single-level intervertebral disc degeneration (Pfirrmann Grade ? III) and/or osteochondrosis (Modic Type ? 2) without symptomatic facet joint degeneration (Fujiwara Grade ? 2, infiltration test) of the segments L4-5 or L5-S1 were randomly assigned to 2 treatment groups. Twenty-five patients were treated with a stand-alone ALIF and the remaining 25 patients underwent TDR. For ALIF and TDR, a retroperitoneal approach was used. At 1 week and at 12 months after surgery, CT was used to analyze paraspinal lumbar muscle tissue volume and relative fat content. Residual muscle tissue volume at 12 months and change in the relative fat content were compared between the groups. In addition, clinical parameters (visual analog scale [VAS] for low-back pain and Oswestry Disability Index [ODI] Questionnaire Version 2 for function) were compared. RESULTS Compared with 1 week after surgery, the radiological analysis at 12 months revealed a small decrease in the posterior muscle volume (the mean decrease was pain and function were significantly improved in both groups compared with 1 week postsurgery, but there were no differences between the groups. CONCLUSIONS Motion restriction via stand-alone ALIF and motion preservation via TDR both present small changes in the posterior lumbar paraspinal muscles with regard to volume atrophy or fatty degeneration at the index and superior adjacent segments. Therefore, although the clinical outcome was not affected by the observed muscular changes, the authors concluded that the expected negative influence of motion restriction on the posterior muscles compared with motion preservation does not occur on a clinically relevant level. PMID:26360146

  17. 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)

  18. 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.)

  19. Bulging Fontanelle and Need for Lumbar Puncture

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-10-01

    Full Text Available Etiologies of bulging fontanelle and fever and clinical evidence for lumbar puncture were determined from medical records of 153 infants treated at Assaf Harofeh Medical Center, Israel.

  20. Constitutional stenosis of the lumbar spinal canal

    Energy Technology Data Exchange (ETDEWEB)

    Wackenheim, A.; Vallier, D.; Babin, E.

    1980-10-01

    The radiographic findings of lumbar spinal stenosis are presented with special reference to the constitutional form and the cheirolumbar dysostotic form as well as the pathologic changes associated with diffuse developmental anomalies of the skeleton.

  1. Extraspinal abnormalities identified on lumbar spine CT

    Energy Technology Data Exchange (ETDEWEB)

    Frager, D.H.; Elkin, C.M.; Kansler, F.; Mendelsohn, S.L.; Leeds, N.E.

    1986-01-01

    Retrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patient's symptomatology is suggestive of spinal abnormalities. (orig.).

  2. 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.

  3. 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

  4. 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.

  5. Partial Facetectomy for Lumbar Foraminal Stenosis

    OpenAIRE

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

    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...

  6. Lumbar disc injury in the athlete.

    Science.gov (United States)

    Watkins, Robert G

    2002-01-01

    The lumbar spine is a highly vulnerable area for injury in a number of different sports. And while the incidence is significant and the time lost may be significant, probably the most important problems are related to the fear of spinal injuries and the need for a therapeutic plan. Lumbar pain is significant in many sports, but an organized diagnostic and therapeutic plan can prevent permanent injury, allowing full function and maximum performance. PMID:11877868

  7. Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

    Directory of Open Access Journals (Sweden)

    Surendra Mohan Tuli

    2011-01-01

    Conclusion: Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

  8. Therapeutic efficacy of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting for tuberculosis of lumbar vertebra

    Directory of Open Access Journals (Sweden)

    Jia-ming LIU

    2015-11-01

    Full Text Available Objective?To evaluate the efficacy and safety of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting in the treatment of tuberculosis of mono-segmental lumbar vertebra. Methods?From January 2010 to April 2013, 21 patients (9 males and 12 females with an average age of 49.1 years with mono-segmental tuberculosis of lumbar vertebra underwent surgery in our hospital were included. Eight patients had neurological deficit. The focus of tuberculosis was located on one side of the vertebral body, and all the patients had obvious signs of bone destruction on CT and MRI. All the patients were given anti-tuberculosis chemotherapy for 2-3 weeks before surgery. The local bone chips and autologous iliac cancellous bone were used as the intervertebral bone graft. Postoperative plain radiographs and CT were obtained to evaluate the fusion rate and degree of lumbar lordosis. The visual analogue scale score (VAS, erythrocyte sedimentation rate (ESR, and C-reactive protein (CRP before and after operation, and at final follow-up date were recorded. Results?All the patients were followed up for 25.3±4.2 months. The mean operation time was 157±39 minutes, and the average blood loss was 470±143ml. The fusion rate of the interbody bone graft was 95.2%, with an average fusion period of 6.1±2.5 months. The neurological function was improved by 100%, and no severe complication or neurological injury occured. The preoperative and postoperative lordosis angles of the lumbar spine were 21.4°±5.7° and 33.6°±3.1°, respectively, and it was 31.3°±2.7° at the final follow up. The preoperative and postoperative VAS scores were 7.8±2.6 and 2.4±1.7 respectively, and it was 0.9±0.7 at the final follow up. The ESR and CRP were significantly decreased 3 months after surgery, and they became normal at 6 months. Conclusion?Pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting is effective and safe in treating mono-segmental lumbar tuberculosis. DOI: 10.11855/j.issn.0577-7402.2015.11.16

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

    Directory of Open Access Journals (Sweden)

    Tevfik Yilmaz

    2014-01-01

    Full Text Available 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 decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

  10. 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

  11. Resolución espontánea de hernia de disco lumbar / Spontaneous resolution of a lumbar disc herniation

    Scientific Electronic Library Online (English)

    M., Gelabert-González; R., Serramito-García; E., Aran-Echabe; A., García-Allut.

    2007-04-01

    Full Text Available La hernia del disco intervertebral lumbar es una causa frecuente de radiculopatía en miembros inferiores y su tratamiento más efectivo sigue siendo objeto de controversia. Tanto el tratamiento quirúrgico como el conservador consiguen buenos resultados cuando se realiza una correcta selección del pac [...] iente. La desaparición espontánea de hernias de disco intervertebral es un hecho conocido con numerosas referencias en la bibliografía. Los autores presentamos el caso clínico de una paciente con radiculopatía secundaria a una hernia de disco lumbar diagnosticada con resonancia magnética y que se resolvió espontáneamente. Abstract in english Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a [...] well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy.

  12. 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.

  13. 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.

  14. MRI after successful lumbar discectomy

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Kelft, E. van de [Department of Neurosurgery, University of Antwerp, Edegem (Belgium); Biltjes, I.G.G.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hasselt, B.A.A.M. van [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Hauwe, L. van den [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Parizel, P.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium); Schepper, A.M.A. de [Department of Radiology, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem (Belgium)

    1996-05-01

    Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20 % of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20 % of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients. (orig.). With 7 figs., 2 tabs.

  15. MRI after successful lumbar discectomy

    International Nuclear Information System (INIS)

    Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20 % of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20 % of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients. (orig.). With 7 figs., 2 tabs

  16. Isthmic lumbar spondylolisthesis with sciatica

    International Nuclear Information System (INIS)

    Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: Normal nerve (n=8), II: Compressed nerve (n=16); III: Disappearance of fat, nerve not possible to identify (n=9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information. (orig.)

  17. 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.)

  18. MR-guided lumbar sympathicolysis

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, University of Tuebingen (Germany); Schneider, Wilke [Department of Vascular Surgery, University of Tuebingen (Germany)

    2002-06-01

    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.)

  19. 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.

  20. Bacterial Sacroiliitis Probably Induced by Lumbar Epidural Analgesia

    OpenAIRE

    Shimon Edelstein; Yeouda Edoute

    2003-01-01

    Background: Properly administered, lumbar epidural analgesia provides adequate pain relief during labor and delivery, and is considered to be a safe procedure with limited complications. The prevalence of infection after lumbar epidural analgesia is negligible.

  1. Bacterial Sacroiliitis Probably Induced by Lumbar Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Shimon Edelstein

    2003-01-01

    Full Text Available Background: Properly administered, lumbar epidural analgesia provides adequate pain relief during labor and delivery, and is considered to be a safe procedure with limited complications. The prevalence of infection after lumbar epidural analgesia is negligible.

  2. 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.)

  3. Discitis pospunción lumbar en un niño

    Directory of Open Access Journals (Sweden)

    Nelson Fuentes Rodríguez

    2004-06-01

    Full Text Available La infección del espacio intervertebral es causada generalmente después de intervenciones quirúrgicas a la columna vertebral y al espacio discal en particular, pero otras múltiples causas se han mencionado y dentro de ellas las punciones lumbares y cateterismos espinales. Se reporta el caso de un niño de 8 años de edad que luego de una punción lumbar comenzó a quejarse de lumbalgia, limitación marcada para la marcha y priapismo. La tomografía axial computadorizada realizada de urgencia mostró signos evidentes de discitis con discreta osteomielitis de los cuerpos vertebrales adyacentes. La conducta terapéutica fue conservadora con administración de antimicrobianos de amplio espectro, se obtuvo una respuesta favorable a las 24 h. Tiene 2 años de seguimiento en consulta, se encuentra asintomático y sin signos radiológicos de inestabilidad lumbosacra.The infection of intervertebral space generally occurs after surgeries performed in the vertebral column and the disc space in particular; but many other causes have been mentioned such lumbar punctures and spinal catheterism. This paper presents the case of an 8-years old boy, who, after lumbar puncture, began complaining of lumbar pain, great difficulties when walking and priapism. Computed tomography showed evident signs of discitis, with discrete osmeolytis in adjacent vertebral bodies. Conservative therapy was applied in the form of administration of wide spectrum antimicrobials to which a positive response was obtained 24 hours later. The boy has been followed-up for two years, and he is asymptomatic, without radiological signs of lumbosacral instability.

  4. 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.

  5. Sensitivity of lumbar spine loading to anatomical parameters

    DEFF Research Database (Denmark)

    Putzer, Michael; Ehrlich, Ingo; Rasmussen, John; Gebbeken, Norbert; Dendorfer, Sebastian

    2015-01-01

    Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the in uence of dened geometrical parameters on lumbar spine loading utilizing ve parametrized musculoskeletal lumbar spine models for four different postures. The in uence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine were studied. Additionally, simul...

  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. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection.

    Science.gov (United States)

    Lee, Yujin; Kim, Joon-Sung; Kim, Ji Yeon

    2015-06-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  8. 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.

  9. 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.)

  10. 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; Xue, Qingyun; Egund, Niels; Lind, Martin; Bünger, Cody

    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. Immedi...

  11. Short-term alendronate treatment does not maintain a residual effect on spinal fusion with interbody devices and bone graft after treatment withdrawal

    DEFF Research Database (Denmark)

    Huang, Baoding; Zou, Xuenong; Li, Haisheng; Xue, Qingyun; Bünger, Cody

    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...

  12. Fine needle diagnosis in lumbar osteomyelitis

    International Nuclear Information System (INIS)

    Lumbar vertebral body and disk infection, presenting as low back pain, is a relatively uncommon disease but is seen more often in drug addicts. Radiographs show typical changes of infection of the lumbar vertebrae and adjacent disc. Under local anesthesia a fine needle is placed, saline injected, and aspirated. The entire needle-syringe unit is submitted to the bacteriology department. Pseudomonas infection is usually found. This method of diagnosis is simple, cost effective, well accepted by the patients, and can be done on outpatients. (orig.)

  13. 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.

  14. 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

  15. Lumbar discitis caused by Clostridium perfringens.

    Science.gov (United States)

    Lotte, Romain; Popoff, M R; Degand, Nicolas; Lotte, Laurene; Bouvet, Philippe; Baudin, Guillaume; Cua, Eric; Roger, Pierre-Marie; Ruimy, Raymond

    2014-10-01

    We report here a rare case of chronic lumbar discitis caused by Clostridium perfringens in an elderly patient that was treated with a combination of ?-lactams and clindamycin. Molecular analysis performed on the strain revealed an unusual toxin gene pattern. PMID:25056327

  16. Lumbar Puncture for First Simple Febrile Seizure

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-01-01

    Full Text Available Compliance with American Academy of Pediatrics consensus statement recommendations regarding lumbar puncture for infants 6-18 months of age with a first simple febrile seizure was investigated by a retrospective review of 704 infants evaluated in the pediatric emergency medicine division at Children’s Hospital Boston, MA, Oct 1995-Oct 2006.

  17. Microendoscopic discectomy for prolapsed lumbar intervertebral disc

    Directory of Open Access Journals (Sweden)

    Ranjan Alok

    2006-01-01

    Full Text Available Background: Lumbar disc prolapse is a common problem and the current surgical standard for its treatment is a microsurgical discectomy. Microendoscopic discectomy (MED is a minimally invasive spinal procedure being done successfully for prolapsed intervertebral disc disease. Aims: We report the technique, outcome and complications seen in 107 cases of prolapsed lumbar intervertebral disc who underwent MED. Setting and Design: The study was carried out at the Department of Neurosurgery, at a tertiary hospital in South India and the data was collected prospectively. Materials and Methods: 107 patients with prolapsed lumbar intervertebral disc who were seen at our institution between November 2002 and January 2006 were included in the study. Data was collected prospectively. The METRx system (Medtronic Sofamor Danek, Memphis,TN was used to perform MED. Outcome assessment was done by the modified Macnab criteria. Results: 107 patients (67 males, 40 females underwent MED for prolapsed lumbar intervertebral disc. Follow up ranged from 2 to 40 months with a mean follow up 12.9 months. Seventy six patients had an excellent outcome, 22 patients had a good outcome, 5 patients had a fair outcome and 3 patients had a poor outcome. One patient with a long dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Complications included dural puncture with K-wire (1, dural tear (2, superficial wound infection (1, discitis (1 and recurrent disc prolapse (2. Conclusions: Microendoscopic Discectomy (MED is a safe and effective procedure for the treatment of prolapsed lumbar intervertebral disc.

  18. Endoscopic inter laminar management of lumbar disease

    Science.gov (United States)

    Yadav, Yad Ram; Parihar, Vijay; Kher, Yatin; Bhatele, Pushp Raj

    2016-01-01

    Discectomy for lumbar disc provides faster relief in acute attack than does conservative management. Long-term results of open, microscopy-, and endoscopy-assisted discectomy are same. Early results of endoscopy-assisted surgery are better as compared to that of open surgery in terms of better visualization, smaller incision, reduced hospital stay, better education, lower cost, less pain, early return to work, and rehabilitation. Although microscopic discectomy also has comparable advantages, endoscopic-assisted technique better addresses opposite side pathology. Inter laminar technique (ILT) and trans foraminal technique (TFT) are two main endoscopic approaches for lumbar pathologies. Endoscopy-assisted ILT can be performed in recurrent, migrated, and calcified discs. All lumbar levels including L5-S1 level, intracanalicular, foraminal disc, lumbar canal and lateral recess stenosis, multiple levels, and bilateral lesions can be managed by ILT. Migrated, calcified discs, L5-S1 pathology, lumbar canal, and lateral recess stenosis can be better approached by ILT than by TFT. Most spinal surgeons are familiar with anatomy of ILT. It can be safely performed in foramen stenosis and in uncooperative and anxious patients. There is less risk of exiting nerve root damage, especially in short pedicles and in presence of facet osteophytes as compared to TFT. On the other hand, ILT is more invasive than TFT with more chances of perforations of the dura matter, pseudomeningocele formation, and cerebrospinal fluid fistula in early learning curve. Obtaining microsurgical experience, attending workshops, and suitable patient selection can help shorten the learning curve. Once adequate skill is acquired, this procedure is safe and effective. The surgeon must be prepared to convert to an open procedure, especially in early learning curve. Spinal endoscopy is likely to achieve more roles in future. Endoscopy-assisted ILT is a safer alternative to the microscopic technique. PMID:26889271

  19. Effects of facet tropism and disk degeneration on far lateral lumbar disk herniation. Comparison with posterolateral lumbar disk herniation

    International Nuclear Information System (INIS)

    Differences in facet tropism and disk degeneration were investigated as key factors distinguishing the development of far lateral lumbar disk herniation from that of posterolateral lumbar disk herniation in 46 patients with far lateral lumbar disk herniation individually matched with 46 patients with posterolateral lumbar disk herniation. Preoperative standing body height, body weight, and body mass index were compared. Facet tropism was measured using computed tomography and disk degeneration was evaluated using magnetic resonance imaging. Mean body mass index showed a significant difference between patients with the far lateral and posterolateral lumbar disk herniation (24.9±2.7 vs. 23.7±2.3 kg/m2, p=0.04). However, no significant differences were found in standing body height and body weight, facet tropism, or disk degeneration between two groups. Neither facet tropism nor disk degeneration are involved in distinguishing the development of far lateral lumbar disk herniation from that of posterolateral lumbar disk herniation. (author)

  20. Clinical application of percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation under CT guidance

    International Nuclear Information System (INIS)

    Objective: To evaluate the effect of the percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation. Methods: 75 cases of lumbar disc herniation with significant clinical signs were confirmed by CT scan. The technique of the percutaneous lumbar puncture led the needle to approach nerve root and injected medicine diffusing into extraduramater, and then relieved the symptom of sciatica. Results: The rate of success of percutaneous lumbar puncture guided by CT reached to 100%. After two weeks of follow-up, the symptom of pain was obviously improved and disappeared in 63.3% cases. There were 23.0% cases needed a second procedure, and no change was obsesved in 9.3% cases. Conclusions: The percutaneous lumbar puncture guided by CT to treat sciatica resulted from lumbar disc herniation is one of the safe, reliable, effective new methods with no complication. The long term effectiveness is still in need of investigation. (authors)

  1. 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 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

  2. Functional implications of variation in lumbar vertebral count among hominins.

    Science.gov (United States)

    Whitcome, Katherine K

    2012-04-01

    As early as the 1970s, Robinson defined lumbar vertebrae according to their zygapophyseal orientation. He identified six lumbar elements in fossil Sts 14 Australopithecus africanus, one more than is commonly present in modern humans. It is now generally inferred that the modal number of lumbar vertebrae for australopiths and early Homo was six, from which the mode of five in later Homo is derived. The two central questions this study investigates are (1) to what extent do differences in human lumbar vertebral count affect lordotic shape and lumbar function, and (2) what does lumbar number variation imply about lumbar spine function in early hominins? To address these questions, I first outline a biomechanical model of lumbar number effect on lordotic function. I then identify relevant morphological differences in the human modal and extra-modal variants, which I use to test the model. These tests permit evaluation of the human L6 variant as a model for reconstructing early hominin modal number and spine function. Application of the biomechanical model in reconstructing australopith/early Homo lumbar spines highlights shared principles of Euler column strength and sagittal spine flexibility among early and modern hominins. Within modern humans, the extra-modal L6 variant has an extended series of three cranially positioned kyphotic vertebrae and strongly oblique zygapophyseal facets at the last lumbar level. Although they share the same radius and length of lumbar curvature, the L6 variant differs functionally from the L5 mode in its expanded range of sagittal flexion/extension and enhanced resistance to shear. Given the modal number of six lumbar vertebrae in australopiths and early Homo, lumbar spine mobility and strength would have been key properties of vertebral function in early bipeds whose upper and lower body segments were coupled by close approximation of the thorax and iliac crests. PMID:22425070

  3. 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

  4. 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

  5. Pressurizing intradiscal injection for lumbar disc herniation

    International Nuclear Information System (INIS)

    We report the clinical results of pressurizing injection into the intervertebral disc for lumbar disc herniation in 57 cases in which conservative treatment was ineffective. The average interval between the onset of symptoms and the pressurizing injection was 7.7 weeks. The needle is inserted under fluoroscopic guidance. Normal saline is injected after injecting contrast medium. We recorded the presence of radiating pain and the contrast discography findings. The pressurizing injection was very effective in 17 cases (30%), effective in 24 cases (42%), and in effective in 14 cases (25%), and in 2 cases (3%) the symptoms were aggravated. It was effective in 85% of the herniations at L4/5 and in 88% of the sequestration type herniations. There was no worsening of motor or sensory status. Pressurizing injection for lumbar disc herniation is safe and worth trying when ordinary conservative treatment is ineffective. (author)

  6. Lumbar Cryptococcal Osteomyelitis Mimicking Metastatic Tumor.

    Science.gov (United States)

    Joo, Hyun Seok; Ha, Jung-Ki; Hwang, Chang Ju; Lee, Dong-Ho; Lee, Choon Sung; Cho, Jae Hwan

    2015-10-01

    Cryptococcus is an encapsulated, yeast-like fungus that rarely causes infection in immunocompetent patients. We present the case report of a 66-year-old female patient with a history of rectal cancer with an isolated lumbar vertebral cryptococcosis proven by biopsy performed during operation. The patient was not an immunocompromised host and did not have any other risk factors except the history of cured rectal cancer. The presumptive diagnosis based on imaging studies was metastatic spine cancer, so operation was performed. However, cryptococcal osteomyelitis was diagnosed in the pathologic examination. This case report emphasizes that we should be aware that lumbar cryptococcosis can be a rare cause of mimicking lesions with metastatic cancer. PMID:26435802

  7. Etiología, cronificación y tratamiento del dolor lumbar

    Directory of Open Access Journals (Sweden)

    M.ª Isabel Casado Morales

    2008-01-01

    Full Text Available El dolor lumbar es un problema que afecta en torno al 70-80 % de la población general en algún momento de su vida, de los que un 15 % aproximadamente tienen un origen claro, pero el resto, se considera inespecífico o inclasificable, siendo en estos casos donde el tratamiento convencional ha fracasado. En el origen de este dolor lumbar inespecífico se encuentran factores biológicos, psicológicos y sociales y factores como las conductas de dolor y otros procesos de aprendizaje que influyen en su proceso de cronificación. Es el mayor responsable de incapacidad y de absentismo laboral con el consiguiente elevado coste económico y deterioro en la calidad de vida de quienes lo padecen. Los tratamientos clínicos deben unificarse para aumentar su eficacia, evitar los procesos de cronificación y reducir los costes económicos.

  8. 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.

  9. The imaging of lumbar spinal stenosis review

    Energy Technology Data Exchange (ETDEWEB)

    Saifuddin, A

    2000-08-01

    Lumbar spinal stenosis (LSS) is a relatively common condition of varied aetiology which results in chronic compression of the cauda equina. It becomes clinically relevant when giving rise to symptoms of neurogenic claudication or leg pain. Lumbar spinal stenosis can be classified based on anatomy or aetiology and the diagnosis in any single case should include a consideration of both the site and the cause. Plain radiography is of limited value. Myelography with erect lateral flexion/extension views will demonstrate the dynamic component of the stenosis which cannot be appreciated on plain computed tomography (CT) or magnetic resonance imaging (MRI). Therefore, in patients with a good history of symptomatic LSS, and a borderline stenosis on MRI, CT myelography is recommended as the definitive pre-operative imaging investigation. Saifuddin, A. (2000)

  10. Dynamic stabilization of the lumbar spine.

    Science.gov (United States)

    Cakir, Balkan; Richter, Marcus; Huch, Klaus; Puhl, Wolfhart; Schmidt, René

    2006-08-01

    This study analyzed the outcome of patients treated with total disk replacement and posterior dynamic stabilization. For pathologies of different origin, dynamic stabilization of the lumbar spine is a novel alternative to fusion surgery. Although a physiological reconstruction of the sagittal profile was not always achieved, improvement was seen in all subscales of the clinical outcome measures in both treatment groups. Posterior dynamic stabilization and total disk replacement are promising alternatives to fusion with acceptable morbidity for strictly defined indications. PMID:16924866

  11. Spontaneous Regression of Lumbar Disc Herniation: Report of Two Cases

    OpenAIRE

    ?ENO?LU, Mehmet; Kas?m Zafer YÜKSEL; Yüksel, Mürvet

    2006-01-01

    Spontaneous disc regression is described in lumbar, thoracic, cervical regions and also in various clinical situations. Although, spontaneous regression of lumbar disc herniation is a well defined clinical situation, the exact mechanism has not been adequately clarified yet. Currently , there are some suggested hypotheses. In this study, two cases with the complaint of lumbar radiculopathy and spontaneous regression of the disc herniation during their follow-up period, relevant with their cli...

  12. Lumbar plexopathy after radical nephrectomy -A case report-

    OpenAIRE

    Lee, Young-Bok; Jeong, Eui-Kyun; Park, Jong Taek

    2012-01-01

    Lumbar plexopathy is characterized by an abrupt onset of sensory disturbances, weakness, and loss of deep tendon reflexes of lower extremities. The various causes of lumbar plexopathy include trauma, infections, space-occupying lesion, vascular diseases, metabolic diseases, and the use of drugs such as heroin. Postoperative rhabdomyolysis occurs secondary to prolonged muscle compression due to surgical positioning. Herein, we report a case of lumbar plexopathy, complicating an injury to the p...

  13. 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.

  14. Lumbar Spinal Stenosis and Intermittent Neurogenic Claudication

    Directory of Open Access Journals (Sweden)

    Cumhur Ertekin

    2010-06-01

    Full Text Available Lumbar spinal stenosis and intermittent neurogenic claudication is a disease that occurs frequently after the age of 55 and becomes complicated after the age of 65 in clinical, radiological and therapeutic aspects. In this review, acquired spinal stenosis secondary to degenerative osteoarthritis is evaluated. In this disease, lumbar and extremity pain and paresthesia are frequent; however, the most characteristic feature of the disease is the occurrence and worsening of these findings with erect posture and walking (intermittent neurogenic claudication. Even though the radiological findings of spinal stenosis are apparent, 1/4-1/5 of the patients may be asymptomatic. In order to support the clinical findings, neurophysiological tests have been used at rest and motion. Certain electrophysiological signs have been found to change after motion. The most helpful signs are the denervation of paravertebral and leg muscles, H-reflex abnormalities, and the findings obtained with the recently used radicular excitation methods. Electrophysiological methods have been found to be more compatible with the clinical findings. Lumbar surgical approach is considered in patients with impaired life quality and in those unresponsive to conservative treatment.

  15. 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)

  16. Percutaneous lumbar disc-ectomy for contained herniation of lumbar disc

    International Nuclear Information System (INIS)

    Objective: To evaluate the influence of lumbar disc herniation type on the curative effect of percutaneous lumbar disc ectomy (PLD). Methods: 158 patients were classified into two groups including contained and discontained herniation according to clinical symptoms and diagnostic images. They were treated by means of the same technique in nonvascular intervention. Their curative effects were compared with each other in this study. Results: The curative and total effective rates were 81.1% and 98.5% respectively in contained group, 7.7% and 38.5% in discontained group without serious complications. The duration of follow up ranged from 3 months to 73 months. Conclusions: PLD is a effective procedure for lumbar disc herniation, which is relatively simple and safe with rapid recovery and without serious complications. It should be confirmed in simple contained herniation only

  17. The Clinical Analysis on 32 Cases of Herniated Lumbar Disc Patients according to Lumbar CT scan

    Directory of Open Access Journals (Sweden)

    Jeong-ho Kim

    2010-06-01

    Full Text Available Objective : This study is to evaluate the effectiveness of the oriental medicine treatment on lumbar disc herniation. Subjects and Methods : The clinical analysis was done on 32 cases of patients with lumbar disc herniation diagnosed by lumbar CT scan. Patients who admitted in Cheongju Oriental Medicine Hospital from April 2007 to April 2008 were analyzed according to the distribution of sex, age, the period of disease, condition on admission, the symptom on admission, Admission day, the treatment efficacy at discharge day. Results : 1. The forties was the most, the acutest phase the most, the day of 8-14 days the most. 2. Multiple bulging disc in 37.5% of CT scan was the most common, followed by a single HNP was 28.1%. 3. Almost 81% patients showed effective efficacy under VAS 3 at discharge day. 4. Single bulging and herniated disc were more short admission days than multiple bulging and herniated disc.

  18. 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

  19. Weightlifter Lumbar Physiology Health Influence Factor Analysis of Sports Medicine

    Science.gov (United States)

    Zhang, Xiangyang

    2015-01-01

    Chinese women's weightlifting project has been in the advanced world level, suggests that the Chinese coaches and athletes have many successful experience in the weight lifting training. Little weight lifting belongs to high-risk sports, however, to the lumbar spine injury, some young good athletes often due to lumbar trauma had to retire, and the national investment and athletes toil is regret things. This article from the perspective of sports medicine, weightlifting athletes training situation analysis and put forward Suggestions, aimed at avoiding lumbar injury, guarantee the health of athletes. In this paper, first of all to 50 professional women's weightlifting athletes doing investigation, found that 82% of the athletes suffer from lumbar disease symptoms, the reason is mainly composed of lumbar strain, intensity is too large, motion error caused by three factors. From the Angle of sports medicine and combined with the characteristics of the structure of human body skeleton athletes lumbar structural mechanics analysis, find out the lumbar force's two biggest technical movement, study, and regulate the action standard, so as to minimize lumbar force, for athletes to contribute to the health of the lumbar spine.

  20. The lumbar high-intensity zone: 20 years on

    International Nuclear Information System (INIS)

    The high intensity zone (HIZ) was first described by Aprill and Bogduk on lumbar spine magnetic resonance imaging (MRI) studies in 1992. Correlation with lumbar computed tomography (CT) discography showed that the HIZ represents a deep radial tear of the annulus fibrosus, which may be a cause of chronic low back pain. Initial studies comparing the finding of a HIZ on MRI with discography suggested that it may be a highly specific marker of a painful lumbar disc, but later investigators demonstrated that it is also present in asymptomatic individuals. The purpose of this article is to review the literature regarding the lumbar HIZ 20 years after its initial description

  1. The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4-5 Herniated Intervertebral Disc.

    Science.gov (United States)

    Yang, Hae-Sun; Yoo, Won-Gyu

    2014-07-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4-5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4-5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4-5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4-5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4-5 HIVD patients. PMID:25140094

  2. The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4–5 Herniated Intervertebral Disc

    Science.gov (United States)

    Yang, Hae-sun; Yoo, Won-gyu

    2014-01-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4–5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4–5 HIVD patients. PMID:25140094

  3. 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.)

  4. [Anterior and posterior stabilization of the lumbosacral spine with the usage of interbody cages in the operational treatment of the isthmic spondylolisthesis].

    Science.gov (United States)

    Pankowski, Rafa?; Smoczy?ski, Andrzej; Smoczy?ski, Maciej; Luczkiewicz, Piotr; Piotrowski, Maciej

    2006-01-01

    In the following work results of the operational treatment of the isthmic spondylolisthesis by the posterior stabilization and anterior lumbosacral interbody fusion with the use of interbody implants--cages was taken under evaluation. The test group consisted of 21 patients (13 male and 8 male). The follow up period exceeded 2 years. The objective clinical outcome assessment was based on Oswestry disability questionnaire. Subjective clinical evaluation was done by the visual analog pain score and two questions concerning the evaluation of success of the operative treatment and a possible agreement to a following operation if necessary. The radiological results were done upon evaluation of the degree of the spondylolisthesis, the angle of the lumbosacral lordosis, the height of the interbody space and intervertebral foramen and the evaluation of the spinal fusion. The conclusion was that the usage of the distraction of the lumbosacral spine in the operational treatment of the isthmic spondylolisthesis result in the reduction of the slippage and the dynamic decompression of the compressed neural roots. The usage of the interbody cages prevented the loss of slippage correction, permanently reconstructed the anatomical conditions in the area of the operated spinal segment and helped to achieve good and very good clinical results in over 95% of patients. The fusion rate was 100%. The restoration of the correct height of the intervertebral foramen in the slip segment caused an improvement of the neurologic state. The usage of two level stabilization in the operative treatment of the isthmic spondylolisthesis prevented the initiation of the secondary degenerative changes adjacent to the fusion. PMID:17128767

  5. 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.; Claes, L.

    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...

  6. The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4–5 Herniated Intervertebral Disc

    OpenAIRE

    Yang, Hae-sun; Yoo, Won-Gyu

    2014-01-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale score...

  7. The clinical effectiveness of percutaneous lumbar diskectomy combined with intradiscal electrothermal therapy for lumbar disc herniation

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical effectiveness of percutaneous lumbar diskectomy (PLD) combined with intradiscal electrothermal therapy (IDET) for the treatment of lumbar disc herniation. Methods: The clinical data of 87 patients with lumbar disc herniation were retrospectively analyzed. Of 87 cases, single PLD was performed in 39 and PLD followed by IDET in 48. The therapeutic results were measured and analyzed, and the complications were recorded. Results: All patients were followed up for 12-36 months. Relief in pain after the procedure was seen in both groups, but the patients in PLD+IDET group showed more improvement than the patients in PLD group. The clinical effective rate for PLD+IDET group and PLD group was 87.50% and 76.92% respectively, with no significant difference between two groups (P>0.01). No serious complications occurred. Conclusion: Both PLD+IDET and PLD are very effective in treating lumbar disc herniation. IDET is very helpful in relieving low back pain, although it can hardly improve patient's daily activities. (authors)

  8. 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.

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

    OpenAIRE

    Sandén Bengt; Robinson Yohan

    2009-01-01

    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 reco...

  10. The Robotic Lumbar Spine: Dynamics and Feedback Linearization Control

    Science.gov (United States)

    Karadogan, Ernur; Williams, Robert L.

    2013-01-01

    The robotic lumbar spine (RLS) is a 15 degree-of-freedom, fully cable-actuated robotic lumbar spine which can mimic in vivo human lumbar spine movements to provide better hands-on training for medical students. The design incorporates five active lumbar vertebrae and the sacrum, with dimensions of an average adult human spine. It is actuated by 20 cables connected to electric motors. Every vertebra is connected to the neighboring vertebrae by spherical joints. Medical schools can benefit from a tool, system, or method that will help instructors train students and assess their tactile proficiency throughout their education. The robotic lumbar spine has the potential to satisfy these needs in palpatory diagnosis. Medical students will be given the opportunity to examine their own patient that can be programmed with many dysfunctions related to the lumbar spine before they start their professional lives as doctors. The robotic lumbar spine can be used to teach and test medical students in their capacity to be able to recognize normal and abnormal movement patterns of the human lumbar spine under flexion-extension, lateral bending, and axial torsion. This paper presents the dynamics and nonlinear control of the RLS. A new approach to solve for positive and nonzero cable tensions that are also continuous in time is introduced. PMID:24151527

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

    Energy Technology Data Exchange (ETDEWEB)

    Iwakura, Yuichiro (Yatsushiro General Hospital, Kumamoto (Japan)); Hayashi, Yasuo; Suzuki, Mutsuaki; Uemura, Mitsuharu; Fukuda, Kazuyuki; Koito, Hirofumi

    1984-06-01

    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.

  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. Magnetic resonance imaging of lumbar disc herniation

    International Nuclear Information System (INIS)

    Thirty-two patients with surgical confirmed lumbar disc herniation were studied retrospectively to compare the diagnostic accuracy of high-field strength surface coil MRI with that of myelography. In 19 cases (60%), MRI diagnosis was extremely reliable, so myelography was considered to be unnecessary. On the other hand, in the remaining 14 cases (40%), MRI diagnosis was less reliable that myelography was necessary in locating the disc causing symptoms. MRI was extremely useful in the large disc herniation whose myelography showed complete block. On the other hand, myelography was useful in patients whose MRI showed multilevel disc herniation and whose myelography showed unilateral single root compression. (author)

  14. Dolor lumbar agudo: mecanismos, enfoque y tratamiento

    OpenAIRE

    Marco Tulio Mahecha Toro

    2009-01-01

    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 patológi...

  15. Percutaneous treatment of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Leonardi, M.; Resta, F.; Bettinelli, A. [Ospedale Maggiore di Milano (Italy); Lavaroni, A.; Fabris, G. [Ospedale Civile di Udine (Italy); Abelli, F. [Fondazione Clinica del Lavorno, Pavia (Italy)

    1994-12-31

    918 patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author). 7 refs, 6 figs, 1 tab.

  16. Spontaneous Regression of Lumbar Disc Herniation: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Mehmet ?ENO?LU

    2006-12-01

    Full Text Available Spontaneous disc regression is described in lumbar, thoracic, cervical regions and also in various clinical situations. Although, spontaneous regression of lumbar disc herniation is a well defined clinical situation, the exact mechanism has not been adequately clarified yet. Currently , there are some suggested hypotheses. In this study, two cases with the complaint of lumbar radiculopathy and spontaneous regression of the disc herniation during their follow-up period, relevant with their clinical improvement and along with the radiological documentation of their situation, are presented. Possibility of the spontaneous regression of the lumbar discs and amelioration in some neurological symptoms with conservative therapy should be taken into account while giving a decision for operation on a patient with lumbar disc herniation.

  17. Diagnosis of the lumbar disc herniation by computed tomography

    International Nuclear Information System (INIS)

    Diagnostic value of plain CT was assessed on 42 patients clinically suspected to have lumbar disc herniation with sacral or lumbar root pains. CT of the lumbar region visualized the site and size of prolapse of the disc and the positional relationship between the prolapsed disc and the compressed nerve root. CT is one of the useful examination methods for lumbar disc herniation, but its large exposure dose calls for selection of indications on the basis of clinical findings. Since it can be conducted on patients with lumbar disc herniation at the outpatient clinic, patients with iodine hypersensitivity or those with difficult postural change because of strong pains can also be studied. (Chiba, N.)

  18. Outcome Prediction in Lumbar Disc Herniation Surgery

    Directory of Open Access Journals (Sweden)

    Harun Brkic

    2010-12-01

    Full Text Available Introduction: It is a well recognized fact that a significant proportion of patients operated on for lumbar disc herniation exhibit a poor outcome, regardless of the apparent technical success of the operative procedure itself. Aim: to identify a set of widely available variables that accurately predict short-term outcome after discectomy and to develop a predictive model based upon those variables. Patients and methods: Basic demographic, clinical and radiological variables were evaluated in a group of 70 patient operated on for disc herniation. Outcome was assessed using VAS and RM scales 6 months postoperatively and correlated to aforementioned variables. Results: Preoperative pain intensity and duration, age and type of disc herniation were all shown to be statistically significant predictors of short-term outcome, unlike sex, type of radiological investigation and preoperative tension sign testing results. Multivariate regression analysis including only variables previously identified as good outcome predictors revealed that the pain intensity exhibited the strongest correlation with outcome, followed by pain duration, type of disc herniation and age. Even though MR scan was more sensitive in detecting disc extrusion than CT (sensitivity of 100% versus 65%, respectively, the presence of preoperative MR scan did not influence the outcome. Conclusion: The study identified a set of widely available and easily attainable variables as fair predictors of short-term outcome after lumbar discectomy. Subsequent logistic regression resulted in a predictive model whose accuracy is to be determined in another prospective study.

  19. Fibroma desmoplásico de la columna lumbar

    Directory of Open Access Journals (Sweden)

    Raúl Candebat Rubio

    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 que 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.

  20. 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

  1. [Lumbar spondylodiscitis caused by Salmonella enteritidis].

    Science.gov (United States)

    Schüler, A; Schaumann, D; Manns, M P; Koch, K M

    1994-10-14

    A 19-year-old boy developed paravertebral muscular pain in the lumbar region after an episode of extremely arduous sporting activity, with fever followed by meningism. The cerebrospinal fluid showed a reactive pleocytosis. Initially, no acute inflammatory changes were present on serum and blood analysis, although the erythrocyte sedimentation rate was moderately increased to 25/60 mm. Pyrexia of up to 38.5 degrees C developed 6 days after admission. Because Borrelia IgM and IgG titres were positive, the diagnosis was at first thought to be atypical borreliosis and the patient was treated with antibiotics. However, after a further episode of fever. Salmonella antibody titres, which had initially been normal, rose to 1: 3200 (Salmonella typhi O and H antigens) and 1: 12800 (Salmonella enteritidis, H antigen). At this stage, the erythrocyte sedimentation rate rose to 86/120 mm and the C-reactive protein to 77 mg/dl. The white cell count remained normal throughout. Blood cultures grew Salmonella enteritidis. Abnormalities on bone scintigraphy were confirmed by CT and MRI scans, showing spondylodiscitis of lumbar vertebrae 1 and 2 with limited osteolysis. The lesion resolved completely on 6 week's treatment with ciprofloxacin (200 mg twice a day intravenously) and conservative supportive treatment. Spondylodiscitis is an uncommon complication of salmonellosis and may occur long after the diarrhoea. Cross reactions with Borrelia flagellin antigens may lead to the wrong diagnosis being made. PMID:7924947

  2. Computed Tomography of the lumbar facet joints

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Mi Ryoung; Kim, Yung Soon; Lee, Joo Hyuk; Jeon, Hae Sang; Kim, Dae Yung [Kang Nam General Hospital, Seoul (Korea, Republic of)

    1989-08-15

    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 gro0008.

  3. Tratamiento microquirúrgico en la hernia discal lumbar

    Directory of Open Access Journals (Sweden)

    Ángel Jesús Lacerda Gallardo

    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 años 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.

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

    International Nuclear Information System (INIS)

    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/cm2 in the femoral neck, while for controls the corresponding figures were 0.989g/cm2 and 0.765g/cm2. 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

  5. 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.

  6. Adverse Event Recording and Reporting in Clinical Trials Comparing Lumbar Disk Replacement with Lumbar Fusion: A Systematic Review.

    Science.gov (United States)

    Hiratzka, Jayme; Rastegar, Farbod; Contag, Alec G; Norvell, Daniel C; Anderson, Paul A; Hart, Robert A

    2015-12-01

    Study Design?Systematic review. Objectives?(1) To compare the quality of adverse event (AE) methodology and reporting among randomized trials comparing lumbar fusion with lumbar total disk replacement (TDR) using established AE reporting systems; (2) to compare the AEs and reoperations of lumbar spinal fusion with those from lumbar TDR; (3) to make recommendations on how to report AEs in randomized controlled trials (RCTs) so that surgeons and patients have more-detailed and comprehensive information when making treatment decisions. Methods?A systematic search of PubMed, the Cochrane collaboration database, and the National Guideline Clearinghouse through May 2015 was conducted. Randomized controlled trials with at least 2 years of follow-up comparing lumbar artificial disk replacement with lumbar fusion were included. Patients were required to have axial or mechanical low back pain of ?3 months' duration due to degenerative joint disease defined as degenerative disk disease, facet joint disease, or spondylosis. Outcomes included the quality of AE acquisition methodology and results reporting, and AEs were defined as those secondary to the procedure and reoperations. Individual and pooled relative risks and their 95% confidence intervals comparing lumbar TDR with fusion were calculated. Results?RCTs demonstrated a generally poor description of methods for assessing AEs. There was a consistent lack of clear definition or grading for these events. Furthermore, there was a high degree of variation in reporting of surgery-related AEs. Most studies lacked adequate reporting of the timing of AEs, and there were no clear distinctions between acute or chronic AEs. Meta-analysis of the pooled data demonstrated a twofold increased risk of AEs in patients having lumbar fusion compared with patients having lumbar TDR at 2-year follow-up, and this relative risk was maintained at 5 years. Furthermore, the pooled data demonstrated a 1.7 times greater relative risk of reoperation in the fusion group compared with lumbar TDR, although this risk decreased to 1.1 at 5-year follow-up. However, given the lack of quality and consistency in the methods of recording and reporting of AEs, we are unable to make a clear recommendation of one treatment over the other. Conclusions?Based on the currently available literature, lumbar TDR appears to be comparable in safety to lumbar fusion. However, due to lack of consistency in reporting of AEs, it is difficult to make conclusions regarding the true safety profile of lumbar TDR. Standardization in AE reporting will significantly improve the reliability of the current literature. PMID:26682099

  7. 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, 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)

  8. Direction of the formation of anterior lumbar vertebral osteophytes

    Directory of Open Access Journals (Sweden)

    Akeda Koji

    2009-01-01

    Full Text Available Abstract Background X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration. Methods The direction of the formation of 14,250 pairs of anterior lumbar vertebral osteophytes across the adjacent intervertebral discs in 2,850 patients who were all over 60 years old was investigated. Anterior lumbar vertebral osteophytes were distributed into six groups based on the direction of extension of each pair of osteophytes across the intervertebral disc space. Results In L1–L2 and L2–L3, the number of patients classified into groups B (the pair of osteophytes extended in the direction of the adjacent disc and C (almost complete bone bridge formation by a pair of osteophytes across the intervertebral disc space was larger than that classified into group D (the pair of osteophytes extended in a direction away from the adjacent disc. In L3–L4, L4–L5 and L5-S1, the number of patients in group D was greater than that of patients belonging to groups B and C. Conclusion Our study showed that pairs of osteophytes frequently formed in the direction of the adjacent disc in the upper lumbar vertebrae (L1–L2 and L2–L3 and in the direction away from the adjacent disc in middle or lower lumbar vertebrae (L3–L4, L4–L5, and L5-S1.

  9. Lumbar spine radiography for osteoporosis via a staging system - CT densitometry of lumbar vertebrae

    International Nuclear Information System (INIS)

    Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes. (orig.)

  10. 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.

  11. Lumbar Periradicular Abscess Mimicking a Fragmented Lumbar Disc Herniation : An Unusual Case

    OpenAIRE

    Bakar, Bulent; Tekkok, Ismail Hakki

    2008-01-01

    We herein describe the case of a focal spontaneous spinal epidural abscess who was initially diagnosed to have a free fragment of a lumbar disc. A 71-year-old woman presented with history of low back and right leg pain. Magnetic resonance imaging suggested a peripherally enhancing free fragment extending down from S1 nerve root axilla. Preoperative laboratory investigation showed elevation of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels. She was taken for surgery and ...

  12. Diagnosis of lumbar disc herniation by computed tomography

    International Nuclear Information System (INIS)

    Plain computed tomography (CT) was performed in 93 patients suspected of having lumbar disc herniation. Its diagnostic value for the responsible height, position and degree of herniation was examined. CT findings for the responsible height and position of lumbar disc herniation coincided completely with laboratory and operative findings (100%), while those for the degree of protrusion coincided with operative findings in a lower rate (84%). In CT diagnosis for lumbar disc herniation, artifacts such as partial volume phenomenon, edge effect, and beam hardening, should be noted. (Namekawa, K.)

  13. 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

  14. The cost–utility of lumbar disc herniation surgery

    OpenAIRE

    Hansson, Elisabeth; Hansson, Tommy

    2006-01-01

    The cost and utility of surgery for a herniated lumbar disc has not been determined simultaneously in a single cohort. The aim of this study is to perform a cost–utility analysis of surgical and nonsurgical treatment of patients with lumbar disc herniation. Ninety-two individuals in a cohort of 1,146 Swedish subjects underwent lumbar disc herniation surgery during a 2-year study. Each person operated on was individually matched with one treated conservatively. The effects and costs of the tre...

  15. Clinical investigation of lumbar spine MRI in lumbar canal stenosis (LCS)

    Energy Technology Data Exchange (ETDEWEB)

    Nobutani, Kazuo [Yamaguchi Univ., Ube (Japan). School of Medicine

    2002-10-01

    Studies were conducted to know the availability of MRI in the diagnosis of lumbar canal stenosis (LCS). Seventy six patients of advanced age with low back pain were chosen; half of the patients showed neurological manifestations in their lower extremities (LCScases) but the remaining half did not (low back pain (LBP) cases). All patients underwent MRI of the lumbar spine and abnormal imagings were analyzed. The results showed that the following changes could be demonstrated at a high frequency in the cases of LCS as compared with those in LBP; (I) morphological changes classified as either the Trefoil or the Deficit type in the spinal canal cross section, (II) protrusion and degeneration of the intervertebral disk, (III) brightness changes of endplate, and (IV) increasing thickness of the yellow ligament. Individual change did not always correspond to the extent of the neurological manifestation of LCS. However, patients of 92 percent showed the changes of both (II) and (III) in LCS cases. Therefore, lumbar spine MRI provides useful information in the diagnosis of LCS when the changes are considered with clinical signs of patients. (author)

  16. 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.

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

    Scientific Electronic Library Online (English)

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

    2011-11-01

    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.

  18. Lumbar disc cyst with contralateral radiculopathy

    Directory of Open Access Journals (Sweden)

    Kishore Tourani

    2012-08-01

    Full Text Available Disc cysts are uncommon intraspinal cystic lesions located in the ventrolateral epidural space. They communicate with the nucleus pulposus of the intervertebral disc and cause symptoms by radicular compression. We report a unique case of lumbar disc cyst that was associated with disc herniation and contralateral radiculopathy. A 22 year old male presented with one month history of back-ache radiating to the left leg. Magnetic Resonance Imaging (MRI showed L3-L4 disc herniation with annular tear and cystic lesion in the extradural space anterior to the thecal sac on right side, which increased in size over a period of 3 weeks. L3 laminectomy and bilateral discectomy and cyst excision was done with partial improvement of patients symptoms.

  19. Upright positional MRI of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Alyas, F.; Connell, D. [London Upright MRI Centre, London (United Kingdom); Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom); Saifuddin, A. [London Upright MRI Centre, London (United Kingdom); Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom)], E-mail: asif.saifuddin@rnoh.nhs.uk

    2008-09-15

    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.

  20. The appearances of lumbar intraspinal synovial cysts.

    Science.gov (United States)

    Knox, A M; Fon, G T

    1991-12-01

    Intraspinal synovial cysts most commonly occur in the lower lumbar spine and may cause radicular symptoms. Eight symptomatic patients are described, each of whom had a single synovial cyst with associated facet joint degeneration. Four were at the L4-5 level and two each at L3-4 and L5-S1. Myelography in four patients revealed a posterolateral indentation on the contrast column in each case. Computed tomography (CT) revealed a structure of similar or greater density than the thecal sac in six cases and of gas density in one case. Two of the former cases also contained gaseous elements, three cases had a mildly dense rim and in the eighth case calcification was demonstrated within the cyst. One cyst resolved after facet joint injection with local anaesthetic and steroid. PMID:1773558

  1. 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.

  2. 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.

  3. Lumbar spinal canal size of sciatica patients

    International Nuclear Information System (INIS)

    Seven measures at the three lowest lumbar interspaces were recorded from conventional radiographs of the lumbar spines of 160 consecutive patients with low back pain and sciatica admitted for myelography and possible surgery. Eighty-eight patients were operated upon for disc herniation, and of the conservatively-treated 72 patients, 18 had a pathologic and 54 a normal myelogram. The results were evaluated after one year using the occupational handicap scales of WHO. Correlations of radiographic measures to stature were moderate and to age small. After adjusting for stature and age, only the male interpedicular distances and the antero-posterior diameter of intervertebral foramen at L3 were greater than those of females. The males with a pathologic myelogram had smaller posterior disc height at L3 and a smaller interarticular distance at L3 and L4 than those with normal myelogram, likewise the midsagittal diameter at L3 and L4 in females. In all patients other measures besides posterior disc height were smaller than those for low back pain patients (p<0.001) or for cadavers (p<0.001). The only correlation between measures and clinical manifestations was between pedicular length at L3 and limited straight leg raising. Where the disc material had been extruded into the spinal canal, the interpedicular distance was significantly wider. Only anterior disc height at L3 revealed differences between good and poor outcome one year after surgery, as did the interarticular distance at S1 in patients with normal myelogram after conservative treatment. (orig.)

  4. Usefulness of dynamic contrast enhanced lumbar spine MR imaging postoperative herniated lumbar disc

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Ji Eun; Chung, Tae Sub; Kim, Young Soo; Cho, Yong Eun; Park, Mi Suk [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To compare the usefulness of dynamic contrast enhanced lumbar spine MR imaging with that of conventional delayed contrast enhanced MR imaging in the assessment of postoperative herniated lumbar disc. Forty-one postoperative herniated lumbar disc (HLD) lesions of 32 patients with back pain were examined with MR imaging (1.5T, Vision, Siemens, Germany). Five-phase dynamic 2D FLASH sagittal images (TR/TE = 118.1msec/4.1msec) were obtained every 19 seconds with a 4 minutes delayed image after contrast injection. As seen on delayed images, the discs were assessed as recurred, fibrosis, or no change. On dynamic images, the pattern of enhancement was evaluated as follows : Type 1 (no change in peripheral disc enhancement between the early and late phases) ; or Type 2 (minimal internal extension of marginal smooth enhancement during the late phase) ; or Type 3 (marked internal extension of peripheral irregular enhancement). Dynamic and delayed imaging were compared, and early epidural space enhancement with rapid wash-out was also evaluated. Of 41 postoperative HLDs, 39 lesions showed peripheral contrast enhancement. Evaluation depended on delayed imaging, and was as follows : recurred HLD (n=27) ; fibrosis (n=5) ; no change in postoperative disc (n=7). On dynamic contrast-enhanced imaging, enhancement patterns were Type 1 (n=29), Type 2 (n=7), and Type 3 (n=3). In 29 Type 1 lesions, there were no significant differences in image findings between dynamic and delayed images. However, in ten lesions (type 2 : n=7, type 3 : n=3), findings additional to those revealed by delayed images were demonstrated by dynamic contrast-enhanced MR imaging. Nine of the ten Type 2 and 3 lesions were diagnosed as recurred HLD. On dynamic images, five lesions showed early epidural space enhancement. Dynamic contrast-enhanced lumbar spine MR imaging provided additional findings such as increased peripheral disc enhancement, and epidural space enhancement, which cannot be detected on conventional delayed images. In recurred postoperative herniated lumbar discs, these findings are frequent.

  5. 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.

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

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Sonne-Holm, Stig; Rovsing, Hans; Monrad, Henrik; Gebuhr, Peter

    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...

  7. [Preoperative selection for lumbar sympathectomy using a mixed hyperemia test].

    Science.gov (United States)

    Verhelst, G; Chastel, C; Paquet, J L; Michel, P; Van Eukem, P; Belva, P

    1985-01-01

    The decision to perform a lumbar sympathectomy in cases of severe distal arteritis should be made according to an objective selection method. The mixed active hyperemia test meets that condition. PMID:4013581

  8. 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)

  9. 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

  10. Functional outcome of surgical management of degenerative lumbar canal stenosis

    Directory of Open Access Journals (Sweden)

    Rajendra Nath

    2012-01-01

    Conclusion: Operative treatment in patients of degenerative lumbar canal stenosis yields excellent results as observed on the basis of JOA scoring system. No patient got recurrence of symptoms of nerve compression.

  11. 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)

  12. 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 vertebra...

  13. On diagnostic blocks for lumbar zygapophysial joint pain

    OpenAIRE

    Bogduk, Nikolai

    2010-01-01

    Diagnostic blocks are used to identify patients with back pain stemming from their lumbar zygapophysial joints. Single, diagnostic blocks have an unacceptably high false positive rate. As well, comparative local anaesthetic blocks lack validity because the prevalence of the condition is low. Relying on 50% relief following single-diagnostic blocks does not provide a valid diagnosis. Placebo-controlled blocks are the only available valid means of establishing a diagnosis of lumbar zygapophysia...

  14. Hemorrhage from lumbar artery following percutaneous renal biopsy

    OpenAIRE

    Devi, B. Vijayalakshmi; Lakshmi, B. Sangeetha; Supraja, C; Vanajakshmma, V.; R Ram; D Rajasekhar; A.Y Lakshmi; V. SIVAKUMAR

    2015-01-01

    We present a 58-year-old lady who underwent ultrasound-guided renal biopsy for suspected acute glomerulonephritis. Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes. Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra. The bleeding vessel was occluded with gelfoam.

  15. 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 s...

  16. Should Cervical and Lumbar Lordosis be Evaluated on MR Imaging?

    Directory of Open Access Journals (Sweden)

    Y?k?lmaz, A.

    2006-01-01

    Full Text Available Purpose: In the literature, data about the cervical and lumbar Lordosis; Magnetic resonance imaging; Vertebrae lumbar. lordotic angle measurements and their clinical implications are based on plain film studies. In this study, we aimed to assess the efficacy of magnetic resonance imaging in cervical and lumbar lordotic angle measurements with respect to plain films. Material and Methods: The measurements obtained from plain films and magnetic resonance images of 66 patients with degenerative disease of cervical (n=32 and lumbar (n=34 spine were investigated using the Cobb method (C1-C7 for cervical spine; L1-L5 and L1-S1 for lumbar spine. Intermethod agreement was determined by correlation analysis and the difference between the measurements were evaluated by paired t test. . Results: There was a poor correlation between the two methods (R •0.5. A high variability in the measurements, which was most pronounced at the cervical region, was noted. The difference between the plain film and magnetic resonance based measurements were insignificant (p>0.05. Conclusion: Due to poor intermethod agreement, lumbar and servical lordosis measurments on magnetic resonance imaging may be misleading.

  17. 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.

  18. 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)

  19. 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.

  20. 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.

  1. Lumbar Intervertebral Disc Puncture under C-arm Fluoroscopy: a New Rat Model of Lumbar Intervertebral Disc Degeneration

    OpenAIRE

    Li, Dapeng; Yang, HuiLin; Huang, Yonghui; Wu, Yan; Sun, Taicun; Li, Xuefeng

    2014-01-01

    To establish a minimally invasive rat model of lumbar intervertebral disc degeneration (IDD) to better understand the pathophysiology of the human condition. The annulus fibrosus of lumbar level 4–5 (L4-5) and L5-6 discs were punctured by 27-gauge needles using the posterior approach under C-arm fluoroscopic guidance. Magnetic resonance imaging (MRI), histological examination by hematoxylin and eosin (H&E) staining, and reverse transcription polymerase chain reaction (RT-PCR) w...

  2. 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.

  3. Comparison of trunk and hip muscle activity during different degrees of lumbar and hip extension.

    Science.gov (United States)

    Kim, Sang-Min; Yoo, Won-Gyu

    2015-09-01

    [Purpose] This study compared the activity of trunk and hip muscles during different degrees of lumbar and hip extension. [Subjects] The study enrolled 18 participants. [Methods] Two exercises (hip and lumbar extension) and two ranges (180° and extension affected the percentage maximal voluntary isometric contraction of the lumbar erector spinae and biceps femoris muscles, with significantly higher average values at >180° than at 180° lumbar extension. No significant differences were found in gluteus maximus activity according to exercise type or range. [Conclusion] Hip extension may be more effective and safer for lumbar rehabilitation than lumbar extension. PMID:26504276

  4. 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

  5. Functional Connectivity Separates Switching Operations in the Posterior Lateral Frontal Cortex

    Science.gov (United States)

    Stelzel, Christine; Basten, Ulrike; Fiebach, Christian J.

    2011-01-01

    Task representations consist of different aspects such as the representations of the relevant stimuli, the abstract rules to be applied, and the actions to be performed. To be flexible in our daily lives, we frequently need to switch between some or all aspects of a task. In the present study, we examined whether switching between abstract task…

  6. Zebrafish yap1 plays a role in differentiation of hair cells in posterior lateral line

    Science.gov (United States)

    Loh, Siau-Lin; Teh, Cathleen; Muller, Julius; Guccione, Ernesto; Hong, Wanjin; Korzh, Vladimir

    2014-03-01

    The evolutionarily conserved Hippo signaling pathway controls organ size by regulating cell proliferation and apoptosis and this process involves Yap1. The zebrafish Yap1 acts during neural differentiation, but its function is not fully understood. The detailed analysis of yap1 expression in proliferative regions, revealed it in the otic placode that gives rise to the lateral line system affected by the morpholino-mediated knockdown of Yap1. The comparative microarray analysis of transcriptome of Yap1-deficient embryos demonstrated changes in expression of many genes, including the Wnt signaling pathway and, in particular, prox1a known for its role in development of mechanoreceptors in the lateral line. The knockdown of Yap1 causes a deficiency of differentiation of mechanoreceptors, and this defect can be rescued by prox1a mRNA. Our studies revealed a role of Yap1 in regulation of Wnt signaling pathway and its target Prox1a during differentiation of mechanosensory cells.

  7. Magnetic resonance imaging of normal lumbar intervertebral discs

    International Nuclear Information System (INIS)

    Objective was to study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed. (author)

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

    Directory of Open Access Journals (Sweden)

    Katz Jeffrey N

    2010-11-01

    Full Text Available 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 group' with performance in the situation where the physical examination was not blinded to MRI results (the 'non-independent group'. The reference standard was the final diagnostic impression of nerve root impingement by the examining physician. Subjects were recruited from a hospital-based outpatient specialty spine clinic. All adults age 18 and older presenting with lower extremity radiating pain of duration ? 12 weeks were evaluated for participation. 154 consecutively recruited subjects with lumbar disk herniation confirmed by lumbar spine MRI were included in this study. Sensitivities and specificities with 95% confidence intervals were calculated in the independent and non-independent groups for the four components of the radiculopathy examination: 1 provocative testing, 2 motor strength testing, 3 pinprick sensory testing, and 4 deep tendon reflex testing. Results The perceived sensitivity of sensory testing was higher with prior knowledge of MRI results (20% vs. 36%; p = 0.05. Sensitivities and specificities for exam components otherwise showed no statistically significant differences between groups. Conclusions Prior knowledge of lumbar MRI results may introduce bias into the pinprick sensory testing component of the physical examination for lumbar radiculopathy. No statistically significant effect of bias was seen for other components of the physical examination. The effect of bias due to prior knowledge of lumbar MRI results should be considered when an isolated sensory deficit on examination is used in medical decision-making. Further studies of bias should include surgical clinic populations and other common diagnoses including shoulder, knee and hip pathology.

  9. 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

  10. 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.    

  11. Risk Factors for Recurrent Lumbar Disc Herniation

    Science.gov (United States)

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Abstract Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH. Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed. A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53–2.58), disc protrusion (OR 1.79, 95% CI 1.15–2.79), and diabetes (OR 1.19, 95% CI 1.06–1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly. Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  12. 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)

  13. Spontaneous regression of herniated lumbar disks

    International Nuclear Information System (INIS)

    Four cases of spontaneous regression of herniated nucleus polposus are described, which were followed after conservative medical treatment. Three female and one male patients who suffered from severe lumbago were evaluated; their age ranged 24-59 years. From the first CT scan on which herniation was diagnosed to follow-up control after complete regression of symptoms an average period of 14 months elapsed. Comparing ours with literature data, a substantial agreement was observed of both timing of spontaneous regression and location (most often involved was the last lumbar invertebral space). The age of one of our patients (59 years) is to be stressed, which is well above the mean age reported in literature (35 years). The pathogenesis of regression is still unknown. The most reliable hypotesis seems to be that of dehydratation and progressive atrophy of the erniated nucleus polposus. The apperance, in some cases, of the vacuum disk phenomenon seems to support such a thesis. Therefore, the diagnosis of a herniated nucleus polposus of relatively small size, still contained in an intact posterior longitudinal ligament, widely justifies the choice of waiting tactics

  14. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

    International Nuclear Information System (INIS)

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

  15. [A 3-dimensional reconstructive procedure in lumbar computed tomography].

    Science.gov (United States)

    Kern, A; Waggershauser, T; Zendel, W; Astinet, A; Hansen, K; Lanksch, W R; Felix, R

    1991-08-01

    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. The accuracy of the 3-D reconstruction software programme was checked by measuring a polyethylene phantom of a second lumbar vertebra. Reconstruction was carried out with a threshold definition of 150 Hu. In each case, four standard projections and medio-sagittal, medio-lateral and coronary sections were reconstructed, photographed and compared with axial CT sections and conventional radiographs. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondylarthrosis, with narrowing of the intervertebral 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 spondylarthrosis 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. PMID:1878546

  16. [Topography, relations and transformation of lumbar lymphatic sacs].

    Science.gov (United States)

    Sharkus, Ye A

    2015-01-01

    The peculiarities of the structure, skeletotopy, and syntopy of the lumbar lymphatic collector were studied on 20 5-8 week-old embryos and on 80 9-36 week-old fetuses using a complex macro-microscopic method. It is found that the lumbar lymphatic collector in fetuses at 9-10 weeks was represented by retroperitoneal and retroaortic lymphatic sacs that had a fusion mode of formation and were interconnected. Retroperitoneal sac was located in the projection of L(I)-L(IV) and was in contact with the anterior surface of the abdominal aorta and inferior vena cava, aortic lumbar paraganglia, abdominal aortic plexus and ganglia of sympathetic trunk. Retroaortic sack at L(I)-L(II) was adjacent to posterior surface of the aorta, the lumbar vertebrae and the medial crus of the diaphragm. These topical relations were preserved throughout the whole fetal period. However, in fetuses of 11-13 weeks lymphatic sacs formed the lymphatic plexuses, while in fetuses of 14-36 weeks they formed lumbar lymph nodes and their interconnecting vessels. PMID:25958724

  17. Perioperative morbidity and mortality after lumbar trauma in the elderly.

    Science.gov (United States)

    Winkler, Ethan A; Yue, John K; Birk, Harjus; Robinson, Caitlin K; Manley, Geoffrey T; Dhall, Sanjay S; Tarapore, Phiroz E

    2015-10-01

    OBJECT Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal trauma. Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. The authors sought to characterize the complications, morbidity, and mortality associated with surgical and nonsurgical management in elderly patients with traumatic fractures of the lumbar spine. METHODS Using the National Sample Program of the National Trauma Data Bank, the authors performed a retrospective analysis of patients ? 55 years of age who had traumatic fracture to the lumbar spine. This group was divided into middle-aged (55-69 years) and elderly (? 70 years) cohorts. Cohorts were subdivided into nonoperative, vertebroplasty or kyphoplasty, noninstrumented surgery, and instrumented surgery. Univariate and multivariable analyses were used to characterize and identify predictors of medical and surgical complications, mortality, hospital length of stay, ICU length of stay, number of days on ventilator, and hospital discharge in each subgroup. Adjusted odds ratios, mean differences, and associated 95% CIs were reported. Statistical significance was assessed at p home. CONCLUSIONS The present study confirms that lumbar surgery in the elderly is associated with increased morbidity. In particular, instrumented fusion is associated with periprocedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is also associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings. PMID:26424342

  18. Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

    OpenAIRE

    Luostarinen, L.; Heinonen, T.; Luostarinen, M.; Salmivaara, A.

    2005-01-01

    Post–lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post–puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post–dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective...

  19. Anatomical Variations of Lumbar Arteries and Their Clinical Implications: A Cadaveric Study

    OpenAIRE

    Karunanayake, Aranjan Lionel; Pathmeswaran, Arunasalam

    2013-01-01

    Lumbar arteries arise from the abdominal aorta. Some abdominal and spinal surgeries can damage these arteries, and that can lead to serious consequences. This study aimed at studying the types and frequencies of variations of lumbar vasculature. We dissected both sides of 109 adult human cadavers and studied the variations of lumbar vasculature. Age range was 43–90?years. Fifty-seven percent were males and 43% were females. The number of lumbar arteries arising from either side of the abdomin...

  20. Lumbar spinal fusion using the Diapason system.

    Science.gov (United States)

    Musha, Y; Okajima, Y; Motegi, M

    1995-01-01

    Lumbar spinal fusion with the Diapason system was performed on 58 patients at Toho University Ohmori Hospital from November 1991 to November 1994. The first 44 consecutive patients were followed for more than 1 year, including 34 cases with degenerative diseases. Those 34 cases consisted of 22 men and 12 women, ages 19-78 years (average 47.4), with 49 vertebral levels; these patients were followed for an average of 26.3 months. The clinical improvement and rate of bony union after 1 year of surgery were examined and the intervertebral angulatory motion degree of fused vertebrae was measured using a radiographic functional photo image during 1 year. We also performed an experimental study to evaluate the rigidity of this system. There were no severe complications. Although there was no instrument breakage or screw migration, two cases of rod migration were observed in L5-S1 arthrodesis. A mean improvement rate of 84.3% in the Japanese Orthopaedics Association (JOA) score was revealed. Thirty-three of 34 (97.1%) patients demonstrated successful arthrodesis after their initial procedure. In 10 segments (20.4%) 3-5 degrees of angulatory mobility were still retained, and no angulatory motion was observed in 27 segments (55.1%) 3 months after the surgery; however, no angulatory motion was observed in 44 segments (89.8%) 1 year after the surgery. In our biomechanical study, we observed that the anterior intervertebral space became narrow and mobile with loading, but when the loading was removed, the space reverted to the initial site. This movement was thought to be due to a certain elasticity in the rod and screw, and not loosening at the connection level. This system was evaluated based on the results of both clinical and biomechanical study. Notwithstanding the fact that this method has been evaluated as semirigid fusion, it does provide satisfactory bony union in posterolateral fusion, with excellent clinical results. PMID:7787346

  1. 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.

  2. Clinical study of CT discography for the lumbar disc herniation

    International Nuclear Information System (INIS)

    The purpose of this clinical study was to introduce technique for correct positioning of the needle into the center of the disc for discography by means of CT analysis and also to clarify usefulness of CT discography for diagnosis of the lumbar disc herniation. We have taken CT analysis in order to determine correct place and the angle of inserting the needle. This measurement provides easy needle insertion. Unless the needle tip places center of disc, discogram false positive or negative will occur as a result. The materials of this study are 222 discs of 105 cases with the lumbar disc herniation. Comparative study of the findings among myelography, discography and CT discography was investigated. The results indicated that CT discography demonstrates the most clear findings and is useful in the diagnosis of lumbar disc herniation, especially in obtaining detailed observation of herniated discs. (author)

  3. [Diagnostic value of saccoradiculography and scanner in lumbar stenoses].

    Science.gov (United States)

    Arrault, I; Benoist, M; Rocolle, J; Busson, J; Lassale, B; Deburge, A

    1987-10-01

    Radiculographic X-rays and CAT scans of 60 patients operated on for stenosis of the lumbar canal were analyzed separately and retrospectively by rheumatologists, a radiologist and surgeons working jointly, without knowledge of findings revealed by surgery. Comparison of findings with a detailed surgical report reveals that in the case of central lumbar canal stenosis, CAT scan provides a higher degree of reliability (72%) in diagnosis than does radiculography (56%). With lateral stenosis of the lateral cleft, reliability of both tests is identical (62%). The diagnostic deficiencies of these two examinations are discussed as well as diagnostic criteria employed and possible avenues of research. Currently, in the case of stenosis of the lumbar canal, it is still necessary to perform both of these examinations in combination and to accept the fact that, in certain cases, only one of the two tests reveals the stenosis, to be able to attain a preoperative rate of correct diagnosis greater than 80%. PMID:3423708

  4. Low back pain and lumbar angles in Turkish coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Sarikaya, S.; Ozdolap, S.; Gumustas, S.; Koc, U. [Zonguldak Karaelmas University, Zonguldak (Turkey). Faculty of Medicine

    2007-02-15

    This study was designed to assess the incidence of low back pain among Turkish coal miners and to investigate the relationship between angles of the lumbar spine and low back pain in coal miners. Fifty underground workers (Group I) and 38 age-matched surface workers (Group II) were included in the study. All the subjects were asked about low back pain in the past 5 years. The prevalence of low back pain was higher in Group I than in Group II (78.0%, 32.4%, respectively, P {lt} 0.001). The results of the study showed that low back pain occurred in 78.0% of Turkish coal miners. Although the nature of the occupation may have influenced coal miners' lumbar spinal curvature, lumbar angles are not a determinant for low back pain in this population. Further extensive studies involving ergonomic measurements are needed to validate our results for Turkish coal mining industry.

  5. 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)

  6. 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.

  7. [Management of deep wound infections in spinal lumbar fusions].

    Science.gov (United States)

    Falavigna, Asdrubal; Righesso Neto, Orlando; Fonseca, Gabriela Poglia; Nervo, Monique

    2006-12-01

    The rate of deep wound infections in spinal lumbar fusions is around 0.7% to 11.6%, being one of the causes of morbidity in acute phase. The aim of this study was to evaluate the management of spinal infection after internal lumbar fusions. Two hundred and sixty patients, who underwent to spinal surgery with lumbar fusion and iliac bone grafting, were analized, from January 1997 to January 2005. Wound infection was observed in eight (3%) cases. The average of age was 56 years, with a higher prevalence in males (5 patients). Most prevalent was Staphylococcus aureus in 6 patients. The treatment was done by intravenous antibiotic therapy folowed by oral therapy and local irrigation. The average time of hospitalization was 35.8 days. It was possible to erradicate infection without removal of instrumentation in all patients. PMID:17221012

  8. Clinical study of CT discography for the lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Sakamoto, Tadashi (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1990-08-01

    The purpose of this clinical study was to introduce technique for correct positioning of the needle into the center of the disc for discography by means of CT analysis and also to clarify usefulness of CT discography for diagnosis of the lumbar disc herniation. We have taken CT analysis in order to determine correct place and the angle of inserting the needle. This measurement provides easy needle insertion. Unless the needle tip places center of disc, discogram false positive or negative will occur as a result. The materials of this study are 222 discs of 105 cases with the lumbar disc herniation. Comparative study of the findings among myelography, discography and CT discography was investigated. The results indicated that CT discography demonstrates the most clear findings and is useful in the diagnosis of lumbar disc herniation, especially in obtaining detailed observation of herniated discs. (author).

  9. Mediciones del canal raquídeo lumbar del adulto cubano

    Directory of Open Access Journals (Sweden)

    Beatriz Expósito Rodríguez

    2002-12-01

    Full Text Available Se realizaron mediciones del canal raquídeo lumbar en estudios radiográficos simples de la columna lumbosacra en las vistas anteroposterior y lateral, en 200 adultos sin antecedentes de dolor y afección lumbar o ambos. Se utilizó la técnica recomendada por Eisenstein en 1976 para definir el margen posterior del canal. Se corroboró la importancia del diámetro sagital como parámetro esencial para determinar la estenosis del canal estando los límites de la normalidad entre 14,7 y 21 mm. Se establece como límite inferior de la distancia interpedicular 22,6 mm. El canal de las mujeres es menor que el de los hombres, y el canal de la raza negroide es menor al de la raza caucasiana y los mestizos en su diámetro sagital. Se recomienda este método con el fin de establecer un diagnóstico precoz de la estenosis del canal en el sector lumbar.Measurements of the lumbar spinal canal were made in simple radiographic studies of the lumbosacral column in the anteroposterior and lateral view in 200 adults with no antecedents of pain or lumbar affection. The technique recommended by Eisenstein in 1976 to define the posterior edge of the canal was used. The importance of the sagittal diameter as an essential parameter to determine the stenosis of the canal was corroborated. Normal limits are between 14.7 and 21 mm. An inferior limit of the interpedicular distance of 22.6 mm is established. The women's canal is smaller than that of men, whereas the canal of the black persons is lower than that of Caucasians and mestizos in its sagittal diameter. This method is recommended in order to made an early diagnosis of the stenosis of the canal in the lumbar sector.

  10. 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.

  11. Diagnostic accuracy of magnetic resonance imaging of lumbar disc herniation

    International Nuclear Information System (INIS)

    We studied the accuracy of MRI in lumbar disc herniation, comparing the results with the operative findings in the assessment of the rupture of the posterior longitudinal ligament (PLL), and type of herniation. The MRI findings in 47 subjects who were operated on for lumbar disc herniation were retrospectively studied. The accuracy rate was 75.2% for the rupture of the PLL and 40.4% for the type of herniation respectively. It was hard to differentiate subligamentous extrusion from transligamentous extrusion on MRI. (author)

  12. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)

    2006-09-15

    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.)

  13. Diagnostic accuracy of magnetic resonance imaging of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Takashi; Nakamura, Takafumi; Kikuchi, Taro; Watanabe, Hiroyuki; Takagi, Katsumasa; Yoshizumi, Kazuhiro; Katahira, Kazuhiro [Kumamoto Univ. (Japan). School of Medicine

    2000-03-01

    We studied the accuracy of MRI in lumbar disc herniation, comparing the results with the operative findings in the assessment of the rupture of the posterior longitudinal ligament (PLL), and type of herniation. The MRI findings in 47 subjects who were operated on for lumbar disc herniation were retrospectively studied. The accuracy rate was 75.2% for the rupture of the PLL and 40.4% for the type of herniation respectively. It was hard to differentiate subligamentous extrusion from transligamentous extrusion on MRI. (author)

  14. CT reconstruction technique in lumbar intraneuroforaminal disc herniation

    International Nuclear Information System (INIS)

    The CT appearance of the lumbar neural foramina and contents is described in detail and compared to histopathological specimens. Direct axial scans with secondary sagittal, coronal and paraxial reconstruction series of slices of the neuralforamen were derived from lumbar spine examination of fifty normal adults. These normal parameters were then used to evaluate and subdivide 20 patients with disc herniation involving the neuralforamen. The new paraxial reformation was able to show an intraneuroforaminal disc involvement. CT-reformation technique and operative results in intraneuroforaminal disc herniation correspond in 80%. This improvement in preoperative diagnosis demonstrates to the neurosurgeon the full extent of disc herniation and results in an optimized operative approach. (orig.)

  15. Predictions of the Length of Lumbar Puncture Needles

    OpenAIRE

    Hon-Ping Ma; Yun-Fei Hung; Shin-Han Tsai; Ju-chi Ou

    2014-01-01

    Introduction. The lumbar puncture is a well-known neurological procedure. The purpose of this study is to build an accurate mathematical formula to estimate the appropriate depth for inserting a lumbar puncture needle for a beginner. Methods. This is a retrospective study of patients who underwent magnetic resonance imaging (MRI) of the L-spine. The depth from the skin to the posterior and anterior margin of the spinal canal at the level of L4-L5 and L3-L4 interspaces of the spine was estimat...

  16. [Interspinous decompression as treatment for lumbar spinal stenosis].

    Science.gov (United States)

    Münnich, U; König, D P; Loch, Ch; Heyll, U

    2007-12-01

    Interspinous process distractors are an effective operative tool for treating patients with lumbar spinal stenosis. Lumbar stenosis with minor secondary instabilities due to degenerative changes in the segment can also be treated successfully with these devices. In case of failure, these devices can easily be revised or removed. As this operative procedure is not very time-consuming, it is a reasonable option for elderly patients with various medical problems and increased anaesthetic risk. There are reports of implanting these devices in certain cases under local anaesthetic. A prospective randomised trial has shown promising results for up to two years postoperatively. There are no long-term results available. PMID:18210989

  17. The “Reverse” Latissimus Dorsi Flap for Large Lower Lumbar Defect

    Science.gov (United States)

    Kotti, Bouraoui; Jaidane, Olfa; Ben Hassouna, Jamel; Rahal, Khaled

    2012-01-01

    The latissimus dorsi (LD) flap is one of the most common flaps used in plastic surgery based on its dominant thoracodorsal pedicle as well as free tissue transfer. The “distally based” or “reverse” fashion design has been used to repair myelomeningoceles, congenital diaphragmatic agenesis, or thoracolumbar defects. We present a case of a large lumbar defect after cancer resection covered by a combined tegument solution starring the “reverse” LD flap in its muscular version with a cutaneous gluteal flap. This flap is a safe and reliable way to cover large distal lumbar defect. PMID:23082273

  18. Lumbar periradicular abscess mimicking a fragmented lumbar disc herniation : an unusual case.

    Science.gov (United States)

    Bakar, Bulent; Tekkok, Ismail Hakki

    2008-12-01

    We herein describe the case of a focal spontaneous spinal epidural abscess who was initially diagnosed to have a free fragment of a lumbar disc. A 71-year-old woman presented with history of low back and right leg pain. Magnetic resonance imaging suggested a peripherally enhancing free fragment extending down from S1 nerve root axilla. Preoperative laboratory investigation showed elevation of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels. She was taken for surgery and a fluctuating mass at the axilla of S1 nerve was found. When the mass was probed with a dissector, a dark yellow, thick pus drained out. Pus cultures were negative. Patients who present with extreme low back plus leg pain and increased leucocyte count, ESR and CRP levels should raise the suspicion of an infection of a vertebral body or spinal epidural space. PMID:19137084

  19. 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.

  20. 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)

  1. 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.

  2. 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 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)

  3. Bilateral Locked Facets at Lower Lumbar Spine Without Facet Fracture: A Case Report

    OpenAIRE

    Im, Sang-Hyuk; Lee, Ki-Yeol; Bong, Ho-Jin; Park, Young-Sup; Kim, Jong-Tae

    2012-01-01

    Bilateral locked facets at L4-5 without facet fracture is a rarely known disease. We present a case of a 37-year-old male patient diagnosed as traumatic L4-5 bilateral facets dislocation without facet fracture. We carried out open reduction, epidural hematoma removal, posterior interbody fusion. After surgery, we attained rapid improvement of the neurologic deficits and competent stabilization.

  4. Microcirugía de disco lumbar en posición de decúbito lateral / Microsurgery of the lumbar disc in lateral position

    Scientific Electronic Library Online (English)

    Juan Manuel, Mejía Villela; Miguel Angel, Sánchez Vázquez; Hermilo, Hernández Estrada; Pablo, Barrera Calatayud; David Gibran, Mejía Amador.

    2004-09-01

    Full Text Available Se reporta una técnica para cirugía de disco lumbar con microscópio quirúrgico y con el paciente en posición de decúbito lateral, realizadas en el Hospital Regional Ignacio Zaragoza del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado ISSSTE en el periodo comprendido de ene [...] ro de 1990 a diciembre del 2003. En total fueron 263 microcirugías de disco lumbar y los resultados se clasificaron como bueno, regular, pobre y malo encontrando el 85 % de los pacientes con un resultado bueno, 10.2% de los pacientes con resultado regular y 4.8% con un resultado pobre. Se hace énfasis en los criterios de inclusión para la microcirugía de disco lumbar tomando en cuenta el aspecto psicológico y los reclamos por accidente de trabajo; así como las ventajas de la cirugía con microscópio quirúrgico ya que mejora la visualización, la descompresión y la mínima extracción de las laminas vertebrales, se presenta esta técnica como una opción satisfactoria para hernias de disco vírgenes en pacientes operados de columna lumbar por primera ocasión. Abstract in english A technique for surgery of the lumbar disc is reported, using the surgical microscope with the patient in lateral position. All patients where operated in the Hospital Regional Ignacio Zaragoza ISSSTE from january of 1990 to december of 2003. A total of 263 procedures for herniated disc where made. [...] The results where classified as good in 85 %, regular in 10.2%, poor in 4.8%. The criterion for the selection of the patients is emphatized as well the use of the surgical microscope which make a better visualization of the structures for removing the disc and decrease the ablations of the vertebral lamina. The technique is presented as a good option in patients for first operation of lumbar herniated disc.

  5. 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 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

  6. The Use of Lumbar Spine Magnetic Resonance Imaging in Eastern China: Appropriateness and Related Factors

    Science.gov (United States)

    Yu, Liedao; Wang, Xuanwei; Lin, Xiangjin; Wang, Yue

    2016-01-01

    Back pain is common and costly. While a general scene of back pain related practice in China remains unknown, there are signs of excessive use of lumbar spine magnetic resonance (MR). We retrospectively studied 3107 lumbar spine MRIs in Eastern China to investigate the appropriateness of lumbar spine MR use. Simple back pain is the most common chief complaint for ordering a lumbar MR study. Only 41.3% of lumbar spine MR studies identified some findings that may have potential clinical significance. Normal lumbar spine is the most common diagnosis (32.7%), followed by lumbar disc bulging and lumbar disc herniation. Walk difficulties, back injury and referred leg pain as chief complaints were associated with greater chance of detecting potentially clinically positive lumbar MR image findings, as compare with simple back pain. There was no difference in positive rates among orthopedic surgeon and specialists of other disciplines. Lumbar spine MR imaging was generally overused in Eastern China by various specialists, particularly at health assessment centers. For appropriate use of lumbar spine MR, orthopedic surgeons are no better than physicians of other disciplines. Professional training and clinical guidelines are needed to facilitate evidence-based back pain practice in China. PMID:26731106

  7. The morphology of lumbar sympathetic trunk in humans: a cadaveric study.

    Science.gov (United States)

    Gandhi, K R; Verma, V K; Chavan, S K; Joshi, S D; Joshi, S S

    2013-08-01

    The vasospastic diseases and chronic pain related to lower limb have been successfully treated by surgical ablation of lumbar sympathetic trunk for last 80 years.Precise knowledge of anatomy of lumbar sympathetic trunk and its adjoining structures is mandatory for safe and uncomplicated lumbar and spinal surgeries.We aim to study the detailed anatomy of entry and exit of lumbar sympathetic trunk, the number, dimensions and location of lumbar ganglia in relation to lumbar vertebra. Thorough dissection was carried out in 30 formalin embalmed cadavers available in the Department of Anatomy, Pravara Institute of Medical Sciences (PIMS), Rural Medical College (RMC), Loni, Maharashtra. A total of 238 ganglia were observed in 60 lumbar sympathetic trunks. The sympathetic trunk traversed dorsal to the crus of diaphragm in 72.6% and in 13.3% it entered dorsal to the medial arcuate ligament. The most common site of the location of lumbar ganglia was in relation to the second lumbar vertebra, sometimes extending up to the L2-L3 vertebral disc. There was a medial shift of sympathetic trunk in lumbar region and it coursed over sacral promontory to reach the pelvic region in 96% of specimens. These variations should be kept in mind in order to prevent hazardous complications like accidental avulsion of first lumbar ganglia and genitofemoral neuritis. PMID:24068683

  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. 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.

  10. 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.

  11. A method for quantitative measurement of lumbar intervertebral disc structures

    DEFF Research Database (Denmark)

    Tunset, Andreas; Kjær, Per; Samir Chreiteh, Shadi; Secher Jensen, Tue

    2013-01-01

    There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI...

  12. Ergonomic lumbar risk analysis of construction workers by NIOSH method

    Directory of Open Access Journals (Sweden)

    Cinara Caetano Pereira

    2015-09-01

    Full Text Available Work in construction has tasks directly connected with manual transport. One of the body segments suffering greater demand in works with these characteristics is the lumbar spine segment. The aim of this study was to analyze the level of risk of lumbar construction workers in the shipment of materials. The sample was composed of 74 construction workers. Were used as a research tool: the NIOSH method for lumbar risk verification expressed by weight limit recommended (WPR and the lifting Index (IL, Visual analogue scale (VAS for the evaluation of pain intensity, the e-1 Corlett.0 for the mapping of the pain and Borg to the subjective perception of the intensity of physical exertion. The present study identified the weight limit (WP of 8.707 for management activity of bags of cement for the load of 8.194 wheelbarrows used. These findings are 6 times under actual weights handled during the activities that revolve around 50 kg with the sacks and averaged 49.72 kg stands with mass. The dimensional settings found in the search are at high risk for ergonomic lumbar region, and measures of reconfiguration of workplaces and operation of auxiliary devices for lifting, transporting and unloading are fundamental, in addition to the need for reflection about the current logistical problems that induce producers to supply the cement sacks with 50 kg.

  13. Surgical treatment in thoraco-lumbar region fractures.

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Jerez Labrada

    2008-08-01

    Full Text Available Background: thoraco-lumbar fractures may affect people at any moment of their lives, especially at their most fruitful and useful stage. Its correct diagnosis and treatment may directly influence in the posterior evolution of the patients. Objectives: to evaluate the results of the surgical treatment in thoraco-lumbar region fractures. Methods: a descriptive retrospective correlational study of series cases which included 54 patients attended due to thoraco-lumbar region fractures in the University Hospital “Dr. Gustavo Aldereguía Lima” in Cienfuegos city, Cuba from January 1999 to June 2007. Age, sex, etiology of the fracture, type and level of the fractures, associated diseases, surgical techniques used for, pre and post operatory neurological damage, usage of metilprednisolone, complications and final results were the variables taken into consideration in this study. Results: most of the patients belonged to male sex under the age of 45. The totality of the cases had type IV fracture, and a great part of them had Denis type II fracture having surgical treatment. The causes of the lesions were traffic accidents, working accidents and height falls. The most useful surgical techniques were posterior decompression, instrumentation and fusion. Surgery improved the neurological damage in almost half of sick patients with this condition. Complications were minimum and rupture of the implant was predominant. Conclusion: surgical treatment in thoraco-lumbar region fractures had satisfactory results in our milieu.

  14. Lumbar spinal mobility changes among adults with advancing age

    Directory of Open Access Journals (Sweden)

    Ismaila Adamu Saidu

    2011-01-01

    Conclusion : Using these data, we developed normative values of spinal mobility for each sex and age group. This study helps the clinicians to understand and correlate the restrictions of lumbar spinal mobility due to age and differentiate the limitations due to disease.

  15. The effect of breast shielding during lumbar spine radiography

    International Nuclear Information System (INIS)

    The aim of the study was to determine the influence of lead shielding on the dose to female breasts in conventional x-ray lumbar spine imaging. The correlation between the body mass index and the dose received by the breast was also investigated. Breast surface dose was measured by thermoluminescent dosimeters (TLD). In the first phase measurements of breast dose with and without shielding from lumbar spine imaging in two projections were conducted on an anthropomorphic phantom. In the second stage measurements were performed on 100 female patients, randomly divided into two groups of 50, with breast shielding only used in one group. On average, breast exposure dose in lumbar spine imaging in both projections (anteroposterior (AP) and lateral) was found reduced by approximately 80% (p < 0,001) when shielding with 0.5 mm lead equivalent was used (from 0.45±0.25 mGy to 0.09±0.07 mGy on the right and from 0.26±0.14 mGy to 0.06±0.04 mGy on the left breast). No correlation between the body mass index (BMI) and the breast surface radiation dose was observed. Although during the lumbar spine imaging breasts receive low-dose exposure even when shielding is not used, the dose can be reduced up to 80% by breast shielding with no influence on the image quality

  16. Interlaminar discectomy and selective foraminotomy in lumbar disc herniation.

    Directory of Open Access Journals (Sweden)

    Garg M

    2001-12-01

    Full Text Available Our objective was to assess the clinical outcome of interlaminar discectomy in patients suffering with degenerated lumbar disc lesions. We made a prospective study of 50 consecutive patients who underwent limited lumbar discectomy. The clinico-radiological parameters, type of surgery performed and the post-operative follow up were assessed. We found that interlaminar discectomy without laminotomy was adequate in 33 cases (66%. Most patients requiring laminotomy (17 cases -34% for discectomy had associated lumbar canal stenosis, herniation at proximal levels (L3-4 and/or sacralization of L5 vertebra. Selective foraminotomy in addition to discectomy was performed in 28 cases (56%. The post-operative results were good in 43 (86%fair in 6 (12% and poor subjective in 1 case (2%. No patient was classified as poor objective. In conclusion, interlaminar discectomy without laminotomy is a safe, effective and reliable surgical technique for treating properly selected patients with herniated lumbar disc at L4-5 and L5-S1 levels.

  17. 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 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.)

  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. 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.

  20. Diagnostic challenge: bilateral infected lumbar facet cysts - a rare cause of acute lumbar spinal stenosis and back pain

    Directory of Open Access Journals (Sweden)

    Yoon S Timothy

    2010-03-01

    Full Text Available Abstract Symptomatic synovial lumbar facet cysts are a relatively rare cause of radiculopathy and spinal stenosis. This case and brief review of the literature, details a patient who presented with acutely symptomatic bilateral spontaneously infected synovial facet (L4/5 cysts. This report highlights diagnostic clues for identifying infection of a facet cyst.

  1. 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 %

  2. Medline Plus

    Full Text Available ... Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson University Hospital, Philadelphia, PA, 11/15/2006) ... of-the-Art Hip Surgeries for Active Adults (Thomas Jefferson University Hospital, Philadelphia, PA, 9/24/2008) ...

  3. Regional differences in lumbar spinal posture and the influence of low back pain

    Directory of Open Access Journals (Sweden)

    Burnett Angus F

    2008-11-01

    Full Text Available Abstract Background Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. Methods One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx, Upper lumbar (ULx and total lumbar (TLx spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. Results Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638, but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p Conclusion This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

  4. 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.

  5. 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

  6. 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)

  7. Ultrasound guided, painful electrical stimulation of lumbar facet joint structures

    DEFF Research Database (Denmark)

    O'Neill, Søren; Graven-Nielsen, Thomas; Manniche, Claus; Arendt-Nielsen, Lars

    of acute low back pain using a new experimental model of lumbar facet joint pain. Thirteen healthy volunteers were included and baseline pressure pain thresholds were assessed at eight separate sites, outside the area of evoked low back and referred pain. Using ultrasonography, two electrode needles...... were placed either side of a lumbar facet joint (right L3-4) and used to induce experimental low back pain for 10 min with continuous stimulation. Thresholds, stimulus-response relationships, distribution and quality of the electrically induced pain were recorded. Electrical facet joint stimulation...... induced low back pain and pain referral into the anterior leg, ipsilaterally, proximal to the knee, similar to what is observed clinically. Pressure pain thresholds did not change significantly before, during and after facet joint stimulation. In conclusion, we describe a novel model of acute experimental...

  8. 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

  9. Evaluation of usefulness of bone SPECT for lumbar spondylolysis

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the usefulness of 99mTc-MDP SPECT (bone SPECT) for lumbar spondylolysis. We analyzed 11 cases with 17 lesions. All cases were compared using plain radiography, computed tomography (CT), planar bone scintigraphy (PBS), and bone SPECT. Four lesions that showed a wide defect on CT were negative on bone SPECT and may have been chronic lesions. Thirteen lesions that were positive on bone SPECT were narrow or showed no defect on CT and may have been early lesions. Two cases showed no defect on CT but were positive on bone SPECT, and one of them progressed to bilateral spondylolysis after one year. This may have been a very early lesion. Thus bone SPECT is useful for the diagnosis of lumbar spondylolysis, especially in its early stage. (author)

  10. [Minimally invasive surgery in treatment of lumbar intervertebral disc herniation].

    Science.gov (United States)

    Rotim, Krešimir; Sajko, Tomislav; Bori?, Marta; Subaši?, Ante

    2015-01-01

    Surgical treatment of lumbar intervertebral disc herniation is one of the most common neurosurgical procedures. Besides conventional surgical techniques, in the last more than 30 years, different methods with minimal damage to neuromuscular spine structures are being developed and introduced, all having the purpose of reducing postoperative back pain. The advantages of the minimally invasive spine surgery include: possibility of performing procedures under local anaesthesia, reduced hospital stay, limited blood loss with consecutively reduced fibrous tissue development. Patients are capable of return to work and everyday activities early after surgery. From the economical point of view, this kind of treatment is considered to be a cost-effective intervention. Three methods that are being used for treatment of lumbar intervertebral disc herniation are: percutaneous laser disc decompression (PLDD), microdiscectomy using tubular retractor system and selective endoscopic discectomy (SED). Conducted prospective studies have shown that minimally invasive methods are adequate alternative to classic surgical procedures. PMID:26065287

  11. Congenital malformation of fifth lumbar vertebra: A case report

    Directory of Open Access Journals (Sweden)

    Jugesh Khanna

    2013-04-01

    Full Text Available Fifth lumbar vertebra is an atypical vertebra as it has widely separated inferior articular processes and thick transverse processes projecting out from the body and pedicles of the vertebra. On routine examination of osteology specimens we found a fifth lumbar vertebra in two separate parts. One part consisted of body, pedicles, transverse and superior articular processes. The other part consisted of lamina, spinous and inferior articular processes. Knowledge of this variation may be of importance to the clinicians for diagnosis of certain neurological deficits in the lower limb and to orthopaedic surgeons and neurosurgeons during the surgical intervention of that area. [Int J Res Med Sci 2013; 1(2.000: 153-155

  12. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Seung Eun; Lee, Sang Ho; Jo, Byung June; Yoon, Deug Hee; Paeng, Sung Suk [Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Inje University College of Medicine, Seoul (Korea, Republic of)

    2005-10-15

    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.

  14. Paraplegia by Acute Cervical Disc Protrusion after Lumbar Spine Surgery.

    Directory of Open Access Journals (Sweden)

    Sheng-Huan Chen

    2005-04-01

    Full Text Available Non-traumatic paraplegia caused by herniation of the cervical intervertebral disc is anuncommon postoperative complication. A patient with claudication and radiculopathy wasscheduled for lumbar laminectomy due to spinal stenosis. Postoperatively, numbness belowT6 was found in his both legs of the patient. MRI showed a protruded intervertebral discbetween C6 and C7. Despite urgent disectomy, the patient's lower extremities remained paralyzedwithout significant improvement for 3 months. Loss of muscle support during generalanesthesia, excessive neck extension during endotracheal intubation and positioning, as wellas bucking and agitation are believed as triggering factors for the protrusion of the cervicaldisc. We suggest that a complete history taking and physical examination be accomplishedin patients scheduled for lumbar spine surgery in order to exclude coexisting cervical spinedisorders. In addition, skillful endotracheal intubation and careful neck positioning aremandatory for patients receiving surgery in the prone position.

  15. Massive Pulmonary Embolism after Lumbar Spinal Fusion Surgery

    Directory of Open Access Journals (Sweden)

    Ezgi Akar

    2014-12-01

    Full Text Available Pulmonary embolism (PE is a rare complication that may result in death after lumbar spinal fusion surgery. Although pulmonary embolism mortality rates decreased with early diagnosis and treatment, delays in the diagnosis of pulmonary embolism is commonly seen even with advanced diagnostic methods. Even though it is rare, the risk of pulmonary embolism as well as thrombophlebitis and deep vein thrombosis are encountered in patients undergoing spinal surgery. In this case presentation, we discussed the case of pulmonary embolism determined in a young patient developing unconsciousness and then cardiopulmonary arrest following mobilization at the postoperative 12th hour after a lumbar spinal fusion surgery and determined to have severe right ventricular enlargement, leftward deviation of the interatrial septum, severe tricuspid failure at the bedside echocardiography and who was discharged after thrombolytic therapy.

  16. 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.

  17. Natural history of symptomatic lumbar disk herniation controlled by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Komori, Hiromichi; Yamaura, Isakichi; Kurosa, Yoshiro; Yoshida, Hirotoshi (Toride Kyodo General Hospital, Ibaraki (Japan)); Nakai, Osamu

    1994-04-01

    The purpose of this study was to compare changes in clinical symptoms and sequential findings of magnetic resonance imaging (MRI) in 66 patients managed with conservative treatment for lumbar disc herniation. In all but 12 patients, there was a good correlation between leg pain and MRI findings, although findings of MRI tended to slightly follow symptom improvement. A notable reduction of herniated mass was seen in a high frequency in sequentrated herniation from an extremely degenerated lumbar disk. The greater the degree of sequentration, the greater the reduction of herniated mass. A shorter duration of leg pain was significantly associated with greater reduction of the herniated mass; leg pain disappeared within 2 months when the herniated mass disappeared on MRI. Because herniated mass disappeared within a short period of time, the involvement of immune reaction was suggested, as well as the possibility of sequentration, degeneration, and phagocytosis. (N.K.).

  18. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Paek, Chung Ho; Kwon, Soon Tae; Lee, Jun Kyu; Ahn, Jae Sung; Lee, Hwan Do; Chung, Yon Su; Jeong, Ki Ho; Cho, Jun Sik [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1999-04-01

    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 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.

  20. Treatment of lumbar disc herniation: Evidence-based practice

    OpenAIRE

    Schoenfeld, Andrew J; Weiner, Bradley K.

    2010-01-01

    Andrew J Schoenfeld1, Bradley K Weiner21Department of Orthopedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA; 2Weill Cornell Medical College and The Methodist Hospital, Houston, TX, USAClinical question: What is the best treatment for lumbar disc herniations? Results: For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate tre...

  1. Lumbar gibbus in storage diseases and bone dysplasias

    Energy Technology Data Exchange (ETDEWEB)

    Levin, T.L. [Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Berdon, W.E. [Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Lachman, R.S. [International Skeletal Dysplasia Registry, Los Angeles, CA (United States); Anyane-Yeboa, K. [Department of Pediatrics, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Ruzal-Shapiro, C. [Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States); Roye, D.P. Jr. [Department of Orthopedic Surgery, Columbia-Presbyterian Medical Center, Babies and Children`s Hospital of New York, NY (United States)

    1997-04-01

    Objective. The objective of this study was to review the problem of lumbar gibbus in children with storage diseases and bone dysplasias utilizing plain films and MR imaging. Materials and methods. Clinical histories and radiographic images in five patients with storage diseases [four mucopolysaccharidosis (MPS) and one mucolipidosis] and two with achondroplasia were reviewed. The International Skeletal Dysplasia Registry (Los Angeles, Calif.), surveyed for all patients with lumbar gibbus and skeletal dysplasias, provided 12 additional cases. Results. All patients had localized gibbus of the upper lumbar spine, characterized by anterior wedging and posterior displacement of the vertebrae at the apex of the curve, producing a beaked appearance. The curve, exaggerated in the sitting or standing position, was most severe in the two patients with MPS-IV (one of whom died). Both developed severe neurologic signs and symptoms requiring surgical intervention. In four patients, MR images demonstrated the apex of the curve to be at or below the conus. Two patients demonstrated anterior herniation of the intervertebral discs at the apex of the curve, though the signal intensity of the intervertebral discs was normal. Conclusion. Lumbar gibbus has important neurologic and orthopedic implications, and is most severe in patients with MPS. The etiology of the gibbus with vertebral beaking is multifactorial and includes poor truncal muscle tone, weight-bearing forces, growth disturbance and anterior disc herniation. The curve is generally at or below the conus. Neurologic complications are unusual, although orthopedic problems can arise. Due to their longer survival, patients with achondroplasia or Morquio`s disease are more vulnerable to eventual gibbus-related musculoskeletal complications. (orig.). With 6 figs., 2 tabs.

  2. 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...

  3. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

    OpenAIRE

    Yoshinori Kadono; Takamichi Yuguchi; Yu-ichiro Ohnishi; Koichi Iwatsuki; Toshiki Yoshimine

    2015-01-01

    Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography mye...

  4. Predictors of vocational prognosis after herniated lumbar disc

    DEFF Research Database (Denmark)

    Jensen, Lone Donbaek; Frost, Poul; Schiøttz-Christensen, Berit; Maribo, Thomas; Christensen, Michael Victor; Svendsen, Susanne Wulff

    2011-01-01

    STUDY DESIGN: A register study with 2 years of follow up. OBJECTIVE: To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). SUMMARY OF BACKGROUND DATA: There is sparse information about vocational prognosis among HLD patients diagnosed at hospital. METHODS: We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfe...

  5. Predictors of vocational prognosis after herniated lumbar disc

    DEFF Research Database (Denmark)

    Jensen, Lone Donbæk; Frost, Poul; Schiøttz-Christensen, Berit; Maribo, Thomas; Christensen, Michael Victor; Svendsen, Susanne Wulff

    2011-01-01

    Study Design. A register study with 2 years of follow up. Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnosed at hospital. Methods. We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfe...

  6. Inter-examiner reproducibility of tests for lumbar motor control

    DEFF Research Database (Denmark)

    Enoch, Flemming; Kjaer, Per; Elkjaer, Arne; Remvig, Lars; Juul-Kristensen, Birgit

    2011-01-01

    Many studies show a relation between reduced lumbar motor control (LMC) and low back pain (LBP). However, test circumstances vary and during test performance, subjects may change position. In other words, the reliability--i.e. reproducibility and validity--of tests for LMC should be based on quantitative data. This has not been considered before. The aim was to analyse the reproducibility of five different quantitative tests for LMC commonly used in daily clinical practice.

  7. Blood-pool scintigraphic diagnosis of fractured lumbar vertebral hemangioma

    International Nuclear Information System (INIS)

    A 57-year-old woman complained of lumbago of 1 year's duration. Radiographs showed a compression fracture of the third lumbar vertebra. CT and MR images revealed an enhancing mass confined to the vertebral body suggestive of a malignant process. A blood-pool scintigram with 99mTc-human serum albumin combined with DTPA (HSA-D) revealed marked accumulation. This strongly suggested a hemangioma, which was confirmed by biopsy. (orig.)

  8. Blood-pool scintigraphic diagnosis of fractured lumbar vertebral hemangioma

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, H.; Ueda, Takuya [Department of Radiology, Numazu City Hospital, Shizuoka (Japan); Masuda, Sumio [Orthopedic Surgery, Numazu City Hospital, Shizuoka (Japan); Nosaka, Kenji [Dept. of Pathology, Numazu City Hospital, Shizuoka (Japan)

    2001-04-01

    A 57-year-old woman complained of lumbago of 1 year's duration. Radiographs showed a compression fracture of the third lumbar vertebra. CT and MR images revealed an enhancing mass confined to the vertebral body suggestive of a malignant process. A blood-pool scintigram with {sup 99m}Tc-human serum albumin combined with DTPA (HSA-D) revealed marked accumulation. This strongly suggested a hemangioma, which was confirmed by biopsy. (orig.)

  9. 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 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

  10. 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)

  11. Early Versus Late Initiation of Rehabilitation After Lumbar Spinal Fusion

    DEFF Research Database (Denmark)

    Oestergaard, Lisa G; Christensen, Finn B; Nielsen, Claus V; Bünger, Cody; Fruensgaard, Soeren; Sogaard, Rikke

    2013-01-01

    Study Design. Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up.Objective. To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery.Summary of Background Data. In a previously reported randomised controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendation...

  12. Trabecular bone density of male human cervical and lumbar vertebrae.

    Science.gov (United States)

    Yoganandan, Narayan; Pintar, Frank A; Stemper, Brian D; Baisden, Jamie L; Aktay, Recyi; Shender, Barry S; Paskoff, Glenn; Laud, Purushottam

    2006-08-01

    The objective of this study was to determine the bone mineral density (BMD) of cervical vertebrae and correlate with the lumbar spine. Fifty-seven young adult healthy male volunteers, ranging from 18 to 41 years of age, underwent quantitative computed tomography (QCT) scanning of C2-T1 and L2-L4 vertebrae. To account for correlations, repeated measures techniques were used to compare data as a function of spinal level and region. Linear regression methods were used (+/-95% CI) to compare data as a function of spinal level and region. The mean age and body height were 25.0 +/- 5.8 years and 181.0 +/- 7.6 cm. BMD decreased from the rostral to caudal direction along the spinal column. Grouped data indicated that the neck is the densest followed by the first thoracic vertebra and low back with mean BMD of 256.0 +/- 48.1, 194.3 +/- 44.2, and 172.2 +/- 28.4 mg/cm(3), respectively; differences were statistically significant. While BMD did not vary significantly between the three lumbar bodies, neck vertebrae demonstrated significant trends. The matrix of correlation coefficients between BMD and spinal level indicated that the relationship is strong in the lumbar (r = 0.92-0.96) and cervical (r = 0.73-0.92) spines. Data from the present study show that the trabecular bony architecture of the neck is significantly different from the low back. These quantitative BMD data from a controlled young adult healthy human male volunteer population may be valuable in establishing normative data specifically for the neck. From a trabecular bone density perspective, these results indicate that lumbar vertebrae cannot act as the best surrogates for neck vertebrae. Significant variations in densities among neck vertebrae, unlike the low back counterpart, may underscore the need to treat these bones as different structures. PMID:16580272

  13. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation

    OpenAIRE

    Tatsuro Sasaji; Kiyoshi Horaguchi; Noboru Yamada; Kazuo Iwai

    2012-01-01

    Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral du...

  14. Musculoskeletal simulations to investigate the influence of vertebral geometrical parameters on lumbar spine loading

    DEFF Research Database (Denmark)

    Putzer, Michael; Rasmussen, John; Penzkofer, Rainer; Ehrlich, Ingo; Gebbeken, Norbert; Dendorfer, Sebastian

    2014-01-01

    Musculoskeletal simulations of subject-specific loads in the lumbar spine are computed by using subject-specific geometrical data. However this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilizing the AnyBody Modeling System and a parameterized musculoskeletal lumbar spine model for four different postures: upright standing, flexion (50°), torsion (10°) and lateral bending (15°). The linear dimensions of the verte...

  15. Paraplegia due to Missed Thoracic Meningioma after Laminotomy for Lumbar Spinal Stenosis: Report of Two Cases

    OpenAIRE

    Ko, Sang-Bong; Lee, Sang-wook; SHIM Jung-Hyun

    2011-01-01

    To describe two cases of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery for lumbar canal stenosis and a complaint of claudication. The follow-up period ranged from 1 year and 6 months to 1 year and 8 months. The neurological deficit due to thoracic meningioma after surgery for lumbar canal stensois was decreased after mass excision. So, careful physical examination and magnetic resonance imaging can reveal ...

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

    OpenAIRE

    Mustafa GURELIK; Cemal BOZKINA; Zafer KARS; Ozen KARADAG; Ozum, Unal; Fatih BAYRAKLI

    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...

  17. Outcomes and Complications of the Midline Anterior Approach 3 Years after Lumbar Spine Surgery

    OpenAIRE

    Fischer, Charla R.; Braaksma, Brian; Peters, Austin; Weinreb, Jeffrey H.; Nalbandian, Matthew; Spivak, Jeffrey M.; Petrizzo, Anthony

    2014-01-01

    Objective. The purpose of this study was to evaluate a new questionnaire to assess outcomes related to the midline anterior lumbar approach and to identify risk factors for negative patient responses. Methods. A retrospective review of 58 patients who underwent anterior lumbar surgery at a single institution for either degenerative disc disease or spondylolisthesis in 2009 was performed. The outcome measures included our newly developed Anterior Lumbar Surgery Questionnaire (ALSQ), ODI, and E...

  18. Spondylodiscitis after lumbar microdiscectomy: effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases

    OpenAIRE

    DUCATI, Alessandro

    2005-01-01

    The role of antibiotic prophylaxis in preventing postoperative lumbar spondylodiscitis is still controversial in medical, ethical, economic, and legal terms. The aim of this retrospective study was to evaluate the efficacy of two intraoperative antibiotic prophylaxis protocols in a large series of lumbar microdiscectomies performed in two different neurosurgical centres. We reviewed the outcome of 1167 patients operated on for a lumbar disc herniation with microsurgical technique, in order to...

  19. Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies

    OpenAIRE

    Huang, Jen-Ting; Chen, Han-Yu; Hong, Chang-Zern; Lin, Ming-Ta; Chou, Li-Wei; Chen, Hsin-Shui; Tsai, Chien-Tsung; Chang, Wen-Dien

    2014-01-01

    Background and aims The aim of this study was to demonstrate the effectiveness of lumbar facet joint injection for piriformis myofascial pain syndrome. Methods Fifty-two patients with chronic myofascial pain in the piriformis muscle each received a lumbar facet injection into the ipsilateral L5–S1 facet joint region, using the multiple insertion technique. Subjective pain intensity, trunk extension range, and lumbar facet signs were measured before, immediately after, and 2 weeks after inject...

  20. The Effect of Early Initiation of Rehabilitation after Lumbar Spinal Fusion

    DEFF Research Database (Denmark)

    Oestergaard, Lisa G; Nielsen, Claus Vinther; Bünger, Cody; Søgaard, Rikke; Fruensgaard, Soeren; Helmig, Peter; Christensen, Finn Bjarke

    2012-01-01

    ABSTRACT: Study design: A multicenter RCT including 82 patients.Objective: To examine the effect of early initiation of rehabilitation after instrumented lumbar spinal fusion.Summary of Background Data: Lumbar spinal fusion has been performed for more than 70 years. Yet, only few studies have examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients.Methods: Patients with degenerative disc dise...

  1. MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases

    OpenAIRE

    Sakai, Toshinori; Sairyo, Koichi; Bhatia, Nitin N.; Miyagi, Ryo; Tamura, Tatsuya; Katoh, Shinsuke; Yasui, Natsuo

    2011-01-01

    Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scan...

  2. MR imaging findings of ring apophyseal fractures in lumbar vertebrae

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yong Soo; Kwon, Soon Tae; Song, Chang Joon; Lee, Young Hwan; Kim, Hyoung Seob; Lee, Hwan Do; Cho, June Sik; Ahn, Jae Sung; Lee, June Kyu [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1997-07-01

    To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7%. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery.

  3. A case of lumbar pain after intraoperative radiotherapy

    International Nuclear Information System (INIS)

    We report a case of abnormal magnetic resonance imaging (MRI) findings after intraoperative radiotherapy. A 53-year-old woman with cancer of the papilla of Vater was treated with pancreatoduodenectomy and 20 Gy of intraoperative radiotherapy by electron beam to the tumor bed. Three months later the patient complained of lumbar pain. A change of signal intensity on MRI was detected in the anterior half of the vertebral body within the irradiated field. The signal was of high intensity but was not enhanced by Gd-DTPA on T1-weighted images, was isointense on T2-weighted images and of low intensity with the fat-suppression method. The radiation dose to the lumbar spine and the surrounding soft tissue was calculated to be 16 Gy. Histologic changes in bone after irradiation may include depletion of bone marrow cells and fat degeneration. The MRI findings were compatible with these changes. The radiation dose that can be tolerated by soft tissue is lower than that tolerated by bone. Therefore, late radiation injury of the soft tissue might have been the cause of the patient's lumbar pain. (author)

  4. A radiological study on lumbar herniated intervertebral disc diseases

    International Nuclear Information System (INIS)

    During 5 years and 8 months, from September 1968 to May 1974, myelographic studies followed by operation were carried out on 118 cases of lumbar HIVD at Seoul National University Hospital. The myelographic findings and operative findings were analyzed and following conclusions were obtained. 1. The sex ratio wa 75 males to 43 females. 2. Among the 118 cases, myelographic findings were consisted of the unilateral defect; 78 cases (67.0%), central defect: 30 cases (25.5%), and, bilateral defects; 10 cases (8.5%) respectively. 3. Among the 118 cases, the greatest incidence was L4-L5 disc space: 87 cases (73.7%) and next incidence was L5-S1 disc space: 25 cases (21.2%). 4. Among the 118 cases of lumbar herniated intervertebral disc disease, the false positive was 8 cases (6.8%) and diagnostic accuracy of myelography was 91.5%. 5. Plain radiography has little value in diagnosis of lumbar herniated intervertebral disc disease among 118 cases, about 30% show significant sign in plain film study

  5. 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.

  6. Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult.

    Science.gov (United States)

    Yoon, Kyeong-Wook; Kim, Young-Jin

    2015-04-01

    Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A 53-year-old male who had no significant medical history was admitted due to complaints of back pain radiating to the flank for the last 3 months, followed by a progressive motor weakness of both lower limbs. Lumbar magnetic resonance imaging (MRI) demonstrated osteomyelitis and diskitis, suspected to be a pyogenic condition rather than a tuberculosis infection. Despite antibiotic treatment for several weeks, the symptoms worsened, and finally, open surgery was performed. Surgical biopsy revealed an Aspergillus infection and medical treatment with amphotericin B was started. It can be diagnosed early through an MRI; biopsy is very important but difficult, and making the correct differential diagnosis is essential for avoiding unexpected complications. The authors report a case of lumbar Aspergillus osteomyelitis in an immunocompetent adult and reviewed previously described cases of spinal aspergillosis. PMID:25221965

  7. Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias

    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.

  8. Magnetic resonance imaging (MRI) anatomy of the ovine lumbar spine.

    Science.gov (United States)

    Nisolle, J F; Wang, X Q; Squélart, M; Hontoir, F; Kirschvink, N; Clegg, P; Vandeweerd, J M

    2014-06-01

    Although the ovine spine is a useful research model for intervertebral disc pathology and vertebral surgery, there is little peer-reviewed information regarding the MRI anatomy of the ovine spine. To describe the lumbar spine MRI anatomy, 10 lumbar segments of cadaver ewes were imaged by 1.5-Tesla MR. Sagittal and transverse sequences were performed in T1 and T2 weighting (T1W, T2W), and the images were compared to gross anatomic sagittal and transverse sections performed through frozen spines. MRI was able to define most anatomic structures of the ovine spine in a similar way as can be imaged in humans. In both T1W and T2W, the signals of ovine IVDs were similar to those observed in humans. Salient anatomic features were identified: (1) a 2- to 3-mm linear zone of hypersignal was noticed on both extremities of the vertebral body parallel to the vertebral plates in sagittal planes; (2) the tendon of the crura of the diaphragm appeared as a hypointense circular structure between hypaxial muscles and the aorta and caudal vena cava; (3) dorsal and ventral longitudinal ligaments and ligamentum flavum were poorly imaged; (4) no ilio-lumbar ligament was present; (5) the spinal cord ended between S1-S2 level, and the peripheral white matter and central grey matter were easily distinguished on T1W and T2W images. This study provides useful reference images to researchers working with ovine models. PMID:23668479

  9. Abnormal Lumbar Magnetic Resonance Imaging in Asymptomatic Individuals

    Directory of Open Access Journals (Sweden)

    Filiz Acar Sivas

    2009-06-01

    Full Text Available Objective: The aim of this study was to evaluate the abnormal findings on Magnetic Resonance Imaging (MRI of lumbar spine in asymptomatic subjects. Materials and Methods: The study included 48 asymptomatic individuals and 27 patients who had already been suffering from low back pain. All participants underwent routine blood analyses and bilateral lumbosacral roentgenograms were taken. In all participants, lumbar MRI scans were performed through L1-S1 intervertebral disc spaces.Results: The mean age of asymptomatic individuals was 25.5±3.5 years, while of the patient group it was 26±2.9 years. In asymptomatic individuals, after lumbar MRI, disc degeneration in at least one intervertebral disc level, annular tear, endplate abnormality, disc bulging, and disc protrusion were detected in 33.3%, 16.6%, 4.16%, 6.25%, and 27% of cases, respectively. When compared with the patient group, only the difference in the disc bulging ratio (25.92% was significantly higher (p<0.05. Conclusion: MRI may reveal high rates of abnormal signs in asymptomatic individuals who do not suffer from low back pain. The present authors believe that ordering this scan on patients who suffer from low back pain but not planned to undergo surgery will unnecessarily increase health care expenses. Turk J Phys Med Rehab 2009;55:73-7.

  10. 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.

  11. 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.

  12. Lumbar CT findings of patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang [Chung-Ang University, Seoul (Korea, Republic of)

    1986-04-15

    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.

  13. Interlaminar fenestration in lumbar canal stenosis- a retrospective study

    Directory of Open Access Journals (Sweden)

    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.

  14. The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    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.

  15. 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.

  16. Access related complications during anterior exposure of the lumbar spine

    Directory of Open Access Journals (Sweden)

    Gary A Fantini

    2013-01-01

    Full Text Available The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation (non-fusion technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimally invasive surgical therapies of the lumbar spine. While injury to the major vascular structures remains the most serious and feared complication of the anterior approach, this occurrence has been nearly eliminated by the use of lateral based approaches for discectomy and fusion cephalad to L5-S1. Whether anterior or lateral based, non-posterior approaches to the lumbar spine share certain access related pitfalls and complications, including damage to the urologic and neurologic structures, as well as gastrointestinal and abdominal wall issues. This review will focus on the recognition, management and prevention of these anterior and lateral access related complications.

  17. 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.

  18. 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.

  19. Treatment of lumbar disc herniation by percutaneous laser disc decompression (PLDD) and modified PLDD

    Science.gov (United States)

    Chi, Xiao fei; Li, Hong zhi; Wu, Ru zhou; Sui, Yun xian

    2005-07-01

    Objective: To study the micro-invasive operative method and to compare the effect of treatment of PLDD and modified PLDD for Lumbar Disc Herniation. Method: Vaporized part of the nucleus pulposus in single or multiple point after acupuncture into lumbar disc, to reach the purpose of the decompression of the lumbar disc. Result: Among the 19 cases of the regular PLDD group, the excellent and good rate was 63.2%, and among the 40 cases of the modified PLDD group, the excellent and good rate was 82.5%. Conclusion: The modified PLDD has good effect on the treatment for lumbar disc herniation.

  20. Anatomical variations of lumbar arteries and their clinical implications: a cadaveric study.

    Science.gov (United States)

    Karunanayake, Aranjan Lionel; Pathmeswaran, Arunasalam

    2013-01-01

    Lumbar arteries arise from the abdominal aorta. Some abdominal and spinal surgeries can damage these arteries, and that can lead to serious consequences. This study aimed at studying the types and frequencies of variations of lumbar vasculature. We dissected both sides of 109 adult human cadavers and studied the variations of lumbar vasculature. Age range was 43-90?years. Fifty-seven percent were males and 43% were females. The number of lumbar arteries arising from either side of the abdominal aorta varied between 3 and 5 pairs. The lumbar arteries arose from a common single stem in 12% of the cadavers. The third and fourth pairs of lumbar arteries arose from a common single stem in 3% and 11% of cadavers, respectively, and the first and second pairs of lumbar arteries arose from a common single stem in 1% and 2% of cadavers, respectively. The first and second lumbar arteries on the right side traveled anterior to the right crus of the diaphragm in 7% and 8% of cadavers, respectively. There were several variations with regard to the number, origin from the abdominal aorta, and pathway of lumbar arteries from what is described in the literature. PMID:25938093

  1. 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).

  2. Dolor lumbar por estreptoquinasa recombinante: Presentación de un caso Lumbar pain caused by recombinant streptokinase: A case presentation

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    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.

  3. Pig lumbar spine anatomy and imaging-guided lateral lumbar puncture: a new large animal model for intrathecal drug delivery.

    Science.gov (United States)

    Pleticha, Josef; Maus, Timothy P; Jeng-Singh, Christian; Marsh, Michael P; Al-Saiegh, Fadi; Christner, Jodie A; Lee, Kendall H; Beutler, Andreas S

    2013-05-30

    Intrathecal (IT) administration is an important route of drug delivery, and its modelling in a large animal species is of critical value. Although domestic swine is the preferred species for preclinical pharmacology, no minimally invasive method has been established to deliver agents into the IT space. While a "blind" lumbar puncture (LP) can sample cerebrospinal fluid (CSF), it is unreliable for drug delivery in pigs. Using computed tomography (CT), we determined the underlying anatomical reasons for this irregularity. The pig spinal cord was visualised terminating at the S2-S3 level. The lumbar region contained only small amounts of CSF found in the lateral recess. Additional anatomical constraints included ossification of the midline ligaments, overlapping lamina with small interlaminar spaces, and a large bulk of epidural adipose tissue. Accommodating the the pig CT anatomy, we developed a lateral LP (LLP) injection technique that employs advanced planning of the needle path and monitoring of the IT injection progress. The key features of the LLP procedure involved choosing a vertebral level without overlapping lamina or spinal ligament ossification, a needle trajectory crossing the midline, and entering the IT space in its lateral recess. Effective IT delivery was validated by the injection of contrast media to obtain a CT myelogram. LLP represents a safe and reliable method to deliver agents to the lumbar pig IT space, which can be implemented in a straightforward way by any laboratory with access to CT equipment. Therefore, LLP is an attractive large animal model for preclinical studies of IT therapies. PMID:23518340

  4. THE ROLE OF LIGAMENTUM FLAVUM CALCIFICATION AT LUMBAR SPINE CAUSING CAUDA EQUINA SYNDROME AND LUMBAR RADICULOPATHY: CASE REPORT

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    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

  5. Artrodesis cervical anterior mediante implante de tantalio: Resultados clínicos y radiológicos / Anterior cervical fusion with tantalum interbody implants: Clinical and radiological results in a prospective study

    Scientific Electronic Library Online (English)

    C., Vicario; F., Lopez-Oliva; T., Sánchez-Lorente; M., Zimmermann; J.J., Asenjo-Siguero; F., Ladero; A., Ibarzábal.

    2006-04-01

    Full Text Available La discectomía cervical anterior con artrodesis intersomática (DCAA) es una técnica quirúrgica ampliamente aceptada en el tratamiento de la enfermedad discal cervical. Recientemente se han introducido con esta indicación las cajas de tantalio debido a sus excelentes propiedades mecánicas y biológica [...] s. Presentamos los resultados iniciales clínicos y radiológicos de un estudio prospectivo de 24 pacientes intervenidos en nuestro servicio tras el empleo de cajas de tantalio en la DCAA. La evaluación clínica pre y postoperatoria se realizó mediante cuestionario que incluía una Escala Visual Analógica de dolor, el Índice de Oswestry, y la Escala de Zung. Los resultados fueron clasificados mediante los criterios de Odom. La evaluación radiológica incluyó radiografías dinámicas en las que se midieron las variaciones del ángulo de Cobb y la distancia interespinosa. Postoperatoriamente los pacientes fueron revisados en el tercer mes y al año de la intervención. Todos los parámetros clínicos mejoraron de forma estadísticamente significativa. Según con los criterios de Odom, el 75% de los casos fueron considerados como excelentes o buenos. Sólo se confirmó clínica y radiológicamente un caso de pseudoartrosis. No se observaron diferencias significativas en las revisiones al año y a los 3 meses. Conclusión: Las cajas de tantalio constituyen un implante prometedor y pensamos que útil entre las diversas opciones quirúrgicas para la DCAA, por sus buenos resultados clínicos, por la no necesidad de autoinjerto, y por su excelente compatibilidad con la resonancia nuclear magnética. Abstract in english Anterior cervical discectomy and interbody fusion (ACDF) is a widely accepted surgical technique in the treatment of cervical disc disease. Tantalum cages have been recently introduced in spine surgery for interbody fusion because of the advantages of their mechanical properties. We present the resu [...] lts of a prospective clinical and radiological study on 24 consecutive patients who underwent an ACDF with tantalum cages. Clinical evaluation was assessed preoperatively and after surgery by a questionnaire that included a Visual Analogic Scale (VAS) of neck and arm pain, the Oswestry Dissability Index and the Zung Depression Scale. Results were classified by Odom's criteria. Radiological evaluation included flexion-extension X-rays, and changes in distance between spinous processes and Cobb angle were measured. Postoperatively patients were reviewed 3 and 12 months after surgery. A statisitical significative improvement in all clinical data was reported. According to Odom's criteria in 75% of patients the results were considered like excellent or good. Only one case of radiological and clinical pseudoarthrosis was confirmed. No significative differences were reported 3 and 12 months after surgery. Tantalum cages are a very promising and usefull alternative among implants available for ACDF. Compatibility with MRI postoperative studies and the unnecessariness of autograft are some of their advantages.

  6. Informed Consent in Lumbar Puncture: ¿a Systematic Practice? Consentimiento informado en la punción lumbar: ¿una práctica sistemática?

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    Ivonne Martín Hernández

    2011-08-01

    Full Text Available Background: the lumbar puncture is an invasive procedure doesn't exempt of risks and for its realization it is necessary to request the patient or family's informed consent. However, this practice is even controversial among our physicians. Objective: to identify how the process of informed consent works for the lumbar puncture in our means and its importance for our professionals. Methods: this study involved 90 physicians who were underwent a validated questionnaire. For the processing of numerical data was used frequency analysis and relative percent. SPSS 11.5 on Windows was employed as statistical system. Results: it was found that informed consent doesn't constitute a systematic practice in our means and was evidenced the deficiencies that even exist in its quality and application. This has been only carried out oral and the informative interest prevails above the respect to the patient's will. The physicians offer insufficient information in aspects like the explanation of the procedure, the contraindications and the complications of proceeding. For most of those interviewed the informed consent is important, but regrettably still some fear that it becomes obstacle for the realization of this to proceed. Conclusions: although most of our physicians value the importance positively of offering the informed consent when they execute the lumbar puncture, many carry out it improperly or they don't still carry out it. Lack of knowledge on the informed consent's ethical foundation and practical aspects is denoted among the physicians interviewed.Fundamento: la punción lumbar es un procedimiento invasivo no exento de riesgos y para su realización es necesario solicitar el consentimiento informado del paciente o familiar. Sin embargo, esta práctica todavía resulta controversial entre nuestros médicos. Objetivo: identificar cómo funciona el proceso de consentimiento informado para la punción lumbar en nuestro medio y su importancia para los profesionales. Métodos: este estudio comprendió 90 médicos a quienes se le aplicó un cuestionario validado. Para el procesamiento de los datos numéricos se utilizó el análisis de frecuencias relativas y porcientos. El sistema estadístico utilizado fue SPSS 11,5 sobre Windows. Resultados: se encontró que el consentimiento informado no constituye una práctica sistemática en nuestro medio y se evidenciaron las deficiencias que aún existen en cuanto a su calidad y cumplimiento. Solo se realiza oralmente y en este predomina el interés informativo por encima del respeto a la voluntad del paciente. Se ofrece insuficiente información sobre aspectos como: la explicación del procedimiento, sus contraindicaciones y complicaciones. Para la mayoría de los encuestados el consentimiento informado es importante, pero lamentablemente todavía algunos temen que se convierta en obstáculo para la realización de la punción lumbar. Conclusiones: a pesar de que la generalidad de los médicos valoran positivamente la importancia de ofrecer el consentimiento informado al ejecutar la punción lumbar, muchos todavía lo realizan inadecuadamente o no lo realizan. Se denota, entre los médicos encuestados, falta de conocimientos sobre el fundamento ético y los aspectos prácticos de este procedimiento.

  7. Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005-2008

    Science.gov (United States)

    ... Neck or Lumbar Spine in Older Adults: United States, 2005–2008 On This Page Key findings In ... lumbar spine among older adults in the United States population based on these WHO categories. Results are ...

  8. Anterolateral lumbar meningocele presenting as an ovarian cyst, in a patient with neurofibromatosis.

    Science.gov (United States)

    Scheltens, P; Burger, C W; Valk, J; Bertelsmann, F W

    1989-01-01

    A case of an anterolateral lumbar meningocele in a patient with neurofibromatosis is presented. As anterolateral lumbar meningocele may present itself only by non-specific symptoms like low back pain or abdominal pain, such symptoms require prompt diagnostic work up in patients with neurofibromatosis. The significance of MR imaging in early recognition of this rare anomaly is emphasized. PMID:2555098

  9. Lumbar microdiscectomy: subperiosteal versus transmuscular approach and influence on the early postoperative analgesic consumption

    OpenAIRE

    Brock, Marko; Kunkel, Philip; Papavero, Luca

    2008-01-01

    Conventional lumbar microdiscectomy requires subperiosteal dissection of the muscular and tendineous insertions from the midline structures. This prospective, randomized, single center trial aimed to compare a blunt splitting transmuscular approach to the interlaminar window with the subperiosteal microsurgical technique. Two experienced surgeons performed first time lumbar microdiscectomy on 125 patients. The type of approach and retractor used was randomized and both patients and evaluator ...

  10. Target radiofrequency combined with collagenase chemonucleolysis in the treatment of lumbar intervertebral disc herniation

    OpenAIRE

    Zhang, Daying; Zhang, Yong; Wang, ZhiJian; Zhang, Xuexue; Sheng, Mulan

    2015-01-01

    Both target radiofrequency thermocoagulation and collagenase chemonucleolysis are effective micro-invasive therapy means for lumbar intervertebral disc herniation. In order to analyze the clinical effects of target radiofrequency thermocoagulation combined with collagenase chemonucleolysis on lumbar intervertebral disc herniation, the contents of hydroxyproline and glycosaminoglycan were measured and the histological changes of nucleus pulposus was detected in the vitro experiments. Radiofreq...

  11. MR guided percutaneous laser lumbar disk hernia ablation

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo; Terao, Tohru; Ishibashi, Toshihiro; Yuhki, Ichiro; Harada, Junta; Tashima, Michiko [Jikei Univ., Chiba (Japan). Kashiwa Hospital; Abe, Toshiaki

    1998-03-01

    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 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)

  12. 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 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)

  13. 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.)

  14. 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 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.)

  15. Correlation between Lumbar vertebral instability and severe degenerative spondylolisthesis

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    Golbakhsh M

    2013-04-01

    Full Text Available Background: Severe spondylolisthesis is related to high degenerative changes in verte-bral spine. Degenerative spondylolisthesis often is seen with high-sacral slope. This study was conducted to investigate the relationship between high degenerative spondyl-olisthesis and sacral slope.Methods: A cross-sectional prospective study was done in patients with low back pain in Shafa Yahyaian and Sina University Hospitals in Tehran, in 18 months (April 2010- October 2011. Intermittent or continuous low back pain for three months and history of two disable low back pain attacks since one year ago were inclusion criteria. Pregnant patients were excluded. Lumbar vertebra displacement to vertebra body size ratio was calculated in dynamic mode. The ratio higher than 8% was considered as a lumbar instability. Rotation angle more than 11 ° was considered abnormal.Results: In this study, 52 patients (30 men, 22 women with 38.35±9.49 years old were enrolled. Mean body mass index was 23.01±4.59kg/m2. Thirty cases had abnormal verte-bral displacement. Angulation of the disc space more than 11 degrees was seen in 20 patients. No statistically significant difference in pelvic index between normal and abn-ormal lumbar vertebra displacement (P=0.443. The mean pelvic index in normal and abnormal angulation groups were 55.97° and 53.58°, respectively; the difference was not statistically significant (P=0.556.Conclusion: The results of the study showed disc degeneration had no association with sacral slope. High sacral slope can intensify spondylolisthesis but does not affect the incidence of degenerative spondylolisthesis. Additional research is required to find the other causes of degenerative spondylolisthesis.

  16. Postural stability disorders in rural patients with lumbar spinal stenosis

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    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.

  17. Clinical outcomes and efficacy of transforaminal lumbar endoscopic discectomy

    Directory of Open Access Journals (Sweden)

    Cezmi Çagri Türk

    2015-01-01

    Full Text Available Background: Transforaminal lumbar endoscopic discectomy (TLED is a minimally invasive procedure for removing lumbar disc herniations. This technique was initially reserved for herniations in the foraminal or extraforaminal region. This study concentrated on our experience regarding the outcomes and efficacy of TLED. Materials and Methods: A total of 105 patients were included in the study. The patients were retrospectively evaluated for demographic features, lesion levels, numbers of affected levels, visual analog scores (VASs, Oswestry disability questionnaire scale scores and MacNab pain relief scores. Results: A total of 48 female and 57 male patients aged between 25 and 64 years (mean: 41.8 years underwent TLED procedures. The majority (83% of the cases were operated on at the levels of L4-5 and L5-S1. Five patients had herniations at two levels. There were significant decreases between the preoperative VAS scores collected postoperatively at 6 months (2.3 and those collected after 1-year (2.5. Two patients were referred for microdiscectomy after TLED due to unsatisfactory pain relief on the 1 st postoperative day. The overall success rate with respect to pain relief was 90.4% (95/105. Seven patients with previous histories of open discectomy at the same level reported fair pain relief after TLED. Conclusions: Transforaminal lumbar endoscopic discectomy is a safe and effective alternative to microdiscectomy that is associated with minor tissue trauma. Herniations that involved single levels and foraminal/extraforaminal localizations were associated with better responses to TLED.

  18. 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 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.

  19. 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.

  20. Radiologic abnormalities of the thoraco-lumbar spine in athletes

    Energy Technology Data Exchange (ETDEWEB)

    Hellstroem, M.; Jacobsson, B.; Swaerd, L.; Peterson, L. (Sahlgrenska Sjukhuset, Goeteborg (Sweden). Dept. of Radiology Oestra Sjukhuset, Goeteborg (Sweden). Dept. of Orthopedics King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Radiology)

    1990-03-01

    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.).