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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... answer as many of your questions as possible. Today we’re performing a lumbar laminectomy for TLIF ... lumbar interbody fusion; or what we’re doing today, a TLIF, which is a transforaminal lumbar interbody ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate ... lumbar interbody fusion. Surgeons take bone off the spine to make more room for the spinal canal, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

Medline Plus

Full Text Available ... they can receive CME credit by completing their evaluation at the end of the broadcast. You can ... transforaminal lumbar interbody fusion from Thomas Jefferson University Hospital in Philadelphia. To make an appointment with a ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... interbody fusion and how we approach doing the discectomy and putting the cage in. What you see ... the disc and enter the disc for a discectomy. Now, once we start to do the discectomy— ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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

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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 fo...

Wei Lu, Yan-hao Li

2010-01-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University ... 01:00:23 ANNOUNCER: This has been a real-time broadcast of a lumbar laminectomy and transforaminal lumbar ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... surgery, other than spinal cord compression in the neck or in the thoracic spine, most pinched nerves in the lumbar spine are operated on for pain and disability, for a patient’s loss of function, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... re performing a lumbar laminectomy for TLIF for spinal stenosis and scoliosis. We’re going to be on ... to medical therapies. She has the diagnosis called spinal stenosis, which is a narrowing of the spine, and ...

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Post-discectomy syndrome treated with lumbar interbody fusion  

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We studied 27 patients with post-discectomy syndrome. All patients had Lumbar Interbody Fusion with titanium cages and pedicle screw fixation either as Anterior (ALIF, n=18) or as Transforaminal Lumbar Interbody Fusion (TLIF, n=9). Follow-up ranged from 24 to 94 months. The clinical and radiological data were compared. The outcome was evaluated using the Oswestry low back pain disability score and the visual analogue pain intensity scale. Outcomes were similar for all patients regardless of s...

Niemeyer, Thomas; Halm, Henry; Hackenberg, Lars; Liljenqvist, Ulf; Bo?vingloh, Albert Schulze

2006-01-01

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

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Transforaminal lumbar interbody fusion (TLIF) is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indication for interbody fusion and posterior decompression. The main advantage of TLIF is that it allows the complete removal of the intervertebral disc through the vertebral foramen, decompression of t...

2004-01-01

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Clinical and radiological outcomes of axial lumbar interbody fusion.  

Science.gov (United States)

Axial lumbar interbody fusion is a novel percutaneous alternative to common open techniques, such as anterior, posterior, and transforaminal lumbar interbody fusion. This minimally invasive technique uses the presacral space to access the L5-S1 and L4-L5 disk space. The goal of this study was to examine outcomes following axial lumbar interbody fusion. The charts of all patients who underwent axial lumbar interbody fusion surgery at our institution between 2006 and 2008 were reviewed. Clinical outcomes included visual analog scale (VAS) and Oswestry Disability Index (ODI). Radiographs were also evaluated for disk space height, L4-L5 and/or L5-S1 Cobb angle, and fusion. Of the 50 patients (32 women, 18 men; mean age, 49.29 years) treated with axial lumbar interbody fusion, 48 had preoperative VAS scores and 16 had preoperative ODI scores available. Complete radiographic data were available at the preoperative, initial postoperative, and final postoperative time points for 46 patients (92%). At last follow-up (average, 12 months), ODI scores were reduced from 46 to 22, and VAS scores were lowered from 8.1 to 3.6. Of the 49 patients with postoperative radiographs, 47 (96%) went on to a solid fusion. There were no significant differences between pre- and postoperative disk space height and lumbar lordosis angle. The most common complications were superficial infection and pseudoarthrosis. Other complications were rectal injury, hematoma, and irritation of a nerve root by a screw. Overall, we found the axial lumbar interbody fusion procedure in combination with pedicle screw placement to have good clinical and radiological outcomes. PMID:21162514

Patil, Suresh S; Lindley, Emily M; Patel, Vikas V; Burger, Evalina L

2010-12-01

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[Axial lumbar Interbody Fusion: Prospective Monocentric Study].  

Science.gov (United States)

PURPOSE OF THE STUDY The aim of this prospective study was to evaluate clinical and radiographic results in the patients who underwent L5-S1 fixation using the technique of percutaneous lumbar interbody fusion (AxiaLIF). MATERIAL The study comprised 23 patients, 11 women and 12 men, who ranged from age of 21 to 63 years, with an average of 48.2 years. In all patients surgical posterior stabilisation involving the L5-S1 segment had previously been done. The initial indications for surgery were L5-S1 spondylolisthesis in 20 and L5-S1 spondylosis and stenosis in three patients. METHODS The AxiaLIF technique for L5-S1 fixation was indicated in overweight patients and in those after repeated abdominal or retroperitoneal surgery. A suitable position and shape of the sacrum or lumbosacral junction was another criterion. The patients were evaluated between 26 and 56 months (average, 40.4 months) after primary surgery and, on the basis of CT and radiographic findings, bone union and lumbosacral junction stability were assessed. The clinical outcome was investigated using the ODI and VAS systems and the results were statistically analysed by the Wilcoxon test for paired samples with statistical significance set at a level of 0.05. RESULTS The average VAS value was 6.6 before surgery and, after surgery, 5.2 at three months, 4.2 at six months, 3.1 at one year, 2.9 at two years and 2.1 at three years (n=18). At two post-operative years, improvement in the VAS value by 56.1% was recorded. The average pre-operative ODI value was 25.1; the post-operative values were 17.0 at six months, 12.3 at one year, 10.6 at two years and 8.2 at three years (n=18). At two years after surgery the ODI value improved by 57.8%. To the question concerning their willingness to undergo, with acquired experience, surgery for the same diagnosis, 21 patients (91.3%) gave an affirmative answer. Neither screw breakage nor neurovascular damage or rectal injury was found. CT scans showed complete interbody bone fusion in 22 of the 23 patients (95.6%), In one patient the finding was not clear. Also, posterolateral fusion was achieved in all but one patients (95.6%). A stable L5-S1 segment was found in all patients at all follow-up intervals. The improvement in both VAS and ODI values was statistically significant. DISCUSSION In addition to indications usual in degenerative disc disease, overweight patients, those who had repeated trans- or retroperitoneal surgery in the L5-S1 region or who underwent long posterior fixation to stabilise the caudal margin of instrumentation are indicated for the AxiaLIF procedure. The clinical results of our study are in agreement with the conclusions of other studies and are similar to the outcomes of surgery using other types of fusion or dynamic stabilisation for this diagnosis. The high rate of fusion in our group is affected by use of a rigid transpedicular fixator together with posterolateral arthrodesis. On the other hand, no negative effects of only synthetic bone applied to interbody space were recorded. CONCLUSIONS The percutaneous axial pre-sacral approach to the L5-S1 interbody space with application of a double-treaded screw is another option for the management of this much strained segment. The technique is useful particularly when contraindications for conventional surgical procedures are present in patients with anatomical anomalies, in overweight patients or in those who have had repeated surgery in the region. Clinical outcomes and the success rate for L5-S1 bone fusion are comparable with conventional techniques. Complications are rare but their treatment is difficult. Key words:AxiaLIF, lumbar spine, spinal fusion, axial lumbar fixation. PMID:24945389

Stulík, J; Adámek, S; Barna, M; Kasp?íková, N; Polanecký, O; Kryl, J

2014-01-01

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Clinical study of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability  

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The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47–72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-colu...

Guo, Shuguang; Sun, Junying; Tang, Genlin

2013-01-01

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Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion  

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We have studied the incidence and functional outcome of retrograde ejaculation as a postoperative complication of anterior lumbar interbody fusion. A questionnaire, specifically designed to analyse this problem, has been used over a 6 to 13 year follow-up. Out of 50 men, 41 completed the questionnaire; 2 complained they had permanent retrograde ejaculation after the operation; one stopped ejaculating for 6 months, and thereafter had a 50% reduction. The Dallas pain que...

Christensen, F. B.; Bu?nger, C. E.

1997-01-01

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

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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 f...

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

2011-01-01

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Minimally invasive lateral lumbar interbody fusion with direct psoas visualization  

Science.gov (United States)

Background Minimally invasive lateral approaches to the lumbar spine have been adopted to allow access to the intervertebral disc space while avoiding the complications associated with anterior or posterior approaches. This report describes a minimally invasive technique for lateral lumbar interbody fusion LLIF that allows direct intraoperative visualization of the psoas and surrounding neurovasculature (DV-LIF). Methods The technique utilizes a radiolucent tubular retractor and a secondary psoas retractor that allows a muscle-sparing approach while offering excellent visualization of the operative site. The unique advantage of this procedure is that the psoas muscle and surrounding nerves can be directly visualized intraoperatively to supplement neuromonitoring. We retrospectively reviewed complication rates in 34 patients treated with DV-LLIF (n?=?19) or standard lateral lumbar interbody fusion (S-LLIF, n?=?15). Results There were 29 complications (median: 1 per patient) with DV-LLIF and 20 (median: 1 per patient) complications with S-LLIF. Postoperative sensory deficits were reported in eight (42%) and seven (47%) patients, respectively. Thigh pain or numbness was reported in eight (42%) and five (33%) patients, respectively. The percentage of the overall complications directly attributable to the procedure was 69% with DV-LLIF and 83% with S-LLIF. One severe complication (back pain) was reported in one DV-LLIF patient and four severe complications (severe bleeding, respiratory failure, deep venous thrombosis and gastrointestinal prophylaxis, and nicked renal vein and aborted procedure) were reported in two S-LLIF patients. Conclusions Preliminary evidence suggests that minimally invasive lateral interbody fusion with direct psoas visualization may reduce the risk for severe procedural complications.

2014-01-01

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Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis.  

Science.gov (United States)

This study compares the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS). Forty DLS patients with Cobb angles of 20-60 degrees were randomized into either the PLF or TLIF treatment group, and were followed up for 2-5 years. Operating time, intraoperative blood loss, clinical outcomes, complications and imaging were compared between the two groups. There were significant differences between the PLF and TLIF treatment groups in operative time (187.8±63.5 minutes and 253.2±57.6 minutes, respectively; p=0.002) and intraoperative blood loss (1166.7±554.1 mL and 1673.7±922.4 mL, respectively; p=0.048). The occurrence rates of early complications in the two groups were 11.1% and 26.3%. The recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different (36.7% versus 62.5% and 44.8% versus 64.1%, respectively). In various domains of the Scoliosis Research Society-22 (SRS-22) questionnaire, the scores for pain and satisfaction with the treatment showed significant differences between PLF and TLIF group (p=0.033 and p=0.006, for pain and satisfaction respectively), and the TLIF group showed better outcomes than the PLF group. There were no significant differences in the recovery rates in the Cobb angle and the spinal coronal balance, function, self-image, or mental health scores. Although TLIF increases the surgical trauma and occurrence of complications, it helps to improve lumbar lordosis and sagittal balance and shows better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option. PMID:23827174

Li, Fang-cai; Chen, Qi-xin; Chen, Wei-shan; Xu, Kan; Wu, Qiong-hua; Chen, Gang

2013-09-01

 
 
 
 
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The Wilhelm tell technique for anterior lumbar interbody fusion. Technical note.  

Science.gov (United States)

Experience indicates that stand-alone cages may lack the necessary stability to secure highly unstable motion segments at the lumbosacral junction. The authors have designed a special carbon fiber composite interbody cage that allows additional screw placement in anterior lumbar interbody fusion procedures performed at the lumbosacral junction. PMID:12650410

Markwalder, Thomas-Marc; Wenger, Markus; Elsig, Jean-Pierre; Laloux, Etienne

2003-03-01

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Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion  

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Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does the same, but could have complications of graft extrusion, compression and instability contributing to pseudarthrosis in the absence of instrumentation. The purpose of this study was to assess and co...

Madan, S. S.; Boeree, N. R.

2003-01-01

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The surgical technique of minimally invasive transforaminal lumbar interbody fusion.  

Science.gov (United States)

We aim to describe the minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) technique. The MI-TLIF procedure was developed to achieve the same goal of neural decompression and interbody arthrodesis as the traditional, open TLIF techniques. MI-TLIF has been utilized in the treatment of an array of lumbar pathologies, while offering the advantages of reducing soft tissue trauma, decreasing postoperative pain, and reducing the rate of complication when compared to the open techniques. The surgical technique of MI-TLIF is described in a step-by-step fassion. A technical review of this novel minimally invasive procedure was performed. Additionally, data collected through our experience with this procedure is reported. Data was collected retrospectively from patients between January 2008 and December 2009 who underwent MI-TLIF. The mean preoperative VAS score was 6.12±2.02 compared to 2.11±2.69 postoperatively. The mean ODI score dropped from 38.29±13.19 preoperatively to 16.00 ±16.598 postoperatively. Eighty-four patients who underwent MI-TLIF between October 2007 and December 2010 were divided based on age (over or under 65 years) and intraoperative estimated blood loss (EBL) was compared. The mean EBL for the young age group was 93.37±102.16 mL compared to 100 ±61.24 mL for the older group. Operation times for the MI-TLIF procedure has decreased from 3-4 hours to approximately 2 hours throughout our experience with this technique. The MI-TLIF technique is a safe and effective procedure offering the advantages of less tissue damage, less blood loss, and reduced postoperative hospitalization over the open techniques. PMID:21968588

Lawton, C D; Smith, Z A; Barnawi, A; Fessler, R G

2011-09-01

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Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients  

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The technique of posterior lumbar interbody fusion allows decompression of the spinal canal and interbody fusion through one posterior incision. A number of techniques exist to achieve additional posterior stability. The literature reports wide variation in outcomes for these different techniques. We assessed retrospectively the clinical and radiological outcome of posterior lumbar interbody fusion (PLIF) supplemented with an instrumented postero-lateral fusion (IPLF) using a pedicle screw sy...

Freeman, B. J. C.; Licina, P.; Mehdian, S. H.

2000-01-01

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Repeated adjacent-segment degeneration after posterior lumbar interbody fusion.  

Science.gov (United States)

One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4-5. At the second operation, L3-4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2-3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment. PMID:24654745

Okuda, Shinya; Oda, Takenori; Yamasaki, Ryoji; Maeno, Takafumi; Iwasaki, Motoki

2014-05-01

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Outcomes of allogenic cages in anterior and posterior lumbar interbody fusion  

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Interbody lumbar fusions provide a proven logical solution to diseases of the intervertebral discs by eliminating motion of the segment. Historically, there are many techniques to achieve spinal fusion in the lumbar spine. These include anterior, posterior, and foramenal approaches, often in combination with various internal fixation devices. The surgeon's choice of the approach and mechanical or biological implant is dependent on the patient's specific pathology and anatomy, in addition to t...

Janssen, M.; Lam, C.; Beckham, R.

2001-01-01

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

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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...

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

2004-01-01

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: Interbody techniques for lumbar fusion.  

Science.gov (United States)

Interbody fusion techniques have been promoted as an adjunct to lumbar fusion procedures in an effort to enhance fusion rates and potentially improve clinical outcome. The medical evidence continues to suggest that interbody techniques are associated with higher fusion rates compared with posterolateral lumbar fusion (PLF) in patients with degenerative spondylolisthesis who demonstrate preoperative instability. There is no conclusive evidence demonstrating improved clinical or radiographic outcomes based on the different interbody fusion techniques. The addition of a PLF when posterior or anterior interbody lumbar fusion is performed remains an option, although due to increased cost and complications, it is not recommended. No substantial clinical benefit has been demonstrated when a PLF is included with an interbody fusion. For lumbar degenerative disc disease without instability, there is moderate evidence that the standalone anterior lumbar interbody fusion (ALIF) has better clinical outcomes than the ALIF plus instrumented, open PLF. With regard to type of interbody spacer used, frozen allograft is associated with lower pseudarthrosis rates compared with freeze-dried allograft; however, this was not associated with a difference in clinical outcome. PMID:24980588

Mummaneni, Praveen V; Dhall, Sanjay S; Eck, Jason C; Groff, Michael W; Ghogawala, Zoher; Watters, William C; Dailey, Andrew T; Resnick, Daniel K; Choudhri, Tanvir F; Sharan, Alok; Wang, Jeffrey C; Kaiser, Michael G

2014-07-01

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Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationality  

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In this prospective study, our aim was to compare the clinical outcome of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in spondylolisthesis. A total of 138 patients with spondylolisthesis were randomly assigned to two groups: those operated on with pedicle screw fixation and posterior lumbar interbody fusion by autografting (PLIF), and those operated on with pedicle screw fixation and posterolateral fusion by autografting (PLF). The patients were followed-up for fo...

Cheng, Lei; Nie, Lin; Zhang, Li

2009-01-01

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

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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 anal...

Xiao Zhitao; Wang Liya; Gong He; Zhu Dong

2012-01-01

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

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"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 met...

Xiangdong Duan; Qingyong Hu; Zhiqiang Wang

2009-01-01

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Failure of a carbon fiber-reinforced polymer implant used for transforaminal lumbar interbody fusion.  

Science.gov (United States)

Lumbar interbody fusion is a common procedure owing to the high prevalence of degenerative spinal disorders. During such procedures, carbon fiber-reinforced polymer (CFRP) cages are frequently utilized to fill the void created between adjacent vertebral bodies, to provide mechanical stability, and to carry graft material. Failure of such implants can lead to significant morbidity. We discuss the possible causes leading to the failure of a CFRP cage in a patient with rheumatoid arthritis. Review of a 49-year-old woman who underwent revision anterior lumbar interbody fusion 2 years after posterior instrumentation and transforaminal lumbar interbody fusion at L4-L5 and L5-S1. The patient developed pseudarthrosis at the two previously fused levels with failure of the posterior instrumentation. Revision surgery reveled failure with fragmentation of the CFRP cage at the L5-S1 level. CFRP implants can break if mechanical instability or nonunion occurs in the spinal segments, thus emphasizing the need for optimizing medical management and meticulous surgical technique in achieving stability. PMID:24436878

Sardar, Zeeshan; Jarzem, Peter

2013-12-01

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

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

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

2012-01-01

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Outcome of instrumented lumbar fusion for low grade spondylolisthesis; Evaluation of interbody fusion with & without cages  

Science.gov (United States)

Object: The aim is to evalute the outcome of posterior lumbar interbody fusion with autologous bone graft versus titanium Cages, BAK system (Bagby – Kuslich, Spine Tech, Inc. Minneapolis, MN) for low grade spondyloisthesis (Grade1,11). Interbody cages have been developed to replace tricortical Interbody grafts in posterior lumbar interbody fusion (PLIF) procedures. The cages provide immediate post operative stability and facilitate bony union with cancellous bone packed in the cage itself. METHOD: We Evaluated 50 consecutive patients in whom surgery was performed between June 2000 to June 2003 in the Main Alexandria University Hospital at EGYPT. Twenty five patients were operated using autologous bone graft and 25 patients using the BAK cages. The neuro–radiologic al work up consisted of; plain X – ray lumbosacral spine including dynamic films preoperative and postoperative follow up; C.T lumbosacral spine and MRI lumbosacral spine. The surgery was performed at L4-5 level in 34 cases and at L5-S1 level in 16 cases. The median follow up was 15 months. RESULTS: Satisfactory fusion was obtained at all levels at a minimum one year follow – up. The fusion rate was 96% (24 patients) for the cage group and 80% (20 patients) for bone graft group however clinical improvement was 64% (16 patients) for those with bone graft group. CONCLUSION: A higher fusion rates and a better clinical outcome have been obtained by Instrumented PLIF with titanium cages that with bone graft. Inderbody fusion cages help to stabilize spainal segment primarily by distracting them as well as by allowing bone ingrowth and fusion. The procedure is safe and effective with 96% fusion rate and 76% overall Satisfactory rate. The use of cages help to distract the space between the vertebral bodies making the correction of the degree of spondylolisthesis easier. Long term follow up revealed better fusion rate and better realignment and less resorption with cages than with bone grafts.

Fathy, Mostafa; Fahmy, Mohamed; Fakhri, Mazen; Aref, Khaled; Abdin, Khaled; Zidan, Ihab

2010-01-01

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Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model  

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A prospective, randomized study was performed in an ovine model to compare the efficacy of an anorganic bovine-derived hydroxyapatite matrix combined with a synthetic 15 amino acid residue (ABM/P-15) in facilitating lumbar interbody fusion when compared with autogenous bone harvested from the iliac crest. P-15 is a biomimetic to the cell-binding site of Type-I collagen for bone-forming cells. When combined with ABM, it creates the necessary scaffold to initiate cell invasion, binding, and sub...

Sherman, Blake P.; Lindley, Emily M.; Turner, A. Simon; Seim Iii, Howard B.; Benedict, James; Burger, Evalina L.; Patel, Vikas V.

2010-01-01

36

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

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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...

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

2000-01-01

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Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine  

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Minimally invasive lumbar fusion techniques have been developed in recent 20 years. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain, and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of minimally invasive transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression or ...

Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

2011-01-01

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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)

2009-10-01

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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  

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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...

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

2009-01-01

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Endoscopy-assisted posterior lumbar interbody fusion in a single segment.  

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Posterior lumbar interbody fusion (PLIF) has been routinely performed for the treatment of lumbar segmental lesions. However, traditional PLIF procedures can result in a variety of approach-related morbidities. The purpose of this study was to determine the efficacy of endoscopy-assisted PLIF in lumbar arthrodesis. From July 2005 to May 2007, a total of 56 patients underwent PLIF, including 24 endoscopy-assisted operations (endoscopic group) and 32 traditional open operations (open group). The perioperative data, clinical outcomes and radiographic results were compared. The intraoperative bleeding volume, postoperative drainage volume, intraoperative and postoperative allogeneic blood transfusion volumes, values for C-reactive protein and erythrocyte sedimentation rate on postoperative day 3 and postoperative hospitalization days were decreased in the endoscopic group (p0.05). Endoscopy-assisted PLIF can achieve a clinical efficacy similar to that of traditional open operations while minimizing destruction to adjacent tissues. This technique is safe and is characterized by less bleeding, less tissue trauma, decreased postoperative pain, rapid recovery, and a shorter postoperative hospital stay. PMID:24238828

Wang, Yun-Tao; Wu, Xiao-Tao; Chen, Hui; Wang, Chen

2014-02-01

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

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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-...

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

2005-01-01

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

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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.

Xiao Zhitao

2012-06-01

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Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips  

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Background: Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature. Methods: We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA). Results: Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact. Conclusion: Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.

Cheng, Yen-Po; Lin, Ping-Yi; Huang, Abel Po-Hao; Cheng, Chun-Yuan; Chen, Chien-Min; Hueng, Dueng-Yuan

2014-01-01

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A biomechanical and histological evaluation of a bioresorbable lumbar interbody fusion cage.  

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Novel spinal interbody fusion cages made of bioactive and bioresorbable composites by a unique forging process were developed. Previous in vitro study demonstrated that these cages marked excellent biomechanical values. The purpose of the present in vivo study was to evaluate the viability and advantage of this forged composite of uncalcined hydroxyapatite/poly L-Lactide (F-u-HA/PLLA) cage radiographically, biomechanically, and histologically, when compared to conventional autologous iliac bone (AIB) and carbon fiber cage (CFC). Twenty-five mature sheep underwent posterior lumbar interbody fusion at L2-3 level with pedicle screws system made of titanium. Three types of interbody fusion implants were grafted: AIB (n = 7), CFCs (n = 9), F-u-HA/PLLA cages (n = 9). Two types of cages were packed with autologous fragmented cancellous bone harvested locally. All animals were euthanized at 120 days after surgery. The fusion scoring using the coronal view CT scans was designed to three-dimensionally evaluate fusion quality within and around cages. The mean CT scores of three groups were 33.3 points, 35.0 points, and 33.6 points in AIB, CFC, and F-u-HA/PLLA cage groups, respectively (full-score: 56 points). Statistical differences were not detected among the three groups. The mean range of motion values among fused groups had no significant difference under all pure loadings. The range of motion showed strong and significant correlation with the CT fusion scores. Histologic results demonstrated that F-u-HA/PLLA cages contacted with the surrounding bone directly, and CFC was encircled with thick fibrous tissue layers without any sign of inflammation around cages. The fusion quality of fused spinal segment using F-u-HA/PLLA cages was equal to that of AIB or CFCs both radiographically and biomechanically. In the histological observation, biocompatibility of F-u-HA/PLLA cage was obviously superior to CFC. It has been confirmed that the novel bioactive and bioresorbable cages had valuable advantages over existing CFC for use in spinal reconstructive surgery. PMID:15585267

Hojo, Yoshihiro; Kotani, Yoshihisa; Ito, Manabu; Abumi, Kuniyoshi; Kadosawa, Tsuyoshi; Shikinami, Yasuo; Minami, Akio

2005-05-01

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Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation.  

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Posterior lumbar interbody fusion (PLIF) using threaded cages has gained wide popularity for lumbosacral spinal disease. Our biomechanical tests showed that PLIF using a single diagonal cage with unilateral facetectomy does add a little to spinal stability and provides equal or even higher postoperative stability than PLIF using two posterior cages with bilateral facetectomy. Studies also demonstrated that cages placed using a posterior approach did not cause the same increase in spinal stiffness seen with pedicle screw instrumentation, and we concluded that cages should not be used posteriorly without other forms of fixation. On the other hand, placement of two cages using a posterior approach does have the disadvantage of risk to the bilateral nerve roots. We therefore performed a prospective study to determine whether PLIF can be accomplished by utilizing a single diagonal fusion cage with the application of supplemental transpedicular screw/rod instrumentation. Twenty-seven patients underwent a PLIF using one single fusion cage (BAK, Sulzer Spine-Tech, Minneapolis, MN, USA) inserted posterolaterally and oriented anteromedially on the symptomatic side with unilateral facetectomy and at the same level supplemental fixation with a transpedicular screw/rod system. The internal fixation systems included 12 SOCON spinal systems (Aesculap AG, Germany) and 15 TSRH spinal systems (Medtronic Sofamor Danek, USA). The inclusion criteria were grade 1 to 2 lumbar isthmic spondylolisthesis, lumbar degenerative spondylolisthesis, and recurrent lumbar disc herniations with instability. Patients had at least 1 year of low back pain and/or unilateral sciatica and a severely restricted functional ability in individuals aged 28-55 years. Patients with more than grade 2 spondylolisthesis or adjacent-level degeneration were excluded from the study. Patients were clinically assessed prior to surgery by an independent assessor; they were then reassessed at 1, 3, 6, 12, 18, and 24 months postoperatively by the same assessor and put into four categories: excellent, good, fair, and poor. Operative time, blood loss, hospital expense, and complications were also recorded. All patients achieved successful radiographic fusion at 2 years, and this was achieved at 1 year in 25 out of 27 patients. At 2 years, clinical results were excellent in 15 patients, good in 10, fair in 1, and poor in 1. Regarding complications, one patient had a postoperative motor and sensory deficit of the nerve root. Reoperation was required in one patient due to migration of pedicle screws. No implant fractures or deformities occurred in any of the patients. PLIF using diagonal insertion of a single threaded cage with supplemental transpedicular screw/rod instrumentation enables sufficient decompression and solid interbody fusion to be achieved with minimal invasion of the posterior spinal elements. It is a clinically safer, easier, and more economical means of accomplishing PLIF. PMID:12709855

Zhao, Jie; Hou, Tiesheng; Wang, Xinwei; Ma, Shengzhong

2003-04-01

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Surgical management of minimally invasive anterior lumbar interbody fusion with stand-alone interbody cage for L4-5 degenerative disorders: clinical and radiographic findings.  

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Surgical treatment for degenerative spinal disorders is controversial, although lumbar fusion is considered an acceptable option for disabling lower back pain. Patients underwent instrumented minimally invasive anterior lumbar interbody fusion (mini-ALIF) using a retroperitoneal approach except for requiring multilevel fusions, severe spinal canal stenosis, high-grade spondylolisthesis, and a adjacent segments disorders. We retrospectively reviewed the clinical records and radiographs of 142 patients who received mini-ALIF for L4-5 degenerative lumbar disorders between 1998 and 2010. We compared preoperative and postoperative clinical data and radiographic measurements, including the modified Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back and leg pain, disc height (DH), whole lumbar lordosis (WL), and vertebral wedge angle (WA). The mean follow-up period was 76 months. The solid fusion rate was 90.1% (128/142 patients). The average length of hospital stay was 6.9 days (range, 3-21 days). The mean blood loss was 63.7 ml (range, 10-456 ml). The mean operation time was 155.5 min (range, 96-280 min). The postoperative JOA and VAS scores for back and leg pain were improved compared with the preoperative scores. Radiological analysis showed significant postoperative improvements in DH, WL, and WA, and the functional and radiographical outcomes improved significantly after 2 years. The 2.8% complication rate included cases of wound infection, liquorrhea, vertebral body fractures, and a misplaced cage that required revision. Mini-ALIF was found to be associated with improved clinical results and radiographic findings for L4-5 disorders. A retroperitoneal approach might therefore be a valuable treatment option. PMID:24140782

Hironaka, Yasuo; Morimoto, Tetsuya; Motoyama, Yasushi; Park, Young-Su; Nakase, Hiroyuki

2013-01-01

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Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2  

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Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open ap...

Wang, Jian; Zhou, Yue; Zhang, Zheng Feng; Li, Chang Qing; Zheng, Wen Jie; Liu, Jie

2010-01-01

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Anterolateral Corrective Lumbar Corpectomy and Interbody Fusion by Using Extended Screw Fixation without Posterior Instrumentation for Posttraumatic Kyphosis  

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A 26-year-old paraplegic schizophrenic Japanese woman suffered from severe kyphosis and back pain derived from lumbar burst fractures caused by jumping. She had already undergone resection of the L1 and L2 spinous processes for sharp angular kyphosis, but she still had severe kyphosis and back pain at the L1 and L2. Radiographical examination revealed fused anterior columns at L1 and L2 with severe local kyphosis and a significantly decreased percutaneous distance in the back. The patient underwent anterior instrumented bony resection including an L2 vertebral osteotomy: bilateral L2-L3 facetectomy and partial posterior osteotomy of the L2 vertebrae via a posterior approach followed by an anterior corpectomy of the L2 vertebrae and insertion of a cylindrical cage. No posterior instrumentation was used owing to the presence of atrophied paraspinal soft tissues. Lumbar interbody fusion was performed with vertebral body screws extending from T12 to L4 and corresponding anterior distension and posterior compression. The procedure corrected the kyphosis by 15° and enhanced local stability. Postsurgical visual analogue scale improved from 9.0 to 2.0 and Oswestry Disability Index from 40 to 17.8, respectively. In conclusion, we have demonstrated that anterolateral interbody fusion using extended fixation can compensate for posterior corrective surgery.

Yamazaki, Atsuro; Orita, Sumihisa; Sainoh, Takeshi; Yamauchi, Kazuyo; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Go; Oikawa, Yasuhiro; Inage, Kazuhide; Nakata, Yukio; Inoue, Gen; Aoki, Yasuchika; Toyone, Tomoaki; Nakamura, Junichi; Miyagi, Masayuki; Takahashi, Kazuhisa; Ohtori, Seiji

2013-01-01

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Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients.  

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Object Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has been demonstrated in previous studies to offer improvement in pain and function comparable to those provided by the open surgical approach. However, comparative studies in the obese population are scarce, and it is possible that obese patients may respond differently to these two approaches. In this study, the authors compared the clinical benefit of open and MI TLIF in obese patients. Methods The authors conducted a retrospective cohort study based on review of electronic medical records at a single institution. Eligible patients had a body mass index (BMI) ? 30 kg/m(2), were ? 18 years of age, underwent single-level TLIF between 2007 and 2011, and outcome was assessed at a minimum 6 months postoperatively. The authors categorized patients according to surgical approach (open vs MI TLIF). Outcome measures included postoperative improvement in visual analog scale (VAS), Oswestry Disability Index (ODI), estimated blood loss (EBL), and hospital length of stay (LOS). Results A total 74 patients (21 open and 53 MI TLIF) were studied. Groups had similar baseline characteristics. The median BMI was 34.4 kg/m(2) (interquartile range 31.6-37.5 kg/m(2)). The mean follow-up time was 30 months (range 6.5-77 months). The mean improvement in VAS score was 2.8 (95% CI 1.9-3.8) for the open group (n = 21) and 2.4 (95% CI 1.8-3.1) for the MI group (n = 53), which did not significantly differ (unadjusted, p = 0.49; adjusted, p = 0.51). The mean improvement in ODI scores was 13 (95% CI 3-23) for the open group (n = 14) and 15 (95% CI 8-22) for the MI group (n = 45), with no significant difference according to approach (unadjusted, p = 0.82; adjusted, p = 0.68). After stratifying by BMI (adjusted, p > 0.05). Complications and EBL were greater for the open group than for the MI group (p < 0.05). Conclusions Obese patients experienced clinically and statistically significant improvement in both pain and function after undergoing either open or MI TLIF. Patients achieved similar clinical benefit whether they underwent an open or MI approach. However, patients in the MI group experienced significantly decreased operative blood loss and complications than their counterparts in the open group. PMID:24745355

Terman, Samuel W; Yee, Timothy J; Lau, Darryl; Khan, Adam A; La Marca, Frank; Park, Paul

2014-06-01

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Osteolysis in transforaminal lumbar interbody fusion with bone morphogenetic protein-2.  

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STUDY DESIGN.: Retrospective radiographic review. OBJECTIVE.: To determine the incidence of osteolysis, graft subsidence, and cage migration after recombinant human bone morphogenetic protein-2 (rhBMP-2) use with transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA.: Osteolysis after TLIF is a recently described phenomenon associated with rhBMP-2 use. Although this is typically a self-limiting condition, complications such as graft subsidence and cage migration have been described. The incidence of this is not well defined and most studies use plain radiographs for diagnosis rather than more advanced imaging. This study serves to quantify the risk of osteolysis and its associated graft complications with routine use of computed tomography. METHODS.: A total of 58 patients who underwent primary TLIF from a single surgeon between 2004 and 2007 underwent routine postoperative computed tomographic scan. Seventy-seven levels of fusion were evaluated for osteolysis. All patients received the same dose of rhBMP-2 of 5 mg per level. Imaging was performed immediately postoperative and again at an average of 4.3 months postoperative (range = 2.4-9.0 months). These images were evaluated for the presence of osteolysis, graft subsidence, and cage migration. These changes were then graded according to their severity. RESULTS.: Osteolysis was found in 16 of the 58 (27.6%) patients and 19 of the 77 (24.7%) levels treated. No significant difference was found between single and two-level fusions. The degree of osteolysis ranged from 3 to 20 mm with an average of 12.5 mm. The osteolysis was characterized as severe (>1 cm) in 12 of the 19 levels. Of the patients with osteolysis, 31.6% demonstrated graft subsidence all of which occurred with severe osteolytic defects. Migration of the intervertebral cage was found in 8.8% of patients. CONCLUSION.: rhBMP-2 use with TLIF is associated with a significant risk of postoperative osteolysis. Patients who demonstrated postoperative osteolysis were associated with significant risk of subsidence or migration of the intervertebral cage. The clinical implications of these changes are not currently known. PMID:21217443

Knox, Jeffrey B; Dai, Joseph M; Orchowski, Joseph

2011-04-15

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Double-segment Wilhelm Tell technique for anterior lumbar interbody fusion in unstable isthmic spondylolisthesis and adjacent segment discopathy.  

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The Wilhelm Tell technique is a novel instrumented anterior lumbar interbody fusion (ALIF) procedure using a specially designed composite carbon fibre cage and a single short-threaded cancellous screw that obliquely passes through the upper adjacent vertebral body, the interbody cage itself and through the lower adjacent vertebral body. This single-stage fusion method, which is in principle a combination of the Louis technique and modern cage surgery, is reported to have a lower rate of pseudoarthrosis formation than stand-alone cage techniques. In addition, it eliminates both the surgical trauma of paravertebral muscle retraction and the risk of neural damage by poorly located pedicular screws. This anterior approach allows decompression of neural structures within the anterior part of the spinal canal and the foraminal region. It is the purpose of this case report, to present the successful application of this novel technique in a 32-year-old woman who concurrently suffered from severe instability-related back pain from L4/5 isthmic spondylolisthesis and marked L5/S1 degenerative disc disease. PMID:16459090

Wenger, Markus; Vogt, Emanuel; Markwalder, Thomas-Marc

2006-02-01

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Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study.  

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Object Minimally invasive (MI) fusion and instrumentation techniques are playing a new role in the treatment of adult spinal deformity. The open pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) are proven segmental methods for improving regional lordosis and global sagittal parameters. Recently the MI anterior column release (ACR) was introduced as a segmental method for treating sagittal imbalance. There is a paucity of data in the literature evaluating the alternatives to PSO and SPO for sagittal balance correction. Thus, the authors conducted a preliminary retrospective radiographic review of prospectively collected data from 2009 to 2012 at a single institution. The objectives of this study were to: 1) investigate the radiographic effect of MI-ACR on spinopelvic parameters, 2) compare the radiographic effect of MI-ACR with PSO and SPO for treatment of adult spinal deformity, and 3) investigate the radiographic effect of percutaneous posterior spinal instrumentation on spinopelvic parameters when combined with MI transpsoas lateral interbody fusion (LIF) for adult spinal deformity. Methods: Patient demographics and radiographic data were collected for 36 patients (9 patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR). Patients included in the study were those who had undergone at least a 2-level MI-LIF procedure; adequate preoperative and postoperative 36-inch radiographs of the scoliotic curvature; a separate second-stage procedure for the placement of posterior spinal instrumentation; and a diagnosis of degenerative scoliosis (coronal Cobb angle > 10° and/or sagittal vertebral axis > 5 cm). Statistical analysis was performed for normality and significance testing. Results Percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved coronal Cobb angle by 16°, and the fractional curve significantly improved in a subgroup treated with L5-S1 transforaminal lumbar interbody fusion. Fifteen ACRs were performed in 9 patients and resulted in significant coronal Cobb angle correction, lumbar lordosis correction of 16.5°, and sagittal vertebral axis correction of 4.8 cm per patient. Segmental analysis revealed a 12° gain in segmental lumbar lordosis and a 3.1-cm correction of the sagittal vertebral axis per ACR level treated. Conclusions The lateral MI-LIF with ACR has the ability to powerfully restore lumbar lordosis and correct sagittal imbalance. This segmental MI surgical technique boasts equivalence to SPO correction of these global radiographic parameters while simultaneously creating additional disc height and correcting coronal imbalance. Addition of posterior percutaneous instrumentation without in situ manipulation or overcorrection does not alter radiographic parameters when combined with the lateral MI-LIF. PMID:24628129

Manwaring, Jotham C; Bach, Konrad; Ahmadian, Amir A; Deukmedjian, Armen R; Smith, Donald A; Uribe, Juan S

2014-05-01

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Good functional outcome and adjacent segment disc quality 10 years after single-level anterior lumbar interbody fusion with posterior fixation.  

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We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance of anterior lumbar interbody fusion with a titanium box cage and posterior fixation, with emphasis on long-term functional outcome. Thirty-two patients with chronic low back pain underwent anterior lumbar interbody fusion and posterior fixation. Radiological and functional results (visual analogue scale [VAS] and Oswestry score) were evaluated. Adjacent segment degeneration (ASD) was evaluated radiologically and by magnetic resonance imaging (MRI). Twenty-five patients (78%) were available for follow-up. Functional scores showed significant improvement in pain and function up to the 2-year follow-up observation. At 4 years, there was some deterioration of the clinical results. At 10-year follow-up, results remained stable compared with 4-year results. MRI showed ASD in 3/25 (12%) above and 2/10 (20%) below index level (compared with absent preoperatively). ASD could not be related to clinical outcome in this study. Anterior lumbar interbody fusion and posterior fixation is safe and effective. Initial improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up. Good clinical results are maintained at 10-year follow-up and are not related to adjacent segment degeneration. PMID:24353942

Horsting, Philip P; Pavlov, Paul W; Jacobs, Wilco C H; Obradov-Rajic, Marina; de Kleuver, Marinus

2012-03-01

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

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

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

2012-12-01

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

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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.

Khusniddin Nuraliev

2012-10-01

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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  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

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Minimally Invasive Lateral Lumbar Interbody Fusion: Clinical and Radiographic Outcome at a Minimum 2-year Follow-up.  

Science.gov (United States)

STUDY DESIGN:: Retrospective case series. OBJECTIVE:: To determine the clinical and radiographic outcomes of patients undergoing minimally invasive lateral lumbar interbody fusion (LLIF) with a minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA:: Minimally invasive LLIF is performed through a lateral, retroperitoneal, transpsoas approach. This procedure is characterized by the use of a tubular retractor to minimize tissue damage and real-time neuromonitoring to ensure safe passage through the psoas muscle. To date, advantages of minimal invasive LLIF, compared to open procedures, has been limited to early postoperative outcomes and complications, with the longest mean follow-up duration of 22 months. METHODS:: 118 patients who underwent minimally invasive LLIF with a minimum of 2 years follow-up were included in this study. Clinical outcomes were determined by using Visual Analog Score (VAS) for the degree of pain (trunk or lower extremity), and Oswestry Disability Index (ODI) and Short Form-12 (SF-12) scoring methods for patient function. Radiographic evaluations included (i) disc height, (ii) segmental coronal angulation, (iii) segmental lordotic angulation, (iv) Cobb angle, (v) cage subsidence, and (vi) fusion status. Data were statistically tested using either paired Students-t-test or Wilcoxon matched pair test. Significance levels was set at Pminimally invasive LLIF in improvements of clinical and radiographic features. PMID:22964885

Kotwal, Suhel; Kawaguchi, Satoshi; Lebl, Darren; Hughes, Alexander; Huang, Russel; Sama, Andrew; Cammisa, Frank; Girardi, Federico

2012-09-01

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The importance of the endplate for interbody cages in the lumbar spine  

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Intervertebral cages in the lumbar spine represent an advancement in spinal fusion to relieve low back pain. Different implant designs require different endplate preparations, but the question of to what extent preservation of the bony endplate might be necessary remains unanswered. In this study the effects of endplate properties and their distribution on stresses in a lumbar functional spinal unit were investigated using finite-element analyses. Three-dimensional finite-element models of L2...

Polikeit, Anne; Ferguson, Stephen J.; Nolte, Lutz P.; Orr, Tracy E.

2003-01-01

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The Outcomes of Surgical Treatment of Recurrent Lumbar Disk Herniation with Discectomy Alone and Discectomy with Posterolateral Interbody Fusion  

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Full Text Available  Background: Recurrent lumbar disk herniation (RLDH is one of the major causes of failure of standard discectomy. The optimal treatment method for RLDH is controversial. In the current study, we aimed to compare the clinical and functional outcomes of treating RLDH with discectomy alone and discectomy associated with posterolateral interbody fusion (PLIF.Material and Methods: There were 41 patients with RLHD after primary discectomy in the current retrospective study. Patients were assigned to 2 groups based on the surgical method: discectomy alone (17 patients and discectomy with PLIF (21 patients. At the final visit the following variables were measured and compared between groups: the back and radicular pain intensity using visual analogue scale (VAS, functional outcome using oswestry low back pain disability scale (ODI, return to previous work and complication. Patients were followed for 13.9±2.8 and 15±3 months in discectomy alone and discectomy with PLIF groups, retrospectively.Results: Complete fusion was achieved in 24 patients of PLIF group. The back pain intensity was the same; however the radicular pain intensity was significantly lower in PLIF group (1.5±0.9 V.s 2.3±1; p=0.017. Also, the mean of ODI scale was the same. 82.3% of patients in discectomy group and 87.5% of patients in PLIF group returned to previous work and the difference was not significant. One patient in discectomy group and 2 patients in PLIF group developed temporary neurological deficit which disappeared after 3 months.Conclusions: Although both discectomy alone and discectomy with PLIF were associated with favorable mid-term results in treating patients with RLDH, however, the authors recommend using discectomy with PLIF for lower radicular pain.

Hossein Nayeb Aghayee

2014-04-01

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Anterior dislodgement of a fusion cage after transforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis.  

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Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach. PMID:24175028

Oh, Hyeong Seok; Lee, Sang-Ho; Hong, Soon-Woo

2013-08-01

 
 
 
 
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Minimally Invasive Multi-Level Posterior Lumbar Interbody Fusion Using a Percutaneously Inserted Spinal Fixation System : Technical Tips, Surgical Outcomes  

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Objective There are technical limitations of multi-level posterior pedicle screw fixation performed by the percutaneous technique. The purpose of this study was to describe the surgical technique and outcome of minimally invasive multi-level posterior lumbar interbody fusion (PLIF) and to determine its efficacy. Methods Forty-two patients who underwent mini-open PLIF using the percutaneous screw fixation system were studied. The mean age of the patients was 59.1 (range, 23 to 78 years). Two levels were involved in 32 cases and three levels in 10 cases. The clinical outcome was assessed using the visual analog scale (VAS) and Low Back Outcome Score (LBOS). Achievement of radiological fusion, intra-operative blood loss, the midline surgical scar and procedure related complications were also analyzed. Results The mean follow-up period was 25.3 months. The mean LBOS prior to surgery was 34.5, which was improved to 49.1 at the final follow up. The mean pain score (VAS) prior to surgery was 7.5 and it was decreased to 2.9 at the last follow up. The mean estimated blood loss was 238 mL (140-350) for the two level procedures and 387 mL (278-458) for three levels. The midline surgical scar was 6.27 cm for two levels and 8.25 cm for three level procedures. Complications included two cases of asymptomatic medial penetration of the pedicle border. However, there were no signs of neurological deterioration or fusion failure. Conclusion Multi-level, minimally invasive PLIF can be performed effectively using the percutaneous transpedicular screw fixation system. It can be an alternative to the traditional open procedures.

Kim, Hyeun Sung; Park, Keun Ho; Ju, Chag Il; Lee, Seung Myung; Shin, Ho

2011-01-01

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

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Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001). The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels) were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure, especially to surgeon's hands, should be carefully monitored.

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

2014-01-01

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

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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

Birkenmaier Christof

2010-09-01

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Evaluation of an injectable silk fibroin enhanced calcium phosphate cement loaded with human recombinant bone morphogenetic protein-2 in ovine lumbar interbody fusion.  

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The objective of this study was to investigate the efficacy of an injectable calcium phosphate cement/silk fibroin/human recombinant bone morphogenetic protein-2 composite (CPC/SF/rhBMP-2) in an ovine interbody fusion model. Twenty-four mature sheep underwent anterior lumbar interbody fusion at the levels of L1/2, L3/4, and L5/6 with random implantation of CPC/SF, CPC/rhBMP-2, CPC/SF/rhBMP-2, or autogenous iliac bone. After the sheep were sacrificed, the fusion segments were evaluated by manual palpation, CT scan, undestructive biomechanical testing, undecalcified histology, and histomorphology. The fusion rates of CPC/SF/rhBMP-2 were 55.56% and 77.78% at 6 and 12 months, respectively. The fusion was superior to all the biomaterial grafts in stiffness, and reached the same stiffness as the autograft at 12 months. The new bone formation was less than autograft at 6 months, but similar with that at 12 months. However, the ceramic residue volume of CPC/SF/rhBMP-2 was significantly decreased compared with CPC/SF and CPC/rhBMP-2 at both times. The results indicated that CPC/SF/rhBMP-2 composite had excellent osteoconduction and osteoinduction, and balanced degradation and osteogenesis. PMID:21381189

Gu, Yong; Chen, Liang; Yang, Hui-Lin; Luo, Zong-Ping; Tang, Tian-Si

2011-05-01

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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)

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.

Christensen, A; Høy, K

2014-01-01

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Transforaminal Thoracic Interbody Fusion (TTIF) for Treatment of a Chronic Chance Injury  

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Multiple anterior and posterior approaches to the thoracic disc space have been reported. However, we are not aware of any previous reports describing a transforaminal approach for thoracic disc release and interbody cage placement. In this case report, we describe a method to perform transforaminal thoracic interbody fusion (TTIF), which is an adaptation of an established lumbar fusion technique (transforaminal lumbar interbody fusion). Key differences between the two procedures are discusse...

Huang, Russel C.; Meredith, Dennis S.; Taunk, Raja

2010-01-01

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Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome  

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The aim of this study was to evaluate the short-term radiological and functional outcome of surgical treatment for symptomatic, low-grade, adult isthmic spondylolisthesis. Twelve patients underwent a monosegmental fusion for symptomatic spondylolisthesis. Posterior reduction with pedicle screw instrumentation was followed by second-stage anterior interbody fusion with a cage. All patients underwent a decompressive laminectomy. At an average of 2.1 (range 1.4–3.0) years following surgery, al...

Spruit, M.; Pavlov, P.; Leitao, J.; Kleuver, M.; Anderson, P.; Den Boer, F.

2002-01-01

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

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

Hsieh Pang-Hsing

2008-06-01

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... you’ll see there’s going to be a final tightening that’s going to happen. You can hear ... tightening it against distraction. This is called the final tightener. It’s two parts to it. You can ...

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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 ... to two weeks after that visit and begin physical therapy. And usually, I tell patients, after an operation ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... The other thing to note as you’re watching this, for the audience, is when patients get ... bladder, and I guess it’s important for our watching audience to know that is one true emergency ...

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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 ... we are left with a patient who cannot walk well because her nerves are pinched. Every time ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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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 ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... camera, but you can see she’s got very thin dura. You can actually see the nerve roots, ... many patients will do. This patient is very thin, healthy, and she will get very active again, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... then we’ll see him at six weeks after surgery, sooner if there’s an issue that we need to take care of, but usually six weeks after surgery, three months after surgery, six months after surgery, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... put it along the side to heal the fusion and, like, weld the spine together. So while they’re hooking up the ... patient’s 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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... MD: Are you not answering that because there’s never been—there’s been no limitation, we’re not ... to be a final tightening that’s going to happen. You can hear that squeak? I don’t ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 2006 00:00:08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists ... now. We’ve been operating for approximately an hour. I want to introduce my co-surgeon, Dr. ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... at these patients have to differentiate neurogenic claudication versus vascular claudication. And in neurogenic claudication, it is ... minimally invasive, maximally invasive, and front-and-back versus back alone. And it has to be—I ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... we distract, it opens up and takes the pressure off this 5 nerve root so it can ... for—emergently if patients lose their bowel or bladder, and I guess it’s important for our watching ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical ... may participate in the program by sending questions at any time; just click the MDirectAccess button on ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... you can see where the nerve goes out under the pedicle, “P.” The “G” is the ganglion; ... X-Stop? Okay. This is—X-Stop is under the broad category of spinal bumpers, and spinal ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... another; we do do it for degenerative disc disease, though much less commonly; scoliosis, as in this patient; a pseudoarthrosis is a nonhealed fusion; failed laminectomies; ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... going to see them for decompression. There’s a number of different types of cages available for the ... is an advantage for the patient. It’s our number one complaint from patients when we take bone ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... only wear a brace when she’s out of bed—and she’ll get out of bed starting tomorrow. We’ll brace her for six ... called polyaxial screws, so they allow us top-loading and they allow us to place the rod ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... associate professor of neurosurgery. He’s at the table holding the instrument right now, and two of our ... see what the facet looks like we’re holding in the camera. And the cartoon of the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to put the cage in, Jim? 00:23:37 JAMES S. HARROP, MD: I actually am. 00:23: ... the way onto the other side. 00:25:37 TODD J. ALBERT, MD: Do you have that ... you’re going to do next? 00:28:37 JAMES S. HARROP, MD: Sure, I was exactly going ...

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Full Text Available ... at the end of the program for CME credit. 00:00:55 TODD J. ALBERT, MD: Hello. ... remind CME viewers that they can receive CME credit by completing their evaluation at the end of ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... co-surgeon, Dr. Harrop, associate professor of neurosurgery. He’s at the table holding the instrument right now, ... was Ron Forcina, our scrub nurse who’s helping. He’s critical. Without him we couldn’t do the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... if there’s an issue that we need to take care of, but usually six weeks after surgery, three months after surgery, six months after surgery, a year after surgery, and then yearly after that. They’re our patients for the rest of their lives because when ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... many patients, this allows them to return to normal activities and an improved quality of life. You ... and crush the disc space, collapse it. The normal position of the spine is more with the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the table holding the instrument right now, and two of our spine fellows, Andrew Wight and David ... you. You can see the dots. The bottom two dots are L5, the middle two dots are ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... ahead and put the screws in? 00:28:05 JAMES S. HARROP, MD: Let’s show what happens when ... instrument to undercut the bone, so. 00:36:05 JAMES S. HARROP, MD: We’re almost done with ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... that is a curvature of the spine due to asymmetric narrowing of the disc. And I showed you her x-ray. It looks like a little bit of a “C” from collapse of those disc spaces. Now, axial ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... is called the fascia you see being taken down along the spinous processes. And that’s the skin ... an instrument called a bovie to take that down. And if you can just run the “Identification ...

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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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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... we’re doing this laminectomy over two to three spinal levels, we’ll save the bone from ... therapy and get back to normal almost within three months. 00:39:30 JAMES S. HARROP, MD: Todd, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... from collapse of those disc spaces. Now, axial low back pain, which many patients complain of with ... Americans, 80 to 90%, will suffer episodes of low back pain in their lifetime. It is not— ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... So the plan for the operation is exposure, instrumentation, neural decompression, or opening up the nerve roots, ... largest inconvenience or limitation, in terms of surgical instrumentation or devices for spinal surgery?” 00:49:42 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... probe down on the screw and put an electrical current through it. Craig’s going to then ramp ... and read if they get what’s called an electrical breech, or at what point they get an ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... bone-making material into the cage that he’s loading that Jim is going to then put into ... called polyaxial screws, so they allow us top-loading and they allow us to place the rod ...

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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’ ...

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Full Text Available ... anterior spacers, so technically this is an off-label use. However, it is in an anterior spacer, ... to use it; however, this is an off-label use of the bone morphogenic protein we’re ...

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Full Text Available ... circle. 00:43:36 ASSISTANT: How do these heights look to you? 00:43:42 JAMES S. HARROP, ... bender. 00:43:45 ASSISTANT: How do these heights look to you? 00:43:48 JAMES S. HARROP, ...

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Full Text Available ... program by sending questions at any time; just click the MDirectAccess button on the screen. Physicians may ... the deformity. Maybe you want to increase one click on that, David, the distractor, so he can ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... we scrape along the sides of the m-plates to get the disc material out And here ... into the interspace. He’s already prepared the m-plates. Jim, I think maybe after we do that ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... cannulated these pedicles, making holes in them and markers, which you’ll see on the field. We ... below, the “P,” is the pedicle. That’s our marker, that’s where we start to do our work ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the operation, so if we could run the initial incision video, please. You’ll see that video ... we distract, it opens up and takes the pressure off this 5 nerve root so it can ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... this procedure minimally invasively and see—get the access and see the nerves in the way that ... removed that entire facet, and that gives me access to the transforaminal area. And there’s—you see ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... muscles off their spine and preparing some sites where we’re going to put screws in, which ... Again, you’re looking at the right side where there’s the pinching. And on the right side ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... the instruments. So Ron’s preparing putting some bone graft material—or bone-making material into the cage ... one complaint from patients when we take bone grafts, so we’ve gone for other materials and ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... blood loss associated with it, it has a large dissection. The X-Stop-type procedure can be ... 44:29 JAMES S. HARROP, MD: I need a large rongeur, please. 00:44:30 TODD ALBERT, MD: ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... questions at any time; just click the MDirectAccess button on the screen. Physicians may take a post- ... during the broadcast by clicking on the MDirectAccess button on your computer screen. We’ll try to ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00:08 ANNOUNCER: During the next hour in a ... the end of the program for CME credit. 00:00:55 TODD J. ALBERT, MD: Hello. Good ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 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 spine based on degeneration of the disc space. Here on ...

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... ligament. And we’re pointing out the facet joint, the facet joint and the—and the lamina. And the area ... is an advantage for the patient. It’s our number one complaint from patients when we take bone ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 00:47:36 JAMES S. HARROP, MD: I don’t know if you can see it or not, but it’s right here. Can you guys just back out so he can get a little light in here for a second. You can see here’s the transverse process between the bones. 00:47:45 TODD ALBERT, MD: We can’t see so well where you’re pointing out. ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Full Text Available ... see because I actually am undercutting. 00:35:52 TODD J. ALBERT, MD: Now, we can see ... JAMES S. HARROP, MD: Looks pretty good. 00:43:52 TODD ALBERT, MD: Andrew, can you go ahead ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... deformity, but the bone graft, the fusion—the rate of fusion is much higher when we put ... the answer is the benefit is increased fusion rate, and it’s very good in that area. It’s ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to prepare. It’s a very involved operation with multiple steps, and we’ve been attempting to prepare ... again, with—this lady has a deformity in multiple planes, and what we’re going to try ...

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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 ...

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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’ ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... TLIF. So both of them—both of the groups did have some issues with persistent radiculopathy. I’ ... I want to thank the Jefferson media marketing group that’s put this— helped us put this webcast ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... where the nerve goes out under the pedicle, “P.” The “G” is the ganglion; that’s the nerve ... of the transforaminal working zone. And below, the “P,” is the pedicle. That’s our marker, that’s where ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... ll put all the screws in. 00:28:40 TODD J. ALBERT, MD: Perfect. We’re at ... you’ve got some local bone, right? 00:40:09 JAMES S. HARROP, MD: Do you have a joystick? 00:40:13 TODD ALBERT, MD: So Dr. Harrop is ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson ... and 4. You probably want to check those real quick, also, those—So maybe you want to ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... time; just click the MDirectAccess button on the screen. Physicians may take a post-assessment survey at ... clicking on the MDirectAccess button on your computer screen. We’ll try to answer as many of ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... only wear a brace when she’s out of bed—and she’ll get out of bed starting tomorrow. We’ll brace her for six ... heard—or watching audience has heard—about cerebrospinal fluid. Cerebrospinal fluid is inside it, and he’s pushing ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... TODD ALBERT, MD: Okay. So the L4 nerve root goes right medial to that. And after we put the screws in, we’re going to do something called triggered EMG, where we’re going to put a little ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... surgery, six months after surgery, a year after surgery, and then yearly after that. They’re our patients for the rest of their lives because when you have a spine operation, you have multiple levels in your spine and we have to keep an eye on the other levels. And generally, patients can ...

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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 ... it’s called cauda equina syndrome, if they lose control of their bowel and bladder from severe compression ...

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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— ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... 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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... stenosis and scoliosis, which is what this patient has. So let’s talk about the patient first. It’s a 67-year-old female who has significant back and leg pain, worse with standing ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... correct for a TLIF, the TLIF in this paper, done by Hee and Castro, showed—looking and ... have this procedure. Is this the latest and best procedure or is there something new on the ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... here you see these special angles—double and triple angle curettes—because we’re going in from ... I please elaborate on spinal spacers, such as X-Stop, how it could ultimately reduce the need ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... have. Most things in spinal surgery, other than spinal cord compression in the neck or in the thoracic ... do here. If we were in the cervical spinal cord, we cannot touch it because we can paralyze ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... to it. You can see there’s a counter-torque piece while we twist it—and you hear ... means it’s tight enough. It has a tightening torque to know that it’s tightened enough. Well, here’s ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... when they arch their back. That doesn’t help for vascular claudication, and it is worse when ... but it is rare. The things we can help much better are sciatica, or nerve pinching, much ...

 
 
 
 
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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... You may participate in the program by sending questions at any time; just click the MDirectAccess button ... all the viewers that you can submit a question at any time during the broadcast by clicking ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... you see being taken down along the spinous processes. And that’s the skin incision. And then we ... here we’re pointing out that’s the spinous processes and inner spinous ligament. And we’re pointing ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... approaches to fit the approach best to what your diagnosis is. We think for this particular pathology and problem ... answer that question, it totally depends on what your exact pathology is, so I would recommend talking to your surgeon ...

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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 ... despite having tried multiple nonoperative things—injections, physical therapy. And we always try that first on a ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... us controlling the bleeders. These are called epidural veins, which are around—which are around the dura, ... With a little foot pedal, we grab these veins and cauterize them. And when we do so, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... has degenerative scoliosis. And degenerative scoliosis is a curvature of the spine based on degeneration of the ... problem is degenerative scoliosis, and that is a curvature of the spine due to asymmetric narrowing of ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... for—emergently if patients lose their bowel or bladder, and I guess it’s important for our watching ... if they lose control of their bowel and bladder from severe compression of the nerves. It’s rare, ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... you look at the canal—I don’t know if you can see my computer or not— ... 25:21 JAMES S. HARROP, MD: I don’t know if you can see. Actually we can see ... do the operation. He’s the only one who knows the names of the instruments. So Ron’s preparing ...

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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 ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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Full Text Available ... some pictures for you and a slide talk here, in terms of a laminectomy and TLIF for ... spine based on degeneration of the disc space. Here on your screen you will see her x- ...

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion  

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

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Time-sequential changes of differentially expressed miRNAs during the process of anterior lumbar interbody fusion using equine bone protein extract, rhBMP-2 and autograft  

Science.gov (United States)

The precise mechanism of bone regeneration in different bone graft substitutes has been well studied in recent researches. However, miRNAs regulation of the bone formation has been always mysterious. We developed the anterior lumbar interbody fusion (ALIF) model in pigs using equine bone protein extract (BPE), recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), and autograft as bone graft substitute, respectively. The miRNA and gene expression profiles of different bone graft materials were examined using microarray technology and data analysis, including self-organizing maps, KEGG pathway and Biological process GO analyses. We then jointly analyzed miRNA and mRNA profiles of the bone fusion tissue at different time points respectively. Results showed that miRNAs, including let-7, miR-129, miR-21, miR-133, miR-140, miR-146, miR-184, and miR-224, were involved in the regulation of the immune and inflammation response, which provided suitable inflammatory microenvironment for bone formation. At late stage, several miRNAs directly regulate SMAD4, Estrogen receptor 1 and 5-hydroxytryptamine (serotonin) receptor 2C for bone formation. It can be concluded that miRNAs play important roles in balancing the inflammation and bone formation.

Chen, Da-Fu; Zhou, Zhi-Yu; Dai, Xue-Jun; Gao, Man-Man; Huang, Bao-Ding; Liang, Tang-Zhao; Shi, Rui; Zou, Li-Jin; Li, Hai-Sheng; Bünger, Cody; Tian, Wei; Zou, Xue-Nong

2014-03-01

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Time-sequential changes of differentially expressed miRNAs during the process of anterior lumbar interbody fusion using equine bone protein extract, rhBMP-2 and autograft  

Science.gov (United States)

The precise mechanism of bone regeneration in different bone graft substitutes has been well studied in recent researches. However, miRNAs regulation of the bone formation has been always mysterious. We developed the anterior lumbar interbody fusion (ALIF) model in pigs using equine bone protein extract (BPE), recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), and autograft as bone graft substitute, respectively. The miRNA and gene expression profiles of different bone graft materials were examined using microarray technology and data analysis, including self-organizing maps, KEGG pathway and Biological process GO analyses. We then jointly analyzed miRNA and mRNA profiles of the bone fusion tissue at different time points respectively. Results showed that miRNAs, including let-7, miR-129, miR-21, miR-133, miR-140, miR-146, miR-184, and miR-224, were involved in the regulation of the immune and inflammation response, which provided suitable inflammatory microenvironment for bone formation. At late stage, several miRNAs directly regulate SMAD4, Estrogen receptor 1 and 5-hydroxytryptamine (serotonin) receptor 2C for bone formation. It can be concluded that miRNAs play important roles in balancing the inflammation and bone formation.

Chen, Da-Fu; Zhou, Zhi-Yu; Dai, Xue-Jun; Gao, Man-Man; Huang, Bao-Ding; Liang, Tang-Zhao; Shi, Rui; Zou, Li-Jin; Li, Hai-Sheng; Bünger, Cody; Tian, Wei; Zou, Xue-Nong

2014-04-01

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Harvesting local cylinder autograft from adjacent vertebral body for anterior lumbar interbody fusion: surgical technique, operative feasibility and preliminary clinical results  

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Autogenous iliac crest has long served as the gold standard for anterior lumbar arthrodesis although added morbidity results from the bone graft harvest. Therefore, femoral ring allograft, or cages, have been used to decrease the morbidity of iliac crest bone harvesting. More recently, an experimental study in the animal showed that harvesting local bone from the anterior vertebral body and replacing the void by a radio-opaque ?-tricalcium phosphate plug was a valid concept. However, such a ...

Arlet, Vincent; Jiang, Liang; Steffen, Thomas; Ouellet, Jean; Reindl, Rudy; Aebi, Max

2006-01-01

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The Significance of Removing Ruptured Intervertebral Discs for Interbody Fusion in Treating Thoracic or Lumbar Type B and C Spinal Injuries through a One-Stage Posterior Approach  

Science.gov (United States)

Objectives To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach. Methods This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients) underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients), the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2–15 days). The clinical, radiologic and complication outcomes were analyzed retrospectively. Results Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%). In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p0.05 Fisher's exact test). Conclusion Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure.

Zhang, Qian-Shi; Lu, Guo-Hua; Wang, Xiao-Bin; Li, Jing

2014-01-01

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Essential requirement for zebrafish anosmin-1a in the migration of the posterior lateral line primordium.  

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Kallmann syndrome (KS) is a human genetic disease that impairs both cell migration and axon elongation. The KAL-1 gene underlying the X-linked form of KS, encodes an extracellular matrix protein, anosmin-1, which mediates cell adhesion and axon growth and guidance in vitro. We investigated the requirement for kal1a and kal1b, the two orthologues of the KAL-1 gene in zebrafish, in the journey of the posterior lateral line primordium (PLLP). First, we established that while the accumulation of ...

Yanicostas, Constantin; Ernest, Sylvain; Dayraud, Cyrielle; Petit, Christine; Soussi-yanicostas, Nadia

2008-01-01

 
 
 
 
181

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... is a procedure known as XLIF. A better term would be extreme lateral interbody fusion. This is ... we call a cage. And that's where the term comes from: extreme lateral interbody fusion. It's a ...

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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

1995-01-01

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Labeling hair cells and afferent neurons in the posterior lateral-line system of zebrafish.  

Science.gov (United States)

The lateral line is a mechanosensory system that comprises a set of discrete sense organs called neuromasts, which are arranged in reproducible patterns on the surface of fish and amphibians. The posterior component of the system, the posterior lateral line, comprises the neuromasts on the body and tail. Each neuromast has a core of mechanosensory hair cells, each of which is depolarized by water motion in one direction and hyperpolarized by motion in the other direction, thereby enabling fish to extract information from the movements of water around their body. Neuromasts are innervated by a few afferent neurons (usually two, but sometimes more), which have their cell bodies clustered in cranial ganglia and project their central axons to the hindbrain, where they extend longitudinally along all rhombomeres. Hair cells are readily labeled by small cationic styryl pyridinium dyes such as DiASP. Afferent fibers are also progressively labeled with this dye, presumably by trans-synaptic uptake. Adjusting the dye concentration and incubation time can lead to the labeling of the entire afferent system, thereby providing a fast and easy method for visualizing the central projection in the hindbrain of live fish. The simplicity of the method makes it potentially useful for screens based on forward or reverse genetic approaches. Here we present protocols for labeling hair cells in live zebrafish and for labeling afferent neurons in zebrafish embryos. PMID:24298034

Schuster, Kevin; Ghysen, Alain

2013-12-01

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

Directory of Open Access Journals (Sweden)

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.

Villablanca Eduardo J

2010-12-01

185

Ipsilateral pedicle screw placement with contralateral percutaneous facet screws: Early results with an alternative in lumbar arthrodesis  

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Richard B Rhiew, Sunil Manjila, Andrew M Lozen, David Hong, Murali Guthikonda, S S RengacharyDepartment of Neurosurgery, Wayne State University, Detroit, MI, USAAbstract: Transforaminal lumbar interbody fusion (TLIF) is a widely used method of surgical treatment for a variety of lumbar spinal disorders. Bilateral transpedicular instrumentation is routinely used in conjunction with an interbody graft to provide additional stability. In this technical note, we describe our fusion construct usin...

Rhiew, Richard B.; Sunil Manjila; Lozen, Andrew M.; David Hong; et al., .

2009-01-01

186

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

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

2010-01-01

187

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... them. So now I can have a mapping where the nerves are. Now back to you, Dr. ... is what we call a cage. And that's where the term comes from: extreme lateral interbody fusion. ...

188

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... lateral interbody fusion. This is a procedure that has been performed for quite a few years, and ... to the arm. Dr. Nichols. And the tube has numbers that is telling me how deep is ...

189

Hybrid construct for two levels disc disease in lumbar spine  

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

2010-01-01

190

Stand-alone cage for posterior lumbar interbody fusion in the treatment of high-degree degenerative disc disease: design of a new device for an “old” technique. A prospective study on a series of 116 patients  

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Chronic lumbar pain due to degenerative disc disease affects a large number of people, including those of fully active age. The usual self-repair system observed in nature is a spontaneous attempt at arthrodesis, which in most cases leads to pseudoarthrosis. In recent years, many possible surgical fusion techniques have been introduced; PLIF is one of these. Because of the growing interest in minimally invasive surgery and the unsatisfactory results reported in the literature (mainly due to t...

Costa, Francesco; Sassi, Marco; Ortolina, Alessandro; Cardia, Andrea; Assietti, Roberto; Zerbi, Alberto; Lorenzetti, Martin; Galbusera, Fabio; Fornari, Maurizio

2011-01-01

191

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... in order to map the nerves on the lumbar plexus. And with the NeuroVision monitoring on the ... and it's used for patients with severe intractable lumbar spondylosis. Anybody that suffers from spine disease from ...

192

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... it's used for patients with severe intractable lumbar spondylosis. Anybody that suffers from spine disease from L4 ... space. This patient is suffering from severe lumbar spondylosis. That means damage to the disc space, damage ...

193

Extreme Lateral Interbody Fusion Procedure  

Science.gov (United States)

... it's used for patients with severe intractable lumbar spondylosis. Anybody that suffers from spine disease from L4 ... space. This patient is suffering from severe lumbar spondylosis. That means damage to the disc space, damage ...

194

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

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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 c...

2007-01-01

195

Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion  

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Adjacent segment degeneration (ASD) is discussed to impair long-term outcome after lumbar interbody fusion. Nevertheless the amount and origin of degeneration and its clinical relevance remain unclear. Only little data is published studying quantitative disc height reduction (DHR) as indicator for ASD in long-term follow-up. Forty patients (23 men, 17 women) (group 1: degenerative disc disease, n = 27; group 2: lytic spondylolisthesis, n = 13) underwent lumbar 360° instrumentation and fu...

Schulte, Tobias L.; Leistra, Freek; Bullmann, Viola; Osada, Nani; Vieth, Volker; Marquardt, Bjo?rn; Lerner, Thomas; Liljenqvist, Ulf; Hackenberg, Lars

2007-01-01

196

Traumatic lumbar hernia: can't afford to miss.  

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We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation. PMID:24424984

Saboo, Sachin S; Khurana, Bharti; Desai, Naman; Juan, Yu-Hsiang; Landman, Wendy; Sodickson, Aaron; Gates, Jonathan

2014-06-01

197

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... Second question: can this procedure be performed at cervical spine area? Well, the neck, no, unfortunately not. We' ... serve as fusion. Because this is a lumbar spine fusion done through a minimal lateral access approach. And ...

198

Extreme Lateral Interbody Fusion Procedure  

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

199

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... with an open procedure, what we call a standard open procedure, it is always a potential for ... and it's considered a lumber -- it's considered a standard lumbar spine fusion. The difference is the approach, ...

200

Extreme Lateral Interbody Fusion Procedure  

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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 ...

 
 
 
 
201

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... down to the psoas muscle that is a large muscle that helps stabilize the spine. From there, ... the lumbar spine with the nerve. That's the large muscle that we call the psoas. This muscle ...

202

Extreme Lateral Interbody Fusion Procedure  

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

203

Extreme Lateral Interbody Fusion Procedure  

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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. ...

204

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... the patient on a lateral decubitus position, that means right side is down, and he's using the ... patient is suffering from severe lumbar spondylosis. That means damage to the disc space, damage to the ...

205

Extreme Lateral Interbody Fusion Procedure  

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Full Text Available ... going to stimulate in order to map the nerves on the lumbar plexus. And with the NeuroVision ... tell me how far I am from the nerves. Generally, numbers 20 or more -- 20 or more ...

206

Biomechanics of Lateral Interbody Spacers: Going Wider for Going Stiffer  

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

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

2012-01-01

207

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

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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...

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

2009-01-01

208

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

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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

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

2010-12-01

209

Tricortical cervical inter-body screw fixation.  

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A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cas...

1997-01-01

210

Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis.  

Science.gov (United States)

Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1 year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4-L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n=1), rupture of anterior longitudinal ligament (n=2), wound breakdown (n=2), cardiac instability (n=1), pedicle fracture (n=1), and nonunion requiring revision (n=1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels. PMID:23906522

Caputo, Adam M; Michael, Keith W; Chapman, Todd M; Jennings, Jason M; Hubbard, Elizabeth W; Isaacs, Robert E; Brown, Christopher R

2013-11-01

211

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

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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.

Ghysen Alain

2007-03-01

212

Lumbar spine CT scan  

Science.gov (United States)

CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... stopping.) A computer creates separate images of the spine area, called slices. These images can be stored, ...

213

Tricortical cervical inter-body screw fixation.  

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Full Text Available A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cases only tricortical screws without the metal plate were used for fixation. The advantages of the technique are discussed.

Goel A

1997-01-01

214

Cervical disc prosthesis replacement and interbody fusion — a comparative study  

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The purpose of this paper is to compare the new functional intervertebral cervical disc prosthesis replacement and the classical interbody fusion operation, including the clinical effect and maintenance of the stability and segmental motion of cervical vertebrae. Twenty-four patients with single C5-6 intervertebral disk hernias were specifically selected and divided randomly into two groups: One group underwent artificial cervical disc replacement and the other group received interbody fusion...

Peng-fei, Sun; Yu–hua, Jia

2008-01-01

215

Bilateral spondylolysis of inferior articular processes of the fourth lumbar vertebra: a case report.  

Science.gov (United States)

Lumbar spondylolysis, a well known cause of low back pain, usually affects the pars interarticularis of a lower lumbar vertebra and rarely involves the articular processes. We report a rare case of bilateral spondylolysis of inferior articular processes of L4 vertebra that caused spinal canal stenosis with a significant segmental instability at L4/5 and scoliosis. A 31-year-old male who had suffered from low back pain since he was a teenager presented with numbness of the right lower leg and scoliosis. Plain X-rays revealed bilateral spondylolysis of inferior articular processes of L4, anterolisthesis of the L4 vertebral body, and right lateral wedging of the L4/5 disc with compensatory scoliosis in the cephalad portion of the spine. MR images revealed spinal canal stenosis at the L4/5 disc level. Posterior lumbar interbody fusion of the L4/5 was performed, and his symptoms were relieved. PMID:22111522

Koakutsu, Tomoaki; Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin; Itoi, Eiji

2012-03-01

216

Lumbar Spinal Canal Stenosis  

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... on the spine's bones and joints can also cause lumbar spinal canal stenosis. Is lumbar spinal canal stenosis the same as ... can I do to prevent or relieve pain cause by lumbar spinal canal stenosis? Will lumbar spinal canal stenosis get worse? What ...

217

Applying hierarchical task analysis to improving the patient positioning for direct lateral interbody fusion in spinal surgery.  

Science.gov (United States)

The present study brings together for the first time the techniques of hierarchical task analysis (HTA), human error identification (HEI), and business process management (BPM) to select practices that can eliminate or reduce potential errors in a surgical setting. We applied the above approaches to the improvement of the patient positioning process for lumbar spine surgery referred to as 'direct lateral interbody fusion' (DLIF). Observations were conducted to gain knowledge on current DLIF positioning practices, and an HTA was constructed. Potential errors associated with the practices specific to DLIF patient positioning were identified. Based on literature review and expert views alternative practices are proposed aimed at improving the DLIF patient positioning process. To our knowledge, this is the first attempt to use BPM in association with HEI/HTA for the purpose of improving the performance and safety of a surgical process - with promising results. PMID:24332824

Al-Hakim, Latif; Maiping, Tanaphon; Sevdalis, Nick

2014-07-01

218

Effects of lumbar spinal fusion on the other lumbar intervertebral levels (three-dimensional finite element analysis).  

Science.gov (United States)

The risk of accelerating the degeneration of adjacent disc levels after lumbar spinal fusion is a controversial issue. A finite element model consisting of L1 to L5 lumbar spines was used to assess the effect on adjacent disc level after lumbar spinal fusion. We compared intact, L4/5 posterior interbody fusion (PLF), and L4/5 posterior lumbar interbody fusion (PLIF) models. The loading conditions applied were compressive force, compressive force plus flexion moment, and compressive force plus extension moment. Evaluations were made for von Mises stress on each vertebral end-plate, Tresca stress of all the annulus fibrosus, and Tresca stress of the annulus fibrosus from the posterior surface of the disc to the neural foramen. As the result, the von Mises stress adjacent to the fusion level was higher than the other nonfusion levels; it was higher under conditions of flexion moment loading plus compression loading [112% (2.59 PMa) in the PLF model and 117% (2.72 Mpa) in the PLIF model] than in the intact model. The Tresca stress of all the annulus fibrosus adjacent to the fusion level was higher than that on other nonfusion intervertebral levels; it was higher under conditions of flexion moment loading plus compression loading [127% (0.57 PMa) in the PLF model and 209% (0.89 Mpa) in the PLIF model] than in the intact model. The Tresca stress of the annulus fibrosus from the posterior surface of the disc to the neural foramen adjacent to the fusion level was higher than that on other nonfusion intervertebral levels; and it was higher under conditions of flexion moment loading plus compression loading [107% (1.48 PMa) in the PLF model and 112% (1.54 Mpa) in the PLIF model] than in the intact model. These findings demonstrate that with lumbar fusion, stresses on the vertebral end-plate and the annulus fibrosus were high adjacent to the fusion level; furthermore, stresses were higher in the PLIF model than in the PLF model. These results suggested that lumbar spinal fusion might bring with it a risk of damage to the annulus fibrosus and the vertebral end-plate adjacent to the fusion level. PMID:12898313

Goto, Keisuke; Tajima, Naoya; Chosa, Etsuo; Totoribe, Koji; Kubo, Shinichiro; Kuroki, Hiroshi; Arai, Takashi

2003-01-01

219

The finite element modeling and analysis of human lumbar segment herniation  

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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.

HUANG Ju-ying

2012-08-01

220

Lumbar puncture (image)  

Science.gov (United States)

... liquid cushion. CSF is usually obtained through a lumbar puncture (spinal tap). During the procedure, a needle is inserted usually between the 3rd and 4th lumbar vertebrae and the CSF fluid is collected for ...

 
 
 
 
221

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 ... 5. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med . 2008;358(8):818- ...

222

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 ...

223

Congenital Lumbar Hernia  

Directory of Open Access Journals (Sweden)

Full Text Available Lumbar hernia is a rare hernia. It constitutes less than one percent of all abdominal hernias. It can becongenital or acquired. Acquired can occur either spontaneously or after surgery or trauma. Only 300cases of lumbar hernia are reported till date. We report a case of congenital lumbar hernia in one month oldmale baby

Sanjay Sharma

2008-01-01

224

The rising psoas sign: an analysis of preoperative imaging characteristics of aborted minimally invasive lateral interbody fusions at L4-5.  

Science.gov (United States)

Minimally invasive lateral interbody fusion for the treatment of degenerative disc disease, spondylolisthesis, or scoliosis is becoming increasingly popular. The approach at L4-5 carries the highest risk of nerve injury given the proximity of the lumbar plexus and femoral nerve. The authors present 3 cases that were aborted during the approach because of pervasive electromyography responses throughout the L4-5 disc space. Preoperative imaging characteristics of psoas muscle anatomy in all 3 cases are analyzed and discussed. In all cases, the psoas muscle on axial views was rising away from the vertebral column as opposed to its typical location lateral to it. Preoperative evaluation of psoas muscle anatomy is important. A rising psoas muscle at L4-5 on axial imaging may complicate a lateral approach. PMID:24606002

Voyadzis, Jean-Marc; Felbaum, Daniel; Rhee, Jay

2014-05-01

225

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available Minimally Invasive Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today you’re joining ... seeing a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a ...

226

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available Minimally Invasive Lumbar Discectomy January 28, 2009 Welcome to OR live. I’m Dr. Sean Kanniff. To today you’re joining us at ... a procedure called a “minimally invasive microscopic lumbar discectomy.” Now this is a patient who a 46- ...

227

Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy.  

Science.gov (United States)

Posterior lateral endoscopic nucleotomy is widely accepted as a minimally invasive surgery for lumbar disc herniation, but few studies have compared the transforaminal approach using two different techniques, YESS and TESSYS. One hundred and fifty lumbar IVFs of cadaveric spines were studied. Eighteen-gauge needles were inserted percutaneously toward IVFs into the discs by either YESS or TESSYS. The distances from the needle to the nerve root and from the needle to the spinal dura were measured and compared across different spinal segments. The incidence of nerve roots compression by the operating endoscope was measured. The mean distances from needle to the nerve root and spinal dura in YESS were 3.5?±?1.4 mm and 6.6?±?1.9 mm. The respective mean distances in TESSYS were 4.6?±?1.5 mm and 5.9?±?1.4 mm. The distance from needle to the nerve root was longer in TESSYS, while the distance from the needle to spinal dura was longer in YESS. The distance from needle to nerve was shorter in proximal segments. The incidence of operating endoscope compression of the nerve root was high in both of techniques. The difference in theory and design between YESS and TESSYS, "intradisc" versus "intracanal", was confirmed by comparison of anatomic distances from the needle to the nerve. Puncture of the annulus in the distal lumbar is safer than proximal puncture. The high incidence of endoscope compression of the nerve root may be related with the transient postoperative dysaesthesia. PMID:23824995

Xin, Gu; Shi-Sheng, He; Hai-Long, Zhang

2013-09-01

228

Lumbar myelography on outpatients  

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54 outpatients who were referred with the clinical diagnosis lumbar disk herniation, underwent lumbar myelography with iohexol. After the examination, the patient returned to the ward where he was observed for about 2 hours while resting in a chair. He was then allowed to leave the hospital with the recommendation to avoid hard physical exercise for the next 24 hours. No serious complications occured. Severe headache was reported by 20% of the patients and 22% experienced transient minor discomfort. It is concluded that lumbar iohexol myeolography can be performed safely on ambulatory patients.

Aasly, J.; Anke, I.M. (University and Regional Hospital, Tromsoe (Norway))

1989-03-01

229

Minimally Invasive Lumbar Discectomy  

Medline Plus

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 ...

230

Minimally Invasive Lumbar Discectomy  

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Full Text Available ... main differences between this minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? ... know, with this particular operation, I mean in terms of recovery time, what are we looking at ...

231

Minimally Invasive Lumbar Discectomy  

Medline Plus

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

232

Lumbar (Open) Microscopic Discectomy  

Science.gov (United States)

Open Discectomy Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. When the outer wall ... area and into one or both legs. Open discectomy uses surgery to remove part of the damaged ...

233

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... the lumbar nerve roots. But without getting some imaging studies, you’re really not going to know ... to what’s going on, but he really needs imaging study, and that really, today, relies on an ...

234

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... this minimally invasive approach in terms of, you know, effectiveness of treating lumbar herniations? 2 Well, the ... more on top here. Okay. Is there, you know, with this particular operation, I mean in terms ...

235

Lumbar peritoneal shunt  

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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 bas...

Yadav Yad; Parihar Vijay; Sinha Mallika

2010-01-01

236

Direct lateral interbody fusion (DLIF) at the lumbosacral junction L5-S1.  

Science.gov (United States)

The direct lateral interbody fusion (DLIF), a minimally invasive lateral approach for placement of an interbody fusion device, does not require nerve root retraction or any contact with the great vessels and can lead to short operative times with little blood loss. Due to anatomical restrictions, this procedure has not been used at the lumbosacral (L5-S1) junction. Lumbosacral transitional vertebrae (LSTV), a structural anomaly of the lumbosacral spine associated with low back pain, can result in a level being wrongly identified pre-operatively due to misnumbering of the vertebral levels. To our knowledge, use of the DLIF graft in this patient is the first report of an interbody fusion graft being placed at the disc space between the LSTV and S1 via the transpsoas route. We present a review of the literature regarding the LSTV variation as well as the lateral placement of interbody fusion grafts at the lumbosacral junction. PMID:22551586

Shirzadi, Ali; Birch, Kurtis; Drazin, Doniel; Liu, John C; Acosta, Frank

2012-07-01

237

Lumbar puncture (spinal tap) (image)  

Science.gov (United States)

A lumbar puncture, or spinal tap, is a procedure to collect cerebrospinal fluid to check for the presence of ... is inserted, usually between the 3rd and 4th lumbar vertebrae in the lower spine. Once the needle ...

238

Lumbar spinal surgery - series (image)  

Science.gov (United States)

Lumbar (lower back) spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes ... spinal column around the spinal cord. Symptoms of lumbar spine problems include: pain that extends (radiates) from ...

239

SACRALISATION OF LUMBAR VERTEBRAE  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Lumbar backache is a very common problem nowadays. Sacralisation of lumbar vertebrae is one of the cause for that. During routine osteology teaching a sacrum with incomplete attached lumbar 5 vertebrae is seen. Observation: Incompletely fused L 5 vertebrae with sacrum is seen. The bodies of the vertebrae are fused but the transverse process of left side is completely fused with the ala of sacrum.But on the right side is incompletely fused. Conclusion: The person is usually asymptomatic or may present with symptoms which include spinal or radicular pain, disc degeneration, L4/L5 disc prolapse, lumbar scoliosis and lumbar extradural defects. In transitional lumbosacral segmentation, it was observed that the lumbosacral intervertebral disc is significantly narrowed. The incidence of disc herniation is found to be higher and can occur even at young ages. There was also relationship established between transitional vertebrae and the degree of slippage in spondylolytic spondylolisthesis. In addition, this anomaly has known implications in the field of disc surgery.

Sangeeta Wazir

2014-06-01

240

QUANTIFICATION OF LUMBAR ENDURANCE ON A BACKUP LUMBAR EXTENSION DYNAMOMETER  

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

Staci M. Hager

2006-12-01

 
 
 
 
241

Evaluation of unilateral cage-instrumented fixation for lumbar spine  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background To investigate how unilateral cage-instrumented posterior lumbar interbody fusion (PLIF affects the three-dimensional flexibility in degenerative disc disease by comparing the biomechanical characteristics of unilateral and bilateral cage-instrumented PLIF. Methods Twelve motion segments in sheep lumbar spine specimens were tested for flexion, extension, axial rotation, and lateral bending by nondestructive flexibility test method using a nonconstrained testing apparatus. The specimens were divided into two equal groups. Group 1 received unilateral procedures while group 2 received bilateral procedures. Laminectomy, facectomy, discectomy, cage insertion and transpedicle screw insertion were performed sequentially after testing the intact status. Changes in range of motion (ROM and neutral zone (NZ were compared between unilateral and bilateral cage-instrumented PLIF. Results Both ROM and NZ, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF, transpedicle screw insertion procedure did not revealed a significant difference between flexion-extension, lateral bending and axial rotation direction except the ROM in the axial rotation. The bilateral group's ROM (-1.7 ± 0. 8 of axial rotation was decreased significantly after transpedicle screw insertion procedure in comparison with the unilateral group (-0.2 ± 0.1. In the unilateral cage-instrumented PLIF group, the transpedicle screw insertion procedure did not demonstrate a significant difference between right and left side in the lateral bending and axial rotation direction. Conclusions Based on the results of this study, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF have similar stability after transpedicle screw fixation in the sheep spine model. The unilateral approach can substantially reduce exposure requirements. It also offers the biomechanics advantage of construction using anterior column support combined with pedicle screws just as the bilateral cage-instrumented group. The unpleasant effect of couple motion resulting from inherent asymmetry was absent in the unilateral group.

Chen Hung-Yi

2010-11-01

242

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... Another part that is a problem is the cervical spine, inside the neck because that’s also very mobile. ... these minimally invasive procedures also be used for cervical spine problems? Yeah. We perform micro-lumbar surgical procedures ...

243

Iatrogenic lumbar pseudomeningocele.  

Science.gov (United States)

The authors describe two cases of pseudomeningocele after surgery for herniated lumbar disc. In order to prevent this rare complication, they suggest to suture the dura and to put on it oxycel or gelfoam every time there is a fluid leakage. The patient has to be placed in Trendelenburg's position for about seven days. PMID:3564761

Rocca, A; Turtas, S; Pirisi, A; Agnetti, V

1986-01-01

244

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... nerve compression on one of the lumbar nerve roots. But without getting some imaging studies, you’re ... I don’t want to damage the nerve root as I mobilize it. It’s really the disc ...

245

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... MRI is by far the gold standard for evaluation of the lumbar spine. Okay. If they can’t have an MRI, is the CT myelogram still in use? Very rarely. We have not performed the myelogram here at Baptist Hospital for many years, except in very rare occasions ...

246

Minimally Invasive Lumbar Discectomy  

Medline Plus

Full Text Available ... or whether it’s a degenerative process that lumbar spinal stenosis, which is a very common problem that presents ... the biggest risk factors over there, which are genetics and which are your age. ... ago was traction, spinal traction. Is that still being used? Someone wants ...

247

Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization.  

Science.gov (United States)

The aim of the current study was to evaluate changes in lumbar kinematics after lumbar monosegmental instrumented surgery with rigid fusion and dynamic non-fusion stabilization. A total of 77 lumbar spinal stenosis patients with L4 degenerative spondylolisthesis underwent L4-5 monosegmental posterior instrumented surgery. Of these, 36 patients were treated with rigid fusion (transforaminal lumbar interbody fusion) and 41 with dynamic stabilization [segmental spinal correction system (SSCS)]. Lumbar kinematics was evaluated with functional radiographs preoperatively and at final follow-up postoperatively. We defined the contribution of each segmental mobility to the total lumbar mobility as the percent segmental mobility [(sagittal angular motion of each segment in degrees)/(total sagittal angular motion in degrees) × 100]. Magnetic resonance imaging was performed on all patients preoperatively and at final follow-up postoperatively. The discs were classified into five grades based on the previously reported system. We defined the progress of disc degeneration as (grade at final follow-up) - (grade at preoperatively). No significant kinematical differences were shown at any of the lumbar segments preoperatively; however, significant differences were observed at the L2-3, L4-5, and L5-S1 segments postoperatively between the groups. At final follow-up, all of the lumbar segments with rigid fusion demonstrated significantly greater disc degeneration than those with dynamic stabilization. Our results suggest that the SSCS preserved 14% of the kinematical operations at the instrumented segment. The SSCS may prevent excessive effects on adjacent segmental kinematics and may prevent the incidence of adjacent segment disorder. PMID:21301893

Morishita, Yuichiro; Ohta, Hideki; Naito, Masatoshi; Matsumoto, Yoshiyuki; Huang, George; Tatsumi, Masato; Takemitsu, Yoshiharu; Kida, Hirotaka

2011-09-01

248

Active thoracic and lumbar spinal tuberculosis in children with kyphotic deformity treated by one-stage posterior instrumentation combined anterior debridement: preliminary study.  

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The aim of this study was to retrospectively evaluate the safety, feasibility and efficacy of one-stage posterior instrumentation combined anterior debridement and interbody fusion for treatment of active thoracic and lumbar spinal tuberculosis (TB) in children with kyphotic deformity. A total of 20 children (12 boys, 8 girls) were enrolled in this study from January 2006 to January 2011. All patients underwent one-stage posterior instrumentation combined anterior debridement and interbody fusion. Clinical and radiographic results were analyzed. Patients were followed up for 28.9 months on average. Improvement was shown in all patients with neurologic dysfunction according to American Spinal Injury Association Impairment Scale. The mean preoperative angle of kyphosis was 35.2° ± 6.8° (range 26°-47°), which reduced to 9.7° ± 1.8° (range 6°-13°) postoperatively. The mean angle of kyphosis at the last follow-up was 12.0° ± 1.9° (range 9°-15°). Erythrocyte sedimentation rate and C-reactive protein returned to normal in all patients within 6 months after surgery. All patients acquired bony fusion, and no major complications were observed through the final follow-up visit. One-stage posterior instrumentation combined anterior debridement and fusion were demonstrated to be a safe and effective method to achieve spinal decompression and kyphosis correction in children with thoracic and lumbar spinal TB. PMID:24700338

Hu, Jianzhong; Li, Dongzhe; Kang, Yijun; Pang, Xiaoyang; Wu, Tianding; Duan, Chunyue; Cao, Yong

2014-07-01

249

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion.  

Science.gov (United States)

In an attempt to enhance the potential to achieve a solid arthrodesis and avoid the morbidity of harvesting autologous iliac crest bone (AICB) for a lumbar fusion, numerous alternatives have been investigated. The use of these fusion adjuncts has become routine despite a lack of convincing evidence demonstrating a benefit to justify added costs or potential harm. Potential alternatives to AICB include locally harvested autograft, calcium-phosphate salts, demineralized bone matrix (DBM), and the family of bone morphogenetic proteins (BMPs). In particular, no option has created greater controversy than the BMPs. A significant increase in the number of publications, particularly with respect to the BMPs, has taken place since the release of the original guidelines. Both DBM and the calciumphosphate salts have demonstrated efficacy as a graft extender or as a substitute for AICB when combined with local autograft. The use of recombinant human BMP-2 (rhBMP-2) as a substitute for AICB, when performing an interbody lumbar fusion, is considered an option since similar outcomes have been observed; however, the potential for heterotopic bone formation is a concern. The use of rhBMP-2, when combined with calcium phosphates, as a substitute for AICB, or as an extender, when used with local autograft or AICB, is also considered an option as similar fusion rates and clinical outcomes have been observed. Surgeons electing to use BMPs should be aware of a growing body of literature demonstrating unique complications associated with the use of BMPs. PMID:24980593

Kaiser, Michael G; Groff, Michael W; Watters, William C; Ghogawala, Zoher; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Sharan, Alok; Wang, Jeffrey C; Dhall, Sanjay S; Resnick, Daniel K

2014-07-01

250

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

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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

Liang ZHOU

2014-01-01

251

Percutaneous lumbar discectomy in the treatment of lumbar discitis  

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Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial cul...

Haaker, R. G.; Senkal, M.; Kielich, T.; Kra?mer, J.

1997-01-01

252

Congenital lumbar hernia.  

Science.gov (United States)

Congenital lumbar hernia (CLH) is a rare anomaly with only 45 cases reported in the English-language literature. This paper describes nine patients with CLH treated in our unit. Unusual features included the relatively high incidence of inferior lumbar hernia, presentation at the age of 6 years in one case, and an association with hydrometrocolpos and anorectal malformation, which is hitherto unreported. In seven patients the hernia could be repaired successfully. One patients' parents refused surgery for the CLH after treatment of a hydrometrocolpos and another died of fulminant pneumonia before the operation. Early operation is the treatment of choice, and repair with local tissues is preferable. The need for prosthetic material arises when the size of the defect is large. A successful operation offers a good quality of life. PMID:10663870

Wakhlu, A; Wakhlu, A K

2000-01-01

253

Lumbar-sacral dysplasias  

International Nuclear Information System (INIS)

By means of some selected examples, the myelographic and CT characteristics are presentated of different lumbar-sacral dysplasias. The advantage of the different methodes of examination (CT, CT myelography and myelography) and the improved presentation of pathological-anatomical details by means of a combination of these methods in the diagnosis of hyperplasia of the filum terminale, diastematomyelia, tethered conus, intracorporal and anterior sacral meningocele have been shown. (orig.)

1984-09-01

254

Laparoscopic lumbar spine surgery  

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The use of transperitoneal endoscopic approaches to the distal segments of the lumbar spine has recently been described. This has been the catalyst for the development of other minimally invasive anterior ¶approaches to the spine. This review looks at the published results so ¶far, and highlights the principles, techniques and complications. The limitations of laparoscopic approaches have meant that surgeons are moving on to endoscopic extraperitoneal and mini-open approaches, but important...

O’dowd, J. K.

2000-01-01

255

Lumbar spinal stenosis.  

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Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful...

1993-01-01

256

Complications of lumbar puncture.  

Science.gov (United States)

This article reviews historical aspects and the following complications of lumbar puncture: cerebral and spinal herniation, postdural puncture headache, cranial neuropathies, nerve root irritation, low back pain, stylet associated problems, infections, and bleeding complications. The incidence of postdural puncture headache can be greatly reduced by pointing the face of the bevel in the direction of the patient's side, replacing the stylet and rotating the needle 90;dg before withdrawing the needle, and using the Sprotte atraumatic needle, especially in high risk patients. PMID:9421542

Evans, R W

1998-02-01

257

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)

1991-01-01

258

Anterior cervical fusion with interbody cage containing ?-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up  

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A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of ?-tricalcium phosphate (?-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing ?-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the ...

2008-01-01

259

IMAGENOLOGIA DEL DOLOR LUMBAR  

Scientific Electronic Library Online (English)

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

Cristian, Matus Y; Eugenio, Galilea M; Aliro, San Martín M.

260

Lumbar spinal stenosis  

International Nuclear Information System (INIS)

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

1982-12-01

 
 
 
 
261

Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: report of 2 cases.  

Science.gov (United States)

The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported. The anterior Maverick device has a ball-and-socket design made of cobalt-chromium-molybdenum metal plates covered with hydroxyapatite. The superior and inferior endplates have keels to resist translation forces. The patient in Case 1 was a 52-year-old man with severe L4-5 discogenic pain; and in Case 2, a 42-year-old woman with disabling L4-5 and L5-S1 discogenic back pain. Both patients were without medical comorbidities and were nonsmokers with no risk factors for osteoporosis. Both had undergone uneventful retroperitoneal approaches performed by a vascular access surgeon. Computed tomography studies on postoperative Day 2 confirmed excellent prosthesis placement. Initial recoveries were uneventful. Two weeks postoperatively, after stretching (extension or hyperextension) in bed at home, each patient suffered the sudden onset of severe abdominal pain with anterior dislocation of the Maverick prosthesis. The patients were returned to the operating room and underwent surgery performed by the same spinal and vascular surgeons. Removal of the Maverick prosthesis and anterior interbody fusion with a separate cage and plate were performed. Both patients had recovered well with good clinical and radiological recovery at the 6- and 12-month follow-ups. Possible causes of the anterior dislocation of the Maverick prosthesis include the following: 1) surgeon error: In both cases the keel cuts were neat, and early postoperative CT confirmed good placement of the prosthesis; 2) equipment problem: The keel cuts may have been too large because the cutters were worn, which led to an inadequate press fit of the implants; 3) prosthesis fault: Both plates of the dislocated implants looked normal and manufacturer analysis reported no fault; 4) patient factors: Both dislocations happened early in the postoperative period, after hyperextension of the spine while the patient was supine in bed. Bracing would not have reduced hyperextension. Dislocation of a lumbar spinal implant represents a life-threatening complication and should therefore be considered and recognized early. Radiographic and CT studies of both the lumbar spine (for prosthesis) and the abdomen (for hematoma) should be performed, as should CT angiography (for vessel damage or occlusion). Any anterior lumbar revision surgery is hazardous, and it is strongly advisable to have a vascular surgeon scrubbed. In cases of dislocation or extrusion of a lumbar interbody prosthesis, the salvage revision strategy is fusing the segment via the same anterior approach. Surgeons should be aware of the risk of anterior dislocation of the Maverick prosthesis. Keel cutters should be regularly checked for sharpness, as they may be implicated in the loosening of implants. Patients and their physical therapists should also avoid lumbar hyperextension in the early postoperative period. PMID:23768025

Gragnaniello, Cristian; Seex, Kevin A; Eisermann, Lukas G; Claydon, Matthew H; Malham, Gregory M

2013-08-01

262

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography  

International Nuclear Information System (INIS)

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. (orig.)

1987-01-01

263

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography  

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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.

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

1987-07-01

264

Outcome of Salvage Lumbar Fusion after Lumbar Arthroplasty  

Science.gov (United States)

Study Design Retrospective review. Purpose This study aims to define the role of lumbar fusion for persistent back pains after the lumbar disc replacement. Overview of Literature Little is written about lumbar fusion after optimally placed lumbar arthroplasty in patients with persistent lower back pains. Methods Retrospective review of cases of lumbar artificial disc requiring subsequent fusion because of persistent back pains despite optimally placed artificial discs. Outcomes were evaluated using Oswestry Disability Index (ODI) and visual analogue scale (VAS). Clinical improvements indicated 25% improvement in ODI and VAS values. Results Five patients met the study criteria. The mean baseline ODI for the five patients was 52. The mean baseline VAS scores for back and leg pains were 76 and 26, respectively. All the five patients had optimally placed prosthesis. The indication for surgery was the constant low back pains found in all the patients. Revision surgery involved disc explantation and fusion in two of the patients and posterolateral fusion without removing the prosthesis in three. None of the patients achieved adequate pain control after the revision surgery despite the solid bony fusion documented by postoperative computed tomography. The mean ODI value after the fusion was 55. The mean values for back and leg pains VAS were 72 and 30, respectively. Conclusions Lack of good pain relief after successful lumbar artifical disc replacements may indicate different etiology for the back pains. The spine-treating surgeons should have a high threshold level to perform salvage fusion at that level.

Deutsch, Harel

2014-01-01

265

Lumbar disk herniations  

International Nuclear Information System (INIS)

This paper reports that little is known concerning spontaneous CT changes of lumbar disk herniations occurring after relief of sciatic pain in patients treated conservatively. Twenty-one consecutive patients underwent CT at the time of presentation with sciatic (n = 19) or femoral (n = 2) nerve root pain and again more than 6 months (12.9 months) after relief of the pain. In all 21 patients, a herniated disk (HD) was seen on the initial CT scan. Eleven patients had a large HD, possibly extruded in five cases. All patients were treated conservatively. None underwent intradiskal therapy. Size and location of the HD on the initial and follow-up CT scans were compared blindly

1990-11-25

266

Ameliorative percutaneous lumbar discectomy  

International Nuclear Information System (INIS)

Objective: To ameliorate the percutaneous lumbar discectomy (APLD) for improving the effectiveness and amplifying the indicative range of PLD. Methods: To ameliorate percutaneous punctured route based on classic PLD and discectomy of extracting pulp out of the herniated disc with special pulpforceps. The statistical analysis of the therapeutic results on 750 disc protrusions of 655 cases undergone APLD following up from 6 to 54 months retrospectively. Results: The effective ratios were excellent in 40.2%, good for 46.6% and bad of 13.3%. No occurrance of intervertebral inflammation and paradiscal hematoma, there were only 1 case complicated with injuried cauda equina, and 4 cases with broken appliance within disc. Conclusions: APLD is effective and safe, not only indicative for inclusion disc herniation, but also for noninclusion herniation. (authors)

2005-06-01

267

Percutaneous lumbar discectomy  

International Nuclear Information System (INIS)

Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

2004-04-01

268

[Intradural lumbar disk hernia].  

Science.gov (United States)

Intradural disc herniation is a rare complication of degenerative disc disease. A correct diagnosis of this process is frequently difficult. If this entity is not preoperatively diagnosed and is omitted at surgery, severe neurologic sequels may be provoked. We report a case of a pathologically proven intradural disc herniation preoperatively diagnosed by MR imaging. Clinically, it was manifested by sudden onset of right leg ciatalgia and progressive right lower extremity weakness. The patient also referred a one-month history of sexual dysfunction. MR imaging revealed interruption of the low signal of the anulus fibrosus and of the posterior longitudinal ligament at L2-L3 level and a voluminous disc fragment migrated in the dural sac that showed rim enhancement with gadolinium.The clinical, neuroradiological, and surgical management of lumbar intradural disc herniation are reviewed. PMID:11412713

Alonso-Bartolomé, P; Canga, A; Vázquez-Barquero, A; García-Valtuille, R; Abascal, F; Cerezal, L

2001-04-01

269

Lumbar myelography with iohexol  

International Nuclear Information System (INIS)

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

1988-01-01

270

Lumbar peritoneal shunt  

Directory of Open Access Journals (Sweden)

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.

Yadav Yad

2010-01-01

271

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.)

2011-06-01

272

Lumbar spondylolysis: a review  

Energy Technology Data Exchange (ETDEWEB)

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.)

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

273

Lumbar peritoneal shunt.  

Science.gov (United States)

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. PMID:20508332

Yadav, Yad R; Parihar, Vijay; Sinha, Mallika

2010-01-01

274

Radicular interdural lumbar disc herniation  

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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...

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

2010-01-01

275

Hybrid construct for two levels disc disease in lumbar spine.  

Science.gov (United States)

Prospective study. To study the validity of Hybrid construction (Anterior Lumbar Interbody Fusion) ALIF at one level and total disc arthroplasty (TDA) at adjacent, for two levels disc disease in lumbar spine as surgical strategy. With growing evidence that fusion constructs in the treatment of degenerative disc disease (DDD) may alter sagittal balance and contribute to undesirable complications in the long-term, total disc arthroplasty (TDA) slowly becomes an accepted treatment option for a selected group of patients. Despite encouraging early and intermediate term results of single-level total disc arthroplasty reported in the literature, there is growing evidence that two-level arthroplasty does not fare as well. Hybrid fusion is an attempt to address two-level DDD by combining the advantages of a single-level ALIF with those of a single-level arthroplasty. 42 patients (25 females and 17 males) underwent Hybrid fusion and had a median follow-up of 26.3 months. The primary functional outcomes were assessed before and after surgery with Oswestry Disability Index and the visual analogue score of the back and legs. Patients were divided into four groups according to the percentage improvement between preop and postop ODI scores. A total of 42 patients underwent a hybrid fusion as follows: 35 L5-S1 ALIF/L4-5 prosthesis, 3 L4-5 ALIF/L3-4 prosthesis, 2 L5-S1 ALIF/L4-5 prosthesis/L3-4 prosthesis, 1 L5-S1 prosthesis/L4-5 ALIF, and 1 L5-S1 ALIF/L4-5 ALIF/L3-4 prosthesis. At 2-years clinical outcomes, mean reduction in ODI is 24.9 points (53.0% improvement compared to preop ODI). The visual analogue score for the back is 64.6% improvement. At 2-year clinical outcomes, Hybrid fusion is a viable surgical alternative for the treatment of two-level DDD in comparison with two-level TDA and with two-level fusion. PMID:19888610

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

2010-02-01

276

Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture  

Science.gov (United States)

Background Currently, Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. But progressive kyphosis and a high rate of hardware failure because of lack of the anterior column support remains a concern. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages. Methods A consecutive series of 20 patients with isolated thoracolumbar/lumbar burst fractures were treated by posterior short segment pedicle screw fixation and transforaminal thoracolumbar/lumbar interbody fusion (TLIF) between January 2005 and December 2007. All patients were followed up for a minimum of 2 years. Demographic data, neurologic status, anterior vertebral body heights, segmental Cobb angle and treatment-related complications were evaluated. Results The mean operative time was 167 minutes (range, 150–220). Blood loss was 450 ~ 1200 ml, an average of 820 ml. All patients recovered with solid fusion of the intervertebral bone graft, without main complications like misplacement of the pedicle screw, nerve or vessel lesion or hard ware failure. The post-operative radiographs demonstrated a good fracture reduction and it was well maintained until the bone graft fusion. Neurological recovery of one to three Frankel grade was seen in 14 patients with partial neurological deficit, three grades of improvement was seen in one patient, two grades of improvement was observed in 6 patients and one grade of improvement was found in 6 patients. All the 6 patients with no paraplegia on admission remained neurological intact, and in one patient with Frankel D on admission no improvement was observed. Conclusion Posterior short-segment pedicle fixation in conjunction with TLIF seems to be a feasible option in the management of selected thoracolumbar/lumbar burst fractures, thereby addressing all the three columns through a single approach with less trauma and good results.

2014-01-01

277

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

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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 clinica...

2010-01-01

278

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

Directory of Open Access Journals (Sweden)

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.

Arai Y

2002-06-01

279

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

Directory of Open Access Journals (Sweden)

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.

Webb John K

2002-10-01

280

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

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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 que 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 in...

2012-01-01

 
 
 
 
281

Quistes sinoviales lumbares  

Scientific Electronic Library Online (English)

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

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

282

Lumbar spinal stenosis  

International Nuclear Information System (INIS)

Spinal stenosis, which has attracted increasing attention in recent years, represents an important group of clinical and radiologic entities. Recognition and ultimate surgical management of the many abnormalities found in this group require precise preoperative delineation of the morbid anatomy. Conventional axial tomography provided the first accurate picture of the sagittal dimension, but it was limited by poor contrast resolution. Computerized tomography and ultrasound have finally provided the means for accurate measurement of midsagittal diameter and surface area. It is now possible to provide a preoperative assessment of bony and soft-tissue canal compression and to guide surgical decompression by objective anatomic measurements. True spinal stenosis of the lumbar vertebral canal is a form of compression produced by the walls of the vertebral canal. It involves the whole of the vertebral canal by exerting compression at two of its opposite surfaces. There are two types of stenosis: (1) transport stenosis, wherein the clinical manifestations are due to impeded flow of fluid, which is dependent on the available cross-sectional area of the canal surface of the stenotic structure, and (2) compressive stenosis, which includes abnormal compression of opposing surfaces only. According to these definitions, indentation on the spinal canal by disc protrusion or localized tumor is not considered true spinal stenoses. In this chapter the authors discuss only those conditions that produce true canal stenosis

1985-01-01

283

Fractures of the Thoracic and Lumbar Spine  

Science.gov (United States)

... Orthopaedic Surgeons. Fractures of the Thoracic and Lumbar Spine A spinal fracture is a serious injury. The most common fractures of the spine occur in the thoracic (midback) and lumbar spine ( ...

284

Lumbar pedicle: surgical anatomic evaluation and relationships  

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Although several clinical applications of transpedicular screw fixation in the lumbar spine have been documented for many years, few anatomic studies concerning the lumbar pedicle and adjacent neural structures have been published. The lumbar pedicle and its relationships to adjacent neural structures were investigated through an anatomic study. Our objective is to highlight important considerations in performing transpedicular screw fixation in the lumbar spine. Twenty cadavers were used for...

Attar, Ayhan; Ugur, Hasan Caglar; Uz, Aysun; Tekdemir, Ibrahim; Egemen, Nihat; Genc, Yasemin

2001-01-01

285

LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING  

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

2013-01-01

286

One-Stage Posterior Debridement and Transpedicular Screw Fixation for Treating Monosegmental Thoracic and Lumbar Spinal Tuberculosis in Adults  

Science.gov (United States)

Spinal tuberculosis is still prevalent in some developing countries. The purpose of this study is to investigate the efficacy and safety of one-stage posterior debridement, autogenous bone grafting, and transpedicular screw fixation in treating monosegmental thoracic and lumbar tuberculosis in adults. 37 patients were retrospectively reviewed in this study. The data of images, operative time and blood loss volume, perioperative complications, time to achieve bony fusion, VAS score, and neurologic function preoperatively and postoperatively were collected. The mean follow-up period was 21.5 ± 3.5 months. The tuberculosis was cured after surgery in all patients, and no recurrence was observed. Bony fusion was achieved in all patients with a mean time of 5.6 ± 2.5 months. Neurological outcome did not change in one case with grade A, and increased by 1–3 grades in the other patients with nerve deficit. The average preoperative and postoperative VAS scores were 5.5 ± 2.23 and 1.5 ± 1.22, respectively; the difference was significant (P < 0.05). There were three perioperative complications (8.1%, 3/37) observed in this study. In conclusion, the procedure of one-stage posterior debridement, interbody fusion with autogenous bone grafting, and posterior fixation with pedicle screw is effective and safe for treating monosegmental thoracic and lumbar spinal tuberculosis in adults.

Liu, Zhili; Peng, Aifeng; Long, Xinhua; Yang, Dong; Huang, Shanhu

2014-01-01

287

Analysis of the effect of lumbar spine fusion on the superior adjacent intervertebral disk in the presence of disk degeneration, using the three-dimensional finite element method.  

Science.gov (United States)

The purpose of this study was to analyze the effect of lumbar spine fusion on the superior adjacent intervertebral disk in the context of disk degeneration, using a nonlinear three-dimensional finite element method. Detailed L3-L5 motion segment models of normal and degenerated intervertebral disks were developed. In fusion models, L4-L5 was fixed by either posterolateral fusion or posterior lumbar interbody fusion (PLIF). Various loading conditions such as compression loading, compression loading plus flexion moment loading, or compression loading plus extension moment loading were applied to study the corresponding stress. Tresca stress on the posterolateral part of intervertebral annulus fiber and von Mises stress on the vertebral endplate (the superior and inferior sides of L3 and L4) were reduced in all degenerated disk models compared with the normal disk models. The PLIF model showed an increase in the percentage change of stress on the vertebral endplate and on the intervertebral annulus fibrosus when flexion and extension moment loadings were applied. This finding suggests that surgeons should consider the risk of exacerbating degeneration of intervertebral disks by undertaking lumbar spine fusion, when degeneration is found in intervertebral disks adjacent to vertebrae requiring fusion. PMID:15260097

Chosa, Etsuo; Goto, Keisuke; Totoribe, Koji; Tajima, Naoya

2004-04-01

288

Subsidence of stand-alone cervical cages in anterior interbody fusion: warning  

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Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages in vivo. We retrospectively reviewed eight patients with cervical radiculopathy opera...

2003-01-01

289

Anterior cervical allograft arthrodesis and instrumentation: Multilevel interbody grafting or strut graft reconstruction  

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This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidenc...

Swank, M. L.; Lowery, G. L.; Bhat, A. L.; Mcdonough, R. F.

1997-01-01

290

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

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

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

2006-01-01

291

49 CFR 572.187 - Lumbar spine.  

Science.gov (United States)

... 7 2010-10-01 2010-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...Dummy, 50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in...

2010-10-01

292

49 CFR 572.187 - Lumbar spine.  

Science.gov (United States)

... 2010-10-01 2010-10-01 false Lumbar spine. 572.187 Section 572.187 Transportation...50th Percentile Adult Male § 572.187 Lumbar spine. (a) The lumbar spine assembly consists of parts shown in drawing...

2010-10-01

293

Functional lumbar myelography with iohexol  

Energy Technology Data Exchange (ETDEWEB)

The results of 25 functional lumbar myelographies with iohexol are reported. The image quality was good or excellent in all. The side effects were mostly mild and showed that the same frequency as reported in lumbar and thoracic myelographies with metrizamide. A slight increase in the frequency of side effects was found in 13 patients with spinal repuncture 6 or 24 hours after the myelography. Vacuolized monocytes in ultracentrifuged CSF following repuncture was found in 5 patients. No EEG changes or serious complications were found. Iohexol is considered safe in intrathecal use.

Nakstad, P.; Aaserud, O.; Sortland, O.; Nyberg-Hansen, R. (Rikshospitalet, Oslo (Norway))

1983-01-01

294

Functional lumbar myelography with iohexol  

International Nuclear Information System (INIS)

The results of 25 functional lumbar myelographies with iohexol are reported. The image quality was good or excellent in all. The side effects were mostly mild and showed that the same frequency as reported in lumbar and thoracic myelographies with metrizamide. A slight increase in the frequency of side effects was found in 13 patients with spinal repuncture 6 or 24 hours after the myelography. Vacuolized monocytes in ultracentrifuged CSF following repuncture was found in 5 patients. No EEG changes or serious complications were found. Iohexol is considered safe in intrathecal use. (Auth.)

1983-01-01

295

Radiology of lumbar spinal stenosis  

International Nuclear Information System (INIS)

Lumbar spinal stenosis is a frequent cause of low back pain. In this paper we discuss both the pathophysiology and clinical symptomatology of the disease. We also discuss advantages and limitations of plain film radiography, myelography, CT and MRI in its diagnosis. Following an analysis of the pertinent literature we try to determine the relative merit of the various radiologic procedures as to their true representation of clinical and intraoperative findings and faithful rendition of postoperative results. Until sufficient statistically valid data regarding the clinical significance of radiological findings have accumulated, surgery of lumbar spinal stenosis can only be performed after critical evaluation of the individual case. (orig.)

1996-07-01

296

Minimally invasive spine surgery for adult degenerative lumbar scoliosis.  

Science.gov (United States)

Object Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. Methods In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. Results Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). Conclusions The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies. PMID:24785489

Dangelmajer, Sean; Zadnik, Patricia L; Rodriguez, Samuel T; Gokaslan, Ziya L; Sciubba, Daniel M

2014-05-01

297

Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine.  

Science.gov (United States)

The lateral extracavitary approach was used for single-staged tumor resection in 12 patients with complex dumbbell or paraspinal tumors of the thoracic and lumbar spine. Six women and six men (age, 28-72 yr) were treated between August 1990 and January 1994. The tumors included schwannoma (6 patients), malignant meningioma (1 patient), hemangioma (1 patient), chondrosarcoma (1 patient), osteocartilaginous exostosis (1 patient), radiation-induced osteogenic sarcoma (1 patient), and metastatic renal carcinoma (1 patient). Gross total resection was achieved in 11 patients. Radical subtotal removal was performed in the remaining patient, who had a malignant osteogenic sarcoma. Concomitant spinal stabilization with internal fixation and anterior interbody strut grafting was performed on two patients. No significant perioperative complications occurred. Ten patients were alive and clinically stable at follow-up visits ranging from 14 to 55 months. Two patients died from systemic tumor dissemination during the follow-up period. The lateral extracavitary approach is useful when extensive or difficult spinal and paraspinal exposure is required. The surgical aspects of these neoplasms and the technique of lateral extracavitary approach are described in detail. PMID:8747953

McCormick, P C

1996-01-01

298

Computed tomography-guided percutaneous facet screw fixation in the lumbar spine. Technical note.  

Science.gov (United States)

The authors describe a new minimally invasive technique for posterior supplementation using percutaneous translaminar facet screw (TFS) fixation with computed tomography (CT) guidance. Oblique axial images were used to determine facet screw fixation sites. After the induction of local anesthesia and conscious sedation, a guide pin was inserted and guided with a laser mounted on the CT gantry. Cannulated TFSs were placed via a percutaneous approach. From December 2002 to August 2003, 18 patients underwent CT-guided TFS. In 17 of these patients this procedure was supplementary to anterior lumbar interbody fusion, which had been performed several days earlier; in the remaining patient, CT-guided TFS fixation was undertaken as the primary therapy. Twelve patients had painful degenerative disc disease or unstable degenerative spondylolisthesis, three had infections, and three had deformities. All screws were inserted accurately and there were no complications. This new minimally invasive surgical technique may offer an alternative to pedicle screw fixation as a method of posterior supplementation. PMID:17633496

Kang, Ho Yeong; Lee, Sang-Ho; Jeon, Sang Hyeop; Shin, Song-Woo

2007-07-01

299

Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis / microsurgical discectomy/ PLIF with cages.  

Science.gov (United States)

The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1-4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications. PMID:15744815

Kuh, Sung-Uk; Kim, Young-Soo; Cho, Young-Eun; Yoon, Young-Sul; Jin, Byung-Ho; Kim, Keun-Su; Chin, Dong-Kyu

2005-02-28

300

Lumbar myelography with omnipaque (iohexol)  

International Nuclear Information System (INIS)

Lumbar myelography with iohexol (Omnipaque) was performed in 103 consecutive adult patients with low back pain or sciatica. The patients were observed for 48 h with registration of possible adverse reactions. Mild or moderate transient side effects were recorded in 24 patients. No serious adverse reactions were noted, and EEG recorded in 25 patients showed no changes. (orig.)

1986-01-01

 
 
 
 
301

Lumbar myelography with Omnipaque (iohexol)  

Energy Technology Data Exchange (ETDEWEB)

Lumbar myelography with iohexol (Omnipaque) was performed in 103 consecutive adult patients with low back pain or sciatica. The patients were observed for 48 h with registration of possible adverse reactions. Mild or moderate transient side effects were recorded in 24 patients. No serious adverse reactions were noted, and EEG recorded in 25 patients showed no changes.

Lilleaas, F.; Bach-Gansmo, T.; Weber, H.

1986-07-01

302

Chondroblastoma of the lumbar vertebra  

Energy Technology Data Exchange (ETDEWEB)

Chondroblastoma of the vertebra is a very rare condition. To our knowledge fewer than 20 cases have been reported in the world literature. We report a 54-year-old man with chondroblastoma of the fifth lumbar vertebra. The clinical and radiological aspects of the tumor are discussed, emphasizing the presence of an extraosseous mass suggestive of locally aggressive behavior. (orig.)

Leung, L.Y.J.; Shu, S.J.; Chan, M.K.; Chan, C.H.S. [Dept. of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (Hong Kong)

2001-12-01

303

MR myelography for lumbar disease  

Energy Technology Data Exchange (ETDEWEB)

The usefulness of MR myelography for lumbar diseases was assessed. The subjects were 92 patients (48 males and 44 females) who had undergone MR myelography since April 1998. The MR myelography studies were performed under the following conditions: turbo spin echo, TR=9000 ms, TE=600 ms, 320 mm FOV, 35 mm slice thickness, and 512 matrix, clear images of the nerve roots were obtained as a result. Three cases (lumbar disk herniation, stenosis of the lumbar spinal canal, and low back pain) are for the most part described. The MR myelograms were inferior to the X-ray myelograms in bone imaging and functional imaging, but MR myelography is non-invasive, there is no risk of infection or iodine allergy, and it can be performed on an out patient basis. MR myelography of the lumbar portion of the spine became more useful after image processing. In the future MR myelography is expected to be performed not only as a preliminary study, but as a substitute for X-ray myelography. (K.H.)

Ohno, Takuya; Takigawa, Souichirou; Aihara, Masanori; Nagai, Takashi; Hasegawa, Makoto [Showa Univ., Tokyo (Japan). Toyosu Hospital; Fujimaki, Etsuo

2000-02-01

304

Hematoma epidural lumbar crónico espontáneo / Chronic spontaneous lumbar epidural hematoma  

Scientific Electronic Library Online (English)

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

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

305

49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.  

Science.gov (United States)

... 2010-10-01 2010-10-01 false Lumbar spine, abdomen, and pelvis. 572.9...DEVICES 50th Percentile Male § 572.9 Lumbar spine, abdomen, and pelvis. (a) The lumbar spine, abdomen, and pelvis consist...

2010-10-01

306

Lumbar Epidural Varix Mimicking Perineural Cyst  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery...

Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent; Izci, Yusuf

2013-01-01

307

Lumbar instability: an evolving and challenging concept  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Identification and management of chronic lumbar spine instability is a clinical challenge for manual physical therapists. Chronic lumbar instability is presented as a term that can encompass two types of lumbar instability: mechanical (radiographic) and functional (clinical) instability (FLI). The components of mechanical and FLI are presented relative to the development of a physical therapy diagnosis and management. The purpose of this paper is to review the historical framework of chronic ...

Beazell, James R.; Mullins, Melise; Grindstaff, Terry L.

2010-01-01

308

CT-guided lumbar sympathectomy  

International Nuclear Information System (INIS)

Experiences gained up to now have shown CT-guided lumbar sympathectomy to be a procedure low in side-effects as well as in costs that is additionally characterised by long-term efficacy and has a large range of indications. The absence of severe side-effects and modest costs would appear to justify the use of this method on a very broad basis. (orig.)

1992-07-01

309

Laparoscopic transabdominal extraperitoneal mesh repair of lumbar hernia  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hern...

Nam, Soon Young; Kee, Se Kook; Kim, Jae Oh

2011-01-01

310

Lumbar instability: an evolving and challenging concept  

Science.gov (United States)

Identification and management of chronic lumbar spine instability is a clinical challenge for manual physical therapists. Chronic lumbar instability is presented as a term that can encompass two types of lumbar instability: mechanical (radiographic) and functional (clinical) instability (FLI). The components of mechanical and FLI are presented relative to the development of a physical therapy diagnosis and management. The purpose of this paper is to review the historical framework of chronic lumbar spine instability from a physical therapy perspective and to summarize current research relative to clinical diagnosis in physical therapy.

Beazell, James R; Mullins, Melise; Grindstaff, Terry L

2010-01-01

311

Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6 ± 10?y/o; 73.1% female; 27.4 ± 3.4?BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures wer...

Marchi, Luis; Abdala, Nitamar; Oliveira, Leonardo; Amaral, Rodrigo; Coutinho, Etevaldo; Pimenta, Luiz

2012-01-01

312

Minimally invasive lumbar decompression for the treatment of spinal stenosis of the lumbar spine.  

Science.gov (United States)

SUMMARY Lumbar spinal stenosis is one of the most common degenerative diseases of the elderly population, and a major cause of debilitating pain and decreased function. Lumbar spinal stenosis is almost always associated with neurogenic claudication characterized as pain worsened by standing or walking and relieved by lumbar flexion or sitting. While initial treatment of lumbar spinal stenosis may involve conservative therapies, as patients become more symptomatic the traditional treatment path has generally led to open laminectomy and other invasive, potentially destabilizing, procedures. More recently, less invasive alternatives to wide laminectomy have been developed. This article describes a new method of percutaneous lumbar decompression for treatment of neurogenic claudication secondary to lumbar spinal stenosis, the minimally invasive lumbar decompression procedure. We review the steps of successfully decompressing the hypertrophic ligamentum flavum and lamina, thereby alleviating pressure on neural structures. This is a major innovation in patient care and a step to reduce risks while minimizing costs. PMID:24645862

Deer, Timothy

2012-09-01

313

Osteomielitis vertebral lumbar / Ostéomyélite vertébrale lombaire / Lumbar vertebral osteomyelitis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

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

314

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: Assessment of economic outcome.  

Science.gov (United States)

A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion. PMID:24980580

Ghogawala, Zoher; Whitmore, Robert G; Watters, William C; Sharan, Alok; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Eck, Jason C; Groff, Michael W; Wang, Jeffrey C; Resnick, Daniel K; Dhall, Sanjay S; Kaiser, Michael G

2014-07-01

315

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status.  

Science.gov (United States)

The ability to identify a successful arthrodesis is an essential element in the management of patients undergoing lumbar fusion procedures. The hypothetical gold standard of intraoperative exploration to identify, under direct observation, a solid arthrodesis is an impractical alternative. Therefore, radiographic assessment remains the most viable instrument to evaluate for a successful arthrodesis. Static radiographs, particularly in the presence of instrumentation, are not recommended. In the absence of spinal instrumentation, lack of motion on flexion-extension radiographs is highly suggestive of a successful fusion; however, motion observed at the treated levels does not necessarily predict pseudarthrosis. The degree of motion on dynamic views that would distinguish between a successful arthrodesis and pseudarthrosis has not been clearly defined. Computed tomography with fine-cut axial images and multiplanar views is recommended and appears to be the most sensitive for assessing fusion following instrumented posterolateral and anterior lumbar interbody fusions. For suspected symptomatic pseudarthrosis, a combination of techniques including static and dynamic radiographs as well as CT images is recommended as an option. Lack of facet fusion is considered to be more suggestive of a pseudarthrosis compared with absence of bridging posterolateral bone. Studies exploring additional noninvasive modalities of fusion assessment have demonstrated either poor potential, such as with (99m)Tc bone scans, or provide insufficient information to formulate a definitive recommendation. PMID:24980581

Choudhri, Tanvir F; Mummaneni, Praveen V; Dhall, Sanjay S; Eck, Jason C; Groff, Michael W; Ghogawala, Zoher; Watters, William C; Dailey, Andrew T; Resnick, Daniel K; Sharan, Alok; Wang, Jeffrey C; Kaiser, Michael G

2014-07-01

316

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.

2009-04-01

317

Homeopatía y dolor lumbar Homeopathy and lumbar pain  

Directory of Open Access Journals (Sweden)

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.

Eva María Castro Morillo

2011-02-01

318

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

Scientific Electronic Library Online (English)

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

Martin, Lima; William, Pérez.

319

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

Directory of Open Access Journals (Sweden)

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

Martin Lima

2007-12-01

320

DOLOR LUMBAR RELACIONADO AL EMBARAZO  

Scientific Electronic Library Online (English)

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

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

 
 
 
 
321

The value of high intensity zone in diagnosing lumbar annular disruption before lumbar intradiscal ozone injection  

International Nuclear Information System (INIS)

Objective: To investigate the sensitivity, specificity and the clinical value of high intensity zone (HIZ) in the detection of annular disruption before lumbar intradiscal ozone injection. Methods: Retrospective analysis was taken for patients undergone MR and lumbar intradiscal ozone injection from July 2005 to Sep. 2006. The correlation of HIZ with annular disruption found during lumbar intradiscal ozone injection was investigated. Results: One hundred and thirteen discs in 68 patients with back and/or radicular pain were examined with lumbar intradiscal ozone injection. Seventy one disc with HIZ were identified on MRI with annular disruption found during lumbar intradiscal ozone injection. The sensitivity and specificity of HIZ in diagnosing annular disruption were 90.9% and 85% respectively, with a positive correlation between HIZ and the lumbar annular disruption. Conclusions: HIZ on MRI is a marker for annular disruption, with high sensitivity and specificity; and helpful for treatment approach selection. (authors)

2007-03-01

322

Estenosis espinal lumbar degenerativa / Degenerative spinal lumbar stenosis  

Scientific Electronic Library Online (English)

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

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

323

CT imaging in lumbar disc disease  

International Nuclear Information System (INIS)

A CT/T 8800 (General Electric) CT scanner was used to study lumbar disc disease in fifty patients. In seven patients so-called computed tomography mexrizamide myelography was performed, whereas in the remaining cases no contrast enhancement was used. Multiplanar reconstructions were done. Irradiation exposure was measured during the investigations and compared with data during conventional myelography. We found that lumbar CT scanning is not a screening method in cases of lumbar disease, but the aimed use gives further information about the underlying process and its differential diagnosis. Multidirectional reconstructions reduce the number of diagnostic errors. This procedure does not increase the radiation exposure dose in comparison with conventional myelography. (Author)

1983-01-01

324

Gonadal dose reduction in lumbar spine radiography  

International Nuclear Information System (INIS)

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

1983-02-01

325

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.Los cordomas son tumores poco frecuentes que pueden presentarse en cualquier parte de la columna vertebral y en el clivus. Sólo un mínimo porcenta...

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

2005-01-01

326

Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy.  

Science.gov (United States)

Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy. PMID:24811105

Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

2014-01-01

327

Lumbar epidural varix mimicking perineural cyst.  

Science.gov (United States)

Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent; Izci, Yusuf

2013-06-01

328

Cervical myelopathy due to nuclear herniations in young adults: clinical and radiological profile, results of microdiscectomy without interbody fusion.  

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A study was made of the clinical and radiological characteristics and the results of microsurgical discectomy without interbody fusion, of 26 young adults, who presented with cervical myelopathy due to nuclear herniations. Neck trauma was not a significant aetiological factor. The disease produced moderate to very severe functional disability in most patients (73%), in a relatively short period (mean symptom duration 6.3 months). Radiological assessment revealed the presence of canal stenosis...

Selladurai, B. M.

1992-01-01

329

Congenital block vertebrae in lumbar spine  

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A 34-year-old female visited our rheumatology clinic with the complaint of non-inflammatory back pain that usually occurred on bending down and radiated to bilateral lower limbs. A diagnosis of compressive neuropathy was suspected and an initially performed digital X-ray of lumbar spine revealed a rare congenital anomaly termed as ‘Congenital block vertebrae’ in the lumbar spine (Fig 1).Block vertebrae, a congenital anomaly, occurs due to improper segmentation of vertebral column during f...

2013-01-01

330

Lumbar epidural perineural injection: a new technique  

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Two controlled studies for a new epidural, perineural, singleshot, selective nerve root injection with a double-needle approach to the anterior epidural space of the lumbar spinal canal are presented. The results were analysed to determine the effectiveness of the new epidural perineural injection technique. The trial comprised two controlled studies on 182 patients. One study compared prospectively randomized results of patients with lumbar radicular syndromes who received epidural perineura...

Kraemer, J.; Ludwig, J.; Bickert, U.; Owczarek, V.; Traupe, M.

1997-01-01

331

Minimally invasive 360° instrumented lumbar fusion  

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A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach ¶anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral ¶fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflat...

Thalgott, J. S.; Chin, A. K.; Ameriks, J. A.; Jordan, F. T.; Giuffre, J. M.; Fritts, K.; Timlin, M.

2000-01-01

332

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

1990-01-01

333

Posteroanterior versus anteroposterior lumbar spine radiology.  

Science.gov (United States)

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. PMID:2338520

Tsuno, M M; Shu, G J

1990-01-01

334

Posteroanterior versus anteroposterior lumbar spine radiology  

Energy Technology Data Exchange (ETDEWEB)

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.

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

1990-03-01

335

Para-muscular and trans-muscular approaches to the lumbar inter-vertebral foramen: an anatomical comparison Acessos paramuscular e transmuscular ao forame intervertebral lombar: comparação anatômica  

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Full Text Available Foraminal and extra-foraminal disc herniations comprise up to 11.7% of all lumbar disc herniations. Facetectomy, which had been the classic approach, is now recognized as cause of pain and instability after surgery. Otherwise, posterior lateral approaches through a trans-muscular or a para-muscular technique offer no significant damage to key structures for spinal stability. The surgical anatomy of these approaches has already been described, but they were not compared. In order to quantify the angle of vision towards the intervertebral foramen offered by each technique, 12 fresh cadavers were dissected and studied regarding these approaches. The angle presented by trans-muscular approach was wider in all studied lumbar levels. Surgery through the trans-muscular approach is performed with a better working angle, requiring a smaller resection of surrounding tissues. Therefore, minor surgical trauma can be expected. Our measurements support previously published data that point the trans-muscular approach as the best surgical option.As hérnias de disco lombares apresentam-se como foraminais ou extra-foraminais em até 11,7% dos casos. Seu tratamento cirúrgico através de facetectomias pode causar dor e instabilidade, o que não ocorre com a utilização de acessos cirúrgicos posteriores laterais ao canal central, quer seja por via transmuscular ou paramuscular. Nosso objetivo foi comparar o ângulo de trabalho relativo ao forame intervertebral permitido por cada via e avaliar possíveis implicações cirúrgicas. Dissecções e medidas realizadas em doze cadáveres frescos demonstraram que este ângulo é maior na via transmuscular em todos os níveis lombares estudados. Dado que um ângulo mais favorável permite uma ressecção menor das estruturas envolvidas para que se estabeleça o campo de trabalho, a cirurgia por meio da via transmuscular permitirá, então, um trauma cirúrgico menor. Nossos resultados corroboram publicações prévias que apontam a via transmuscular como a melhor opção cirúrgica.

Arthur Werner Poetscher

2005-03-01

336

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

Scientific Electronic Library Online (English)

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

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

337

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

338

Headache and Meningismus Following Lumbar Puncture  

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Full Text Available Post-lumbar puncture headache is the most common complication of lumbar puncture. This condition is thought to be the result of persistent cerebrospinal fluid leakage at the puncture site, leading to low cerebrospinal fluid pressure and traction on the meninges and intracranial veins. Associated symptoms may include nausea, vomiting, auditory and vestibular symptoms. Meningeal irritation signs are unexpected as clinical findings unless serious medical conditions such as subarachnoid hemorrhage or meningitis occur. We are present a case of headache and meningismus following by lumbar puncture. A 17-year-old female presented to the emergency department suffering from headache, nausea and vomiting, starting one day after a lumbar puncture procedure. The characteristics of the headache were different and more severe than the previous form. Her vital signs and physical and detailed neurological examination were normal, except meningismus findings such as neck stiffness and Brudzinksy’s sign. Since the meningismus findings were unexpected, lumbar puncture was performed again to diagnose meningitis and subarachnoid hemorrhage. Cerebrospinal fluid pressure, protein, glucose, microscopic examination, blood and cerebrospinal fluid cultures were normal. Finally, magnetic resonance imaging of the brain revealed no pathological meningeal enhancement. In patients harboring uncontrollable factors, variables such as needle size, bevel orientation and the avoidance of traumatic lumbar puncture should be taken into consideration more seriously than ever. Furthermore, since, meningeal irritation signs such as neck stiffness and Brudzinksy’s and Kernig’s signs are not the expected clinical findings of post-lumbar puncture headache, serious medical conditions such as subarachnoid hemorrhage and meningeal infections should be investigated in the emergency setting.

F?rat Bekta?

2012-06-01

339

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

International Nuclear Information System (INIS)

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

2001-01-01

340

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.)

2002-06-01

 
 
 
 
341

MR-guided lumbar sympathicolysis  

Energy Technology Data Exchange (ETDEWEB)

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.)

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

342

Transforaminal Percutaneous Endoscopic Lumbar Discectomy  

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Full Text Available Background: In this study we analyzed and presented our experience of performing transforaminalpercutaneous endoscopic lumbar discectomy (TPELD.Methods: A retrospective study of 142 TPELD was conducted on 134 consecutivepatients from 2001 through 2005. The inclusion criteria for patients werethose who had leg pain with or without low back pain and magnetic resonanceimaging (MRI that revealed soft contained or noncontained but contiguouslumbar disc herniation (LDH. All patients failed at least 6 weeks ofconservative treatment or could not tolerate it.Results: The patients had an average age of 38 years. The mean follow-up period was8 months. The outcomes were evaluated using the modified MacNab criteria.The percentage of successful outcomes (excellent or good was 89%. Amongthe remainder of the patients, six (4.5% had open surgery later. Moreover,eight patients (6% sustained temporary dysesthesia over the proximal lowerlimb of the operated side. No major neurovascular injuries or deathsoccurred.Conclusions: In experienced hands, TPELD is minimally invasive, safe and effective fortreating soft contained or noncontained but contiguous LDH.

Wen-Ching Tzaan

2007-06-01

343

MRI after successful lumbar discectomy  

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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.

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

344

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

1996-05-01

345

Lumbar Hernia: An Unusual Presentation of Bear Maul  

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Full Text Available Introduction: Typical lumbar hernias are very rare surgical conditions. Lumbar hernias can be congenital or acquired. About 25% of all lumbar hernias have a traumatic etiology. Case-Report: We here reported a case of a 55-year-old male who was mauled by a bear. The patient developed an atypical lumbar hernia after 6 months of sustaining craniofacial and abdominal trauma. Open hernioplasty, which was a very challenging job, was done in this patient. Conclusion: Post traumatic lumbar hernias have been reported but till today no case of lumbar hernia following an attack by a bear has been reported in literature. Both acute and long-standing post-traumatic lumbar hernias are rare but challenging conditions. The corrective surgical procedure becomes more complex as hernial defect enlarges. Reconstruction is a challenging aspect of lumbar hernia surgery.

Mubashir Ahmad Shah

2013-10-01

346

Discitis pospunción lumbar en un niño  

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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.

Nelson Fuentes Rodríguez

2004-06-01

347

Dolor lumbar agudo: mecanismos, enfoque y tratamiento  

Directory of Open Access Journals (Sweden)

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.

Marco Tulio Mahecha Toro

2009-10-01

348

Discographic demonstration of a posttraumatic transvertebral lumbar disc herniation  

International Nuclear Information System (INIS)

The differential-diagnostic and methodological difficulties in demonstrating rare traumatic lesions of the lumbar intervertebral discs are described, in which transvertebral herniation of the nucleus pulposus through the compressed vertebral body along the fracture lines take place. The diagnosis could only be established by transdural lumbar discography. The neuroradiological findings and the validity of lumbar discography in comparison to the other investigations of the lumbar spine with help of contrast material are discussed. (orig.)

1981-01-01

349

Is bed rest useful after diagnostic lumbar puncture?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A randomized study of 110 patients undergoing their first diagnostic lumbar puncture was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache. There was no difference between the mobile (n = 54) and bed rest (n = 56) groups in the incidence of post lumbar puncture headache (32% versus 31%, respectively). We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient, as well as on...

Spriggs, D. A.; Burn, D. J.; French, J.; Cartlidge, N. E.; Bates, D.

1992-01-01

350

49 CFR 572.85 - Lumbar spine flexure.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572...DEVICES 9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected...with paragraph (b) of this section, the lumbar spine assembly shall flex by an...

2010-10-01

351

49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Lumbar spine, abdomen, and pelvis. 572.9 Section... 50th Percentile Male § 572.9 Lumbar spine, abdomen, and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the...

2010-10-01

352

49 CFR 572.19 - Lumbar spine, abdomen and pelvis.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Lumbar spine, abdomen and pelvis. 572.19 Section... 3-Year-Old Child § 572.19 Lumbar spine, abdomen and pelvis. (a) The lumbar spine, abdomen, and pelvis consist of the...

2010-10-01

353

49 CFR 572.85 - Lumbar spine flexure.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Lumbar spine flexure. 572.85 Section 572.85...9-Month Old Child § 572.85 Lumbar spine flexure. (a) When subjected to continuously...paragraph (b) of this section, the lumbar spine assembly shall flex by an amount that...

2010-10-01

354

Vertebral body size in lumbar spinal canal stenosis  

International Nuclear Information System (INIS)

The transverse and sagittal diameters of the lumbar vertebral bodies have been compared in patients with symptoms and myelographic findings consistent with stenosis of the lumbar canal, in patients with some narrowing of the lumbar canal, and in patients without clinical or myelographic indication of stenosis. No significant difference in the measured diameters was found. (Auth.)

1980-01-01

355

Congenital block vertebrae in lumbar spine  

Directory of Open Access Journals (Sweden)

Full Text Available A 34-year-old female visited our rheumatology clinic with the complaint of non-inflammatory back pain that usually occurred on bending down and radiated to bilateral lower limbs. A diagnosis of compressive neuropathy was suspected and an initially performed digital X-ray of lumbar spine revealed a rare congenital anomaly termed as ‘Congenital block vertebrae’ in the lumbar spine (Fig 1.Block vertebrae, a congenital anomaly, occurs due to improper segmentation of vertebral column during fetal development. Improper segmentation leads to fusion of adjacent vertebrae through their inter-vertebral disc. The most common site of this deformity is cervical spine and the lumbar vertebral involvement is rare. The disco-vertebral articulation is always involved and depending on the degree of involvement, the presenting complaints could be either neurological due to the compression of nerve roots or scoliosis due to the vertebral deformity.

Ankur Nandan Varshney

2013-05-01

356

Image quality in conventional lumbar spine radiography  

International Nuclear Information System (INIS)

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

2009-05-01

357

Functional oblique views of the lumbar spine  

International Nuclear Information System (INIS)

The first part of the paper deals with measurements of 152 radiographs. It was found that the conventional views of the lumbar spine in two planes can demonstrate only 49.1% of the articular joints. Oblique views in two planes increase the accuracy to 88.7%. In view of the relatively high accuracy of the oblique views, these were used as the basis for a new functional method for examining the intervertebral joints. For this examination, oblique views of the lumbar spine are taken in the lordotic and kyphotic positions. The position of the patient during the examination is described in detail. In the second part of the paper, the results of measurements of 80 functional examinations are evaluated. Average values for the mobility of individual elements of the lumbar spine have been derived. Finally, the practical value of the new technique is demonstrated. Its special place for subluxations and spondylolyses is stressed. (orig.)

1980-01-01

358

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.)

1990-01-01

359

Biomechanical implications of lumbar spinal ligament transection.  

Science.gov (United States)

Many lumbar spine surgeries either intentionally or inadvertently damage or transect spinal ligaments. The purpose of this work was to quantify the previously unknown biomechanical consequences of isolated spinal ligament transection on the remaining spinal ligaments (stress transfer), vertebrae (bone remodelling stimulus) and intervertebral discs (disc pressure) of the lumbar spine. A finite element model of the full lumbar spine was developed and validated against experimental data and tested in the primary modes of spinal motion in the intact condition. Once a ligament was removed, stress increased in the remaining spinal ligaments and changes occurred in vertebral strain energy, but disc pressure remained similar. All major biomechanical changes occurred at the same spinal level as the transected ligament, with minor changes at adjacent levels. This work demonstrates that iatrogenic damage to spinal ligaments disturbs the load sharing within the spinal ligament network and may induce significant clinically relevant changes in the spinal motion segment. PMID:23477405

Von Forell, Gregory A; Bowden, Anton E

2014-11-01

360

Interlaminar decompression in lumbar canal stenosis.  

Directory of Open Access Journals (Sweden)

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.

Patond K

1999-10-01

 
 
 
 
361

Degenerative lumbar spinal stenosis: evaluation and management.  

Science.gov (United States)

Degenerative lumbar spinal stenosis is caused by mechanical factors and/or biochemical alterations within the intervertebral disk that lead to disk space collapse, facet joint hypertrophy, soft-tissue infolding, and osteophyte formation, which narrows the space available for the thecal sac and exiting nerve roots. The clinical consequence of this compression is neurogenic claudication and varying degrees of leg and back pain. Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly. The natural history of this condition varies; however, it has not been shown to worsen progressively. Nonsurgical management consists of nonsteroidal anti-inflammatory drugs, physical therapy, and epidural steroid injections. If nonsurgical management is unsuccessful and neurologic decline persists or progresses, surgical treatment, most commonly laminectomy, is indicated. Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis. PMID:22855855

Issack, Paul S; Cunningham, Matthew E; Pumberger, Matthias; Hughes, Alexander P; Cammisa, Frank P

2012-08-01

362

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

Science.gov (United States)

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. PMID:12118123

Chotivichit, Areesak; Fujita, Takuya; Wong, Tze-Hong; Kostuik, John P; Sieber, Ann N

2001-12-01

363

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

Directory of Open Access Journals (Sweden)

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.

Chotivichit A

2001-12-01

364

Imaging of the lumbar spine after diskectomy  

International Nuclear Information System (INIS)

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs

1995-01-01

365

A reappraisal of the anatomy of the human lumbar erector spinae.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In the lumbar region the longissimus thoracis and iliocostalis lumborum are separated by the erector spinae aponeurosis and its ventral reflection--the lumbar intermuscular aponeurosis. Lumbar fibres of the longissimus arise from the ilium and the lumbar intermuscular aponeurosis and insert into the accessory processes and proximal ends of the transverse processes of the lumbar vertebrae. Lumbar fibres of iliocostalis insert into the costal elements of the first four lumbar vertebrae. The lum...

Bogduk, N.

1980-01-01

366

Ligaments associated with lumbar intervertebral foramina. 2. The fifth lumbar level.  

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The lumbosacral spines of two fetal and twelve adult cadavers have been studied by dissection. Evidence shows that the fifth lumbar intervertebral foramen is crossed on its external aspect by a strong, cord-like corporotransverse ligament passing obliquely downwards, forwards and medially from the inferior aspect of the accessory process of the fifth lumbar vertebra to the lateral surface of the intervertebral disc and the adjacent parts of the bodies of the fifth and first sacral vertebrae. ...

1988-01-01

367

Biomechanical effects of polyaxial pedicle screw fixation on the lumbosacral segments with an anterior interbody cage support  

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Full Text Available Abstract Background Lumbosacral fusion is a relatively common procedure that is used in the management of an unstable spine. The anterior interbody cage has been involved to enhance the stability of a pedicle screw construct used at the lumbosacral junction. Biomechanical differences between polyaxial and monoaxial pedicle screws linked with various rod contours were investigated to analyze the respective effects on overall construct stiffness, cage strain, rod strain, and contact ratios at the vertebra-cage junction. Methods A synthetic model composed of two ultrahigh molecular weight polyethylene blocks was used with four titanium pedicle screws (two in each block and two rods fixation to build the spinal construct along with an anterior interbody cage support. For each pair of the construct fixed with polyaxial or monoaxial screws, the linked rods were set at four configurations to simulate 0°, 7°, 14°, and 21° lordosis on the sagittal plane, and a compressive load of 300 N was applied. Strain gauges were attached to the posterior surface of the cage and to the central area of the left connecting rod. Also, the contact area between the block and the cage was measured using prescale Fuji super low pressure film for compression, flexion, lateral bending and torsion tests. Results Our main findings in the experiments with an anterior interbody cage support are as follows: 1 large segmental lordosis can decrease the stiffness of monoaxial pedicle screws constructs; 2 polyaxial screws rather than monoaxial screws combined with the cage fixation provide higher compression and flexion stiffness in 21° segmental lordosis; 3 polyaxial screws enhance the contact surface of the cage in 21° segmental lordosis. Conclusion Polyaxial screws system used in conjunction with anterior cage support yields higher contact ratio, compression and flexion stiffness of spinal constructs than monoaxial screws system does in the same model when the spinal segment is set at large lordotic angles. Polyaxial pedicle screw fixation performs nearly equal percentages of vertebra-cage contact among all constructs with different sagittal alignments, therefore enhances the stabilization effect of interbody cages in the lumbosacral area.

Chen Hsiang-Ho

2007-03-01

368

Effect of Laminectomy on Stability of Lumbar Spine Effect of Laminectomy on Stability of Lumbar Spine  

Directory of Open Access Journals (Sweden)

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

Petr Tichy

2009-12-01

369

Posterior Interspinous Fusion Device for One-Level Fusion in Degenerative Lumbar Spine Disease : Comparison with Pedicle Screw Fixation - Preliminary Report of at Least One Year Follow Up  

Science.gov (United States)

Objective Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. Methods From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. Results The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16±2.1 and 8.03±2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3±2.9 and 1.2±3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). Conclusion Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

Kim, Ho Jung; Chun, Hyoung Joon; Oh, Suck Jun; Kang, Tae Hoon; Yang, Moon Sool

2012-01-01

370

Benign fibrous histiocytoma of the lumbar vertebrae  

International Nuclear Information System (INIS)

Benign fibrous histiocytoma is an extremely rare spinal tumor with ten reported cases in the literature. Benign fibrous histiocytoma constitutes a diagnostic challenge because it shares common clinical symptoms, radiological characteristics, and histological features with other benign lesions involving the spine. We present a case of benign fibrous histiocytoma of the lumbar spine and discuss its differential diagnosis and management. (orig.)

2009-02-01

371

A case of inferior lumbar hernia  

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

2013-01-01

372

Computer tomography assisted stereotactic percutaneous lumbar discectomy  

International Nuclear Information System (INIS)

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

1997-01-01

373

Lumbar myelography with iohexol and metrizamide  

International Nuclear Information System (INIS)

Two non-ionic contrast media, iohexol and metrizamide, were compared in a double-blind clinical trial which included 50 patients who underwent lumbar myelography for disc herniation or spinal stenosis. The frequency of adverse reactions was lower for iohexol which is recommended for extended trials and for examination of other compartments of the subarachnoid space. (orig.)

1984-01-01

374

Discitis pospunción lumbar en un niño  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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 ni [...] ño 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. Abstract in english 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 pun [...] cture, 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.

Nelson, Fuentes Rodríguez; Armando, Felipe Morán; José A., Prince López.

375

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

2001-01-01

376

PEEK Cages in Lumbar Fusion: Mid-term Clinical Outcome and Radiological Fusion.  

Science.gov (United States)

STUDY DESIGN:: Historical cohort analysis. OBJECTIVE:: Evaluation of mid-term clinical outcome and radiological fusion in patients treated with a polyetheretherketone (PEEK) cage. SUMMARY OF BACKGROUND DATA:: Anterior Lumbar Interbody Fusion (ALIF) can be a good alternative in chronic low back pain when conservative treatment fails. Although titanium alloy cages give good fusion rates, disadvantages are the subsidence of the cage in the adjacent vertebrae and problematic radiological evaluation of fusion. PEEK cages, such as the Synfix-LR® cage (Synthes, Switzerland) should overcome this. METHODS:: From December 2004 until August 2007 a total of 95 patients (21 double-level, 74 single-level) with degenerative disc disease from L3-S1 were operated by a single surgeon. The number of reoperations was counted. Radiological fusion on CT-scan was scored with a new scoring system by an independent skeletal radiologist and orthopaedic surgeon. Intra-observer agreement and specificity were assessed. Clinical improvement was measured by the ODI score. The median duration of clinical follow-up was 47.7 months (range 29.9-61.6 months). RESULTS:: In total 26 patients were reoperated after a median of 17.6 months (range 6.7-46.9) of the initial surgery. In total 23 patients (18 single-level, 5 double-level) were reoperated for symptomatic pseudarthrosis. A moderate agreement (?=0.36) and a specificity of 70% and 37% for the radiologist and orthopaedic surgeon, respectively, were found for scoring bony bridging. The ODI score improved after initial surgery, but reoperated patients reported a significantly lower improvement. CONCLUSIONS:: A high number of reoperations after an ALIF-procedure with the Synfix-LR® cage was found, mainly due to symptomatic pseudarthrosis. The absence of posterior fixation in combination with lower stiffness and the hydrophobic characteristics of PEEK probably leads to insufficient initial stability, creating suboptimal conditions for bony bridging, and thus solid fusion. The proposed ease of the evaluation of radiological fusion could not be supported. Clinicians should be alert on pseudarthrosis when patients treated with the Synfix-LR® cage presented with persisted or aggravated complaints. PMID:22907069

Schimmel, Janneke J P; Poeschmann, Marcel S; Horsting, Phillip P; Schönfeld, Dirk H W; van Limbeek, Jacques; Pavlov, Paul W

2012-08-18

377

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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

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.

378

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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.

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

379

49 CFR 572.75 - Lumbar spine, abdomen, and pelvis assembly and test procedure.  

Science.gov (United States)

...2009-10-01 2009-10-01 false Lumbar spine, abdomen, and pelvis assembly... 6-Year-Old Child § 572.75 Lumbar spine, abdomen, and pelvis assembly and test procedure. (a) Lumbar spine, abdomen, and pelvis...

2009-10-01

380

Laparoscopic transabdominal extraperitoneal repair of lumbar hernia  

Directory of Open Access Journals (Sweden)

Full Text Available Lumbar hernias need to be repaired due to the risk of incarceration and strangulation. A laparoscopic intraperitoneal approach in the modified flank position causes the intraperitoneal viscera to be displaced medially away from the hernia. The creation of a wide peritoneal flap around the hernial defect helps in mobilization of the colon, increased length of margin is available for coverage of mesh and more importantly for secure fixation of the mesh under vision to the underlying fascia. Laparoscopic lumbar hernia repair by this technique is a tensionless repair that diffuses total intra-abdominal pressure on each square inch of implanted mesh. The technique follows current principles of hernia repair and appears to confer all benefits of a minimal access approach.

Sharma A

2005-01-01

 
 
 
 
381

Indental gynecological findings on lumbar spine MRI  

International Nuclear Information System (INIS)

Female genital organs are partly visible on lumbar spine MRI. Uterus and/or ovaries were partly visualized in 100 out of 227 women. The examinations were performed at a 1,5 T system. In a group of 100 patients,the abnormalities of these organs were found in 38 cases.The following diagnoses were suggested:leiomyoma in 23 cases, adenomyosis in 3, deep endometrial endometriosis in 1,endometrial carcinoma in 4, Nabothian cyst in 8, simple ovarian cyst in 1, endometrial cyst in 1, dermoid cyst in 1, ovarian cancer in 1, fluid in Douglas ' pouch in 2. Lumbar spine MRI should be interpreted using unmagnified images, including the localizer series, because of frequent incidental gynecological findings in unaware women. (author)

2004-01-01

382

Clinical trial of iohexol in lumbar myelography  

Energy Technology Data Exchange (ETDEWEB)

Iohexol containing 180 mg I/ml was used in 20 patients for lumbar myelography. By using an adequate volume up to a maximum of 15 ml, satisfactory films were obtained in all cases. Minor or moderate adverse effects occurred in 4 patients. There were no changes in vital signs or neurologic examination related to the examinations. No patient had difficulty with concentration, personality changes or seizures. Later encephalographies performed in all patients before and during 24 h after the iohexol injections, showed no seizure or abnormal activity or any significant change. Repeated lumbar puncture was performed in 9 patients 24 h after the injection of iohexol. One of these, a patient with symptoms due to disc prolapse, whose CSF was abnormal before the myelography, had a slightly increased cellular response. There was no significant change in any of the other patients. Iohexol is a very satisfactory contrast medium for myelography and compared favorably with other non-ionic contrast media.

Kendall, B.; Harrison, M.; Schneidau, A. (Middlesex Hospital, London (UK))

1983-01-01

383

Clinical trial of iohexol in lumbar myelography  

International Nuclear Information System (INIS)

Iohexol containing 180 mg I/ml was used in 20 patients for lumbar myelography. By using an adequate volume up to a maximum of 15 ml, satisfactory films were obtained in all cases. Minor or moderate adverse effects occurred in 4 patients. There were no changes in vital signs or neurologic examination related to the examinations. No patient had difficulty with concentration, personality changes or seizures. Later encephalographies performed in all patients before and during 24 h after the iohexol injections, showed no seizure or abnormal activity or any significant change. Repeated lumbar puncture was performed in 9 patients 24 h after the injection of iohexol. One of these, a patient with symptoms due to disc prolapse, whose CSF was abnormal before the myelography, had a slightly increased cellular response. There was no significant change in any of the other patients. Iohexol is a very satisfactory contrast medium for myelography and compared favorably with other non-ionic contrast media. (Auth.)

1983-01-01

384

Side effects after ambulatory lumbar iohexol myelography  

International Nuclear Information System (INIS)

Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to nonambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results support the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography. (orig.)

1989-01-01

385

Side effects after ambulatory lumbar iohexol myelography  

Energy Technology Data Exchange (ETDEWEB)

Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to nonambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results support the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography.

Sand, T.; Myhr, G.; Stovner, L.J.; Dale, L.G.; Tangerud, A.

1989-03-01

386

The imaging of lumbar spinal stenosis review  

International Nuclear Information System (INIS)

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)

2000-08-01

387

Should Cervical and Lumbar Lordosis be Evaluated on MR Imaging?  

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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 ...

2006-01-01

388

Sagittal spinal alignment in patients with lumbar disc herniation  

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A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and...

Endo, Kenji; Suzuki, Hidekazu; Tanaka, Hidetoshi; Kang, Yupeng; Yamamoto, Kengo

2010-01-01

389

Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study  

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This study investigated electromyographic (EMG) activity as a marker of nerve root irritation during two different surgical procedures for lumbar disc herniation. Mechanically elicited EMG activity was recorded during the dynamic stages of surgery in muscle groups innervated by lumbar nerve roots. Confirmation of surgical activity was correlated with the activity of the electromyogram. Fifteen patients with lumbar disc herniations were treated via an endoscopic medial approach, and 15 patient...

Schick, U.; Do?hnert, J.; Richter, A.; Ko?nig, A.; Vitzthum, H.

2002-01-01

390

Dural tears in percutaneous endoscopic lumbar discectomy  

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The objective of the study was to demonstrate the clinical characteristics of dural tears during percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent this unintended complication. The study used data from 816 consecutive patients who underwent PELD between 2003 and 2007. A total of nine patients (1.1%) experienced symptomatic dural tears. The clinical outcomes were evaluated using the visual analogue scale (VAS), the Oswestry disability index (ODI), and modified MacN...

Ahn, Yong; Lee, Ho Yeon; Lee, Sang-ho; Lee, June Ho

2011-01-01

391

Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology.  

Science.gov (United States)

Idiopathic low back pain has confounded health care practitioners for decades. Although there has been much advance in the understanding of the biomechanics of the lumbar spine over the past 25 years, the cellular and neural mechanisms that lead to facet pain are not well understood. An extensive series of experiments was undertaken to help elucidate these mechanisms and gain a better understanding of lumbar facet pain. Biomechanic and neuroanatomic studies were performed in human cadaveric facet joints and neurophysiologic studies were performed in New Zealand White rabbits. These studies provide the following evidence to help explain the mechanisms of lumbar facet pain: (1) The facet joint can carry a significant amount of the total compressive load on the spine when the human spine is hyperextended. (2) Extensive stretch of the human facet joint capsule occurs when the spine is in the physiologic range of extreme extension. (3) An extensive distribution of small nerve fibers and free and encapsulated nerve endings exists in the lumbar facet joint capsule, including nerves containing substance P, a putative neuromodulator of pain. (4) Low and high threshold mechanoreceptors fire when the facet joint capsule is stretched or is subject to localized compressive forces. (5) Sensitization and excitation of nerves in facet joint and surrounding muscle occur when the joint is inflamed or exposed to certain chemicals that are released during injury and inflammation. (6) Marked reduction in nerve activity occurs in facet tissue injected with hydrocortisone and lidocaine. Thus, the facet joint is a heavily innervated area that is subject to high stress and strain. The resulting tissue damage or inflammation is likely to cause release of chemicals irritating to the nerve endings in these joints, resulting in low back pain. PMID:8872268

Cavanaugh, J M; Ozaktay, A C; Yamashita, H T; King, A I

1996-09-01

392

Percutaneous treatment of lumbar disc herniation  

International Nuclear Information System (INIS)

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)

1994-01-01

393

Lumbar route use for abscess appendicular plastron  

International Nuclear Information System (INIS)

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. (author)

2010-01-01

394

Concomitant noncontiguous level (thoracic & lumbar) spinal stenosis  

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Presented here is a prospective study assessing the efficacy of decompression of concomitant noncontiguous level (thoracic & lumbar) stenosis in accordance with neurological findings, nerve root blocks, and myelographically proven disease. The objective was to determine the efficacy, clinical outcome, and functional recovery in patients undergoing simultaneous decompression. No previous study has focussed on the clinical outcome of such simultaneous decompression. Twenty-one patients with neu...

Gupta, Ankur; Dave, Bharat; Nanda, Ankur; Modi, Hitesh

2009-01-01

395

Chemical lumbar sympathectomy with radiological assessment.  

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Forty cases of chemical lumbar sympathectomy are presented. A 7.5% solution of phenol in meglumine iothianate was injected under local anaesthesia and abdominal radiography performed. Skin temperature changes in the legs were compared with the radiological appearances and clinical results. Six injections were performed on cadavers before autopsy using a solution of methylene blue and meglumine iothianate in order to correlate the radiological appearance with the exact site of the injection. ...

Sanderson, C. J.

1981-01-01

396

Experience with iohexol in lumbar myelography  

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An open phase II clinical trial of iohexol for lumbar myelography in 17 patients is reported. The overall frequency of adverse reactions was exceedingly low. Special attention was paid to psychic reactions and no such were recorded. The CSF analyses and EEG recordings before and after myelography did not differ significantly. The CSF protein content could not be evaluated as the contrast medium interfered with the reagents.

Ericson, K.; Hindmarsh, T.; Hannerz, J. (Karolinska Sjukhuset, Stockholm (Sweden))

1983-01-01

397

Major vascular injury during lumbar laminectomy.  

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Major vascular injury during lumbar laminectomy is an extremely rare complication of one of the commonest surgical procedures performed in orthopaedic and neurosurgical units. Its occurrence may be associated with high morbidity and mortality, particularly if it is not diagnosed in the early stages. Early diagnosis and repair is associated with an improved prognosis in the long term. We illustrate these points with a description of two cases, and discuss the anatomical factors predisposing to...

Ezra, E.; Richenberg, J. L.; Smellie, W. A.

1996-01-01

398

Synovial chondromatosis in a lumbar apophyseal joint  

International Nuclear Information System (INIS)

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

1998-07-01

399

Synovial chondromatosis in a lumbar apophyseal joint  

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A 31-year-old woman presented with painful swelling in the right paravertebral region that had been present for 2 years. Radiography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue. (orig.) With 5 figs., 11 refs.

Burrafato, V.; Campanacci, D.A.; Capanna, R. [Department of Orthopedic Oncology, Centro Traumatologico Ortopedico, Florence (Italy); Franchi, A. [Institute of Pathology, University of Florence, Florence (Italy)

1998-07-01

400

Remote Cerebellar Hemorrhage after Lumbar Spinal Surgery  

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Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The m...

Nam, Taek Kyun; Park, Seung Won; Min, Byung Kook; Hwang, Sung Nam

2009-01-01

 
 
 
 
401

Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration.  

Science.gov (United States)

The goal of this review is to discuss the mechanisms of postural degeneration, particularly the loss of lumbar lordosis commonly observed in the elderly in the context of evolution, mechanical, and biological studies of the human spine and to synthesize recent research findings to clinical management of postural malalignment. Lumbar lordosis is unique to the human spine and is necessary to facilitate our upright posture. However, decreased lumbar lordosis and increased thoracic kyphosis are hallmarks of an aging human spinal column. The unique upright posture and lordotic lumbar curvature of the human spine suggest that an understanding of the evolution of the human spinal column, and the unique anatomical features that support lumbar lordosis may provide insight into spine health and degeneration. Considering evolution of the skeleton in isolation from other scientific studies provides a limited picture for clinicians. The evolution and development of human lumbar lordosis highlight the interdependence of pelvic structure and lumbar lordosis. Studies of fossils of human lineage demonstrate a convergence on the degree of lumbar lordosis and the number of lumbar vertebrae in modern Homo sapiens. Evolution and spine mechanics research show that lumbar lordosis is dictated by pelvic incidence, spinal musculature, vertebral wedging, and disc health. The evolution, mechanics, and biology research all point to the importance of spinal posture and flexibility in supporting optimal health. However, surgical management of postural deformity has focused on restoring posture at the expense of flexibility. It is possible that the need for complex and costly spinal fixation can be eliminated by developing tools for early identification of patients at risk for postural deformities through patient history (genetics, mechanics, and environmental exposure) and tracking postural changes over time. PMID:24785474

Sparrey, Carolyn J; Bailey, Jeannie F; Safaee, Michael; Clark, Aaron J; Lafage, Virginie; Schwab, Frank; Smith, Justin S; Ames, Christopher P

2014-05-01

402

Risk factors for recurrent lumbar disc herniations.  

Science.gov (United States)

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

Shin, Byung-Joon

2014-04-01

403

Working channel endoscope in lumbar spine surgery.  

Science.gov (United States)

Percutaneous endoscopic lumbar discectomy (PELD) is a well established modality in the treatment of patients with herniated lumbar discs. Since the time of its inception towards the end of 20th century, this technique has undergone significant modifications. With better understanding of the patho-anatomy and development of instrumentation the indications for PELD are on the rise. In the modern era of knowledge exchange there have been considerable variations among different endoscopic surgeons about classical indications and the implications of a particular technique pertaining to those indications. During last 15 years of experience in practicing endoscopic surgery, Choi has published many articles, regarding the techniques of PELD, across many scientific journals. In our practice there has been considerable shift from central debulking to discectomy to selective fragmentectomy. With further advancements the span of this technique is definitely on the rise. Here, we wish to share all the published data along with my current practice trends in more precise manner to help newer endoscopic spine surgeons understand the implications and limitations of a working channel endoscope in lumbar spine pathologies. PMID:24819484

Choi, G; Lee, S H; Deshpande, K; Choi, H

2014-06-01

404

Linear Lumbar Localized Lysis of Elastic Fibers  

Science.gov (United States)

Background: The absence or loss of elastic fibers in the skin is referred to as dermal elastolysis. Purpose: This paper describes a woman with a distinctive clinical presentation of mid-dermal elastolysis characterized morphologically by multiple horizontal raised bands on the lower back. Methods: A 20-year-old Filipino woman presented with multiple asymptomatic, flesh-colored, raised, firm, linear, cord-like bands on the lumbar area of her back. There were neither similar lesions elsewhere nor a family member with this condition. Results: Microscopic examination of the raised band showed nearly complete absence of elastic fibers in the mid dermis. In contrast, a biopsy of symmetrically located normal-appearing skin showed a uniform distribution of elastic fibers throughout the dermis. Linear lumbar localized elastolysis is a descriptive designation that accurately reflects a correlation of the clinical and pathological changes of this condition. Conclusion: The clinical differential of raised horizontal cord-like bands on the lower back (without a family history of an inherited elastic fiber disorder, a prior history of trauma, or a significant change in weight or exercise habit) includes linear focal elastosis and linear lumbar localized elastolysis. Microscopic evaluation of a Verhoeff-van Gieson stained lesion specimen (which may be accompanied by a biopsy of normal-appearing skin for comparison) will readily differentiate these conditions. The former is usually characterized by increased elastic fibers, whereas the latter, as in this patient, shows a paucity or absence of elastic fibers in the mid dermis.

Tschen, Jaime A.

2013-01-01

405

X-Ray parameters of lumbar spine  

Directory of Open Access Journals (Sweden)

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.

Otabek Ablyazov

2012-05-01

406

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

2001-06-01

407

Delayed Retroperitoneal Hemorrhage due to Lumbar Artery Pseudoaneurysm after Lumbar Posterolateral Fusion.  

Science.gov (United States)

A 55-year-old female patient presented with lower back pain and neurogenic intermittent claudication and underwent L3-L4 posterolateral fusion. To prepare the bone fusion bed, the transverse process of L3 and L4 was decorticated with a drill. On the 9th post-operative day, the patient complained of a sudden onset of severe abdominal pain and distension. Abdominal computed tomography revealed retroperitoneal hematoma in the right psoas muscle and iatrogenic right L3 transverse process fracture. Lumbar spinal angiography showed the delayed hematoma due to rupture of the 2nd lumbar artery pseudoaneurysm and coil embolization was done at the ruptured lumbar artery pseudoaneusyrm. Since then, the patient's postoperative progress proceeded normally with recovery of the hemodynamic parameters. PMID:24294460

Oh, Young Min; Choi, Ha Young; Eun, Jong Pil

2013-10-01

408

Measurements of the lumbar spinal canal by computed tomography in lumbar diseases  

International Nuclear Information System (INIS)

To assess the significance of computed tomography (CT) in the elucidation of morphology of the lumbar spinal canal (LSC), the antero-posterior (AP) and transverse (T) diameter, and T area of the soft and bony LSC, and dural canal (DC) were measured by CT in 15 patients with lumbar canal stenosis, 45 patient with spondylosis, and 33 control subjects. The AP diameter failed to indicate the degree of stenosis because it was independent of morphology of the LSC. The T area of the LSC did not always help to determine the degree of DC compression, but showed some degree of stenosis. The T area of the DC was useful in determining the degree of stenosis and morphology of the stenosed site. With the use of the T area of the DC, the upper margin of articular segment was found to be most stenosed in patients with lumbar canal stenosis. (Namekawa, K.)

1986-01-01

409

Safety and acceptability of the research lumbar puncture.  

Science.gov (United States)

Three hundred forty-two subjects underwent 428 research lumbar punctures for studies of cerebrospinal fluid (CSF) biomarkers. Subjects were 67 Alzheimer disease or mild cognitive impairment (AD/MCI) patients and 275 cognitively normal adults aged 21 to 88. Lumbar puncture was performed in the lateral decubitus or sitting position using the Sprotte 24 g atraumatic spinal needle. Up to 34 ml of cerebrospinal fluid were collected. Anxiety and pain experienced during lumbar puncture were rated on a visual analog scale. The frequency of any adverse event (11.7%), clinically significant adverse events (3.97%), and typical post-lumbar puncture headache (PLPHA) (0.93%) was low. Risk of post-lumbar puncture headache was unrelated to age, gender, position during lumbar puncture, ml of cerebrospinal fluid collected, or minutes of recumbent rest following lumbar puncture. The frequency of post-lumbar puncture headache was lower in AD/MCI (P = 0.03) than any other subject group. Anxiety and pain ratings were low. Younger subjects reported more anxiety than old (P = 0.001) and AD/MCI subjects (P = 0.008) and more pain than older normal subjects (P = 0.013). Pain ratings for women were higher than those for men (P = 0.006). Using the Sprotte 24 g spinal needle, research lumbar puncture can be performed with a very low rate of clinically significant adverse events and with good acceptability in cognitively impaired persons and cognitively normal adults of all ages. PMID:16327349

Peskind, Elaine R; Riekse, Robert; Quinn, Joseph F; Kaye, Jeffrey; Clark, Christopher M; Farlow, Martin R; Decarli, Charles; Chabal, Charles; Vavrek, Darcy; Raskind, Murray A; Galasko, Douglas

2005-01-01

410

Lumbar epidural steroid injections: indications, contraindications, risks, and benefits.  

Science.gov (United States)

The clinical use of lumbar epidural steroid injections has increased dramatically. Although there are certainly beneficial effects to using epidural steroid injections in a treatment regimen for lumbar radicular pain, there is a lack of well designed, placebo-controlled studies to define conclusively specific indications and techniques for different spinal diagnoses. This article reviews the pathophysiology of lumbar radiculopathy and the use of epidural steroid injections as one treatment option, as well as describes their risks and benefits. Based on current literature, we offer an evidence-based perspective regarding rational use of lumbar epidural steroid injections for certain indications and treatment goals. PMID:20071921

Friedrich, Jason M; Harrast, Mark A

2010-01-01

411

Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy  

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We present a case of an acute psoas muscle hematoma following percutaneous endoscopic lumbar discectomy. A 60-year-old female who presented with far lateral lumbar disc herniation underwent endoscopic discectomy on the right side at the L4-5 level. On the second postoperative day, the patient complained of severe right flank and leg pain and her blood pressure decreased. A computed tomography scan showed a large acute psoas muscle hematoma at right L4-5 level. The patient was transfused with ...

Kim, Hyeun Sung; Ju, Chang Il; Kim, Seok Won; Kim, Jong Gue

2009-01-01

412

The Association of Presacral Nodules with Biomechanics of the Lumbar Region and Lumbar Discopaties in Patients with Low Back Pain  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: The aim of this study was to investigate the relationship between Copeman’s nodules, which are seen in the presacral region, and demographic features such as: age, gender, body mass index, number of pregnancies, and presence of lumbar disc lesions and biomechanics of the lumbar region.Materials and Methods: This trial included 58 inpatients (49 women, 9 men; mean age SD:40.7±11.7 years, range 21-67 years with low back pain. Standing lateral roentgenograms of lumbo-sacral region, ultrasonography of soft tissues and lumbar magnetic resonance imaging were performed in all patients. Sacral angle, lumbo-sacral angle and lumbar lordotic curve were evaluated using Cobb’s method in lumbo-sacral x-rays. Results: Significant correlations between Copeman’s nodules and body mass index, presence of lumbar discopathy, degrees of lumbar lordotic curve were found. However, age, gender, number of pregnancies, sacral and lumbosacral angle did not correlate with the presence of Copeman’s nodules. Conclusion: Copeman’s nodules may represent the alterations of the biomechanics of lumbo-sacral region and lumbar disc herniation due to weakness of abdominal muscles. Therefore, strengthening of abdominal muscles and correction of lumbar biomechanics in patients with nodules and low back pain are important in the management of lumbar lordosis. Turk J Phys Med Rehab 2010;56:18-20.

Öznur Öken

2010-03-01

413

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)

2009-03-01

414

Classification of the lumbar disc degeneration using MRI  

International Nuclear Information System (INIS)

Magnetic resonance (MR) imaging has been performed in consecutive 114 patients with a chief complaint of lumbar pain. A retrospective review of MR images of a total of 570 lumbar vertebrae from these patients were done to examine lumbar disc degeneration. According to the MR intensity of nucleus pulposus on T2-wighted sagittal images, lumbar disc degeneration was graded on a scale of 0-4: 0=uniform hyperintensity; 1=slight hypointensity; 2=centrally band-like hypointensity with marginal hyperintensity; 3=irregular hypointensity in both the central and marginal sites; 4=uniform hypointensity. Lumbar disc degeneration was observed in 76%; and it was rapidly increased in frequency in the 30 or older age groups. Of 570 vertebrae, 51 (8.9%) had narrowing of intervertebral cavity. For these vertebrae, a mean score of lumbar disc degeneration was 3.1. Lumbar disc herniation was seen in 93 vertebrae, with a mean score of lumbar disc degeneration being 3.07. Changes in vertebral body marrow were seen in 14 vertebrae (2.5%), in which a mean score of intervertebral disc degeneration was 3.71. (N.K.)

1992-11-01

415

Lumbar hernia - a case report and review of the literature  

International Nuclear Information System (INIS)

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

1999-01-01

416

Abdominal aortic pseudoaneurysm caused by lumbar discectomy: case report  

Energy Technology Data Exchange (ETDEWEB)

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

Kim, Dong Hun; Yoon, Sang Won; Kim, Kyung Seuk; Kim, Woo Hyuk [Armed Forces Kwang Ju Hospital, Kwangju (Korea, Republic of)

2003-01-01

417

Abdominal aortic pseudoaneurysm caused by lumbar discectomy: case report  

International Nuclear Information System (INIS)

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

2003-01-01

418

Iohexol versus metrizamide for lumbar myelography: double-blind trial  

Energy Technology Data Exchange (ETDEWEB)

Lumbar myelography was performed in 50 patients; 25 received iohexol and 25 received metrizamide. The two media produced radiographs of equal quality. However, iohexol is stable in solution, while metrizamide is not. Further, markedly less morbidity resulted from iohexol. These features indicate that iohexol may be superior to metrizamide as a contrast agent for lumbar myelography.

Gabrielsen, T.O.; Gebarski, S.S.; Knake, J.E.; Latack, J.T.; Yang, P.J.; Hoff, J.T.

1984-05-01

419

Iohexol versus metrizamide for lumbar myelography: double-blind trial  

International Nuclear Information System (INIS)

Lumbar myelography was performed in 50 patients; 25 received iohexol and 25 received metrizamide. The two media produced radiographs of equal quality. However, iohexol is stable in solution, while metrizamide is not. Further, markedly less morbidity resulted from iohexol. These features indicate that iohexol may be superior to metrizamide as a contrast agent for lumbar myelography

1984-01-01

420

Complications of lumbar puncture in a child treated for leukaemia  

Energy Technology Data Exchange (ETDEWEB)

Lumbar puncture may lead to neurological complications. These include intracranial hypotension, cervical epidural haematomas, and cranial and lumbar subdural haematomas. MRI is the modality of choice to diagnose these complications. This report documents MRI findings of such complications in a child treated for leukaemia. (orig.)

Staebler, Melanie; Delpierre, Isabelle; Damry, Nash; Christophe, Catherine [Children' s University Hospital Queen Fabiola, Department of Medical Imaging, Brussels (Belgium); Azzi, Nadira [Children' s University Hospital Queen Fabiola, Haematology-Oncology Unit, Brussels (Belgium); Sekhara, Tayeb [Children' s University Hospital Queen Fabiola, Department of Neurology, Brussels (Belgium)

2005-11-01

 
 
 
 
421

Complex radiodiagnosis of the lumbar spine spinal canal stenosis  

International Nuclear Information System (INIS)

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

2006-01-01

422

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

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

2000-01-01

423

CT features and clinical significance of lumbar articular facet syndrome  

International Nuclear Information System (INIS)

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

2009-04-01

424

Spontaneous Regression of Lumbar Disc Herniation: Report of Two Cases  

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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.

Mehmet ?ENO?LU

2006-12-01

425

Percutaneous treatment of lumbar disc herniation  

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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.

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

426

The Evaluation of Lumbar Spinal Canal Diameters by MRI  

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Full Text Available Background/Objective: Lumbar spinal stenosis is the common cause of low back pain. MRI is the best modality for diagnosis of spinal canal stenosis. The aim of this study is to evaluate lumbar spinal canal diameters and relationship with gender, age, stature, weight and job."nPatients and Methods: One-hundred men and 100 women in the age range of 25 to 40 years from East Azarbayjan who were referred to Sheikholrais MRI Center were selected. The diameters of the spinal canal were measured on the midsagittal and axial section on T2 weighted images by 0.3 T MRI Unite. The results of measurements were analyzed by SPSS software. "nResults: The results showed that the least anteroposterior diameter was at the third lumbar vertebra but the narrowest transverse diameter was at the first lumbar vertebra. The mean anteroposterior diameter of the lumbar spinal canal decreased from the first to the third lumbar vertebra, followed by an increase from the third to the fifth. From the first to the fifth lumbar vertebra, there was an increase in the mean transverse diameters. The mean transverse diameter in the middle part of the vertebra is longer than the lower part. A frank relation was seen between the gender of physical workers with lumbar spinal canal stenosis, although there was no relation between age, stature, and weight with lumbar spinal canal stenosis."nConclusion: Considering the high incidence of lumbar canal stenosis and the relationship with heavy manual work, it is recommended that a plain radiography is taken before choosing heavy manual work and exercises. People whose canal is relatively narrow should be refused from heavy manual work and exercises.

Mehrnaz Mashoufi

2010-05-01

427

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

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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

2001-04-01

428

Repair of the spondylolysis in lumbar spine  

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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

2005-09-01

429

Outcome Prediction in Lumbar Disc Herniation Surgery  

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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.

Harun Brkic

2010-12-01

430

Conjoined nerve root of the lumbar spine  

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There have been a number of reports on lumbosacral nerve root anomalies. Among the most common of these anomalies is the conjoined nerve root. However, it is difficult to diagnose this condition preoperatively. We review the records of 142 patients who underwent microendoscopic discectomy (MED) for herniation of the lumbar disc. All patients had undergone magnetic resonance imaging (MRI) of the lumbar spine before surgery. For most patients, only sagittal and axial images were obtained; coronal images were obtained in only a minority of the patients. Postoperative coronal images were obtained in patients with conjoined nerve roots. A diagnosis of conjoined nerve roots was made intraoperatively in 4 patients; this diagnosis had not been possible preoperatively. After surgery, new coronal images were obtained for the 4 patients with conjoined nerve roots; however, there was no evidence of the condition on the new images. The surgical procedure employed was endoscopic decompression and herniotomy. The results were favorable, even though pediculotomy was not performed. It is difficult to diagnose nerve root anomalies preoperatively. However, the possibility of nerve root anomalies should always be considered during surgery to ensure a safe procedure, without intraoperative occurrence of nerve root injury. (author)

2009-07-01

431

MR imaging assessment of lumbar fusion stability  

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Pain after lumbar fusion may result from a pseudoarthrosis. CT, which permits assessment of the anatomic integrity of the fusion, may fail to demonstrate functional segmental instability. The conventional spinal radiographs and the lumbar spinal CT scans were compared with the spinal MR studies of 33 patients who had undergone surgical spinal fusion. The MR studies were performed on a whole-body superconductive 0.35-T Diasonics MTS system (four patients) and a whole body superconductive 1.5-T GE Signa MR imager. Of the patients who had diagnoses of solid fusion, 16 of 19 demonstrated areas of high signal intensity on the more T1-weighted images. The signal intensity of these areas was either isointense or normal on the T2-weighted images. In ten of the 14 patients with segmental instability at the fusion site, subchondral vertebral bands of decreased signal intensity were demonstrated on T1-weighted images which increased on T2-weighted images. MR appears to be useful in patients with symptoms of fusion pseudoarthrosis in whom CT fails to demonstrate anatomic disruption

1987-12-04

432

Myeloperoxidase Activities in Polymorphonuclear Leukocytes in Lumbar Disc Disease  

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Full Text Available Objectives: The exact pathogenesis of lumbar pain and radiculopathy is often poorly understood. Although nerve root entrapment resulting in mechanical pressure has been the most widely held concept to explain radiculopathy and lumbar pain, much of the recent research work increasingly supports an inflammatory reaction occurring in the lumbar intervertebral disc tissue. In this study, we aimed to show the role of Myeloperoxidase as an inflammatory marker and the correlation of inflammation with lumbar radiculopathy.Methods: We evaluated 15 patients and 15 healthy controls of a similar age and sex distribution. Myeloperoxidase activities in polymorphonuclear leukocytes were measured spectrophotometrically by the method of O-dianisidine.Results: The mean Myeloperoxidase level was 440 U/mg protein in the patient group and 142 U/mg protein in the control group. The Myeloperoxidase levels of patients in the lumbar radiculopathy group were significantly higher than in the control group (p < 0.001.Conclusion: In this preliminary study, we had found increased Myeloperoxidase level in the lumbar disc patients with radiculopathy. The significantly high level of Myeloperoxidase might indicate a systemic inflammatory response to impingement of the nerve root caused by lumbar disc herniation. This led us to think that Myeloperoxidase might play a role in the activity status of the disease.

Mehmet ?ENO?LU

2009-09-01

433

MRI manifestations of lumbar active inflammation in ankylosing spondylitis  

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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)

2008-06-01

434

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

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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.)

1993-10-01

435

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

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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.

Luis Pita Armenteros

2010-06-01

436

Vascular complications in lumbar spinal surgery: Percutaneous endovascular treatment  

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Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery, in two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula.We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.

2000-01-01

437

Lumbar Osteochondroma Arising from Spondylolytic L3 Lamina  

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Osteochondromas are common, benign tumors in the long bones, but osteochondromas are rare in the vertebrae. Most vertebral osteochondromas arise from the cervical or upper thoracic spine. However, lumbar osteochondromas have rarely been reported. In this report, a rare case of a lumbar osteochondroma arising from the spondylolytic L3 lamina in a 57-year-old woman is presented. She also had a ruptured disc and lumbar canal stenosis at L4-5-S1. The osteochondroma was completely removed and a po...

Choi, Byung Kwan; Han, In Ho; Cho, Won Ho; Cha, Seung Heon

2010-01-01

438

A global CT to US registration of the lumbar spine  

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During percutaneous lumbar spine needle interventions, alignment of the preoperative computed tomography (CT) with intraoperative ultrasound (US) can augment anatomical visualization for the clinician. We propose an approach to rigidly align CT and US data of the lumbar spine