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Sample records for posterior-lateral lumbar interbody

  1. Lateral Lumbar Interbody Fusion

    Science.gov (United States)

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

    2015-01-01

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

  2. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

  4. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    Full Text Available ... LAMINECTOMY AND TRANSFORAMINAL LUMBAR INTERBODY FUSION THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA, PENNSYLVANIA November 15, 2006 00:00: ... time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical procedure to treat ...

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

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

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

    Scientific Electronic Library Online (English)

    MJD, Jacobsohn; RN, Dunn.

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

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

    Directory of Open Access Journals (Sweden)

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

    2010-03-01

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

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Science.gov (United States)

    Chrastil, Jesse; Patel, Alpesh A

    2012-05-01

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

  14. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion

    DEFF Research Database (Denmark)

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

    2014-01-01

    PURPOSE: Long-lasting low back pain is an increasing problem, and for some patients surgery is the final option for improvement. Several techniques for spinal fusion are available and the optimal technique remains uncertain. The objective of this study was to assess the cost-effectiveness and cost-utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. METHODS: 100 Patients were randomized to TLIF or PLF (51/49)...

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

    OpenAIRE

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

    2012-01-01

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

  16. Healing properties of allograft from alendronate-treated animal in lumbar spine interbody cage fusion

    OpenAIRE

    Xue, Qingyun; Li, HaiSheng; Zou, Xuenong; Bünger, Mathias; Egund, Niels; Lind, Martin; Christensen, Finn Bjarke; Bünger, Cody

    2004-01-01

    This study investigated the healing potential of allograft from bisphosphonate-treated animals in anterior lumbar spine interbody fusion. Three levels of anterior lumbar interbody fusion with Brantigan cages were performed in two groups of five landrace pigs. Empty Brantigan cages or cages filled with either autograft or allograft were located randomly at different levels. The allograft materials for the treatment group were taken from the pigs that had been fed with alendronate, 10 mg daily ...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    PURPOSE: The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific ...

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

    Scientific Electronic Library Online (English)

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

    2004-09-01

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

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2011-01-01

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

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

    OpenAIRE

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

    2004-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Najmus Sakeb

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rapp SM

    2011-08-01

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

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2000-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-07-01

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

  10. Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

    Science.gov (United States)

    ?i?man, Lokman; Türkmen, Faik; Efe, Duran; Pekince, O?uzhan; Göncü, Recep Gani; Sever, Cem

    2015-01-01

    Study Design A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. Purpose This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. Overview of Literature Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. Methods A total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. Results The average follow-up time was 35.05±8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. Conclusions Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion. PMID:26435789

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

    Scientific Electronic Library Online (English)

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

    2013-06-01

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

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Zeilstra DJ

    2013-08-01

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

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

    OpenAIRE

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

    2005-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Xiao Zhitao

    2012-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Cohen Anders

    2011-09-01

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

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

    Science.gov (United States)

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

    2015-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Xiangdong Duan

    2009-05-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

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

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    Hardenbrook MA

    2013-06-01

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

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

    DEFF Research Database (Denmark)

    HØy, Kristian; Bünger, Cody

    2013-01-01

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

  2. Particular Features of Surgical Site Infection in Posterior Lumbar Interbody Fusion

    Science.gov (United States)

    Kim, Jin Hak; Kim, Jin Woo; Kim, Go We

    2015-01-01

    Background Previous reports have observed differences only in infection rates between posterolateral fusion and posterior lumbar interbody fusion (PLIF). There have been no reports that describe the particular features of surgical site infection (SSI) in PLIF. In this study, we endeavor to identify the distinguishing characteristics and risk factors of SSI in PLIF. Methods Our study undertook a review of a case series of an institute. Patients who had undergone PLIF consecutively in the author's hospital were reviewed. Two proactive procedures were introduced during the study period. One was irrigation of the autolocal bone, and the other was the intradiscal space irrigation with a nozzle. Infection rate and risk factors were analyzed. For subgroup analysis, the elapsed time to a diagnosis (ETD), clinical manifestations, hematologic findings, and causative bacteria were examined in patients with SSI. Results In a total of 1,831 cases, there were 30 cases of SSI (1.6%). Long operation time was an independent risk factor (p = 0.008), and local bone irrigation was an independent protective factor (p = 0.001). Two cases of referred SSI were included in the subgroup analysis. There were 6/32 (19%) superficial incisional infections (SII), 6/32 (19%) deep incisional infections (DII), and 20/32 (62%) organ/space infections (O/SI). The difference of incidence among three groups was significant (p = 0.002).The most common bacteria encountered were methicillin-resistant Staphylococcus epidermidis followed by methicillin-resistant S. aureus in incisional infections, and no growth followed by S. epidermidis in O/SI. ETD was 8.5 ± 2.3 days in SII, 8.7 ± 2.3 days in DII and 164.5 ± 131.1 days in O/SI (p = 0.013). Conclusions The rate of SSI in PLIF was 1.6%, with the most common type being O/SI. The causative bacteria of O/SI was of lower virulence than in the incisional infection, and thus diagnosis was delayed due to its latent and insidious feature. Contamination of auto-local bone was presumed attributable to the progression of SSI. Irrigation of auto-local bone helped in the reduction of SSI. PMID:26330956

  3. Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Relief in Patients with Lumbar Disc Degeneration Compared to Anterior Lumbar Interbody Fusion

    Science.gov (United States)

    Rischke, Burkhard; Smith, Eric

    2015-01-01

    Background Lumbar disc degeneration (LDD) is one of the most frequently diagnosed spinal diseases. The symptoms these disorders cause are anticipated to increase as the population in Western countries ages. Purpose Compare back and leg pain alleviation in patients with LDD and a viscoelastic disc prosthesis documented in the SWISSspine registry versus patients with anterior lumbar interbody fusion documented in the Spine Tango registry. Study Design Prospectively collected clinical and outcome data in two independent spine registries. Outcome Measures were back and leg pain relief on 0 to 10 numerical rating scales. Materials and Methods The analysis included a single surgeon series of 48 patients with viscoelastic total disc replacement (VTDR) from the SWISSspine registry which were compared to 131 patients with anterior lumbar interbody fusion (ALIF) from the Spine Tango registry. Two linear multivariate regression models were built to assess the associations of patient characteristics with back and leg pain relief. The following covariates were included in the models: patient age and sex, disc herniation as additional diagnosis, number of treated segments, level of treated segment, treatment type (VTDR, ALIF), preoperative back and leg pain levels and follow-up interval. Results Both models showed VTDR to be associated with significantly higher back (2.76 points; 95% confidence interval (CI) 1.78 - 3.73; p < 0.001) and leg pain (2.12 points; 95% CI 1.12 to 3.13; p < 0.001) relief than ALIF. Other influential factors for higher back pain relief were female sex compared with male sex (1.03 additional points; 95% CI 0.27 to 1.78; p = 0.008), monosegmental surgery compared with bisegmental surgery (1.02 additional points; 95% CI 0.21 to 1.83; p = 0.014), and higher back pain at baseline (0.87 points additional pain relief per level of preoperative back pain; 95% CI 0.70 to 1.03; p < 0.001). Other influential factors for leg pain relief were monosegmental surgery (0.93 additional points; 95% CI 0.10 to 1.77; p = 0.029) and higher leg pain at baseline (0.83 points additional pain relief per level of preoperative leg pain; 95% CI 0.70 to 0.96). In both models the L3/4 segment showed 2.36 points (95% CI -4.27 to -0.45; p = 0.016) and 3.69 points (95% CI -5.66 to -1.71; p < 0.001) less pain relief than L5/S1. Discussion Significantly higher back and leg pain relief were observed after viscoelastic total disc replacement in comparison with anterior lumbar interbody fusion. The new less rigid materials used in the second generation total disc replacements (TDRs) may make artificial disc replacement an increasingly attractive option for patients with degenerative lumbar disc disease. Further controlled and long-term follow-up studies are required for more detailed comparisons of the outcomes of these types of disc implants. The Freedom Lumbar Disc is limited by U.S. federal law to investigational use only. PMID:26196033

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    DEFF Research Database (Denmark)

    Christensen, Ann Demant; Hoy, K.; Bunger, C.; Helmig, P.; Hansen, E.; Andersen, T.; Sogaard, R.

    2014-01-01

    Long-lasting low back pain is an increasing problem, and for some patients surgery is the final option for improvement. Several techniques for spinal fusion are available and the optimal technique remains uncertain. The objective of this study was to assess the cost-effectiveness and cost-utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. 100 Patients were randomized to TLIF or PLF (51/49) and followed for ...

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

    OpenAIRE

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

    2010-01-01

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

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

    OpenAIRE

    Khusniddin Nuraliev

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Q R Abdul

    2011-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-12-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Miller Larry E

    2011-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Birkenmaier Christof

    2010-09-01

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

  13. Building the posterior lateral line system in zebrafish

    OpenAIRE

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Kuo-Feng Huang

    2003-03-01

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

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

    Scientific Electronic Library Online (English)

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

    2009-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Cristiano Magalhães Menezes

    2009-09-01

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

  18. Surgical Data and Early Postoperative Outcomes after Minimally Invasive Lumbar Interbody Fusion: Results of a Prospective, Multicenter, Observational Data-Monitored Study

    Science.gov (United States)

    Pereira, Paulo; Buzek, David; Franke, Jörg; Senker, Wolfgang; Kosmala, Arkadiusz; Hubbe, Ulrich; Manson, Neil; Rosenberg, Wout; Assietti, Roberto; Martens, Frederic; Barbanti Brodano, Giovanni; Scheufler, Kai-Michael

    2015-01-01

    Minimally invasive lumbar interbody fusion (MILIF) offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD). Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study. Objective: To observe and document short-term recovery after minimally invasive interbody fusion for DLD. Materials and Methods: In a predefined 4-week analysis from this study, experienced surgeons (?30 MILIF surgeries pre-study) treated patients with DLD by one- or two-level MILIF. The primary study objective was to document patients’ short-term post-interventional recovery (primary objective) including back/leg pain (visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), health status (EQ-5D) and Patient satisfaction. Results: At 4 weeks, 249 of 252 patients were remaining in the study; the majority received one-level MILIF (83%) and TLIF was the preferred approach (94.8%). For one-level (and two-level) procedures, surgery duration was 128 (182) min, fluoroscopy time 115 (154) sec, and blood-loss 164 (233) mL. Time to first ambulation was 1.3 days and time to study-defined surgery recovery was 3.2 days. Patients reported significantly (P < 0.0001) reduced back pain (VAS: 2.9 vs 6.2), leg pain (VAS: 2.5 vs 5.9), and disability (ODI: 34.5% vs 45.5%), and a significantly (P < 0.0001) improved health status (EQ-5D index: 0.61 vs 0.34; EQ VAS: 65.4 vs 52.9) 4 weeks postoperatively. One adverse event was classified as related to the minimally invasive surgical approach. No deep site infections or deaths were reported. Conclusions: For experienced surgeons, MILIF for DLD demonstrated early benefits (short time to first ambulation, early recovery, high patient satisfaction and improved patient-reported outcomes) and low major perioperative morbidity at 4 weeks postoperatively. PMID:25811615

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

    DEFF Research Database (Denmark)

    Christensen, A; HØy, K

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Christensen, Ann Demant; Hoy, K.

    2014-01-01

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

  1. A Comparative Radiographic Analysis of Fusion Rate between L4-5 and L5-S1 in a Single Level Posterior Lumbar Interbody Fusion

    Science.gov (United States)

    Han, Sang-Hyun; Hyun, Seung-Jae; Jahng, Tae-Ahn

    2015-01-01

    Objective This study aimed to investigate radiographic fusion rates at L4-5 and L5-S1 after single level posterior lumbar interbody fusion (PLIF) and evaluate the relationship between fusion rates and preoperative disc slope angle (DSA), lumbar lordosis (LL), segmental angle (SA), and pelvic parameters. Methods We conducted a retrospective review of patients who underwent single level PLIF at L4-5 or L5-S1 during May 2003-December 2012 at our institution. 73 patients were finally enrolled. Fusion was assessed by use of the Brantigan-Steffee classification, less than 2mm translation and less than 5° motion on the flexion-extension lateral radiographs. We analyzed the radiographic fusion rates, risk factors, and relationship of fusion rates with DSA, LL, SA, and pelvic parameters. Results There were 59 patients (80.8%) in the L4-5 group and 14 (19.2%) in L5-S1 (average follow-up, 34 months). The radiographic fusion rates were 89.8% in the L4-5 group (53/59) and 42.9% in L5-S1 (6/14) (p<0.001).The preoperative DSA was significantly lesser in the L4-5 group than in the L5-S1 group (13.1±8.1° vs. 27.2±6.7°, p<0.001). The LL, SA, and pelvic parameters were not related with radiographic fusion rates in both groups. Risk factors for non-union were not identified between the two groups except for the surgery level (p<0.001). Conclusion The radiographic fusion rate at L5-S1 was less than half that at L4-5 after single level PLIF. This may be due to the anatomical and biomechanical differences between the two levels. More vigorous effort to achieve successful fusion at L5-S1 should be considered. PMID:26217384

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

    Scientific Electronic Library Online (English)

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

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chen Shih-Hao

    2012-05-01

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

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

    DEFF Research Database (Denmark)

    Li, Haisheng; Zou, Xuenong

    2004-01-01

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

  6. Interbody allograft in a skeletally immature spine model

    OpenAIRE

    Rapoff, Andrew J.; Johnson, Wesley M.; Handel, Jeremy; Woo, Raymund

    2003-01-01

    The objective of this cadaveric biomechanical study was to establish further bovine spines as models for evaluating lumbar interbody allografts and to provide guidance for their use in pediatric humans. It is unknown whether interbody allografts can be used in the pediatric spine without failure of the host vertebral bone. Allografts were placed in cow and calf spines and loaded in compression. The cow spines were much stronger and stiffer than the calf, but moderate in vivo activities were e...

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

    OpenAIRE

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

    2008-01-01

    Abstract Background Initial promise of a stand-alone interbody fusion cage to treat chronic back pain and restore disc height has not been realized. In some instances, a posterior spinal fixation has been used to enhance stability and increase fusion rate. In this manuscript, a new stand-alone cage is compared with conventional fixation methods based on the finite element analysis, with a focus on investigating cage-bone interface mechanics and stress distribution on the adjacent tissues. Met...

  8. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

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

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

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

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

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    Full Text Available ... scoliosis and instability of her spine. So the plan for the operation is exposure, instrumentation, neural decompression, ... with—this lady has a deformity in multiple planes, and what we’re going to try to ...

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    Full Text Available ... next clip, you’re going to see us controlling the bleeders. These are called epidural veins, which ... her, and that deformity would get rapidly worse, leading to a significant increase in back pain and ...

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    Full Text Available ... get some leg pain. It usually responds to steroids, and it’s always self-limited, but it can ... out to you to answer: “What is the benefit of putting the bone graft in the disc ...

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

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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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    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 ...

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

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

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

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

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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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    Full Text Available ... be a little too short, but we’ll check it out. Might have to make it a little longer. ... is there anything else you want to point out before we have to sign off here? 00:57:57 JAMES S. HARROP, MD: No, just once again we’re going to check all the nerves, and they look great. 00: ...

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

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

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    Full Text Available ... have this procedure. Is this the latest and best procedure or is there something new on the ... comfortable with multiple approaches to fit the approach best to what your diagnosis is. We think for ...

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

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    Full Text Available ... next clip, you’re going to see us controlling the bleeders. These are called epidural veins, which ... MD: I want to thank the Jefferson media marketing group that’s put this— helped us put this ...

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

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    Full Text Available ... camera. Jim, looks like we’ve got a nice laminectomy and you’re feeling throughout the—what’s ... that’s 6mm-diameter by 40mm. It’s got a nice, sharp enough point that it will go down. ...

  17. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

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    Full Text Available ... is due to a disc herniation. This is something that we’re the most successful with surgery. ... the screws in, we’re going to do something called triggered EMG, where we’re going to ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... is to prop up the disc space and form a fusion. First let’s talk about the diagnosis ... the patient mixed with some more bone morphogenic protein that’s leftover from what we used in that ...

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

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

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

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

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

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

  9. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... we use what’s called osteotomes, which are bone-cutting instruments, to take down this bone. And we ... sharp instrument—you’re going to see it cutting through the bone and then removing what we ...

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

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

  12. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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    Full Text Available ... point, exposing their spine, which is somewhat involved: taking the muscles off their spine and preparing some ... Because this patient has severe stenosis, we’re taking off the middle part of her bone as ...

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    Full Text Available ... patient is dependent on their diagnosis, but the results, the potential complications which we have to go ... Because this patient has severe stenosis, we’re taking off the middle part of her bone as ...

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

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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 ...

  18. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

  20. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... on their diagnosis, but the results, the potential complications which we have to go over with the ... blood loss was less. In addition, having lower complication rates and lower arthrosis, or non-healing rates ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

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

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

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    Full Text Available ... actually—skipping around a little bit. What we did it—I’ll take you down to—this ... was completely compressed in the foramen. And we did our—we already did our discectomy here where ...

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

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

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

  11. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

  13. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

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

  15. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... would say that this patient on the right side of her spine was as collapses 2 mm. And the effect of spreading that out, of opening it up, ... we get a secondary—we get a secondary effect. If we look on the x-ray, if ... third dot up on the left side of the left picture, you can imagine that ...

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

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

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

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    Full Text Available ... They’re a critical portion—part of our team as well. Craig Matsumoto, who will help us ... to help, both the neurosurgical and orthopedic department works closely together on spinal problems and we’re ...

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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 ...

  1. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... they walk uphill or if they ride a bicycle, a patient with vascular claudication, or hardening of ... at the transverse processes so that the high-speed burr that they’re using is unseating the ...

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

  3. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Science.gov (United States)

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

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

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    Full Text Available ... 55 TODD J. ALBERT, MD: Hello. Good afternoon, I’m Dr. Todd Albert, professor and vicechairman of orthopedics at Thomas Jefferson University. I’m at the operating room at Thomas Jefferson ...

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    Full Text Available ... the spreader where the metal instrument is, the big hole. 00:25:29 JAMES S. HARROP, MD: Here’s ... we go off air. This is just some data, and important, when people say, “Why do you ...

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

  8. 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 ... it for the appropriate indications and the right type of surgery matched to their indications. And we ...

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    Full Text Available ... next clip, you’re going to see us controlling the bleeders. These are called epidural veins, which ... They’re a critical portion—part of our team as well. Craig Matsumoto, who will help us ...

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    Full Text Available ... next clip, you’re going to see us controlling the bleeders. These are called epidural veins, which ... TLIF. So both of them—both of the groups did have some issues with persistent radiculopathy. I’ ...

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    Full Text Available ... spinal arthritis. So the spine becomes sloppy, the tissues grow into the spinal canal and compress the ... skin incision and taken down all the soft tissue to bone, here we’re pointing out that’s ...

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

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

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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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    Full Text Available ... 00:08 ANNOUNCER: During the next hour in a real-time Internet broadcast, spine specialists at Thomas Jefferson University Hospital will demonstrate a surgical procedure to treat lower back pain. The ...

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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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    Full Text Available ... minutes now, so we’re in pretty good shape. I have a question from the viewing audience ... have this procedure. Is this the latest and best procedure or is there something new on the ...

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

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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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    Full Text Available ... and walking, and it’s been refractory to medical therapies. She has the diagnosis called spinal stenosis, which is a narrowing of the spine, and she has degenerative scoliosis. And degenerative scoliosis is a curvature of the ...

  1. 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 ... ligament. And we’re pointing out the facet joint, the facet joint and the—and the lamina. And the area ... or limitation, in terms of surgical instrumentation or devices for ... latest medical education to both patients and the healthcare community. ...

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    Full Text Available ... going to put it along the side to heal the fusion and, like, weld the spine together. ... through them. So we can watch the bone heal. They have little dots, and here are—you ...

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    Full Text Available ... forgot to introduce was Ron Forcina, our scrub nurse who’s helping. He’s critical. Without him we couldn’ ... MD: Yeah, that’s actually a good picture. Somebody’s head’s in the way now. 00:42:31 JAMES S. ...

  5. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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

  6. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

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    Full Text Available ... have you experienced as your largest inconvenience or limitation, in terms of surgical instrumentation or devices for ... that because there’s never been—there’s been no limitation, we’re not limited in what we have? ...

  7. Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion

    Medline Plus

    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 ...

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

    Scientific Electronic Library Online (English)

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

    2007-09-01

    Full Text Available O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espon [...] dilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida. Abstract in english The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted t [...] o surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.

  9. Allograft Cellular Bone Matrix in Extreme Lateral Interbody Fusion: Preliminary Radiographic and Clinical Outcomes

    OpenAIRE

    Tohmeh, Antoine G.; Watson, Blake; Tohmeh, Mirna; Zielinski, Xavier J.

    2012-01-01

    Introduction. Extreme lateral interbody fusion (XLIF) is a minimally disruptive alternative for anterior lumbar interbody fusion. Recently, synthetic and allograft materials have been increasingly used to eliminate donor-site pain and complications secondary to autogenous bone graft harvesting. The clinical use of allograft cellular bone graft has potential advantages over autograft by eliminating the need to harvest autograft while mimicking autograft's biologic function. The objective of th...

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

    OpenAIRE

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

    2014-01-01

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

  11. Extreme Lateral Interbody Fusion Procedure

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

  12. Extreme Lateral Interbody Fusion Procedure

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

  13. Extreme Lateral Interbody Fusion Procedure

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  16. Sacrum fracture following L5-S1 stand-alone interbody fusion for isthmic spondylolisthesis.

    Science.gov (United States)

    Phan, Kevin; Mobbs, Ralph J

    2015-11-01

    We report a 72-year-old man with a rare sacral fracture following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis. The man underwent a minimally invasive management strategy using posterior percutaneous pedicle fixation and partial reduction of the deformity. We also discuss the current literature on fusion procedures for isthmic spondylolisthesis. PMID:26100158

  17. Calcium pyrophosphate dihydrate deposition in degenerate lumbar discs

    OpenAIRE

    U Berlemann; Gries, N. C.; Moore, R. J.; Fraser, R. D.; Vernon-Roberts, B.

    1998-01-01

    Calcium pyrophosphate dihydrate (CPPD) crystal deposition in lumbar intervertebral discs has been described, but its clinical significance remains unclear. The present study analyzed histological sections of lumbar discs that were obtained from patients undergoing anterior lumbar interbody fusion. Immunohistological staining was undertaken to identify neural elements and blood vessels. Patients with CPPD deposition were compared with a group without CPPD deposition undergoing the same operati...

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

    Science.gov (United States)

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

    2014-01-01

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

  19. Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis.

    Science.gov (United States)

    Blizzard, Daniel J; Hills, Christopher P; Isaacs, Robert E; Brown, Christopher R

    2015-11-01

    The purpose of this study was to evaluate our initial experience utilizing extreme lateral interbody fusion (XLIF; NuVasive, San Diego, CA, USA) with percutaneous posterior instrumentation to treat 11 spondylodiscitis patients between January 2011 and February 2014. Although medical management is the first line treatment for spondylodiscitis, many patients fail antibiotic therapy and bracing, or present with instability, neurologic deficits, or sepsis, requiring operative debridement and stabilization. High rates of fusion and infection clearance have been reported with anterior lumbar interbody fusion (ALIF), but this approach requires a morbid exposure, associated with non-trivial rates of vascular and peritoneal complications. XLIF is an increasingly popular interbody fusion technique which utilizes a fast and minimally invasive approach, sparing the anterior longitudinal ligament, and allowing sufficient visualization of the intervertebral discs and bodies to debride and place a large, lordotic cage. The outcome measures for this study included lumbar lordosis, sagittal balance, subsidence, fusion, pain, neurological deficit, and microbiology/laboratory evidence of infection. The mean follow-up time was 9.3months. All patients had improvements in pain and neurological symptoms. The mean lordosis change was 11.0°, from 23.1° preoperatively to 34.0° postoperatively. Fusion was confirmed with CT scans in five of six patients. At the last follow-up, all patients had normalization of inflammatory markers, no symptoms of infection, and none required repeat surgical treatment for spondylodiscitis. XLIF with percutaneous posterior instrumentation is a minimally invasive technique with reduced morbidity for lumbar spine fusion which affords adequate exposure to the vertebral bodies and discs to aggressively debride necrotic and infected tissue. This study suggests that XLIF may be a safe and effective alternative to ALIF for the treatment of spondylodiscitis. PMID:26138052

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

    Directory of Open Access Journals (Sweden)

    Hey Hwee Weng

    2010-01-01

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

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

    Science.gov (United States)

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

    2014-05-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  3. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

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

  4. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

    Full Text Available ... injure them. So now I can have a mapping where the nerves are. Now back to you, ... intractable lumbar spondylosis. Anybody that suffers from spine disease from L4 and above could potentially benefit from ...

  5. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

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

  6. Extreme Lateral Interbody Fusion Procedure

    Medline Plus

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

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

    OpenAIRE

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2010-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Chung Sung-Soo

    2011-04-01

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

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

    OpenAIRE

    Su, I-Chang; Chen, Chang-Mu

    2007-01-01

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

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

    OpenAIRE

    Cédric Barrey; Gilles Perrin; Sabina Champain

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Szu-Yuan Chen

    2015-06-01

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

  13. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    Scientific Electronic Library Online (English)

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

    2015-02-01

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

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

    DEFF Research Database (Denmark)

    Zhou, Zhiyu; Wei, Fuxin

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    HUANG Ju-ying

    2012-08-01

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

  16. 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 ...

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

    Science.gov (United States)

    Khoshab, Hamid A; Sloboda, Tomáš

    2015-01-01

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

  18. Adjacent Segment Instability and Degeneration After Posterior Lumbar Stabilisation

    Directory of Open Access Journals (Sweden)

    Engin Ozar

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nitin Garg

    2014-01-01

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

  20. Minimally invasive transforaminal lumbar interbody fusion Results of 23 consecutive cases

    Directory of Open Access Journals (Sweden)

    Amit Jhala

    2014-01-01

    Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use.

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

    Science.gov (United States)

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

    2016-01-01

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

  2. Minimally Invasive Lumbar Discectomy

    Medline Plus

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

  3. Minimally Invasive Lumbar Discectomy

    Medline Plus

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

  4. 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. ...

  5. Minimally Invasive Lumbar Discectomy

    Medline Plus

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

  6. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... 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 ...

  7. 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 ...

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2014-12-01

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

  10. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Liang ZHOU

    2014-01-01

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

  12. Lumbar spinal stenosis

    Scientific Electronic Library Online (English)

    JA, Shipley.

    2008-06-01

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

  13. 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)

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

    OpenAIRE

    Dai, Li-Yang; Jiang, Lei-Sheng

    2008-01-01

    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 fus...

  15. Lumbar spondylolysis: a review

    International Nuclear Information System (INIS)

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

  16. Lumbar spondylolysis: a review

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-06-15

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

  17. Lumbar peritoneal shunt

    Directory of Open Access Journals (Sweden)

    Yadav Yad

    2010-01-01

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

  18. Pars Stress Fracture (Lumbar Spondylolysis)

    Science.gov (United States)

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

  19. Manejo del síndrome doloroso lumbar Management of lumbar syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Rivas Hernández

    2010-03-01

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

  20. NEUROMUSCULAR CONTROL IN LUMBAR DISORDERS

    Directory of Open Access Journals (Sweden)

    Ville Leinonen

    2004-03-01

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

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

    Science.gov (United States)

    Kolasa, P; Grabarczyk, J; Depczyk, T

    2002-08-30

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

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

    Science.gov (United States)

    Su, I-Chang; Chen, Chang-Mu

    2007-12-01

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

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

    OpenAIRE

    Hardenbrook MA; Miller LE; Block JE

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Webb John K

    2002-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Hardenbrook MA

    2013-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Arai Y

    2002-06-01

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

  7. Lumbar discography: an update.

    Science.gov (United States)

    Anderson, Mark W

    2004-01-01

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

  8. DOLOR LUMBAR RELACIONADO AL EMBARAZO

    Directory of Open Access Journals (Sweden)

    Milan Munjin L

    2007-01-01

    Full Text Available El dolor lumbar ha sido considerado la complicación más frecuente del embarazo, a pesar de ello, su etiopatogenia aún es controvertida. La prevalencia en nuestro medio es desconocida, y el tratamiento se basa para muchos médicos solo en el reposo, medida que no tiene sustento en la literatura. En esta 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 embarazoThe 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 rationality. 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

  9. Physiotherapeutic rehabilitation and lumbar fusion surgery

    OpenAIRE

    Abbott, Allan

    2010-01-01

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

  10. Plexiform Schwannoma of Lumbar Region

    OpenAIRE

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

    2015-01-01

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

  11. Laparoscopic transabdominal extraperitoneal mesh repair of lumbar hernia

    OpenAIRE

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

    2011-01-01

    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...

  12. Lumbar discoidectomy by minimal incision

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Ding Zi-hai

    2011-04-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-06-01

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

  15. Extraspinal abnormalities identified on lumbar spine CT

    International Nuclear Information System (INIS)

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

  16. Remote cerebellar hemorrhage after lumbar spinal surgery

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

  17. 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.

  18. Homeopatía y dolor lumbar / Homeopathy and lumbar pain

    Scientific Electronic Library Online (English)

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

    2011-02-01

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

  19. Homeopatía y dolor lumbar Homeopathy and lumbar pain

    Directory of Open Access Journals (Sweden)

    Eva María Castro Morillo

    2011-02-01

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

  20. DOLOR LUMBAR RELACIONADO AL EMBARAZO

    Scientific Electronic Library Online (English)

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

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

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

    International Nuclear Information System (INIS)

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

  2. Migrating lumbar facet joint cysts

    International Nuclear Information System (INIS)

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

  3. Extraspinal abnormalities identified on lumbar spine CT

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-01-01

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

  4. Lumbar disc injury in the athlete.

    Science.gov (United States)

    Watkins, Robert G

    2002-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jia-ming LIU

    2015-11-01

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2007-04-01

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

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

    Scientific Electronic Library Online (English)

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

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

  9. 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

  10. 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.)

  11. MR-guided lumbar sympathicolysis

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-06-01

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

  12. Bacterial Sacroiliitis Probably Induced by Lumbar Epidural Analgesia

    OpenAIRE

    Shimon Edelstein; Yeouda Edoute

    2003-01-01

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

  13. Bacterial Sacroiliitis Probably Induced by Lumbar Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Shimon Edelstein

    2003-01-01

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

  14. Dolor lumbar agudo: mecanismos, enfoque y tratamiento

    Directory of Open Access Journals (Sweden)

    Marco Tulio Mahecha Toro

    2009-10-01

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

  15. Discitis pospunción lumbar en un niño

    Directory of Open Access Journals (Sweden)

    Nelson Fuentes Rodríguez

    2004-06-01

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

  16. Sensitivity of lumbar spine loading to anatomical parameters

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  17. The lumbar spine in Neanderthals shows natural kyphosis

    OpenAIRE

    Weber, Jochen; Pusch, Carsten Matthias

    2008-01-01

    Nowadays, lumbar spondylosis is one of the most frequent causes of lower back pain. In order to improve our understanding of the lumbar spine anatomy and functionality over time, we compared the lumbar vertebrae of Neanderthals with those of anatomically modern humans. The fossil record reports on only two Neanderthal skeletons (i.e., Kebara 2 and Shanidar 3, both predating the appearance of modern humans) with full preservation of the entire lumbar spine. Examination of these early hominids ...

  18. 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.)

  19. Fine needle diagnosis in lumbar osteomyelitis

    International Nuclear Information System (INIS)

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

  20. Adjacent Instability after Instrumented Lumbar Fusion.

    Directory of Open Access Journals (Sweden)

    Wen-Jer Chen

    2003-11-01

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

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

    Science.gov (United States)

    Hughes, D G; Isherwood, I

    1992-09-01

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

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

    Scientific Electronic Library Online (English)

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

    2014-10-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Chen Hsiang-Ho

    2007-03-01

    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.

  5. Microendoscopic discectomy for prolapsed lumbar intervertebral disc

    Directory of Open Access Journals (Sweden)

    Ranjan Alok

    2006-01-01

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

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

    DEFF Research Database (Denmark)

    Li, Haisheng; Zou, Xuenong; Xue, Qingyun; Egund, Niels; Lind, Martin; Bünger, Cody

    2004-01-01

    Platelet-rich plasma (PRP) is an autogenous source of growth factor and has been shown to enhance bone healing both in clinical and experimental studies. PRP in combination with porous hydroxyapatite has been shown to increase the bone ingrowth in a bone chamber rat model. The present study investigated whether the combination of beta tricalcium phosphate (beta-TCP) and PRP may enhance spinal fusion in a controlled animal study. Ten Danish Landrace pigs were used as a spinal fusion model. Immedi...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-09-15

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

  8. 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

  9. Medline Plus

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

  10. Medline Plus

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

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

    Scientific Electronic Library Online (English)

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

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

  12. Oriental Medical Treatment of Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2003-12-01

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

  13. Lumbar Cryptococcal Osteomyelitis Mimicking Metastatic Tumor.

    Science.gov (United States)

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

    2015-10-01

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

  14. Lumbar Cryptococcal Osteomyelitis Mimicking Metastatic Tumor

    Science.gov (United States)

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

    2015-01-01

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

  15. Myeloperoxidase Activities in Polymorphonuclear Leukocytes in Lumbar Disc Disease

    OpenAIRE

    Mehmet ?ENO?LU; Ergul Belge KURUTA?; ?dris ALTUN; Yalç?n ATLI; Vedat NAC?TARHAN

    2009-01-01

    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 wit...

  16. X-Ray parameters of lumbar spine

    Directory of Open Access Journals (Sweden)

    Otabek Ablyazov

    2012-05-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Jeong-ho Kim

    2010-06-01

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

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

    Science.gov (United States)

    Yang, Hae-Sun; Yoo, Won-Gyu

    2014-07-01

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

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

    Science.gov (United States)

    Yang, Hae-sun; Yoo, Won-gyu

    2014-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Adaletli, Ibrahim; Omeroglu, Alp; Kurugoglu, Sebuh; Cantasdemir, Murat; Numan, Furuzan [Istanbul University, Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul (Turkey); Elicevik, Mehmet [Istanbul University, Department of Paediatric Surgery, Cerrahpasa Faculty of Medicine, Istanbul (Turkey)

    2005-10-01

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

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

    International Nuclear Information System (INIS)

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

  3. Tadpole system as new lumbar spinal instrumentation

    Directory of Open Access Journals (Sweden)

    Akeda Koji

    2008-09-01

    Full Text Available Abstract Background There have been reports of serious complications associated with pedicle screw fixation, including nerve root injuries caused by accidental screw insertion. We have developed a new system of lumbar spinal instrumentation that we call Tadpole system®. The purposes of this report were to show the results of a biomechanical study and the short-term outcome of a clinical study, as well as to determine the usefulness of this system. Methods The Tadpole system® lumbar spinal fusion is a hook-and-rod system according to which the spine is stabilized using 2 sets of 2 spinous processes each that are held in place by 4 hooks tandemly connected to a rod. The biomechanical study was done using 5 human lumbar cadaveric spines, and the range of motion (ROM was examined in a non-treatment model, an injured model, a pedicle screw fixation model and a Tadpole system® model. For the short-term clinical study the Tadpole system® was used in 31 patients, and the factors analyzed were operation time, time required for spinal instrumentation, amount of intraoperative bleeding, postoperative improvement rate of the Japanese Orthopaedic Association (JOA score for lumbar spinal disorders, instrumentation failure, spinous process fracture, spinal fluid leakage, nerve root injury, postoperative infection, and bone fusion 2 years after the operation. Results The ROM in the Tadpole system® model was slightly bigger than that in the pedicle screw fixation model, but smaller than that in the normal control model. These biomechanical data indicated that the Tadpole system® provided fairly good stability. The mean operation time was 79 min, the mean time required for spinal instrumentation was 8 min, and the mean amount of intraoperative bleeding was 340 mL. The mean postoperative improvement rate of JOA score was 70.9 ± 24.8%. Instrumentation failure (dislocation of a hook occurred in one patient, and none of the patients developed spinous process fracture, spinal fluid leakage, nerve root injury, or postoperative infection. Two years after the operation, bone union was confirmed in 29 of the 31 patients (93.5%. Conclusion We conclude that this system is a useful, easy-to-use and safe spinal instrumentation technique for lumbar fusion surgery.

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

    Scientific Electronic Library Online (English)

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

    2013-12-01

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

  5. Complications of lumbar puncture in a child treated for leukaemia

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

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

    OpenAIRE

    Sandén Bengt; Robinson Yohan

    2009-01-01

    Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging reco...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-06-01

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

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

    Science.gov (United States)

    Karadogan, Ernur; Williams, Robert L.

    2013-01-01

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

  9. Hernia discal lumbar: algunos aspectos del diagnóstico

    Directory of Open Access Journals (Sweden)

    Rafael Rivero Torres

    2004-06-01

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

  10. Symptomatic lumbar spinal arachnoiditis: fact or fallacy?

    Science.gov (United States)

    Petty, P G; Hudgson, P; Hare, W S

    2000-09-01

    It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor. PMID:10942659

  11. Percutaneous treatment of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-12-31

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

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

    OpenAIRE

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

    2000-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-04-01

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

  14. Computed Tomography of the lumbar facet joints

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-08-15

    The lumbar facet disease is a frequently overlooked cause of sciatic pain, but the lumbar facet joints are well-recognized source of low back pain and radiating leg pain which can be confused with sciatica due to herniated disc. We measured the angulation of the facet joints on axial spine CT films in 149 cases which contains 41 normal group and 108 abnormal group and studied the relationship between the angulation and degeneration of the facets, the asymmetry of each sided facets and facet degeneration, the asymmetry and disc protrusion, and the asymmetry and annular bulging of the disc. The results were as follows: 1. Facet angulation in abnormal group were more sagittally oriented than the normal group. 2. The angulation of right facet was more sagittally oriented than the left in L4-5 level of abnormal group. 3. Degeneration of facet joints occur asymmetrically, and the more facet joint degenerates, the more it orients sagittally, particularly in L4-5. 4. Asymmetry in facet joint degeneration and unilateral disc protrusion of L5-SI level is greater than the normal gro0008.

  15. [Lumbar spondylodiscitis caused by Salmonella enteritidis].

    Science.gov (United States)

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

    1994-10-14

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

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

    Directory of Open Access Journals (Sweden)

    J. E. Martínez-Suárez

    2005-10-01

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

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

    International Nuclear Information System (INIS)

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

  18. The cost–utility of lumbar disc herniation surgery

    OpenAIRE

    Hansson, Elisabeth; Hansson, Tommy

    2006-01-01

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

  19. Lumbar Osteochondroma Arising from Spondylolytic L3 Lamina

    OpenAIRE

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

    2010-01-01

    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...

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

    OpenAIRE

    Bakar, Bulent; Tekkok, Ismail Hakki

    2008-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2011-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Marcelo Molina

    2011-11-01

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

  4. The appearances of lumbar intraspinal synovial cysts.

    Science.gov (United States)

    Knox, A M; Fon, G T

    1991-12-01

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

  5. Adjacent Segment Pathology after Lumbar Spinal Fusion.

    Science.gov (United States)

    Lee, Jae Chul; Choi, Sung-Woo

    2015-10-01

    One of the major clinical issues encountered after lumbar spinal fusion is the development of adjacent segment pathology (ASP) caused by increased mechanical stress at adjacent segments, and resulting in various radiographic changes and clinical symptoms. This condition may require surgical intervention. The incidence of ASP varies with both the definition and methodology adopted in individual studies; various risk factors for this condition have been identified, although a significant controversy still exists regarding their significance. Motion-preserving devices have been developed, and some studies have shown their efficacy of preventing ASP. Surgeons should be aware of the risk factors of ASP when planning a surgery, and accordingly counsel their patients preoperatively. PMID:26435804

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-02-01

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

  7. Hérnia discal lombar / Lumbar disc herniation

    Scientific Electronic Library Online (English)

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

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

  8. Hérnia discal lombar Lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Luis Roberto Vialle

    2010-01-01

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

  9. Lumbar spinal canal size of sciatica patients

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    F. T. A Yuing

    2010-06-01

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

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

    Science.gov (United States)

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

    1992-12-01

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

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

    Science.gov (United States)

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

    1985-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rajendra Nath

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Endres Stefan

    2011-11-01

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

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

    OpenAIRE

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

    2000-01-01

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

  16. On diagnostic blocks for lumbar zygapophysial joint pain

    OpenAIRE

    Bogduk, Nikolai

    2010-01-01

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

  17. Factors predicting the outcome following treatment for lumbar spondylolysis

    OpenAIRE

    Debnath, Ujjwal Kanti

    2010-01-01

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

  18. Short fusion versus long fusion for degenerative lumbar scoliosis

    OpenAIRE

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

    2008-01-01

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

  19. Ruling out Piriformis Syndrome before Diagnosing Lumbar Radiculopathy

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    Chi-Chien Niu

    2009-04-01

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

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

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    Y?k?lmaz, A.

    2006-01-01

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

  1. Single photon emission computed tomography in lumbar degenerative spondylolisthesis

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2010-06-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    Science.gov (United States)

    Kim, Sang-Min; Yoo, Won-Gyu

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Carlos Sajama l

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Manchikanti L

    2012-08-01

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

  7. Magnetic resonance imaging of normal lumbar intervertebral discs

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Katz Jeffrey N

    2010-11-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-04-01

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

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

    DEFF Research Database (Denmark)

    Huang, Baoding; Zou, Xuenong

    2013-01-01

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

  11. Spine loading at different lumbar levels during pushing and pulling.

    Science.gov (United States)

    Knapik, Gregory G; Marras, William S

    2009-01-01

    As the nature of many materials handling tasks have begun to change from lifting to pushing and pulling, it is important that one understands the biomechanical nature of the risk to which the lumbar spine is exposed. Most previous assessments of push-pull tasks have employed models that may not be sensitive enough to consider the effects of the antagonistic cocontraction occurring during complex pushing and pulling motions in understanding the risk to the spine and the few that have considered the impact of cocontraction only consider spine load at one lumbar level. This study used an electromyography-assisted biomechanical model sensitive to complex motions to assess spine loadings throughout the lumbar spine as 10 males and 10 females pushed and pulled loads at three different handle heights and of three different load magnitudes. Pulling induced greater spine compressive loads than pushing, whereas the reverse was true for shear loads at the different lumbar levels. The results indicate that, under these conditions, anterior-posterior (A/P) shear loads were of sufficient magnitude to be of concern especially at the upper lumbar levels. Pushing and pulling loads equivalent to 20% of body weight appeared to be the limit of acceptable exertions, while pulling at low and medium handle heights (50% and 65% of stature) minimised A/P shear. These findings provide insight to the nature of spine loads and their potential risk to the low back during modern exertions. PMID:19308819

  12. Three-dimensional static modeling of the lumbar spine.

    Science.gov (United States)

    Karadogan, Ernur; Williams, Robert L

    2012-08-01

    This paper presents three-dimensional static modeling of the human lumbar spine to be used in the formation of anatomically-correct movement patterns for a fully cable-actuated robotic lumbar spine which can mimic in vivo human lumbar spine movements to provide better hands-on training for medical students. The mathematical model incorporates five lumbar vertebrae between the first lumbar vertebra and the sacrum, with dimensions of an average adult human spine. The vertebrae are connected to each other by elastic elements, torsional springs and a spherical joint located at the inferoposterior corner in the mid-sagittal plane of the vertebral body. Elastic elements represent the ligaments that surround the facet joints and the torsional springs represent the collective effect of intervertebral disc which plays a major role in balancing torsional load during upper body motion and the remaining ligaments that support the spinal column. The elastic elements and torsional springs are considered to be nonlinear. The nonlinear stiffness constants for six motion types were solved using a multiobjective optimization technique. The quantitative comparison between the angles of rotations predicted by the proposed model and in the experimental data confirmed that the model yields angles of rotation close to the experimental data. The main contribution is that the new model can be used for all motions while the experimental data was only obtained at discrete measurement points. PMID:22938364

  13. Functional kyphosis and lumbar kyphosis in adolescent paddlers

    Directory of Open Access Journals (Sweden)

    Pedro Ángel López-Miñarro

    2010-01-01

    Full Text Available The objective of this study was to evaluate the frequency of functional kyphosis and lumbar kyphosis in adolescent paddlers. A total of 140 paddlers (mean age: 13,67 ± 0,61 years participated in this study. The sagittal spinal curvatures (thoracic and lumbar curves in relaxed standing and in maximal trunk flexion with knees extended (sit-and-reach test were evaluated with an inclinometer. The analysis of angular values with respect to the normality references showed that 63% of athletes with normal thoracic curve in standing, while in maximal trunk flexion there were many athletes (91.2% with a moderate or slight kyphotic posture. With respect to lumbar curve, 68.5% of the subjects had normal values in standing, while 83.9% showed lumbar kyphotic postures in maximal trunk flexion. In conclusion, there was a high percentage of paddlers with normal angular values in relaxed standing, although when maximal trunk flexion with knees extended was performed there was a significant increase of kyphotic postures in both thoracic and lumbar curves. For this reason, the evaluation of sagittal spinal curvatures of paddlers is an important variable to include in training planning.

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

    Science.gov (United States)

    Sharkus, Ye A

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

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

    OpenAIRE

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

    2005-01-01

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

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

    OpenAIRE

    Karunanayake, Aranjan Lionel; Pathmeswaran, Arunasalam

    2013-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-08-01

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

  2. Lumbar spinal fusion using the Diapason system.

    Science.gov (United States)

    Musha, Y; Okajima, Y; Motegi, M

    1995-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  4. Predictions of the Length of Lumbar Puncture Needles

    OpenAIRE

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

    2014-01-01

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

  5. Lumbar adhesive arachnoiditis following attempted epidural anesthesia--case report.

    Science.gov (United States)

    Haisa, T; Todo, T; Mitsui, I; Kondo, T

    1995-02-01

    A 30-year-old female experienced a sudden sharp pain radiating down to the left leg from the lower back at epidural intubation for anesthesia at childbirth. She continued to complain of pain in the left leg afterwards. Magnetic resonance images demonstrated a conglomeration of adherent nerve roots due to lumbar adhesive arachnoiditis. Microsurgical dissection of adherent nerve roots was performed. Her symptoms disappeared after surgery, but soon recurred, being less severe and responsive to anti-inflammatory agents. Lumbar adhesive arachnoiditis should be considered for differential diagnosis in patients presenting with back and leg pain syndrome. PMID:7753309

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lucky Gupta

    2014-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

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

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

    Science.gov (United States)

    Bakar, Bulent; Tekkok, Ismail Hakki

    2008-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-06-01

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

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

    Scientific Electronic Library Online (English)

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

    2004-09-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-04-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2013-08-01

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

  15. CT of postoperative lumbar disk herniation

    International Nuclear Information System (INIS)

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

  16. Medline Plus

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

  17. Medline Plus

    Full Text Available ... Back Pain Lumbar Laminectomy and Transforaminal Lumbar Interbody Fusion (Thomas Jefferson University Hospital, Philadelphia, PA, 11/15/2006) Spinal Fusion Surgery for Relief of Chronic Lower Back Pain ( ...

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

    Czech Academy of Sciences Publication Activity Database

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

    2004-01-01

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

  19. Laparoscopic surgery for treatment of incisional lumbar hernia

    Scientific Electronic Library Online (English)

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

    2005-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Sandén Bengt

    2009-07-01

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

  1. Lumbar spinal mobility changes among adults with advancing age

    Directory of Open Access Journals (Sweden)

    Ismaila Adamu Saidu

    2011-01-01

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

  2. The effect of breast shielding during lumbar spine radiography

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Garg M

    2001-12-01

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

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

    Science.gov (United States)

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

    2014-03-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Scientific Electronic Library Online (English)

    Ivonne, Martín Hernández.

    2013-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2002-12-01

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

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

    Scientific Electronic Library Online (English)

    Félix Dolorit, Verdecia; Hiram Martinez, Medina.

    2015-03-01

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

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

    Scientific Electronic Library Online (English)

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

    2015-03-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Lumbar posterior marginal intra-osseous cartilaginous node

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-04-01

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

  13. Magnetic resonance imaging of canine degenerative lumbar spine diseases

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  17. Lumbar Extension during Stoop Lifting is Delayed by the Load and Hamstring Tightness

    OpenAIRE

    Iwasaki, Risa; Yokoyama, Ginga; Kawabata, Satoshi; Suzuki, Tomotaka

    2014-01-01

    [Purpose] This study investigated the relationship between lumbar pelvic rhythm and the physical characteristics of stoop lifting. [Subjects and Methods] Participants performed a stoop lifting task under two conditions: with and without load. We assessed the lumbar kyphosis and sacral inclination angles using the SpinalMouse® system, as well as hamstring flexibility. During stoop lifting, surface electromyograms and the lumbar and sacral motions were recorded using a multi-chan...

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

    DUCATI, Alessandro

    2005-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  1. Cirugía lumboscópica de la litiasis del uréter lumbar

    OpenAIRE

    González León, Tania

    2012-01-01

    Las litiasis del uréter lumbar se solucionan generalmente, con litotricia extracorpórea o ureteroscopia, pero ante situaciones complejas, si fallan los tratamientos anteriores o no se dispone de ellos, la ureterolitotomía a cielo abierto era la única alternativa terapéutica. Se realiza una investigación de desarrollo tecnológico para una técnica de ureterolitotomía (ULL), con el propósito de describirla, presentar sus resultados y pautar la actuación ante su aplicación. Se describen ocho...

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

    OpenAIRE

    Schoenfeld, Andrew J; Bradley K. Weiner

    2010-01-01

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

  3. Predictors of vocational prognosis after herniated lumbar disc

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  4. Predictors of vocational prognosis after herniated lumbar disc

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

  6. The effect of posture on diffusion into lumbar intervertebral discs.

    OpenAIRE

    Adams, M.A.; Hutton, W. C.

    1986-01-01

    The diffusion of small solutes into the intervertebral discs of cadaveric lumbar motion segments was measured using a radioactive tracer technique. The motion segments were wedged and loaded to simulate erect posture and flexed sitting postures. The results show that erect posture favours diffusion into the anterior half of the disc compared to the posterior half. Flexed posture, by deforming the annulus fibrosus, reverses this imbalance.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

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

    International Nuclear Information System (INIS)

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

  9. Interpretation of computed tomograms of postoperative lumbar intervertebral disk

    International Nuclear Information System (INIS)

    In a relatively large number of patients, postoperatively persisting or recurrent trouble with the lumbar spine is observed. Hitherto, the accuracy of postoperative CT diagnoses has been judged to be insufficient. The crucial task of postoperative CT of the spine is to distinguish physiological healing processes from complications or consequences of intervertebral disk surgery that require postoperative treatment. The differential diagnosis allowing distinction between postoperative scar tissue and recidivation is of great importance. (orig.)

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  11. Fracture of posterior margin of lumbar vertebral body

    Directory of Open Access Journals (Sweden)

    Krishnan Ajay

    2005-01-01

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

  12. Double insurance transfacetal screws for lumbar spinal stabilization

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2014-01-01

    Full Text Available Aim: The authors report experience with 14 cases where two screws or ??double insurance?? screws were used for transfacetal fixation of each joint for stabilization of the lumbar spinal segment. The anatomical subtleties of the technique of insertion of screws are elaborated. Materials and Methods: During the period March 2011 to June 2014, 14 patients having lumbar spinal segmental instability related to lumbar canal stenosis were treated by insertion of two screws into each articular assembly by transfacetal technique. After a wide surgical exposure, the articular cartilage was denuded and bone chips were impacted into the joint cavity. For screw insertion in an appropriate angulation, the spinous process was sectioned at its base. The screws (2.8 mm in diameter and 18 mm in length were inserted into the substance of the medial or inferior articular facet of the rostral vertebra via the lateral limit of the lamina approximately 6-8 mm away from the edge of the articular cavity. The screws were inserted 3 mm below the superior edge and 5 mm above the inferior edge of the medial (inferior facets and directed laterally and traversed through the articular cavity into the lateral (superior articular facet of the caudal vertebra toward and into the region of junction of base of transverse process and of the pedicle. During the period of follow-up all treated spinal levels showed firm bone fusion. There was no complication related to insertion of the screws. There was no incidence of screw misplacement, displacementor implant rejection. Conclusions: Screw insertion into the firm and largely cortical bones of facets of lumbar spine can provide robust fixation and firm stabilization of the spinal segment. The large size of the facets provides an opportunity to insert two screws at each spinal segment. The firm and cortical bone material and absence on any neural or vascular structure in the course of the screw traverse provides strength and safety to the process.

  13. Evaluation of 60 cases of surgically treated lumbar spinal stenosis

    Directory of Open Access Journals (Sweden)

    Kemal YUCESOY

    2003-06-01

    Full Text Available In this retrospective study, 60 patients who are operated due to lumbar spinal stenosis are evaluated in respect to age, sex, symptoms of the disease, radiological findings, surgical procedures and clinical results. Clinical evaluation was done using Oswestry low back pain disability questionary. Of patients 31 were male, 29 were female, in a range of 15-84 years-old. Majority of patients were between 40-60 years-old. Radiologically all patients were evaluated with anteroposterior, lateral and dynamic plain radiographies, magnetic resonance imaging and last 11 patients were evaluated with additional magnetic resonance myelography also. Most frequent lumbar level was L4-5 level, cause of the stenosis was congenital in four patients and degenerative in the remaining. Two surgical procedures were applied, laminectomy and foraminotomies in 43 patients and inverse laminoplasty in 17 patients. In 11 patients dural laceration complicated the operations but no patient developed cerebrospinal fluid fistula postoperatively. No neurological progression of present neorogical findings was observed. Clinically preoperative mean score of Oswestry was 41.1 and decreased to 11.3 postoperatively. During the follow up of 33 months, three patients were operated due to stenosis at the different levels and posterior spinal instrumentation was performed in four patients because of iatrogenic spondylolisthesis.In conclusion, lumbar spinal stenosis can be treated surgically by laminectomy successfully and inverse laminoplasty is preferred in young patients.

  14. Lumbar CT findings of patients with low back pain

    International Nuclear Information System (INIS)

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  15. Lumbar stenosis: clinical case / Estenose lombar: caso clínico

    Scientific Electronic Library Online (English)

    Pedro, Sá; Pedro, Marques; Bruno, Alpoim; Elisa, Rodrigues; António, Félix; Luís, Silva; Miguel, Leal.

    2014-07-01

    Full Text Available A estenose lombar é uma patologia cada vez mais frequente, que acompanha o aumento da esperança média de vida e que comporta custos elevados para a nossa sociedade. Apresenta inúmeras causas, entre as quais destacam-se a degenerativa, a neoplásica e a traumática. A maioria dos pacientes responde bem [...] à terapêutica conservadora. O tratamento cirúrgico está reservado para aqueles doentes que apresentem sintomatologia após a implementação de medidas conservadoras. É apresentado um caso de estenose grave da coluna lombar em vários níveis, numa doente do sexo feminino com antecedentes patológicos/cirúrgicos da coluna lombar, na qual foram aplicadas duas técnicas distintas de descompressão, no mesmo ato cirúrgico. Abstract in english Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservativ [...] e therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

  16. A case of lumbar pain after intraoperative radiotherapy

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Tae Yong; Baik, Seong Kug [Dept. of Radiology, Pusan National University Yangsan Hospital, Yangsan(Korea, Republic of); Lee, In Sook [Dept. of Radiology and Medical Research Institite, Pusan National University Hosptal, Pusan (Korea, Republic of)

    2011-05-15

    To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms. We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris. In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants. The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

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

    International Nuclear Information System (INIS)

    To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms. We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris. In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants. The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

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

    Science.gov (United States)

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

    2014-06-01

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

  20. Lumbar CT findings of patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-04-15

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  1. A radiological study on lumbar herniated intervertebral disc diseases

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Gary A Fantini

    2013-01-01

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

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

    Science.gov (United States)

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

    2005-07-01

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

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

    Science.gov (United States)

    Karunanayake, Aranjan Lionel; Pathmeswaran, Arunasalam

    2013-01-01

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

  5. Ganglioneuroma coincidente con una extrusión discal lumbar / Ganglioneuroma coinciding with a lumbar disk herniation

    Scientific Electronic Library Online (English)

    J.V., Martínez-Quiñones; F., Consolini; J., Aso-Escario; M., Domínguez-Páez; R., Arregui.

    2011-10-01

    Full Text Available Introducción. Los ganglioneuromas o gangliomas son tumores de los ganglios simpáticos que contienen células de la cresta neural, pudiendo aparecer en cualquier parte del organismo. Son generalmente benignos, más frecuente entre los 10 y los 40 años, pueden secretar hormonas y, en ocasiones, asociars [...] e a trastornos genéticos, como la neurofibromatosis tipo I. Objetivo. Revisar la literatura científica relacionada con el tema y presentar un caso tratado en nuestro servicio. Discusión. La sintomatología de estas lesiones depende de su ubicación y de las sustancias vasoactivas que puedan secretar. A pesar de que son tumores benignos en su mayoría, en ocasiones pueden metastatizar. Las pruebas de imagen y de laboratorio son inespecíficas, por lo que el diagnóstico definitivo es anatomopatológico. En los casos sintomáticos el tratamiento de elección es la resección quirúrgica. Conclusión. La asociación de un ganglioneuroma y de una hernia discal lumbar es algo excepcional. El tratamiento requiere su resección quirúrgica. Abstract in english Introduction. Ganglioneuromas or gangliomas are tumours of the sympathetic ganglia that contain cells of the neural crest, so they can appear in all body localizations. They are generally benign, more frequent between 10 and 40 years, may secrete hormones and, sometimes, Neurofibromatosis type I and [...] other genetic disorders can be associated. Objective. To review the scientific literature related to the topic and to present a case treated in our service. Discussion. The symptoms depend on location and vasoactive secreted hormones. In spite of that, they are generally benign tumours, although sometimes they can spread out. Since laboratory and image test are of limited usefulness, the conclusive diagnosis is anatomopathologic. In symptomatic patients the best procedure is surgical revoming. Conclusión. Ganglioneuroma and disk herniation association constitute an excepcional disorder. Its treatment implies surgery resection.

  6. TAHU MENGHAMBAT KEHILANGAN TULANG LUMBAR TIKUS BETINA OVARIEKTOMI [Tofu Attenuates Lumbar Bone Loss of Ovariectomized Female Rats

    Directory of Open Access Journals (Sweden)

    Suyanto Pawiroharsono 4

    2002-12-01

    Full Text Available The objectives of this research were to examine the efeects of feed containing soybean tofu and tempeh on lumbar bone density and mass of ovariectomized female rats. Twenty four 17 weeks-old Sprague-Dawley rats were randomly assigned to four group, i.e.: (1 non-ovariectomized rats fed casein based diet (NonOvx, (2 ovariectomized rats fed casein based diet (OvxC, (3 ovariectomized rats fed diet containing soybean tofu (OvxH, and (4 ovariectomized rats fed diet containing soybean tempeh (OvxT; in three block based on their body weight. The result show that body weight gram of ovariectomized rats was greater than nonovariectomized. Ovariectomy caused atrophy of the uterus, and resulted in higher serum calcium level. The lower lumbar vertebrae density of ovariectomized rats was observed and the decrease was prevented by tofu.

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

    Directory of Open Access Journals (Sweden)

    María Julia Cigales Reyes

    2009-08-01

    Full Text Available La Heberkinasa® (estreptoquinasa recombinante, es un trombolítico utilizado en el tratamiento del infarto agudo del miocardio, presentada en forma de liofilizado en bulbos estériles, de conocidos y probados efectos de reperfusión coronaria y reducción del tamaño del infarto, además de otras aplicaciones como en la trombosis venosa profunda, trombosis de acceso vascular permanente de pacientes con insuficiencia renal crónica terminal tratados por hemodiálisis periódicas, disfunción de prótesis valvulares cardíacas por trombos y en el tromboembolismo pulmonar; se asocian reacciones adversas durante el tratamiento, frecuentes y menos frecuentes, dentro de las que se encuentra el dolor lumbar. Se presenta a una paciente con el diagnóstico de un infarto agudo del miocardio, de cara diafragmática, a quien se le aplicó la trombolisis con Heberkinasa y durante esta presentó dolor lumbar agudo, intenso, que cedió con la reducción de goteo de la infusión y esta se pudo continuar sin más problemas.The Heberkinase® (recombinant streptokinase is a thrombolytic agent used in treatment of acute myocardial infarction, presented as sterile bulbs, of known and proved effects of coronary reperfusion and reduction of infarction dimension, besides of other applications e.g. the deep venous thrombosis, permanent vascular access thrombosis in patients presenting with terminal chronic renal insufficiency treated by periodical hemodialysis, dysfunction of cardiac vascular prostheses by thrombi, and in case of pulmonary thromboembolism; there are adverse reactions associated during treatment, frequent and less frequent including those of lumbar pain. Authors present a case of a woman diagnosed with acute myocardial infarction of diaphragmatic side undergoing thrombolysis with Heberkinase, and during it she had intense and acute lumbar pain improving with reduction of dripping infusion without subsequent problems.

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

    Directory of Open Access Journals (Sweden)

    Gajanan

    2013-10-01

    Full Text Available ABSTRACT: The focal calcification or ossification of ligamentum flavum is a rare cau se of thoracic myelopathy and most often occurs among individuals of Japanese descent. It is rare in other ethnic groups and in individuals below the age of 50 year. It is most often described at the lower thoracic level, being uncommon in the lumbar regio n and rare in the cervical region. Here, we present the case of a 40 - year - old Indian female patient who sought medical attention with a six month history of paraesthesia of the lower limbs and progressive difficulty in walking. The clinical profile, togeth er with computed tomography and magnetic resonance imaging of the spine, led to a diagnosis of compressive lumbar myelopathy due to ossification of the ligamentum flavum of lumbar spine. The patient underwent laminectomy and dissection of some of the affec ted ligamentum flavum. After three months of clinical follow - up, the patient had progressed favorably , having no sensory complaints and again becoming ambulatory

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

    Directory of Open Access Journals (Sweden)

    Ivonne Martín Hernández

    2011-08-01

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

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

    Science.gov (United States)

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

    1989-01-01

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

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

    OpenAIRE

    Brock, Marko; Kunkel, Philip; Papavero, Luca

    2008-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

  13. Asymmetry of the multifidus muscle in lumbar radicular nerve compression

    Energy Technology Data Exchange (ETDEWEB)

    Farshad, Mazda; Gerber, Christian; Farshad-Amacker, Nadja A.; Dietrich, Tobias J.; Laufer-Molnar, Viviane; Min, Kan [Balgrist University Hospital, University of Zuerich, Zuerich (Switzerland)

    2014-01-15

    The multifidus muscle is the only paraspinal lumbar muscle that is innervated by a single nerve root. This study aimes to evaluate if the asymmetry of the multifidus muscle is related to the severity of compression of the nerve root or the duration of radiculopathy. MRI scans of 79 patients with symptomatic single level, unilateral, lumbar radiculopathy were reviewed for this retrospective case series with a nested case-control study. The cross-sectional area (CSA) of the multifidus muscle and the perpendicular distance of the multifidus to the lamina (MLD) were measured bilaterally by two radiologists and set into relation to the severity of nerve compression, duration of radiculopathy and probability of an indication for surgical decompression. In 67 recessal and 12 foraminal symptomatic nerve root compressions, neither the MLD ratio (severe 1.19 ± 0.55 vs less severe nerve compression: 1.12 ± 0.30, p = 0.664) nor the CSA ratio (severe 1 ± 0.16 vs less severe 0.98 ± 0.13, p = 0.577) nor the duration of symptoms significantly correlated with the degree of nerve compression. MR measurements of multifidus were not different in patients with (n = 20) and those without (n = 59) clinical muscle weakness in the extremity caused by nerve root compression. A MLD >1.5 was, however, associated with the probability of an indication for surgical decompression (OR 3, specificity 92 %, PPV 73 %). Asymmetry of the multifidus muscle correlates with neither the severity nor the duration of nerve root compression in the lumbar spine. Severe asymmetry with substantial multifidus atrophy seems associated with the probability of an indication of surgical decompression. (orig.)

  14. MR guided percutaneous laser lumbar disk hernia ablation

    International Nuclear Information System (INIS)

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  15. MR guided percutaneous laser lumbar disk hernia ablation

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-03-01

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  16. Clinical outcomes and efficacy of transforaminal lumbar endoscopic discectomy

    Directory of Open Access Journals (Sweden)

    Cezmi Çagri Türk

    2015-01-01

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

  17. Correlation between Lumbar vertebral instability and severe degenerative spondylolisthesis

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    Golbakhsh M

    2013-04-01

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

  18. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM IN PATIENTS WITH LUMBAR RADICULOPATHY (L5 / S1 NERVE ROOT IN LUMBAR DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    Sahiba Yadav

    2014-10-01

    Full Text Available Background: Various manual therapy techniques are known to treat discogenic pain. Research is limited and controversial in the effectiveness of manual therapy for treatment of lumbar radiculopathy due to lumbar disc disease. In manual therapy, Mulligan has described spinal mobilisation with leg movement technique, for improvement in lumbar lesion resulting in pain and other signs below knee. Purpose of the study: To find out if Mulligan’s Spinal Mobilisation with Leg Movement technique (SMWLM in conjunction with conventional treatment is better than conventional treatment alone in improving leg pain intensity (VAS, localization of leg pain (body diagram by Donelson, back specific disability (RMQ in patients with lumbar radiculopathy (L5/ S1 nerve root in lumbar disc herniation. Methods: The study is a randomized controlled trial performed on 30 patients with lumbar radiculopathy. Both the groups received back extension exercises, hot pack, precautions and ergonomic advice. The experimental group received SMWLM technique in addition to the conventional treatment. Outcomes included leg pain intensity, Roland Morris Questionnaire and body diagram by Donelson. Results: There was significant improvement in VAS (p=0.000, body diagram (p=0.000 for experimental group and p=0.003 for conventional group and Roland Morris Questionnaire score (p=0.000 within the groups. Between group analysis showed significant improvement in VAS (p=0.000, body diagram score (p=0.000. Although there was significant improvement in Roland Morris Questionnaire score within the groups but there no significant difference between the group (p=0.070. Conclusion: Spinal Mobilization with Leg Movement technique in addition to conventional physical therapy produced significant improvement in leg pain intensity, location of pain and back specific disability in patients with lumbar radiculopathy in lumbar disc herniation.

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

    International Nuclear Information System (INIS)

    A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male nonathletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occured in both athletes and non-athletes but were more common among athletes, especially male-gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers. (orig.)

  20. Multivariate prognostic modeling of persistent pain following lumbar discectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2013-03-04

    Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-03-01

    A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male nonathletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occured in both athletes and non-athletes but were more common among athletes, especially male-gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers. (orig.).

  2. Ganglioneuroma of Lumbar Nerve Root: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Min Hye; Lee, Seung Hun; Joo, Kyung Bin; Jang, Ki Seok [Dept. of Hanyang University Seoul Hospital, Seoul (Korea, Republic of); Bae, Ji Yoon [Dept. of Pathology, National Police Hospital, Seoul (Korea, Republic of)

    2013-02-15

    Ganglioneuroma is a rare, benign, slow-growing, well-differentiated tumor consisting of ganglion cells and Schwann cells. Ganglioneuromas originate from neural crest cells and can affect any part of the sympathetic tissue from the skull base to the pelvis. However, ganglioneuroma occurring in the nerve root is extremely rare. We describe a 50-year-old man with ganglioneuroma involving the right 5th lumbar nerve root. The ganglioneuroma showed intermediate signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image with homogeneous enhancement on the gadolinium-enhanced T1-weighted image.

  3. A generic detailed rigid-body lumbar spine model

    DEFF Research Database (Denmark)

    De Zee, Mark; Hansen, Lone; Wong, Christian; Rasmussen, John; Simonsen, Erik B

    2007-01-01

    The objective of this work is to present a musculo-skeletal model of the lumbar spine, which can be shared and lends itself to investigation in many locations by different researchers. This has the potential for greater reproducibility and subsequent improvement of its quality from the combined effort of different research groups. The model is defined in a text-based, declarative, object-oriented language in the AnyBody Modelling System software. Text-based models will facilitate sharing of the ...

  4. Influence of lumbar curvature and rotation on forward flexibility in idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Feng-Chun Kao

    2014-04-01

    Full Text Available Background: Lumbar spine facet joints are arranged sagittally and mainly provide forward flexibility. Rotation of the lumbar vertebral body and coronal plane deformity may influence the function of lumbar forward flexibility. We hypothesize that the more advanced axial and coronal plane deformity could cause more limitation on forward flexibility in patients with idiopathic scoliosis. Methods: Between January 2011 and August 2011, 85 patients with adolescent idiopathic scoliosis were enrolled in this study. The proximal thoracic, major thoracic, thoracolumbar/lumbar (TL/L, and lumbar (L1/L5 curves were measured by Cobb's method. Lumbar apical rotation was graded using the Nash-Moe score. Lumbar forward flexibility was measured using the sit and reach (S and R test. Statistical analysis was performed using one-way analysis of variance (ANOVA, Spearman's and Pearson's correlation coefficients. Results: The mean age was 16.1 ± 2.84 years. The mean proximal thoracic, major thoracic, TL/L, and L1/L5 curves were 17.61° ± 8.92, 25.56° ± 11.61, 26.09° ± 8.6, and 15.10° ± 7.85, respectively. The mean S and R measurement was 25.56 ± 12.33 cm. The magnitude of the TL/L and L1/L5 curves was statistically positively related to vertebral rotation (rs = 0.580 and 0.649, respectively. The correlation between the S and R test and both the TL/L and L1/L5 curves was negative (rp = –0.371 and –0.595, respectively. Besides, the S and R test also demonstrated a significant negative relationship with vertebral rotation (rs = –0.768. Conclusion: In patients with idiopathic scoliosis, spinal deformity can diminish lumbar forward flexibility. Higher lumbar curvature and rotation lead to greater restriction of lumbar flexion.

  5. Factores relacionados con la cirugía fallida de hernia discal lumbar / Related factors with the failed surgery of herniated lumbar disc

    Scientific Electronic Library Online (English)

    J., Rodríguez-García; A., Sánchez-Gastaldo; T., Ibáñez-Campos; C., Vázquez-Sousa; M., Cantador-Hornero; J.A., Expósito-Tirado; A., Cayuela-Domínguez; C., Echevarría-Ruiz de Vargas.

    2005-12-01

    Full Text Available Introducción. La cirugía descompresiva de hernia discal es la intervención quirúrgica más frecuente a nivel de la columna lumbar. La cirugía fallida oscila entre un 10 y un 40% de los casos, constituyendo el denominado Síndrome de la Cirugía Raquídea Fracasada (SCRF). La reincorporación laboral a me [...] dio plazo tras la cirugía se sitúa en torno al 70-85%, y existen pocos estudios que analicen la calidad de vida tras la intervención. Los objetivos de este estudio son conocer la incidencia de cirugía fallida de hernia discal lumbar en nuestro medio, identificando aquellos factores que puedan influir en su aparición; y estudiar factores ambientales como la reincorporación laboral y la calidad de vida a medio plazo tras esta cirugía, así como su relación con el éxito o fracaso quirúrgico. Material y métodos. Estudio descriptivo transversal de 117 pacientes intervenidos de hernia discal lumbar durante el primer semestre del 2003 en nuestro hospital. Para valorar la incidencia de cirugía fallida y factores relacionados se han recogido datos clínicos de la Historia Clínica de los pacientes de la muestra. Y, asimismo, se ha entrevistado telefónicamente a 91 de ellos -los que contestaron- para valorar factores no clínicos relacionados con el SCRF, tales como reincorporación laboral, satisfacción con la cirugía, realización de tratamiento rehabilitador y calidad de vida a través del Cuestionario de Salud SF-36. Para el análisis de resultados se ha empleado el programa estadístico SPSS 11.01. Resultados. En una muestra en la que la proporción ente ambos sexos es de 1/1 y la edad media de 45 [35-54] años, con una clínica más frecuente de ciática derecha, de más de 6 meses de evolución, correlacionada con el hallazgo radiológico de hernia L5-S1, un 37,9% ha presentado el SCRF. Aunque es escaso el número de pacientes que en nuestra serie afrontan una reintervención, se ha observado en ellos una incidencia del SCRF notablemente superior (52,2%) a los que se someten a una primera cirugía (32%). Los factores clínicos predictivos de resultados desfavorables en pacientes sometidos a primera cirugía han sido la clínica precirugía de ciática bilateral, el hallazgo de estenosis de canal asociada a hernia discal y la comorbilidad; mientras que los socio-laborales han sido pacientes sin estudios y aquellos que trabajan en los sectores de la conducción, construcción y hostelería. La reincorporación laboral se produjo en el 64 % de los trabajadores activos previamente. Sólo en torno al 10% se encuentran insatisfechos con la opción quirúrgica, relacionándose significativamente tanto esto como las dimensiones de función física, dolor, vitalidad y rol emocional en el SF-36 con el SCRF. Conclusiones. Uno de cada 3 pacientes intervenidos de hernia discal lumbar en nuestro medio presenta cirugía fallida, reincorporándose laboralmente 2 de cada 3 pacientes previamente activos. El paciente con cirugía fallida se encuentra afectado por dolor, hasta el punto de repercutir y limitar las actividades del hogar y las laborales. Además presenta frecuentemente sensación de cansancio o agotamiento, y problemas emocionales que interfieren tanto en las actividades de la vida diaria como en el trabajo. Abstract in english Introduction. The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few [...] studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. Material and methods. A descriptive transversal study of 117 patients operated fo

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

    Directory of Open Access Journals (Sweden)

    Kabatas Serdar

    2010-01-01

    Full Text Available Background: Epidural steroid injection (ESIs is one of the treatment modalities for chronic low back pain (CLBP with various degrees of success. Aim: We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. Materials and Methods: We analyzed the data of 40 patients (February 2008 and April 2009 with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term, six months (midterm and one year (long term after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS and North American Spine Society (NASS patient satisfaction scores. Results: The mean age of the patients was 59.87 ± 15.06 years (range 30 - 89 years, 25 women. Average follow-up period was 9.22 ± 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P < 0.01, Pearson Correlation Test. Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P < 0.05, linear regression test. At short term evaluation in post treatment (one month, 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8 had a successful long-term outcome at a follow-up of one year. Conclusion: Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores.

  7. Tratamiento microquirúrgico en la hernia discal lumbar / Traitement microchirurgical de la hernie discale lombaire / Microsurgical treatment in herniated lumbar disc

    Scientific Electronic Library Online (English)

    Ángel Jesús, Lacerda Gallardo; Oilen, Hernández Guerra; Julio, Díaz Agramonte.

    1999-12-01

    Full Text Available Se realizó un estudio observacional descriptivo de 35 pacientes operados por hernia discal lumbar, con técnicas de microcirugía, en el período comprendido entre febrero de 1996 y febrero de 1997. De éstos el 68,57 % eran masculinos y 31,43 % femeninos, con una edad promedio para el grupo de 42,11 añ [...] os y un rango de edades comprendido entre 23 y 74 años. Los métodos diagnósticos que influyeron en la decisión quirúrgica fueron la mielografía lumbar con contraste hidrosoluble en el 37,14 % y la TAC en el 34,28 %, mientras que la electromiografía (EMG), la clínica y los rayos X simples fueron menos determinantes, 20 % y 14,29 % respectivamente. Los espacios L5-S1 (57,14 %) y L4-L5 (31,43 %), fueron los más afectados, mientras la combinación de ambos se presentó en el 11,43 %. La complicación más encontrada fue la hernia discal recidivante (8,57 %) y la estadía hospitalaria promedio fue de 2,79 días, el 48,57 % con menos de 24 h (cirugía ambulatoria). Los resultados quirúrgicos a los 6 meses, según la escala de Ebeling fueron satisfactorios en el 97,14 % de los casos con 57,14 % clasificado como bueno; 31,43 % excelente; 8,57 % regular y sólo 2,86 % malo. No existieron casos de fallo de la técnica. Abstract in english An observational descriptive study of 35 patients operated on of herniated lumbar disc by microsurgery techniques from February, 1996, to February, 1997, was conducted. 68.57% of these patients were males and 31.43% were females, with an average age of 42.11 and an age range between 23 and 74. The d [...] iagnostic methods that influenced on the surgical decision were lumbar myelography with hydrosoluble contrast in 37.l4% and CAT in 34.28%, whereas electromyogram (EMG), the clinic and simple X-rays were less determining 20 % and 14.29 %, respectively. The spaces L5-S1 (57.14%) and L4-L5 (31.43%) were the most affected. The combination of both was observed in 11.43%. The most frequent complication was herniated disc (8.57%). Average hospital stay was 2.79 days, 48.57% with less than 24 hours (ambulatory surgery). The surgical results at 6 months according to Ebeling’s scale were satisfactory in 97.l4% of the cases with 57.l4% classified as good; 31.43%, excellent; 8.57%, fair and only 2.86%, poor. The technique did not fail in any of the cases.

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

    Scientific Electronic Library Online (English)

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

    2006-04-01

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

  9. A generic detailed rigid-body lumbar spine model

    DEFF Research Database (Denmark)

    De Zee, Mark; Hansen, Lone

    2007-01-01

    The objective of this work is to present a musculo-skeletal model of the lumbar spine, which can be shared and lends itself to investigation in many locations by different researchers. This has the potential for greater reproducibility and subsequent improvement of its quality from the combined effort of different research groups. The model is defined in a text-based, declarative, object-oriented language in the AnyBody Modelling System software. Text-based models will facilitate sharing of the models between different research groups. The necessary data for the model has been taken from the literature. The work resulted in a detailed lumbar spine model with seven rigid segments with 18 degrees-of-freedom and 154 muscles. The model is able to produce a maximum extension moment of 238 Nm around L5/S1. Moreover, a comparison was made with in vivo intradiscal pressure measurements of the L4-5 disc available from the literature. The model is based on inverse dynamics, where the redundancy problem is solved using optimization in order to compute the individual muscle forces and joint reactions. With the presented model it is possible to investigate a range of research questions, because the model is relatively easy to share and modify due to the use of a well-defined and self-contained scripting language. Validation is though still necessary for specific cases.

  10. Return-to-work (RTW) of patients after Lumbar Surgery

    Scientific Electronic Library Online (English)

    Herculene, van Staden; René, Kemp; Susan, Beukes.

    Full Text Available BRACKGROUND: Return to work (RTW) after lumbar surgery due to a work-related injury poses a challenge internationally. Work hardening is used as an intervention for acute and chronic lower back pain (CLBP), but it is not necessarily used in post-operative treatments. Method: The RTW rate of an exper [...] imental group (Group A) of unskilled labourers was compared with that of a control group (Group B) of unskilled labourers. Group A received multidisciplinary intervention, including a work hardening programme with ergonomic adaptations, while Group B received only physiotherapy after surgery as a multidisciplinary team was not available. A RTW questionnaire was used as an outcome measure for both groups. During the multidisciplinary intervention, the improvement of pain and functionality of patients from Group A were also evaluated from the pre-operative state to 24 weeks post-operatively with the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) as additional outcome measures. Results: There was a positive tendency to successful RTW after work hardening for Group A, but no statistical significance between Groups A and B. The improvement of pain and functionality in Group A was highly significant from time of surgery to six months post-operatively. Conclusion: Work hardening was found to have a positive tendency towards ensuring RTW for work-injured patients after lumbar surgery, with a highly significant effect on pain and functionality.

  11. Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis.

    Science.gov (United States)

    Ren, Longxi; Han, Zhengfeng; Zhang, Jianhua; Zhang, Tongtong; Yin, Jian; Liang, Xibin; Guo, Han; Zeng, Yanjun

    2014-05-01

    The objective of this study is to observe the effect of percutaneous laser disc decompression (PLDD) on lumbar spinal stenosis (LSS). Thirty-two LSS patients were treated using pulsed Nd: YAG laser, of which 21 cases (11 males and 10 females with an average age of 64 years old) were followed up for 2 years. All of the 21 patients had intermittent claudication with negative straight leg raising test results. Fifteen patients suffered from anterior central disc herniation which often compressed the cauda equina but seldom compressed the posterior part; six patients suffered from posterior ligamentum flavum hypertrophy which often compressed the cauda equina but seldom compressed the anterior part. The efficacy was evaluated 1, 3, 6, 12 and 24 months after surgery on 21 patients using the performance evaluation criteria of the lumbago treatment by the Japanese Orthopaedic Association (JOA 29 scores). The fineness (i.e. excellent and good treatment outcome) rate 1, 3, 6, 12 and 24 months after the operation were 46.7%, 66.7%, 66.7%, 66.7% and 66.7%, respectively, in patients with severe anterior compression and 16.7%, 33.3%, 33.3%, 33.3% and 33.3%, respectively, in patients with severe posterior compression. PLDD had certain positive efficacy on the treatment of lumbar spinal stenosis, which was more significant on LSS dominated by the anterior compression than that by the posterior compression. PMID:23996073

  12. CT of lumbar disc herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Suk Yl; Lee, Dong Jin; Sung, Kyu Bo; Woo, Won Hyung [Korea General Hospital, Seoul (Korea, Republic of)

    1986-10-15

    CT from forty nine patients with 53 surgical disc explorations were reviewed and correlated with surgical findings. The results were as follows: 1. Frequent locations of HNP were in L4-5 (65%) and L5-S1 (31%). The most common type of HNP was paramidine type (71%). 2. Focal protrusion of the posterior margin of disc and obliteration of epidural fat pad were observed in all of cases (100%) and other common findings were indentation of epidural sac in 46 cases (96%) and compression of nerve root sleeve in 33 cases (69%). 3. Cephalad and caudad extension of protruded soft tissue density in the spinal canal was observed in 15 cases (31%) with variable degree. And more than 6mm extension were provided to be extruded disc in 9 cases. 4. Vacuum phenomenon was demonstrated in 5 cases (10%) and was accompanied with bulging annulus. 5. Forty eight herniated nucleus (HNP) were confirmed surgically in 44 patients. Misinterpretations were made in 4 instances (4 patients); 1 because of lumbar scoliosis, 1 because of spondylolisthesis, and the other 2 because of calcified posterior longitudinal ligament and bulging annulus. One case of true negative examination was central and foraminal stenosis in spinal CT. Thus, sensitivity, specificity and overall accuracy of lumbar spine CT in HNP were 92%, 100% and 92%, respectively.

  13. Predictors of Oswestry Disability Index worsening after lumbar fusion.

    Science.gov (United States)

    Gum, Jeffrey L; Carreon, Leah Y; Stimac, Jeffrey D; Glassman, Steven D

    2013-04-01

    The authors identified patients with an increase in their Oswestry Disability Index (ODI) score after lumbar spine fusion to evaluate whether this is a plausible definition of deterioration and to determine whether any common patient characteristics exist.A total of 1054 patients who underwent lumbar spinal fusion and had 2-year follow-up data, including the Short Form 36, the ODI, and numeric rating scales for back and leg pain, were identified. Patients with worsening ODI were compared with the remaining cohort. Twenty-eight patients had an absolute increase (worse) in ODI at 1 year postoperatively. Participants with worsening ODI scores included 13 men and 15 women with an average age of 43.3 years; 15 (54%) were smokers. Common medical comorbidities included obesity and hypertension. Complications occurred in 5 (18%) patients and included wound infection, dural tear, and nerve root injury. Pseudarthrosis was common (n=8; 28%). Twenty-one patients required an additional intervention, including epidural injections, fusion revision, and cervical spine surgery.It is important to have a clear definition of deterioration to better provide informed consent or choice of treatment. Only 28 (2.6%) patients were identified as having an increase in ODI score at 2-year follow-up. PMID:23590789

  14. Correlations between the cross-sectional area and moment arm length of the erector spinae muscle and the thickness of the psoas major muscle as measured by MRI and the body mass index in lumbar degenerative kyphosis patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun; Lee, Sang Jin; Lee, Sang Ho [Busan Wooridul Hospital, Busan (Korea, Republic of)

    2006-03-15

    Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA and MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age and gender) control group with regard to the CSA, MAL, PT and BMI. The 17 LDK patients were all females [age: 62.5 {+-} 4.93 years, height: 157 {+-} 6.19 cm, weight: 55.59 {+-} 4.7 kg, and BMI: 22.58 {+-} 2.08 kg/m{sup 2}]. The control group patients were all female [age: 63.6 {+-} 2.27 years, height: 156 {+-} 5.05 cm, weight: 59.65 {+-} 7.39 kg and BMI: 24.38 {+-} 2.94 kg/m{sup 2}]. Spearman's rho indicated a positive association between the CSA and BMI (rho = 0.49, {rho} = 0.046), between the MAL and BMI (rho = 0.808, {rho} = 0.000) and between the CSA and PT (rho = 0.566, {rho} = 0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho = 0.67, {rho} = 0.000, MAL = 0.023CSA + 5.454 in the LDK group; rho = 0.564, {rho} 0.018, MAL = 0.02CSA + 5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically different mean values ({rho} =0.000) in terms of the CSA and MAL. This study showed that the patients with LDK not only had atrophied erector spinae muscles, but also atrophied psoas major muscles and short MALs, which is harmful because of the increased lower back load in the aged patients. Along with BMI, measurement of the CSA, MAL and PT on the MR images provides an objective assessment of the dimension and severity of the muscle atrophy in the LDK patients.

  15. Lumbar Extension during Stoop Lifting is Delayed by the Load and Hamstring Tightness.

    Science.gov (United States)

    Iwasaki, Risa; Yokoyama, Ginga; Kawabata, Satoshi; Suzuki, Tomotaka

    2014-01-01

    [Purpose] This study investigated the relationship between lumbar pelvic rhythm and the physical characteristics of stoop lifting. [Subjects and Methods] Participants performed a stoop lifting task under two conditions: with and without load. We assessed the lumbar kyphosis and sacral inclination angles using the SpinalMouse(®) system, as well as hamstring flexibility. During stoop lifting, surface electromyograms and the lumbar and sacral motions were recorded using a multi-channel telemetry system and flexible electrogoniometers. [Results] In the initial phase of lifting, lumbar extension was delayed by load; the delay showed a negative correlation with sacral inclination angle at trunk flexion, whereas a positive correlation was observed with electromyogram activity of the lumbar multifidus. Additionally, a positive correlation was observed between sacral inclination angle and hip flexion range of motion during the straight leg raise test. [Conclusion] We found that a disorder of the lumbar pelvic rhythm can be caused by both load and hamstring tightness. In the initial phase of stoop lifting, delayed lumbar extension is likely to lead to an increase in spinal instability and stress on the posterior ligamentous system. This mechanism shows that stoop lifting of a load may be harmful to the lower back of people with hamstring tightness. PMID:24567676

  16. Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Kai XU

    2011-09-01

    Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

  17. A Study on Visualizing the Twist and the Load on the Lumbar Region in Nursing Care

    OpenAIRE

    Maekawa, Yasuko; Shiozaki, Akira; Majima, Yukie

    2012-01-01

    Most nurses suffer from lower back pain (LBP). The load on the lumbar region in nursing practice depends on patient's condition and situation. So we regard it as the load of nursing practice, and suggest visualizing the load on the lumbar region for nursing management. This study focuses on “twist” which is one of factors of LBP. We measured the twist angle of the lumbar region and the surface electromyogram (EMG) in three methods of transferring a patient from a bed to a wheelchair. Experime...

  18. Myelography, CT and MRI in leukaemic infiltration of the lumbar theca

    Energy Technology Data Exchange (ETDEWEB)

    Shen, W.C. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Lee, S.K. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Ho, Y.J. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Lee, K.R. (Inst. of Life Science, National TsingHua Univ. (Taiwan, Province of China))

    1993-08-01

    A 25-year-old woman with acute lymphoblastic leukaemia, while in remission, developed paraparesis, with faecal and urinary incontinence. CT demonstrated increased density of the lumbar theca and enlargement of the nerve roots. Myelography showed complete obstruction below the L3 level. MRI showed increased signal intensity in the lumbar sac on T1 weighting, and the cauda equina enhanced with gadolinium-DTPA. Lymphoblasts were seen in the lumbar spinal fluid. After chemoterhapy, these abnormalities resolved, as did the paraparesis and incontinence. (orig.)

  19. The history and development of Microendoscopic Discectomy for lumbar disc herniations

    Directory of Open Access Journals (Sweden)

    Bulent ERDOGAN

    2003-06-01

    Full Text Available Lumbar microendoscopic discectomy is a new endoscopic intervention that successfully combines endoscopic technology with the principles of standart microdiscectomy. The goal of microendoscopic discectomy is the same as that of open lumbar discectomy which is to decompress the affected nerve root caused by disc and/or bony pathology under endoscopic visualization. Endoscopic spinal approaches have been widely used since 1990’s. In this article we reported our first experiences in 16 patients using this new percutaneous endoscopic procedure and technical details of this system, reviewing also the history of percutaneous approaches to lumbar disc herniation.

  20. Simpatectomia lombar por pneumoretroperitonioscopia (SLPR) / Retroperitoneal endoscopic lumbar sympathectomy

    Scientific Electronic Library Online (English)

    Wander Eduardo, Sardinha; Jose Manoel da Silva, Silvestre; Fernando, Thomazinho; Rodrigo Gomes de, Oliveira; Domingos de, Morais Filho.

    2007-12-01

    Full Text Available CONTEXTO: A simpatectomia ainda encontra indicação no tratamento de várias doenças, tais como a insuficiência arterial periférica crônica aterosclerótica grau IV (Fontaine) sem condições de revascularização, úlceras hipertensivas e o fenômeno de Raynaud acompanhado de lesões tróficas. A cirurgia clá [...] ssica é realizada através do acesso retroperitoneal, mas também pode ser realizada por meio de técnicas minimamente invasivas. OBJETIVO: Este trabalho tem o objetivo de mostrar os resultados da simpatectomia lombar por pneumoretroperitonioscopia. MÉTODOS: Trinta e um pacientes foram submetidos a simpatectomia lombar por pneumoretroperitonioscopia (22 homens e nove mulheres), com média de idade de 48 anos (41-70). Vinte eram pacientes com insuficiência arterial periférica crônica, sem possibilidade de revascularização, todos com lesões (necroses ou úlceras); sete pacientes eram portadores de tromboangeite obliterante; três tinham úlcera hipertensiva; e um apresentava fenômeno de Raynaud secundário. As cirurgias foram realizadas por pneumoretroperitoneoscopia, sendo feita a exérese do segundo ao quarto gânglio da cadeia lombar. RESULTADOS: Não houve complicações intra-operatórias, havendo necessidade de apenas uma conversão para cirurgia convencional por dificuldade técnica. A duração média do procedimento foi de 103 minutos e o tempo médio de internação foi de 2 dias. CONCLUSÃO: A simpatectomia pode ser realizada por pneumoretroperitonioscopia com as vantagens de uma cirurgia minimamente invasiva. Abstract in english BACKGROUND: Sympathectomy can still be performed in the treatment of many diseases, such as chronic atherosclerotic peripheral arterial disease stage IV without conditions of revascularization, hypertensive ulcer and necrosis associated with Raynaud phenomenon. The classical treatment is performed t [...] hrough retroperitoneal access, but can also be performed through minimally invasive techniques. OBJECTIVE: This study aims at evaluating results of retroperitoneal endoscopic lumbar sympathectomy. METHODS: Thirty-one patients were submitted to retroperitoneal endoscopic lumbar sympathectomy (22 males and nine females), mean age of 48 years (41-70). Twenty patients had chronic peripheral arterial disease, with no possibility of revascularization, all presenting with necrosis or ulcer; seven patients had thromboangiitis obliterans, three had hypertensive ulcer, and one patient had secondary Raynaud phenomenon. Surgical procedures were performed by retroperitoneal endoscopic access, besides excision of ganglia L2-L4 of the lumbar sympathetic chain. RESULTS: There were no intraoperative complications, only the need of converting to open surgery due to technical difficulties. Mean operative time was 103 minutes and mean hospital stay was 2 days. CONCLUSION: Sympathectomy can be performed by retroperitoneal endoscopy using the advantages of a minimally invasive surgery.

  1. Use of autologous growth factors in lumbar spinal fusion.

    Science.gov (United States)

    Lowery, G L; Kulkarni, S; Pennisi, A E

    1999-08-01

    The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGF) prepared by ultraconcentration of platelets contains multiple growth factors having a chemotactic and mitogenic effect on mesenchymal stem cells and osteoblasts and may play a role in initiating bone healing. The purpose of this retrospective study is to review our results with AGF in lumbar spinal fusions. To date, AGF has been used in 39 patients having lumbar spinal fusion. The study group consisted of the first 19 consecutive cases to allow at least 6 months follow-up. The average follow-up was 13 months (range 6 to 18 months). Follow-up compliance was 91%. There were 7 men and 12 women. Average age was 52 years (range 30-72 years). Nine patients had prior back surgery. There were 8 smokers. AGF was used in posterior (n = 15) or anterior intradiscal (n = 4) fusions. AGF was used with autograft and coraline hydroxyapatite in all posterior fusions, and autograft, coral, and intradiscal spacer (carbon fiber spinal fusion cages or Synthes femoral ring) in intradiscal fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion. Autologous iliac crest bone graft was taken in 14 cases and local autograft used in 5 cases. Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3. No impending pseudoarthroses were noted on plain radiographic examination at last follow-up visit. Solid fusion was confirmed in 3 patients having routine hardware removal, and in 2 patients who had surgery at an adjacent level. There was one posterior wound infection, which was managed without sequelae. When used as an adjunct to autograft, AGF offers theoretical advantages that need to be examined in controlled studies. Further study is necessary to determine whether coralline hydroxyapatite used as a bone graft extender in lumbar spinal fusion may help to obviate the need for secondary site graft harvesting. PMID:10458274

  2. Recurrent acute low back pain secondary to lumbar epidural calcification

    International Nuclear Information System (INIS)

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  3. Tonsillar Herniation After Lumbar Puncture in Idiopathic Intracranial Hypertension.

    Science.gov (United States)

    Borire, Adeniyi A; Hughes, Andrew R; Lueck, Christian J

    2015-09-01

    A 30-year-old woman with coexisting renal tubular acidosis and idiopathic intracranial hypertension (IIH), treated with acetazolamide, experienced coning (cerebellar tonsillar herniation) after a lumbar puncture (LP). Brain magnetic resonance imaging at initial diagnosis of IIH showed minor tonsillar descent and computed tomographic venography revealed hypoplasia of the left transverse sinus. The patient previously had three uneventful LPs, all of which showed high opening pressures and normal cerebrospinal fluid composition. In retrospect, it was noted that her serum bicarbonate had fallen to 9 mmol/L (normal: 22-28 mm/L) 1 week before the LP. We hypothesize that the combination of cerebral edema (due to worsening metabolic acidosis), poor venous drainage, and preexisting minor tonsillar descent contributed to her post-LP coning. PMID:25786203

  4. Post-lumbar puncture arachnoiditis. The need for directed questioning.

    Science.gov (United States)

    Etchepare, Fabien; Roche, Bruno; Rozenberg, Sylvie; Dion, Elisabeth; Bourgeois, Pierre; Fautrel, Bruno

    2005-03-01

    The inflammation of the arachnoid mater may produce a fibrinous exudate around the roots that causes them to adhere to the dural sheath. We report the case of a man aged 23 years who suffered from acute inflammatory truncated sciatica. The diagnosis of adhesive arachnoiditis was made in front of clinical arguments associated to typical signs on Myelo CT Scan and MRI. The only explanation ever found was a traumatic lumbar puncture at the age of 6 years for suspected meningitis. Sequelae of arachnoiditis are difficult to diagnosis. When MRI or myelography suggests it as a possibility, precise directed questioning is necessary to seek a history, albeit distant, of spinal or meningeal events. PMID:15797502

  5. The role of laparoscopic biopsies in lumbar spondylodiscitis.

    Science.gov (United States)

    Corpataux, J M; Halkic, N; Wettstein, M; Dusmet, M

    2000-12-01

    Infection of an intervertebral disk is a serious condition. Diagnosis often is elusive and difficult. It is imperative to obtain appropriate microbiological specimens before initiation of treatment. The authors describe a 51-year-old woman with lumbar spondylodiscitis that was because of infection after the placement of an epidural catheter for postoperative analgesia. A spinal magnetic resonance imaging confirmed the diagnosis, but computed tomography-guided fine needle biopsy did not provide adequate material for a microbiologic diagnosis. Laparoscopic biopsies of the involved disk provided good specimens and a diagnosis of Propionibacterium acnes infection. The authors believe that this minimally invasive procedure should be performed when computed tomography-guided fine needle biopsy does not provide a microbiologic diagnosis in spondylodiscitis. PMID:11147923

  6. Free epidural fat-grafting after lumbar laminectomy using MRI

    International Nuclear Information System (INIS)

    Free epidural fat-grafting was performed to prevent adhesion between scar tissue of the epidural space and dura and nerve root after lumbar laminectomy. The results were evaluated using MRI. Fifteen cases were operated upon with an average follow-up period of 7.5 months. MRI was recorded and the findings were classified into four types as follow: I, equally high signal case; II, slight fibrosis case; III, severe fibrosis case; IV, high signal disappeared case. The results showed 3 cases of type I, 7 cases of type II, 3 cases of type III, and 2 cases of type IV. According to MRI findings, free epidural fat is supposed to be still viable and alive, although slightly fibroses but the dural side remains a high signal area. Free epidural fat-grafting was useful for preventing adhesion around the epidural space. There was high relationship to age and sex with regard to viability of the free fat graft. (author)

  7. Solitary myofibroma of the lumbar vertebra: adult case

    Energy Technology Data Exchange (ETDEWEB)

    Konishi, E.; Yanagisawa, A. [Kyoto Prefectural University of Medicne, Department of Pathology, Kyoto (Japan); Mazaki, T.; Urata, Y. [Kyoto City Hospital, Department of Pathology, Kyoto (Japan); Tanaka, K.; Kanoe, H.; Ikenaga, M. [Kyoto City Hospital, Department of Orthopedic Surgery, Kyoto (Japan); Hayakawa, K. [Kyoto City Hospital, Department of Radiology, Kyoto (Japan)

    2007-06-15

    We present the first known adult case of solitary myofibroma of bone, which affected a lumbar vertebra in a 33-year-old male. Radiography identified a purely lytic lesion with a sclerotic rim in the right pedicle of L1. CT showed an expansile lytic lesion with a sclerotic rim. MRI of the lesion revealed an isointense signal on T1-weighted images, an inhomogeneously hyperintense signal on T2-weighted images, and marked enhancement with gadolinium. Pathological study showed a mixed picture of nodular proliferation of spindle-shaped myoid cells and hemangiopericytomatous proliferation of short spindle/small round cells. The tumor cells were immunoreactive for smooth muscle actin and immunonegative for desmin. This case of solitary myofibroma of bone is exceptionally rare because of its occurrence in an adult older than 20 years of age and its location at an extra-craniofacial site. (orig.)

  8. Solitary myofibroma of the lumbar vertebra: adult case

    International Nuclear Information System (INIS)

    We present the first known adult case of solitary myofibroma of bone, which affected a lumbar vertebra in a 33-year-old male. Radiography identified a purely lytic lesion with a sclerotic rim in the right pedicle of L1. CT showed an expansile lytic lesion with a sclerotic rim. MRI of the lesion revealed an isointense signal on T1-weighted images, an inhomogeneously hyperintense signal on T2-weighted images, and marked enhancement with gadolinium. Pathological study showed a mixed picture of nodular proliferation of spindle-shaped myoid cells and hemangiopericytomatous proliferation of short spindle/small round cells. The tumor cells were immunoreactive for smooth muscle actin and immunonegative for desmin. This case of solitary myofibroma of bone is exceptionally rare because of its occurrence in an adult older than 20 years of age and its location at an extra-craniofacial site. (orig.)

  9. CT changes after conservative treatment for lumbar disk herniation

    International Nuclear Information System (INIS)

    In order to assess changes occurring to lumbar disk herniations and bulges and to the disk spaces after conservative treatment, a follow-up CT was carried out of 106 pathologic disks in 92 patients at a mean interval of 14 months after the initial examination. There was a strong association between the evolution of the hernias and clinical results, with a decrease in size of the majority of hernias in successfully treated patients, whereas the others essentially remained unchanged (p<0.0001). A significantly higher proportion of large hernias diminished as compared to the smaller ones (P<0.0001). Diffuse disk bulges were associated with a poor outcome and never regressed. There was a lower incidence of diminution of the central hernias compared to other locations. Patients with normal disk space at the initial examination had a better outcome than those with disk space narrowing. Only occasionally was a reduction of the disk space observed at follow-up. (orig.)

  10. Is the lumbar disk herniation an indication for NMR tomography?

    International Nuclear Information System (INIS)

    It is reported on our clinical experiences with MR imaging in 70 operated patients with lumbar disk herniation. In all cases CT examinations had additionally been carried out. MR imaging has proved to be the superior method. This concerns as well the rate of detected disk herniations with clinical relevance as the perceptebility of additional findings. The advantages of MR images are its major contrast range in comparison to CT and the possibility to examine not only in axial but also sagittal direction. Because of the major contrast range one can precisely differentiate between nucleus pulposus and annulus fibrosus and therefore between protrusion and herniation, which is of practical use for planning the proper therapy. (orig.)

  11. Level Set Segmentation of Lumbar Vertebrae Using Appearance Models

    Science.gov (United States)

    Fritscher, Karl; Leber, Stefan; Schmölz, Werner; Schubert, Rainer

    For the planning of surgical interventions of the spine exact knowledge about 3D shape and the local bone quality of vertebrae are of great importance in order to estimate the anchorage strength of screws or implants. As a prerequisite for quantitative analysis a method for objective and therefore automated segmentation of vertebrae is needed. In this paper a framework for the automatic segmentation of vertebrae using 3D appearance models in a level set framework is presented. In this framework model information as well as gradient information and probabilities of pixel intensities at object edges in the unseen image are used. The method is tested on 29 lumbar vertebrae leading to accurate results, which can be useful for surgical planning and further analysis of the local bone quality.

  12. Lumbar disc ultrasonography for evaluation of chemonucleolysis: a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Tae Sub; Kim, Young Soo; Park, Hyung Chun; Suh, Jung Ho; Kim, Dong Ik; Oh, Seong Hoon [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1988-06-15

    There has been no reported change of ultrasonographic findings of nucleus pulposus in chemonucleolysis. We have found that the particle of herniated nucleus pulposus are highly echogenic and change to low echogenic after chemonucleolysis. On an in vitro experimental study, ultrasonography of the surgical specimen of the herniated nucleus pulposus was highly echogenic. After soaking the chymopapain into the surgical specimen of the herniated nucleus pulposus, the echogenicity was progressively lowered as time passed from 3 minutes to 12 hours. Our preliminary results are divided as two folds; 1. High echogenic shadows of outside of annulus fibrosus on ultrasonography of herniated lumbar disc will be important indicator of selection of patients for good therapeutic results of chemonucleolysis. 2. Progressively lowered echogenicity of high echogenic shadow after chemouncleolysis suggests good reaction of chymopapain with herniated nucleus pulposus.

  13. Review Article: MRI of the postoperative lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van; Parizel, P.M. [Department of Radiology, University of Antwerp, Wilrijkstraat 10, Edegem 2650 (Belgium); Jinkins, J.R. [Department of Radiology, Medical College of Pennsylvania-Hahnemann University, Philadelphia, PA (United States)

    2002-09-01

    Imaging assessment of the lumbosacral spine following surgery is complex and depends upon several factors, including the anatomy of the patient, the surgical procedure and the disease process for which it was performed, the age of the patient, the biomechanical condition of the underlying cortical and cancellous bone, intervertebral disc and musculoligamentous tissues, the time since surgery procedure and the duration and nature of the postsurgical syndrome. Depending upon these factors, one or a combination of complementary imaging modalities may be required to demonstrate any clinically relevant abnormality, to assist the surgeon in deciding if repeat surgery is necessary, its nature and at which vertebral level(s) it should be directed. This review stresses the important role of MRI following lumbar discectomy, intervertebral fusion and/or instrumentation in achieving the most beneficial and timely outcome in the patient presenting with an acute, subacute or chronic failed back surgery syndrome. (orig.)

  14. The effects of gait with use of smartphone on repositioning error and curvature of the lumbar spine.

    Science.gov (United States)

    Yoon, Jeong-Oh; Kang, Min-Hyeok; Kim, Jun-Seok; Oh, Jae-Seop

    2015-08-01

    [Purpose] This study evaluated the effect of smartphone use on lumbar spine repositioning error and lumbar curvature while walking on a treadmill. [Subjects] A total of 20 healthy individuals (18 males and 2 females) volunteered for this study. [Methods] The subjects walked for 20?min on a treadmill while using a smartphone. To determine the effect of smartphone use, lumbar repositioning error was measured using an electronic goniometer while lumbar curvature was assessed using a Spinal Mouse before and immediately after treadmill use. Differences in the lumbar repositioning error and lumbar curvature data between the pre- and post-walking were compared using the paired t-test. [Results] The lumbar spine repositioning error was significantly greater post-walking compared with pre-walking (6.70±2.91° vs. 3.02±1.79°). There was no significant difference in lumbar curvature between pre- and post-walking (14.24±3.18° vs. 13.94±3.12°). [Conclusion] These findings indicate that the lumbar repositioning error increased immediately after walking while using a smartphone, but that the lumbar curvature was unchanged. PMID:26357430

  15. The influences of bowel condition with lumbar spine BMD measurement

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Joon; Lee, Hoo Min; Lee, Jung Min; Kwon, Soon Mu; Cho, Hyung Wook [Dept. of Radiologic Technology, Dongnam Health College, Suwon (Korea, Republic of); Kim, Yun Min; Kang, Yeong Han; Kim, Boo Soon; Kim, Jung Soo [Dept. of Diagonostic Radiology, Samsung Medical Center, Seoul (Korea, Republic of)

    2014-12-15

    Bone density measurement use of diagnosis of osteoporosis and it is an important indicator for treatment as well as prevention. But errors in degree of precision of BMD can be occurred by status of patient, bone densitometer and radiological technologist. Therefore the author evaluated that how BMD changes according to the condition of the patient. As Lumbar region, which could lead to substantial effects on bone density by diverse factors such as the water, food, intentional bowels. We recognized a change of bone mineral density in accordance with the height of the water tank and in the presence or absence of the gas using the Aluminum Spine Phantom. We also figured out the influence of bone mineral density by increasing the water and food into a target on the volunteers. Measured bone mineral density through Aluminum Spine Phantom had statistically significant difference accordance with increasing the height of water tank(p=0.026). There was no significant difference in BMD according to the existence of the bowl gas(p=0.587). There was no significant difference in a study of six people targeted volunteers in the presence or absence of the food(p=0.812). And also there was no significant difference according to the existence of water(p=0.618). If it is not difficult to recognize the surround of bone in measuring BMD of lumbar bone, it is not the factor which has the great effect on bone mineral density whether the test is after endoscopic examination of large intestine and patient’s fast or not.

  16. Findings and outcome of revision lumbar disc surgery.

    Science.gov (United States)

    Ozgen, S; Naderi, S; Ozek, M M; Pamir, M N

    1999-08-01

    One hundred fourteen patients (64 men, 50 women) with prior lumbar disc surgery underwent a reexploration for intractable back and/or leg pain. The finding in revision surgery included disc herniation in 89 cases (78%), epidural fibrosis in 14 cases (12.2%), adhesive arachnoiditis in 4 cases (3.5%), isolated lateral spinal stenosis in 3 cases (2.6%), and iatrogenic instability in 4 cases (3.5%). Review of operative reports of patients who underwent a first operation in our institute revealed that seven cases (12.5%) had a second laminotomy without a discectomy in addition to the previous laminotomy and discectomy performed in the same session. Fifty-six of the patients with disc hemiation in revision surgery had a true recurrence. Disc hemiation was protruded in 38 cases (42.8%), extruded in 44 cases (49.4%), and sequestrated in 7 cases (7.8%). The outcome was assessed using Prolo's functional and economic scale. According to Prolo's scale, a good outcome was detected in 79 cases (69.2%), moderate in 22 (19.2%), and a poor outcome was detected in 13 cases (11.4%). The best outcome was achieved in patients with disc hemiation. It is concluded that recurrent disc disease is the most important cause of reexploration. This fact dictates a careful preoperative workup and discectomy in the first intervention. The likelihood of occurrence of disc herniation in the negative laminotomy level (i.e., laminotomy without discectomy procedure) also requires a careful preoperative radiologic workup before lumbar disc surgery. PMID:10451043

  17. MR imaging of epidural hematoma in the lumbar spine

    International Nuclear Information System (INIS)

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk extrusions. (orig.)

  18. The effects of needle deformation during lumbar puncture

    Science.gov (United States)

    Özdemir, Hasan Hüseyin; Demir, Caner F.; Varol, Sefer; Arslan, Demet; Y?ld?z, Mustafa; Akil, E?ref

    2015-01-01

    Objective: The aim of this study is to assess deformation of the tip and deflection from the axis of 22-gauge Quincke needles when they are used for diagnostic lumbar puncture (LP). Thus, it can be determined whether constructional alterations of needles are important for predicting clinical problems after diagnostic LP. Materials and Methods: The 22-gauge Quincke needles used for diagnostic LP were evaluated. A specially designed protractor was used for measurement and evaluation. Waist circumference was measured in each patient. Patients were questioned about headaches occurring after LP. Results: A total of 115 Quincke-type spinal needles used in 113 patients were evaluated. No deflection was detected in 38 (33.1%) of the needles. Deflection between 0.1° and 5° occurred in 43 (37.3%) of the needles and deflection ? 5.1° occurred in 34 patients (29.6%). Forty-seven (41.5%) patients experienced post lumbar puncture headache (PLPH) and 13 (11.5%) patients experienced intracranial hypotension (IH). No statistically significant correlation between the degree of deflection and headache was found (P > 0.05). Epidural blood patch was performed for three patients. Deformity in the form of bending like a hook occurred in seven needles and IH occurred in six patients using these needles. Two of the needles used in three patients requiring blood patch were found to be bent. Conclusion: Deformation of needles may increase complications after LP. Needle deformation may lead to IH. In case of deterioration in the structure of the needle, termination of the puncture procedure and the use of a new needle could reduce undesirable clinical consequences, especially IH. PMID:25883480

  19. The effects of needle deformation during lumbar puncture

    Directory of Open Access Journals (Sweden)

    Hasan Hüseyin Özdemir

    2015-01-01

    Full Text Available Objective: The aim of this study is to assess deformation of the tip and deflection from the axis of 22-gauge Quincke needles when they are used for diagnostic lumbar puncture (LP. Thus, it can be determined whether constructional alterations of needles are important for predicting clinical problems after diagnostic LP. Materials and Methods: The 22-gauge Quincke needles used for diagnostic LP were evaluated. A specially designed protractor was used for measurement and evaluation. Waist circumference was measured in each patient. Patients were questioned about headaches occurring after LP. Results: A total of 115 Quincke-type spinal needles used in 113 patients were evaluated. No deflection was detected in 38 (33.1% of the needles. Deflection between 0.1° and 5° occurred in 43 (37.3% of the needles and deflection ? 5.1° occurred in 34 patients (29.6%. Forty-seven (41.5% patients experienced post lumbar puncture headache (PLPH and 13 (11.5% patients experienced intracranial hypotension (IH. No statistically significant correlation between the degree of deflection and headache was found (P > 0.05. Epidural blood patch was performed for three patients. Deformity in the form of bending like a hook occurred in seven needles and IH occurred in six patients using these needles. Two of the needles used in three patients requiring blood patch were found to be bent. Conclusion: Deformation of needles may increase complications after LP. Needle deformation may lead to IH. In case of deterioration in the structure of the needle, termination of the puncture procedure and the use of a new needle could reduce undesirable clinical consequences, especially IH.

  20. Comparison of MR myelography with conventional myelography lumbar disc diseases

    International Nuclear Information System (INIS)

    To compare MR myelography(MRM) using heavily T2 weighted fast spin echo(FSE) with conventional myelography in the evaluation of lumbar degenerative disc diseases. A total of 50 patients with lumbar degenerative disc diseases underwent both MRM and conventional myelography. A 1.5 T Sigma MR system was used. For MRM, heavily T2 weighted FSE pulse sequences were performed in sagittal, coronal and both oblique planes. The images of MRM and conventional myelography were analyzed retrospectively and compared, focusing on the pattern of compression of the cal sac and nerve roots. MRM yielded comparable images to conventional myelography in 68% (34/50). MRM was superior to conventional myelography in 11 cases (22%), and the opposite resulted in 5 cases(10%). MRM could visualize the spinal canal below the level of complete block in 6 patients, provided better contrast in the cases of dural ectasia in 3 cases and better delineation of individual nerve roots with source images in 1 case. Additional informations such as incidental retroperitoneal vascular malformation and extravasation of the CSF could be obtained by MRM in 1 case each. Disadvantages of MRM were poor contrast in the cases of multiple spinal stenosis, obscuration of the nerve roots by engorged paraspinal vessels, and occasional difficulty in defining the levels due to vanishment of the bony background image. MRM is a safe, noninvasive, nonionizing which in very effective in evaluating the lumbosacral disc disease. Use of FSE-MRM in addition to the routine MR imaging could be very helpful not only for better evaluation of nerve roots but also for the additional informations

  1. Degenerative lumbar stenosis: update / Estenose lombar degenerativa: atualização

    Scientific Electronic Library Online (English)

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

    2009-06-01

    Full Text Available Apresentamos uma revisão de literatura do diagnóstico e tratamento da estenose lombar (EL) adquirida, enfatizando as novas técnicas de manejo cirúrgico. A EL é a causa mais comum de cirurgia na coluna de pacientes com mais de 65 anos de idade. Claudicação neurogênica e radiculopatias são sintomas re [...] sultantes da compressão das raízes lombossacrais pelos elementos degenerados. A descompressão cirúrgica é um procedimento bem estabelecido para pacientes com sintomas severos ou refratários ao tratamento clínico. Contudo, as opções cirúrgicas são amplas. Novas técnicas de fusão e artrodese são úteis para melhorar os resultados funcionais. Neste artigo, varias alternativas cirúrgicas são apresentadas, incluindo as novas tecnologias na área. Evidências científicas mais contundentes com seguimento longo são necessárias para a incorporação destas práticas na atividade médica de rotina. Abstract in english We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from c [...] ompression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.

  2. Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery

    DEFF Research Database (Denmark)

    Kjærgaard, M; Møiniche, S; Olsen, K S

    2012-01-01

    In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery.

  3. The Relation Between Rotation Deformity and Nerve Root Stress in Lumbar Scoliosis

    Science.gov (United States)

    Kim, Ho-Joong; Lee, Hwan-Mo; Moon, Seong-Hwan; Chun, Heoung-Jae; Kang, Kyoung-Tak

    Even though several finite element models of lumbar spine were introduced, there has been no model including the neural structure. Therefore, the authors made the novel lumbar spine finite element model including neural structure. Using this model, we investigated the relation between the deformity pattern and nerve root stress. Two lumbar models with different types of curve pattern (lateral bending and lateral bending with rotation curve) were made. In the model of lateral bending curves without rotation, the principal compressive nerve root stress on the concave side was greater than the principal tensile stress on the convex side at the apex vertebra. Contrarily, in the lateral bending curve with rotational deformity, the nerve stress on the convex side was higher than that on the concave side. Therefore, this study elicit that deformity pattern could have significantly influence on the nerve root stress in the lumbar spine.

  4. Taking it to the next level: lumbar radiculopathy from thoracic nerve schwannoma

    Directory of Open Access Journals (Sweden)

    Anene Ukaigwe

    2015-02-01

    Full Text Available Compression or irritation of the sciatic nerve and its branches, the common fibular and tibial nerves, causes sciatica which is a common syndrome characterized most often by radiating pain from the lower back down the legs and also manifesting as sensory and motor deficits. Sciatica is a common presentation of lumbosacral disc prolapse and degenerative disease of the lumbar spine in ambulatory settings. Schwannomas rarely cause sciatica; hence, it is seldom considered in evaluation of a patient with radiculopathy. Our patient presented with lumbar radiculopathy, mild degenerative changes on lumbar magnetic resonance imaging (MRI scan, and failed conservative treatment. Myelopathy was confirmed with electromyogram (EMG. Thoracolumbar spine MRI revealed the schwannoma in the thoracic region. He recovered neurologic function after tumor excision. This case highlights the diagnostic challenge that may arise in evaluating a patient with lumbar radiculopathy, negative lumbosacral spine imaging, and failure of conservative therapy.

  5. Taking it to the next level: lumbar radiculopathy from thoracic nerve schwannoma.

    Science.gov (United States)

    Ukaigwe, Anene; Olugbodi, Akintomi; Alweis, Richard L

    2015-01-01

    Compression or irritation of the sciatic nerve and its branches, the common fibular and tibial nerves, causes sciatica which is a common syndrome characterized most often by radiating pain from the lower back down the legs and also manifesting as sensory and motor deficits. Sciatica is a common presentation of lumbosacral disc prolapse and degenerative disease of the lumbar spine in ambulatory settings. Schwannomas rarely cause sciatica; hence, it is seldom considered in evaluation of a patient with radiculopathy. Our patient presented with lumbar radiculopathy, mild degenerative changes on lumbar magnetic resonance imaging (MRI) scan, and failed conservative treatment. Myelopathy was confirmed with electromyogram (EMG). Thoracolumbar spine MRI revealed the schwannoma in the thoracic region. He recovered neurologic function after tumor excision. This case highlights the diagnostic challenge that may arise in evaluating a patient with lumbar radiculopathy, negative lumbosacral spine imaging, and failure of conservative therapy. PMID:25656663

  6. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  7. Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases

    Directory of Open Access Journals (Sweden)

    Mingyuan Yang

    2014-01-01

    Conclusion: Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

  8. The arterial anatomy of the adult human lumbar vertebral body: a microarteriographic study.

    OpenAIRE

    Ratcliffe, J. F.

    1980-01-01

    The anatomy of the arteries of 93 adult human lumbar vertebral bodies was studied microarteriographically. There is a network of periosteal arteries joining the arteries of adjacent vertebrae on the anterolateral and posterior surfaces. These are prominent between the fourth and fifth lumbar arteries. There are three types of intra-osseous arteries: equatorial, metaphyseal and peripheral. Each supplies a separate zone. The peripheral arteries are short, branch early and have centripetally dir...

  9. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up

    OpenAIRE

    Norén, Lotta; Östgaard, Solveig; Johansson, Gun; Östgaard, Hans C.

    2001-01-01

    This study is a prospective, consecutive, 3-year cohort study of women with back pain in an index pregnancy. The aim was to describe the physical status and disability among women with back pain 3 years after delivery. Pain was identified as lumbar back pain, posterior pelvic pain or combined lumbar as well as posterior pelvic pain. Previous studies have established that all three types of pain can be reduced by structured physiotherapy during pregnancy, and the beneficial effect may last for...

  10. A method to evaluate the in vivo behaviour of lumbar spine implants

    OpenAIRE

    Gunnarsson, G.; Axelsson, Paul; Johnsson, Ragnar; Strömqvist, Björn

    2000-01-01

    The aim of the study was to design a method for evaluating the stabilizing effect of different lumbar spine implants in vivo, and to apply this method to a comparison of plates versus rods in lumbar spine posterolateral fusion using transpedicular screw fixation. Fourteen patients, seven operated on with transpedicular plates and screws (VSP), and seven operated on with rods and screws (Diapason), matched according to number of levels fused, had tantalum markers inserted in the vertebrae at s...

  11. Computed tomography of lumbar apophyseal joint lipoma: Report of three cases

    International Nuclear Information System (INIS)

    The authors report three cases of lumbar apophyseal joint lipoma located at the L4/L5 or L5/S1 level. CT scan makes the diagnosis easily possible; indeed erosive changes with enlargement of the upper portion of the lumbar articular joint and anterior displacement of the top of the superior facet are associated with intra-articular fatty densities. Clinical symptoms are rarely encountered and may be related to narrowing of the upper portion of the intervertebral foramen. (orig.)

  12. Correlation between Lumbar Lordosis Angle and Degree of Gynoid Lipodystrophy (Cellulite) in Asymptomatic Women

    OpenAIRE

    Giovana Barbosa Milani; A'Dayr Natal Filho; Sílvia Maria Amado João

    2008-01-01

    INTRODUCTION: Gynoid lipodystrophy (cellulite) has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis. OBJECTIVE: To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women. METHOD...

  13. ISSLS prize winner: cost-effectiveness of two forms of circumferential lumbar fusion

    DEFF Research Database (Denmark)

    Freeman, Brian J C; Steele, Nicholas A; Sach, Tracey H; Hegarty, James; Soegaard, Rikke

    2007-01-01

    STUDY DESIGN: Economic evaluation alongside a prospective, randomized controlled trial from a secondary care National Health Service (NHS) perspective. OBJECTIVE: To determine the cost-effectiveness of titanium cages (TC) compared with femoral ring allografts (FRA) in circumferential lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: A randomized controlled trial has shown the use of TC to be clinically inferior to the established practice of using FRA in circumferential lumbar fusion. Health eco...

  14. The effects of set volume during isolated lumbar extension resistance training in recreationally trained males

    OpenAIRE

    Steele, James; Fitzpatrick, Adam; Bruce-Low, Stewart; Fisher, James

    2015-01-01

    Background/Aim. Exercise designed to condition the lumbar extensor musculature is often included in resistance training (RT) programs. It is suggested that deconditioning of this musculature may be linked to low back pain. Thus effective means of conditioning these muscles are of interest to pursue. Evidence suggests that isolated lumbar extension (ILEX) RT might be most efficacious, however, the best means of manipulating resistance training variables in this regard is unknown. Set volume is...

  15. Diagnostic and therapeutic lumbar puncture performed safely and efficiently with a thin blunt needle

    DEFF Research Database (Denmark)

    Møller, Anders; Afshari, Arash; Bjerrum, Ole Weis

    2013-01-01

    The risk of postdural puncture headache following lumbar puncture can be reduced by choosing a blunt spinal needle or by using a smaller needle diameter. Reports indicate that lumbar puncture practiced outside of the anaesthetic discipline does not adhere to the current level of evidence. To examine the practice among haematologists in Denmark, we performed a national survey. In addition, we analysed the flow rate of a blunt 27-gauge (0.4 mm) spinal needle typically used for spinal anaesthesia b...

  16. Clinical application of a handy intraoperative measurement device for lumbar segmental instability

    OpenAIRE

    Kasai, Yuichi; Inaba, Tadashi; Kato, Takaya; Akeda, Koji; Uchida, Atsumasa

    2009-01-01

    We describe the development of a new device that permits handy intraoperative measurement of lumbar segmental instability. The subjects comprised 80 patients with lumbar degenerative disease. Relationships between preoperative radiological assessments and extended distance as measured using our new device were investigated. Mean extended distance measured using the device was 3.7?±?1.9 mm. Correlation coefficients between angular motion and extended distance, and translational motion and exte...

  17. Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy

    OpenAIRE

    Bahari, Syah; El-Dahab, Mohamed; Cleary, May; Sparkes, Joseph

    2010-01-01

    The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. Preoperative, day 1 and 6 weeks pain score, 24-h postoperative opiate requirements and duration of inpatient stay were recorded. ...

  18. MR myelography of the lumbar spine with a PSIF sequence: First experiences

    International Nuclear Information System (INIS)

    A rapid gradient-echo acquisition (PSIF) was used to delineate the lumber spine. Because this sequence is heavily T2 weighted the cerebrospinal fluid shows a bright signal, the myelon has a poor signal. 5 healthy voluteers and 5 patients with suspected lumbar disc herniation were examined by this technique. All MR myelograms were compared with spin-echo sequences (sagittal and transversal slices). All lumbar disc herniations which were recognized by MRI were also delineated by MR myelography. (orig.)

  19. Contribution of Hamstring Fatigue to Quadriceps Inhibition Following Lumbar Extension Exercise

    OpenAIRE

    Joseph M. Hart; D. Casey Kerrigan; FRITZ, JULIE M.; Saliba, Ethan N; Bruce Gansneder; Ingersoll, Christopher D.

    2006-01-01

    The purpose of this study was to determine the contribution of hamstrings and quadriceps fatigue to quadriceps inhibition following lumbar extension exercise. Regression models were calculated consisting of the outcome variable: quadriceps inhibition and predictor variables: change in EMG median frequency in the quadriceps and hamstrings during lumbar fatiguing exercise. Twenty-five subjects with a history of low back pain were matched by gender, height and mass to 25 healthy controls. Subjec...

  20. The shape of the human lumbar vertebral canal A forma do canal vertebral lombar humano

    Directory of Open Access Journals (Sweden)

    Edmundo Zarzur

    1996-09-01

    Full Text Available Literature on the anatomy of the human vertebral column characterizes the shape of the lumbar vertebral canal as triangular. The purpose of the present study was to determine the precise shape of the lumbar vertebral canal. Ten lumbar vertebral columns of adult male cadavers were dissected. Two transverse sections were performed in the third lumbar vertebra. One section was performed at the level of the lower border of the ligamenta flava, and the other section was performed at the level of the pedicles. The shape of the lumbar vertebral canal at the level of the pedicles tends to be oval or circular, whereas the shape of the lumbar vertebral canal at the level of the lower border of the ligamenta flava is triangular. Thus, the shape of the human lumbar vertebral canal is not exclusively triangular, as reported in the literature. It is related to the level of the transversal section performed on the lumbar vertebra. This finding should be taken into consideration among factors involved in the spread of solutions introduced into the epidural space.A literatura sobre a anatomia da coluna vertebral descreve como sendo triangular o formato do canal vertebral na região lombar. O objetivo deste estudo é determinar a real forma do canal da coluna vertebral lombar.Dez colunas vertebrais de cadáveres de homens adultos foram dissecadas. Dois cortes transversais foram executados na terceira vértebra lombar. Um corte foi feito no nível das bordas inferiores de dois ligamentos amarelos vizinhos e o outro corte foi transversal, no nível dos pedículos. A forma do canal vertebral variou: no nível dos pedículos ela tende a ser oval ou circular e junto às bordas inferiores dos ligamentos amarelos passa a ser triangular. Portanto, a forma do canal vertebral lombar não é somente triangular; ela depende do nível em que se faz o corte transversal da vértebra. Estes achados devem ser levados em consideração entre os fatores envolvidos na difusão das soluções introduzidas no espaço peridural.

  1. CORRELATION OF PAIN AND DISABILITY WITH MRI FINDINGS IN PATIENTS WITH LUMBAR DISCOGENIC BACK PAIN

    OpenAIRE

    Surendra K. Wani; Neha Deshpande

    2014-01-01

    Background: Lumbar disc prolapse is one of the common causes of low back pain seen in the working population. There are contradictorty reports regarding the clinical significance of various magnetic resonance imaging (MRI) findings observed in these patients. Purpose: The aim of the study was to determine the association of magnetic resonance imaging (MRI) findings with intensity of pain and self reported disability among persons with lumbar discogenic back pain. Material And M...

  2. Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn B; Lauerberg, Ida; Lauersen, Ida; Bünger, Cody E

    2006-01-01

    Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up....

  3. The influence of muscle forces on the stress distribution in the lumbar spine

    DEFF Research Database (Denmark)

    Wong, C; Rasmussen, J; Simonsen, Erik B.; Hansen, Lone; de Zee, M; Dendorfer, S

    2011-01-01

    Introduction: Previous studies of bone stresses in the human lumbar spine have relied on simplified models when modeling the spinal musculature, even though muscle forces are likely major contributors to the stresses in the vertebral bones. Detailed musculoskeletal spine models have recently become available and show good correlation with experimental findings. A combined inverse dynamics and finite element analysis study was conducted in the lumbar spine to investigate the effects of muscle for...

  4. Anatomical basis for the interpretation of CT-scan imaging of the lumbar spine. Pitfalls

    International Nuclear Information System (INIS)

    A good understanding of the normal anatomy of the lumbar spine is required for the interpretation of CT-scans obtained for ischiatic or crural neuralgia. An attempt has been made to rely on precise terminology to designate each anatomical region pertaining to the lumbar canal. Examples of tomodensitometric investigations of the normal intervertebral space are given, and criteria allowing for the identification of normal anatomical variations are also provided

  5. Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations

    DEFF Research Database (Denmark)

    Rollason, Jess; McDowell, Andrew; Albert, Hanne B; Barnard, Emma; Worthington, Tony; Hilton, Anthony C; Vernallis, Ann; Patrick, Sheila; Elliott, Tom; Lambert, Peter

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients h...

  6. Genotypic and Antimicrobial Characterisation of Propionibacterium acnes Isolates from Surgically Excised Lumbar Disc Herniations

    OpenAIRE

    Jess Rollason; Andrew McDowell; Albert, Hanne B; Emma Barnard; Tony Worthington; Anthony C. Hilton; Ann Vernallis; Sheila Patrick; Tom Elliott; Peter Lambert

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patient...

  7. A stress fracture of the lumbar spine in a professional rugby player

    OpenAIRE

    Castinel, Bernard H; Adam, Philippe; Prat, Christophe

    2006-01-01

    In modern rugby, the spine is subjected to great physical pressure, with an increased number of impacts, on both the cervical and the lumbar spine. This case report illustrates overuse injuries of the lumbar spine in international professional rugby players. A 32?year?old sportsman had been practising rugby for 24 years and was playing for a championship level French team when he started suffering from a right lateral pain in the lumbosacral spine. A CT scan showed a unilateral isthmolysis an...

  8. Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis

    OpenAIRE

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

    2002-01-01

    Intervertebral cages in the lumbar spine have been an advancement in spinal fusion to relieve low back pain. Even though initial stability is accepted as a requirement for fusion, there are other factors. The load transfer and its effect on the tissues adjacent to the cage may also play an essential role, which is not easily detectable with experimental tests. In this study the effects of an intervertebral cage insertion on a lumbar functional spinal unit were investigated using finite elemen...

  9. Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica?

    OpenAIRE

    Brötz, D; Maschke, E; Burkard, S; Engel, C.; Mänz, C; Ernemann, U; Wick, W.; Weller, M

    2010-01-01

    Patients with acute lumbar disc prolapse with sciatica who are not considered candidates for surgery are usually treated with physiotherapy and non-steroidal anti-inflammatory agents. Moreover, the treatment with benzodiazepines is common practice in the absence of class I or II level of evidence. Here we assessed the role of benzodiazepines in the conservative management of acute lumbar disc prolapse. Using a placebo-controlled, double-blinded design, 60 patients were randomized to receive p...

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

    Scientific Electronic Library Online (English)

    Niladri Kumar, Mahato.

    2013-03-01

    Full Text Available La literatura relacionada con el estudio del ligamento interespinoso en la región lumbar es escasa. Pocos estudios han permitido comprender la orientación de las fibras de este ligamento en diferentes niveles lumbares. Fueron disecados cadáveres de 19 hombres 6 y mujeres para exponer los ligamentos [...] interespinosos debajo de las vértebras lumbares. La unión de las fibras y su dirección se observó en todos los espacios interespinosos lumbares. El grosor de los ligamentos se midieron en todos los niveles. Las fibras del ligamento interespinoso se encontró orientada de manera diferente en los espacios lumbares interespinosos. En los dos espacios superiores las fibras eran más horizontales. En los dos espacios centrales (por debajo de L3 y L4) las fibras se curvaban y extendían postero-superiormente. Las fibras eran más gruesas en los ligamentos de los espacios inferiores en comparación con los superiores. La media de espesor presentada por región fue: Alta (0,22 mm), Medio (0,37 mm) y L5-S1 (0,72 mm). Los ligamentos en mujeres fueron ligeramente más delgados. También se observó que las fibras de los ligamentos interespinosas se adhieren a las superficies internas del ligamento supraespinoso. La unión de los ligamentos en L5-S1 eran relativamente más verticales y robustas. En ningún caso se observó ausencia o cavitaciones de los ligamentos, excepto en un caso con ligamento bilaminar a nivel L3-L4. La anatomía de los ligamentos interespinosos señala su probable rol en la restricción de la flexión aguda en la columna lumbar. Abstract in english Literature related to the study of interspinous ligament in the lumbar region is sparse. Very few studies have elucidated the fibre orientation of this ligament at different lumbar levels. Male (19) and female (6) cadavers were dissected to expose the interspinous ligaments beneath all the lumbar ve [...] rtebrae. Fibre attachments and directions were observed at all lumbar interspinous spaces. Thicknesses of the ligaments were measured at all levels. Interspinous ligament fibres were found to be oriented differently in the lumbar inter-spinous spaces. In the upper spaces the fibres were more horizontal. In the spaces beneath L3 and L4, fibres were curved and extended postero-superiorly. Fibres were thicker in the ligaments at the lower spaces in comparison to the upper ones. The mean thicknesses presented as: Upper (0.22 mm); Middle (0.37 mm) and L5-S1 (0.72 mm). Ligaments in the females were slightly thinner in comparison to the males. Fibres of inter-spinous ligaments were also found to attach to the inner aspects of the supraspinous ligament. Ligaments at L5-S1 junction were relatively vertical and stronger. None of the specimen demonstrated absence or cavitations of these ligaments except in a case with bi-laminar ligament at the L3-L4 level. The anatomy of the interspinous ligaments points to their probable role in graded restricting of acute flexion at the lumbar spine.

  11. Lesión del uréter tras una cirugía lumbar posterior: Caso clínico / Ureteral injury after posterior lumbar surgery: Case report

    Scientific Electronic Library Online (English)

    C. de, Quintana-Schmidt; P., Clavel-Laria; F., Bartumeus-Jené.

    2011-04-01

    Full Text Available Introducción. La frecuencia de complicaciones en la cirugía lumbar por vía posterior oscila entre 1,9 y 10,8%. Dentro de estas complicaciones la lesión de estructuras retroperitoneales es una complicación poco común pero potencialmente grave. La lesión del uréter es una complicación extremadamente r [...] ara existiendo en la literatura únicamente 24 casos documentados. Caso clínico. Mujer de 43 años que durante la realización de una microdiscectomía L4-L5 se observó un sangrado profundo que fue controlado con compresión sin que existiera compromiso hemodinámico. A las 36 horas la paciente presentó un abdomen distendido y doloroso acompañado de anemia y leucocitosis. A través de un TAC abdominal y una pielografía retrógrada se diagnostico de rotura del uréter izquierdo. Se le practicó una laparotomía de urgencias y se observó una sección total del uréter izquierdo que se trató con una anastomosis termino-terminal. Discusión. La lesión del uréter en la cirugía lumbar posterior es posible debido a la estrecha relación anatómica que presenta con el cuerpo vertebral y disco intervertebral. El nivel más frecuentemente afectado es el L4-L5. El uréter al contrario de otras estructuras retroperitoneales, se encuentra rodeado de grasa periureteral que le otorga cierta movilidad y hace más dificultosa su lesión lo que explica el bajo número de casos documentados. Aunque la sintomatología inicial puede resultar inespecífica es esencial un diagnóstico temprano para evitar complicaciones como la sepsis o incluso la pérdida del riñón. Existen varias alternativas terapéuticas, aunque el tratamiento más frecuentemente empleado es la anastomosis termino-terminal sobre todo si existe una rotura total del uréter. Abstract in english Introduction. The percentage of complications in posterior lumbar spine surgery varies from 1,9 to 10,8%. Injury to retroperitoneal structures is a severe but unfrequent complication. Ureter injury is an extremely rare complication with only 24 documented cases up to date. Case report. 43 year old w [...] oman. A deep bleeding was observed while performing a L4-L5 microdiscectomy. It was controlled with firm pressure and hemostatic agents. 36 hours later the patient developed a distended and painful abdomen associated with anemia and an increase in white blood cell count. Abdominal CT and retrograde pyelography confirmed the diagnosis of ureter injury. An emergency laparotomy was perfomed and a total section of the left ureter was treated with a end to end anastomosis. Discussion. Ureter injury in posterior lumbar spine surgery can happen due to its close anatomical relationship with the vertebral body and disc. L4-L5 is the level most often affected. Due to the fact the ureter is surrounded by retroperitoneal fat, injury is less likely to happen and thus the low number of documented cases. Although the initial symptomatology may be inespecific, an early diagnosis is essential in order to avoid further complications such as a sepsis or a kidney loss. There are several treatment options although the most often used is the end to end anastomosis specially if there is a complete ureter injury.

  12. Uso de morfina intratecal en artrodesis lumbar / Intrathecal morphine in lumbar spine fusion / Uso da morfina intratecal na artrodese lombar

    Scientific Electronic Library Online (English)

    Ronald Schulz, Ibaceta; Nicolás Macchiavello, Cornejo; Sergio, Ramirez; Jaime, Escobar; Marcos Ganga, Villagrán; Hermann, Schulz.

    2009-12-01

    Full Text Available OBJETIVO: determinar a eficácia e a seguridade do uso da morfina intratecal, em baixas doses, em pacientes submetidos à cirurgia de instrumentação e artrodese lombar. MÉTODOS: estudo prospectivo, randomizado, cego e controlado. Foram utilizados dois grupos de pacientes: Grupo Estudo, que recebeu mor [...] fina intratecal no final da cirurgia e o Grupo Controle, que recebeu somente o protocolo de analgesia padrão. RESULTADOS: foram encontradas diferenças significativas na escala visual analógica (EVA) entre os dois grupos às 12 horas pós-operatórias. A EVA em repouso, em média, do Grupo Estudo foi de 2,15 cm e do Grupo Controle, 5 cm (p=0,013). Durante atividade, o Grupo Estudo apresentou uma EVA de aproximadamente 4,36 cm e no Grupo Controle, 6,9 cm (p=0,029). Não foram encontradas diferenças com relação às complicações entre os dois grupos. CONCLUSÃO: o uso de morfina intratecal, em baixas doses, foi seguro e efetivo no controle da dor nas primeiras 12 horas pós-operatórias na cirurgia de artrodese lombar. Abstract in spanish OBJETIVO: determinar la eficacia y la seguridad del uso de morfina intratecal, en bajas dosis, en pacientes sometidos a cirugía de instrumentación y artrodesis lumbar. MÉTODOS: estudio prospectivo, randomizado, ciego y controlado. Fueron utilizados dos grupos de pacientes: Grupo Estudio, que recibió [...] morfina intratecal al final de su cirugía, y Grupo Control que sólo recibió el protocolo de analgesia estándar. RESULTADOS: se encontraron diferencias significativas en la escala visual análoga (EVA) entre los dos grupos a las 12 horas postoperatorias. La EVA en reposo promedio del Grupo Estudio fue de 2,15 cm y el del Grupo Control, 5 cm (p=0,013). En actividad, el Grupo Estudio presentó una EVA promedio de 4,36 cm, y el Grupo Control 6,9 cm (p=0,029). No se encontraron diferencias en relación a las complicaciones entre los dos grupos. CONCLUSIÓN: el uso de morfina intratecal, en bajas dosis, es seguro y efectivo en el control del dolor en las primeras 12 horas postoperatorias en cirugía de artrodesis lumbar. Abstract in english OBJECTIVE: to determine the efficacy and safety of low-dose intrathecal morphine use in lumbar instrumented arthrodesis. METHODS: prospective, randomized, blind and controlled study, comparing two groups of patients, with and without the administration of intrathecal morphine at the end of surgery. [...] RESULTS: statistically significant differences were found in the visual analogue score (VAS) between the two groups, 12 hours after surgery. Average VAS (at rest) in the Study Group was 2.15 cm versus 5 cm in the Control Group (p=0.013). In activity, average, VAS in the Study Group was 4.36 cm and in the Control Group, 6.9 cm (p=0.029). No differences were found when comparing complication rates. CONCLUSION: the use of low-dose intrathecal morphine in instrumented lumbar arthrodesis, for postoperative pain management, is safe and effective.

  13. Uso de morfina intratecal en artrodesis lumbar Uso da morfina intratecal na artrodese lombar Intrathecal morphine in lumbar spine fusion

    Directory of Open Access Journals (Sweden)

    Ronald Schulz Ibaceta

    2009-12-01

    Full Text Available OBJETIVO: determinar la eficacia y la seguridad del uso de morfina intratecal, en bajas dosis, en pacientes sometidos a cirugía de instrumentación y artrodesis lumbar. MÉTODOS: estudio prospectivo, randomizado, ciego y controlado. Fueron utilizados dos grupos de pacientes: Grupo Estudio, que recibió morfina intratecal al final de su cirugía, y Grupo Control que sólo recibió el protocolo de analgesia estándar. RESULTADOS: se encontraron diferencias significativas en la escala visual análoga (EVA entre los dos grupos a las 12 horas postoperatorias. La EVA en reposo promedio del Grupo Estudio fue de 2,15 cm y el del Grupo Control, 5 cm (p=0,013. En actividad, el Grupo Estudio presentó una EVA promedio de 4,36 cm, y el Grupo Control 6,9 cm (p=0,029. No se encontraron diferencias en relación a las complicaciones entre los dos grupos. CONCLUSIÓN: el uso de morfina intratecal, en bajas dosis, es seguro y efectivo en el control del dolor en las primeras 12 horas postoperatorias en cirugía de artrodesis lumbar.OBJETIVO: determinar a eficácia e a seguridade do uso da morfina intratecal, em baixas doses, em pacientes submetidos à cirurgia de instrumentação e artrodese lombar. MÉTODOS: estudo prospectivo, randomizado, cego e controlado. Foram utilizados dois grupos de pacientes: Grupo Estudo, que recebeu morfina intratecal no final da cirurgia e o Grupo Controle, que recebeu somente o protocolo de analgesia padrão. RESULTADOS: foram encontradas diferenças significativas na escala visual analógica (EVA entre os dois grupos às 12 horas pós-operatórias. A EVA em repouso, em média, do Grupo Estudo foi de 2,15 cm e do Grupo Controle, 5 cm (p=0,013. Durante atividade, o Grupo Estudo apresentou uma EVA de aproximadamente 4,36 cm e no Grupo Controle, 6,9 cm (p=0,029. Não foram encontradas diferenças com relação às complicações entre os dois grupos. CONCLUSÃO: o uso de morfina intratecal, em baixas doses, foi seguro e efetivo no controle da dor nas primeiras 12 horas pós-operatórias na cirurgia de artrodese lombar.OBJECTIVE: to determine the efficacy and safety of low-dose intrathecal morphine use in lumbar instrumented arthrodesis. METHODS: prospective, randomized, blind and controlled study, comparing two groups of patients, with and without the administration of intrathecal morphine at the end of surgery. RESULTS: statistically significant differences were found in the visual analogue score (VAS between the two groups, 12 hours after surgery. Average VAS (at rest in the Study Group was 2.15 cm versus 5 cm in the Control Group (p=0.013. In activity, average, VAS in the Study Group was 4.36 cm and in the Control Group, 6.9 cm (p=0.029. No differences were found when comparing complication rates. CONCLUSION: the use of low-dose intrathecal morphine in instrumented lumbar arthrodesis, for postoperative pain management, is safe and effective.

  14. Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

    International Nuclear Information System (INIS)

    Purpose: Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Methods: Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). Results and conclusion: The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm2), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm2) is lower than for four view functional radiography (7.34 Gy cm2). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm2) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased

  15. Hernia de disco lumbar en un niño con fibrosis quística: caso clínico / Lumbar disc herniation in a child with cystic fibrosis: case report

    Scientific Electronic Library Online (English)

    George A, Alexiou; Kalliopi, Stefanaki; George, Sfakianos; Neofytos, Prodromou.

    2014-04-01

    Full Text Available Presentamos el caso de un niño con fibrosis quística y hernia de disco lumbar. Un niño de 8 años de edad consultó por dolor lumbar que aumentaba con la tos, al sentarse, caminar o inclinarse, y disminuía al acostarse. La prueba de levantamiento de la pierna en extensión fue positiva cuando el miembr [...] o inferior derecho llegó a 60 grados. La prueba contralateral fue negativa. La resonancia magnética nuclear mostró una protrusión central del disco intervertebral entre L5-S1. El tratamiento conservador no fue efectivo, por lo cual se efectuó tratamiento quirúrgico, que hizo desaparecer el dolor. Según nuestro conocimiento, este es el primer caso comunicado de hernia de disco lumbar en un niño con fibrosis quística. Aunque este caso podría ser una coincidencia, se debe realizar una investigación detallada ante el dolor de espalda, síntoma frecuente en pacientes con fibrosis quística. Abstract in english We report a case of child with cystic fibrosis and lumbar disc herniation. An 8-year-old boy presented with low back pain that exacerbated on coughing, sitting, walking, or bending and diminished when lying down. The straight leg raising test was positive when the right leg was lifted at 60 degrees. [...] Crossed leg raising test was negative. Lumbar MRI revealed a L5-S1central disc protrusion. Conservative treatment was not effective and the patient underwent surgery. Postoperatively the patient experienced regression of the pain. To the best of our knowledge this is the first reported case of lumbar disc herniation in a child with cystic fibrosis. Although this case might be coincidental, thorough investigation of back pain, which is frequent in patients with cystic fibrosis, should be performed.

  16. Biomechanical caracterisation of lumbar belt by full-field techniques: Preliminary results

    CERN Document Server

    Bonnaire, Rebecca; Calmels, Paul; Convert, Reynald

    2013-01-01

    In France, 50% of the population per year is suffering from low back pain. Lumbar belt are frequently proposed as a part of the treatment of this pathology. However mechanical ways of working of this medical device is not clearly understood, but abdominal pressure is often related. So an optical method was developed in this study to measure strain in lumbar belt and trunk interface and to derive a pressure estimation. Optical method consisted of coupling fringe projection and digital image correlation (DIC). Measurement has been carried out on the right side of a manikin wearing a lumbar belt. Average strain is 0.2 and average pressure is 1 kPa. Continuation of this study will be comparison of strain and pressure in different areas of lumbar belt (left side, front and back) and comparison of different lumbar belts. Results will be used in a finite elements model to determine lumbar belt impact in intern body. In long term, this kind of study will be done on human.

  17. Sensitivity of lumbar spine loading to anatomical parameters Journal of Biomechanics

    DEFF Research Database (Denmark)

    Putzer, Michael; Ehrlich, Ingo

    2015-01-01

    Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the in uence of dened geometrical parameters on lumbar spine loading utilizing ve parametrized musculoskeletal lumbar spine models for four different postures. The in uence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine were studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most in uential. The results indicated that measuring these parameters from X-rays would be most important to morph an existing musculoskeletal lumbar spine model for a subject-specic approach with respect to bone geometry. Furthermore, degeneration processes could lead to computational problems and it is advised that stiffness properties of discs and ligaments should be individualized.

  18. Recurrent back pain after diskectomy: MRI findings MR of the postoperative lumbar spine

    International Nuclear Information System (INIS)

    Purpose: To show the morphological changes in postoperative lumbar spine. Material and methods: We reviewed 128 Magnetic Resonance Imaging (MRI) studies of lumbar spine. All patients complained of low back pain and had a previous lumbar surgery (1 month to 8 years). All the examinations include axial and sagittal Gadopentate-dimeglumine enhanced T1 weighted imaging. Results: Only 7,8% have the normal appearance of the postoperative lumbar spine. Epidural scar was found in 69% of examinations; of this group, 72% showed radicular involvement, and 28% had no radicular involvement. Recurrent disc herniation was found in 14,8% of exams, using gadopentate-dimeglumine to assist the differentiation from epidural fibrosis; infections like spondylodiscitis and abscess in 12,5%. Other findings included arachnoiditis, pseudomeningoceles and seromas. Conclusions: MRI is a useful method to study the postoperative lumbar spine, specially when enhanced with gadopentate-dimeglumine. Enhanced images can differentiate two of the major complication like epidural fibrosis, and recurrent disc herniation. Spondylodiscitis are important and frequent too. Although the findings of complications in our series in the postoperative lumbar spine represent 92,18 %, these not always explain the symptomatology. Therefore, the interrelation is important with the surgeon to determine which abnormalities are clinically significant. (authors)

  19. Pelvic Incidence and Lumbar Spine Instability Correlations in Patients with Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    Mohammad-Reza Golbakhsh

    2012-12-01

    Full Text Available Purpose: Many factors such as lumbar instability and spinopelvic alignment are associated with low back pain. Our purpose was to analyze the pelvic incidence - one of spinopelvic alignment parameters- and spine instability correlations inpatients with chronic low back pain.Methods: Fifty-two patients suffering from chronic low back pain entered this case control study. Lateral spine radiography was taken from patients. pelvic incidence and L3, L4 and L5‘s vertebral body width were measured for all patients, and lumbar instability was evaluated in 3 different levels: L5-S1, L4- L5 and L3-L4.Results: Thirty-two patients having lumbar instability formed group A and 20 patients without lumbar spine instability allocated to group B. Average age, mean weight, height, body mass index and mean vertebral width of both groups did not differ meaningfully. Pelvic incidence‘s mean amounts set to 53.9 in group B and 57.7 in group A without any significant difference; but pelvic incidence was significantly lower in patients with lumbar instability of L5-S1origin (P=0.01. Conclusions: Overall, pelvic incidence did not differ between two groups.However, separate evaluation of each level revealed lumbar instability of L5-S1 segment to be associated with lower pelvic incidence.

  20. Seguridad de la práctica de la discectomía lumbar bajo régimen ambulatorio / Safety of the practice of lumbar discectomy under ambulatory procedure

    Scientific Electronic Library Online (English)

    Ariel, Varela Hernández; Gretel, Mosquera Betancourt; Guillermo, Pardo Camacho; Denis, Suárez Monne; Ileydis, Hernández Cabezas.

    2012-04-01

    Full Text Available Fundamento: la gran demanda social que acoge la atención de los pacientes con hernia discal lumbar, obliga la aplicación de sistemas que mejoren la reinserción social de los pacientes. Objetivo: valorar la seguridad de la realización de la discectomía lumbar de forma ambulatoria. Método: se practicó [...] un estudio cuasiexperimental, longitudinal y prospectivo con todos los pacientes sometidos a discectomía lumbar de forma ambulatoria en el servicio de Neurocirugía de Camagüey, desde el primero de enero de 2010 hasta el 31 de marzo de 2011. Se utilizó un grupo de control externo obtenido de otras investigaciones realizadas en el servicio. Los indicadores analizados fueron: frecuencia de pacientes operados, técnicas anestésicas y quirúrgicas empleadas, complicaciones, necesidad de ingreso hospitalario y frecuencia de reintervenciones quirúrgicas. Se aplicaron técnicas descriptivas para variables no paramétricas y chi-cuadrado. Resultados: se operaron de forma ambulatoria 73 pacientes, en el 40 % se aplicó anestesia peridural, el 46,56 % de los enfermos se operó mediante fenestración interlaminar o microdiscectomía de Caspar y el 86,3 % no presentó complicaciones, dato con significación estadística respecto al grupo control. Conclusiones: se comprobó en esta serie de pacientes que la realización de la discectomía lumbar de forma ambulatoria, constituye un método seguro y eficiente en el tratamiento quirúrgico. Abstract in english Background: the great social demand for patients'care with lumbar disk hernia requires the use of systems that improve social reintegration of these patients. Objective: to evaluate the safety of ambulatory lumbar discectomy. Method: a quasi-experiment, longitudinal and prospective study was conduct [...] ed with all patients who underwent ambulatory lumbar discectomy at the Neurosurgical unit in Camagüey, from January 1st, 2010 to March 31st, 2011. An external control group was obtained from previous researches carried out in the unit. The analyzed indicators were: frequency of operated patients, anesthetic and surgical techniques used, complications, and the need of hospital admissions, as well as, the frequency of surgical reinterventions. Descriptive techniques of non parametric variables and chi-squared test were applied. Results: 73 patients were operated on ambulatory procedure, peridural anesthesia was used in 40 % of patients, the 46, 56 % of sick people had interlaminar fenestration or Caspar's microdiskectomy and the 86, 3 % had no complications, value with statistical significance regarding the control group. Conclusion: in this series of patients was demonstrated that ambulatory lumbar discectomy, constitutes a safe and effective method in surgical treatment.