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Sample records for acute lumbar spinal

  1. Acquired lumbar spinal stenosis.

    Science.gov (United States)

    Deasy, JoAnn

    2015-04-01

    Lumbar spinal stenosis is the most frequent reason for spinal surgery in patients over age 65 years. In this condition, narrowing of the lumbar spinal canal and nerve root canals leads to painful, debilitating compression of spinal nerves and blood vessels. As the population ages, an increasing number of patients will be diagnosed and treated for lumbar spinal stenosis by primary care providers. This article reviews the pathophysiology, diagnosis, and management of lumbar spinal stenosis in adults over age 50 years.

  2. Remote cerebellar hemorrhage after lumbar spinal surgery

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    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.

  3. FUNCTIONAL PATHOLOGY OF LUMBAR SPINAL STENOSIS

    NARCIS (Netherlands)

    PENNING, L

    1992-01-01

    This paper deals with the effect of motion upon the stenotic lumbar spinal canal and its contents. A review is presented of personal investigations and relevant data from the literature. The normal spinal canal and its lateral recesses are naturally narrowed by retroflexion and/or axial loading, as

  4. Computed tomographic evaluation of lumbar spinal structures during traction.

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    Sari, Hidayet; Akarirmak, Ulkü; Karacan, Ilhan; Akman, Haluk

    2005-01-01

    In the previous studies, it is reported that traction diminishes the compressive load on intervertebral discs, reduces herniation, stretches lumbar spinal muscle and ligaments, decreases muscle spasm, and widens intervertebral foramina. The aim of this study was to evaluate the effects of horizontal motorized static traction on spinal anatomic structures (herniated area, spinal canal area, intervertebral disc heights, neural foraminal diameter, and m.psoas diameter) by quantitative measures in patients with lumbar disc herniation (LDH). At the same time the effect of traction in different localizations (median and posterolateral herniation) and at different levels (L4-L5 and L5-S1) was assessed. Thirty two patients with acute LDH participated in the study. A special traction system was used to apply horizontally-motorized static lumbar traction. Before and during traction a CT- scan was made to observe the changes in the area of spinal canal and herniated disc material, in the width of neural foramina, intervertebral disc heights, and in the thickness of psoas muscle. During traction, the area of protruded disc area, and the thickness of psoas muscle decreased 24.5% (p = 0.0001), and 5.7% (p = 0.0001), respectively. The area of the spinal canal and the width of the neural foramen increased 21.6% (p = 0.0001) and 26.7% (p = 0.0001), respectively. The anterior intervertebral disc height remained unchanged with traction however the posterior intervertebral disc height was significantly expanded. This study is the first to evaluated in detail and quantitatively the effect of motorized horizontal lumbar spinal traction on spinal structures and herniated area. According to detailed measures it was concluded that during traction of individuals with acute LDH there was a reduction of the size of the herniation, increased space within the spinal canal, widening of the neural foramina, and decreased thickness of the psoas muscle.

  5. Oriental Medical Treatment of Lumbar Spinal Stenosis

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    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.

  6. Patient positioning and spinal locking for lumbar spine rotation manipulation.

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    Gibbons, P; Tehan, P

    2001-08-01

    High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.

  7. Minimal Invasive Decompression for Lumbar Spinal Stenosis

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    Victor Popov

    2012-01-01

    Full Text Available Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time-honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with less bleeding, smaller incisions, and quicker patient recovery. This paper will review the technique of performing ipsilateral and bilateral decompressions using a tubular retractor system and microscope.

  8. Costs and effects in lumbar spinal fusion

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    Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel

    2007-01-01

    ) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means...... of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted...... of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself--at least from an administrator...

  9. A Rare Case of Pediatric Lumbar Spinal Ependymoma Mimicking Meningitis.

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    Ekuma, Ezeali Mike; Ito, Kiyoshi; Chiba, Akihiro; Hara, Yosuke; Kanaya, Kohei; Horiuchi, Tetsuyoshi; Ohaegbulam, Samuel; Hongo, Kazuhiro

    2017-02-12

    Spontaneous acute subarachnoid hemorrhage (SAH) from lumbar ependymoma in children is rare. We report a case of a14-year-old boy who developed sudden radicular low back pain while playing baseball. He was initially managed conservatively in a local hospital for suspected lumbar disc herniation, but later developed meningeal symptoms and fever before being referred to our hospital. There he underwent a diagnostic lumbar puncture in the emergency room; his cerebrospinal fluid suggested an SAH. Physical examination showed meningeal signs and cauda equina features. Cerebrospinal fluid analysis was negative for bacterial meningitis. Lumbar magnetic resonance imaging revealed a mass characterized as a hemorrhagic lesion. The patient had an emergent evacuation of the mass via the posterior approach. Postoperatively, his symptoms resolved completely. The histological diagnosis was, surprisingly, an ependymoma (WHO grade II). This case is particularly interesting because of its rarity in children, and its pattern of presentation. Though bacterial or viral meningitis is the most frequent cause of meningeal features in children, SAH from a hemorrhagic spinal tumor should be considered. Ultimately, a high index of suspicion is needed for prompt diagnosis.

  10. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

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    Mukhergee G. S

    2016-06-01

    Full Text Available BACKGROUND Spinal stenosis is one of the most common conditions in the elderly. It is defined as a narrowing of the spinal canal. The term stenosis is derived from the Greek word for narrow, which is “Stenos”. The first description of this condition is attributed to Antoine portal in 1803. Verbiest is credited with coining the term spinal stenosis and the associated narrowing of the spinal canal as its potential cause. [1-10] Kirkaldy–Willis subsequently described the degenerative cascade in the lumbar spine as the cause for the altered anatomy and pathophysiology in spinal stenosis. [11-15] If compression does not occur, the canal should be described as narrow but not stenotic. Some studies defined lumbar spinal stenosis as a “narrowing of the osteoligamentous vertebral canal and/or the intervertebral foramina causing compression of the thecal sac and/or the caudal nerve roots; at a single vertebral level, narrowing may affect the whole canal or part of it” (Postacchini 1983. This definition distinguished between disc herniation and stenosis. [16] . The most common type of spinal stenosis is caused by degenerative arthritis of the spine. Hypertrophy and ossification of the posterior longitudinal ligament which usually are confined to the cervical spine, and diffuse idiopathic skeletal hyperostosis (DISH syndrome also may result in an acquired form of spinal stenosis. Congenital forms caused by disorders such as achondroplasia and dysplastic spondylolisthesis are much less common. Congenital spinal stenosis usually is central and is evident or imaging studies. Idiopathic congenital narrowing usually involves the anteroposterior dimension of the canal secondary to short pedicles; the patient otherwise is normal. In contrast, in achondroplasia, the canal is narrowed in the anteroposterior plane owing to shortened pedicles and in lateral dimension because of diminished interpedicular distance. Acquired forms of spinal stenosis usually are

  11. LUMBAR SPINAL STENOSIS. A REVIEW OF BIOMECHANICAL STUDIES

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    戴力扬; 徐印坎

    1998-01-01

    ObjectS. To investigate the biomechanical aspects of etiology, pathology, clinical manifestation, diagnosis and surgical treatment of the lumbar spinal stenosis. Methods. A series of biomechanical methods, such as three-dimensional finite element models, threedimensional kinematic measurement, cadeveric evaluation, and imaging assessment was applied to correlate lumbar biomechanics and lumber spinal stenosls. Surgery of lumber spinal stenosis has been improved. Results.The stresses significantly concentrate on the posterolateral part of the annulus fibrcsms of disc, the posterior surface of vertebral body, the pedlcle, the interarticularis and the beet joints. This trend is intensified by disc degeneration and lumber backward extension. Posterior elcxnent resection has a definite effect upon the biomechanical behavior of lumbar vertebrae. The improved operations proved satisfactory. Conclusion. Stress concentration in the lumber vertebrae is of importance to the etiology of degenerative lumbar spinal stenosls, and disc degeneratkm is the initial key of this process. Than these will be aggravatnd by backward extension. Functloval radiography and myelography are of assistance to the diagnosis of the lumhar spinal stenosls. For the surgcal treatment of the lumber spinal stenosis, destruction of the posterior element should be avoid as far as possible based upon the thorough decmnpression. Maintaining the lumbar spine in flexion by fusion after decorapression has been proved a useftd method. When developmental spinal stenoals is combined with disc herniation, discectoray through laminotomy is recommend for decompression.

  12. Lumbar spinal mobility changes among adults with advancing age

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    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.

  13. Manipulative physiotherapists can reliably palpate nominated lumbar spinal levels.

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    Downey, B J; Taylor, N F; Niere, K R

    1999-08-01

    Palpating a nominated spinal level is a prerequisite to more complex tasks such as palpating the level most likely to be the source of the patient's symptoms. The aim of this study was to investigate the reliability of physiotherapists with a post-graduate qualification in manipulation (manipulative physiotherapists) in palpating the lumbar spines of patients in a clinical setting. Three pairs of manipulative physiotherapists palpated the randomly-nominated lumbar spinal levels of 20 patients presenting to their practices for treatment of low-back pain. Each therapist marked the skin overlying the spinous process of the nominated spinal level with an ultraviolet pen and these marks were transcribed onto transparencies for analysis. The therapists obtained an overall weighted kappa of 0.92 indicating almost perfect agreement for locating the nominated spinal level. The results of this study indicate that manipulative physiotherapists can reliably palpate nominated lumbar spinal levels, suggesting further training in spinal therapy enhances the palpatory skills of physiotherapists in palpating nominated lumbar spinal levels.

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

    DEFF Research Database (Denmark)

    Oestergaard, Lisa Gregersen; Nielsen, Claus Vinther; Bünger, Cody E;

    2012-01-01

    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 diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate...

  15. Spinal CT scan, 2. Lumbar and sacral spines

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    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

    1982-08-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

  16. IMPACT OF SPINAL DECOMPRESSION ON PAIN IN PATIENTS WITH CHRONIC LUMBAR DISC PROLAPSE

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    Salwa R. El-Gendy

    2015-10-01

    Full Text Available Background: DRX9000 spinal decompression is slightly known for treating chronic lumbar disc prolapse. The aim of the study was to examine the effectiveness of DRX9000spinal decompression on pain in chroniclumbar disc prolapse (CLDP. Methods: twenty male subjects with chronic lumbar disc prolapse,aged between 40:60 years were included in the study. They were assessed forpain intensity byslump test,straight leg raising test (SLR,modified Oswestery questionnaire (OQ and visual analogue scale (VAS. The study continued forsix weeks, the 20 patients were equally divided into two groups. Group A (experimental received spinal decompression, stability and McKenzie exercises; and ice, at a rate of 3 days per week, the duration of each session was 60 minutes. While group B (control were treated by exercises and ice only. Results: Majority of patients had positive findings in reducing pain clinically; however, statistically there was no significant difference. Conclusion: It can be concluded that spinal decompression has an effect, but not statistically significant in decreasing pain on patients with lumbar disc prolapse. This may be due to limited number of patients. We can recommend increasing the sample size to generalize the results, MRI scan follow up should be done after one year to determine if the effects are permanent or transient, comparing the effects of decompression between acute & chronic cases of lumbar disc prolapse, also male & female patients.

  17. Dynamic stabilization for degenerative spondylolisthesis and lumbar spinal instability.

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    Ohtonari, Tatsuya; Nishihara, Nobuharu; Suwa, Katsuyasu; Ota, Taisei; Koyama, Tsunemaro

    2014-01-01

    Lumbar interbody fusion is a widely accepted surgical procedure for patients with lumbar degenerative spondylolisthesis and lumbar spinal instability in the active age group. However, in elderly patients, it is often questionable whether it is truly necessary to construct rigid fixation for a short period of time. In recent years, we have been occasionally performing posterior dynamic stabilization in elderly patients with such lumbar disorders. Posterior dynamic stabilization was performed in 12 patients (6 women, 70.9 ± 5.6 years old at the time of operation) with lumbar degenerative spondylolisthesis in whom % slip was less than 20% or instability associated with lumbar disc herniation between March 2011 and March 2013. Movement occurs through the connector linked to the pedicle screw. In practice, 9 pairs of D connector system where the rod moves in the perpendicular direction alone and 8 pairs of Dynamic connector system where the connector linked to the pedicle screw rotates in the sagittal direction were installed. The observation period was 77-479 days, and the mean recovery rate of lumbar Japanese Orthopedic Association (JOA) score was 65.6 ± 20.8%. There was progression of slippage due to slight loosening in a case with lumbar degenerative spondylolisthesis, but this did not lead to exacerbation of the symptoms. Although follow-up was short, there were no symptomatic adjacent vertebral and disc disorders during this period. Posterior dynamic stabilization may diminish the development of adjacent vertebral or disc disorders due to lumbar interbody fusion, especially in elderly patients, and it may be a useful procedure that facilitates decompression and ensures a certain degree of spinal stabilization.

  18. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.

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    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-07-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  19. Roseomonas Spinal Epidural Abscess Complicating Instrumented Posterior Lumbar Interbody Fusion

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    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-01-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  20. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

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    Koshi Ninomiya

    2014-01-01

    Full Text Available A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted.

  1. Sagittal spinal alignment in patients with lumbar disc herniation.

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

    2010-03-01

    A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and 60 age-matched healthy subjects. Preoperative and 6-month postoperatively lateral whole-spine standing radiographs were assessed for the distance between C7 plumb line and posterior superior corner on the top margin of S1 sagittal vertical axis (SVA), lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra (L1S1), pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). Subjective symptoms were evaluated by the Japanese Orthopedic Association (JOA) score for lower back pain (nine points). The mean SVA value of the LDH group (32.7 +/- 46.5 mm, +/- SD) was significantly larger than that of the control (2.5 +/- 17.1 mm), while L1S1 was smaller (36.7 +/- 14.5 degrees ) and PA was larger (25.1 +/- 9.0 degrees ) in LDH than control group (49.0 +/- 10.0 degrees and 18.2 +/- 6.0 degrees , respectively). At 6 months after surgery, the malalignment recovered to almost the same level as the control group. SVA correlated with the subjective symptoms measured by the JOA score. Sagittal spinal alignment in LDH exhibits more anterior translation of the C7 plumb line, less lumbar lordosis, and a more vertical sacrum. Measurements of these spinal parameters allowed assessment of the pathophysiology of LDH.

  2. Double insurance transfacetal screws for lumbar spinal stabilization

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    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

  3. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess.

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    Bang, Jin Hyuk; Cho, Keun-Tae

    2015-09-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.

  4. The association of spinal osteoarthritis with lumbar lordosis

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    Sapkas Georgios

    2010-01-01

    Full Text Available Abstract Background Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis. Methods 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1was also measured. Results and discussion 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups Conclusions There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis.

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

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    Yoshinori Kadono

    2015-01-01

    Full Text Available Spinal epidural arachnoid cyst (EAC is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

  6. Ogilvie′s syndrome following posterior spinal instrumentation in thoraco lumbar trauma

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    R Krishnakumar

    2015-01-01

    Full Text Available Objectives: To report unique cases of Ogilvie′s syndrome (acute intestinal pseudo-obstruction following posterior spinal instrumentation in thoraco lumbar trauma. Materials and Methods: A single centre retrospective study. We reviewed the surgical data of 420 patients who underwent thoracolumbar spinal surgery over a period of four years. Two patients who developed post operative Ogilvie′s syndromes were identified. Results: The clinical presentation and blood investigations ruled out any infectious pathology. Computed tomography scans ruled out the mechanical obstruction. All patients improved with conservative management. Conclusion: Ogilvie′s syndrome should be considered as a differential diagnosis in patients with postoperative significant abdominal distension who had undergone posterior instrumentation for spinal trauma. Early recognition and appropriate conservative treatment would be necessary to prevent complications such as bowel ischemia and perforation.

  7. A case of acute spinal intradural hematoma due to spinal anesthesia

    Institute of Scientific and Technical Information of China (English)

    Josu M Avecillas-Chasn; Jordi A Matias-Guiu; Gustavo Gomez; Javier Saceda-Gutierrez

    2015-01-01

    Spinal intradural hematoma is a rare complication of diagnostic lumbar puncture or spinal anesthesia. This complication could be overlooked with devastating neurological consequences due to a delay in diagnosis. Here, we reported a case of a patient with a lumbar spinal intradural hematoma as a result of a difficult spinal anesthesia.

  8. Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy

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    Liang, Chen; Sun, Jianmin; Cui, Xingang; Jiang, Zhensong; Zhang, Wen; Li, Tao

    2016-01-01

    Background Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Methods Twenty-five adults with spinal sagittal imbalance who initially ...

  9. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

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    Luiz Eduardo Imbelloni

    2014-01-01

    Full Text Available Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007. Settings and Design: Prospective observational. Materials and Methods: From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO 2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T 3 . Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. Statistical Analysis Used: Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher′s exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125 Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89% patients. There were significant differences in time to reach T 3 , obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher

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

    Directory of Open Access Journals (Sweden)

    Aleksandra Truszczyńska

    2014-03-01

    Full Text Available Introduction. Hard work in farming may lead to lumbar spinal stenosis, and consequently, to pain. The pain and neurological disorders may lead to disability and postural disorders. Objective. The aim of the presented study was to analyse postural stability and its correlation with functional disability of patients with lumbar spinal stenosis living in rural areas. Materials and methods. The study population consisted of 30 rural patients with lumbar spinal stenosis; mean age: 51.40 (±12.92; mean BMI: 28.60 (±3.77. The control group consisted of 30 rural inhabitants without spinal disorders. Postural stability was tested on the Biodex Balance System. The patients were also evaluated according to the ODI, the Rolland- Morris disability questionnaire, and VAS. Results. The mean results of the patients studied were as follows: 49.37 (±17.39 according to ODI, 15 (±6.19 according to the Rolland-Morris disability scale, and pain intensity of 7 (±1.93 according to the VAS. The following statistically significant differences were found: the mean balance index result was 1.8 (±1.88 and 0.64 (±0.41 in the control group. The mean centre of mass deviation in the A/P plane was 1.39 (±1.88 and 0.46 (±0.41 in the control group. The mean centre of mass deviation in the M/L plane was 0.8 (±0.51 and 0.32 (±0.22 in the control group. The balance in the studied population correlated significantly with the Rolland-Morris disability questionnaire and the VAS. Conclusions: 1 Serious disability was found in rural patients with spinal stenosis. There was a statistically significant correlation between the disability and postural stability disorders. 2 Most of the patients (84% were overweight. 3 Postural stability disorders were statistically significant for both the stability index and the A/P plane deviation.

  11. 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

  12. Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis

    Science.gov (United States)

    Hwang, Hee-Jong; Lee, Gwang-Soo; Heo, June-Young; Chang, Jae-Chil

    2016-01-01

    Objective The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation. Methods A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored. Results Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation. Conclusion Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS. PMID:28127375

  13. A new lumbar posterior fixation system, the memory metal spinal system : an in-vitro mechanical evaluation

    NARCIS (Netherlands)

    Kok, Dennis; Firkins, Paul John; Wapstra, Frits H.; Veldhuizen, Albert G.

    2013-01-01

    Background: Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylolisthesis or degenerative disc disease use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection de

  14. Puncture laser microdiscectomy in treatment of large lumbar spinal hernias

    Directory of Open Access Journals (Sweden)

    Zorin M.M.

    2013-06-01

    Full Text Available Degree of hernia size influence on final result of PLME in 34 patients with discogenic neurocompressive lumbar spinal syndrome was detected. In medical center "Endoscopic Neurosurgery" from 2006 to 2010 we examined and treated 34 patients with hernia size from 6 to 8 mm by CT data. Patients were from 19 to 49 years of age. Average age was 35.9 ± 1.5 years. Males – 16 (47.1%, females – 18 (52.9%. Disease duration – 5.53 ± 0.44 months with duration of last exacerbation – 1.87 ± 0.21 months. Duration of conservative therapy is 4.6 ± 2.1 weeks. During survey and objec¬tive examination we determined pain syndrome intensity, pain location, degree of spinal static – dynamic function disorder. Neurological examination determined severity of sensory and motor disorders. Pain syndrome intensity, quality of life in patients before and after surgery, surgery effectiveness were determined by common scales: VAS, OSWESTRY, Roland - Morris, McNab. Before PLME we evaluated preoperative spondylograms performed with functional load. Height of intervertebral fissure was determined by these images. By SCT and MRI data we measured hernia size, its shape and location as well as intervertebral disk dehydration degree. For PLME performance we used neodymium laser with aluminum garnet (Dorinyer Fibertom Medilas 4060 with wave-length of 1.06 micrometers. In the next period of observation after PLME its effectiveness was 79%, and in 3-5 years - 76%. At the same time it must be emphasized that 75% of patients with discogenic neurocompressive lumbar spinal syndrome significantly and for a long time improved their life quality avoiding more traumatic surgery. Satisfactory results with PLM use in the nearest future could be obtained in 79% of patients, in the remote term - in 76% of patients with large hernia size.

  15. Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis

    OpenAIRE

    Tafazal, Suhayl I.; Ng, Leslie; Sell, Philip

    2006-01-01

    This is a double blind randomised controlled trial to assess the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. The trial compared the outcome of salmon calcitonin nasal spray to placebo nasal spray in patients with MRI confirmed lumbar spinal stenosis. Lumbar spinal stenosis is one of the commonest conditions encountered by spine surgeons. It more frequently affects elderly patients and lumbar decompression has been used to treat the condition with varia...

  16. Tactics of surgical treatment for thoracic and lumbar spinal injuries

    Directory of Open Access Journals (Sweden)

    V. D. Usikov

    2013-01-01

    Full Text Available The analysis of results of surgical treatment of 154 patients with a vertebral and spinal trauma of chest and lumbar departments of a backbone aged from 16 till 75 years is carried out. All patients were operated in Bryansk city hospital N 1. The volume and sequence of surgeries, and existence were defined with the combined damages, character of an injury of a backbone and a spinal cord or absence free part bone bodies of the injured vertebra compressing a spinal cord defined different accesses on a backbone. So, surgeries at 125 (81,2 % patients were carried out from one back access, at 23 (14,9 % patients - to the combined back and lobbies and at 6 (3,9 % patients - front and back access. In all cases for fixing of a spine implants “Sintez” firm (St. Petersburg were used. Results of treatment were estimated on neurologic dynamics, restoration of an axis of a backbone, a gleam of the vertebral channel and restoration possibility of a support of a backbone. Good results of treatment are received at 87 (56,5 %, satisfactory - at 55 (35,7 % and unsatisfactory - at 12 (7,8 % patients.

  17. Apoptosis of lumbar spinal cord neurons in cauda equina syndrome rats

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Objective To explore the law of apoptosis of lumbar spinal cord neurons in cauda equina syndrome (CES). Methods Cauda equina of rats was compressed by a piece of silica gel stick. From day 1 to day 28,the lumbar spinal cord specimens were harvested and assessed by Nissl's staining and TUNEL staining. Results Compression of cauda equina caused lesion and apoptosis of neurons in lumbar spinal cord,and the extent of apoptosis reached the peak on 7th day after compression. Conclusion Apoptosis of neurons in lum...

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

    Directory of Open Access Journals (Sweden)

    Burnett Angus F

    2008-11-01

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

  19. Fibromyalgia and arachnoiditis presented as an acute spinal disorder

    Directory of Open Access Journals (Sweden)

    Zamzuri Idris

    2014-01-01

    Full Text Available Background: Adhesive arachnoiditis is a chronic, insidious condition that causes debilitating intractable pain and a range of other neurological problems. Its pathophysiology is not well understood. This manuscript discusses its presentations, which can mimic an acute spinal disorder, its hypothetical pathophysiology, treatment, and its relationship with fibromyalgia. Case Description: The authors present a case of a 47-year-old female who presented with clinical features mimicking an acute spinal disorder but later found to have an adhesive arachnoiditis. She was admitted following a trauma with complaints of back pain and paraplegia. On examination, there was marked tenderness over thoracolumbar spine with lower limbs upper motor neuron weakness. An urgent magnetic resonance imaging (MRI of the spine revealed multiple lesions at her thoracic and lumbar spinal canals, which did not compress the spinal cord. Therefore, conservative management was initiated. Despite on regular therapies, her back and body pain worsened and little improvement in her limbs power was noted. Laminectomy was pursued and found to have spinal cord arachnoiditis. Subsequently, she was operated by other team members for multiple pelvic masses, which later proved to be benign. After gathering all the clinical information obtained at surgery and after taking detailed history inclusive of cognitive functions, diagnosis of an adhesive arachnoiditis syndrome was made. Currently, she is managed by neuropsychologist and pain specialist. Conclusion: This case report highlights the importance of knowing an adhesive arachnoiditis syndrome - a rarely discussed pathology by the neurosurgeon, which discloses a significant relationship between immune and nervous systems.

  20. Lumbar disc herniation treated with qi pathway intervention and spinal adjustment:a randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    杨军雄

    2013-01-01

    Objective To compare the efficacy difference in the treatment of lumbar disc herniation(LDH)between the comprehensive therapy of Qi pathway intervention and the spinal adjustment and the conventional therapy of acupuncture and Tuina and explore the analgesic mechanism

  1. Efficacy of Epidural Injections in the Treatment of Lumbar Central Spinal Stenosis: A Systematic Review

    OpenAIRE

    Manchikanti, Laxmaiah; Kaye, Alan David; Manchikanti, Kavita; Boswell, Mark; Pampati, Vidyasagar; Hirsch, Joshua

    2015-01-01

    Context: Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis. Evidence Acquisition: Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the man...

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

    OpenAIRE

    2008-01-01

    Abstract Background Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. Methods One hundre...

  3. Effect of Electroacupuncture Combined with Tuina on Lumbar Muscle Tone in Patients with Acute Lumbar Sprain

    Institute of Scientific and Technical Information of China (English)

    Fan Yuan-zhi; Wu Yao-chi

    2014-01-01

    Objective: To observe the clinical effect of electroacupuncture (EA) combined with tuina on acute lumbar sprain and lumbar muscle tone before and after treatment. Methods: A total of 130 acute lumbar sprain cases were randomly allocated into an observation group and a control group, 65 in each group. Cases in the observation group were treated with EA combined with tuina, whereas cases in the control group were treated with Diclofenac Sodium Dual Release Enteric-coated capsules. The muscle tones in two groups were tested before and after treatment. Results: The recovery rate and overall response rate in the observation group were 66.2% and 93.8% respectively, versus 56.9% and 87.7% in the control group, showing no between-group statistical significances (P>0.05). After treatment, the force-displacement area under curve (AUC) in both groups showed a significance difference (P Conclusion: Both EA combined with tuina and aforementioned oral medication have remarkable effects for acute lumbar sprain, and the former can better improve the lumbar muscle tone in patients with acute lumbar sprain.

  4. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, A.H. [Department of CT-MRI, Larissa General Hospital (Greece); Zibis, A.H.; Papaliaga, M.; Georgiou, E.; Rousogiannis, S. [Larissa Medical School, University of Thessaly, Larissa (Greece)

    1998-12-01

    The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient. (orig.) With 1 fig., 6 tabs., 24 refs.

  5. Treatment of 34 Cases of Acute Lumbar Sprain with Electroacupuncture plus Cupping Therapy

    Institute of Scientific and Technical Information of China (English)

    张力; 洪珏

    2009-01-01

    @@ Acute lumbar sprain due to improper exercise is very common in college students. The author has treated 34 patients with acute lumbar sprain by electroacupuncture plus cupping therapy, now it was presented as follows.

  6. Treatment of the Moderate Lumbar Spinal Stenosis with an Intespinous Distraction Device IMPALA

    Directory of Open Access Journals (Sweden)

    Haso Sefo

    2013-09-01

    Full Text Available Introduction: The aim of this study was the evaluation of symptom improvements in patients with moderate lumbar spinal stenosis, who consecutively underwent placement of interspinous distraction deviceIMPALA®.Methods: This study included a total of 11 adult patients with moderate lumbar spinal stenosis. Clinical evaluations were performed preoperatively and 3-months after surgery using the Visual Analogue Scale (VAS and Oswestry Disability Index (ODI.Results: The mean preoperative VAS was 7.09 and fell to 2.27 a 3-months after surgery. The mean preoperative ODI was 59.45 fell to 20.72 a 3-months after surgery.Conclusions: Using the IMPALA® device in patients with moderate lumbar spinal stenosis is a minimal invasive, effective and safe procedure. Clinical symptoms were improved 3 months after surgery.

  7. 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

    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. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral...... service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program....

  8. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS: a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

    Directory of Open Access Journals (Sweden)

    Friedly Janna L

    2012-03-01

    Full Text Available Abstract Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone. Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization

  9. Patient are satisfied one year after decompression surgery for lumbar spinal stenosis

    DEFF Research Database (Denmark)

    Paulsen, Rune Tendal; Bouknaitir, Jamal Bech; Fruensgaard, Søren;

    2016-01-01

    INTRODUCTION: Lumbar spinal stenosis (LSS) is a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain. The syndrome is associated with diminished space available for the neural and vascular elements in the lumbar spine. LSS is typically seen in elderly...... and perioperative complications of spinal decompression surgery in LSS patients. METHODS: This study is a retrospective study based on prospectively collected data from 3,420 consecutive patients with clinical and magnetic resonance imaging confirmed LSS. Patients were treated with posterior decompression surgery...

  10. RADIOLOGICAL DIAGNOSTIC METHODS OF SOFT-TISSUE COMPONENTS IN THE SPINAL CANAL FORMING LUMBAR STENOSIS

    Directory of Open Access Journals (Sweden)

    OTABEK ABLYAZOV

    2011-08-01

    Full Text Available The modern categorization defines the different forms of lumbar part spine stenosis, coming from anatomical and pathological of the principle. One of the varieties is a central lumbar stenosis. Compression of medulla spinalis occurs due to reduction of sizes of the spine central cannel caused either by osseous structure or softtissue of the spine canal. All softtissue components of the spinal canal can form stenos including defeat of intervertebral disk (the hernia of the disk. This work studies efficiency of Xray (at 33 patients and MRI (at 92 patients methods in diagnostics of the hernia of the disk that participates in forming lumbar part spine stenosis.

  11. Treatment of Acute Lumbar Sprain by Acupuncture plus Cupping

    Institute of Scientific and Technical Information of China (English)

    WANG Jun-ying; WANG Si-you

    2003-01-01

    Fifty cases of acute lumbar sprain were treated by the combination of acupuncture, cupping and kinesitherapy. Forty-three cases were cured and 7 cases improved, the total effective rate being 100%. This therapy has an exact effect with a short course of treatment.

  12. Evaluation of the lumbar multifidus in rowers during spinal stabilization exercise

    Directory of Open Access Journals (Sweden)

    Joseani Ceccato

    2014-03-01

    Full Text Available Lumbar stabilization is important in high performance rowing due to the high incidence of low back pain. The purpose of this study was to evaluate the lumbar stabilizers muscles performance during an exercise of spinal segmental stabilization and in lumbar multifidus muscle thickness in rowing athletes trained and untrained for this exercise. Nine rowers trained with lumbar stabilization (TLS and eight rowers without training (CON participated in the study. Lumbar stabilization performance and multifidus muscle thickness were measured during a maximal voluntary isometric contraction. Lumbar stabilization performance was higher (p=0.015 in the TLS (mean 18.38 ± 8.00 mmHg compared to the CON (9.31 ± 4.91 mmHg group. Muscle thickness variation was higher (p=0.023 in the TLS (6.92% ± 3.98 compared to the CON (2.81% ± 1.40 group. Lumbar stabilization training is an efficient clinical tool to strengthen lumbar muscles and may help to prevent low back pain in rowers.

  13. 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

  14. Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mehtap Bozkurt

    2014-03-01

    Full Text Available Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI. The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery.

  15. Evaluations of Computed Tomography Images and Lumbar Specimens in Mimic Operations of Transverse Rotation Laminoplasty for Lumbar Spinal Stenosis

    Institute of Scientific and Technical Information of China (English)

    Xian-Wu Pei; Yong-Hui Liang; Hui Zhang; Zi-Shun Gong; Hong-Xing Song

    2015-01-01

    Background:Laminectomy is a major method to treat lumbar spinal stenosis (LSS),but it has lots of flaws such as scar tissue can form around the dura again or spinal instability.This study aimed to investigate the feasibility of transverse rotation laminoplasty (TRL) in the treatment of LSS.Methods:The mimic operations of TRL were performed both in the computerized image processing and on the lumbar specimen.Computed tomography (CT) images were either collected from 80 clinical patients with complaints of lumbago or obtained from 40 sets of lumbar specimens after rebuild of spinal canals.In the CT image processing the heights of the spinous process and laminae at L3-L5 were measured.The total length of the spinous process plus one side laminae after the operation was evaluated and compared with the length of inner margin of pedical before the operation.The areas of the vertebral canal were examined before and after the operation.Results:In the CT images,the height of spinous process of L3,L4 and L5 was 24.74 ± 3.45,22.68 ± 5.96 and 21.54 ± 4.12 mm respectively,and that of laminae was 23.66 ± 2.32,22.68 ± 5.36 and 20.99 ± 3.67 mm respectively (P > 0.05).Distance of inner border of pedical of L3,L4 and L5 was 23.01 ± 6.59,24.65 ± 5.54 and 26.03 ± 7.34 mm respectively,and length of spinous process with laminae of those was 29.76 ± 4.91,29.31 ± 6.43 and 32.53 ± 5.76 mm respectively (P < 0.05).Preoperative area of spinal canals of L3,L4 and L5 was 299.81 ± 10.09,297.66 ± 9.54 and 308.22 ± 10.04 mm2 respectively,and postoperative area was 480.01 ± 9.33,487.32 ± 8.65 and 501.03 ± 9.12 mm2 respectively (P < 0.05).In the human lumbar vertebrae specimen,the data similar to the former.Conclusions:The excised canal posterior was covered,and the lumbar canals enlarged by TRL.The TRL provided a new alternative in the treatment of LSS.

  16. Topacheous gout as a rare cause of spinal stenosis in the lumbar region. Case report.

    LENUS (Irish Health Repository)

    Kelly, Joseph

    2012-02-03

    Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.

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

    Directory of Open Access Journals (Sweden)

    Surendra Mohan Tuli

    2011-01-01

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

  18. Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

    Science.gov (United States)

    Lee, Chong-Suh; Chung, Sung-Soo; Lee, Jun-Young; Yum, Tae-Hoon; Shin, Seong-Kee

    2016-01-01

    Study Design Prospective observational study. Purpose To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity Overview of Literature Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal. Methods Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded. Results No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p sagittal balance and reducing the necessity of more extensive surgery. PMID:27994777

  19. [Sacroiliac joint dysfunction with groin pain after an operation for lumbar spinal disorder. A case report].

    Science.gov (United States)

    Shimoda, Yusuke; Morimoto, Daijiro; Isu, Toyohiko; Motegi, Hiroaki; Imai, Tetsuaki; Matsumoto, Ryouji; Isobe, Masanori; Kim, Kyongsong; Sugawara, Atsushi

    2010-11-01

    A 75-year-old male presented with groin pain after an operation to treat lumbar spondylolisthesis (L5). Groin tenderness was localized to the medial border of the anterior superior iliac spine (ASIS). Radiographical and physical examination raised the suspicion of sacroiliac joint (SIJ) dysfunction. Injection of a painkiller into the SIJ relieved symptoms, including groin tenderness. Symptoms improved gradually, and finally disappeared after five SIJ injections. Groin pain has been reported as a referred symptom of SIJ dysfunction in 9.3-23% of patients. Prior to the patient undergoing surgery to treat lumbar spondylolisthesis, SIJ dysfunction had not been noted on physical examination. Long periods spent in the abnormal posture due to lumbar spondylolisthesis induced SIJ stress. After the operation, an improvement in daily activity actually increased stress on the SIJ, resulting in SIJ dysfunction. Certain pathologies, including SIJ dysfunction, should be considered as residual symptoms after operations for lumbar spinal diseases.

  20. Abscess or tumour? Lumbar spinal abscess mimicking a filum terminale tumour.

    Science.gov (United States)

    Sajjad, Jahangir; Kaliaperumal, Chandrasekaran; O'Sullivan, Michael

    2012-05-30

    A 62-year-old woman presented with a 4-month history of central lower backache and a 2-week history of progressive bilateral leg weakness. She also complained of numbness on her left thigh and gluteal region, associated with urinary hesitancy and constipation. On examination, she had bilateral partial foot drop, absent knee and ankle reflexes and a negative Babinski's reflex and associated hyperaesthesia in L3 distribution bilaterally with decreased anal tone. Laboratory results revealed normal inflammatory markers. MRI scan demonstrated a large uniformly enhancing lesion in the filum terminale suggestive of a lumbar spinal tumour. An emergency spinal laminectomy from L3 to S2 was performed. Per operatively, the duramater was thickened and hyperaemic. The histopathology report suggested inflammation with no evidence of malignancy. Tissue specimen of cultured Staphylococcus aureus was sensitive to flucloxacillin. A final diagnosis of lumbar spinal abscess was made and subsequent antibiotic treatment led to good clinical recovery.

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

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    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

  2. PARAMETERS OF NUCLEAR MAGNETIC RESONANCE IN PATIENTS WITH CONGENITAL NARROWING OF THE LUMBAR SPINAL CANAL

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    ELIU HAZAEL MORALES-RANGEL

    Full Text Available ABSTRACT Objective: To compare the morphological parameters of magnetic resonance in patients with congenital narrowing of the lumbar spinal canal with patients with low back pain. Methods: A descriptive, retrospective, observational study was conducted with measurements in the axial and sagittal magnetic resonance sections of the vertebral body and canal of the lumbar spine of 64 patients with diagnosis of low back pain, which were compared with resonance images taken from 31 Mexican patients with congenital narrowing of the lumbar spinal canal. Results: The results show that patients with congenital narrowing of the lumbar spinal canal in the axial sections have a difference in diameters, being L2<13.9 mm, L3<13.3 mm, L4<12.9 mm, L5<13.1 mm, compared with controls L2<20.5 mm, L3<20.5 mm, L4<19.3 mm, L5<18.1 mm with p = 0.000. Conclusions: We found different measurements in the Mexican population compared to those found by similar studies. With the parameters obtained, it would be possible to make the proper diagnosis, surgical planning, and treatment.

  3. Spinal muscles can create compressive follower loads in the lumbar spine in a neutral standing posture.

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    Han, Kap-Soo; Rohlmann, Antonius; Yang, Seok-Jo; Kim, Byeong Sam; Lim, Tae-Hong

    2011-05-01

    The ligamentous spinal column buckles under compressive loads of even less than 100N. Experimental results showed that under the follower load constraint, the ligamentous lumbar spine can sustain large compressive loads without buckling, while at the same time maintaining its flexibility reasonably well. The purpose of this study was to investigate the feasibility of follower loads produced by spinal muscles in the lumbar spine in a quiet standing posture. A three-dimensional static model of the lumbar spine incorporating 232 back muscles was developed and utilized to perform the optimization analysis in order to find the muscle forces, and compressive follower loads (CFLs) along optimum follower load paths (FLPs). The effect of increasing external loads on CFLs was also investigated. An optimum solution was found which is feasible for muscle forces producing minimum CFLs along the FLP located 11 mm posterior to the curve connecting the geometrical centers of the vertebral bodies. Activation of 30 muscles was found to create CFLs with zero joint moments in all intervertebral joints. CFLs increased with increasing external loads including FLP deviations from the optimum location. Our results demonstrate that spinal muscles can create CFLs in the lumbar spine in a neutral standing posture in vivo to sustain stability. Therefore, its application in experimental and numerical studies concerning loading conditions seems to be suitable for the attainment of realistic results.

  4. Lumbar spinal loading during bowling in cricket: a kinetic analysis using a musculoskeletal modelling approach.

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    Zhang, Yanxin; Ma, Ye; Liu, Guangyu

    2016-01-01

    The objective of the study was to evaluate two types of cricket bowling techniques by comparing the lumbar spinal loading using a musculoskeletal modelling approach. Three-dimensional kinematic data were recorded by a Vicon motion capture system under two cricket bowling conditions: (1) participants bowled at their absolute maximal speeds (max condition), and (2) participants bowled at their absolute maximal speeds while simultaneously forcing their navel down towards their thighs starting just prior to ball release (max-trunk condition). A three-dimensional musculoskeletal model comprised of the pelvis, sacrum, lumbar vertebrae and torso segments, which enabled the motion of the individual lumbar vertebrae in the sagittal, frontal and coronal planes to be actuated by 210 muscle-tendon units, was used to simulate spinal loading based on the recorded kinematic data. The maximal lumbar spine compressive force is 4.89 ± 0.88BW for the max condition and 4.58 ± 0.54BW for the max-trunk condition. Results showed that there was no significant difference between the two techniques in trunk moments and lumbar spine forces. This indicates that the max-trunk technique may not increase lower back injury risks. The method proposed in this study could be served as a tool to evaluate lower back injury risks for cricket bowling as well as other throwing activities.

  5. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

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    Savni R Satoskar

    2014-01-01

    Full Text Available Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ′Goel facet spacer′ in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions : Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.

  6. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature.

    Science.gov (United States)

    Ghobrial, George M; Theofanis, Thana; Darden, Bruce V; Arnold, Paul; Fehlings, Michael G; Harrop, James S

    2015-10-01

    OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term "lumbar durotomy" (under the 2015 medical subject heading [MeSH] "cerebrospinal fluid leak") was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally

  7. Percutaneous radiofrequency rhizotomy of lumbar spinal facets: the results of 46 cases.

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    Göçer, A I; Cetinalp, E; Tuna, M; Ildan, F; Bağdatoğlu, H; Haciyakupoğlu, S

    1997-01-01

    The results of percutaneous radiofrequency rhizotomy of lumbar spinal facets in 46 patients followed at least three months (mean 15 months) are reported and compared with those reported previously. Satisfactory pain relief three months after the procedure was achieved in 36.4 percent of patients without operations and in 41.7 percent of patients, with operations other than fusion. No patient had previously undergone fusion. Treatment of low-back pain by using radio-frequency thermocoagulation of spinal facets is a simple, safe, and well-tolerated procedure. It can be used to relief of pain in spite of decreasing rates of success within the follow-up period.

  8. Painful pseudoarthrosis following lumbar spinal fusion: Detection by combined SPECT and planar bone scintigraphy

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    Slizofski, W.J.; Hellman, R.S.; Isitman, A.T.; Collier, B.D.; Carrera, G.F.; Flatley, T.J.

    1987-02-01

    Twenty-six adult patients more than 6-months post-lumbar spinal fusion were studied. Flexion and extension radiographs showing motion or bone scintigrams, showing focal areas of increased activity within the fusion mass were considered positive for pseudarthrosis. Patients were classified as either symptomatic or asymptomatic. Among the 15 symptomatic patients, scintigraphy had a sensitivity of 0.78 and a specificity of 0.83 which was superior to the 0.43 sensitivity and 0.50 specificity of radiography. Six of the 11 asymptomatic patients had focal areas of increased activity in the bony fusion mass, possibly reflecting painless pseudarthrosis. Planar imaging was substantially enhanced by SPECT in 14 of the 26 cases. It is concluded that for the patient who remains symptomatic after lumbar spinal fusion, bone scintigraphy with SPECT is of significant value in detecting painful pseudarthrosis.

  9. Diagnostic value of multiplanar reconstruction in CT recognition of lumbar spinal disorders

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    Im, S. K.; Choi, J. H.; Kim, C. H.; Sohn, M. H.; Lim, K. Y.; Choi, K. C. [Chonbuk National University College of Medicine, Chonju (Korea, Republic of)

    1984-12-15

    The computer tomography is useful in evaluation of bony structures and adjacent soft tissues of the lumbar spine. Recently, the multiplanar reconstruction of lumbar spine of CT of significant value for the anatomical localization and for the myelographic and surgical correlation. We observed 177 cases of lumbar spine CT, who complains of spinal symptom, during the period from Dec. 1982 to Aug. 1984. The results were as follows: 1. The sex distribution of cases were 113 males and 44 females. The CT diagnosis showed 152 cases of herniated lumbar disc, 15 cases of degenerative disease, 5 cases of spine tbc., 3 cases of spine trauma and 2 cases of meningocele. 2. CT findings of herniated disc were as follows: focal protrusion of posterior disc margin and obliteration of anterior epidural fat in all cases, indentation on dural sac in 92 cases (60.5%) soft tissue mass in epidural fat in 85 cases (55.9%), compression or displacement of nerve root sheath in 22 cases(14.4%). 3. Sites of herniated lumbar disc were at L4-L5 level in 100 cases(59.1%) and at L5-S1 level in 65 cases (38.4%). Location of it were central type in 70 cases(41.1%), left-central type in 46 cases (27.2%), right-central type in 44 cases(26.0%) and lateral type in 9 cases (5.1%). 4. The sagittal reconstruction images were helpful in evaluating neural foramina, size of disc bluge into spinal canal, especially at L5-S1, and patients with spondylolisthesis. The coronal reconstruction images were the least informative, although they contributed to the evaluation of lumbar nerve roots of course, the axial CT scans were the most sensitive and specific.

  10. Traumatic lumbar artery rupture after lumbar spinal fracture dislocation causing hypovolemic shock: An endovascular treatment.

    Science.gov (United States)

    Eun, Jong-Pil; Oh, Young-Min

    2015-01-01

    Recently, we observed a case of lumbar artery injury after trauma, which was treated by endovascular embolization. A 67-year-old woman who was injured in a traffic accident was brought to the emergency room. She was conscious and her hemodynamic condition was stable, but she had paraplegia below L1 dermatome. Contrast-enhanced computed tomography scan of abdomen and pelvis revealed fracture dislocation of L3/4 along with retroperitoneal hematomas. However, there was no evidence of traumatic injury in both thoracic and abdominal cavity. At that time, her blood pressure suddenly decreased to 60/40 mmHg and her mental status deteriorated. Also, her hemoglobin level was 5.4 g/dl. While her hemodynamic condition stabilized with massive fluid resuscitation including blood transfusion, an angiography was immediately performed to look for and embolize site of retroperitoneal hemorrhage. On the angiographic images, there was an active extravasation from ruptured left 3rd lumbar artery, and we performed complete embolization with GELFOAM and coil. Lumbar artery injury after trauma is rare and endovascular treatment is useful in case of hemodynamic instability.

  11. Noradrenergic modulation of intrinsic and synaptic properties of lumbar motoneurons in the neonatal rat spinal cord

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    Maylis Tartas

    2010-03-01

    Full Text Available Although it is known that noradrenaline powerfully controls spinal motor networks, few data are available regarding the noradrenergic modulation of intrinsic and synaptic properties of neurons in motor networks. Our work explores the cellular basis of noradrenergic modulation in the rat motor spinal cord. We first show that lumbar motoneurons express the three classes of adrenergic receptors at birth. Using patch-clamp recordings in the newborn rat spinal cord preparation, we characterized the effects of noradrenaline and of specific agonists of the three classes of adrenoreceptors on motoneuron membrane properties. Noradrenaline increases the motoneuron excitability partly via the inhibition of a KIR like current. Methoxamine (α1, clonidine (α2 and isoproterenol (β differentially modulate the motoneuron membrane potential but also increase motoneuron excitability, these effects being respectively inhibited by the antagonists prazosin (α1, yohimbine (α2 and propranolol (β. We show that the glutamatergic synaptic drive arising from the T13-L2 network is enhanced in motoneurons by noradrenaline, methoxamine and isoproterenol. On the other hand, noradrenaline, isoproterenol and clonidine inhibit both the frequency and amplitude of miniature glutamatergic EPSCs while methoxamine increases their frequency. The T13-L2 synaptic drive is thereby differentially modulated from the other glutamatergic synapses converging onto motoneurons and enhanced by presynaptic α1 and β receptor activation. Our data thus show that the noradrenergic system exerts a powerful and complex neuromodulation of lumbar motor networks in the neonatal rat spinal cord.

  12. Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series

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    Ploumis Avraam

    2012-10-01

    Full Text Available Abstract Background Interspinous distraction devices (IPDD are indicated as stand-alone devices for the treatment of spinal stenosis. The purpose of this study is to evaluate the results of patients undergoing surgery for spinal stenosis with a combination of unilateral microdecompression and interspinous distraction device insertion. Methods This is a prospective clinical and radiological study of minimum 2 years follow-up. Twenty-two patients (average age 64.5 years with low-back pain and unilateral sciatica underwent decompressive surgery for lumbar spinal stenosis. Visual Analogue Scale, Oswestry Disability Index and walking capacity plus radiologic measurements of posterior disc height of the involved level and lumbar lordosis Cobb angle were documented both preoperatively and postoperatively. One-sided posterior subarticular and foraminal decompression was conducted followed by dynamic stabilization of the diseased level with an IPDD (X-STOP. Results The average follow-up time was 27.4 months. Visual Analogue Scale and Oswestry Disability Index improved statistically significantly (p Conclusions The described surgical technique using unilateral microdecompression and IPDD insertion is a clinically effective and radiologically viable treatment method for symptoms of spinal stenosis resistant to non-operative treatment.

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

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    Sahiba Yadav

    2014-10-01

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

  14. Is epidural steroid injection effective for degenerative lumbar spinal stenosis?

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    Sebastián Flores

    2015-12-01

    Full Text Available Existe una variada cantidad de alternativas no quirúrgicas para tratar el dolor radicular producido por la raquiestenosis lumbar degenerativa. Los corticoides epidurales se utilizan desde hace varias décadas, sin embargo la eficacia reportada en la literatura es muy variable. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos nueve revisiones sistemáticas que en conjunto incluyen siete estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la inyección de corticoides epidurales probablemente tiene poco o nulo efecto en reducir el dolor radicular por estenorraquis.

  15. SPINAL POSTURE OF THORACIC AND LUMBAR SPINE AND PELVIC TILT IN HIGHLY TRAINED CYCLISTS

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    José M. Muyor

    2011-06-01

    Full Text Available The aim of this study was to evaluate sagittal thoracic and lumbar spinal curvatures and pelvic tilt in elite and master cyclists when standing on the floor, and sitting on a bicycle at three different handlebar-hand positions. A total of 60 elite male cyclists (mean age: 22.95 ± 3.38 years and 60 master male cyclists (mean age: 34.27 ± 3.05 years were evaluated. The Spinal Mouse system was used to measure sagittal thoracic and lumbar curvature in standing on the floor and sitting positions on the bicycle at three different handlebar-hand positions (high, medium, and low. The mean values for thoracic and lumbar curvatures and pelvic tilt in the standing position on the floor were 48.17 ± 8.05º, -27.32 ± 7.23º, and 13.65 ± 5.54º, respectively, for elite cyclists and 47.02 ± 9.24º, -25.30 ± 6.29º, and 11.25 ± 5.17º for master cyclists. A high frequency of thoracic hyperkyphosis in the standing position was observed (58.3% in elite cyclists and 53.3% in master cyclists, whereas predominately neutral values were found in the lumbar spine (88.3% and 76.7% in elite and master cyclists, respectively. When sitting on the bicycle, the thoracic curve was at a lower angle in the three handlebar-hand positions with respect to the standing position on the floor in both groups (p < 0.01. The lumbar curve adopted a kyphotic posture. In conclusion, cyclists present a high percentage of thoracic hyperkyphotic postures in standing positions on the floor. However, thoracic hyperkyphosis is not directly related to positions adopted on the bicycle

  16. Quality of life after surgical decompression of lumbar spinal stenosis with and without instrumentation.

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    Grivas, Theodoros B; Vasiliadis, Elias; Papadakis, Stamatios A; Mouzakis, Vasilios; Segos, Dimitrios

    2006-01-01

    The aim is to evaluate the influence on quality of life of surgical decompression with and without instrumentation in lumbar spinal stenosis. Twenty three patients, (16 women, 7 men) with a mean age of 62,8 years old (range 44-80) who underwent a surgical decompression for lumbar spinal stenosis filled the SF-36 questionnaire pre- and postoperatively, during the follow up period which was at a mean value of 42 months (range 6 to 50 months). Spinal stenosis was degenerative in 18 patients and as a consequence of spondylolisthisis in 5. In 15 patients decompression and fusion using instrumentation (group I) was performed and in 8 patients only decompression was performed (group II). Statistical analysis was carried out using the Wilcoxon Signed Rank Test. In group I, the domains that evidenced statistical significant improvement were bodily pain (p<0,041), general health (p<0,042), vitality (p<0,042), social functioning (p<0,043), and mental health (p<0,042). Not any specific domain in group II showed a statistical significant improvement postoperatively. Comparing the two groups overall SF-36 score, a statistical significant improvement was noted for group I (p<0,001) and for group II (p<0,017). The statistical significance of improvement was stronger in patients of group I than group II. Surgical decompression for lumbar spinal stenosis reduces pain and restores significantly physical and mental health. Decompression and instrumentation presents superior results in patients' quality of life when compared to patients that single decompression was performed.

  17. Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction

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    Koyanagi, Izumi; Isu, Toyohiko; Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi; Tashiro, Kunio; Miyasaka, Kazuo; Abe, Satoru; Kaneda, Kiyoshi

    1988-10-01

    Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here. MRI is also a useful method for diagnosing a compressive lesion at the thoraco-lumbar junction.

  18. Magnetic resonance imaging of lumbar spinal disorders; A comparison with myelography and discography

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    Nojiri, Hajime (Nagoya City Univ. (Japan). Faculty of Medicine)

    1992-12-01

    To evaluate the stenotic condition of the lumbar spinal canal, MRI was compared with myelography and with discography in 102 patients, all of whom underwent surgical exploration. Various pathologic conditions were studied including 50 cases of herniated nucleus pulposus, 39 cases of lumbar canal stenosis (central, peripheral type or combined type), and 13 cases of spondylolisthesis (degenerative, spondylolytic, and dysplastic type). High correlation was detected between the T2 weighted mid-sagittal image of the thecal sac and the lateral view of a full-column myelogram, but subtle changes such as adhesive changes, or redundancy, or anomalous changes of the nerve roots were more clearly demonstrated on myelograms than on MRI. Actually some of these changes could not be detected on MRI. The degrees of disc degeneration were classified into five grades according to the signal intensity and the irregularity of the disc on the T2-weighted image. The MRI evaluation of disc degeneration in this series was similar to that of the discography. However, MRI could not replace discography for identifying the source of pain in symptomatic patients. Although MRI might be the imaging modality for diagnostic screening and for detecting stenotic conditions of the lumbar spinal canal, it will not be able to replace myelography and/or discography for determining indication for surgery and preferred surgical approach. (author).

  19. Magnetic Resonance Imaging of the Cervical, Thoracic, and Lumbar Spine in Children: Spinal Incidental Findings in Pediatric Patients

    Science.gov (United States)

    Ramadorai, Uma E.; Hire, Justin M.; DeVine, John G.

    2014-01-01

    Study Design Retrospective case series. Objective To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102

  20. Acute estrogen surge enhances inflammatory nociception without altering spinal Fos expression.

    Science.gov (United States)

    Ralya, Andrew; McCarson, Kenneth E

    2014-07-11

    Chronic pain is a major neurological disorder that can manifest differently between genders or sexes. The complex actions of sex hormones may underlie these differences; previous studies have suggested that elevated estrogen levels can enhance pain perception. The purpose of this study was to investigate the hypothesis that acute, activational effects of estradiol (E2) increase persistent inflammatory nociception, and anatomically where this modulation occurs. Spinal expression of Fos is widely used as a marker of nociceptive activation. This study used formalin-evoked nociception in ovariectomized (OVX) adult female rats and measured late-phase hindlimb flinching and Fos expression in the spinal cord, and their modification by acute estrogen supplementation similar to a proestrus surge. Six days after ovariectomy, female rats were injected subcutaneously (s.c.) with 10μg/kg E2 or vehicle. Twenty-four hours later, 50μL of 1.25% or 100μL of 5% formalin was injected into the right hindpaw; hindlimb flinches were counted, and spinal cords removed 2h after formalin injection. The numbers of Fos-expressing neurons in sections of the lumbar spinal cord were analyzed using immunohistochemistry. Formalin-induced inflammation produced a dose-dependent increase in late-phase hindlimb flinching, and E2 pretreatment increased flinching following 5%, but not 1.25% formalin injection. Despite the modification of behavior by E2, the number of spinal Fos-positive neurons was not altered by E2 pretreatment. These findings demonstrate that an acute proestrus-like surge in serum estrogen can produce a stimulus-intensity-dependent increase in inflammation-evoked nociceptive behavior. However, the lack of effect on spinal Fos expression suggests that this enhancement of nociceptive signaling by estrogen is independent of changes in peripheral activation of, expression of the immediate early gene Fos by, or signal throughput of spinal nociceptive neurons.

  1. [Penetrating stab injury to the lumbar spinal cord in a child].

    Science.gov (United States)

    Scheiderer, B; Mild, K; Gebhard, F; Scola, A

    2016-03-01

    This article reports the case of an 8-year-old boy with a knife stab injury to the lumbar spine without neurological deficits. The computed tomography (CT) scan revealed a longitudinal penetration of the conus medullaris at the level of the first lumbar vertebra. The knife blade was extracted and primary closure was carried out on the stab wound. The immediately postoperative magnetic resonance imaging (MRI) as well as the follow-up examinations after 1 and 6 weeks showed no evidence of compressive spinal bleeding, myelopathy or cerebrospinal fluid leakage. In addition, no secondary changes of the neurological status developed. Consequently, in cases of neurologically asymptomatic patients without concomitant injuries the surgical exploration of a stab wound does not seem to be absolutely necessary.

  2. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

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    Pampati Vidyasagar

    2004-05-01

    Full Text Available Abstract Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine, in accordance with the criteria established by the International Association for the Study of Pain (IASP. The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%, with thoracic spine pain was 42% (95% CI, 30% – 53%, and in with lumbar spine pain was 31% (95% CI, 27% – 36%. The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72% in the cervical spine, 55% (95% CI, 39% – 78% in the thoracic spine, and 27% (95% CI, 22% – 32% in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.

  3. Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis

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    Pierce D. Nunley

    2016-01-01

    Full Text Available Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were all very large (>1.0 for Superion and laminectomy at 2, 3, and 4 years. For ZCQ, the 2-year Superion symptom severity (1.26 and physical function (1.29 domains were very large; laminectomy effect sizes were very large (1.07 for symptom severity and large for physical function (0.80. Current projections indicate a marked increase in the number of patients with spinal stenosis. Consequently, there remains a keen interest in minimally invasive treatment options that delay or obviate the need for invasive surgical procedures, such as decompressive laminectomy or fusion. Stand-alone interspinous spacers may fill a currently unmet treatment gap in the continuum of care and help to reduce the burden of this chronic degenerative condition on the health care system.

  4. Early diagnosis and treatment of acute or subacute spinal epidural hematoma

    Institute of Scientific and Technical Information of China (English)

    YU Hang-ping; FAN Shun-wu; YANG Hui-lin; TANG Tian-si; ZHOU Feng; ZHAO Xing

    2007-01-01

    Background Despite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.Methods Of the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3-48 hours afterappearance of symptoms, and 6 patients were transferred from community hospitals within 21-106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients,B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T1 weighted image and mixed hyperintensity on T2 weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.Results Neither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1-6 years. A marked difference was noted between

  5. Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

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    Vazquez-Barquero, A.; Pinto, J.I. [Univ. Hospital ' ' Marques de Valdecilla' ' , Santander (Spain). Dept. of Neurosurgery; Abascal, F.; Garcia-Valtuille, R.; Cerezal, L. [Hospital Mompia, Cantabria, (Spain). Dept. of Radiology; Figols, F.J. [Univ. Hospital Marques de Valdecilla, Santander (Spain). Dept. of Pathology

    2000-10-01

    An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. (orig.)

  6. Stress myelography. A new functional examination for diseases of the lumbar spinal canal

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    Schumacher, M.

    1986-12-01

    To optimize functional diagnostics in lumbar syndromes a new myelographic technique was developed termed 'loading myelography'. During the procedure the patient stands with a 10 kg weight on his out-stretched arms. Based on the law of leverage the load exercised on the vertebral column is more than two and a half times of one-half of the body weight. The author tested the efficacy of the method in 119 patients suffering from disc prolapse, spinal canal stenosis, spondylolisthesis or arachnitis. The results of the conventional myelogram compared with myelography under load conditions demonstrate the value of the method: without load the diagnosis would have remained uncertain in 25% and in 18% load myelogram revealed a pathological finding although conventional myelography was normal. We consider as indications for load myelography: Discrepancy between clinical and conventional myelographic findings; clinically expected multisegmental lesions; spinal canal stenosis; and spondylolisthesis.

  7. Acute cervical spinal subdural hematoma not related to head injury.

    Science.gov (United States)

    Kim, Hee Yul; Ju, Chang Il; Kim, Seok Won

    2010-06-01

    We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

  8. Promoting lumbar spinal fusion by adenovirus-mediated bone morphogenetic protein-4 gene therapy

    Institute of Scientific and Technical Information of China (English)

    ZHAO Jian; ZHAO Dun-yan; SHEN Ai-guo; LIU Fan; ZHANG Feng; SUN Yu; WU Hong-fu; LU Chun-feng; SHI Hong-guang

    2007-01-01

    Objective: To determine whether an adenoviral construct containing bone morphogenetic protein-4 (BMP-4) gene can be used for lumbar spinal fusion. Methods: Twelve New Zealand white rabbits were randomly divided into two groups, 8 in the experimental group and 4 in the control group. Recombinant, replication-defective type 5 adenovirus with the cytomegalovirus (CMV) promoter and BMP-4 gene (Ad-BMP-4) was used. Another adenovirus constructed with the CMV promoter and β-galactosidase gene (Ad-β-gal) was used as control. Using collagen sponge as a carrier, Ad-BMP-4 (2.9×108 pfu/ml ) was directly implanted on the surface of L5-L6 lamina in the experimental group, while Ad-β-gal was implanted simultaneously in the control group. X-ray was obtained at 3, 6, and 12 weeks postoperatively to observe new bone formation. When new bone formation was identified, CT scans and three-dimensional reconstruction were obtained. After that, the animals were killed and underwent histological inspection.Results: In 12 weeks after operation, new bone formation and fusion were observed on CT scans in the experimental group, without the evidence of ectopic calcification in the canal. Negative results were found in the control group. Histological analysis demonstrated endochondral bone formation at the operative site and fusion at early stage was testified.Conclusions: In vivo gene therapy using Ad-BMP-4 for lumbar posterolateral spinal fusion is practicable and effective.

  9. Endoscopic decompression combined with interspinous process implant fusion for lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    LIU Gang; ZHAO Jian-ning; Akira Dezawa

    2008-01-01

    Objective: To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods: This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 21306. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association (JOA) score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results: There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions: The median approach endoscopic decom-pression is an ideal method for bilateral radicuiopathy result-ing from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exUent. Preservation of adjacent level disease can be assessed only in long-term follow-up.

  10. Lumbar Spinal Stenosis Minimally Invasive Treatment with Bilateral Transpedicular Facet Augmentation System

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    Masala, Salvatore, E-mail: salva.masala@tiscali.it [Interventional Radiology and Radiotherapy, University of Rome ' Tor Vergata' , Department of Diagnostic and Molecular Imaging (Italy); Tarantino, Umberto [University of Rome ' Tor Vergata' , Department of Orthopaedics and Traumatology (Italy); Nano, Giovanni, E-mail: gionano@gmail.com [Interventional Radiology and Radiotherapy, University of Rome ' Tor Vergata' , Department of Diagnostic and Molecular Imaging (Italy); Iundusi, Riccardo [University of Rome ' Tor Vergata' , Department of Orthopaedics and Traumatology (Italy); Fiori, Roberto, E-mail: fiori.r@libero.it; Da Ros, Valerio, E-mail: valeriodaros@hotmail.com; Simonetti, Giovanni [Interventional Radiology and Radiotherapy, University of Rome ' Tor Vergata' , Department of Diagnostic and Molecular Imaging (Italy)

    2013-06-15

    Purpose. The purpose of this study was to evaluate the effectiveness of a new pedicle screw-based posterior dynamic stabilization device PDS Percudyn System Trade-Mark-Sign Anchor and Stabilizer (Interventional Spine Inc., Irvine, CA) as alternative minimally invasive treatment for patients with lumbar spine stenosis. Methods. Twenty-four consecutive patients (8 women, 16 men; mean age 61.8 yr) with lumbar spinal stenosis underwent implantation of the minimally invasive pedicle screw-based device for posterior dynamic stabilization. Inclusion criteria were lumbar stenosis without signs of instability, resistant to conservative treatment, and eligible to traditional surgical posterior decompression. Results. Twenty patients (83 %) progressively improved during the 1-year follow-up. Four (17 %) patients did not show any improvement and opted for surgical posterior decompression. For both responder and nonresponder patients, no device-related complications were reported. Conclusions. Minimally invasive PDS Percudyn System Trade-Mark-Sign has effectively improved the clinical setting of 83 % of highly selected patients treated, delaying the need for traditional surgical therapy.

  11. Sparing of descending axons rescues interneuron plasticity in the lumbar cord to allow adaptive learning after thoracic spinal cord injury

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    Christopher Nelson Hansen

    2016-03-01

    Full Text Available This study evaluated the role of spared axons on structural and behavioral neuroplasticity in the lumbar enlargement after a thoracic spinal cord injury (SCI. Previous work has demonstrated that recovery in the presence of spared axons after an incomplete lesion increases behavioral output after a subsequent complete spinal cord transection (TX. This suggests that spared axons direct adaptive changes in below-level neuronal networks of the lumbar cord. In response to spared fibers, we postulate that lumbar neuron networks support behavioral gains by preventing aberrant plasticity. As such, the present study measured histological and functional changes in the isolated lumbar cord after complete TX or incomplete contusion (SCI. To measure functional plasticity in the lumbar cord, we used an established instrumental learning paradigm. In this paradigm, neural circuits within isolated lumbar segments demonstrate learning by an increase in flexion duration that reduces exposure to a noxious leg shock. We employed this model using a proof-of-principle design to evaluate the role of sparing on lumbar learning and plasticity early (7 days or late (42 days after midthoracic SCI in a rodent model. Early after SCI or TX at 7d, spinal learning was unattainable regardless of whether the animal recovered with or without axonal substrate. Failed learning occurred alongside measures of cell soma atrophy and aberrant dendritic spine expression within interneuron populations responsible for sensorimotor integration and learning. Alternatively, exposure of the lumbar cord to a small amount of spared axons for 6 weeks produced near-normal learning late after SCI. This coincided with greater cell soma volume and fewer aberrant dendritic spines on interneurons. Thus, an opportunity to influence activity-based learning in locomotor networks depends on spared axons limiting maladaptive plasticity. Together, this work identifies a time dependent interaction between

  12. Sparing of Descending Axons Rescues Interneuron Plasticity in the Lumbar Cord to Allow Adaptive Learning After Thoracic Spinal Cord Injury.

    Science.gov (United States)

    Hansen, Christopher N; Faw, Timothy D; White, Susan; Buford, John A; Grau, James W; Basso, D Michele

    2016-01-01

    This study evaluated the role of spared axons on structural and behavioral neuroplasticity in the lumbar enlargement after a thoracic spinal cord injury (SCI). Previous work has demonstrated that recovery in the presence of spared axons after an incomplete lesion increases behavioral output after a subsequent complete spinal cord transection (TX). This suggests that spared axons direct adaptive changes in below-level neuronal networks of the lumbar cord. In response to spared fibers, we postulate that lumbar neuron networks support behavioral gains by preventing aberrant plasticity. As such, the present study measured histological and functional changes in the isolated lumbar cord after complete TX or incomplete contusion (SCI). To measure functional plasticity in the lumbar cord, we used an established instrumental learning paradigm (ILP). In this paradigm, neural circuits within isolated lumbar segments demonstrate learning by an increase in flexion duration that reduces exposure to a noxious leg shock. We employed this model using a proof-of-principle design to evaluate the role of sparing on lumbar learning and plasticity early (7 days) or late (42 days) after midthoracic SCI in a rodent model. Early after SCI or TX at 7 days, spinal learning was unattainable regardless of whether the animal recovered with or without axonal substrate. Failed learning occurred alongside measures of cell soma atrophy and aberrant dendritic spine expression within interneuron populations responsible for sensorimotor integration and learning. Alternatively, exposure of the lumbar cord to a small amount of spared axons for 6 weeks produced near-normal learning late after SCI. This coincided with greater cell soma volume and fewer aberrant dendritic spines on interneurons. Thus, an opportunity to influence activity-based learning in locomotor networks depends on spared axons limiting maladaptive plasticity. Together, this work identifies a time dependent interaction between spared

  13. Changes in the Expressions of Iba1 and Calcitonin Gene-Related Peptide in Adjacent Lumbar Spinal Segments after Lumbar Disc Herniation in a Rat Model.

    Science.gov (United States)

    Cho, Hee Kyung; Ahn, Sang Ho; Kim, So-Yeon; Choi, Mi-Jung; Hwang, Se Jin; Cho, Yun Woo

    2015-12-01

    Lumbar disc herniation is commonly encountered in clinical practice and can induce sciatica due to mechanical and/or chemical irritation and the release of proinflammatory cytokines. However, symptoms are not confined to the affected spinal cord segment. The purpose of this study was to determine whether multisegmental molecular changes exist between adjacent lumbar spinal segments using a rat model of lumbar disc herniation. Twenty-nine male Sprague-Dawley rats were randomly assigned to either a sham-operated group (n=10) or a nucleus pulposus (NP)-exposed group (n=19). Rats in the NP-exposed group were further subdivided into a significant pain subgroup (n=12) and a no significant pain subgroup (n=7) using mechanical pain thresholds determined von Frey filaments. Immunohistochemical stainings of microglia (ionized calcium-binding adapter molecule 1; Iba1), astrocytes (glial fibrillary acidic protein; GFAP), calcitonin gene-related peptide (CGRP), and transient receptor potential vanilloid 1 (TRPV1) was performed in spinal dorsal horns and dorsal root ganglions (DRGs) at 10 days after surgery. It was found immunoreactivity for Iba1-positive microglia was higher in the L5 (P=0.004) dorsal horn and in the ipsilateral L4 (P=0.009), L6 (P=0.002), and S1 (P=0.002) dorsal horns in the NP-exposed group than in the sham-operated group. The expression of CGRP was also significantly higher in ipsilateral L3, L4, L6, and S1 segments and in L5 DRGs at 10 days after surgery in the NP-exposed group than in the sham-operated group (Plumbar disc herniation upregulates microglial activity and CGRP expression in many adjacent and ipsilateral lumbar spinal segments.

  14. Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

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    Tayfun Hakan

    2016-01-01

    Conclusion: Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.

  15. Activation of neurotrophins in lumbar dorsal root probably contributes to neuropathic pain after spinal nerve ligation

    Science.gov (United States)

    Kazemi, Abdolreza; Rahmati, Masoud; Eslami, Rasoul; Sheibani, Vahid

    2017-01-01

    Objective(s): Neurotrophins (NTs) exert various effects on neuronal system. Growing evidence indicates that NTs are involved in the pathophysiology of neuropathic pain. However, the exact role of these proteins in modulating nociceptive signaling requires being defined. Thus, the aim of this study was to evaluate the effects of spinal nerve ligation (SNL) on NTs activation in the lumbar dorsal root. Materials and Methods: Ten male Wistar rats were randomly assigned to two groups: tight ligation of the L5 spinal nerve (SNL: n=5) and Sham (n=5). In order to produce neuropathic pain, the L5 spinal nerve was tightly ligated (SNL). Then, allodynia and hyperalgesia tests were conducted weekly. After 4 weeks, tissue samples were taken from the two groups for laboratory evaluations. Here, Real-Time PCR quantity method was used for measuring NTs gene expression levels. Results: SNL resulted in a significant weight loss in the soleus muscle (Pthermal hyperalgesia thresholds (respectively, P<0.05; P<0.05). Also, NGF, NT-4, NT-3, TrkA, TrkB and TrkC expression were up-regulated following spinal nerve ligation group (respectively, P=0.025, P=0.013, P=0.001, P=0.002, P<0.001, P=001) (respectively, 4.7, 5.2, 7.5, 5.1, 7.2, 6.2 folds). Conclusion: The present study provides new evidence that neuropathic pain induced by spinal nerve ligation probably activates NTs and Trk receptors expression in DRG. However, further studies are needed to better elucidate the role of NTs in a neuropathic pain. PMID:28133521

  16. Increased multiaxial lumbar motion responses during multiple-impulse mechanical force manually assisted spinal manipulation

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    Gunzburg Robert

    2006-04-01

    Full Text Available Abstract Background Spinal manipulation has been found to create demonstrable segmental and intersegmental spinal motions thought to be biomechanically related to its mechanisms. In the case of impulsive-type instrument device comparisons, significant differences in the force-time characteristics and concomitant motion responses of spinal manipulative instruments have been reported, but studies investigating the response to multiple thrusts (multiple impulse trains have not been conducted. The purpose of this study was to determine multi-axial segmental and intersegmental motion responses of ovine lumbar vertebrae to single impulse and multiple impulse spinal manipulative thrusts (SMTs. Methods Fifteen adolescent Merino sheep were examined. Tri-axial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 lumbar spinous processes under fluoroscopic guidance while the animals were anesthetized. A hand-held electromechanical chiropractic adjusting instrument (Impulse was used to apply single and repeated force impulses (13 total over a 2.5 second time interval at three different force settings (low, medium, and high along the posteroanterior axis of the T12 spinous process. Axial (AX, posteroanterior (PA, and medial-lateral (ML acceleration responses in adjacent segments (L1, L2 were recorded at a rate of 5000 samples per second. Peak-peak segmental accelerations (L1, L2 and intersegmental acceleration transfer (L1–L2 for each axis and each force setting were computed from the acceleration-time recordings. The initial acceleration response for a single thrust and the maximum acceleration response observed during the 12 multiple impulse trains were compared using a paired observations t-test (POTT, alpha = .05. Results Segmental and intersegmental acceleration responses mirrored the peak force magnitude produced by the Impulse Adjusting Instrument. Accelerations were greatest for AX and PA measurement axes. Compared to

  17. An investigation of the value of tridimensional kinematic analysis in functional diagnosis of lumbar spinal stenosis.

    Science.gov (United States)

    Garbelotti, Silvio Antonio; Lucareli, Paulo Roberto Garcia; Ramalho, Amâncio; de Godoy, Wagner; Bernal, Milena; D'Andréa Greve, Julia Maria

    2014-01-01

    Diagnosis of lumbar spinal stenosis (LSS) is based on clinical examination and imaging. The aim of this study was to evaluate the influence of 3D gait analysis as a tool in the differential diagnosis of LSS. Fourteen patients participated in the study that consisted of three phases: (1) capture six gait cycles after rest, (2) walk on a treadmill for a maximum of 20 min, (3) capture six gait cycles after effort. From these data, the kinematic variables were compared with the perception of pain and the cross sectional area of the spinal canal as measured by magnetic resonance. Most of correlations were weak and showed that the most significant results are reported by the Gait Deviation Index (GDI). The Gait Deviation Index demonstrated moderate negative correlation with the perception of pain after effort was made by both limbs. This means that there is a significant decrease in the overall function of the lower limbs according to the increase in pain symptoms. This situation may be reflected in decreased cadence and speed beyond the times of single support for the left limb, and the balance of the right limb, as part of a strategy to protect against pain and imbalance. We found no correlation between gait and pain in the cross-sectional area of the spinal canal. Therefore, we believe that there is no advantage for the patient to make a 3-D gait analysis because the analysis does not add relevant information to clinical diagnosis.

  18. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

    Science.gov (United States)

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved.

  19. Treatment of Acute Lumbar Sprain with Single Acupoint: A RCT

    Institute of Scientific and Technical Information of China (English)

    WU Yao-chi; WANG Cong-miao; ZHANG Bi-meng; Macario Bruna; XIAO Yuan-chun

    2004-01-01

    目的:评价单一穴位治疗急性腰扭伤的治疗效果.方法:根据统一的诊断标准,在多个临床中心进行随机对照研究.全部病例320例经随机数字表法分为针刺后溪穴观察组和针刺腰痛点对照组.对患者的疼痛程度分别由医师和患者进行评分.结果:治疗2个疗程后,观察组和对照组近期有效率分别为89.4%和82.5%,远期有效率分别为95.6%和93.5%.经Ridit分析,近期疗效差异有统计意义(P0.05).结论:针刺单一穴位治疗急性腰扭伤疗效确切,取穴简便,后溪穴疗效好于腰痛点.%Objective: To assess the clinical efficacy of single acupoint in the treatment of acute lumbar sprain. Methods: According to the same diagnostic standard, the randomized controlled trial was conducted in several clinical centers. All 320 subjects were digitally randomized into observation group in which Houxi (SI 3) was needled and control group in which Yaotongdian (Ex-UE 7) was needled. The pain severity was scored respectively by the doctors and patients. Results: After 2-course treatment, the short-term effective rates were 89.4% and 82.5% in observation group and control group, and the long-term effective rates were 95.6% and 93.5% respectively. Ridit analysis showed a difference in the short-term effects (P<0.05) and no difference in the long-term effects (P>0.05). Conclusion: Single acupoint is quite effective for acute lumbar sprain, with better effects of Houxi (SI 3) than Yaotongdian (Ex-UE 7).

  20. Black esophagus (acute esophageal necrosis) after spinal anesthesia.

    Science.gov (United States)

    Román Fernández, A; López Álvarez, A; Fossati Puertas, S; Areán González, I; Varela García, O; Viaño López, P M

    2014-01-01

    Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.

  1. Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

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    Shunji Asamoto

    2016-01-01

    Full Text Available Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF. Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS. A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL, which involves a microsurgical technique, is a safe, complication-free procedure.

  2. [Results of decompressive-stabilizing procedures via unilateral approach in lumbar spinal stenosis].

    Science.gov (United States)

    Krut'ko, A V

    2012-01-01

    Aim of this study was to investigate the capabilities, advantages and limitations of bilateral decompression via unilateral approach in decompressive-stabilizing procedures in patients with degenerative lumbar spine disease, and to develop the technology and its technical performance. The controlled study included 372 patients (age range was 27-74 years). All of them were operated due to clinical manifestation of lumbar spinal stenosis. The main group consisted of 44 patients who underwent bilateral decompression via unilateral approach with stabilization of involved segments. The control group included 328 patients who were operated using standard bilateral technique with stabilization. A total of 52 segments were treated in the first group and 351 in the second one. In all patients with neurogenic intermittent claudication symptoms relieved after decompressive-stabilizing surgery. Analysis of duration of surgery (considering 1 segment) demonstrated that less invasive technique requires as much time as conventional. However mean intraoperative blood loss in the first group was twice as low as the second. Neither patient from the first group required hemotransfusion while in the second group in 57 (17.4%) cases hemotransfusion was performed due to blood loss. In the early postoperative period in both groups intensity of pain (according to VAS) gradually decreased. Mean hospital stay was 9.9 +/- 3.1 day in the main group and 14.7 +/- 4.7 days in the control group. Bilateral spinal canal decompression via unilateral approach decreases surgical trauma, blood loss, complication rate and hospital stay. Postoperative results are comparable with conventional technique.

  3. The relationship between developmental lumbar spinal stenosis and its BMD value : comparison by single energy quantitative CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hak Jin; Kim, Kun Il; Song, Keun Sung [Pusan National Univ. Hospital, Pusan (Korea, Republic of)

    1996-03-01

    The purpose of this study is to evaluate the relationship between developmental lumbar spinal stenosis and its BMD value by using the single energy quantitative CT(SEQCT). Eighty normal volunteers(20-60years) were selected as a control group and 28 patients with developmental lumbar spinal stenosis were selected as a disease group. The two groups were divided into a younger (20-39 years) and an older subgroup (40-60 years), and were further divided into male and female subgroups. All the cases showed no evidence of metabolic disease, fracture, herniated nucleus pulposus, degererative spondylosis, infectious disease, tumors or had no history of absolute immobilization of more than two weeks. All underwent lumbar spine CT and SEQCT. we measured bone mineral density(BMD) at the cancellous bone of L1, 2, 3 and obtained the mean and its one standard deviation, and compared the data between each sub-group of the control and the disease group using ANOVA. There was a significant low BMD value in the younger male patient subgroup compared with the control subgroup(p<0.005). Developmental lumbar spinal stenosis in a young male may be a factor of decreasing BMD of the body of the spine.

  4. Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis.

    Directory of Open Access Journals (Sweden)

    Pekka Kuittinen

    Full Text Available To study the predictive value of preoperative magnetic resonance imaging (MRI findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS.84 patients (mean age 63±11 years, male 43% with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0-100% and treadmill test (0-1000 m, pain symptoms with the overall Visual Analogue Scale (VAS 0-100 mm, and specific low back pain (LBP and specific leg pain (LP separately with a numeric rating scale from 0-10 (NRS-11. Satisfaction with the surgical outcome was also assessed.Preoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05. Moreover, severe stenosis predicted higher postoperative satisfaction (p = 0.029. Preoperative scoliosis predicted an impaired outcome in the ODI (p = 0.031 and lowered the walking distance in the treadmill test (p = 0.001. The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p = 0.026. No significant differences were detected between quantitative measurements and the patient outcome.Routine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability.

  5. Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes

    Directory of Open Access Journals (Sweden)

    Sudhakar Vadivelu

    2014-01-01

    Full Text Available We report two unusual cases of a 17-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an intradural dermoid cyst and holocord edema or syrinx, presenting with paraparesis and sphincter dysfunction secondary to an intramedullary abscess and a 26-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an infected dermoid cyst and intramedullary abscess, presenting with recurrent episodes of meningitis and hydrocephalus. Pre-operative magnetic resonance imaging (MRI studies in these patients were initially confused for an intramedullary spinal cord tumor; however, the presence of an associated dermal sinus tract made this diagnosis of neoplasm less likely. Total excision of the dermal sinus tract, debulking of the dermoid cyst and drainage of the intramedullary abscess through an L1-L5 osteoplastic laminoplasty and midline myelotomy, followed by long-term antibiotic therapy resulted in a good functional recovery. Post-operative MRI of the spine showed removal of the dermoid cyst, decreased inflammatory granulation tissue and resolution of the holocord edema or syrinx. We also performed a literature review to determine the cumulative experience of management of intramedullary abscess in this rare clinical setting.

  6. Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain.

    Science.gov (United States)

    Koppenhaver, Shane L; Fritz, Julie M; Hebert, Jeffrey J; Kawchuk, Greg N; Parent, Eric C; Gill, Norman W; Childs, John D; Teyhen, Deydre S

    2012-10-01

    Understanding the clinical characteristics of patients with low back pain (LBP) who display improved lumbar multifidus (LM) muscle function after spinal manipulative therapy (SMT) may provide insight into a potentially synergistic interaction between SMT and exercise. Therefore, the purpose of this study was to identify the baseline historical and physical examination factors associated with increased contracted LM muscle thickness one week after SMT. Eighty-one participants with LBP underwent a baseline physical examination and ultrasound imaging assessment of the LM muscle during submaximal contraction before and one week after SMT. The relationship between baseline examination variables and 1-week change in contracted LM thickness was assessed using correlation analysis and hierarchical multiple linear regression. Four variables best predicted the magnitude of increases in contracted LM muscle thickness after SMT. When combined, these variables suggest that patients with LBP, (1) that are fairly acute, (2) have at least a moderately good prognosis without focal and irritable symptoms, and (3) exhibit signs of spinal instability, may be the best candidates for a combined SMT and lumbar stabilization exercise (LSE) treatment approach.

  7. Characterization of DTI Indices in the Cervical, Thoracic, and Lumbar Spinal Cord in Healthy Humans

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    Rachael L. Bosma

    2012-01-01

    Full Text Available The aim of this study was to characterize in vivo measurements of diffusion along the length of the entire healthy spinal cord and to compare DTI indices, including fractional anisotropy (FA and mean diffusivity (MD, between cord regions. The objective is to determine whether or not there are significant differences in DTI indices along the cord that must be considered for future applications of characterizing the effects of injury or disease. A cardiac gated, single-shot EPI sequence was used to acquire diffusion-weighted images of the cervical, thoracic, and lumbar regions of the spinal cord in nine neurologically intact subjects (19 to 22 years. For each cord section, FA versus MD values were plotted, and a k-means clustering method was applied to partition the data according to tissue properties. FA and MD values from both white matter (average FA=0.69, average MD=0.93 × 10−3 mm2/s and grey matter (average FA=0.44, average MD=1.8 × 10−3 mm2/s were relatively consistent along the length of the cord.

  8. Magnetic resonance imaging of acute spinal-cord injury

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    Yamamoto, Hideki; Nakagawa, Hiroshi; Yamada, Takahisa; Iwata, Kinjiro (Aichi Medical Univ., Nagakute (Japan)); Okumura, Terufumi; Hoshino, Daisaku

    1992-04-01

    Magnetic resonance imaging (MRI) provides a noninvasive and very important method of investigating spinal-cord injuries. By means of MRI we examined 36 patients with spinal injuries, 34 of them in the acute stage. 19 cases had complete spinal-cord injury with paraplegia, while 17 cases had incomplete spinal-cord injury. MRI showed the injured spinal-cord in the acute stage to be partially swollen, with a high signal intensity in the T[sub 2]-weighted images. In the chronic stage, the injured cord may show atrophic changes with a post-traumatic cavity or myelomalacia, which appears as a high-signal-intensity lesion in the T[sub 2]-weighted images and as a low-signal intensity in the T[sub 1]-weighted images. The cases with complete spinal injuries showed a high signal intensity at the wide level, and these prognoses were poor. The cases with incomplete injuries showed normal findings or a high-signal-intensity spot. In the Gd-DTPA enhanced images, the injured cords were enhanced very well in the subchronic stage. MRI is thus found to be useful in the diagnosis of spinal injuries; it also demonstrates a potential for predicting the neurological prognosis. (author).

  9. Regeneration of a spinal ligament after total lumbar disk arthroplasty in primates.

    Science.gov (United States)

    Cunningham, Bryan W; Berven, Sigurd H; Hu, Nianbin; Beatson, Helen J; De Deyne, Patrick G; McAfee, Paul C

    2009-01-01

    Total disk arthroplasty (TDA) is a new procedure that replaces the intervertebral disk space with an artificial motion segment and necessitates the resection of the anterior longitudinal ligament (ALL). We assessed whether a collagen-based graft made from porcine small-intestine submucosa (SIS) can be used as a regenerative scaffold to restore the function and structure of the ALL in the lumbar spine. A total of 10 mature male baboons underwent TDA at L5-L6 using one of two treatments: (1) TDA only (n = 5) or (2) TDA combined with SIS (n = 5). Six months postoperatively, mock revision surgery was performed to assess tissue adhesions followed by non-destructive multidirectional flexibility testing of the spinal segment. The vertebral segments were then processed for histology. The tissue adhesion score was 2.8 +/- 0.8 in the TDA only group and 1.8 +/- 1.4 in the TDA-SIS group (p = 0.2). Segmental range of motion and the length of the neutral zone were similar in both groups. Histology showed that the SIS scaffold led to an organized ligamentous structure with a significantly (p = 0.027) higher thickness (2.18 +/- 0.25 mm) compared to the connective tissue structure in the TDA-only group (1.66 +/- 0.33 mm). We concluded that using a SIS bioscaffold after TDA did not lead to increased great vessel adhesion while its use facilitated the formation of highly organized ligamentous tissues. However, the SIS- induced and newly formed ligamentous tissue anterior to the spinal segment did not lead to a measurable limitation of spinal extension.

  10. Acute rehabilitation of spinal cord injury

    OpenAIRE

    KIDRIČ-SIVEC, Urška; SEDEJ, Bogdana; MAROLT, Melita

    2015-01-01

    Traumatic spinal cord injury presents with loss of function of neuromuscular and other systems below the level of injury. Patients may suffer from minor loss of strength to complete quadriplegia with respiratory distress. All the patients with traumatic spinal cord injury who are admitted and treated in University Medical Centre Ljubljana are evaluated after admission and individualized plan of rehabilitation is made. The neurological level of injury is documented with international standa...

  11. Primary spinal extradural hydatid cyst associated with acute bleeding

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    Guohua Zhu

    2009-07-01

    Full Text Available Aims: To report a case of unilocular primary spinal extradural hydatid cyst which manifested as acute bleeding. Methods: The clinical presentation, diagnosis, and surgical treatment of this rare case are discussed. Published cases of primary extradural hydatid cysts are reviewed. Results: Complete recovery was achieved. Repeated clinical, radiological, and serological examinations did not show any evidence of local recurrence or systemic hydatidosis during the follow-up period of 50 months. Conclusions: Primary spinal extradural hydatid cyst may present as acute bleeding.

  12. Primary spinal extradural hydatid cyst associated with acute bleeding

    Directory of Open Access Journals (Sweden)

    Yongxin Wang

    2009-01-01

    Full Text Available Aims: The purpose of this article is to report a case of unilocular primary spinal extradural hydatid cyst which manifested as acute bleeding. Methods: The clinical presentation, diagnosis, and surgical treatment of this rare case are discussed and published cases of primary extradural hydatid cysts are reviewed. Results: Complete recovery was achieved. Repeated clinical, radiological, and serological examinations did not show any evidence of local recurrence or systemic hydatidosis during the follow-up period of 50 months. Conclusions: Primary spinal extradural hydatid cyst may present as acute bleeding. (Wang Y, Geng D, Zhu G, Du G.

  13. Acute spinal cord injury | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available s of SUN13837 Injection in Adult Subjects with Acute Spinal Cord Injury A.3.1Titl...under investigation E.1.1Medical condition(s) being investigated Acute spinal cord injury E.1.1.1Medical con...ub-study No E.3Principal inclusion criteria 1. Acute traumatic injury to the cervical neurological spinal co

  14. Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis.

    Science.gov (United States)

    Tafazal, Suhayl I; Ng, Leslie; Sell, Philip

    2007-02-01

    This is a double blind randomised controlled trial to assess the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. The trial compared the outcome of salmon calcitonin nasal spray to placebo nasal spray in patients with MRI confirmed lumbar spinal stenosis. Lumbar spinal stenosis is one of the commonest conditions encountered by spine surgeons. It more frequently affects elderly patients and lumbar decompression has been used to treat the condition with variable success. Non operative measures have been investigated, but their success ranges from 15% to 43% in patients followed up for 1-5 years (Simotas in Clin Orthop 1(384):153-161, 2001). Salmon calcitonin injections have been investigated in previous trials and may have a treatment effect. Nasal salmon calcitonin has become available and if effective would have advantages over injections. Forty patients with symptoms of neurogenic claudication and MRI proven lumbar spinal stenosis were randomly assigned either nasal salmon calcitonin or placebo nasal spray to use for 4 weeks. This was followed by a 'washout' period of 6 weeks, and subsequent treatment with 6 weeks of nasal salmon calcitonin. Standard spine outcome measures including Oswestry disability index (ODI), low back outcome score, visual analogue score and shuttle walking test were administered at baseline, 4, 10 and 16 weeks. Twenty patients received nasal salmon calcitonin and twenty patients received placebo nasal spray. At 4 weeks post treatment there was no statistically significant difference in the outcome measures between the two groups. The change in ODI was a mean 1.3 points for the calcitonin group and 0.6 points for the placebo group (P = 0.51), the mean change in visual analogue score for leg pain was 10 mm in the calcitonin group and 0 mm in the placebo group (P = 0.51). There was no significant difference in walking distance between the two groups, with a mean improvement in walking distance of 21 m in the

  15. Intracerebroventricular administration of riluzole prevents morphine-induced apoptosis in the lumbar region of the rat spinal cord.

    Science.gov (United States)

    Hassanzadeh, Kambiz; Habibi-asl, Bohlool; Roshangar, Leila; Nemati, Mahboob; Ansarin, Masood; Farajnia, Safar

    2010-01-01

    Opiates are the most effective drugs for pain relief. However, the repeated use of opiates induces tolerance to their analgesic effects. It has been shown that this morphine-induced tolerance is associated with apoptosis in the central nervous system. The aim of this study is to evaluate the effects of intracerebroventricular (i.c.v.) administration of riluzole, an anti-glutamatergic drug, on morphine-induced apoptosis in the lumbar region of the rat spinal cord. Animals were given daily injections of morphine and vehicle, morphine and riluzole, or riluzole alone. Nociception was assessed using a hot plate apparatus, and apoptosis was assessed using the in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) method. The levels of anti-apoptotic factors Bcl-2 and HSP 70 and the pro-apoptotic agent caspase-3 were evaluated using immunoblotting. The glutamate concentration in the lumbar spinal cord was measured with high performance liquid chromatography (HPLC). The results indicate that the i.c.v. administration of riluzole attenuated morphine tolerance and reduced the number of TUNEL positive cells. Immunoblotting revealed that the levels of the selected anti-apoptotic agents were greater in the treatment groups compared to the controls. Furthermore, the results demonstrated that the administration of riluzole can attenuate the morphine-induced elevation of glutamate in the lumbar spinal cord. In conclusion, i.c.v. administration of riluzole attenuated morphine-induced tolerance to analgesia and apoptosis in addition to preventing the morphine-induced increase of glutamate in the lumbar spinal cord of rats.

  16. The sacral networks and neural pathways used to elicit lumbar motor rhythm in the rodent spinal cord

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    Meir eCherniak

    2014-12-01

    Full Text Available Identification of neural networks and pathways involved in activation and modulation of spinal central pattern generators (CPGs in the absence of the descending control from the brain is important for further understanding of neural control of movement and for developing innovative therapeutic approaches to improve the mobility of spinal cord injury patients. Activation of the hindlimb innervating segments by sacrocaudal afferent input and by specific application of neurochemicals to the sacral networks is feasible in the isolated spinal cord preparation of the newborn rat. Here we review our recent studies of sacral relay neurons with lumbar projections and evaluate their role in linking the sacral and thoracolumbar networks during different motor behaviors. Our major findings show that: 1 Heterogeneous groups of dorsal, intermediate and ventral sacral-neurons with ventral and lateral ascending funicular projections mediate the activation of the locomotor central pattern generators through sacral sensory input, and 2 Rhythmic excitation of lumbar flexor motoneurons, produced by bath application of alpha-1 adrenoceptor agonists to the sacral segments is mediated exclusively by ventral clusters of sacral-neurons with lumbar projections through the ventral funiculus.

  17. Value of additional cervicothoracic sagittal T2- weighted images in elderly patients with symptoms suggestive of lumbar spinal stenosis

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    Park, Sung Hee; Ahn, Joong Mo; Lee, Joon Woo; Lee, Guen Young; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    The purpose of this study was to analyze the incidence and predictive factors of tandem cervical spinal stenosis (CSS) in patients with lumbar spinal stenosis (LSS) based on MR. From January to May of 2011, 140 consecutive patients (36 men, 94 women; mean age, 68.9 years; age range, 60-87 years) were included for the analysis. All patients were at least 60 years old, had undergone lumbar spine MRI including additional cervicothoracic sagittal T2-weighted images, and were clinically suspected of LSS. Two spine radiologists evaluated the risk factors for CSS, considering the possible risk factors such as age, sex, alignment disorder of the lumbar spine, number of levels of LSS, and severity of LSS, based on MR. Of the 140 patients, 42 (30%) patients had tandem spinal stenosis. CSS was more common among patients with LSS (42 of 61, 69%) than among patients without LSS (27 of 79, 34%) (p = 0.000). Grade 2 or 3 CSS was more commonly observed among patients with grade 2 or 3 LSS (15 of 53, 28%), than among patients with grade 0 or 1 LSS (8 of 87, 9%) (p = 0.003). Only the severity of LSS showed a significant association with the severity of CSS (p = 0.045). Tandem CSS is common in LSS, and the severity of LSS is a risk factor of CSS.

  18. [Exercise reduced the need for operation in lumbar spinal stenosis. Circulatory load in the form of cycling gave good effect].

    Science.gov (United States)

    Nord, Tomas; Kornerup, Ulf; Grönlund, Per; Reuterwall, Christina

    2015-01-27

    Conservative treatment is being reported to relieve walk related leg pain or improve life quality in patients with lumbar spinal stenosis. Such treatment often combines various interventions, making it difficult to identify single effective measures. At our clinic, specialized in spine surgery, the care of the patients with lumbar spinal stenosis starts with a 4 months training program when the patient typically uses a stationary bike at a circulatory load of about 70% of maximal capacity. Need of surgery is evaluated after the training period. The present study compares oxygen uptake capacity and walking capacity before and after the training period. The main findings are: no clear correlation between change of oxygen uptake capacity and change of walking distance; no correlation between individual cauda equina cross-sectional area and improvement of walking distance during the training program; almost half of the patients who completed the training program felt their lumbar spinal stenosis symptoms improved to such an extent that surgery was not required (26/54).

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

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

    2015-11-15

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

  20. Acute paraplegia by spinal angiolipoma. Case report and literature review

    Directory of Open Access Journals (Sweden)

    Enrique Gonzalo Bovier

    2014-01-01

    Full Text Available Spinal angiolipoma is an uncommon form of benign tumor. There are 142 reported cases and only one of acute paraplegia. We describe a case of a 39 year old male with acute spinal paraplegia angiolipoma in T4-T5 with surgical resolution three weeks after the onset of the neurological syndrome. Postoperative neurologic recovery was complete. The angiolipoma consists of mature fat cells and abnormal blood vessels. There are 2 types: non-infiltrating and infiltrating. Its clinical course is slow and progressive, it can be accelerated by vascular phenomena, intratumoral abscess, and pregnancy. There is just one report of spontaneous intratumoral hemorrhage and acute paraplegia, coinciding with our case. There is no consensus as to treatment, and release and complete resection are suggested, as it is a disease with good prognosis. Angiolipoma spinal epidural is a rare form of benign tumor, and the treatment of this pathology continues to be release and resection of the tumor, with a favorable prognosis, despite the delay in surgery, as in the case reported. Intratumoral bleeding should be considered a cause of acute spinal compression syndrome, as ocurred in our patient.

  1. THE CORRELATION OF RADIOLOGICAL EXAMINATION AND VOLITIONAL VOIDING IN THORACO - LUMBAR FRACTURES AND SPINAL INJURY

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    Mathangi Santhosh

    2015-04-01

    Full Text Available BACKGROUND: Spinal Cord Injury (SCI is a devastating medical condition which results in paraplegia with decreased bladder and bowel control. Investigation used to predict volitional voiding in persons with acute SCI include clinical examination, X - rays of the spine, CT scan, MRI, even though the later ones are not available in every medical center and all cannot afford. AIM: To determine if those with a mild narrowing of the vertebral canal have a better prognosis for volitional voiding. SETTINGS AND DESIGN: Prospective study of 20 consecutive patients with thoracolumbar fractures and spinal injury, admitted in the Department of Physical Medicine Rehabilitation, Christian Medical College, and Vellore within three weeks of injury, were recruited into the study. METHODS AND MATERIALS: Initial neurological examination was performed on admission and final between 16 - 20 weeks after the injury. Lateral and anteroposterior X - rays of the spine were done to measure the antero - posterior and transverse diameters of the spinal canal as well as the canal - body ratio at the level of the lesion. Bladder function was assessed between 16 - 20 weeks following the injury by Urodynamic study. The bladder outcome was divided into first category was assisted bladder emptying, which included intermittent catheterization, indwelling catheterization and second category was with volitional voiding. STATISTICAL ANALYSIS: D ata collection was subjected to statistical analysis using SPSS Version 11.0. Fisher’s exact test, Independent t - test and Mann - Whitney test were used. RESULTS AND CONCLUSIONS: The level of fracture did not correspond to the type of bladder. The use of Canal body ratio at the level of vertebral fracture on plain radiographs was not useful in prediction of volitional voiding. (P> 0.05. Therefore plain radiography was not found to be a good predictor of bladder function in persons with spinal injuries.

  2. Nonoperative Korean Medicine Combination Therapy for Lumbar Spinal Stenosis: A Retrospective Case-Series Study

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    Kiok Kim

    2015-01-01

    Full Text Available This is a retrospective case series exploring the therapeutic benefits and harm of nonoperative Korean medicine combination therapy for lumbar spinal stenosis (LSS. The medical records of a total of 33 LSS patients, who were treated as inpatients at Mokhuri Neck and Back Hospital, Republic of Korea, from November 2010 to January 2012, were reviewed first and telephone survey on these patients was conducted after one year. Body acupuncture, pharmacoacupuncture, Chuna, and oral administration of herbal medicines were offered to all patients. A Visual analogue scale (VAS of pain and the walking duration without pain were used to assess the patients during the approximately 1-month treatment period. The average VAS score of pain and the walking duration improved significantly; the VAS score decreased from 9 (SD, 1.15 to 2.75 (2.22 (p<0.01, and the walking duration increased from 5.5 (6.66 to 16.75 (13.00 minutes (p<0.01. No adverse event was reported during the treatment. In addition, the decreased pain level and improved function continued for over one year. Although we did not find definitive evidence, the study results suggest that KM combination therapy may be beneficial for decreasing pain and improving function in LSS patients and may produce comparatively few adverse events.

  3. Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures

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    Percio Ramón Becker Benitez

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. CONTENT: Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. CONCLUSION: Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.

  4. Acute spinal cord injury and neurogenic shock in pregnancy.

    Science.gov (United States)

    Gilson, G J; Miller, A C; Clevenger, F W; Curet, L B

    1995-07-01

    A case of a pregnant woman with a subluxation of C-6 on C-7 with acute quadriplegia and sensory loss to the T-10 dermatome is described. Hemodynamic and fetal monitoring during the 3-week period of neurogenic shock resulted in good maternal and fetal outcomes. Pulmonary complications and anesthetic issues are important aspects of the care of these critically ill patients. Major trauma is a common cause of death and disability in young adults and may contribute to as much as 15 percent of nonobstetric maternal deaths. Spinal cord injuries involve young women in 15 percent of cases. The literature is replete with information on the obstetric management of patients with preexisting spinal cord injury (1-4) but there is little on the management and special problems of the pregnant patient with acute spinal cord trauma. We report here the management of a case of acute cord transection accompanied by spinal shock and discuss the specific maternal as well as fetal considerations in this syndrome.

  5. Excacerbation of systemic lupus erythematodes, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography

    Energy Technology Data Exchange (ETDEWEB)

    Gelmers, H.J.

    1984-01-01

    A clinical constellation of excacerbation of systemic lupus erythematodes (SLE), together with aseptic meningitis, and acutre mental symptoms occurred following lumbar myelography with metrizamide. Excacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new.

  6. Lumbar disc herniation and cauda equina syndrome following spinal manipulative therapy: a review of six court decisions in Canada.

    Science.gov (United States)

    Boucher, Pierre; Robidoux, Sébastien

    2014-02-01

    The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient's history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine.

  7. Interspinous spacer decompression (X-STOP) for lumbar spinal stenosis and degenerative disk disease: a multicenter study with a minimum 3-year follow-up.

    Science.gov (United States)

    Puzzilli, Fabrizio; Gazzeri, Roberto; Galarza, Marcelo; Neroni, Massimiliano; Panagiotopoulos, Konstantinos; Bolognini, Andrea; Callovini, Giorgio; Agrillo, Umberto; Alfieri, Alex

    2014-09-01

    Interspinous distraction devices provide an effective treatment for patients suffering from lumbar spinal stenosis and/or degenerative disk disease. The aim of this multicenter study was the prospective evaluation of patients treated for symptomatic lumbar spinal stenosis with interspinous process decompression (IPD) implants compared with a population of patients managed with conservative treatment. 542 patients affected by symptomatic lumbar spine degenerative disease were enrolled in a controlled trial. 422 patients underwent surgical treatment consisting of X-STOP device implantation, whereas 120 control cases were managed conservatively. Both patient groups underwent follow-up evaluations at 6, 12, 24, and 36 months using the Zurich Claudication Questionnaire, the Visual Analog Scale score and spinal lumbar X-rays, CT scans and MR imaging. One-year follow-up evaluation revealed positive good results in the 83.5% of patients treated with IPD with respect to 50% of the nonoperative group cases. During the first three years, in 38 out of the 120 control cases, a posterior decompression and/or spinal fixation was performed because of unsatisfactory results of the conservative therapy. In 24 of 422 patients, the IPD device had to be removed, and a decompression and/or pedicle screw fixation was performed because of the worsening of neurological symptoms. Our results support the effectiveness of surgery in patients with stenosis. IPD may offer an effective and less invasive alternative to classical microsurgical posterior decompression in selected patients with spinal stenosis and lumbar degenerative disk diseases.

  8. Immunohistochemical study of motoneurons in lumbar spinal cord of c57black/6 mice after 30-days space flight

    Science.gov (United States)

    Tyapkina, Oksana; Islamov, Rustem; Nurullin, Leniz; Petrov, Konstantin.; Rezvyakov, Pavel; Nikolsky, Evgeny

    To investigate mechanisms of hypogravity motor syndrome development the immunoexpression of heat shock proteins (Hsp27 and Hsp70), proteins of synaptic transmission (Synaptophysin and PSD95) and neuroprotective proteins (VEGF and Flt-1) in motoneurons of lumbar spinal cord in c57black/6 control mice (n=2) and after 30-days space flight (n=2) was studied. For a quantitative assessment of target proteins level in motoneurons frozen cross sections of lumbar spinal cord were underwent to immunohistochemical staining. Primary antibodies against VEGF, Flt-1, Hsp27 and Hsp70 (SantaCruz Biotechnology, inc. USA), against Synaptophysin and PSD95 (Abcam plc, UK) were visualized by streptavidin-biotin method. Images of spinal cords were received using OlympusBX51WI microscope with AxioCamMRm camera (CarlZeiss, Germany) and the AxioVisionRel. 4.6.3 software (CarlZeiss, Germany). The digitized data were analyzed using ImageJ 1.43 software (NIH, the USA). Quantitively, protein level in motoneurons was estimated by the density of immunoprecipitation. Results of research have not revealed any reliable changes in the immunnoexpression of vascular endothelial growth factor (VEGF) and its Flt-1 receptor in motoneurons of lumbar spinal cord in control and in mice after 30-day space flight. Studying of heat shock proteins, such as Hsp27 and Hsp70, revealed the decrease in level of these proteins immunoexpression in motoneurons of mice from flight group by 15% and 10%, respectively. Some decrease in level of immunnoexpression of presynaptic membrane proteins (synaptophysin, by 21%) and proteins of postsynaptic area (PSD95, by 55%) was observed after space flight. The data obtained testify to possible changes in a functional state (synaptic activity and stress resistance) of motoneurons of lumbar spinal cord in mice after space flight. Thus, we obtained new data on involvement of motoneurons innervating skeletal muscles in development of hypogravity motor syndrome. Research was supported

  9. Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy

    Directory of Open Access Journals (Sweden)

    Shearwood McClelland

    2015-01-01

    Full Text Available Lumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level.

  10. Evaluation of spinal internal loads and lumbar curvature under holding static load at different trunk and knee positions.

    Science.gov (United States)

    Kahrizi, Sedighe; Parnianpour, Mohammad; Firoozabadi, Seyyed Mohammad; Kasemnejad, Anoshirvan; Karimi, Elham

    2007-04-01

    A study was performed to investigate how different trunk and knee positions while holding static loads affect the lumbar curvature and internal loads on the lumbar spine at L4-L5. Ten healthy male subjects participated in this study. Two inclinometers were used to evaluate the curvature of lumbar spine, lordosis, while a 3D static biomechanical model was used to predict the spinal compression and shear forces at L4-L5. Eighteen static tasks while holding three level of load (0, 10 and 20 kg), two levels of knee position (45 and 180 degrees of flexion) and three levels of trunk position (neutral, 15 and 30 degree of flexion) were simulated for 10 healthy male subjects. The results of this study revealed that the lordosis of lumbar spine changed to kyphosis with increasing weight of load from 0 to 20 kg in trunk flexion position (pcurvature. The results of this study suggested, at a more flexed trunk and standing position with higher loads both external moment and internal loads increased significantly at L4-L5 level but with 45 knee flexion external moment and compression force increased and shear force decreased significantly (p < 0.05). Subjects made more effort to maintain stability of the body in squat position. The highest external moment and compression force were computed at flexed knee and trunk position with highest loads. Hence holding weight in this position must be avoided by implementing ergonomic change to the workplace.

  11. Somatotopic organization of lumbar muscle-innervating neurons in the ventral horn of the rat spinal cord.

    Science.gov (United States)

    Takahashi, Yuzuru; Ohtori, Seiji; Takahashi, Kazuhisa

    2010-04-01

    The ventral horn of the rat spinal cord was investigated with respect to the somatotopic organization of the motor neurons that innervate the lumbar muscles. Neurotracer 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) was applied to specific sites in lumbar muscles. Spinal cord segments at L1 through L4 levels were cut into 40-mum serial transverse sections. Labeled neurons were located in the ventromedial nucleus (VM) and lateromedial nucleus (LM) nuclei of Rexed's lamina IX. Motor neurons innervating the m. interspinales lumborum and m. multifidus were without exception present in the VM, whereas all motor neurons innervating the m. rectus abdominis were present in the LM. Forty percent of motor neurons innervating the m. quadratus lumborum were present in the VM and the other 60% were in the LM. Although most of the motor neurons innervating the m. psoas major were present in the LM, a few labeled neurons existed in the VM. These results suggest that the border zone demarcating the areas of innervation of the dorsal and ventral rami of spinal nerves crosses the m. quadratus lumborum.

  12. Repeat Lumbar Puncture: CSF Lactic Acid Levels are Predictive of Cure with Acute Bacterial Meningitis

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    Burke A. Cunha

    2013-12-01

    Full Text Available A common clinical problem concerns the utility of repeat lumbar puncture (LP in adults with acute bacterial meningitis (ABM, e.g., pneumococcal meningitis [1]. An LP is initially done for diagnostic purposes in patients with suspected ABM, i.e., diagnostic lumbar puncture (DLP. A repeat LP (RLP may be done 1–3 days after the initial DLP, if the patient shows no improvement. If a patient with ABM is not doing well after three days, adequacy of antimicrobial therapy is the main concern. Other reasons for RLP is to detect possible intracranial complications of ABM unrelated to adequacy of therapy [1–2].

  13. Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip.

    Science.gov (United States)

    Yokogawa, Noriaki; Toribatake, Yasumitsu; Murakami, Hideki; Hayashi, Hiroyuki; Yoneyama, Takeshi; Watanabe, Tetsuyou; Tsuchiya, Hiroyuki

    2015-01-01

    It is important to differentially diagnose thigh pain from lumbar spinal stenosis (particularly lumbar fourth nerve root radiculopathy) and osteoarthritis of the hip. In this study, using a treadmill and a motion analysis method, gait characteristics were compared between these conditions. Patients with lumbar fourth nerve root radiculopathy had increased physiological knee flexion immediately after foot-ground contact, possibly owing to a slight decrease in the muscle strength of the quadriceps femoris muscle. Patients with osteoarthritis of the hip had decreased range of motion of the hip joint probably due to anatomically limited mobility as well as gait strategy to avoid pain resulting from increased internal pressure on the hip joint during its extension. Our facile and noninvasive method can be useful for the differential diagnosis of lumbar spinal canal stenosis from osteoarthritis of the hip.

  14. Acute lymphocytic leukemia recurring in the spinal epidural space.

    Science.gov (United States)

    Higashida, Tetsuhiro; Kawasaki, Takashi; Sakata, Katsumi; Tanabe, Yutaka; Kanno, Hiroshi; Yamamoto, Isao

    2007-08-01

    A 27-year-old man presented with a very rare spinal epidural mass associated with recurrence of acute lymphocytic leukemia (ALL) manifesting as acute progressive neurological deficits. The patient presented with shoulder pain and ambulatory difficulties 3 years after remission of ALL treated by bone marrow transplantation. Magnetic resonance imaging revealed an epidural mass extending from C-7 to T-3, which compressed the cord and extended to the intervertebral foramen along the roots. After decompression surgery, the symptoms dramatically improved. Histological examination showed clusters of immature lymphocytes consistent with recurrence of leukemia, so chemotherapy and radiation therapy were carried out. At 1 year after the operation, no local mass expansion or systemic progression of leukemia had occurred. Leukemic mass must be considered in the differential diagnosis of spinal epidural mass, even in patients with ALL.

  15. Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer

    Directory of Open Access Journals (Sweden)

    Shabat S

    2011-09-01

    Full Text Available Shay Shabat1, Larry E Miller2,3, Jon E Block3, Reuven Gepstein11Spinal Care Unit, Sapir Medical Center, Kfar Saba, Israel; 2Miller Scientific Consulting, Inc, Biltmore Lake, NC, USA; 3Jon E Block, PhD, Inc, San Francisco, CA, USAPurpose: To assess the safety and effectiveness of a novel, minimally invasive interspinous spacer in patients with moderate lumbar spinal stenosis (LSS.Methods: A total of 53 patients (mean age, 70 ± 11 years; 45% female with intermittent neurogenic claudication secondary to moderate LSS, confirmed on imaging studies, were treated with the Superion® Interspinous Spacer (VertiFlex, Inc, San Clemente, CA and returned for follow-up visits at 6 weeks, 1 year, and 2 years. Study endpoints included axial and extremity pain severity with an 11-point numeric scale, Zurich Claudication Questionnaire (ZCQ, back function with the Oswestry Disability Index (ODI, health-related quality of life with the Physical Component Summary (PCS and Mental Component Summary (MCS scores from the SF-12, and adverse events.Results: Axial and extremity pain each decreased 54% (both P < 0.001 over the 2-year follow-up period. ZCQ symptom severity scores improved 43% (P < 0.001 and ZCQ physical function improved 44% (P < 0.001 from pre-treatment to 2 years post-treatment. A statistically significant 50% improvement (P < 0.001 also was noted in back function. PCS and MCS each improved 40% (both P < 0.001 from pre-treatment to 2 years. Clinical success rates at 2 years were 83%–89% for ZCQ subscores, 75% for ODI, 78% for PCS, and 80% for MCS. No device infection, implant breakage, migration, or pull-out was observed, although two (3.8% patients underwent explant with subsequent laminectomy.Conclusion: Moderate LSS can be effectively treated with a minimally invasive interspinous spacer. This device is appropriate for select patients who have failed nonoperative treatment measures for LSS and meet strict anatomical criteria.Keywords: Superion, axial

  16. Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement.

    Science.gov (United States)

    Arora, Sumit; Kumar, Ramesh

    2011-07-27

    Musculoskeletal tuberculosis is known for its ability to present in various forms and guises at different sites. Tubercular spinal epidural abscess (SEA) is an uncommon infectious entity. Its presence without associated osseous involvement may be considered an extremely rare scenario. We present a rare case of tubercular SEA in an immune-competent 35-year-old male patient. The patient presented with acute cauda equina syndrome and was shown to have multisegmental SEA extending from D5 to S2 vertebral level without any evidence of vertebral involvement on MRI. The patient made an uneventful recovery following surgical decompression and antitubercular chemotherapy. The diagnosis was confirmed by histopathological demonstration of Mycobacterium tuberculosis in drained pus. Such presentation of tubercular SEA has not been reported previously in the English language based medical literature to the best of our knowledge.

  17. Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis.

    Science.gov (United States)

    Pao, Jwo-Luen; Chen, Wein-Chin; Chen, Po-Quang

    2009-05-01

    The goal of surgical treatment for degenerative lumbar spinal stenosis (LSS) is to effectively relieve the neural structures by various decompressive techniques. Microendoscopic decompressive laminotomy (MEDL) is an attractive option because of its minimally invasive nature. The aim of prospective study was to investigate the effectiveness of MEDL by evaluating the clinical outcomes with patient-oriented scoring systems. Sixty consecutive patients receiving MEDL between December 2005 and April 2007 were enrolled. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. A total of 53 patients (36 women and 17 men, mean age 62.0) were included. Forty-five patients (84.9%) were satisfied with the treatment result after a follow-up period of 15.7 months (12-24). The clinical outcomes were evaluated with the Oswestry disability index (ODI) and the Japanese Orthopedic Association (JOA) score. Of the 50 patients providing sufficient data for analysis, the ODI improved from 64.3 +/- 20.0 to 16.7 +/- 20.0. The JOA score improved from 9.4 +/- 6.1 to 24.2 +/- 6.0. The improvement rate was 73.9 +/- 30.7% and 40 patients (80%) had good or excellent results. There were 11 surgical complications: dural tear in 5, wrong level operation in 2, and transient neuralgia in 4 patients. No wound-related complication was noted. Although the prevalence of pre-operative comorbidities was very high (69.8%), there was no serious medical complication. There was no post-operative instability at the operated segment as evaluated with dynamic radiographs at final follow-up. We concluded that MEDL is a safe and very effective minimally invasive technique for degenerative LSS. With an appropriate patient selection, the risk of post-operative instability is minimal.

  18. Spinal manipulative therapy for acute low-back pain (Review)

    OpenAIRE

    Rubinstein, S.M.; Terwee, C. B.; Assendelft, W J J; Boer, M.R.M. de; van Tulder, M. W.

    2012-01-01

    BACKGROUND: Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practised intervention. This report is an update of the earlier Cochrane review, first published in January 2004 with the last search for studies up to January 2000. OBJECTIVES: To examine the effects of SMT for acute low-back pain, which is defined as pain of less than six weeks duration. SEARCH METHODS: A comprehensive search was conducted on 31 ...

  19. [Acute rhabdomyolysis after spinal anesthesia for knee arthroscopy].

    Science.gov (United States)

    Bouché, P M; Chavagnac, B; Cognet, V; Banssillon, V

    2001-08-01

    We report an observation of acute rhabdomyolysis of gluteus maximum muscles occurring in a non-obese patient installed in supine position that underwent knee arthroscopy under spinal anaesthesia. The patient had insulin-dependent diabetes melitus with documented microangiopathy. The interest of this observation resides in the occurrence of the syndrome after a short period of time (one hour) of installation in the supine position in a patient that did not have any of the generally described risk factors of rhabdomyolysis.

  20. Development of an Animal Model of Thoracolumbar Burst Fracture Induced Acute Spinal Cord Injury

    Science.gov (United States)

    2015-05-01

    AWARD NUMBER: W81XWH-14-2-0013 TITLE: DEVELOPMENT OF AN ANIMAL MODEL OF THORACOLUMBAR BURST FRACTURE- INDUCED ACUTE SPINAL CORD INJURY...2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER DEVELOPMENT OF AN ANIMAL MODEL OF THORACOLUMBAR BURST FRACTURE-INDUCED ACUTE SPINAL CORD INJURY 5b...controlled spinal cord impactor for use in large animal models of SCI in order to more reliably recreate the human injury. A custom designed spinal cord

  1. RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

    Directory of Open Access Journals (Sweden)

    EMILIANO NEVES VIALLE

    Full Text Available ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks, and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

  2. Comparison of lumbar spinal canal measurements on MRI and CT; Comparaison des mesures du canal lombaire en IRM et TDM

    Energy Technology Data Exchange (ETDEWEB)

    Malghem, J.; Willems, X.; Vande Berg, B.; Cosnard, G.; Lecouvet, F. [Cliniques Universitaires Saint Luc, Dept. d' Imagerie Medicale, Bruxelles (Belgium); Robert, A. [Ecole de Sante Publique, Faculte de Medecine, Unite d' Epidemiologie, Biostatistique et Methodes Operationnelles en Sante, Bruxelles (Belgium)

    2009-04-15

    Purpose. To compare AP diameter measurements of spinal canal and thecal sac on MM and CT. Materials and methods. The AP diameter of the spinal canal at L4 and thecal sac at L4-5 were measured on both MRI and CT performed on patients at less than one month interval. Measurements were obtained from axial CT images of the abdomen on CT and sagittal T1W (n=98 ) and T2W (n=78) MR images of the spine. The examinations were reviewed at more than 24 hours interval. Radiologists were blinded. Inter-observer agreement evaluation was performed prior to this study. Measurements were compared using a t test for paired variables. Results. For the spinal canal, mean measurements were 0.4 {+-} 1.5 mm inferior on CT compared to MRI. For the thecal sac, mean measurements were 0.1 {+-} 1.4 mm inferior on CT compared to MRI. Conclusion. Measurements on CT and MRI for lumbar spinal canal and thecal sac are fairly comparable, with mean measurement differences inferior to the degree of precision of the measurement technique itself. (authors)

  3. Serial Neu rophysiologieal Changes in Experimental Selective Lumbar Spinal Nerve Root Compression in a Feline Model

    Institute of Scientific and Technical Information of China (English)

    Zhou Hui; XH He; HK Wong

    2000-01-01

    The spinal nerve root may be subjected to compression in a variety of clinical conditions which may lead to disabling leg pain and disability. The objective documentation of the clinical symptoms by electrophysiological tests could be procedure dependent. In the experimental study of nerve root compression in animal models, electrophytsiological tests are one of the few available methods to assess the effects of in nerve root compression. The purpose of this study is to evaluate the effects of compression of the spinal nerve root on the motor conduction velocity(MCV) and cortical somatosensory evoked potentials(SCEP) over a period of 6 weeks in a feline model. Ten cats were used in this study. Under anaesthesia, a laminectomy at L6 and L7 was performed. The right L6 nerve root was exposed and compressed by a Surg i-loop around nerve root and maintained by a Ligacap. MCV was recorded by stimulating the proximal end of nerve root before and after compression. Stimulating the right posterior tibial nerve and recording at the skull performed CSEP. After nerve root compression, MCV showed a significant reduction of amplitudes (immediate:64 ± 11%; 3-week: 73± 13%; 6-week: 73± 12% p<0.01 ) . The lateneies of MCV were not significant changed. The amplitudes of CSEP were also reduced significantly (immediate:56±9%; 5-minute:74± 12%). The N1 peak disappeared and latencies prolonged. We conclude that amplitude changes of MCV and CSEP could be used for diagnosis of acute peripheral nerve injury in the feline model, which may have clinical implication.

  4. Efficacy of acupuncture for degenerative lumbar spinal stenosis: protocol for a randomised sham acupuncture-controlled trial

    Science.gov (United States)

    Qin, Zongshi; Ding, Yulong; Wu, Jiani; Zhou, Jing; Yang, Likun; Liu, Xiaoxu; Liu, Zhishun

    2016-01-01

    Introduction Degenerative lumbar spinal stenosis (DLSS) is a major public health problem and the primary reason why older adults seek lumbar spine surgery. Acupuncture may be effective for DLSS, but the evidence supporting this possibility is still limited. Methods and analysis A total of 80 participants with DLSS will be randomly allocated to either an acupuncture group or a sham acupuncture (SA) group at a ratio of 1:1. 24 treatments will be provided over 8 weeks. The primary outcome is the score change of the Modified Roland-Morris Disability Questionnaire (RMDQ) responses from baseline to week 8. The secondary outcomes include the assessment of lower back pain and leg pain using the Numeric Rating Scale (NRS), the change in the number of steps per month, and the assessment of the specific quality of life using the Swiss Spinal Stenosis Questionnaire (SSSQ). We will follow-up with the participants until week 32. All of the participants who received allocation will be included in the statistical analysis. Ethics/dissemination This protocol has been approved by the Research Ethical Committee of Guang'anmen Hospital (Permission number: 2015EC114) and Fengtai Hospital of Integrated Traditional and Western Medicine (Permission number: 16KE0409). The full data set will be made available when this trial is completed and published. Applications for the release of data should be made to ZL (principal investigator). Trial registration number NCT02644746. PMID:27852717

  5. 21 CFR 888.3070 - Pedicle screw spinal system.

    Science.gov (United States)

    2010-04-01

    ... treatment of the following acute and chronic instabilities or deformities of the thoracic, lumbar, and... conditions are significant mechanical instability or deformity of the thoracic, lumbar, and sacral spine... screw spinal system because this is a technically demanding procedure presenting a risk of...

  6. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    Directory of Open Access Journals (Sweden)

    Laxmaiah Manchikanti, Kimberly A. Cash, Carla D. McManus, Vidyasagar Pampati

    2013-01-01

    Full Text Available Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.Study Design: A prospective evaluation.Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS, the Oswestry Disability Index 2.0 (ODI, employment status, and opioid intake with assessment at 3, 6

  7. Oligodendrocyte-like cell transplantation for acute spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Yongtao Xu; Anmin Chen; Feng Li; Hougeng Lu

    2011-01-01

    In this study, we used insulin-like growth factor-1 to induce bone marrow mesenchymal stem cells (MSCs) to differentiate into oligodendrocyte-like cells. Cell surface marker identification showed that they expressed myelin basic protein and galactosylceramide, two specific markers of oligodendrocytes. These cells were transplanted into rats with acute spinal cord injury at T10. At 8 weeks post-implantation, oligodendrocyte-like cells were observed to have survived at the injury site. The critical angle of the inclined plane, and Basso, Beattie and Bresnahan scores were all increased. Furthermore, latencies of motion-evoked and somatosensory-evoked potentials were decreased. These results demonstrate that transplantation of oligodendrocytic-induced MSCs promote functional recovery of injured spinal cord.

  8. Computed tomography before lumbar puncture in acute meningitis: a review of the risks and benefits.

    OpenAIRE

    Archer, B D

    1993-01-01

    OBJECTIVE: To determine the indications, if any, for routine computed tomography (CT) of the brain before lumbar puncture in the management of acute meningitis. DATA SOURCES: Original research papers, reviews and editorials published in English from 1965 to 1991 were retrieved from MEDLINE. The bibliographies of these articles and of numerous standard texts were examined for pertinent references. A survey of local neurologists was conducted, and legal opinion was sought from the Canadian Medi...

  9. Acute kidney injury following spinal instrumentation surgery in children

    Science.gov (United States)

    Jöbsis, Jasper J; Alabbas, Abdullah; Milner, Ruth; Reilly, Christopher; Mulpuri, Kishore; Mammen, Cherry

    2017-01-01

    AIM To determine acute kidney in jury (AKI) incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery. METHODS AKI incidence in children undergoing spinal instrumentation surgery at British Columbia Children’s Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identified from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis (idiopathic vs non-idiopathic scoliosis). RESULTS Thirty five of 208 patients met criteria for AKI with an incidence of 17% (95%CI: 12%-23%). Of all children who developed AKI, 17 (49%) developed mild AKI (AKI Stage 1), 17 (49%) developed moderate AKI (Stage 2) and 1 patient (3%) met criteria for severe AKI (Stage 3). An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively classified by fluid tertiles: 70% incidence in those that received the least amount of fluids vs 29% that received the most fluids (> 7.9, P = 0.02). Patients who developed AKI were more frequently exposed to nephrotoxins (non steroidal anti inflammatory drugs or aminoglycosides) than control patients during their peri-operative course (60% vs 22%, P < 0.001). CONCLUSION We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fluid administered peri-operatively. PMID:28316941

  10. Acute longitudinal ligament rupture following acute spinal trauma

    Directory of Open Access Journals (Sweden)

    Donald Hansom

    2014-06-01

    Full Text Available The authors present a rare case of anterior longitudinal ligament (ALL rupture in a 47- year-old gentleman following a bicycle accident. The ALL is a continuous band of a variable thickness that acts as a primary spinal stabiliser. Stress, strain or rupture of the ALL usually occurs as a result of hyperextension, with the primary perpetrator being whiplash injuries. Such injuries have been shown to result in cervical spine instability during extension, axial rotation, and lateral bending modes. Spine radiographs of such patients may be routinely assessed as normal, therefore this specific type of injury does not lend itself to identification by traditional imaging methods. This account demonstrates the importance of having a high index of suspicion of a ligamentous neck injury in the setting of normal plain radiographs but abnormal clinical examination.

  11. Height and weight are correlated with lumbar spinal bone mineral contents and densities in Chinese adolescents with early ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    MA Xing; HU Yun-yu; MA Xiang-dong; WANG Quan-ping; LI Xiao-juan; LU Rong; WANG Jun; XU Xin-zhi

    2004-01-01

    Objective: To explore the possible factors influencing lumbar spinal bone mineral contents and bone mineral densities in Chinese adolescents with early ankylosing spondylitis(AS). Methods: Thirty-one male Chinese adolescent outpatients with early AS were included and compared with 31 age-matched male controls. Age (year), height (cm), total body weight (kg) together with body mass index (BMI, kg/m2 ) of all subjects and disease duration (month), BASMI,BASFI, BASDAI, SASSS as well as ESR (mm/h) of AS patients were obtained. Lumbar2-4 bone mineral content (L2-4BMC, g) and lumbar2-4 areal bone mineral density (L2-4 BMD, g/cm2 ) were evaluated using dual-energy X-ray absorptiometry (DEXA) with Lunar DPX-IQ device and lumbar2-4 volumetric bone mineral apparent density (L2-4 BMAD, g/cm3 )was subsequently calculated. Correlation and multiple regression analyses were performed. Results: Compared with 31 agematched male controls, AS patients had significantly lower L2-4 BMD [ (0. 984 ± 0.142) g/cm2 vs ( 1.055 ± 0. 137) g/cm2,P = 0.049 ] and L2- 4 BMAD [ (0. 1527 ± 0. 0173) g/cm3 vs (0. 1630 ± 0. 0195) g/cm3, P = 0. 032 ]. In AS patients,multiple regression analysis identified that only the factor of height was significantly correlated with L2- 4 BMC ( R = 0. 673,P = 0.000) and the factor of weight had predominant influences on L2-4 BMD ( R = 0. 620, P = 0. 000) as well as L2-4BMAD (R=0.510, P = 0.003). Conclusion: The young patients with early AS had marked reduction in lumbar spine bone mineral densities, which indicated an important primary event leading to osteoporosis. Positive effects of height and weight on lumbar spine bone mass and densities could expectantly make favorable contributions to early prevention of AS associated bone loss and subsequent osteoporosis.

  12. Diagnosis and treatment for degenerative lumbar spinal disease%退变性腰椎疾病的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    林红; 董健

    2005-01-01

    腰腿痛是困扰人类的常见病和多发病,引起腰腿痛的主要原因是退变性腰椎疾病(degenerative lumbar spinal dis-ease,DLSD)。笔者对DLSD的诊断及治疗进展作一综述。

  13. Case study of Oriental Medicine Treatment with Mae-sun therapy of the spinal cord injury due to lumbar burst fracture

    Directory of Open Access Journals (Sweden)

    Kwon Gi-sun

    2010-03-01

    Full Text Available Objective : Traumatic lumbar burst fracture causes significant spinal cord injury. This report is intended to estimate the efficacy using oriental treatment on a patient with lumbar burst fracture and spinal cord injury. Methods : From 21th December, 2009 to 5th February, 2010, 1 female inpatient diagnosed with lumbar burst fracture and spinal cord injury was treated with general oriental medicine therapy : mae-sun therapy ; acupuncture ; moxibustion ; pharmacopuncture ; physical therapy and herbal medication. TUG, SCIMⅡ and VAS were used for evaluation of gait disturbance and pain in both feet. Measurement of self voiding amount and remaining amount through CIC was used for evaluation of neurogenic vesical dysfunction. Results : The patient showed a certain degree of improvement in gait disturbance, pain in both feet and neurogenic vesical dysfunction through above evaluation methods. Conclusion : Oriental treatments such as mae-sun therapy, acupuncture and moxibustion therapy, pharmacopuncture therapy and herbal medication can be effective for spinal cord injury due to traumatic lumbar burst fracture.

  14. Acute spinal cord injury: tetraplegia and paraplegia in small animals.

    Science.gov (United States)

    Granger, Nicolas; Carwardine, Darren

    2014-11-01

    Spinal cord injury (SCI) is a common problem in animals for which definitive treatment is lacking, and information gained from its study has benefit for both companion animals and humans in developing new therapeutic approaches. This review provides an overview of the main concepts that are useful for clinicians in assessing companion animals with severe acute SCI. Current available advanced ancillary tests and those in development are reviewed. In addition, the current standard of care for companion animals following SCI and recent advances in the development of new therapies are presented, and new predictors of recovery discussed.

  15. A Prospective Study on the Outcome of Degenerative Lumbar Spinal Stenosis Treated With Open Laminotomy

    Directory of Open Access Journals (Sweden)

    Martin Wong Chung-Ting

    2012-12-01

    Result: There were significant improvement of mean Japanese Orthopaedic Association lumbar score, Oswestry Disability Index(ODI, and visual analogue scale (VAS. Male had significantly better result in ODI and VAS. There was no significant difference regarding to older age (>65 or the presence of preexisting degenerative spondylolisthesis. One patient was found to have increased lumbar instability after operation. The overall reoperation rate was 6.9%.

  16. Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

    OpenAIRE

    Lykissas, Marios G; Aichmair, Alexander

    2013-01-01

    Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to ...

  17. Surgical treatment of senile lumbar disc herniation complicated with lumbar spinal stenosis%老年腰椎间盘突出合并椎管狭窄症的手术治疗

    Institute of Scientific and Technical Information of China (English)

    段俊虎

    2016-01-01

    目的:探讨老年腰椎间盘突出合并椎管狭窄症的临床疗效。方法:收治老年腰椎间盘突出合并椎管狭窄症患者90例,随机分成对照组和观察组,观察组采用手术治疗,对照组采用保守治疗,比较两组的治疗效果。结果:观察组的疗效及Oswestry功能障碍指数明显优于对照组(P<0.05)。结论:手术治疗老年腰椎间盘突出合并椎管狭窄症的临床疗效显著。%Objective:To explore the effect of senile lumbar disc herniation complicated with lumbar spinal stenosis.Methods:90 elderly patients with lumbar disc herniation complicated with lumbar spinal stenosis were selected.They were randomly divided into the control group and the observation group.The observation group was treated with surgical treatment.The control group was treated with conservative treatment.We compared the treatment effect of the two groups.Results:In the observation group,the efficacy and Oswestry dysfunction index were significantly better than those of the control group(P<0.05).Conclusion:The effect of surgical treatment for senile lumbar disc herniation complicated with lumbar spinal stenosis was significant.

  18. EARLY AND LONG-TERM RESULTS OF SURGICAL TREATMENT OF THE THORACIC AND LUMBAR VERTEBRAL AND SPINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    V. D. Usikov

    2014-01-01

    Full Text Available The article demonstrates the outcomes of operative treatment of 190 patients with spinal cord injuryof thoracic and lumbar spine for 10 years. Associated injuries were revealed in 96 patients, the mean ISS score being27.5. All patients underwent decompressive and stabilizing interventions using a transpedicular system of “Synthes” production (Saint Petersburg. Ventral interventions were performed in 27 (14.2% patients. In all cases, decompression of the spinal canalcontents at the level of damage was achieved. In those patients who were operated within two weeks after trauma, transpedicular system allowed for recovery of a form and size of the spinal canal and the damaged vertebral body. The fractures of transpedicular system were observed in patients operated both with only rear and with combined access. The errors and complications, which happened during surgery, did not influence the outcomes of treatment. The outcomes of treatment were assessed according to the neurological statusdynamics (ASIA score, recovery of support ability of the spine, the presence of pain, and patients’ recovery (Е Denis score. Favorable outcomes were achieved in 114 (61.3% patients, satisfactoryin 53 (28.5%,and poor in 19 (10.2 %.

  19. Limited effect of fly-wheel and spinal mobilization exercise countermeasures on lumbar spine deconditioning during 90 d bed-rest in the Toulouse LTBR study

    Science.gov (United States)

    Belavý, Daniel L.; Ohshima, Hiroshi; Bareille, Marie-Pierre; Rittweger, Jörn; Felsenberg, Dieter

    2011-09-01

    We examined the effect of high-load fly-wheel (targeting the lower-limb musculature and concurrent loading of the spine via shoulder restraints) and spinal movement countermeasures against lumbar spine muscle atrophy, disc and spinal morphology changes and trunk isokinetic torque loss during prolonged bed-rest. Twenty-four male subjects underwent 90 d head-down tilt bed-rest and performed either fly-wheel (FW) exercises every three days, spinal movement exercises in lying five times daily (SpMob), or no exercise (Ctrl). There was no significant impact of countermeasures on losses of isokinetic trunk flexion/extension ( p≥0.65). Muscle volume change by day-89 of bed-rest in the psoas, iliacus, lumbar erector spinae, lumbar multifidus and quadratus lumborum, as measured via magnetic resonance imaging (MRI), was statistically similar in all three groups ( p≥0.33). No significant effect on MRI-measures of lumbar intervertebral disc volume, spinal length and lordosis ( p≥0.09) were seen either, but there was some impact ( p≤0.048) on axial plane disc dimensions (greater reduction than in Ctrl) and disc height (greater increases than in Ctrl). MRI-data from subjects measured 13 and 90-days after bed-rest showed partial recovery of the spinal extensor musculature by day-13 after bed-rest with this process complete by day-90. Some changes in lumbar spine and disc morphology parameters were still persistent 90-days after bed-rest. The present results indicate that the countermeasures tested were not optimal to maintain integrity of the spine and trunk musculature during bed rest.

  20. Both unilateral and bilateral pedicle screw fixation are effective for lumbar spinal fusion—A meta-analysis-based systematic review

    Directory of Open Access Journals (Sweden)

    Jiaquan Luo

    2014-04-01

    Full Text Available A series of studies have been conducted to evaluate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion, but there is still controversy about which one is more superior. We performed a meta-analysis to more accurately estimate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Studies on the comparison between unilateral and bilateral pedicle screw fixation in lumbar spinal fusion were identified from PubMed, SpringerLink, China National Knowledge Infrastructure (CNKI, the Wanfang database and the China Biology Medical literature database (CBM and related references were searched. The included trials were screened according to the criteria of inclusion and exclusion. The quality of included trials was evaluated. Data were extracted by two reviewers independently. RevMan 5.1.1 was used for data analysis. The fixed or random effect model was selected based on the heterogeneity test among studies evaluated using the I2 statistic. A total of nine studies involving 567 patients were included in the analyses for the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Unilateral pedicle screw fixation was performed in 287 patients and bilateral pedicle screw fixation in 280 patients. The results of the meta-analysis indicated that statistically significant differences were observed between the two fixation procedures with regard to mean operation time and amount of bleeding. There were no differences in hospitalisation days, fusion rate, complication rate, and excellent and good rates. This meta-analysis suggested that both unilateral and bilateral pedicle screw fixation are effective in one or two segmental lumbar spinal fusion. In comparison with bilateral fixation, unilateral fixation can shorten the operation time, reduce the amount of bleeding, and reduce medical expenses. There were similar effects with regard to

  1. Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients

    Directory of Open Access Journals (Sweden)

    Pawel Zwolak

    2013-11-01

    Full Text Available We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland nine patients (three women and six men; mean age 68.6, range 43- 87 years were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30. The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.

  2. Diagnostic value of the nerve root sedimentation sign, a radiological sign using magnetic resonance imaging, for detecting lumbar spinal stenosis: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Liangming; Chen, Ruiqiang; Xie, Peigen; Zhang, Wei; Yang, Yang; Rong, Limin [Sun Yat-Sen University, Department of Spine Surgery, the Third Affiliated Hospital, Guangzhou (China)

    2014-11-28

    This study aimed to determine the diagnostic value of the nerve root sedimentation sign, a relatively new radiological sign using magnetic resonance imaging, for diagnosing lumbar spinal stenosis. The literature search was based on PUBMED, EMBASE, Cochrane Library, Google Scholar, and the Chinese Biomedical Literature Database up to March 2014. A total of 120 articles were identified. Seven studies involving 1,182 patients were included. The quality of the methodology of the seven studies was good. Overall, the pooled weighted value showed that the sedimentation sign had moderate sensitivity of 0.80 [95 % confidence interval (CI) 0.77-0.83] and high specificity of 0.96 (95 % CI 0.94-0.98). The area under the curve was 0.76. Subgroup analysis showed that the degree of morphological spinal stenosis was responsible for the heterogeneity. In the patients with severe morphological lumbar spinal stenosis, the sedimentation sign had even higher sensitivity and specificity: 0.899 (95 % CI 0.87-0.92) and 0.99 (95 % CI 0.98-1.00), respectively. The area under the curve was 0.96. In the patients with lumbar spinal stenosis without definition of morphological stenosis, there was a notable threshold effect and significant heterogeneity. The area under the curve was 0.63. Current evidence suggests that the sedimentation sign has high sensitivity and specificity for diagnosing severe lumbar spinal stenosis. Its performance in diagnosing moderate and mild spinal stenosis, however, has yet to be corroborated in properly designed studies. (orig.)

  3. A 3D map of the hindlimb motor representation in the lumbar spinal cord in Sprague Dawley rats

    Science.gov (United States)

    Borrell, Jordan A.; Frost, Shawn B.; Peterson, Jeremy; Nudo, Randolph J.

    2017-02-01

    Objective. Spinal cord injury (SCI) is a devastating neurological trauma with a prevalence of about 282 000 people living with an SCI in the United States in 2016. Advances in neuromodulatory devices hold promise for restoring function by incorporating the delivery of electrical current directly into the spinal cord grey matter via intraspinal microstimulation (ISMS). In such designs, detailed topographic maps of spinal cord outputs are needed to determine ISMS locations for eliciting hindlimb movements. The primary goal of the present study was to derive a topographic map of functional motor outputs in the lumbar spinal cord to hindlimb skeletal muscles as defined by ISMS in a rat model. Approach. Experiments were carried out in nine healthy, adult, male, Sprague Dawley rats. After a laminectomy of the T13-L1 vertebrae and removal of the dura mater, a four-shank, 16-channel microelectrode array was inserted along a 3D (200 µm) stimulation grid. Trains of three biphasic current pulses were used to determine evoked movements and electromyographic (EMG) activity. Via fine wire EMG electrodes, stimulus-triggered averaging (StTA) was used on rectified EMG data to determine response latency. Main results. Hindlimb movements were elicited at a median current intensity of 6 µA, and thresholds were significantly lower in ventrolateral sites. Movements typically consisted of whole leg, hip, knee, ankle, toe, and trunk movements. Hip movements dominated rostral to the T13 vertebral segment, knee movements were evoked at the T13-L1 vertebral junction, while ankle and digit movements were found near the rostral L1 vertebra. Whole leg movements spanned the entire rostrocaudal region explored, while trunk movements dominated medially. StTAs of EMG activity demonstrated a latency of ~4 ms. Significance. The derived motor map provides insight into the parameters needed for future neuromodulatory devices.

  4. Lumbar spinal stenosis CAD from clinical MRM and MRI based on inter- and intra-context features with a two-level classifier

    Science.gov (United States)

    Koh, Jaehan; Alomari, Raja S.; Chaudhary, Vipin; Dhillon, Gurmeet

    2011-03-01

    An imaging test has an important role in the diagnosis of lumbar abnormalities since it allows to examine the internal structure of soft tissues and bony elements without the need of an unnecessary surgery and recovery time. For the past decade, among various imaging modalities, magnetic resonance imaging (MRI) has taken the significant part of the clinical evaluation of the lumbar spine. This is mainly due to technological advancements that lead to the improvement of imaging devices in spatial resolution, contrast resolution, and multi-planar capabilities. In addition, noninvasive nature of MRI makes it easy to diagnose many common causes of low back pain such as disc herniation, spinal stenosis, and degenerative disc diseases. In this paper, we propose a method to diagnose lumbar spinal stenosis (LSS), a narrowing of the spinal canal, from magnetic resonance myelography (MRM) images. Our method segments the thecal sac in the preprocessing stage, generates the features based on inter- and intra-context information, and diagnoses lumbar disc stenosis. Experiments with 55 subjects show that our method achieves 91.3% diagnostic accuracy. In the future, we plan to test our method on more subjects.

  5. Altered activation patterns by triceps surae stretch reflex pathways in acute and chronic spinal cord injury.

    Science.gov (United States)

    Frigon, Alain; Johnson, Michael D; Heckman, C J

    2011-10-01

    Spinal reflexes are modified by spinal cord injury (SCI) due the loss of excitatory inputs from supraspinal structures and changes within the spinal cord. The stretch reflex is one of the simplest pathways of the central nervous system and was used presently to evaluate how inputs from primary and secondary muscle spindles interact with spinal circuits before and after spinal transection (i.e., spinalization) in 12 adult decerebrate cats. Seven cats were spinalized and allowed to recover for 1 mo (i.e., chronic spinal state), whereas 5 cats were evaluated before (i.e., intact state) and after acute spinalization (i.e., acute spinal state). Stretch reflexes were evoked by stretching the left triceps surae (TS) muscles. The force evoked by TS muscles was recorded along with the activity of several hindlimb muscles. Stretch reflexes were abolished in the acute spinal state due to an inability to activate TS muscles, such as soleus (Sol) and lateral gastrocnemius (LG). In chronic spinal cats, reflex force had partly recovered but Sol and LG activity remained considerably depressed, despite the fact that injecting clonidine could recruit these muscles during locomotor-like activity. In contrast, other muscles not recruited in the intact state, most notably semitendinosus and sartorius, were strongly activated by stretching TS muscles in chronic spinal cats. Therefore, stretch reflex pathways from TS muscles to multiple hindlimb muscles undergo functional reorganization following spinalization, both acute and chronic. Altered activation patterns by stretch reflex pathways could explain some sensorimotor deficits observed during locomotion and postural corrections after SCI.

  6. [Acute lumbar disk displacement with nerve root compression. Indications for peridural steroid injection].

    Science.gov (United States)

    Schlumpf, U; Jöhr, M

    1997-02-18

    The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. The state of the art is based on recent meta-analyses and the understanding of the pathophysiology of discal hernia which includes inflammation. Contemporary concepts and data from recent reviews are summarized to elucidate current recommendations and suggestions for the management of patients with acute sciatica. The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.

  7. Estimation of lumbar spinal loading and trunk muscle forces during asymmetric lifting tasks: application of whole-body musculoskeletal modelling in OpenSim.

    Science.gov (United States)

    Kim, Hyun-Kyung; Zhang, Yanxin

    2016-06-03

    Large spinal compressive force combined with axial torsional shear force during asymmetric lifting tasks is highly associated with lower back injury (LBI). The aim of this study was to estimate lumbar spinal loading and muscle forces during symmetric lifting (SL) and asymmetric lifting (AL) tasks using a whole-body musculoskeletal modelling approach. Thirteen healthy males lifted loads of 7 and 12 kg under two lifting conditions (SL and AL). Kinematic data and ground reaction force data were collected and then processed by a whole-body musculoskeletal model. The results show AL produced a significantly higher peak lateral shear force as well as greater peak force of psoas major, quadratus lumborum, multifidus, iliocostalis lumborum pars lumborum, longissimus thoracis pars lumborum and external oblique than SL. The greater lateral shear forces combined with higher muscle force and asymmetrical muscle contractions may have the biomechanical mechanism responsible for the increased risk of LBI during AL. Practitioner Summary: Estimating lumbar spinal loading and muscle forces during free-dynamic asymmetric lifting tasks with a whole-body musculoskeletal modelling in OpenSim is the core value of this research. The results show that certain muscle groups are fundamentally responsible for asymmetric movement, thereby producing high lumbar spinal loading and muscle forces, which may increase risks of LBI during asymmetric lifting tasks.

  8. Successful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis

    Directory of Open Access Journals (Sweden)

    Izumi M

    2011-12-01

    Full Text Available Manabu Izumi, Shoko Teraoka, Keisuke Yamashita, Kenji Matsumoto, Tomohiro Muronoi, Yoshimitsu Izawa, Chikara Yonekawa, Masaki Ano, Masayuki SuzukawaDepartment of Emergency and Critical Care Medicine, Jichi Medical University, Tochigi, JapanAbstract: A 74-year-old man with coronary artery disease was suffering from acute nonobstructive cholecystitis and was admitted to a nearby hospital. Dual antiplatelet (aspirin and ticlopidine therapy was discontinued before preparation for surgical resection of the gall bladder. During his time in hospital he was aware of lumbar pain and weakness in both legs. He was transferred to our hospital for further evaluation and therapy. Diffuse intra-aortic thrombi were revealed by computed tomography with contrast media, and magnetic resonance imaging showed spinal cord infarction. However, computed tomography scans of the descending aorta obtained 4 months before admission exhibited no signs of atherosclerotic plaques or intra-aortic thrombi. Laboratory data suggest that antiphospholipid antibody syndrome might have caused these acute multiple intra-arterial thrombi. By restarting dual antiplatelet therapy and increasing the dose of heparin (from 10,000 IU/day to 15,000 IU/day we successfully managed the patient's clinical condition and symptoms. It is important to understand that stopping antiplatelet therapy may rapidly grow thrombi in patients with a hypercoagulative state.Keywords: intra-aortic thrombus, antiphospholipid antibody syndrome, spinal cord infarction

  9. CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE PLUS MANUAL REPOSITION FOR TREATMENT OF ACUTE LUMBAR VERTEBRAL ARTICULAR DYSKINESIA

    Institute of Scientific and Technical Information of China (English)

    骆钧梵

    2003-01-01

    Objective: To observe the therapeutic effect of acupuncture plus manual reposition for treatment of acute lumbar vertebral articular dyskinesia for choosing a better remedy. Methods: 66 cases of acute lumbar vertebral articular dyskinesia were randomly divided into acupuncture plus manual reposition group (treatment group, n= 33) and routine manual reposition group (control group, n = 33). Yaotong-point was punctured, when, the patient was asked to move his or her waist simultaneously. Results: After one session of treatment, of the two 33 cases in treatment and control groups, 28 (84.85%) and20 (60.61%) were cured, 4 (12.12%) and 9 (27.27%) were improved, and 1 (3.03%) and 4 (12.12%) failed in the treatment. The therapeutic effect of treatment group was significantly superior to that of control group ( P< 0.05). Conclusion: Acupuncture combined with manual reposition is apparently superior to simple routine manual reposition in relieving acute lumbar vertebral articular dyskinesia.

  10. Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate.

    Science.gov (United States)

    Bowers, Christian A; Kundu, Bornali; Hawryluk, Gregory W J

    2016-06-01

    Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS) was hailed as a breakthrough for patients with acute spinal cord injury (SCI). MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS's status as a historical standard of care.

  11. Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate

    Directory of Open Access Journals (Sweden)

    Christian A Bowers

    2016-01-01

    Full Text Available Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS was hailed as a breakthrough for patients with acute spinal cord injury (SCI. MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS′s status as a historical standard of care.

  12. Radilogic evaluation of pedicle lumbar and spinal canal dimensions in north-west of Iran using computed tomography

    Directory of Open Access Journals (Sweden)

    Lotfinia I

    2010-05-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Pedicular screws are currently the gold standard of internal fixation of spinal column. Pedicular screws have their own complications, however the surgeon should be aware of morphometery of pedicles, as well as the anatomy of surrounding neural structures to minimize these risks. No national study has ever examined the physical characteristics of lumbar pedicles and this study is unique for this purpose."n"nMethods: This study covers the patients undergoing lumbar spinal CT-scanning due to variable causes. 25 vertebrae were selected in either gender, 18 years or older and E-Film computer software was employed to measure different diameters of pedicle and the results were analyzed with p≤0.05 regarded as significant."n"nResults: L5 pedicle was the widest (16.8 mm, while L1 was the narrowest (8.25 mm. this figure was 8.82, 10.48 and 12.86 mm for L2, L3, L4 respectively. Longitudinal depth of pedicle was 47.98, 48.68, 50.42, 48.32 and 47.8 mm for L1, L2, L3, L4, L5 respectively. Statistically significant differences were found between some dimensions detected in our study and similar studies."n"nConclusions: The advantages of pedicular screws and rods to stabilize spinal column are well known. To avoid

  13. Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach.

    Science.gov (United States)

    Haba, Katsuhiko; Ikeda, Masato; Soma, Mariko; Yamashima, Tetsumori

    2005-02-01

    Lumbar canal stenosis due to hypertrophy and calcification of the facet joints and/or ligamentum flavum is a common condition in the elderly. Although a large number of individuals are symptom-free, the degenerative process, usually encroaching on both central and lateral pathways, may lead to symptoms of itself or decompensate a preexisting narrow canal. Even at an advanced age, decompression surgery is effective for symptomatic stenosis. Less invasive procedures preserving maximal bony and ligamentous structures have recently been recommended to reduce associated morbidity. This paper introduces a unilateral surgical approach for bilateral decompression by ligamentectomy, partial facetectomy and foraminal unroofing. Using a specially designed, one-side retractor, after the ipsilateral nerve root decompression the contralateral dural sac and nerve roots were approached through an 8 x 15 mm window in the interspinous ligament. The contralateral ligamentum flavum, facet joints and foraminal roof were resected, preserving the supraspinous ligament complex and much of the contralateral musculature. This technique, preserving anatomy and biomechanical function of the lumbar spine, is useful for surgery on multilevel lumbar canal stenoses.

  14. Lumbar spinal implants for degenerative lumbar spondylolisthesis: biocompatibility evaluation%腰椎植入物应用于退变性腰椎滑脱:生物相容性评价

    Institute of Scientific and Technical Information of China (English)

    张志敏; 霍建忠

    2015-01-01

    背景:脊柱内固定物被广泛用于退变性腰椎滑脱症的治疗,其目的是利于腰椎融合、重建腰椎矢状位序列、解除脊髓或神经根的压迫.目的:综述腰椎植入物应用于退变性腰椎滑脱症的生物相容性.方法:应用计算机检索2000年1月至2015年1月PubMed数据库和中国期刊全文数据库数据库,在标题和摘要中以"生物相容性,内植物,退变性腰椎滑脱;biocompatibility,Degenerative lumbar spondylolisthesis, Implant"为检索词进行检索.结果与结论:目前常用的腰椎内植入物为椎弓根螺钉与椎间融合器.椎间融合器主要包括生物型椎间融合器、金属型椎间融合器、复合材料型椎间融合器及可吸收行椎间融合器.不同材料的内固定植入物具有不同的生物相容性,同时也具有不同的稳定性.随着仿生学、3D打印技术、生物力学、材料学的发展,腰椎植入物将具有更好的生物相容性、更好的骨替代能力、更好的生物力学特性.%BACKGROUND:Spinal internal fixation is widely used in the treatment of lumbar spondylolisthesis, with the purpose of lumbar fusion, reconstruction of lumbar sagittal sequences, relieving spinal cord or nerve root compression. OBJECTIVE:To review the biocompatibility of lumbar spinal implants applied in the treatment of degenerative lumbar spondylolisthesis. METHODS:A computer-based retrieval of PubMed and CNKI was performed for relevant articles published from January 2000 to January 2015. The keywords were "biocompatibility, degenerative lumbar spondylolisthesis, implant" in English and Chinese, respectively, which appeared in the title and abstract. RESULTS AND CONCLUSION:Lumbar spinal implants commonly used include pedicle screws and interbody fusion cages. The fusion cages are mainly classified as biological fusion cage, metal fusion cage, composite fusion cage and absorbable fusion cage. Internal fixation implants made of different materials have different

  15. 退变性腰椎管狭窄症的治疗进展%Degenerative Lumbar Spinal Stenosis Syndrome Treatment

    Institute of Scientific and Technical Information of China (English)

    李建亮; 关永林; 孙乐伟

    2013-01-01

      退变性腰椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)是腰椎椎管、神经根管、侧隐窝或椎间孔因退行性变,导致骨性或纤维结构形态和容积异常,单一平面或多平面的一处或多处管腔内径狭窄,引起神经根、马尾及血管受压出现的临床症状.一般多发生在50~70岁之间的老年人,发病率为1.7%~10%.随着社会老龄化进程的加快及人们生活方式的变化,腰椎退行性变所导致的腰椎管狭窄症日益增多,这为社会及家庭带来严重负担.目前DLSS的治疗主要分为保守治疗及手术治疗.现就其治疗加以综述.%Degenerative lumbar spinal stenosis syndrome (degenerative lumbar spinal stenosis, DLSS) is lumbar spinal canal, nerve root canal, side crypts or intervertebral hole for degenerative changes, lead to osseous or fiber structure form and volume anomaly, a single plane or more plane one or more points pipe cavity diameter stenosis, cause nerve root, horsetail and vascular compression appear clinical symptoms. Generally occurs in 50 a 70 years old of the old people, a 10% rate was 1.7%. With the quickening of the process of aging society and people's life of the change of the mode of lumbar degenerative change caused by the lumbar spinal stenosis disease is increasing, the social and family serious burden. At present the treatment of DLSS mainly divided into conservative treatment and surgical treatment. Now the treatment are reviewed.

  16. 3D visualization of Thoraco-Lumbar Spinal Lesions in German Shepherd Dog

    Science.gov (United States)

    Azpiroz, J.; Krafft, J.; Cadena, M.; Rodríguez, A. O.

    2006-09-01

    Computed tomography (CT) has been found to be an excellent imaging modality due to its sensitivity to characterize the morphology of the spine in dogs. This technique is considered to be particularly helpful for diagnosing spinal cord atrophy and spinal stenosis. The three-dimensional visualization of organs and bones can significantly improve the diagnosis of certain diseases in dogs. CT images were acquired of a German shepherd's dog spinal cord to generate stacks and digitally process them to arrange them in a volume image. All imaging experiments were acquired using standard clinical protocols on a clinical CT scanner. The three-dimensional visualization allowed us to observe anatomical structures that otherwise are not possible to observe with two-dimensional images. The combination of an imaging modality like CT together with imaging processing techniques can be a powerful tool for the diagnosis of a number of animal diseases.

  17. Methylprednisolone inhibits Nogo-A protein expression after acute spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Zhaozong Fu; Hai Lu; Jianming Jiang; Hui Jiang; Zhaofei Zhang

    2013-01-01

    Oligodendrocyte-produced Nogo-A has been shown to inhibit axonal regeneration. Methylprednisolone plays an effective role in treating spinal cord injury, but the effect of methylprednisolone on Nogo-A in the injured spinal cord remains unknown. The present study established a rat model of acute spinal cord injury by the weight-drop method. Results showed that after injury, the motor behavior ability of rats was reduced and necrotic injury appeared in spinal cord tissues, which was accompanied by increased Nogo-A expression in these tissues. After intravenous injection of high-dose methylprednisolone, although the pathology of spinal cord tissue remained unchanged, Nogo-A expression was reduced, but the level was still higher than normal. These findings implicate that methylprednisolone could inhibit Nogo-A expression, which could be a mechanism by which early high dose methylprednisolone infusion helps preserve spinal cord function after spinal cord injury.

  18. Does obesity preclude lumbar puncture with a standard spinal needle? The use of computed tomography to measure the skin to lumbar subarachnoid space distance in the general hospital population.

    LENUS (Irish Health Repository)

    Halpenny, Darragh

    2013-06-05

    OBJECTIVES: Failed lumbar puncture (LP) is a common indication for referral for radiologically guided LP. This study aims to evaluate what percentage of the hospital population would fail an LP using a standard 9-cm needle because of obesity and a skin to subarachnoid space distance greater than 9 cm. METHODS: Images of 402 consecutive patients undergoing computed tomography of the abdomen and pelvis were reviewed. Skin to subarachnoid space distance was calculated using sagittal images. A survey was conducted among junior hospital doctors to assess their experience of performing lumbar puncture in obese patients. RESULTS: Four hundred patients were included. Fifty-five patients (13.8 %) had a skin to subarachnoid space distance greater than 9 cm. Intra-abdominal fat, subcutaneous fat and abdominal girth correlated with distance between the skin and subarachnoid space. Among junior doctors, 68.3 % (n = 41) reported LP failure on an obese patient; 78.4 % (n = 47) were unaware of the existence of a longer needle and 13.3 % (n = 8) had experience using a longer needle. CONCLUSIONS: A significant proportion of the hospital population will fail LP with a standard length spinal needle. Selecting a longer needle may be sufficient to successfully complete LP in obese patients. KEY POINTS : • Lumbar puncture failure commonly leads to referral for an image-guided procedure • Standard lumbar puncture may fail in 13.8 % of patients due to obesity • 78.4 % of trainee doctors are unaware of the existence of longer spinal-needles • Using longer spinal needles may allow successful LP in obese patients.

  19. MRI of degenerative cysts of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Khalatbari, K. [Department of MRI, Iran Gamma Knife Centre, Iran University of Medial Sciences-Kamrani Charity Foundation, Tehran (Iran, Islamic Republic of)], E-mail: khalatbarik@yahoo.com; Ansari, H. [Department of Orthopaedics, Rassoul Akram University Hospital, Tehran (Iran, Islamic Republic of)

    2008-03-15

    Degenerative cysts of the lumbar spine encompass a heterogeneous group of cystic lesions that are presumed to share a common aetiology. Some of these cysts may be incidental findings, whereas others may produce acute or chronic symptoms. These cysts have been categorized using various combinations of topographic and pathological characteristics and by their attachment to or communication with a specific spinal structure.

  20. Spinal manipulation or mobilization for radiculopathy: a systematic review.

    Science.gov (United States)

    Leininger, Brent; Bronfort, Gert; Evans, Roni; Reiter, Todd

    2011-02-01

    In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions.

  1. Influence of lumbar spine rhythms and intra-abdominal pressure on spinal loads and trunk muscle forces during upper body inclination.

    Science.gov (United States)

    Arshad, Rizwan; Zander, Thomas; Dreischarf, Marcel; Schmidt, Hendrik

    2016-04-01

    Improved knowledge on spinal loads and trunk muscle forces may clarify the mechanical causes of various spinal diseases and has the potential to improve the current treatment options. Using an inverse dynamic musculoskeletal model, this sensitivity analysis was aimed to investigate the influence of lumbar spine rhythms and intra-abdominal pressure on the compressive and shear forces in L4-L5 disc and the trunk muscle forces during upper body inclination. Based on in vivo data, three different spine rhythms (SRs) were used along with alternative settings (with/without) of intra-abdominal pressure (IAP). Compressive and shear forces in L4-L5 disc as well as trunk muscle forces were predicted by inverse static simulations from standing upright to 55° of intermediate trunk inclination. Alternate model settings of intra-abdominal pressure and different spine rhythms resulted in significant variation of compression (763 N) and shear forces (195 N) in the L4-L5 disc and in global (454 N) and local (156 N) trunk muscle forces at maximum flexed position. During upper body inclination, the compression forces at L4-L5 disc were mostly released by IAP and increased for larger intervertebral rotation in a lumbar spine rhythm. This study demonstrated that with various possible assumptions of lumbar spine rhythm and intra-abdominal pressure, variation in predicted loads and muscles forces increase with larger flexion. It is therefore, essential to adapt these model parameters for accurate prediction of spinal loads and trunk muscle forces.

  2. Body Position Influences Which Neural Structures Are Recruited by Lumbar Transcutaneous Spinal Cord Stimulation.

    Directory of Open Access Journals (Sweden)

    Simon M Danner

    Full Text Available Transcutaneous stimulation of the human lumbosacral spinal cord is used to evoke spinal reflexes and to neuromodulate altered sensorimotor function following spinal cord injury. Both applications require the reliable stimulation of afferent posterior root fibers. Yet under certain circumstances, efferent anterior root fibers can be co-activated. We hypothesized that body position influences the preferential stimulation of sensory or motor fibers. Stimulus-triggered responses to transcutaneous spinal cord stimulation were recorded using surface-electromyography from quadriceps, hamstrings, tibialis anterior, and triceps surae muscles in 10 individuals with intact nervous systems in the supine, standing and prone positions. Single and paired (30-ms inter-stimulus intervals biphasic stimulation pulses were applied through surface electrodes placed on the skin between the T11 and T12 inter-spinous processes referenced to electrodes on the abdomen. The paired stimulation was applied to evaluate the origin of the evoked electromyographic response; trans-synaptic responses would be suppressed whereas direct efferent responses would almost retain their amplitude. We found that responses to the second stimulus were decreased to 14%±5% of the amplitude of the response to the initial pulse in the supine position across muscles, to 30%±5% in the standing, and to only 80%±5% in the prone position. Response thresholds were lowest during standing and highest in the prone position and response amplitudes were largest in the supine and smallest in the prone position. The responses obtained in the supine and standing positions likely resulted from selective stimulation of sensory fibers while concomitant motor-fiber stimulation occurred in the prone position. We assume that changes of root-fiber paths within the generated electric field when in the prone position increase the stimulation thresholds of posterior above those of anterior root fibers. Thus, we

  3. Acute diagnosis of spinal trauma; Akutdiagnostik des Wirbelsaeulentraumas

    Energy Technology Data Exchange (ETDEWEB)

    Rieger, M.; Mallouhi, A.; Jaschke, W. [Medizinische Universitaet, Universitaetsklinik fuer Radiodiagnostik, Innsbruck (Austria); El Attal, R.; Kathrein, A.; Knop, C.; Blauth, M. [Medizinische Universitaet, Universitaetsklinik fuer Unfallchirurgie, Innsbruck (Austria)

    2006-06-15

    Most traumatic spinal injuries result from a high-energy process and are accompanied by other injuries. Following the CCSPR study, the presence of all low-risk factors (simple trauma mechanism, fully conscious, ambulatory at any time since trauma, neck rotation exceeding 45 bilaterally) obviates the need to acutely image the cervical spine. Imaging is indicated in all other patients. Emergency spiral CT should be performed as the first imaging method in high-risk and moderate-risk patients; only in low-risk patients should conventional radiography be performed and trusted as the sole modality. The AO classification according to Magerl et al. is used for the subaxial spine, whereas the upper cervical spine should be classified separately because the anatomy is different at each level. Radiological evaluation of traumatic spinal injuries should be done systematically using the ''ABCS'' scheme. (orig.) [German] Wirbelsaeulentraumen entstehen zumeist infolge hochenergetischer Mechanismen und sind haeufig von weiteren Verletzungen begleitet. Auf eine Diagnostik der Wirbelsaeule kann laut CCSPR-Studie nur dann verzichtet werden, wenn alle Niedrigrisikofaktoren (bewusstseinsklar, gehfaehig, ausreichender Bewegungsumfang, einfacher Unfallmechanismus) erfuellt sind. Alle anderen Patienten muessen radiologisch abgeklaert werden. Dabei sollten Patienten mit einer hohen und mittleren Verletzungswahrscheinlichkeit primaer computertomographisch untersucht werden, nur bei einer geringen Verletzungswahrscheinlichkeit kann der konventionellen Diagnostik vertraut werden. Die Frakturen der subaxialen Wirbelsaeule werden nach der Magerl-AO-Klassifikation eingeteilt, wohingegen fuer die obere HWS separate Einteilungen angewandt werden. Die radiologische Beurteilung des Wirbelsaeulentraumas sollte systematisch anhand des ''ABCS''-Schemas erfolgen. (orig.)

  4. 肺部及腰椎结核一例%Lung and lumbar spinal tuberculosis:a case report

    Institute of Scientific and Technical Information of China (English)

    钱金根; 潘国庆; 范国平

    2014-01-01

    Mycobacterium tuberculosis infection is most common in lung.A misdiagnosis would be made if imaging findings is not typical.Herein we reported one case of lung and lumbar spinal tuberculosis. The patient’s symptoms of tuberculosis were not typical,with negative results of all regular tuberculosis tests, thus a correct diagnosis was not confirmed until further clinical history inquiry and MRI of lumbar spinal was made.The patient was cured after antituberculosis therapy and operation,with good follow-up.From this case, we learned that:detailed clinical history and physical examination as well as scientific thinking,strengthened clinician awareness of atypical tuberculosis infection and a correct understanding of laboratory tests are very im-portant for correct diagnosis.%结核分支杆菌感染以肺结核最多见,影像学检查表现不典型时容易误诊。该文分析1例肺部及腰椎结核的诊治经过,该例因肺结核表现不典型、结核的常规检查均阴性而未能在入院初立即确诊,其后因进一步完善病史询问及行腰椎MRI发现腰椎结核灶而明确诊断,经积极的抗结核及腰椎手术治疗后,患者好转出院,随访情况良好。通过该例的诊治过程,应明确到,详细的病史询问和体格检查,不完全依赖实验室检查结果而应采用科学的综合的临床思维方法,对正确诊断是非常重要的。

  5. Enthesitis of lumbar spinal ligaments in clinically suspected spondyloarthritis: value of gadolinium-enhanced MR images in comparison to STIR

    Energy Technology Data Exchange (ETDEWEB)

    Agten, Christoph A.; Zubler, Veronika; Rosskopf, Andrea B.; Pfirrmann, Christian W.A. [Balgrist University Hospital, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Weiss, Bettina [Balgrist University Hospital, Rheumatology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2016-02-15

    To compare detection of spinal ligament enthesitis between gadolinium-enhanced fat-saturated T1-weighted gadolinium-enhanced fat-saturated T1-weighted (T1+Gd) and STIR sequences in patients with suspected spondyloarthritis. Sixty-eight patients (37 males, 42 ± 14 years) with a sacroiliac-joint (SIJ) and lumbar spine MRI for suspected spondyloarthritis were prospectively included. Sagittal T1+Gd and STIR images of the lumbar spine were assessed by two readers for enthesitis of interspinous/supraspinous ligaments, and for capsulitis of facet-joints between T12-S1. Patients' MRI were grouped according to ASAS (Assessment of SpondyloArthritis international Society) criteria in positive (group A) or negative (group B) SIJs. Enthesitis/capsulitis were compared between groups. Interreader agreement was assessed. Enthesitis/capsulitis per patient was statistically significantly more frequent with T1+Gd compared to STIR (p ≤ 0.007), except for interspinous ligaments for reader 1 (p = 0.455). Interspinous enthesitis, supraspinous enthesitis, and capsulitis were present with T1+Gd(STIR) in 64.7 %(72.1 %), 60.3 %(17.7 %), and 61.8 %(29.4 %) for reader 1, and 51.5 %(41.2 %), 45.6 %(7.4 %), and 91.2 %(45.5 %) for reader 2. There were 76.5 %(52/68) patients in group A and 23.5 %(16/68) in group B. Total number of enthesitis/capsulitis on T1+Gd was statistically significantly higher in group A than B (4.96 vs. 2.94, p = 0.026; 8.12 vs. 5.25, p = 0.041 for reader 1 and 2, respectively). Interreader agreement showed mixed results for interspinous/supraspinous/capsulitis but was higher on T1+Gd (ICC = 0.838/0.783/0.367; p ≤ 0.001) compared to STIR (ICC = 0.652/0.298/0.224; p ≤ 0.032). In patients with suspected spondyloarthritis, enthesitis/capsulitis in the lumbar spine are common findings and more frequently/reliably detected with T1+Gd than STIR. In patients with positive SIJ-MRI, the total number of enthesitis/capsulitis in T1+Gd was higher compared to patients with

  6. MRT atlas of the lumbar spine. Herniated disk - stenosis of the spinal canal - CT-controlled injection techniques; MRT-Atlas der Lendenwirbelsaeule. Bandscheibenvorfall - Spinalkanalstenose - mit einem Beitrag zur CT-gesteuerten Injektionstechnik

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, J.; Koester, O.; Kraemer, R.; Schmid, G.

    2001-07-01

    Two thirds of all degenerative diseases of the spinal cord are located in the lumbar spinal cord. Magnetic resonance tomography has a key role in diagnosis and therapy. This atlas contains 78 examples of different diseases. More than 450 impressive images of common and infrequent findings are to improve the user's diagnostic abilities. Next to the MRT findings, also the clinical findings and the history of the disease are reported in each case, so that typical correlations are established between clinical and imaging findings. The value of diagnostic imaging techniques is characterized in order to provide comprehensive information on selective imaging of the lumbar spinal cord. (orig.)

  7. Activation of Lumbar Spinal Wide-Dynamic Range Neurons by a Sanshool Derivative

    OpenAIRE

    Sawyer, Carolyn M.; Carstens, Mirela Iodi; Simons, Christopher T.; Slack, Jay; McCluskey, T. Scott; Furrer, Stefan; Carstens, E.

    2009-01-01

    The enigmatic sensation of tingle involves the activation of primary sensory neurons by hydroxy-α-sanshool, a tingly agent in Szechuan peppers, by inhibiting two-pore potassium channels. Central mechanisms mediating tingle sensation are unknown. We investigated whether a stable derivative of sanshool—isobutylalkenyl amide (IBA)—excites wide-dynamic range (WDR) spinal neurons that participate in transmission of chemesthetic information from the skin. In anesthetized rats, the majority of WDR a...

  8. Use of robotics in assessing the adaptive capacity of the rat lumbar spinal cord.

    Science.gov (United States)

    de Leon, Ray D; Reinkensmeyer, David J; Timoszyk, Wojciech K; London, Nicolas J; Roy, Roland R; Edgerton, V Reggie

    2002-01-01

    We have developed a robotic device that can record the trajectory of the hindlimb movements in rats. The robotic device can also impose programmed forces on the limbs during stepping. In the present paper we describe experiments using this robotic device, i.e. the rat stepper, to determine whether step training improves the locomotor capacity of adult rats that received complete spinal cord transections as neonates. We also determined to what extent the locomotor patterns can be maintained when the step cycle is physically perturbed by the robotic device. The results of the present study demonstrate that a robotic device can be used effectively to quantify the improvements in the locomotor capacity of spinal transected rats that occurs over a period of step training. The present results also demonstrate that when an external force is imposed to disrupt the step cycle, the spinal cord has the neural control elements necessary to normalize the kinematics over a number of steps, in the face of the disrupted forces.

  9. Acute effects of two different tennis sessions on dorsal and lumbar spine of adult players.

    Science.gov (United States)

    Gallotta, Maria Chiara; Bonavolontà, Valerio; Emerenziani, Gian Pietro; Franciosi, Emanuele; Tito, Alessandro; Guidetti, Laura; Baldari, Carlo

    2015-01-01

    The aim of the study was to evaluate the dorsal and lumbar spine of expert and recreational tennis players before (pre) and after (post) two different training sessions. The sample consisted of 17 male tennis players, nine expert and eight recreational males (age 21.2 ± 1.6 years). We assessed the back surface by rasterstereography pre and post two different training sessions both lasting 1.5 h: a standard training and a specific over-shoulder shots training session, respectively. Lordotic and kyphotic angle, length, imbalance, inclination for trunk, pelvic torsion, left and right lateral deviation and surface rotation were measured. Tennis expertise (expert versus recreational) significantly affected the surface rotation and right lateral deviation (P tennis players had higher values on surface rotation and right lateral deviation, around or just above physiological values (0-5° and 0-5 mm, respectively). Type of session significantly affected left lateral deviation, indicating that over-shoulder shots lead to a higher stress for the spine; the workload produced by both single sessions led to a shortening effect on trunk length. A single training session can induce acute modifications in some parameters of dorsal and lumbar spine of players.

  10. Origin and neurochemical properties of bulbospinal neurons projecting to the rat lumbar spinal cord via the medal longitudinal fasciculus and caudal ventrolateral medulla

    Directory of Open Access Journals (Sweden)

    Zilli eHuma

    2014-04-01

    Full Text Available Bulbospinal systems (BS originate from various regions of the brainstem and influence spinal neurons by classical synaptic and modulatory mechanisms. Our aim was to determine the brainstem locations of cells of origin of BS pathways passing through the medial longitudinal fasciculus (MLF and the caudal ventrolateral medulla (CVLM. We also examined the transmitter content of spinal terminations of the CVLM pathway. Six adult rats received Fluorogold (FG injections to the right intermediate grey matter of the lumbar cord (L1-L2 and the b-subunit of cholera toxin (CTb was injected either into the MLF or the right CVLM (3 animals each. Double-labelled cells were identified within brainstem structures with confocal microscopy and mapped onto brainstem diagrams. An additional 3 rats were injected with CTb in the CVLM to label axon terminals in the lumbar spinal cord. Double-labelled cells projecting via the MLF or CVLM were found principally in reticular regions of the medulla and pons but small numbers of cells were also located within the midbrain. CVLM projections to the lumbar cord were almost exclusively ipsilateral and concentrated within the intermediate grey matter. Most (62% of terminals were immunoreactive for the vesicular glutamate transporter 2 while 23% contained the vesicular GABA transporter. The inhibitory subpopulation was glycinergic, GABAergic or contained both transmitters. The proportions of excitatory and inhibitory axons projecting via the CVLM to the lumbar cord are similar to those projecting via the MLF. Unlike the MLF pathway, CVLM projections are predominantly ipsilateral and concentrated within intermediate grey but do not extend into motor nuclei or laminia VIII. Terminations of the CVLM pathway are located in a region of the grey matter that is rich in premotor interneurons; thus its primary function may be to coordinate activity of premotor networks.

  11. 39. Ultrastructural Changes of Neurons Located at Anterior Horn of Lumbar Spinal cord in Ethylene Oxide Exposed Mice

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Mice inhaled ethylene oxide at concentration of 360 mg/m3 for two hours a day, six days a week for 14 weeks. At the end of second and third month, the neurons located at anterior horn of lumbar spinal cord were observed under transmission electron microscope and scanning electron microscope with freeze etching. The results showed that the morphological changes in neuron cells became more obvious as the inhalation period prolonged. Following changes were observed : The distribution of integrating proteins in neuron membrane changed from normal stochastic into clustered one, the endoplasmic reticulum reduced in number and appeared as small vesicles, the ribosomes attached to the surface of rough endoplasmic reticulum were also decreased in number, arranged irregularly, disintegrated or even degranulated. The numher of mitochondria was also decreased. Observed aiso were the swelling of the axons of myelinated nerve fibers and loss of stratification of their myelin sheaths. The above results indicated that the ethylene oxide can induce structural changes in neuron cells, and this inevitably may cause functional abnormality of nervous system and manifestation of neurotoxic symptoms in ethylene oxide exposed individuals.

  12. [The use of minimally invasive instrumental spinal surgical technique in lumbar diseases of degenerative or traumatic origin].

    Science.gov (United States)

    Schwarcz, Attila; Kasó, Gábor; Büki, András; Dóczi, Tamás

    2013-03-30

    Paradigm change has recently taken place in spine surgery with the application of minimally invasive techniques. Minimally invasive techniques have several advantages over the open traditional techniques: less blood loss, preservation of spine muscle integrity, shorter hospitalization, early mobilization, reduced pain levels, lower risk of infection. The presented cases cover following lumbar pathologies: segmental spinal instability, LV-SI grade II. spondylolisthesis, degenerative spondylolisthesis, spine trauma. Unilateral or bilateral mini-open technique was employed in the degenerative cases, depending on symptoms and signes. If unilateral symptoms--pathology was identified, screws and rod were implanted percutaneously on the side contralateral to the pathology. The segmental fusion between vertebral bodies was always assured by a cage and autologous bone. The presented trauma case involved combined AO type A2 and B fractures. The anterior column was strengthened with vertebral body stents filled with bone cement, the posterior column was fixed with a percutaneously implanted screw rod system. Insertion of stents in the collapsed vertebra significantly increased the vertebral body height and also improved the stability of the spine. Minimally invasive spine surgery techniques appear more advantageous over the traditional open spine surgery that necessitates for large midline approaches.

  13. Substance P immunoreactivity in the lumbar spinal cord of the turtle Trachemys dorbigni following peripheral nerve injury

    Directory of Open Access Journals (Sweden)

    W.A. Partata

    2003-04-01

    Full Text Available Immunoreactive substance P was investigated in turtle lumbar spinal cord after sciatic nerve transection. In control animals immunoreactive fibers were densest in synaptic field Ia, where the longest axons invaded synaptic field III. Positive neuronal bodies were identified in the lateral column of the dorsal horn and substance P immunoreactive varicosities were observed in the ventral horn, in close relationship with presumed motoneurons. Other varicosities appeared in the lateral and anterior funiculi. After axotomy, substance P immunoreactive fibers were reduced slightly on the side of the lesion, which was located in long fibers that invaded synaptic field III and in the varicosities of the lateral and anterior funiculus. The changes were observed at 7 days after axonal injury and persisted at 15, 30, 60 and 90 days after the lesion. These findings show that turtles should be considered as a model to study the role of substance P in peripheral axonal injury, since the distribution and temporal changes of substance P were similar to those found in mammals.

  14. Effect of Acupuncture on Pain and Quality of Life in Patients with Lumbar Spinal Stenosis: A Case Series Study.

    Science.gov (United States)

    Hadianfard, Mohammad J; Aminlari, Ali; Daneshian, Arghavan; Safarpour, Ali R

    2016-08-01

    Lumbar spinal stenosis (LSS) is a major cause of debilitation in adults, and acupuncture is a recommended treatment. We assessed the effect of acupuncture on pain and quality of life in patients with LSS. Twenty-four patients with LSS who had symptoms of neurogenic claudication were randomly selected and underwent 10 sessions of acupuncture. Pain and quality of life were evaluated before and immediately after the intervention and 6 weeks later using a visual analogue scale and Short Form-36 Health Survey. Paired t tests and repeated measure tests were used to analyze the data. The mean age of the patients was 48.2 ± 10.8 years. The mean visual analogue scale scores before and immediately after intervention (7.9 ± 1.3 and 4.3 ± 2.1) were statistically different (p acupuncture (p pain, and physical well-being. Therefore, acupuncture had a significant short-term effect on pain and quality of life in patients with LSS.

  15. 运动行针法治疗急性腰扭伤65例%Treatment of 65 cases of acute lumbar sprain with active exercise and needle manipulation

    Institute of Scientific and Technical Information of China (English)

    史丽英

    2010-01-01

    @@ Acute lumbar sprain is a common symptom in acupuncture and moxibustion department. It is acute laceration induced by over traction of soft tissues,such as lumbar muscle, fascia and ligament due to external exertions. Lumbar pain is typical in clinic.The pain is drastic, persistent, with fixed location and combined with limited motor function.

  16. Activation of lumbar spinal wide-dynamic range neurons by a sanshool derivative.

    Science.gov (United States)

    Sawyer, Carolyn M; Carstens, Mirela Iodi; Simons, Christopher T; Slack, Jay; McCluskey, T Scott; Furrer, Stefan; Carstens, E

    2009-04-01

    The enigmatic sensation of tingle involves the activation of primary sensory neurons by hydroxy-alpha-sanshool, a tingly agent in Szechuan peppers, by inhibiting two-pore potassium channels. Central mechanisms mediating tingle sensation are unknown. We investigated whether a stable derivative of sanshool-isobutylalkenyl amide (IBA)-excites wide-dynamic range (WDR) spinal neurons that participate in transmission of chemesthetic information from the skin. In anesthetized rats, the majority of WDR and low-threshold units responded to intradermal injection of IBA in a dose-related manner over a >5-min time course and exhibited tachyphylaxis at higher concentrations (1 and 10%). Almost all WDR and low-threshold units additionally responded to the pungent agents mustard oil (allyl isothiocyanate) and/or capsaicin, prompting reclassification of the low-threshold cells as WDR. The results are discussed in terms of the functional role of WDR neurons in mediating tingle sensation.

  17. Activation of Lumbar Spinal Wide-Dynamic Range Neurons by a Sanshool Derivative

    Science.gov (United States)

    Sawyer, Carolyn M.; Carstens, Mirela Iodi; Simons, Christopher T.; Slack, Jay; McCluskey, T. Scott; Furrer, Stefan; Carstens, E.

    2009-01-01

    The enigmatic sensation of tingle involves the activation of primary sensory neurons by hydroxy-α-sanshool, a tingly agent in Szechuan peppers, by inhibiting two-pore potassium channels. Central mechanisms mediating tingle sensation are unknown. We investigated whether a stable derivative of sanshool—isobutylalkenyl amide (IBA)—excites wide-dynamic range (WDR) spinal neurons that participate in transmission of chemesthetic information from the skin. In anesthetized rats, the majority of WDR and low-threshold units responded to intradermal injection of IBA in a dose-related manner over a >5-min time course and exhibited tachyphylaxis at higher concentrations (1 and 10%). Almost all WDR and low-threshold units additionally responded to the pungent agents mustard oil (allyl isothiocyanate) and/or capsaicin, prompting reclassification of the low-threshold cells as WDR. The results are discussed in terms of the functional role of WDR neurons in mediating tingle sensation. PMID:19164099

  18. Application of Shutter-type Lumbar Laminoplasty with the Spinal Ligament Complex for the Treatment of Degenerative Lumbar Spinal Stenosis%卷帘式腰椎管成形术治疗老年退变性腰椎管狭窄症

    Institute of Scientific and Technical Information of China (English)

    贺建新; 林雪英

    2011-01-01

    目的 探讨与总结采用卷帘式椎管成形术治疗老年退变性腰椎管狭窄症的疗效及优越性.方法 自2004年5月至2009年12月,对22 例老年退变性腰椎管狭窄症患者采用保留椎板棘突韧带复合结构椎管减压的卷帘式腰椎管成形术治疗.结果 本组病人均获随访,时间3个月~5年,无症状复发,无腰椎不稳,取得良好的临床疗效.14 例患者在术后2~3个月CT扫描可看到满意的骨痂生长,未见回植椎板移入椎管或有移入倾向,未见截骨前缘过度增生对硬膜产生新的压迫等.结论 卷帘式腰椎管成形术安全、可靠、疗效好,具有避免椎管内黏连与瘢痕压迫,恢复局部解剖和维持脊柱稳定的特点.既可对腰椎管狭窄进行减压,又可减少对腰椎稳定性的损害.%Objective To investigate security,reliability and advantage of shutter-type lumbar laminoplasty with the spinal ligament complex for the treatment of degenerative lumbar spinal stenosis (DLSS). Methods From May 2004-December 2009 in 22 elderly patients with degenerative lumbar spinal stenosis treated with shutter-style treat ment of lumbar laminoplasty. Results All patients were followed up for 3 months or more (3 months to 5 years) ,and got a good clinical effect. Satisfactory callus growth can be seen in most cases (14 cases) from 2 to 3 months postoperatively by CT scans. No nonunion,displacement of reimplanted lamina,overgrowth of anterior bone edge of osteotomy,no recompression of the nerves and instability of lumbar spine occurred in this group. Conclusion Application of the shutter-type lumbar laminoplasty with the Spinal Ligament Complex for the Treatment of Degenerative Lumbar Spinal Stenosis has advantages of avoiding adhesion and scar formation of the lumbar canal,restoring the anatomy and keeping stability of the spine. It can carry out the decompression of lumbar spinal stenosis,but also keep the stability of the lumbar spine.

  19. Successful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis.

    Science.gov (United States)

    Izumi, Manabu; Teraoka, Shoko; Yamashita, Keisuke; Matsumoto, Kenji; Muronoi, Tomohiro; Izawa, Yoshimitsu; Yonekawa, Chikara; Ano, Masaki; Suzukawa, Masayuki

    2011-01-01

    A 74-year-old man with coronary artery disease was suffering from acute nonobstructive cholecystitis and was admitted to a nearby hospital. Dual antiplatelet (aspirin and ticlopidine) therapy was discontinued before preparation for surgical resection of the gall bladder. During his time in hospital he was aware of lumbar pain and weakness in both legs. He was transferred to our hospital for further evaluation and therapy. Diffuse intra-aortic thrombi were revealed by computed tomography with contrast media, and magnetic resonance imaging showed spinal cord infarction. However, computed tomography scans of the descending aorta obtained 4 months before admission exhibited no signs of atherosclerotic plaques or intra-aortic thrombi. Laboratory data suggest that antiphospholipid antibody syndrome might have caused these acute multiple intra-arterial thrombi. By restarting dual antiplatelet therapy and increasing the dose of heparin (from 10,000 IU/day to 15,000 IU/day) we successfully managed the patient's clinical condition and symptoms. It is important to understand that stopping antiplatelet therapy may rapidly grow thrombi in patients with a hypercoagulative state.

  20. Numerical evaluation of the correlation between the normal variation in the sagittal alignment of the lumbar spine and the spinal loads.

    Science.gov (United States)

    Galbusera, Fabio; Brayda-Bruno, Marco; Costa, Francesco; Wilke, Hans-Joachim

    2014-04-01

    We present a numerical approach to reproduce various patterns of spino-pelvic organization. We wanted to predict the spinal loads in two static conditions (standing and holding a weight in the hands) based on parameters describing the shape of the lumbar spine: type following Roussouly classification, sacral slope, apex, inflection point and lumbar lordosis. Four hundred eighty finite element models including trunk muscles and representing the entire range of normal variability were created. The models predicted that, in the case of a moderate external load of 50 N, a lordotic and well balanced spine (e.g., type 3) could reduce the muscle activation in comparison with a more lordotic (type 4) spine, with negligible differences compared to a more straight spine (type 2). However, such a sagittal configuration was not correlated with a minimization of the loading state in the intervertebral discs, especially regarding anteroposterior shear loads. In the standing posture without any additional load, a less lordotic and more vertical spine (e.g., types 1 and 2) was sufficient to ensure a condition of minimal spinal loads. Despite a number of limitations, inverse statics numerical models of spine biomechanics including trunk muscles appear to be a promising tool to fill the knowledge gap between the clinical observations of the correlations between the spino-pelvic organization and the consequent spinal disorders.

  1. Time representation of mitochondrial morphology and function after acute spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Zhi-qiang Jia; Gang Li; Zhen-yu Zhang; Hao-tian Li; Ji-quan Wang; Zhong-kai Fan; Gang Lv

    2016-01-01

    Changes in mitochondrial morphology and function play an important role in secondary damage after acute spinal cord injury. We re-corded the time representation of mitochondrial morphology and function in rats with acute spinal cord injury. Results showed that mitochondria had an irregular shape, and increased in size. Mitochondrial cristae were disordered and mitochondrial membrane rupture was visible at 2–24 hours after injury. Fusion protein mitofusin 1 expression gradually increased, peaked at 8 hours after injury, and then decreased to its lowest level at 24 hours. Expression of dynamin-related protein 1, amitochondrial ifssion protein, showed the opposite kinetics. At 2–24 hours after acute spinal cord injury, malondialdehyde content, cytochrome c levels and caspase-3 expression were in-creased, but glutathione content, adenosine triphosphate content, Na+-K+-ATPase activity and mitochondrial membrane potential were gradually reduced. Furthermore, mitochondrial morphology altered during the acute stage of spinal cord injury. Fusion was important within the ifrst 8 hours, but ifssion played a key role at 24 hours. Oxidative stress was inhibited, biological productivity was diminished, and mitochondrial membrane potential and permeability were reduced in the acute stage of injury. In summary, mitochondrial apoptosis is activated when the time of spinal cord injury is prolonged.

  2. The Value Analysis of CT Diagnosis for Lumbar Spinal Stenosis%腰椎管狭窄的CT诊断价值分析

    Institute of Scientific and Technical Information of China (English)

    胡雪珍; 李正军; 陈虎; 于小利

    2014-01-01

    Objective:To investigate the value of CT diagnosis for lumbar spinal stenosis.Method:CT images of 77 patients with lumbar spinal stenosis were retrospectively analyzed.Result:The analysis in the 77 patients with lumbar spinal stenosis showed that there were 41 cases with lumbar intervertebral disc protrusion(among them 17 cases were L3-4,37 cases were L4-5,32 cases were L5-S1),21 cases with the left side,18 cases on the right side,23 cases were L3-S1 vertebral hyperplasia of small joints and inside,35 cases with the lumbar yellow ligament hypertrophy,both coexist in 19 cases,27 cases were lumbar disc with yellow ligament hypertrophy,15 cases with L3-S1 of lumbar posterior marginal intraosseous cartilaginous node(12 cases were L4)and 7 cases with L3-5 of vertebral compression fracture.L4-5 spondylolisthesis in 14 cases(including 9 cases were L4,9 cases were L5).Conclusion:CT examination can clear the reason,position,degree,scope of lumbar spinal stenosis,provide an important basis for the diagnosis of clinical.%目的:探讨腰椎管狭窄的CT诊断价值。方法:回顾性分析77例腰椎管狭窄患者的CT表现。结果:椎间盘突出41例(其中L3~417例,L4~537例,L5~S132例),伴有左侧突21例,右侧突18例,23例L3~S1椎小关节增生、内突,35例黄韧带肥厚,两者并存19例;腰椎间盘突出伴有黄韧带肥厚27例,L3~S1椎体后缘骨内软骨结节15例(其中L412例);L3~5椎体压缩性骨折7例,L4~5椎体滑脱14例(其中L49例,L55例)。结论:CT检查可以明确腰椎管狭窄的原因、部位、程度、范围,为临床提供重要的诊断依据。

  3. Spinal aneurysmal bone cyst causing acute cord compression without vertebral collapse: CT and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Monica S.M.; Wong, Yiu-Chung; Yuen, Ming-Keung [Department of Diagnostic Radiology, Tuen Mun Hospital, Hongkong (China); Lam, Dicky [Department of Orthopaedics and Traumatology, Hongkong (China)

    2002-08-01

    Aneurysmal bone cyst (ABC) of the spine can cause acute spinal cord compression in young patients. We report the CT and MRI findings in a histology-proven case of spinal ABC presenting with sudden paraplegia. Typical features of a spinal ABC at the thoracic level with considerable extension into the posterior epidural space and cord compression were demonstrated. Special note was made of the disproportionately large longitudinal extent of the epidural component of the lesion. Associated vertebral collapse was absent. A fracture of the overlying cortex had probably allowed the lesion to decompress and track along the epidural space without significantly jeopardizing integrity of the osseous structures. This case illustrates a less frequently recognised mechanism of acute spinal cord compression by ABC. (orig.)

  4. Locomotor-activated neurons of the cat. II. Noradrenergic innervation and colocalization with NEα 1a or NEα 2b receptors in the thoraco-lumbar spinal cord.

    Science.gov (United States)

    Noga, Brian R; Johnson, Dawn M G; Riesgo, Mirta I; Pinzon, Alberto

    2011-04-01

    Norepinephrine (NE) is a strong modulator and/or activator of spinal locomotor networks. Thus noradrenergic fibers likely contact neurons involved in generating locomotion. The aim of the present study was to investigate the noradrenergic innervation of functionally related, locomotor-activated neurons within the thoraco-lumbar spinal cord. This was accomplished by immunohistochemical colocalization of noradrenergic fibers using dopamine-β-hydroxylase or NEα(1A) and NEα(2B) receptors with cells expressing the c-fos gene activity-dependent marker Fos. Experiments were performed on paralyzed, precollicular-postmamillary decerebrate cats, in which locomotion was induced by electrical stimulation of the mesencephalic locomotor region. The majority of Fos labeled neurons, especially abundant in laminae VII and VIII throughout the thoraco-lumbar (T13-L7) region of locomotor animals, showed close contacts with multiple noradrenergic boutons. A small percentage (10-40%) of Fos neurons in the T7-L7 segments showed colocalization with NEα(1A) receptors. In contrast, NEα(2B) receptor immunoreactivity was observed in 70-90% of Fos cells, with no obvious rostrocaudal gradient. In comparison with results obtained from our previous study on the same animals, a significantly smaller proportion of Fos labeled neurons were innervated by noradrenergic than serotonergic fibers, with significant differences observed for laminae VII and VIII in some segments. In lamina VII of the lumbar segments, the degree of monoaminergic receptor subtype/Fos colocalization examined statistically generally fell into the following order: NEα(2B) = 5-HT(2A) ≥ 5-HT(7) = 5-HT(1A) > NEα(1A). These results suggest that noradrenergic modulation of locomotion involves NEα(1A)/NEα(2B) receptors on noradrenergic-innervated locomotor-activated neurons within laminae VII and VIII of thoraco-lumbar segments. Further study of the functional role of these receptors in locomotion is warranted.

  5. Relationship Between Depressive State and Treatment Characteristics of Acute Cervical Spinal Cord Injury in Japan

    OpenAIRE

    2016-01-01

    Background Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Methods Using an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepr...

  6. Morphometry study on pre and post-hatching nerve cell bodies of lumbar spinal ganglia of Gallus domesticus

    Directory of Open Access Journals (Sweden)

    Claudio A. Ferraz de Carvalho

    1983-09-01

    Full Text Available A cytomorphometric study was performed in lumbar spinal ganglia neurons of Gallus domesticus on the 10th and 18th incubation days and 8th, 35th, 61st, and 120th post-hatching days. The absolute volume of nucleus and relative volume of cytoplasm were respectively estimated by the Bach² caryometric method and by point-counting volumetry, carried out in 0.5mm thick araldite sections. The relative volume, the surface-to-volume ratio and the total surface of RER, SER, mitochondria, dense bodies, Golgi complex and the relative volume of hyaloplasm inside and outside the Nissl bodies were estimated from electronmicrographs by the Weibel et al.58 method. The conclusions were: a there was an increase of the cell volume and a decrease of the nucleo-cytoplasmic ratio, particularly between the first two ages; b the relative volumes of RER and SER change inversely with respect to each other: the RER increases before hatching, decreasing progressively afterwards; the changes of relative volume of dense bodies are similar to those of the RER, and the mitochondria show relatively small variations concerning the same parameter; c the relative volume of hyaloplasm inside the Nissl bodies decreases while those outside increases; d the surface-to-volume ratio drops sharply for all organelles from the 10th to the 18th day of incubation; after hatching, a tendency to increase is observed; e the membrane surface-to-cytoplasmic volume ratio decreases for all organelles from the 10th to the 18th day of incubation; after hatching, this ratio increases slightly for mitochondria and Golgi complex, sharply for SER, dropping for dense bodies. The RER values alternate regularly.

  7. Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach.

    Science.gov (United States)

    Dishman, J Donald; Weber, Kenneth A; Corbin, Roger L; Burke, Jeanmarie R

    2012-09-30

    The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.e., 22 time series per group. If the detection of outliers and correlograms revealed a pattern of non-randomness that was only time-locked to a single, specific event in the normalized time series, then an experimental effect would be inferred beyond the inherent variability of H-reflex responses. Tibial nerve F-wave responses were included to determine if any new information about central nervous function following a HVLA SM procedure could be ascertained. Time series analyses of H(max)/M(max) ratios, pre-post L5-S1 HVLA SM, substantiated the hypothesis that the specific aspects of the manipulative thrust lead to a greater attenuation of the H(max)/M(max) ratio as compared to the non-specific aspects related to the postural perturbation and joint pre-loading. The attenuation of the H(max)/M(max) ratio following the HVLA SM procedure was reliable and may hold promise as a translational tool to measure the consistency and accuracy of protocol implementation involving SM in clinical trials research. F-wave responses were not sensitive to mechanical perturbations of the lumbar spine.

  8. Effects of Nasal Calcitonin vs. Oral Gabapentin on Pain and Symptoms of Lumbar Spinal Stenosis: A Clinical Trial Study.

    Science.gov (United States)

    Haddadi, Kaveh; Asadian, Leila; Isazade, Ahdie

    2016-01-01

    Lumbar spinal stenosis (LSS) is a chronic and prevalent disease that occurs in 10.8% of the general population, mostly in old age. We designed the first clinical trial study to compare the effects of administering the nasal salmon calcitonin spray and gabapentin in patients with LSS. In this clinical trial, 90 patients with symptoms of neurogenic claudication and magnetic resonance imaging-proven LSS were randomly assigned to nasal salmon calcitonin, gabapentin, or placebo treatments for eight weeks (30 participants in each group). This was followed by a washout period of four weeks. After three months of study and after four weeks off the prescription, mean values of Oswestry Disability Index in the calcitonin, gabapentin, and control groups were 23 ± 12.05, 32 ± 16.08, and 38 ± 22.09, respectively (P ≤ 0.05, calcitonin group vs. gabapentin group, and P ≤ 0. 001, calcitonin group vs. control group with respect to pretreatment scores). Thus, three months after the treatment, although most of the patients in the control group had a satisfactory period of improvement, the improvement in the calcitonin group was more than the other two groups with a significant difference (P ≤ 0.05 when compared to gabapentin group and P ≤ 0.01 when compared to placebo group). We revealed that the 200 International Unit (IU) and nasal calcitonin spray daily are more effective compared to 300 mg gabapentin three times per day and the placebo effect for eight weeks of treatment of symptoms of patients with LSS.

  9. Assessment of the trauma degree and spinal cord function of para-median minimally invasive and open TLIF for single segmental lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    Zheng Bo-long; He Bao-rong; Yang Xiao-bin; Yang Ming; Yan Liang; Bai Xiao-fan; Hao Ding-jun

    2016-01-01

    Objective:To study the trauma degree of para-median minimally invasive and open TLIF for single segmental lumbar degenerative disease and the effect on spinal cord function.Methods:A total of 78 cases of patients with single segmental lumbar disc herniation who received TLIF treatment in our hospital were selected as the research subjects and randomly divided into two groups, minimally invasive group received para-median minimally invasive TLIF and open group received open TLIF. Perioperative serum levels of oxidative stress indicators and pain mediators as well as spinal cord function were compared between two groups.Results: 1 d and 3 d after operation, serum SOD, GSH-Px and SP levels of minimally invasive group were significantly higher than those of open group, and MDA, AOPP, NO,β-EP, PGE2 and CGRP levels were significantly lower than those of open group; 1 week after operation, NCV and DL of common peroneal nerve and tibial nerve of two groups were not different from those before operation; 4 weeks and 16 weeks after operation, NCV of common peroneal nerve and tibial nerve of both groups were higher than those before operation while DL were lower than those before operation, and NCV of common peroneal nerve and tibial nerve of minimally invasive group were significantly higher than those of open group while DL were significantly lower than those of open group.Conclusion:The trauma degree of para-median minimally invasive TLIF for single segmental lumbar degenerative disease is less and the postoperative spinal cord function recovery is more ideal.

  10. Lumbar spinal imaging in radicular pain and related conditions. Understanding diagnostic images in a clinical context

    Energy Technology Data Exchange (ETDEWEB)

    Wilmink, Jan T. [University Hospital Maastricht (Netherlands). Dept. Radiology

    2010-07-01

    There is general agreement that lumbosacral nerve root compression is a prime factor in the pathogenesis of sciatica and neurogenic claudication, although humoral and vascular factors certainly play a role as well. This book focuses on imaging of the various ways in which nerve root compression can come about, and assessing which anatomic features are reliably associated with the occurrence of radicular pain, as opposed to morphologic findings which are probably coincidental. After a discussion of the nature of radicular pain and related symptoms, spinal imaging techniques and options are reviewed, with emphasis on the role of MR myelography in assessing the condition of the intradural nerve roots. A chapter on normal topographic, sectional, and functional (dynamic) radiologic anatomy is followed by a presentation on pathologic anatomy, addressing the various mechanisms of nerve root compression. In the chapter on pre- and postoperative imaging, features which may help to predict the evolution of the symptoms are discussed, with an eye to selecting candidates for surgical treatment. This is followed by a discussion of the role and limitations of imaging studies in various adverse postoperative conditions. In illustrations involving patient studies, imaging features are linked where possible to the clinical symptoms and history of the individuals involved. (orig.)

  11. Axon diversity of lamina I local-circuit neurons in the lumbar spinal cord.

    Science.gov (United States)

    Szucs, Peter; Luz, Liliana L; Pinho, Raquel; Aguiar, Paulo; Antal, Zsófia; Tiong, Sheena Y X; Todd, Andrew J; Safronov, Boris V

    2013-08-15

    Spinal lamina I is a key area for relaying and integrating information from nociceptive primary afferents with various other sources of inputs. Although lamina I projection neurons have been intensively studied, much less attention has been given to local-circuit neurons (LCNs), which form the majority of the lamina I neuronal population. In this work the infrared light-emitting diode oblique illumination technique was used to visualize and label LCNs, allowing reconstruction and analysis of their dendritic and extensive axonal trees. We show that the majority of lamina I neurons with locally branching axons fall into the multipolar (with ventrally protruding dendrites) and flattened (dendrites limited to lamina I) somatodendritic categories. Analysis of their axons revealed that the initial myelinated part gives rise to several unmyelinated small-diameter branches that have a high number of densely packed, large varicosities and an extensive rostrocaudal (two or three segments), mediolateral, and dorsoventral (reaching laminae III-IV) distribution. The extent of the axon and the occasional presence of long, solitary branches suggest that LCNs may also form short and long propriospinal connections. We also found that the distribution of axon varicosities and terminal field locations show substantial heterogeneity and that a substantial portion of LCNs is inhibitory. Our observations indicate that LCNs of lamina I form intersegmental as well as interlaminar connections and may govern large numbers of neurons, providing anatomical substrate for rostrocaudal "processing units" in the dorsal horn.

  12. The Impact of Surgical Timing in Acute Traumatic Spinal Cord Injury

    Science.gov (United States)

    2014-10-01

    quality of life) in patients with a traumatic SCI. For the first reporting period, we have completed recruitment of traumatic spinal cord injured ...the  major  goals  were  to  complete  recruitment  of  our  sample  of   136  traumatic   spinal   cord   injured ...TYPE Annual 3. DATES COVERED 30 Sep 2013 – 29 Sep 2014 4. TITLE AND SUBTITLE The impact of surgical timing in acute traumatic spinal cord

  13. Superion® InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Patel VV

    2015-10-01

    Full Text Available Vikas V Patel,1 Pierce D Nunley,2 Peter G Whang,3 Thomas R Haley,4 W Daniel Bradley,5 Raphael P Davis,6 Jon E Block,7 Fred H Geisler8 1The Spine Center, University of Colorado Hospital, Denver, CO, 2Spine Institute of Louisiana, Shreveport, LA, 3Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, 4Performance Spine and Sports Physicians, PC, Pottstown, PA, 5Texas Back Institute, Denton, TX, 6Department of Neurological Surgery, Stony Brook Medicine, Stony Brook, NY, 7Jon Block, Ph.D. San Francisco, CA, 8McLaren Hospital, Petoskey, MI, USA Purpose: This report provides the 3-year clinical outcomes from the randomized, controlled US Food and Drug Administration Investigational Device Exemption trial of the Superion® for the treatment of moderate degenerative lumbar spinal stenosis. Patients and methods: The Superion® was evaluated in the treatment of subjects aged 45 years or older suffering from symptoms of intermittent neurogenic claudication, secondary to a confirmed diagnosis of moderate degenerative lumbar spinal stenosis at one or two contiguous levels from L1 to L5. Patients were treated between June 2008 and December 2011 at 31 investigational sites. Three hundred ninety-one subjects were included in the randomized study group consisting of 190 Superion® and 201 X-STOP® control subjects. The primary composite endpoint was individual patient success based on four components: improvement in two of three domains of the Zurich Claudication Questionnaire, no reoperations at the index level, no major implant/procedure-related complications, and no clinically significant confounding treatments. Results: At 3 years, the proportion of subjects achieving the primary composite endpoint was greater for Superion® (63/120, 52.5% than for X-STOP® (49/129, 38.0% (P=0.023 and the corresponding success rates exceeded 80% for each of the individual components of the primary endpoint in the Superion® group

  14. Surgical treatment of lumbar spinal canal stenosis%腰椎椎管狭窄症的外科治疗

    Institute of Scientific and Technical Information of China (English)

    庞晓东; 彭宝淦; 杨洪; 李端明; 高春华

    2011-01-01

    目的 探讨腰椎椎管狭窄症外科治疗的临床疗效.方法 回顾性研究手术治疗退变性腰椎椎管狭窄患者共172例,其中10例有脊柱侧凸改变,22例I~Ⅱ度滑脱.单节段狭窄者90例,双节段狭窄者51例,3个节段狭窄者31例.采用单纯开窗减压者5例,后路融合固定者100例,后路椎间融合固定62例,Dynesys弹性内固定5例.临床疗效评定采用疼痛视觉模拟量表(visual analogue scale,VAS)评分,功能评分采用北美脊柱外科学会改良腰椎功能障碍指数(modified Oswestry low back pain disability questionaire index,MODI),从腰腿痛、生活自理、行走和举重物等10个方面评估患者腰椎的ODI分数.结果 所有病例随访6~72个月,平均50个月.术前腰腿痛平均评分为7.5分,术后3个月为3.2分,末次随访时为3.6分.术后3个月随访,MODI改善的优良率为94.3%;末次随访时优良率为87.6%.结论 对退行性腰椎椎管狭窄根据术前临床及影像学检查,有针对性地进行椎管减压或联合椎弓根螺钉内固定治疗均可取得较好疗效.%Objective To evaluate the clinical outcomes of surgical treatment for the patients with degenerative lumbar spinal stenosis ( DLSS ). Methods A retrospective study was conducted with a total of 172 DLSS patients who underwent decompression surgery with or without arthrodesis. The patients included 90 with single segment stenosis, 51 with double stenoses, and 31 with triple stenosis. Ten of the patients also had scoliosis and 22 had Ⅰ - Ⅱ degrees of spondylolysis. Five patients underwent simple decompression, 100 patients underwent posterior spinal fusion and fixation, 62 underwent posterior spinal fusion and fixation, and 5 underwent Dynesys semirigid fixation. The symptom relief and function improvement were assessed with a visual analogue scale ( VAS ) and modified Oswestry low back pain disability questionaire index ( MODI ), respectively. Results The patients were followed-up for 6

  15. Third-Degree Hindpaw Burn Injury Induced Apoptosis of Lumbar Spinal Cord Ventral Horn Motor Neurons and Sciatic Nerve and Muscle Atrophy in Rats

    Directory of Open Access Journals (Sweden)

    Sheng-Hua Wu

    2015-01-01

    Full Text Available Background. Severe burns result in hypercatabolic state and concomitant muscle atrophy that persists for several months, thereby limiting patient recovery. However, the effects of burns on the corresponding spinal dermatome remain unknown. This study aimed to investigate whether burns induce apoptosis of spinal cord ventral horn motor neurons (VHMNs and consequently cause skeletal muscle wasting. Methods. Third-degree hindpaw burn injury with 1% total body surface area (TBSA rats were euthanized 4 and 8 weeks after burn injury. The apoptosis profiles in the ventral horns of the lumbar spinal cords, sciatic nerves, and gastrocnemius muscles were examined. The Schwann cells in the sciatic nerve were marked with S100. The gastrocnemius muscles were harvested to measure the denervation atrophy. Result. The VHMNs apoptosis in the spinal cord was observed after inducing third-degree burns in the hindpaw. The S100 and TUNEL double-positive cells in the sciatic nerve increased significantly after the burn injury. Gastrocnemius muscle apoptosis and denervation atrophy area increased significantly after the burn injury. Conclusion. Local hindpaw burn induces apoptosis in VHMNs and Schwann cells in sciatic nerve, which causes corresponding gastrocnemius muscle denervation atrophy. Our results provided an animal model to evaluate burn-induced muscle wasting, and elucidate the underlying mechanisms.

  16. The transcriptional response of neurotrophins and their tyrosine kinase receptors in lumbar sensorimotor circuits to spinal cord contusion is affected by injury severity and survival time.

    Directory of Open Access Journals (Sweden)

    M Tyler Hougland

    2013-01-01

    Full Text Available Traumatic spinal cord injury (SCI results in changes to the anatomical, neurochemical, and physiological properties of cells in the central and peripheral nervous system. Neurotrophins, acting by binding to their cognate Trk receptors on target cell membranes, contribute to modulation of anatomical, neurochemical, and physiological properties of neurons in sensorimotor circuits in both the intact and injured spinal cord. Neurotrophin signaling is associated with many post-SCI changes including maladaptive plasticity leading to pain and autonomic dysreflexia, but also therapeutic approaches such as training-induced locomotor improvement. Here we characterize expression of mRNA for neurotrophins and Trk receptors in lumbar dorsal root ganglia (DRG and spinal cord after two different severities of mid-thoracic injury and at 6 and 12 weeks post-SCI. There was complex regulation that differed with tissue, injury severity, and survival time, including reversals of regulation between 6 and 12 weeks, and the data suggest that natural regulation of neurotrophins in the spinal cord may continue for months after birth. Our assessments determined that a coordination of gene expression emerged at the 12 week post-SCI time point and bioinformatic analyses address possible mechanisms. These data can inform studies meant to determine the role of the neurotrophin signaling system in post-SCI function and plasticity, and studies using this signaling system as a therapeutic approach.

  17. Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jin Song; Huan, Yi [Fourth Military Medical University, Department of Radiology, Xijing Hospital, Xi' an (China)

    2014-03-15

    To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value. Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72 h after the onset of trauma. Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t = -7.621, P < 0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma. Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord. (orig.)

  18. Effect of chronic administration of morphine on the gene expression level of sodium-dependent vitamin C transporters in rat hippocampus and lumbar spinal cord.

    Science.gov (United States)

    Zarebkohan, Amir; Javan, Mohammad; Satarian, Leila; Ahmadiani, Abolhasan

    2009-07-01

    Chronic morphine leads to dependence, tolerance, and neural apoptosis. Vitamin C inhibits the withdrawal syndrome in morphine-dependent subjects and prevents apoptosis in experimental models. Sodium-dependent vitamin C transporter (SVCT) type-2 is the main transporter for carrying vitamin C into the brain and neural cells. The mechanism(s) by which vitamin C inhibits morphine dependence in not understood. SVCT activity determines the vitamin C availably within the nervous system. We have examined the alterations in the expression of SVCT1, SVCT2, and its splice variants in morphine-tolerant rats. Morphine (20 mg/kg) was injected twice/day to male rats for either 7 or 14 days. The development of analgesic tolerance was assessed using tail-flick test. Lumbar spinal cord and the hippocampus were isolated for RNA extraction. Semiquantitative reverse transcriptase-polymerase chain reaction method was used to assess the levels of gene expression. Administration of morphine for 7 or 14 days reduced the expression level of SVCT2 in both hippocampus and dorsal lumbar spinal cord of rats. SVCT2 expression was reduced in vitamin C-, and vitamin C combined with morphine-treated animals. Results did not show SVCT2 splice variation. SVCT1 did not express in control or morphine-treated rats. It seems that reduced expression level of SVCT2 might be involved in the development of morphine side effects such as tolerance and dependency.

  19. Advancement of traditional Chinese medicine treatment for lumbar spinal stenosis%腰椎管狭窄症的中医治疗研究进展

    Institute of Scientific and Technical Information of China (English)

    张正浩; 潘汉升

    2015-01-01

    As a common and high incidence disease in the elderly population,lumbar spinal stenosis has made a heavy burden to the family,society,and even national.With the development of medical Times,Chinese medicine treatment of the disease are varied,showing burgeons scene.By browsing resent advancement of traditional Chinese medicine treatment for lumbar spinal stenosis,this peper hopes to enhance the clinician's understanding of treatment for the disease.%腰椎管狭窄症是困扰中老年人群的常见病、高发病,给家庭、社会、甚至国家造成沉重的负担。随着医学时代的发展,中医治疗该病已是多种多样,呈现百家齐放的景象。文章针对近几年来腰椎管狭窄症的中医治疗研究进展做一综述,希望能够增强临床医生对该疾病治疗的认识。

  20. Clinical potential and limitation of MRI for degenerative lumbar spinal diseases. Comparison of MRI, myelography, CT and selective nerve root infiltration

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Michihiro; Kikuchi, Shinichi [Fukushima Medical Coll. (Japan)

    1994-12-01

    To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.).

  1. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

    Science.gov (United States)

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-07-01

    Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

  2. Quality of life in preoperative patients with sacroiliac joint dysfunction is at least as depressed as in other lumbar spinal conditions

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-09-01

    Full Text Available Daniel Joseph Cher, W Carlton RecklingSI-BONE, Inc., San Jose, CA, USABackground: Pain from the sacroiliac joint (SIJ is an under-recognized cause of low back pain. The degree to which SIJ pain decreases quality of life has not been directly compared to other more familiar conditions of the lumbar spine.Methods: Multivariate regression analysis of individual patient data from two prospective multicenter clinical trials of SIJ fusion and three prospective multicenter clinical trials of surgical treatments for degenerative lumbar spine conditions.Results: Controlling for baseline demographic parameters as well as a validated disability score, quality of life scores (EuroQOL 5-D and SF-36 were, in most cases, lower in the SIJ cohorts compared to the three other spine surgery cohorts.Conclusion: Patients with SIJ dysfunction considering surgery have decrements in quality of life as or more severe compared to patients with degenerative spondylolisthesis, spinal stenosis, and intervertebral disc herniation.Keywords: spine surgery, disability, low back pain, sacroiliac joint pain, lumbar stenosis, intervertebral disc herniation, degenerative spondylolisthesis, sacroiliac joint fusion

  3. Androgen regulates development of the sexually dimorphic gastrin-releasing peptide neuron system in the lumbar spinal cord: evidence from a mouse line lacking androgen receptor in the nervous system.

    Science.gov (United States)

    Sakamoto, Hirotaka; Saito, Kazuhiro; Marie-Luce, Clarisse; Raskin, Kalina; Oti, Takumi; Satoh, Keita; Tamura, Kei; Sakamoto, Tatsuya; Mhaouty-Kodja, Sakina

    2014-01-13

    Androgens including testosterone, organize the nervous system as well as masculine external and internal genitalia during the perinatal period. Androgen organization involves promotion of masculine body features, usually by acting through androgen receptors (ARs). We have recently demonstrated that the gastrin-releasing peptide (GRP) system in the lumbar spinal cord also mediates spinal centers promoting penile reflexes during male sexual behavior in rats. Testosterone may induce sexual differentiation of this spinal GRP system during development and maintain its activation in adulthood. In the present study, we examined the role of ARs in the nervous system regulating the development of the sexually dimorphic GRP system. For this purpose, we used a conditional mouse line selectively lacking the AR gene in the nervous system. AR floxed males carrying (mutants) or not (controls) the nestin-Cre transgene were castrated in adulthood and supplemented with physiological amounts of testosterone. Loss of AR expression in the nervous system resulted in a significant decrease in the number of GRP neurons compared to control littermates. Consequently, the intensity of GRP axonal projections onto the lower lumbar and upper sacral spinal cord was greater in control males than in mutant males. These results suggest that ARs expressed in the nervous system play a significant role in the development of the GRP system in the male lumbar spinal cord. The AR-deletion mutation may attenuate sexual behavior and activity of mutant males via spinal GRP system-mediated neural mechanisms.

  4. Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    Full Text Available BACKGROUND: Dynamic interspinous spacers, such as X-stop, Coflex, DIAM, and Aperius, are widely used for the treatment of lumbar spinal stenosis. However, controversy remains as to whether dynamic interspinous spacer use is superior to traditional decompressive surgery. METHODS: Medline, Embase, Cochrane Library, and the Cochrane Controlled Trials Register were searched during August 2013. A track search was performed on February 27, 2014. Study was included in this review if it was: (1 a randomized controlled trial (RCT or non-randomized prospective comparison study, (2 comparing the clinical outcomes for interspinous spacer use versus traditional decompressive surgery, (3 in a minimum of 30 patients, (4 with a follow-up duration of at least 12 months. RESULTS: Two RCTs and three non-randomized prospective studies were included, with 204 patients in the interspinous spacer (IS group and 217 patients in the traditional decompressive surgery (TDS group. Pooled analysis showed no significant difference between the IS and TDS groups for low back pain (WMD: 1.2; 95% CI: -10.12, 12.53; P = 0.03; I2 = 66%, leg pain (WMD: 7.12; 95% CI: -3.88, 18.12; P = 0.02; I2 = 70%, ODI (WMD: 6.88; 95% CI: -14.92, 28.68; P = 0.03; I2 = 79%, RDQ (WMD: -1.30, 95% CI: -3.07, 0.47; P = 0.00; I2 = 0%, or complications (RR: 1.39; 95% CI: 0.61, 3.14; P = 0.23; I2 = 28%. The TDS group had a significantly lower incidence of reoperation (RR: 3.34; 95% CI: 1.77, 6.31; P = 0.60; I2 = 0%. CONCLUSION: Although patients may obtain some benefits from interspinous spacers implanted through a minimally invasive technique, interspinous spacer use is associated with a higher incidence of reoperation and higher cost. The indications, risks, and benefits of using an interspinous process device should be carefully considered before surgery.

  5. A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2006-02-01

    Full Text Available Abstract Background While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS, little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM and neural mobilization (NM. Methods This is a prospective consecutive case series with long term follow up (FU of fifty-seven consecutive patients who were diagnosed with LSS. Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM and pain intensity was measured using the Three Level Numerical Rating Scale (NRS. Patients were also asked to rate their perceived percentage improvement. Results The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in "on average" pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in "at worst" pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in "on average" pain intensity from baseline to long

  6. Delayed acute spinal cord injury following intracranial gunshot trauma: case report.

    Science.gov (United States)

    Cheng, Jason S; Richardson, R Mark; Gean, Alisa D; Stiver, Shirley I

    2012-04-01

    The authors report the case of a patient who presented with a hoarse voice and left hemiparesis following a gunshot injury with trajectory entering the left scapula, traversing the suboccipital bone, and coming to rest in the right lateral medullary cistern. Following recovery from the hemiparesis, abrupt quadriparesis occurred coincident with fall of the bullet into the anterior spinal canal. The bullet was retrieved following a C-2 and C-3 laminectomy, and postoperative MR imaging confirmed signal change in the cord at the level where the bullet had lodged. The patient then made a good neurological recovery. Bullets can fall from the posterior fossa with sufficient momentum to cause an acute spinal cord injury. Consideration for craniotomy and bullet retrieval should be given to large bullets lying in the CSF spaces of the posterior fossa as they pose risk for acute spinal cord injury.

  7. Mental function and morbidity after acute hip surgery during spinal and general anaesthesia.

    Science.gov (United States)

    Bigler, D; Adelhøj, B; Petring, O U; Pederson, N O; Busch, P; Kalhke, P

    1985-07-01

    Forty elderly patients (mean age 78.9 years) undergoing acute surgery for hip fracture were given at random either spinal analgesia with bupivacaine 0.75% or general anaesthesia with diazepam, fentanly and N2O/O2. Mental function was studied pre-operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups. Mortality and number of complications was similar in the two groups, but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group. No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation.

  8. Spinal manipulative therapy for acute low-back pain (Review)

    NARCIS (Netherlands)

    Rubinstein, S.M.; Terwee, C.B.; Assendelft, W.J.J.; Boer, M.R.M. de; Tulder, M.W. van

    2012-01-01

    BACKGROUND: Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practised intervention. This report is an update of the earlier Cochrane review, first published in January 2004 with the last search for studies up to J

  9. 胸腰椎爆裂骨折并术后功能训练对脊髓功能恢复的作用%Effect of functional exercises on spinal function recovery after thoracic and lumbar fracture operation

    Institute of Scientific and Technical Information of China (English)

    黄国忠; 韦敢; 苏士乐; 钟贵彬

    2003-01-01

    @@ INTRODUCTION Thoracic and lumbar vertebrae fracture accompanied with spinal cordinjury is rarely seen in clinics. Most of the scholars taken operation toreplace, to return normal volume of the vertebral cannal, to regen-erate stability of the spine and to promote early recovery of spine andrehabilitation[1], thus make a better clinical effects.

  10. Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis : a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

    NARCIS (Netherlands)

    den Boogert, Hugo F.; Keers, Joost C.; Oterdoom, D. L. Marinus; Kuijlen, Jos M. A.

    2015-01-01

    OBJECT The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two pop

  11. Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

    NARCIS (Netherlands)

    Boogert, H.F.; Keers, J.C.; Oterdoom, D.L. Marinus; Kuijlen, J.M.

    2015-01-01

    OBJECT The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two pop

  12. [Operative treatment of traumatic fractures of the thoracic and lumbar spinal column: Part III: Follow up data].

    Science.gov (United States)

    Reinhold, M; Knop, C; Beisse, R; Audigé, L; Kandziora, F; Pizanis, A; Pranzl, R; Gercek, E; Schultheiss, M; Weckbach, A; Bühren, V; Blauth, M

    2009-03-01

    In this third and final part, the Spine Study Group (AG WS) of the German Trauma Association (DGU) presents the follow-up (NU) data of its second, prospective, internet-based multicenter study (MCS II) for the treatment of thoracic and lumbar spinal injuries including 865 patients from 8 trauma centers. Part I described in detail the epidemiologic data of the patient collective and the subgroups, whereas part II analyzed the different methods of treatment and radiologic findings. The study period covered the years 2002 to 2006 including a 30-month follow-up period from 01.01.2004 until 31.05.2006. Follow-up data of 638 (74%) patients were collected with a new internet-based database system and analyzed. Results in part III will be presented on the basis of the same characteristic treatment subgroups (OP, KONS, PLASTIE) and surgical treatment subgroups (Dorsal, Ventral, Kombi) in consideration of the level of injury (thoracic spine, thoracolumbar junction, lumbar spine). After the initial treatment and discharge from hospital, the average duration of subsequent inpatient rehabilitation was 4 weeks, which lasted significantly longer in patients with persistent neurologic deficits (mean 10.9 weeks) or polytraumatized patients (mean 8.6 weeks). Following rehabilitation on an inpatient basis, subsequent outpatient rehabilitation lasted on average 4 months. Physical therapy was administered significantly longer to patients with neurologic deficits (mean 8.7 months) or type C injuries (mean 8.6 months). The level of injury had no influence of the duration of the inpatient or outpatient rehabilitation. A total of 382 (72.2%) patients who were either operated from posterior approach only or in a combined postero-anterior approach had an implant removal after an average 12 months. During the follow-up period 56 (8.8%) patients with complications were registered and of these 18 (2.8%) had to have surgical revision. The most common complications reported were infection, loss

  13. 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.)

  14. Do cranial subdural hematomas migrate to the lumbar spine?

    Science.gov (United States)

    Moscovici, S; Paldor, I; Ramirez de-Noriega, F; Itshayek, E; Shoshan, Y; Spektor, S; Attia, M

    2011-04-01

    We report a patient with minor head trauma-related bilateral hemispheric subdural hematoma (SDH) and subsequent delayed spinal SDH or presumed migration to the lumbar spine. An acutely confused 88-year-old man presented to the Emergency Department after minor head trauma. Head CT scan revealed a small hemispheric SDH. The patient was admitted for observation. CT scan 6 hours later showed bilateral SDH with extension to the tentorium. Three days later SDH had resolved leaving bilateral subdural hygromas. Local leg weakness localized to the lumbar spine developed on day 6; spinal CT scan and MRI revealed a posterior L5-S1 collection. A pure subacute subdural hematoma compressing the cauda equina was drained after an L5 laminectomy. His lower leg weakness improved. The patient was discharged to rehabilitation two weeks after surgery. Patients with traumatic SDH who develop late-onset neurological deterioration attributable to any region of the spine should be evaluated for spinal SDH.

  15. Effect of spinal decompression on the lumbar muscle activity and disk height in patients with herniated intervertebral disk

    OpenAIRE

    Kang, Jeong-il; Jeong, Dae-Keun; Choi, Hyun

    2016-01-01

    [Purpose] This study was conducted to clarify the difference in therapeutic effects between traction and decompression therapies, and their clinical therapeutic significance. [Subjects and Methods] The subjects were 31 patients aged 35 to 50 years who had unilateral or bilateral lumbar and radicular leg pain. An intervention program was implemented in 31 patients with lumbar herniated intervertebral disks. For the experimental group, 15 subjects were randomly selected to receive decompression...

  16. Methylprednisolone– acute spinal cord injury, benefits or risks? 

    Directory of Open Access Journals (Sweden)

    Maciej Tęsiorowski

    2013-06-01

    Full Text Available Methylprednisolone is a synthetic glucocorticoid with a potent and long-acting anti-inflammatory, antiallergic and immunosuppressant. Its mechanism of action of methylprednisolone is the result of many cellular changes. Methylprednisolone is used in many diseases, such as rheumatic diseases, autoimmune diseases, allergic, anaphylactic shock, asthma. Methylprednisolone was also used in patients with spinal cord injury, in order to minimize neurological damage. While in the above mentioned fields of medicine is undeniable role of methylprednisolone, whereas its use in the treatment of traumatic spinal cord injury within the last few years raises a lot of controversy, and in most cases, the side effects of its use outweigh the potential benefits. 

  17. Repair of acutely injured spinal cord through constructing tissue-engineered neural complex in adult rats

    Institute of Scientific and Technical Information of China (English)

    PU Yu; GUO Qing-shan; WANG Ai-min; WU Si-yu; XING Shu-xing; ZHANG Zhong-rong

    2007-01-01

    Objective: To construct tissue-engineered neural complex in vitro and study its effect in repairing acutely injured spinal cord in adult rats. Methods: Neural stem cells were harvested from the spinal cord of embryo rats and propagated in vitro. Then the neural stem cells were seeded into polyglycolic acid scaffolds and co-cultured with extract of embryonic spinal cord in vitro. Immunofluorescence histochemistry and scanning electron microscope were used to observe the microstructure of this complex. Animal model of spine semi-transection was made and tissue-engineered neural complex was implanted by surgical intervention. Six weeks after transplantation, functional evaluation and histochemistry were applied to evaluate the functional recovery and anatomic reconstruction. Results: The tissue-engineered neural complex had a distinct structure, which contained neonatal neurons, oligodendrocytes and astrocytes. After tissue-engineered neural complex was implanted into the injured spinal cord, the cell components such as neurons, astrocytes and oligodendrocytes, could survive and keep on developing. The adult rats suffering from spinal cord injury got an obvious neurological recovery in motor skills. Conclusions: The tissue-engineered neural complex appears to have therapeutic effects on the functional recovery and anatomic reconstruction of the adult rats with spinal cord injury.

  18. Evidence-based approach to use of MR imaging in acute spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Wendy A. E-mail: wcohen@u.washington.edu; Giauque, Anthony P.; Hallam, Danial K.; Linnau, Ken F.; Mann, F.A

    2003-10-01

    MR imaging directly shows integrity of spinal cord, and provides sensitive assessments of structurally important soft tissue investments of the vertebral column. High-resolution images should be acquired in at least two planes, with T1 and fluid sensitive sequences. In the acute and subacute settings, MR may be used to assess integrity of intervertebral discs prior to closed reduction of inter-facetal dislocations, to discriminate between neurological deficits due to intra-substance hemorrhage or edema, and to determine the status of spinal ligaments as an adjunct to 'clearing' the spine.

  19. Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

    DEFF Research Database (Denmark)

    Malmqvist, L; Biering-Sørensen, T; Bartholdy, K;

    2015-01-01

    OBJECTIVES: Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate...... variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI. METHODS: As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring...

  20. Lumbar Spinal Canal Stenosis

    Science.gov (United States)

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  1. X-ray signs of traumas of the cervical region of the spinal cord in the acute period

    Energy Technology Data Exchange (ETDEWEB)

    Brodskaya, Z.L. (Inst. Usovershenstvovaniya Vrachej, Novokuznetsk (USSR))

    The results are analyzed of an X-ray examination of 208 patients with traumas of the cervical region of the spinal column and spinal cord in the acute period of trauma. The authors proposed a scheme that included telespondylography in standard and oblique projections, flebospondylography, discography and pneumomyelography in the Schantz collar with a patient lying on the back. Four types of the spinal cord traumas were diagnosed: compression with osseous elements (76.92%), with sharp discs and strained epidural hematomas (3.85%), isolated contusion of the spinal cord (10.1%) and disorder of the spinal circulation (9.13%). Special emphasis was laid on clinicospondylographic correlations, a critical distance, congenital narrowing of the vertebral canal. The concept of traumatic decompression of the spinal cord was stressed. Symptoms of its contusion and trauma of the spinal circulation were indicated.

  2. The use of spinal manipulation to treat an acute on field athletic injury: a case report

    Science.gov (United States)

    Duquette, Sean A.; Kazemi, Mohsen

    2016-01-01

    This case describes the utilization of spinal manipulative therapy for an acute athletic injury during a Taekwondo competition. During the tournament, an athlete had a sudden, non-traumatic, ballistic movement of the cervical spine. This resulted in the patient having a locked cervical spine with limited active motion in all directions. The attending chiropractor assessed the athlete, and deemed manipulation was appropriate. After the manipulation, the athlete’s range of motion was returned and was able to finish the match. Spinal manipulation has multiple positive outcomes for an athlete with an acute injury including the increase of range of motion, decrease in pain and the relaxation of hypertonic muscles. However, there should be some caution when utilizing manipulation during an event. In the article the authors propose four criteria that should be met before utilizing manipulation for an acute, in competition, athletic injury. These include the lack of red flags, limited time for the intervention, preexisting doctor-patient relationship and the athlete has experience receiving spinal manipulation. Clinicians should be aware that manipulation may be an effective tool to treat an acute in competition athletic injury. The criteria set out in the article may help a practitioner decide if manipulation is a good option for them. PMID:27385835

  3. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population

    Directory of Open Access Journals (Sweden)

    Jarvik Jeffrey G

    2011-09-01

    Full Text Available Abstract Background- Prior studies that have concluded that disk degeneration uniformly precedes facet degeneration have been based on convenience samples of individuals with low back pain. We conducted a study to examine whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observations of degeneration in a community-based population. Methods- 361 participants from the Framingham Heart Study were included in this study. The prevalences of anterior vertebral structure degeneration (disk height loss and posterior vertebral structure degeneration (facet joint osteoarthritis were characterized by CT imaging. The cohort was divided into the structural subgroups of participants with 1 no degeneration, 2 isolated anterior degeneration (without posterior degeneration, 3 combined anterior and posterior degeneration, and 4 isolated posterior degeneration (without anterior structure degeneration. We determined the prevalence of each degeneration pattern by age group Results- As the prevalence of the no degeneration and isolated anterior degeneration patterns decreased with increasing age group, the prevalence of the combined anterior/posterior degeneration pattern increased. 22% of individuals demonstrated isolated posterior degeneration, without an increase in prevalence by age group. Isolated posterior degeneration was most common at the L5-S1 and L4-L5 spinal levels. In multivariate analyses, disk height loss was independently associated with facet joint osteoarthritis, as were increased age (years, female sex, and increased BMI (kg/m2, but not smoking. Conclusions- The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures, for the majority of individuals. However, some individuals demonstrate atypical patterns of degeneration, beginning in the posterior joints. Increased age and BMI

  4. Effects of modified bridging exercises on static postural control of a poststroke hemiplegic patient who had received surgery for lumbar spinal stenosis: a case report.

    Science.gov (United States)

    Kim, Young-Dong

    2015-04-01

    [Purpose] This study investigated the efficacy on postural control of a bridging exercise in order to suggest a pertinent procedure for the bridging exercise. [Subject] One poststroke hemiplegic patient who had received surgery for lumbar spinal stenosis participated in this study [Methods] A reverse ABAB single-case experimental design was used. To assess postural control, foot pressure and the stability limit test were evalulated once a week a total of 4 times during the intervention period. [Results] Noticeable improvement in the distribution of foot pressure and increased stability limit were shown after performing the bridging exercise supervised by a physical therapist. [Conclusion] Bridging exercise on a plinth is effective at balancing body weight-bearing and resulted in the patient putting her weight on both feet evenly and in both the anterior and posterior directions.

  5. The effects of aquatic walking and jogging program on physical function and fall efficacy in patients with degenerative lumbar spinal stenosis.

    Science.gov (United States)

    Lee, Jae-Hyun; Sung, Eunsook

    2015-10-01

    The purpose of this study was to evaluate the effects of 12-week aqua walking and jogging program on muscle function, ankle range of motion (ROM), balance and fell efficacy in degenerative lumbar spinal stenosis (DLSS) patients. Six patients (2 males, 4 females) with DLSS participated in aquatic exercise program 3 times per week with each session of 60 min (warming-up, aqua walking, aqua jogging and cool down) at 1 m 20 cm-1 m 30 cm deep pool. Janda's muscle function test, ankle ROM, Berg balance scale (BBS) and fall efficacy scale (FES) were analyzed before and after the training intervention. We found significant increases in balance, muscle function, ankle ROM and fall efficacy after training intervention. In conclusion, aquatic exercise seems to affect physical function and fall efficacy positively in elderly DLSS patients.

  6. 腰椎管狭窄症术后感染及危险因素分析%Related risk factors for postoperative infections of lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    杨林; 海涌; 周君琳; 曲铁兵

    2011-01-01

    目的 分析腰椎管狭窄症术后感染的危险因素,为临床合理使用抗菌药物和控制医院感染提供科学依据.方法 采用前瞻性监测和回顾性调查相结合的方法,对2009年1月-2010年12月入住骨科的206例腰椎管狭窄症患者临床资料进行统计分析.结果 腰椎管狭窄症术后感染发生率为3.4%,其中上呼吸道感染占42.9%,肺部感染占57.1%,伴有伤口局部感染占42.9%;病原菌以革兰阴性菌为主,占57.1%,其次是革兰阳性菌,占42.9%,且对多种抗菌药物有不同程度的耐药性.结论认真施行无菌操作,严格掌握手术适应证,熟练进行手术操作,尽可能缩短手术时间,加强环境管理和感染监控,合理使用抗菌药物,积极治疗基础疾病,对降低腰椎管狭窄症术后感染具有重要意义.%OBJECTIVE To analyze the risk factors of postoperative infection in the lumbar spinal stenosis, to provide the scientific bases for clinical reasonable use of antiseptic medcine and controlling hospital infection.METHODS A prospective study combining with retrospective investigation method were carried out. The clinical data of 206 patients with lumbar spinal stenosis were analyzed at orthopaedic department from Jan 2009 to Dec 2010. RESULTS Lumbar spinal stenosis postoperative infection rate was 3.40%. And respiratory infections rate was 42. 9%, and pulmonary infections rate was 57. 1%, complicated wound local infection rate accounted for 42.9%. Pathogens mostly were Gram-negative bacteria, accounting for 57. 1%, followed by Gram-positive bacteria, accounting for 42.9 %, and some degree of antibiotic resistance existed. CONCLUSION Strictly abiding by sterile rules, mastering operational indication,improving relative skill, shorting operation time, strengthening environmental management and infection monitoring, the correctly use of antibiotic medicine, actively treating underlying diseases have great significance for reducing postoperative

  7. Comparing the effects of epidural methylprednisolone acetate injected in patients with pain due to lumbar spinal stenosis or herniated disks: a prospective study

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    Gharibi F

    2011-12-01

    Full Text Available Jafar Mobaleghi1, Faramarz Allahdini2, Karim Nasseri3, Behzad Ahsan3, Shoaleh Shami4, Mansour Faizi5, Fardin Gharibi51Department of Surgery, 2Department of Neurosurgery, 3Department of Anesthesia, 4Faculty of Nursing, 5Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, IranObjective: Satisfactory results have been seen with epidural steroid injections (ESI in patients with herniated disks (HD, but the role in lumbar spinal stenosis (LSS has been less investigated. We compared long-term effects of ESI in HD and LSS patients.Methods: In a prospective, single-blind uncontrolled study, 60 patients with radicular pain due to HD (n = 32 or LSS (n = 28 were enrolled over a 9-month period. Methylprednisolone acetate 80 mg plus 0.5% bupivacaine 10 mg were diluted in normal saline up to a total volume of 10 mL, and injected into the epidural space. The amount of pain based on numeric pain score, level of activity, and subjective improvement were reported by patients after 2 and 6 months by telephone. Demographic data were analyzed with the chi-square test. The differences in numeric pain scale scores between the two groups at different times were analyzed with the t-test.Results: There were no differences between HD and LSS patients regarding age, sex, and average duration of pain prior to ESI. The degree of pain was significantly higher in LSS patients in comparison with HD patients in the pre-injection period. The amount of pain was significantly reduced in both groups 2 months after injection. This pain reduction period lasted for 6 months in the HD group, but to a lesser extent in LSS patients (P < 0.05.Discussion: Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.Keywords: methylprednisolone acetate, lumbar spinal stenosis, herniated disk

  8. Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience

    Science.gov (United States)

    2015-10-01

    AWARD NUMBER: W81XWH-14-1-0618 TITLE: Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury...Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience 5a. CONTRACT NUMBER...military and veterans. All persons with SCI are at increased risk of pressure ulcer development which remains one of the most significant secondary

  9. Validation of the cat as a model for the human lumbar spine during simulated high-velocity, low-amplitude spinal manipulation.

    Science.gov (United States)

    Ianuzzi, Allyson; Pickar, Joel G; Khalsa, Partap S

    2010-07-01

    High-velocity, low-amplitude spinal manipulation (HVLA-SM) is an efficacious treatment for low back pain, although the physiological mechanisms underlying its effects remain elusive. The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and it has been theorized that the neurophysiological benefits of HVLA-SM are partially induced by stimulation of FJC neurons. Biomechanical aspects of this theory have been investigated in humans while neurophysiological aspects have been investigated using cat models. The purpose of this study was to determine the relationship between human and cat lumbar spines during HVLA-SM. Cat lumbar spine specimens were mechanically tested, using a displacement-controlled apparatus, during simulated HVLA-SM applied at L5, L6, and L7 that produced preload forces of approximately 25% bodyweight for 0.5 s and peak forces that rose to 50-100% bodyweight within approximately 125 ms, similar to that delivered clinically. Joint kinematics and FJC strain were measured optically. Human FJC strain and kinematics data were taken from a prior study. Regression models were established for FJC strain magnitudes as functions of factors species, manipulation site, and interactions thereof. During simulated HVLA-SM, joint kinematics in cat spines were greater in magnitude compared with humans. Similar to human spines, site-specific HVLA-SM produced regional cat FJC strains at distant motion segments. Joint motions and FJC strain magnitudes for cat spines were larger than those for human spine specimens. Regression relationships demonstrated that species, HVLA-SM site, and interactions thereof were significantly and moderately well correlated for HVLA-SM that generated tensile strain in the FJC. The relationships established in the current study can be used in future neurophysiological studies conducted in cats to extrapolate how human FJC afferents might respond to HVLA-SM. The data from the current study warrant further

  10. Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction.

    Science.gov (United States)

    Platz, Thomas; Gillner, Annett; Borgwaldt, Nicole; Kroll, Sylvia; Roschka, Sybille

    2016-01-01

    Objective. Results of a device-training for nonambulatory individuals with thoracic and lumbar spinal cord injury (SCI) using a powered exoskeleton for technically assisted mobility with regard to the achieved level of control of the system after training, user satisfaction, and effects on quality of life (QoL). Methods. Observational single centre study with a 4-week to 5-week intensive inpatient device-training using a powered exoskeleton (ReWalk™). Results. All 7 individuals with SCI who commenced the device-training completed the course of training and achieved basic competences to use the system, that is, the ability to stand up, sit down, keep balance while standing, and walk indoors, at least with a close contact guard. User satisfaction with the system and device-training was documented for several aspects. The quality of life evaluation (SF-12v2™) indicated that the use of the powered exoskeleton can have positive effects on the perception of individuals with SCI regarding what they can achieve physically. Few adverse events were observed: minor skin lesions and irritations were observed; no falls occurred. Conclusions. The device-training for individuals with thoracic and lumbar SCI was effective and safe. All trained individuals achieved technically assisted mobility with the exoskeleton while still needing a close contact guard.

  11. The Neuroprotective Effect of Puerarin in Acute Spinal Cord Injury Rats

    Directory of Open Access Journals (Sweden)

    Dapeng Zhang

    2016-08-01

    Full Text Available Background: Acute spinal cord injury (SCI leads to permanent disabilities. This study evaluated the neuroprotective effect of puerarin, a natural extract, in a rat model of SCI. Methods: Acute SCI models were established in rats using a modified Allen's method. Locomotor function was evaluated using the BBB test. The histological changes in the spinal cord were observed by H&E staining. Neuron survival and glial cells activation were evaluated by immunostaining. ELISA and realtime PCR were used to measure secretion and gene expression of cytokines. TUNEL staining was used to examine cell apoptosis and western blot analysis was used to detect protein expression. Results: Puerarin significantly increased BBB score in SCI rats, attenuated histological injury of spinal cord, decreased neuron loss, inhibited glial cells activation, alleviated inflammation, and inhibited cell apoptosis in the injured spinal cords. In addition, the downregulated PI3K and phospho-Akt protein expression were restored by puerarin. Conclusion: Puerarin accelerated locomotor function recovery and tissue repair of SCI rats, which is associated with its neuroprotection, glial cell activation suppression, anti-inflammatory and anti-apoptosis effects. These effects may be associated with the activation of PI3K/Akt signaling pathway.

  12. A modified collagen scaffold facilitates endogenous neurogenesis for acute spinal cord injury repair.

    Science.gov (United States)

    Fan, Caixia; Li, Xing; Xiao, Zhifeng; Zhao, Yannan; Liang, Hui; Wang, Bin; Han, Sufang; Li, Xiaoran; Xu, Bai; Wang, Nuo; Liu, Sumei; Xue, Weiwei; Dai, Jianwu

    2017-03-15

    Due to irreversible neuronal loss and glial scar deposition, spinal cord injury (SCI) ultimately results in permanent neurological dysfunction. Neuronal regeneration of neural stem cells (NSCs) residing in the spinal cord could be an ideal strategy for replenishing the lost neurons and restore function. However, many myelin-associated inhibitors in the SCI microenvironment limit the ability of spinal cord NSCs to regenerate into neurons. Here, a linearly ordered collagen scaffold was used to prevent scar deposition, guide nerve regeneration and carry drugs to neutralize the inhibitory molecules. A collagen-binding EGFR antibody Fab fragment, CBD-Fab, was constructed to neutralize the myelin inhibitory molecules, which was demonstrated to promote neuronal differentiation and neurite outgrowth under myelin in vitro. This fragment could also specifically bind to the collagen and undergo sustained release from collagen scaffold. Then, the scaffolds modified with CBD-Fab were transplanted into an acute rat SCI model. The robust neurogenesis of endogenous injury-activated NSCs was observed, and these NSCs could not only differentiate into neurons but further mature into functional neurons to reconnect the injured gap. The results indicated that the modified collagen scaffold could be an ideal candidate for spinal cord regeneration after acute SCI.

  13. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices

    DEFF Research Database (Denmark)

    Damgaard, Morten; Nimb, Lars; Madsen, Jan L

    2010-01-01

    PURPOSE: It is difficult to evaluate the stability of the lumbar spondylodesis with metallic fixation devices by conventional imaging methods such as radiography or magnetic resonance imaging. It is unknown whether single photon emission computed tomography/computed tomography (SPECT/CT) may be u...

  14. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices

    DEFF Research Database (Denmark)

    Damgaard, Morten; Nimb, Lars; Madsen, Jan L

    2010-01-01

    PURPOSE: It is difficult to evaluate the stability of the lumbar spondylodesis with metallic fixation devices by conventional imaging methods such as radiography or magnetic resonance imaging. It is unknown whether single photon emission computed tomography/computed tomography (SPECT/CT) may...

  15. Acute paraplegia following embolization of spinal dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    HUANG Cheng-guang; QI Xiang-qian; CHEN Huai-rui; L(U) Li-quan; WU Xiao-jun; BAI Ru-lin; LU Yi-cheng

    2011-01-01

    Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

  16. Acute paraplegia in a patient with spinal tophi: a case report.

    Science.gov (United States)

    Wang, L C; Hung, Y C; Lee, E J; Chen, H H

    2001-03-01

    A 28-year-old man with a 5-year history of gouty arthritis suffered from an acute episode of lower back pain. He visited a rehabilitative clinic and received physical therapy following his examination. Weakness and numbness of both lower legs developed rapidly after physical therapy. He was sent to our hospital with complete paralysis of both lower limbs and complete sensory loss below the umbilicus 3 hours after the physical therapy. No peripheral tophi were found. Myelography showed an extrinsic compression of the dura sac at T10. Emergency decompressive laminectomy of T9 to T11 was performed. During the surgery, caseous material was found deposited in the ligamentum flavum and the left T9 to T10 facet joint, with indentation of the dura sac. The pathologic diagnosis was spinal tophi. After surgery, the patient's neurologic function recovered rapidly. It was suspected that inappropriate physical therapy might have aggravated acute inflammation of spinal gout and resulted in a rapid deterioration of neurologic function. Though gout is a chronic medical disease, an acute attack of spinal gout may be disastrous and requires emergency neurosurgical intervention.

  17. Transitional cell carcinoma of urinary bladder with metastasis in lumbar vertebrae and spinal cord compression in an ocelot(Leopardus pardalis

    Directory of Open Access Journals (Sweden)

    Karen Y.R. Nakagaki

    2015-01-01

    Full Text Available This paper reports a case of nonpapillary and infiltrative transitional cell carcinoma (TCC of the urinary bladder with metastasis of lumbar vertebrae and spinal cord compression in an adult female ocelot (Leopardus pardalis, from the Mato Grosso state, Brazil. The ocelot had pelvic limb paralysis and skin ulcers in the posterior region of the body and was submitted to euthanasia procedure. At necropsy was observed a multilobulated and irregular shaped, yellowish to white nodule in the urinary bladder. The nodule had a soft consistency and arised from the mucosa of the urinary bladder extending throughout the muscular layers and the serosa. Nodules of similar appearance infiltrating the vertebral column the at L6 and L7 vertebrae with corresponding spinal canal invasion were also observed. The histological evaluation showed epithelial neoplastic proliferation in the urinary bladder with characteristics of nonpapillary and infiltrative TCC, with positive immunohistochemical staining for pancytokeratin, and strong immunostaining for cytokeratin of low molecular weight, and weak or absent labeling for high molecular weight cytokeratin. This is the first report of TCC of urinary bladder in ocelot in Brazil.

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

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    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

  19. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

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    Meng H

    2015-08-01

    Full Text Available Hai Meng, Qi Fei, Bingqiang Wang, Yong Yang, Dong Li, Jinjun Li, Nan Su Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China Background: Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone.Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies.Results: We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50% was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1 and in 56.4% of those administered with local anesthetic alone (group 2. Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups.Conclusion: Both epidural injections with

  20. Exercise pressor reflex function following acute hemi-section of the spinal cord in cats

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    Megan N Murphy

    2013-02-01

    Full Text Available Cardiovascular disease is a leading cause of morbidity and mortality in patients post spinal cord injury (SCI. The prescription of exercise as a therapeutic modality for disease prevention in this population is promising. It is logical to suggest that the sooner an exercise program can begin the more benefit the patient will receive from the therapy. However, the time point after injury at which the requisite circulatory responses needed to support exercise are viable remains largely unknown. The skeletal muscle exercise pressor reflex (EPR significantly contributes to cardiovascular control during exercise in healthy individuals. Experiments in patients with a chronic lateral hemi-section of the spinal cord (Brown-Séquard syndrome suggest that the EPR, although blunted, is operational when examined months to years post injury. However, whether this critically important reflex remains functional immediately after lateral SCI or, in contrast, experiences a period of reduced capacity due to spinal shock has not been established. This study was designed to assess EPR function after acute lateral transection of the spinal cord. The EPR was selectively activated in seven decerebrate cats via electrically stimulated static contraction of the triceps surae muscles of each hindlimb before and after lateral hemi-section of the T13-L2 region of the spinal cord. Compared to responses prior to injury, increases in mean arterial pressure (MAP were significantly decreased when contracting the hindlimb either ipsilateral to the lesion (MAP = 17±3 mmHg before and 9±2 mmHg after or contralateral to the lesion (MAP = 22±5 mmHg before and 12±4 mmHg after. The HR response to stimulation of the EPR was largely unaffected by induction of acute SCI. The findings suggest that the EPR maintains the ability to importantly contribute to cardiovascular regulation during exercise immediately following a Brown-Séquard-like injury.

  1. Ependymal cell proliferation and apoptosis following acute spinal cord injury in the adult rat

    Institute of Scientific and Technical Information of China (English)

    Xu Wang; Jun Qian; Yanchao Ma; Guoxin Nan; Shuanke Wang; Yayi Xia; Youcheng Zhang

    2008-01-01

    BACKGROUND: Studies have reported that spinal cord injury can induce the reactive proliferation of ependymal cells and secondarily cause the apoptosis of nerve cells. However, there is no generally accepted theory on the apoptotic characteristics of ependymal cells in the injured spinal cord.OBJECTIVE: To observe the reactive proliferation and apoptosis of ependymal cells in adult rats following acute spinal cord injury.DESIGN, TIME AND SETTING: A randomized control study based on neuropathology was performed in the Third Military Medical University of Chinese PLA between 2005 and 2007.MATERIALS: Forty healthy, adult, Wistar rats were included in the present study.METHODS: Moderate spinal cord injury was established in twenty rats using Feeney's method, while the remaining 20 rats served as controls and were only treated with laminectomy. All rats were injected intraperitoneally with 1.25 mL of BrdU solution (10 mg BrdU/mL saline) 3 times at 4 hours intervals during the 12 hours prior to sacrifice.MAIN OUTCOME MEASURES: Ependymal cell proliferation and apoptosis in the rat spinal cord were determined by BrdU and nestin immunofluorescence double-labeling, as well as the TUNEL method, at 1, 3, 7, and 14 days after operation.RESULTS: In the moderate spinal cord injury rats, nestin expression was observed in the cytoplasm of ependymal cells. One day immediately following surgery, ependymal cells were BrdU-labeled. The number of BrdU-positive cells increased at 3 days, reached a peak at 7 days, and gradually reduced thereafter. The ependyma developed ti'om a constitutive monolayer cells to a multi-layer cell complex. Some BrdU/Nestin double-positive ependymal cells migrated out from the ependyma. TUNEL-positive cells were also detected in the ependyma in the central region, as well as ischemic regions of the injured spinal cord. In addition, TUNEL-positive cells were visible in the ependyma. No TUNEL-positive ependymal cells were observed in the normal spinal cord

  2. THE RATE OF ACUTE SPINAL CORD INJURY IN TASHKENT CITY BETWEEN 2005-2012 YEARS

    Directory of Open Access Journals (Sweden)

    Rukhulla Zabikhullaevich Khikmatullaev

    2014-11-01

    Full Text Available Objective: to analyze main clinical-statistical indices of spine and spinal cord injuries (SCI and system of organization of medical aid to the victims. We conducted a cohort retrospective study of materials of medical institutions of Tashkent city. Medical records of patients and records of forensic examinations were analyzed. 242 cases of spinal cord injuries were studied. Over the last 10 years in Tashkent the frequency of SCI have been tend to increase, males and working-age people are dominated. In 60.9% of cases the injury was associated, in 36.2% - isolated, and in 2.9% - combined. Fallings from height and road traffic accidents were the main reasons for getting SCI. Lesions at cervical level registered in 45% of cases, thoracic level - 27.3%, at lumbar level - 27.7%, respectively. According to ASIA/IMSOP, full injuries were noted in 40.1% of cases, incomplete injures were in 59.9%. Overall mortality from SCI was 68.6%. Thus, for the first time this study allowed to get in detail the clinical and statistical indicators of SCI in the region.

  3. Medida da área do canal vertebral lombar em diferentes faixas etárias Medida de la superficie del canal vertebral lumbar en los diferentes grupos de edad Lumbar spinal canal area in different age groups

    Directory of Open Access Journals (Sweden)

    Jair Ortiz

    2009-03-01

    rango de edad fue 0,258 y para el sexo de 0,062; en el caso de la L5, el "p-value" para el rango de edad fue 0,279 y el sexo de 0,003. CONCLUSIÓN: no hay diferencia en el ámbito de la canal vertebral lumbar entre los grupos de edad analizados, pero hay diferencias entre los sexos, siendo mayor en los hombres.OBJECTIVE: to measure the lumbar spinal canal area, using computerized tomography, compare different age groups and determine if there are differences between those. METHODS: the lumbar spinal canal area was measured in 78 individuals, divided in eight age groups, with data obtained from computerized tomography scans of the abdomen. The measurements were made at L1, L3 and L5 levels at the transpedicular section. RESULTS: the values for L1 produced a p-value of 0,586 for the age group and a p-value of 0,003 for sex. Therefore, we can say that there is no evidence of differences among age rage groups, but shows evidence of difference for sex being larger in males. For L3, the p-value of age rage was 0,258, and the value for sex was 0,062. For L5, the p-value for the age range was 0279, and the value for sex was 0,003. CONCLUSION: there is no difference of spinal canal area between the age groups, but there is difference for the sex being larger in males.

  4. Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase.

    Science.gov (United States)

    Wray, Steven; Mimran, Ronnie; Vadapalli, Sasidhar; Shetye, Snehal S; McGilvray, Kirk C; Puttlitz, Christian M

    2015-05-01

    OBJECT Low bone mineral density in patients undergoing lumbar spinal surgery with screws is an especially difficult challenge because poor bone quality can severely compromise the maximum achievable purchase of the screws. A relatively new technique, the cortical bone screw trajectory, utilizes a medialized trajectory in the caudocephalad direction to engage a greater amount of cortical bone within the pars interarticularis and pedicle. The objectives of this cadaveric biomechanical study were to 1) evaluate a cortical screw system and compare its mechanical performance to the traditional pedicle screw system; 2) determine differences in bone quality associated with the cortical screw trajectory versus the normal pedicle screw insertion technique; 3) determine the cortical wall breach rate with both the cortical and traditional screw trajectories; and 4) determine the performance of the traditional screw in the cortical screw trajectory. METHODS Fourteen fresh frozen human lumbar spine sections (L1-5) were used in this study (mean age 57 ± 19 years). The experimental plan involved drilling and tapping screw holes for 2 trajectories under navigation (a traditional pedicle screw and a cortical screw) in both high-and low-quality vertebrae, measuring the bone quality associated with these trajectories, placing screws in the trajectories, and evaluating the competence of the screw purchase via 2 mechanical tests (pullout and toggle). The 3 experimental variants were 1) traditional pedicle screws placed in the traditional pedicle screw trajectory, 2) traditional pedicle screws placed in the cortical screw trajectory, and 3) cortical screws placed in the cortical screw trajectory. RESULTS A statistically significant increase in bone quality was observed for the cortical trajectories with a cortical screw (42%; p parameter comparisons (screw type and trajectory) between high-quality and lowquality samples were significant (p parameters determined from pullout and toggle

  5. A method for unit recording in the lumbar spinal cord during locomotion of the conscious adult rat

    DEFF Research Database (Denmark)

    Berg, Rune W; Chen, Ming-Teh; Huang, Hsueh-Chen;

    2009-01-01

    Extracellular recordings from single units in the brain, for example the neocortex, have proven feasible in moving, awake rats, but have not yet been possible in the spinal cord. Single-unit activity during locomotor-like activity in reduced preparations from adult cats and rats have provided...

  6. Haemodynamic collapse in a patient with acute inferior myocardial infarction and concomitant traumatic acute spinal cord injury.

    Science.gov (United States)

    Kumagai, Naoto; Dohi, Kaoru; Tanigawa, Takashi; Ito, Masaaki

    2013-11-22

    A 71-year-old man suddenly collapsed and went into cardiopulmonary arrest. The cardiopulmonary resuscitation attempt succeeded in restoration of spontaneous circulation. The initial 12-lead electrocardiogram showed inferior acute myocardial infarction (AMI). The patient was initially diagnosed as having cardiogenic shock associated with inferior AMI. In spite of early coronary revascularisation, bradycardia and hypotension were sustained. After termination of sedation and extubation, he was found to have a quadriplegia and diagnosed with a cervical spinal cord injury (SCI). Therefore, the patient was finally diagnosed with neurogenic shock caused by acute cervical SCI due to the traumatic injury preceded by loss of consciousness complicating inferior AMI. We should recognise that SCI has unique haemodynamic features that mimic those associated with inferior AMI, but requires very different treatment.

  7. Multiple spinal extradural meningeal cysts presenting as acute paraplegia. Case report and review of the literature.

    Science.gov (United States)

    Marbacher, Serge; Barth, Alain; Arnold, Marlene; Seiler, Rolf W

    2007-05-01

    Multiple spinal extradural meningeal cysts are rare. To the authors' knowledge, there have been only four reported cases in the world literature. The authors report a case of multiple spinal extradural meningeal cysts in a 31-year-old woman presenting with acute paraplegia. Magnetic resonance imaging of the thoracolumbar spine revealed multiple extradural cystic lesions extending from T-7 to T-8 and from T-12 to L-3. Intraoperative findings demonstrated a white, fibrous, and tense cyst filled with cerebrospinal fluid-like colorless fluid. Excision of the posterior wall of the symptomatic cyst was followed by immediate neurological improvement. The examination of the pathological specimen showed a thick duralike layer of collagen and an inner membrane of arachnoid that is often not found in these lesions. The final diagnosis was based on combined imaging, intraoperative, and histopathological findings. The authors review the literature and discuss the etiological, diagnostic, and therapeutic aspects of this lesion.

  8. Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series

    Directory of Open Access Journals (Sweden)

    Muhammad Babar Khan

    2014-01-01

    Full Text Available Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia. Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS and Oswestry Disability Index (ODI scores. Results: Five patients had interlaminar decompressions for stenosis alone, while two patients had laminectomies for debulking of tumors. The mean duration of surgery was 79.8 ± 16.6 min, the mean estimated blood loss was 157.1 ± 53.4 ml, the mean dose of local anesthetic was 1.9 ± 0.7 mg/kg, and the mean length of hospital stay after surgery was 3.2 ± 1.2 days. There were no intraoperative complications. The surgery resulted in improved VAS and ODI scores consistent with significant improvement in pain (P = 0.017 and functionality (P = 0.011. Conclusions: Performing spinal surgery under local anesthesia is a safe and effective alternative when patient′s major comorbidities preclude a general anesthetic. For all the seven patients studied, spinal surgery, performed under a local anesthetic, resulted in a statistically significant reduction in pain and improvement in function.

  9. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion.

    Science.gov (United States)

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Yang, Sidong; Wang, Yanhong; Wang, Qian; Zhang, Feng; Ding, Wenyuan

    2016-08-01

    The aim of this study was to identify the prevalence of proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS) following long instrumented posterior spinal fusion, and to search for predictable risk factors for the progression of junctional kyphosis.In total 98 DLS patients with a minimum 2-year follow-up were reviewed prospectively. According to the occurrence of PJK at the last follow-up, patients were divided into 2 groups: PJK group and non-PJK group. To investigate risk values for the progression of PJK, 3 categorized factors were analyzed statistically: patient characteristics-preoperative data of age, sex, body mass index (BMI), bone mineral density (BMD) were investigated; surgical variables-the most proximal and distal levels of the instrumentation, the number of instrumented levels; pre- and postoperative radiographic parameters include the scoliotic angle, sagittal vertical axis, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope.PJK was developed in 17 of 98 patients (17.3%) until to the final follow-up and were enrolled as the PJK group, and 81 patients without PJK at final follow-up were enrolled as the non-PJK group. There was no statistically significant difference between the 2 groups in age at operation (P = 0.900). The patient's sex was excluded in statistical analysis because of the predominance of female patients. There were statistically significant difference between the 2 groups in BMI ([25.5 ± 1.7] kg/m in the PJK group and [23.6 ± 1.9] kg/m in the non-PJK group, P 25 kg/m, osteoporosis, and UIV at thoracolumbar junction were independently associated with PJK.In conclusion, osteoporosis, obesity, and UIV at thoracolumbar junction are risk factors for the development and progression of PJK in DLS patients following long instrumented posterior spinal fusion. Antiosteoporosis treatment extends the fusion level above the thoracolumbar

  10. Classification of High Intensity Zones of the Lumbar Spine and Their Association with Other Spinal MRI Phenotypes: The Wakayama Spine Study

    Science.gov (United States)

    Teraguchi, Masatoshi; Samartzis, Dino; Hashizume, Hiroshi; Yamada, Hiroshi; Muraki, Shigeyuki; Oka, Hiroyuki; Cheung, Jason Pui Yin; Kagotani, Ryohei; Iwahashi, Hiroki; Tanaka, Sakae; Kawaguchi, Hiroshi; Nakamura, Kozo; Akune, Toru; Cheung, Kenneth Man-Chee; Yoshimura, Noriko; Yoshida, Munehito

    2016-01-01

    Introduction High intensity zones (HIZ) of the lumbar spine are a phenotype of the intervertebral disc noted on MRI whose clinical relevance has been debated. Traditionally, T2-weighted (T2W) magnetic resonance imaging (MRI) has been utilized to identify HIZ of lumbar discs. However, controversy exists with regards to HIZ morphology, topography, and association with other MRI spinal phenotypes. Moreover, classification of HIZ has not been thoroughly defined in the past and the use of additional imaging parameters (e.g. T1W MRI) to assist in defining this phenotype has not been addressed. Materials and Methods A cross-sectional study of 814 (69.8% females) subjects with mean age of 63.6 years from a homogenous Japanese population was performed. T2W and T1W sagittal 1.5T MRI was obtained on all subjects to assess HIZ from L1-S1. We created a morphological and topographical HIZ classification based on disc level, shape type (round, fissure, vertical, rim, and enlarged), location within the disc (posterior, anterior), and signal type on T1W MRI (low, high and iso intensity) in comparison to the typical high intensity on T2W MRI. Results HIZ was noted in 38.0% of subjects. Of these, the prevalence of posterior, anterior, and both posterior/anterior HIZ in the overall lumbar spine were 47.3%, 42.4%, and 10.4%, respectively. Posterior HIZ was most common, occurring at L4/5 (32.5%) and L5/S1 (47.0%), whereas anterior HIZ was most common at L3/4 (41.8%). T1W iso-intensity type of HIZ was most prevalent (71.8%), followed by T1W high-intensity (21.4%) and T1W low-intensity (6.8%). Of all discs, round types were most prevalent (anterior: 3.6%, posterior: 3.7%) followed by vertical type (posterior: 1.6%). At all affected levels, there was a significant association between HIZ and disc degeneration, disc bulge/protrusion and Modic type II (plumbar spine. This study is the first that has utilized T2W and T1W MRIs in differentiating HIZ sub-phenotypes. Specific HIZ sub

  11. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  12. Effect of spinal decompression on the lumbar muscle activity and disk height in patients with herniated intervertebral disk

    Science.gov (United States)

    Kang, Jeong-Il; Jeong, Dae-Keun; Choi, Hyun

    2016-01-01

    [Purpose] This study was conducted to clarify the difference in therapeutic effects between traction and decompression therapies, and their clinical therapeutic significance. [Subjects and Methods] The subjects were 31 patients aged 35 to 50 years who had unilateral or bilateral lumbar and radicular leg pain. An intervention program was implemented in 31 patients with lumbar herniated intervertebral disks. For the experimental group, 15 subjects were randomly selected to receive decompression therapy and trunk stabilization exercise. For the control group, 16 subjects were randomly selected to receive traction therapy and trunk stabilization exercise. [Results] Activities of the rectus abdominis, transverse abdominis, and external oblique muscles increased significantly in both groups. However, the activity of the erector spine muscle decreased, which was the only significant change in muscle activity among those of the other muscles in both groups. The disk herniation index in the experimental group decreased significantly in comparison with that in the control group, and the difference in the change in disk herniation index between the groups was significant. [Conclusion] Decompression therapy was demonstrated to be more effective clinically than conventional traction therapy as an intervention method for disk disease. PMID:27942133

  13. Intrathecal morphine attenuates acute opioid tolerance secondary to remifentanil infusions during spinal surgery in adolescents

    Directory of Open Access Journals (Sweden)

    Tripi PA

    2015-09-01

    Full Text Available Paul A Tripi,1 Matthew E Kuestner,1 Connie S Poe-Kochert,2 Kasia Rubin,1 Jochen P Son-Hing,2 George H Thompson,2 Joseph D Tobias3 1Division of Pediatric Anesthesiology, 2Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, 3Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA Introduction: The unique pharmacokinetic properties of remifentanil with a context-sensitive half-life unaffected by length of infusion contribute to its frequent use during anesthetic management during posterior spinal fusion in children and adolescents. However, its intraoperative administration can lead to increased postoperative analgesic requirements, which is postulated to be the result of acute opioid tolerance with enhancement of spinal N-methyl-D-aspartate receptor function. Although strategies to prevent or reduce tolerance have included the coadministration of longer acting opioids or ketamine, the majority of these studies have demonstrated little to no benefit. The current study retrospectively evaluates the efficacy of intrathecal morphine (ITM in preventing hyperalgesia following a remifentanil infusion.Methods: We retrospectively analyzed 54 patients undergoing posterior spinal fusion with segmental spinal instrumentation, to evaluate the effects of ITM on hyperalgesia from remifentanil. Patients were divided into two groups based on whether they did or did not receive remifentanil during the surgery: no remifentanil (control group (n=27 and remifentanil (study group (n=27. Data included demographics, remifentanil dose and duration, Wong–Baker visual analog scale postoperative pain scores, and postoperative intravenous morphine consumption in the first 48 postoperative hours.Results: The demographics of the two study groups were similar. There were no differences in the Wong–Baker visual analog

  14. Preoperative education for lumbar surgery for radiculopathy

    OpenAIRE

    Louw, A; Louw, Q; L. Crous

    2009-01-01

    To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptive...

  15. [Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery].

    Science.gov (United States)

    van de Meent, H; Vos, P E; Schreuder, H W; van der Hoeven, J G

    2004-05-29

    Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardia are common phenomena following acute traumatic cervical and thoracic spinal cord injury. Awareness of cardiovascular complications as a possible threat for functional recovery and adequate insight in the neurological cause of hypotension and bradycardia are important issues in the acute treatment of patients with spinal cord injury. It seems sensible to admit these patients to a medium-care or intensive-care department where they can be monitored and treated by a specialised team in accordance with an adequate protocol.

  16. Lumbar Spinal Stenosis Has a Negative Impact on Quality of Life Compared with Other Comorbidities: An Epidemiological Cross-Sectional Study of 1862 Community-Dwelling Individuals

    Directory of Open Access Journals (Sweden)

    Koji Otani

    2013-01-01

    Full Text Available Lumbar spinal stenosis (LSS is common in the elderly. However, there have been few reports on its impact on quality of life (QoL in community-dwelling individuals. The purpose of this study was to clarify how symptomatic LSS affects QoL at the community level. A total of 1862 people (697 males and 1165 females, most subjects were between 40 and 85 y.o. agreed to participate and were interviewed. The presence of symptomatic LSS was assessed by a specially designed questionnaire. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36 was also administered. In addition, the presence of comorbid conditions that affect QoL, such as osteoarthritis of the knee and hip, cardiovascular disease, cerebrovascular disease, or respiratory disease, was also analyzed. The prevalence of symptomatic LSS gradually increased with age. Furthermore, the presence of symptomatic LSS had a strong negative effect on all 8 physical and mental domains and the physical component summary (PCS (OR: 1.547–2.544 but not the mental component summary (MCS. In comparison with comorbid conditions, LSS had a much stronger negative impact on health-related QoL (HR-QoL. The current study confirmed that the presence of symptomatic LSS might have a strong negative influence on HR-QoL in the community setting.

  17. Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joon Woo; Myung, Jae Sung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Seong Nam, Gyeongi-do (Korea); Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Seong Nam, Gyeongi-do (Korea)

    2010-07-15

    To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. Two hundred and sixteen patients (male: female = 75:141; mean age 69.2 years; range 48{proportional_to}91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors. (orig.)

  18. Limited magnetic resonance imaging of the lumbar spine has high sensitivity for detection of acute fractures, infection, and malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Benjamin; Fintelmann, Florian J.; Kamath, Ravi S.; Kattapuram, Susan V.; Rosenthal, Daniel I. [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States)

    2016-12-15

    The objective of this study is to determine how a limited protocol MR examination compares to a full conventional MR examination for the detection of non-degenerative pathology such as acute fracture, infection, and malignancy. A sample of 349 non-contrast MR exams was selected retrospectively containing a 3:1:1:1 distribution of negative/degenerative change only, acute fracture, infection, and malignancy. This resulted in an even distribution of pathology and non-pathology. A limited protocol MR exam was simulated by extracting T1-weighted sagittal and T2-weighted fat-saturated (or STIR) sagittal sequences from each exam and submitting them for blinded review by two experienced musculoskeletal radiologists. The exams were evaluated for the presence or absence of non-degenerative pathology. Interpretation of the limited exam was compared to the original report of the full examination. If either reader disagreed with the original report, the case was submitted for an unblinded adjudication process with the participation of a third musculoskeletal radiologist to establish a consensus diagnosis. There were five false negatives for a sensitivity of 96.9 % for the limited protocol MR exam. Infection in the psoas, paraspinal muscles, and sacroiliac joint, as well as acute fractures in transverse processes and sacrum were missed by one or more readers. No cases of malignancy were missed. Overall diagnostic accuracy was 96.0 % (335/349). MR imaging of the lumbar spine limited to sagittal T1-weighted and sagittal T2 fat-saturated (or STIR) sequences has high sensitivity for the detection of acute fracture, infection, or malignancy compared to a conventional MR examination. (orig.)

  19. Expression and significance of type A lamin in lumbar spinal degenerative disease%A 型核纤层蛋白在腰椎退行性疾病中的表达及其意义

    Institute of Scientific and Technical Information of China (English)

    欧定强; 吴承志; 刘钰瑜; 戎利民; 徐义春; 王其友

    2015-01-01

    Objective To preliminarily explore the expression levels and clinical significance of type A lamin (lamin A)in lumbar spinal degenerative disease.Methods Seventy four patients diagnosed with lumbar spinal degenerative disease were divided into the lumbar disc herniation (n =32)and lumbar spinal stenosis groups (n =42)and healthy subjects were recruited into the control group (n =12).The expression of lamin A in the lumbar tissue samples from three groups was assessed by immunohistochemical examination and western blotting.Results Immunohistochemical analysis revealed that lamin A was expressed in the interver-tebral disk cells from all three groups.The staining of lamin A in the tissue from lumbar spinal stenosis group was stronger than those from the other two groups.Western blot demonstrated that lamin A was expressed in the fibrous ring tissue of intervertebral disk from all three groups.In the lumbar spinal stenosis group,the expres-sion level of lamin A was 3.55 ±0.16(gray level),1.02 ±0.13 in the lumbar disc herniation group and 0.78 ± 0.14 in the control group with statistical significance among three groups (F =14.326,P <0.01).Statistical significance was noted between the lumbar spinal stenosis and lumbar disc herniation group /the control group (both P <0.001).There was no statistically significant difference between the lumbar disc herniation and con-trol groups (P =0.134).Conclusions Over the progression of degenerative lumbar spinal disease,the ex-pression level of lamin A is gradually up-regulated,which is probably associated with the incidence and devel-opment of degenerative lumbar spinal disease.%目的:初步探讨A型核纤层蛋白(Lamin A)在腰椎退行性疾病中的表达特点及意义。方法将74例腰椎退行性疾病患者分为腰椎间盘突出组(32例)及腰椎管狭窄组(42例),另设腰椎正常组(12例)作为对照。采用免疫组织化学检查(免疫组化)及蛋白免疫印迹法检测 Lamin A

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

    Science.gov (United States)

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

    2016-01-01

    OBJECTIVE The Dynesys, a pedicle-based dynamic stabilization (PDS) system, was introduced to overcome the drawbacks of fusion procedures. Nevertheless, the theoretical advantages of PDS over fusion have not been clearly confirmed. The aim of this study was to compare clinical and radiological outcomes of patients who underwent PDS using the Dynesys system with those who underwent posterior lumbar interbody fusion (PLIF). METHODS The authors searched PubMed, Embase, Web of Science, and the Cochrane Database. Studies that reported outcomes of patients who underwent PDS or PLIF for the treatment of degenerative lumbar spinal disease were included. The primary efficacy end points were perioperative outcomes. The secondary efficacy end points were changes in the Oswestry Disability Index (ODI) and back and leg pain visual analog scale (VAS) scores and in range of motion (ROM) at the treated and adjacent segments. A meta-analysis was performed to calculate weighted mean differences (WMDs), 95% confidence intervals, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 274 retrieved articles, 7 (which involved 506 participants [Dynesys, 250; PLIF, 256]) met the inclusion criteria. The Dynesys group showed a competitive advantage in mean surgery duration (20.73 minutes, 95% CI 8.76-32.70 minutes), blood loss (81.87 ml, 95% CI 45.11-118.63 ml), and length of hospital stay (1.32 days, 95% CI 0.23-2.41 days). Both the Dynesys and PLIF groups experienced improved ODI and VAS scores after 2 years of follow-up. Regarding the ODI and VAS scores, no statistically significant difference was noted according to surgical procedure (ODI: WMD 0.12, 95% CI -3.48 to 3.72; back pain VAS score: WMD -0.15; 95% CI -0.56 to 0.26; leg pain VAS score: WMD -0.07; 95% CI -0.47 to 0.32). The mean ROM at the adjacent segment increased in both groups, and there was no substantial difference between them (WMD 1.13; 95% CI -0.33 to 2.59). Although the

  1. Relationship Between Depressive State and Treatment Characteristics of Acute Cervical Spinal Cord Injury in Japan

    Science.gov (United States)

    Matsuda, Yasufumi; Kubo, Tatsuhiko; Fujino, Yoshihisa; Matsuda, Shinya; Wada, Futoshi; Sugita, Atsuko

    2016-01-01

    Background Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Methods Using an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepressants (tricyclic, tetracyclic, Selective Serotonin Reuptake Inhibitors, Serotonin Noradrenaline Reuptake Inhibitors, Trazodone, Sulpiride, or Mirtazapine) as having a depressive state. We compared the rate of each acute treatment between the depressive state group and the non-depressive state group using chi-square tests, and a multiple logistic regression model was used to identify the association between the acute treatment and depressive state. Results There were 151 patients who were judged to be in a depressive state, and the other 2115 patients were categorized into the non-depressive state group. Intervention of intravenous anesthesia, tracheostomy, artificial respiration, and gastrostomy had a significant positive correlation with depressive state. Multiple logistic regression analysis showed that tracheostomy (odds ratio [OR] 2.18; 95% confidence interval [CI], 1.09–4.38) and artificial respiration (OR 2.28; 95% CI, 1.32–3.93) were significantly associated with depressive state, and men had a 36% reduction in the risk of depressive state compared with women (OR 0.64; 95% CI, 0.44–0.94), whereas age, wound-treatment, all of the orthopedic procedures, intravenous anesthesia, and gastrostomy were not associated with depressive state. Conclusions These findings suggest that tracheostomy, artificial respiration and female gender in the acute phase after cervical SCI might be associated with the development of depression. PMID:26567604

  2. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    Science.gov (United States)

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  3. Roentgenography and CT diagnosis of thoraco-lumbar spine fracture complicated by spinal cord injuries%胸腰结合部脊髓损伤影像学诊断临床评价

    Institute of Scientific and Technical Information of China (English)

    王宵光; 周新社

    2001-01-01

    目的:探讨X线片和CT检查诊断胸腰结合部(T12~L1)脊髓和(或)神经根损伤的临床价值。方法:将61例手术治疗的胸腰结合部骨折患者,依据其临床症状分有无合并脊髓和(或)神经根损伤两组,分别进行X线片和CT影像比较和评价。结果:脊髓和(或)神经根损伤组和无损伤组之间的X线片三项指标,差异均无显著性(P>0.05),同时CT测量椎管狭窄率<50%无显著性差别。但CT测量椎管狭窄率>50%者,两组差异有显著性(P<0.01),且手术证实46例损伤组中30例存在不同程度椎管梗阻,阳性率为65.2%。结论:胸腰结合部骨折合并脊髓和(或)神经根损伤者,CT显示椎管狭窄率>50%,可作为临床预测及选择手术治疗的参考指标。%Objective:To evaluate roentgenography and CT identification ofthe thoraco-lumbar(T12~L1) spine fracture complicated by spinal cord and(or) nerve root injury.Methods:Sixty-one patients with thoraco-lumbar spine fracture treated by operation were divided into two groups:one with thoraco-lumbar spine fracture complicated by spinal cord injury,the other with thoraco-lumbar spine fracture alone.The results of roentgenography and CT were compared and evaluated.Results:The three parameters of roentgenography between the two groups show no significant differences(P<0.01),so do that when the rate of spinal canal stenosis measured by CT was<50%,but when the rate of spinal canal stenosis was>50%,the differences were significant.Among 30 of 46 patients with spinal canal stenosis rate>50%,various extend spinal obstructions were verified by operative explorations,and the positive rate of spinal obstruction was 65.2%.Conclusions:CT identification of spinal canal stenosis rate>50% in patients with thoraco-lumbar spine fracture complicated by spinal cord and/or nerve root injury may be used as an indication of prognosis and surgical treatment.

  4. Needle knife with lumbar spinal chiropractic therapy for knee osteoarthritis combined lumbar joints staggered joints clinical observation%针刀配合腰椎整脊疗法治疗膝骨关节炎合并腰椎小关节错缝临床观察

    Institute of Scientific and Technical Information of China (English)

    孙利伟; 王方; 孙刚; 李鹤; 徐仕富; 高建波

    2013-01-01

      Objective: to observe the needle knife with lumbar spinal chiropractic therapy for treatment of knee osteoarthritis. Methods:retrospective between December 2010 and December 2010, knee osteoarthritis treated were 60 cases of patients with combined knee osteoarthritis combined lumbar joints staggered joints ,treatment group 30 cases with lumbar spinal chiropractic to needle knife therapy for knee osteoarthritis treatment, control group 30 cases of Celecoxib Capsules treatment, the knee joint as observation indexes to assess pain and joint mobility. Results: after 4 weeks follow-up treatment, treatment group total effectiveness 94.3%, control group total effective rate was 70.0%. Conclusion: needle knife with lumbar spinal chiropractic therapy for knee osteoarthritis clinical effect is remarkable, is worth further research and promotion.%  目的:观察针刀配合腰椎整脊疗法治疗膝骨关节炎的临床效果。方法:回顾2010年12月至2012年12月收治的膝骨关节炎合并腰椎小节错缝的患者60例,治疗组30例予针刀配合腰椎整脊疗法治疗膝骨关节炎治疗,对照组30例西乐葆治疗,将膝关节疼痛和关节活动度作为观察指标进行评定。结果:治疗四周后随访,治疗组总有效率94.3%,对照组总有效率70.0%。结论:针刀配合腰椎整脊疗法治疗膝骨关节炎临床效果显著,值得进一步研究和推广。

  5. 退变性腰椎管狭窄症的腰后路减压椎间植骨融合术治疗观察%The Treatment Observation of Degenerative Lumbar Spinal Stenosisby Posterior Lumbar Decompression and Interbody Fusion

    Institute of Scientific and Technical Information of China (English)

    赖征文; 李敏; 李平安; 刘云彬

    2011-01-01

    Objective:Observed the treatment effect of degenerative lumbar spinal stenosis by posterior lumbar decompression and interbody fusion.Methods:42 patients admitted to our hospital with degenerative lumbar spinal stenosis were divided into two groups,the control group were taken a simple decompression,the treatment group were taken by lumbar posterior decompression and interbody fusion surgery,compared the efficacy and prognosis of two groups.Results:The treatment group,the three time periods JOA scores are significantly better than the control group,P>0.05.Conclusion:The lumbar posterior decompression and interbody fusion can improve the symptoms,the effect last stability,is a good treatment option.%目的:观察腰后路减压椎间植骨融合术对于退变性腰椎管狭窄症的治疗效果.方法:将本院收治的42例退变性腰椎管狭窄症患者分为两组,对照组采取单纯减压术,治疗组采取经腰后路减压椎间植骨融合术,对比两组的近期疗效及预后情况.结果:治疗组在三个时间段的JOA评分均明显优于对照组,P>0.05.结论:经腰后路减压椎间植骨融合术可有效改善患者的症状,效果持久稳定,是一种良好的治疗选择.

  6. Treatment of manual massage matching function training for acute lumbar sprain%手法按摩配合功能锻炼治疗急性腰扭伤

    Institute of Scientific and Technical Information of China (English)

    李加斌

    2002-01-01

    @@ Background: Acute lumbar sprain usually results from improper posture and more fierce force when working, which can result in spasm of muscule and fracture of soft tissue.Mannual massage can eliminate local lumbar spasm,restore contortion of muscular fiber, improve congestion and swelling,and promote blood circulation so as to reach the purpose of regulating vital energy,activating blood circulation and analgesia,and restoring function. Objective: To discuss the treatment effect of manual massage matching function training for acute lumbar sprain.

  7. Spinal analgesic action of endomorphins in acute, inflammatory and neuropathic pain in rats.

    Science.gov (United States)

    Przewłocka, B; Mika, J; Labuz, D; Toth, G; Przewłocki, R

    1999-02-19

    We studied spinal analgesic and antiallodynic effects of endomorphin-1 and endomorphin-2 administered i.t. in comparison with Tyr-D-Ala-Gly-MePhe-Gly-ol (DAMGO) or morphine, during acute, inflammatory and neuropathic pain in rats chronically implanted with intrathecal cannulas. Endomorphin-1 and endomorphin-2 (2.5, 5, 10 microg i.t.) increased the tail-flick latency and, to the lesser extent, the paw pressure latency. The range of potencies in both those models of acute pain was as follows: DAMGO > morphine = endomorphin-1 > endomorphin-2. In a model of inflammatory pain, the number of formalin-induced flinching episodes was decreased by endomorphin-1. The effect of endomorphin-2 was much less pronounced. Both DAMGO and morphine significantly inhibited the pain-related behavior evoked by formalin. In a neuropathic pain model (sciatic nerve crushing in rats), endomorphin-1 and -2 (5 microg i.t.) had a statistically significant effect on the tail-flick latency and on the cold-water tail flick latency. Morphine, 5 microg, was found to be ineffective. Endomorphin-1 and -2 (2.5 and 5 microg i.t.) dose-dependently antagonized allodynia. Those effects of endomorphins were antagonized in acute (30 microg), inflammatory (30 microg) and neuropathic pain models (60 microg) by cyprodime, a selective mu-opioid receptor antagonist. In conclusion, our results show a strong analgesic action of endomorphins at the spinal cord level. The most interesting finding is a strong, stronger than in the case of morphine, antiallodynic effect of endomorphins in rats subjected to sciatic nerve crushing, which suggests a possible use of these compounds in a very difficult therapy of neuropathic pain.

  8. Epidural spinal cord compression as initial clinical presentation of an acute myeloid leukaemia: case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Dominique N'Dri Oka; Alpha Boubacar Bah; André Valentin Tokpa; Louis Derou

    2016-01-01

    Epidural localization of myeloid leukaemia is rarely reported.Spinal cord compression as an initial presentation of acute myeloid leukaemia is extremely rare.This is a report of a 17-year-old black boy who presented to emergency department with neurological symptoms of spinal cord compression.Imaging modalities showed multiple soft tissue masses in the epidural space.After surgical treatment,histopathological examination of the epidural mass showed myeloid leukaemia cells infiltration.Literature review on Medline and "scholar Google" database was done.The characteristics and management of extra-medullary leukaemia are discussed.Granulocytic sarcoma,myeloid sarcoma or chloroma with acute myeloid leukaemia should be considered as part of epidural spinal cord compression.Therefore surgery is indicated on an emergent basis.

  9. Dynesys与后路椎间融合治疗腰椎管狭窄症的临床效果比较研究%Dynesys and posterior lumbar interbody fusion for lumbar spinal stenosis in the comparative study of clinical effect

    Institute of Scientific and Technical Information of China (English)

    高洪亮

    2015-01-01

    Objective: To investigate the Dynesys and posterior lumbar interbody fusion in the treatment of lumbar spinal stenosis in.Methods:a total of August 2012 to 2014 years 5 months in our hospital from lumbar spinal stenosis were 85 cases, and were randomly divided into group A (n = 42) and group B (n = 43). The A group was treated by posterior lumbar interbody fusion, and the B group was treated by pedicle Dynesys operation, and the treatment effect was compared between the two groups. Results: there was no significant difference in the length of the incision in the A group and the B group (P>0.05). ODI score and VAS score were significantly lower in A group and B group (P0.05) and the VAS score at the end of groups (ODI).Conclusion: in lumbar spinal canal stenosis treatment in, posterior lumbar interbody fusion surgery and transpedicular Dynesys surgical treatment effect is similar, but the latter has a shorter operation time, less trauma and bleeding quantity low characteristic, can effectively stabilize the spine, and is worthy to be popularized.%目的:探讨Dynesys与后路椎间融合在腰椎管狭窄症中的治疗效果.方法:选取2012年8月到2014年5月我院收治的腰椎管狭窄症者85例,并随机分为A组(n=42)和B组(n=43).A组都采用后路椎间融合手术,B组均采用经椎弓根Dynesys手术治疗,对比两组的治疗效果.结果:A组、B组切口长度相比,差异无统计学意义(P>0.05).A组、B组末次随访ODI评分、VAS评分显著比手术前降低(P0.05).结论:在腰椎管狭窄症治疗中,后路椎间融合手术和经椎弓根Dynesys手术治疗效果相近,但后者具有手术时间短、创伤小和出血量低等特点,可有效地稳定脊柱,值得推广.

  10. 拔罐刺络放血治疗急性腰扭伤%Cupping Pricking Blood of Acute Lumbar Sprain

    Institute of Scientific and Technical Information of China (English)

    赵阳

    2011-01-01

    Objective: To observe the cupping pricking blood therapy combined with the efficacy of acute lumbar sprain. Methods: 120 patients with acute lumbar sprain acupuncture and cupping pricking blood therapy. Results : 120 patients were cured,86%, effective in 12%. Conclusion: Acupuncture Cupping pricking blood therapy of acute lumbar sprain with pain qi, promoting blood circulation effect, and the method is simple, safe operation, results were satisfactory.%目的:观察拔罐刺络放血结合治疗急性腰扭伤的疗效.方法:对120例急性腰扭伤针灸拔罐刺络放血治疗.结果:120例患者中,治愈占86%,显效占12%.结论:针灸拔罐刺络放血治疗急性腰扭伤,具有理气止痛、活血化瘀功效,并且方法简单,操作安全,疗效满意.

  11. Spinal curves (image)

    Science.gov (United States)

    There are four natural curves in the spinal column. The cervical, thoracic, lumbar, and sacral curvature. The curves, along with the intervertebral disks, help to absorb and distribute stresses that occur from everyday activities such as walking or from ...

  12. [Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery

    NARCIS (Netherlands)

    Meent, H. van de; Vos, P.E.; Schreuder, H.W.B.; Hoeven, J.G. van der

    2004-01-01

    Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardi

  13. Effects of thrust amplitude and duration of high velocity low amplitude spinal manipulation on lumbar muscle spindle responses to vertebral position and movement

    Science.gov (United States)

    Cao, Dong-Yuan; Reed, William R.; Long, Cynthia R.; Kawchuk, Gregory N.; Pickar, Joel G.

    2013-01-01

    OBJECTIVE Mechanical characteristics of high velocity low amplitude spinal manipulations (HVLA-SM) can be variable. Sustained changes in peripheral neuronal signaling due to altered load transmission to a sensory receptor’s local mechanical environment are often considered a mechanism contributing to the therapeutic effects of spinal manipulation. The purpose of this study was to determine whether an HVLA-SM’s thrust amplitude or duration altered neural responsiveness of lumbar muscle spindles to either vertebral movement or position. METHODS Anesthetized cats (n=112) received L6 HVLA-SMs delivered to the spinous process. Cats were divided into 6 cohorts depending upon the peak thrust force (25%, 55%, 85% body weight) or thrust displacement (1, 2, 3mm) they received. Cats in each cohort received 8 thrust durations (0–250ms). Afferent discharge from 112 spindles was recorded in response to ramp and hold vertebral movement before and after the manipulation. Changes in mean instantaneous frequency (MIF) during the baseline period preceding the ramps (ΔMIFresting), during ramp movements (ΔMIFmovement), and with the vertebra held in the new position (ΔMIFposition) were compared. RESULTS Thrust duration had a small but statistically significant effect on ΔMIFresting at all six thrust amplitudes compared to control (0ms thrust duration). The lowest amplitude thrust displacement (1mm) increased ΔMIFresting at all thrust durations. For all the other thrust displacements and forces, the direction of change in ΔMIFresting was not consistent and the pattern of change was not systematically related to thrust duration. Regardless of thrust force, displacement, or duration, ΔMIFmovement and ΔMIFposition were not significantly different from control. Conclusion Relatively low amplitude thrust displacements applied during an HVLA-SM produced sustained increases in the resting discharge of paraspinal muscle spindles regardless of the duration over which the thrust was

  14. Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Hillmann Axel

    2010-10-01

    Full Text Available Abstract Background Degenerative musculoskeletal disorders are among the most frequent diseases occurring in adulthood, often impairing patients' functional mobility and physical activity. The aim of the present study was to investigate and compare the impact of three frequent degenerative musculoskeletal disorders -- knee osteoarthritis (knee OA, hip osteoarthritis (hip OA and lumbar spinal stenosis (LSS -- on patients' walking ability. Methods The study included 120 participants, with 30 in each patient group and 30 healthy control individuals. A uniaxial accelerometer, the StepWatch™ Activity Monitor (Orthocare Innovations, Seattle, Washington, USA, was used to determine the volume (number of gait cycles per day and intensity (gait cycles per minute of walking ability. Non-parametric testing was used for all statistical analyses. Results Both the volume and the intensity of walking ability were significantly lower among the patients in comparison with the healthy control individuals (p 50 gait cycles/min, which was significantly lower in comparison with patients with knee and hip OA at 2.5 (IQR 4.4 and 3.4 (IQR 16.1 min/day, respectively (p Conclusions Patients with degenerative musculoskeletal disorders suffer limitations in their walking ability. Objective assessment of walking ability appeared to be an easy and feasible tool for measuring such limitations as it provides baseline data and objective information that are more precise than the patients' own subjective estimates. In everyday practice, objective activity assessment can provide feedback for clinicians regarding patients' performance during everyday life and the extent to which this confirms the results of clinical investigations. The method can also be used as a way of encouraging patients to develop a more active lifestyle.

  15. The Role of Diffusion-Weighted MRI in Differentiation of Idiopathic Acute Transverse Myelitis and Acute Spinal Cord Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Goon; Lee, Joon Woo; Kim, Jae Hyoung; Kang, Heung Sik [Dept. of Radiology, Bundang Hospital, Seoul University College of Medicine, Seoul (Korea, Republic of); Park, Kyung Seok [Dept. of Neurology, Bundang Hospital, Seoul University College of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    To compare the diffusion characteristics of idiopathic acute transverse myelitis (ATM) and acute spinal cord infarction (SCI). Diffusion-weighted images (DWI) and an apparent diffusion coefficient (ADC) map were prospectively obtained from patients diagnosed with myelopathy between February 2006 and April 2009. Inclusion criteria included 1) the presence of an intramedullary T2-high signal intensity and 2) a final diagnosis of idiopathic ATM or SCI established by one neurologist. In total, 13 patients (M : F = 8 : 5; mean age, 39.5 years; range, 29-50 years) with idiopathic ATM and seven patients (M : F = 2 : 5; mean age, 58 years; range, 48-75 years) with SCI were included in this study. Two radiologists evaluated the DWIs and ADC map in consensus. The extent of the cord signal change was also evaluated on T2-weighted sagittal images. Among the 16 patients with ATM, 14 patients showed iso-signal on an ADC map, but one case showed restricted diffusion and another showed increased diffusion on the ADC map. Among the seven patients with SCI, five patients showed restricted diffusion. Idiopathic ATM usually does not demonstrate restricted diffusion, which can be a clue to differentiate it from SCI. However, idiopathic ATM with larger segment involvement can show focal diffusion restriction.

  16. Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery

    DEFF Research Database (Denmark)

    Nielsen, Rikke V; Siegel, Hanna; Fomsgaard, Jonna S;

    2015-01-01

    with morphine. Primary outcome was pain during mobilization (visual analog scale) 2 to 24 hours postoperatively. Secondary outcomes were acute pain at rest, morphine consumption, nausea, vomiting, ondansetron consumption, sedation, and quality of sleep. Patients were followed up by written questionnaire 3...... months postoperatively. Acute pain during mobilization (weighted average area under the curve, 2-24 hours) was significantly reduced in the dexamethasone group: 33 (22) mm vs placebo 43 (18) mm, (95% confidence interval [CI] 3-16) P = 0.005. Vomiting 0 to 24 hours postoperatively was reduced...

  17. Therapeutic Effect Analysis of Traction and Microwave Plus Interferential Electrotherapy in Treating Lumbar Spinal Stenos%牵引、微波加干扰电联合治疗腰椎管狭窄症疗效分析

    Institute of Scientific and Technical Information of China (English)

    陆保全; 卢爱玲

    2013-01-01

      目的:观察应用多种物理方法治疗腰椎管狭窄症的效果.方法:将120例腰椎管狭窄症患者随机分为对照组和物理治疗组,每组60例.对照组采用常规治疗,物理治疗组在对照组基础上加用牵引、微波和干扰电治疗,1次/d,10 d 一疗程,2个疗程后观察疗效.结果:对照组总有效率75.0%,物理治疗组总有效率96.7%,两组比较差异有统计学意义(P<0.05).结论:多种物理因子联用治疗腰椎管狭窄症疗效显著,值得临床推广使用.%Objective:To explore the therapeutic effect of comprehensive physical therapy in treating lumbar spinal stenosis.Method:120 cases of lumbar spinal stenosis were randomly divided into control group and the combined treatment group.Every group has 60 cases.60 cases of the control group received conventional therapy,60 cases of the combined therapy group were given a comprehensive physical therapy(traction+microwave+interfere ntial electrotherapy)on the base of the control group.Result:The total effective rate were 75.0%,96.7%,combined treatment group were better than the control group(P<0.05).Conclusion:Traction and microwave plus interferential electrotherapy is one of the effective methods for the treatment of lumbar spinal stenosis,and worthy of clinical application.

  18. Interexaminer reliability of the electromagnetic radiation receiver for determining lumbar spinal joint dysfunction in subjects with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Gemmell, H.A.; Jacobson, B.H.; Edwards, S.W.; Heng, B.J.

    1990-03-01

    Twenty subjects (6 male, 14 female) with low back pain were examined by two experienced and licensed chiropractic doctors (E1 and E2). Both examiners examined the patients using a Toftness Electromagnetic Radiation Receiver (EMRR) and by manual palpation (MP) of the spinous processes. Interexaminer reliability was calculated at three sites (L3, L4, L5) for the following combinations: (a) E1,MP--E2,MP; (b) E1,EMRR--E2,EMRR; (c) E1,MP--E2,EMRR; and (d) E2,MP--E1,EMRR, and intraexaminer reliability was calculated for the following variables: (e) E1,MP--E1,EMRR; and (f) E2,MP--E2,EMRR. Results of a Kappa coefficient analysis for interexaminer reliability of the stated combinations and at the specific sites were: (a) -0.071, 0.400, 0.200; (b) -0.013, 0.100, -0.120; (c) 0.286, 0.300, 0.200; (d) -0.081, 0.000, 0.048. These results predominantly indicate a poor to fair interexaminer reliability. The results of a Kappa coefficient analysis for intraexaminer reliability of the stated combinations were: (e) 0.111, 0.400, 0.737; (f) 0.000, 0.100, 0.368. These results indicate a poor to fair reliability. It was concluded that in subjects with low back pain the EMRR may not be a reliable indicator of spinal joint dysfunction.

  19. Spinal spondylosis and acute intervertebral disc prolapse in a European brown bear (Ursus arctos arctos : clinical communication

    Directory of Open Access Journals (Sweden)

    W.M. Wagner

    2005-06-01

    Full Text Available A 22-year-old male European brown bear (Ursus arctos arctos was presented to the Onderstepoort Veterinary Academic Hospital after an acute onset of hind limb paralysis 4 days earlier. Previous radiographs revealed marked degenerative joint disease of the stifles, tarsi and digits. The clinical findings were consistent with acute disc prolapse. Lateral radiographs of the entire vertebral column were made as well as ventrodorsal pelvic radiographs. The latter were within normal limits. The vertebral column revealed multiple lesions consistent with chronic and acute disc herniations. Lateral compression of the caudal lumbar nerve roots could not be ruled out. Owing to multiple significant findings of the vertebral column and the poor prognosis for full recovery after surgery, the bear was euthanased. The diagnosis of an acute disc prolapse and multiple chronic disc herniations was confirmed on necropsy.

  20. PRDM5 Expression and Essential Role After Acute Spinal Cord Injury in Adult Rat.

    Science.gov (United States)

    Liu, Jie; Wu, Weijie; Hao, Jie; Yu, Mingchen; Liu, Jin; Chen, Xinlei; Qian, Rong; Zhang, Feng

    2016-12-01

    PR (PRDI-BF1 and RIZ) domain proteins (PRDM) are a subfamily of the kruppel-like zinc finger gene products that modulate cellular processes such as differentiation, cell growth and apoptosis. PRDM5 is a recently identified family member that functions as a transcriptional repressor and behaves as a putative tumor suppressor in different types of cancer. However, the expression and function of PRDM5 in spinal cord injury (SCI) are still unknown. In the present study, we have performed an acute SCI model in adult rats and investigated the dynamic changes of PRDM5 expression in the spinal cord. We found that PRDM5 protein levels gradually increased, reaching a peak at day 5 and then gradually declined to a normal level at day 14 after SCI with Western blot analysis. Double immunofluorescence staining showed that PRDM5 immunoreactivity was found in neurons, astrocytes and microglia. However, the expression of PRDM5 was increased predominantly in neurons. Additionally, colocalization of PRDM5/active caspase-3 was been respectively detected in neurons. In vitro, we found that depletion of PRDM5 by short interfering RNA, obviously decreases neuronal apoptosis. In summary, this is the first description of PRDM5 expression in SCI. Our results suggested that PRDM5 might play crucial roles in CNS pathophysiology after SCI and this research will provide new drug targets for clinical treatment of SCI.

  1. Methylprednisolone for acute spinal cord injury:an increasingly philosophical debate

    Institute of Scientific and Technical Information of China (English)

    Christian A. Bowers; Bornali Kundu; Gregory W. J. Hawryluk

    2016-01-01

    Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS) was hailed as a breakthrough for patients with acute spinal cord injury (SCI). MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst cli-nicians. Patient opinion has the potential to break this stalemate and we review our recent ifndings which reported that spinal cord injured patients informed of the risks and beneifts of MPSS reported a prefer-ence for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when beneifts may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS’s status as a his-torical standard of care.

  2. Adverse effects in lumbar spinal cord morphology and tissue biochemistry in Sprague Dawley male rats following exposure to a continuous 1-h a day 900-MHz electromagnetic field throughout adolescence.

    Science.gov (United States)

    Kerimoğlu, Gökçen; Aslan, Ali; Baş, Orhan; Çolakoğlu, Serdar; Odacı, Ersan

    2016-12-01

    Cell phones, an indispensable element of daily life, are today used at almost addictive levels by adolescents. Adolescents are therefore becoming increasingly exposed to the effect of the electromagnetic field (EMF) emitted by cell phones. The purpose of this study was to investigate the effect of exposure to a 900-MHz EMF throughout adolescence on the lumbar spinal cord using histopathological, immunohistochemical and biochemical techniques. Twenty-four Sprague Dawley (28.3-43.9g) aged 21days were included in the study. These were divided equally into three groups - control (CG), sham (SG) and electromagnetic (ELMAG). No procedure was performed on the CG rats until the end of the study. SG and ELMAG rats were kept inside an EMF cage (EMFC) for 1h a day every day at the same time between postnatal days 22 and 60. During this time, ELMAG rats were exposed to the effect of a 900-MHz EMF, while the SG rats were kept in the EMFC without being exposed to EMF. At the end of the study, the lumbar regions of the spinal cords of all rats in all groups were extracted. Half of each extracted tissue was stored at -80°C for biochemical analysis, while the other half was used for histopathological and immunohistochemical analyses. In terms of histopathology, a lumbar spinal cord with normal morphology was observed in the other groups, while morphological irregularity in gray matter, increased vacuolization and infiltration of white matter into gray matter were pronounced in the ELMAG rats. The cytoplasm of some neurons in the gray matter was shrunken and stained dark, and vacuoles were observed in the cytoplasms. The apoptotic index of glia cells and neurons were significantly higher in ELMAG compared to the other groups. Biochemical analysis revealed a significantly increased MDA value in ELMAG compared to CG, while SOD and GSH levels decreased significantly. In conclusion, our study results suggest that continuous exposure to a 900-MHz EMF for 1h a day through all stages of

  3. Characterization of postsynaptic potentials evoked by sural nerve stimulation in hindlimb motoneurons from acute and chronic spinal cats.

    Science.gov (United States)

    Baker, L L; Chandler, S H

    1987-09-15

    The purpose of this study was to characterize the changes in postsynaptic potentials recorded in ankle extensor motoneurons resulting from activation of the sural nerve after spinal cord transection in the adult cat. Eight acute and nine chronic animals were spinalized at T12. Intracellular recordings from motoneurons innervating the triceps surae were performed. Sural nerve stimulation evoked complex synaptic potentials consisting of early and late components in all motoneurons. Early excitatory and inhibitory postsynaptic potentials (PSPs), as well as long latency excitatory postsynaptic potentials were recorded and averaged for assessment of PSP amplitude and duration. Early PSPs, both excitatory and inhibitory, were significantly larger in the motoneurons of cats spinalized 4-6 months earlier. Central latency of excitatory potentials were similar in the two samples of motoneurons, but the central latency associated with the initial inhibitory PSP was significantly shorter in the recordings from motoneurons of chronic spinal cats. In most recordings, an additional inhibitory PSP followed the initial excitatory PSP in motoneurons, and this secondary inhibitory PSP was similar in peak amplitude and duration in both samples of motoneurons. Also, a long latency excitatory PSP was recorded in a large percentage of motoneurons from both samples. This potential was typically of greater amplitude and longer duration in the motoneurons from chronic animals, when compared to recordings from acute animals. Although changes in amplitude and duration of PSP activity could be documented, there was no marked alteration in the frequency of occurrence of each PSP pattern recorded from the two preparations. This suggests that the synaptic pathways mediating the sural nerve reflexes have not qualitatively changed in the chronic spinal animal. The changes in amplitudes and durations of the PSPs in the chronic spinal cat indicate, however, that quantitative changes have occurred

  4. Variability in the treatment of acute spinal cord injury in the United Kingdom: results of a national survey.

    Science.gov (United States)

    Werndle, Melissa C; Zoumprouli, Argyro; Sedgwick, Philip; Papadopoulos, Marios C

    2012-03-20

    The aim of this study was to examine how traumatic spinal cord injury is managed in the United Kingdom via a questionnaire survey of all neurosurgical units. We contacted consultant neurosurgeons and neuroanesthetists in all neurosurgical centers that manage patients with acute spinal cord injury. Two clinical scenarios-of complete and incomplete cervical spinal cord injuries-were given to determine local treatment policies. There were 175 responders from the 33 centers (36% response rate). We ascertained neurosurgical views on urgency of transfer, timing of surgery, nature and aim of surgery, as well as neuroanesthetic views on type of anesthetic, essential intraoperative monitoring, drug treatment, and intensive care management. Approximately 70% of neurosurgeons will admit patients with incomplete spinal cord injury immediately, but only 40% will admit patients with complete spinal cord injury immediately. There is no consensus on the timing or even the role of surgery for incomplete or complete injuries. Most (96%) neuroanesthetists avoid anesthetics known to elevate intracranial pressure. What was deemed essential intraoperative monitoring, however, varied widely. Many (22%) neuroanesthetists do not routinely measure arterial blood pressure invasively, central venous pressure (85%), or cardiac output (94%) during surgery. There is no consensus among neuroanesthetists on the optimal levels of arterial blood pressure, or oxygen and carbon dioxide partial arterial pressure. We report wide variability among U.K. neurosurgeons and neuroanesthetists in their treatment of acute traumatic spinal cord injury. Our findings reflect the lack of Class 1 evidence that early surgical decompression and intensive medical management of patients with spinal cord injury improves neurological outcome.

  5. Bladder response to acute sacral neuromodulation while treating rats in different phases of complete spinal cord injury: a preliminary study

    Directory of Open Access Journals (Sweden)

    Ping Shi

    2015-12-01

    Full Text Available Background: Compared to conventional therapies, sacral neuromodulation (SNM may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder response to SNM treatment for SCI in different phases may yield new insights for innovative use of this promising technique. Materials and Methods: Female Sprague-Dawley rats were used in this study to examine the effects of acute SNM on bladder reflex in complete SCI rats. All rats were anesthetized and set up for continuous saline infusion. Acute SNM treatment was implemented for about 6 hours for each rat. Cystometric parameters, including time between contractions, contraction duration, bladder peak pressure, and number of uninhibited contractions, were analyzed and compared within rats before and after SNM treatment. Results: For the spinally transected rats during early phase (less than two weeks post spinalization, the time between contractions and contraction duration both increased after SNM treatments, yet the increased amplitude was about or less than 20%. For the spinally transected rats with a longer days survival (about two to four weeks post spinalization, the time between contractions and contraction duration substantially increased after SNM treatment and the changes for their average values were more than 90%. For the spinally transected rats with a much longer days survival (more than five weeks post spinalization, the time between contractions and contraction duration increased after SNM treatments, yet the magnitude of changes were less than 30%. Conclusion: The present study suggested that the significant effectiveness of SNM for complete SCI played its role after the spinal shock phase and prior to the development of detrusor overactivity. It indicated that the time point of SNM treatment is necessary to be paid attention.

  6. Acute Reciprocal Changes Distant from the Site of Spinal Osteotomies Affect Global Postoperative Alignment

    Directory of Open Access Journals (Sweden)

    Eric Klineberg

    2011-01-01

    Full Text Available Introduction. Three-column vertebral resections are frequently applied to correct sagittal malalignment; their effects on distant unfused levels need to be understood. Methods. 134 consecutive adult PSO patients were included (29 thoracic, 105 lumbar. Radiographic analysis included pre- and postoperative regional curvatures and pelvic parameters, with paired independent t-tests to evaluate changes. Results. A thoracic osteotomy with limited fusion leads to a correction of the kyphosis and to a spontaneous decrease of the unfused lumbar lordosis (−8°. When the fusion was extended, the lumbar lordosis increased (+8°. A lumbar osteotomy with limited fusion leads to a correction of the lumbar lordosis and to a spontaneous increase of the unfused thoracic kyphosis (+13°. When the fusion was extended, the thoracic kyphosis increased by 6°. Conclusion. Data from this study suggest that lumbar and thoracic resection leads to reciprocal changes in unfused segments and requires consideration beyond focal corrections.

  7. Synergistic actions of olomoucine and bone morphogenetic protein-4 in axonal repair after acute spinal cord contusion

    Institute of Scientific and Technical Information of China (English)

    Liang Chen; Jianjun Li; Liang Wu; Mingliang Yang; Feng Gao; Li Yuan

    2014-01-01

    To determine whether olomoucine acts synergistically with bone morphogenetic protein-4 in the treatment of spinal cord injury, we established a rat model of acute spinal cord contusion by impacting the spinal cord at the T8 vertebra. We injected a suspension of astrocytes derived from glial-restricted precursor cells exposed to bone morphogenetic protein-4 (GDAsBMP) into the spinal cord around the site of the injury, and/or olomoucine intraperitoneally. Olomoucine effectively inhibited astrocyte proliferation and the formation of scar tissue at the injury site, but did not prevent proliferation of GDAsBMP or inhibit their effects in reducing the spinal cord lesion cavity. Furthermore, while GDAsBMP and olomoucine independently resulted in small improve-ments in locomotor function in injured rats, combined administration of both treatments had a signiifcantly greater effect on the restoration of motor function. These data indicate that the combined use of olomoucine and GDAsBMP creates a better environment for nerve regeneration than the use of either treatment alone, and contributes to spinal cord repair after injury.

  8. Treatment of pain with lumbar spinal stenosis by epidural intervention of spinal nerves with three different drugs%腰椎管狭窄病人疼痛的腰椎神经根管封闭治疗

    Institute of Scientific and Technical Information of China (English)

    卫沛然; 邹德威; 陈晓明; 张刚

    2013-01-01

    [Objective]Multiple interventional techniques such as epidural injections of local anesthetic and/or Steroids commonly performed in managing pain related to spinal stenosis.TNF - a is thought to play a crucial role in the radicular pain caused by lumbar disc herniation and spinal stenosis.Tumor necrosis factor - alpha inhibitor has been used to control pain caused by cancer,Rheumatoid arthritis and some other systemic autoimmune disorder.This study is to assess the efiects of caudal epidural injections with local anesthetic only, local anesthetic mixed with tumor necrosis factor - alpha inhibitor, and local anesthetic mixed with steroids in pain relief in the management of chronic low back pain related to lumbar spinal stenosis.[Methods] Ninty patients with low back and radicular leg pain were investigated.We diagnosed the patients by physical examination,and X - ray and magnetic resonance imaging.They were randomly assigned tol of the 3 groups.Group Ⅰ patients received caudal epidural injections administered 2.0 ml of lidocaine and 10 mg of tumor necrosis factor - alpha inhibitor (etanercept) onto the affected spinal nerve,and Group Ⅱ patients received caudal epidural injections with lidocaine 2 ml mixed with 2mL of teroid (Diprospan), Group Ⅲ patients received caudal epidural injections with 4.O ml of lidocaine only.Low back and leg pain were evaluated using a visual analogue scale (VAS) before and for 1 week after pidural administration.[ Results]Low back and leg pain in the 3 groups were not significantly different before epidural administration.And significant pain relief improvement in Group Ⅰ was more effective than that of Group Ⅱ and Group Ⅲ; while it showed no significant difference between Group Ⅱ and group Ⅲ. [ Conclusion] Our results indicate that epidural administration of a TNF - a inhibitor may be useful tools for the treatment of radicular pain caused by spinal stenosis.Caudal epidural injections of local anesthetic with or without

  9. (-)-Epigallocatechin-3-gallate (EGCG) modulates neurological function when intravenously infused in acute and, chronically injured spinal cord of adult rats.

    Science.gov (United States)

    Renno, Waleed M; Al-Khaledi, Ghanim; Mousa, Alyaa; Karam, Shaima M; Abul, Habib; Asfar, Sami

    2014-02-01

    Spinal cord injury (SCI) causes severe and long lasting motor and sensory deficits, chronic pain, and autonomic dysreflexia. (-)-epigallocatechin-3-gallate (EGCG) has shown to produce neuroprotective effect in a broad range of neurodegenerative disease animal models. This study designed to test the efficacy of intravenous infusion of EGCG for 36 h, in acutely injured rats' spinal cord: within first 4 h post-injury and, in chronically SC injured rats: after one year of injury. Functional outcomes measured using standard BBB scale, The Louisville Swim Scale (LSS) and, pain behavior assessment tests. 72 Female adult rats subjected to moderate thoracic SCI using MASCIS Impactor, blindly randomized as the following: (I) Acute SCI + EGCG (II) Acute SCI + saline. (III) Chronic SCI + EGCG. (IV) Chronic SCI + saline and, sham SCI animals. EGCG i.v. treatment of acute and, chronic SCI animals resulted in significantly better recovery of motor and sensory functions, BBB and LSS (P spinal cord increased (P < 0.001). Percent areas of GAP-43 and GFAP immunohistochemistry showed significant (P < 0.05) increase. We conclude that the therapeutic window of opportunity for EGCG to depict neurological recovery in SCI animals, is viable up to one year post SCI when intravenously infused for 36 h.

  10. Clinical Analysis on the Operation Treatment in 62 Elderly Patients with Degenerative Lumbar Spondylolisthesis and Lumbar Spinal Stenosis%手术治疗老年退变性腰椎滑脱合并腰椎管狭窄症62例临床分析

    Institute of Scientific and Technical Information of China (English)

    陈志强; 林健泽

    2013-01-01

    目的:分析观察不同手术治疗方法在老年退变性腰椎滑脱合并腰椎管狭窄症中的临床效果。方法:选取2011年1月-2012年4月于笔者所在医院进行手术治疗的62例老年退变性腰椎滑脱合并腰椎管狭窄症患者为研究对象,根据手术方式的不同将其分为A组(有限减压术组)31例和观察组(椎管减压、椎弓根内固定及植骨融合术组)31例,比较两组治疗后腰椎JOA评分优良率及治疗前后的滑脱率、Prolo评分、VAS评分。结果:B组中不同滑脱度者的JOA评分优良率均高于A组,治疗后的滑脱度、Prolo评分、VAS评分均优于A组,差异均有统计学意义(P<0.05)。结论:椎管减压、椎弓根内固定及植骨融合术治疗老年退变性腰椎滑脱合并腰椎管狭窄症的临床效果相对更好。%Objective:To analyze and observe the clinical effect of different operation treatment in elderly patients with degenerative lumbar spondylolisthesis and lumbar spinal stenosis. Method:Sixty-two elderly patients with degenerative lumbar spondylolisthesis and lumbar spinal stenosis who were treated in anthors’s hospital from January 2011 to April 2012 were selected as research object,and they were divided into group A(limited decompression group)31 cases and group B(decompression of the spinal canal,pedicle screw fixation and bone graft fusion group)31 cases,then the JOA score excellent and good rate of different spondylolisthesis degree and spondylolisthesis degree,Prolo score,VAS score before and after the treatment of two groups were compared. Result:The JOA score excellent and good rate of group B with different spondylolisthesis degree were higher than those of group A,spondylolisthesis degree,Prolo score,VAS score after the treatment were all better than those of group A,there were all significant differences(P<0.05). Conclusion:The clinical effect of decompression of the spinal canal,pedicle screw fixation and bone

  11. Quadrant 单侧固定椎间融合治疗不稳定型腰椎间盘突出症%Unilateral Pedicle Screw Fixation and Interbody Fusion for the Treatment of Lumbar Disc Hernia-tion with Lumbar Spinal Instability under Mast Quadrant System

    Institute of Scientific and Technical Information of China (English)

    李青; 姚海燕; 梁道臣; 赵成毅; 张爱明; 梅治; 陈应超; 张非

    2014-01-01

    Objective To explore the clinical outcome of the minimally invasive surgical approach by mast Quadrant sys-tem in the treatment of lumbar disc herniation with lumbar spinal instability. Methods For 31 patients with single level lum-bar disc herniation with lumbar spinal instability which diagnosed by magnetic resonance imaging and dynamic X-rays. This group included 20 males and 11 females. All patients were managed by unilateral pedicle screw fixation and interbody fusion under Mast Quadrant system. We evaluate the therapeutic effect according to Japanese Orthopaedic Association(JOA)and Os-westry disability index(ODI)before and after surgery. X-rays was used to evaluate the height variation and fusion of interverte-bral space. Results All patients were followed up for 14 to 36 months,with a mean period of 20. 4 months. The symptoms of lumbar and lower extremity were relieved completely. There was no decrease of intervertebral height. Radiographic interbody fu-sion rate was 100% . According to JOA scoring,the score increased from(7. 6 ± 2. 5)before operation to(25. 7 ± 1. 4)in the last follow-up,improvement rate of treatment was 84. 46% ,the score of ODI decreased from(55. 5 ± 5. 2)to(10. 9 ± 3. 0)in the last follow up after surgery. Conclusion The minimally invasive surgical treatment of unilateral pedicle screw fixation and interbody fusion assisted mast Quadrant system for lumbar disc herniation with lumbar spinal instability is reliable and provides satisfactory lumbar fusion and clinical results.%目的:探讨在 MastQuadrantTM 可扩张管通道系统下单侧固定加 Cage 治疗腰椎间盘突出症伴腰椎不稳的临床疗效。方法对31例腰椎间盘突出症伴腰椎不稳患者,采用 Quadrant 微创下单侧固定加 Cage 椎间融合术治疗,其中男20例,女11例;年龄34~76岁。术前、术后采用日本骨科学会(Japanese orthopaedic association,JOA)腰背痛评分及 Oswestry 功能障碍指数(oswestry disability

  12. Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

    Science.gov (United States)

    Belci, Maurizio; Van Middendorp, Joost J; Al Halabi, Ahmed; Meagher, Tom M

    2016-01-01

    To review the evidence of thromboembolism incidence and prophylaxis in the sub-acute phase of spinal cord injury (SCI) 3–6 months post injury. All observational and experimental studies with any length of follow-up and no limitations on language or publication status published up to March 2015 were included. Two review authors independently selected trials for inclusion and extracted data. Outcomes studied were incidence of pulmonary embolism (PE) and deep vein thrombosis (DVT) in the sub-acute phase of SCI. The secondary outcome was type of thromboprophylaxis. Our search identified 4305 references and seven articles that met the inclusion criteria. Five papers reported PE events and three papers reported DVT events in the sub-acute phase of SCI. Studies were heterogeneous in populations, design and outcome reporting, therefore a meta-analysis was not performed. The included studies report a PE incidence of 0.5%–6.0% and DVT incidence of 2.0%–8.0% in the sub-acute phase of SCI. Thromboprophylaxis was poorly reported. Spinal patients continue to have a significant risk of PE and DVT after the acute period of their injury. Clinicians are advised to have a low threshold for suspecting venous thromboembolism in the sub-acute phase of SCI and to continue prophylactic anticoagulation therapy for a longer period of time.

  13. Locomotor-activated neurons of the cat. I. Serotonergic innervation and co-localization of 5-HT7, 5-HT2A, and 5-HT1A receptors in the thoraco-lumbar spinal cord.

    Science.gov (United States)

    Noga, Brian R; Johnson, Dawn M G; Riesgo, Mirta I; Pinzon, Alberto

    2009-09-01

    Monoamines are strong modulators and/or activators of spinal locomotor networks. Thus monoaminergic fibers likely contact neurons involved in generating locomotion. The aim of the present study was to investigate the serotonergic innervation of locomotor-activated neurons within the thoraco-lumbar spinal cord following induction of hindlimb locomotion. This was determined by immunohistochemical co-localization of serotonin (5-HT) fibers or 5-HT(7)/5-HT2A/5-HT1A receptors with cells expressing the activity-dependent marker c-fos. Experiments were performed on paralyzed, decerebrate cats in which locomotion was induced by electrical stimulation of the mesencephalic locomotor region. Abundant c-fos immunoreactive cells were observed in laminae VII and VIII throughout the thoraco-lumbar segments of locomotor animals. Control sections from the same segments showed significantly fewer labeled neurons, mostly within the dorsal horn. Multiple serotonergic boutons were found in close apposition to the majority (80-100%) of locomotor cells, which were most abundant in lumbar segments L3-7. 5-HT7 receptor immunoreactivity was observed on cells across the thoraco-lumbar segments (T7-L7), in a dorsoventral gradient. Most locomotor-activated cells co-localized with 5-HT7, 5-HT2A, and 5-HT1A receptors, with largest numbers in laminae VII and VIII. Co-localization of c-fos and 5-HT7 receptor was highest in the L5-L7 segments (>90%) and decreased rostrally (to approximately 50%) due to the absence of receptors on cells within the intermediolateral nucleus. In contrast, 60-80 and 35-80% of c-fos immunoreactive cells stained positive for 5-HT2A and 5-HT1A receptors, respectively, with no rostrocaudal gradient. These results indicate that serotonergic modulation of locomotion likely involves 5-HT(7)/5-HT2A/5-HT1A receptors located on the soma and proximal dendrites of serotonergic-innervated locomotor-activated neurons within laminae VII and VIII of thoraco-lumbar segments.

  14. Efficacy of a Human Amniotic Tissue-derived Allograft, NuCel, in Patients Undergoing Posteriolateral Lumbar Fusions for Degenerative Disc Disease

    Science.gov (United States)

    2016-10-13

    Lumbar Degenerative Disc Disease; Spinal Stenosis; Spondylolisthesis; Spondylosis; Intervertebral Disk Displacement; Intervertebral Disk Degeneration; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Spondylolysis

  15. Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: A preliminary study

    Directory of Open Access Journals (Sweden)

    Saud Al-Obaidi

    2014-05-01

    Full Text Available Objective. This study explores the immune responses following 4 weeks of McKenzie lumbar spine exercise in individuals with acute low back pain (ALBP. Patients and methods. Fifteen patients with ALBP and 15 healthy individuals volunteered in this study. Ten ml of peripheral blood were obtained from each patient before and after exercise sessions, and from healthy individuals at the beginning of the study. Flow cytometric analysis was used to evaluate the frequencies of CD4+ T lymphocyte sub-populations and the intracellular cytokine expression within this cell population. Pain perceptions were obtained at baseline and following each week of exercise sessions. Results. In comparison with healthy subjects there was an elevated frequency of memory (CD4+CD45RO+ T cells, helper inducer (CD4+CD29+ T cells, CD3+CD16+CD56+ T cells and a lower frequency of naïve/suppressor (CD4+CD45RA+ T cells at base line in back pain patients (p<0.05. After 4 weeks of McKenzie exercise sessions, pain intensity significantly decreased (p<0.05; however, there was no significant difference in the frequency of memory (CD4+CD45RO+ T cells, helper inducer (CD4+CD29+ T cells, CD3+CD16+CD56+ T cells and naïve/suppressor (CD4+CD45RA+ T cells at base line relative to these cell populations after exercise sessions. The percentage of Pan (CD3+ T cells expressing IL-8 and TNF-α and the CD3+ T cells expressing the anti-inflammatory cytokine IL-4 increased significantly (p<0.05 following exercise sessions in comparison with baseline and healthy references. The reduction in pain scores did not correlate with elevated anti-inflammatory cytokines. Conclusion. McKenzie exercise sessions induced an immune activation state and simultaneously up regulated anti-inflammatory IL-4 cytokines that boost pain relief.

  16. Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma

    Directory of Open Access Journals (Sweden)

    Schmidt Oliver

    2007-01-01

    Full Text Available Polytraumatized patients following a severe trauma suffer from substantial disturbances of the immune system. Secondary organ dysfunction syndromes due to early hyperinflammation and late immunparalysis contribute to adverse outcome. Consequently the principle of damage control surgery / orthopedics developed in the last two decades to limit secondary iatrogenic insult in these patients. New percutaneous internal fixators provide implants for a damage control approach of spinal trauma in polytraumatized patients. The goal of this study is to evaluate the feasibility of minimal-invasive instrumentation in the setting of minor and major trauma and to discuss the potential benefits and drawbacks of this procedure. Materials and Methods: The present study is a prospective analysis of 76 consecutive patients (mean age 53.3 years with thoracolumbar spine fractures following major or minor trauma from August 2003 to January 2007 who were subjected to minimal-invasive dorsal instrumentation using CD Horizon ® Sextant TM Rod Insertion System and Longitude TM Rod Insertion System (Medtronic ® Sofamor Danek. Perioperative and postoperative outcome measures including e.g. local and systemic complications were assessed and discussed. Results: Forty-nine patients (64.5% suffered from minor trauma (Injury Severity Score < 16. Polytraumatized patients (n=27; 35.5% had associated chest (n=20 and traumatic brain injuries (n=22. For mono- and bisegmental dorsal instrumentation the Sextant TM was used in 60 patients, whereas in 16 longer ranging instrumentations the (prototype Longitude TM system was implanted. Operation time was substantially lower than in conventional approach at minimum 22.5 min for Sextant and 36.2 min for Longitude TM , respectively. Geriatric patients with high perioperative risk according to ASA classification benefited from the less invasive approach and lack of approach-related complications including no substantial blood loss

  17. Application of Laminoplasty of Pedicled Complex Replantation on Reconstruction of Spinal Canal at Degenerative Lumbar Spinal Stenosis%带蒂椎板复合体回植钛网固定在退变性腰椎管狭窄治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    肖睿; 李同相; 官清; 李兴波; 魏书一

    2015-01-01

    Objective To investigate the therapeutic effects of laminoplasty of pedicled complex replantation on recon-struction of spinal canal at lumbar spinal stenosis. Methods The involved segments were determinged by symptoms, clinical fea-tures and radiographic at the initial examination. 15patients with lumbar spinal stenosis were treated in our hospital. Each case was reserved bilateral facet joint,one or several vertebral lamina were cut by burr drill or micro-rongeur along the inner edge of bilateral facet joint,Superspinal and interspinal ligaments of one side were cut,then pedicelar vertehral lamina complex was retroflexed and intraspinal canal was exposured. After Lumbar spinal canal decompression,pedicelar vertebral lamina complex was replanted and ti-tanic mesh was fixated to reconstruct the integrity of vertebral canal and the stability of spinal column. Application VAS and ODI scoring method for subjective and objective evaluation of clinical curative effect before and after operation. Results The patients were followed up for 12 to 28 months[(13 ± 0. 5) months on average],during which no collapse of the replanted tissues or spinal canal stenosis occurred. Postoperative patients VAS and ODI score significantly higher than before,the difference was statistically sig-nificant(P<0. 05). Conclusion Retroflexing pedicelar vertebral plate complex and fixating with titanium plate in the lumbar spi-nal stenosis is simple,safe. The spinal column active naturelv without limit postoperatively,the technique can maintain the spinal col-umn good stability and protect the spinal column from degradation.%目的:探讨带蒂椎板复合体回植、钛网固定行椎管成形术治疗退行性腰椎管狭窄症的临床疗效。方法根据临床表现和影像学检查确定减压部位,对15例退行性腰椎管狭窄患者保留双侧关节突关节,采用磨钻或微型咬骨钳沿双侧关节突内侧缘打开一个或多个椎板,切断一端棘上和棘间韧

  18. Neuroligin 2 regulates spinal GABAergic plasticity in hyperalgesic priming, a model of the transition from acute to chronic pain.

    Science.gov (United States)

    Kim, Ji-Young V; Megat, Salim; Moy, Jamie K; Asiedu, Marina N; Mejia, Galo L; Vagner, Josef; Price, Theodore J

    2016-06-01

    Plasticity in inhibitory receptors, neurotransmission, and networks is an important mechanism for nociceptive signal amplification in the spinal dorsal horn. We studied potential changes in GABAergic pharmacology and its underlying mechanisms in hyperalgesic priming, a model of the transition from acute to chronic pain. We find that while GABAA agonists and positive allosteric modulators reduce mechanical hypersensitivity to an acute insult, they fail to do so during the maintenance phase of hyperalgesic priming. In contrast, GABAA antagonism promotes antinociception and a reduction in facial grimacing after the transition to a chronic pain state. During the maintenance phase of hyperalgesic priming, we observed increased neuroligin (nlgn) 2 expression in the spinal dorsal horn. This protein increase was associated with an increase in nlgn2A splice variant mRNA, which promotes inhibitory synaptogenesis. Disruption of nlgn2 function with the peptide inhibitor, neurolide 2, produced mechanical hypersensitivity in naive mice but reversed hyperalgesic priming in mice previously exposed to brain-derived neurotrophic factor. Neurolide 2 treatment also reverses the change in polarity in GABAergic pharmacology observed in the maintenance of hyperalgesic priming. We propose that increased nlgn2 expression is associated with hyperalgesic priming where it promotes dysregulation of inhibitory networks. Our observations reveal new mechanisms involved in the spinal maintenance of a pain plasticity and further suggest that disinhibitory mechanisms are central features of neuroplasticity in the spinal dorsal horn.

  19. Degenerative spinal disease in large felids.

    Science.gov (United States)

    Kolmstetter, C; Munson, L; Ramsay, E C

    2000-03-01

    Degenerative spinal disorders, including intervertebral disc disease and spondylosis, seldom occur in domestic cats. In contrast, a retrospective study of 13 lions (Panthera leo), 16 tigers (Panthera tigris), 4 leopards (Panthera pardis), 1 snow leopard (Panthera uncia), and 3 jaguars (Panthera onca) from the Knoxville Zoo that died or were euthanatized from 1976 to 1996 indicated that degenerative spinal disease is an important problem in large nondomestic felids. The medical record, radiographic data, and the necropsy report of each animal were examined for evidence of intervertebral disc disease or spondylosis. Eight (three lions, four tigers, and one leopard) animals were diagnosed with degenerative spinal disease. Clinical signs included progressively decreased activity, moderate to severe rear limb muscle atrophy, chronic intermittent rear limb paresis, and ataxia. The age at onset of clinical signs was 10-19 yr (median = 18 yr). Radiographic evaluation of the spinal column was useful in assessing the severity of spinal lesions, and results were correlated with necropsy findings. Lesions were frequently multifocal, included intervertebral disc mineralization or herniation with collapsed intervertebral disc spaces, and were most common in the lumbar area but also involved cervical and thoracic vertebrae. Marked spondylosis was present in the cats with intervertebral disc disease, presumably subsequent to vertebral instability. Six of the animals' spinal cords were examined histologically, and five had acute or chronic damage to the spinal cord secondary to disc protrusion. Spinal disease should be suspected in geriatric large felids with decreased appetite or activity. Radiographic evaluation of the spinal column is the most useful method to assess the type and severity of spinal lesions.

  20. Activation of ERK1/2 in spinal cord contributes to the development of acute cystic pain in rabbits

    Institute of Scientific and Technical Information of China (English)

    Yong-Hong WANG; Li-Cai ZHANG; Yin-Ming ZENG

    2006-01-01

    Objective To investigate the role of activated extracellular signal-regulated kinase 1/2 (ERK1/2) in spinal cord in the development of cystic pain in rabbit. Methods We observed the relationship between the activation of ERK1/2 in spinal cord and nociceptive behaviors, as well as the effect of U0126, a mitogen-activated protein kinase (MEK, upstream protein of ERK1/2) inhibitor, on cystic pain in rabbits by behavioral test, immunohistochemistry and western blot analysis. Results After injecting 0.5 ml formalin into gallbladder, the behaviors such as grasping of the cheek and licking of theabdomen increased in 30 min, with a significant increase in pERK1/2 expression in the spinal cord, as well as the pERK1/2 immunoreactive cells located in laminae Ⅴ~Ⅶ and X of the dorsal horn and ventral horn of T6 spinal cord. Administration of U0126 (100 ~400 μg/kg body weight, i.v., 10 min before instillation of formalin) could attenuated nociceptive behaviors dose-dependently, but could not restrain the nociceptive behaviors completely even at the maximal efficient dose of 400 μg/kg body weight. Conclusion Activated ERK1/2 in the spinal cord at least partly participates in the development of acute inflammatory cystic pain induced by formalin in rabbits.

  1. Hyperlipidemia and statins affect neurological outcome in lumbar spine injury.

    Science.gov (United States)

    Chung, Wu-Fu; Liu, Shih-Wei; Chang, Peng-Yuan; Lin, Feng-Shu; Chen, Li-Fu; Wu, Jau-Ching; Chen, Yu-Chun; Liu, Laura; Huang, Wen-Cheng; Cheng, Henrich; Lo, Su-Shun

    2015-01-05

    The disabling pathophysiologic effects of lipid and neuroprotective effects of statins have recently been demonstrated for acute spinal cord injuries in animal models. This large scale population-based study aimed to investigate the effect hyperlipidemia and the use of statins in patients with lumbar spine injury. The National Health Insurance Research Database of Taiwan was used to identify patients with lumbar spine injury. A total of 2844 patients were grouped into three: no hyperlipidemia, hyperlipidemia using low-dose of statins (≤90 of the defined daily dosage (DDD)), and severe hyperlipidemia using high-dose of statins (>90 DDD). A Cox multiple regression model was used to compare the incidence rates of disability among the three groups. The results showed that patients with hyperlipidemia appeared a higher risk of permanent disability (adjusted HR = 1.38, p = 0.28). In subgroup analysis, patients with severe hyperlipidemia had a higher risk of disability (adjusted HR = 3.1, p hyperlipidemia using low-dose statins had a similar risk of permanently disability (adjusted HR = 0.83, p = 0.661). Hyperlipidemia adversely affected the neurological outcomes of lumbar spinal injury. Statins may have the potential to reverse this higher risk of disability. However, this beneficiary effect of statins only existed in patients using a lower dose (≤90 DDD).

  2. Clinical Comparative Study: Efficacy and Tolerability of Tolperisone and Thiocolchicoside in Acute Low Back Pain and Spinal Muscle Spasticity

    OpenAIRE

    Rao, Rajeev; Panghate, Atul; Chandanwale, Ajay; Sardar, Indrajeet; Ghosh, Mriganka; Roy, Modan; Banerjee, Bireswar; Goswami, Ankur; Kotwal, Prakash P

    2012-01-01

    Study Design We performed a multicentric, randomized, comparative clinical trial. Eligible patients were randomly assigned to receive 150 mg of Tolperisone thrice daily or 8 mg of Thiocolchicoside twice daily for 7 days. Purpose To assess the efficacy and tolerability of Tolperisone in comparison with Thiocolchicoside in the treatment of acute low back pain with spasm of spinal muscles. Overview of Literature No head on clinical trial of Tolperisone with Thiocolchicoside is available and so t...

  3. Primary Dural Spinal Lymphoma Presentation of a Rare Spinal Tumor Case

    Directory of Open Access Journals (Sweden)

    Dilber Ayçiçek Çeçen

    2015-01-01

    Full Text Available Background. Primary spinal dural lymphomas (PSDL are tumors with characteristic histopathology of a lymphoma, which are completely in the spinal epidural space without any other systemic involvement. Extranodal primary lymphoma involving nervous system prefers thalamus/basal ganglia, periventricular region, cerebellum, eyes, meninges/dura, and cranial nerves or spinal cord. Rare spinal localization with acute spinal cord compression is worth attention. Case Presentation. A 48-year-old male presented with a several-month-long history of upper back pain. Lately, he had numbness and weakness at both lower extremities and was unable to walk for one week. A spinal MRI showed a thoracic lesion with cord compression at T2–T4 levels. The patient underwent surgical decompression, with his final histopathology showing diffuse large B-cell lymphoma. Systemic work-up was negative for nodal disease. Following surgery, he received radiotherapy combined with chemotherapy. He experienced a good outcome after four years. Conclusion. The upper thoracic cord is a rare location for primary spinal lesions/metastases, both of which prefer the lower thoracic and upper lumbar regions. In cases of progressive paraparesis, there should be immediate surgical intervention in the case of denovo disease, followed by combined radiotherapy and chemotherapy procedures.

  4. The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study FNx01

    Directory of Open Access Journals (Sweden)

    Saeid Abrishamkar

    2011-01-01

    Full Text Available Background: Low Back Pain (LBP and radicular leg pain (RLP after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. Methods: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1, methylprednisolone acetate (group2 and normal saline (control group. The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS. Results: Of 66 patients, 53% were female and 47% male. The average (SE LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. Conclusions: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery.

  5. The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study*

    Science.gov (United States)

    Abrishamkar, Saeid; Rafiei, Ahmad Reza; Sabouri, Masih; Moradi, Siamak; Tabesh, Homayoun; Rahmani, Payman; Hekmatnia, Ali; Torkashvand, Mostafa; Eshraghi, Noorolah; Baghershahi, Ghasem

    2011-01-01

    BACKGROUND: Low Back Pain (LBP) and radicular leg pain (RLP) after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT) with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. METHODS: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1), methylprednisolone acetate (group2) and normal saline (control group). The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS). RESULTS: Of 66 patients, 53% were female and 47% male. The average (SE) LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. CONCLUSIONS: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery. PMID:22091284

  6. SACRALISATION OF LUMBAR VERTEBRAE

    Directory of Open Access Journals (Sweden)

    Sangeeta Wazir

    2014-06-01

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

  7. CAPABILITIES OF ELECTRONEUROSTIMULATION IN PATIENTS WITH VERTEBRAL-SPINAL INJURIES

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    A. I. Toma

    2010-01-01

    Full Text Available The possibilities of epidural electrical stimulation in the complex treatment of patients with spinal injury in the acute and late periods of traumatic disease of the spinal cord. The authors presented the analysis of treatment results of 356 patients with a spinal-cord injury at age 16 to 71 years, including 293 patients in the acute and early periods of trauma, and 63 - in the late period. Injuries of the cervical spine were observed in 145 (40,7% men, thoracic - in 59 (16,6%, thoracolumbar - in 89 (25,0%, lumbar - in 63 (17,7%. As the result of the conducted electropulse influence on the spinal cord in the acute period of the trauma we succeeded in achieving positive outcomes in 80,9% of patients, and that is 11,7% better, than in the comparison group. That allowed us to restore lost functions of the spinal cord more completely in more than the half of the patients with consequences of vertebral cerebro-spinal trauma.

  8. Activation of JNK pathway in spinal astrocytes contributes to acute ultra-low-dose morphine thermal hyperalgesia.

    Science.gov (United States)

    Sanna, Maria Domenica; Ghelardini, Carla; Galeotti, Nicoletta

    2015-07-01

    Accumulating evidence suggests that opioid analgesics can lead to paradoxical sensitization to pain when delivered in different administration patterns. Although opioid tolerance-induced hyperalgesia is largely studied, little is known about the mechanisms underlying acute ultra-low-dose morphine hyperalgesia. Activation of spinal glial cells is reported to regulate pain hypersensitivity. To elucidate the mechanism involved in acute ultra-low-dose morphine hyperalgesia, we tested whether an opioid agonist promoted the activation of spinal astrocytes and microglia and investigated the cellular pathways involved. Ultra-low-dose morphine activated spinal astrocytes with no effect on microglia. The astrocyte activation was selectively prevented by the opioid antagonist naloxone, the μ-opioid receptor (MOR) silencing and the JNK inhibitor SP600125. Morphine elevated spinal JNK1, JNK2, and c-Jun phosphorylation. Conversely, phosphorylation of cAMP response element-binding protein (CREB) and signal transducer and activator of transcription-1 (STAT-1) was not elevated, and nuclear factor kappa B (NF-κB) levels remained unmodified. Administration of SP600125 and the N-methyl-D-aspartate (NMDA) antagonist MK801 prevented morphine hyperalgesia. Ultra-low-dose morphine increased protein kinase C (PKC) γ phosphorylation. Pretreatment with a PKC inhibitor prevented morphine hyperalgesia and JNK and c-Jun overphosphorylation, indicating PKC is a JNK upstream modulator and illustrating the presence of a pathway involving PKC, NMDA, and JNK activated by morphine. Immunofluorescence experiments indicated the neuronal localization of spinal MOR. However, JNK was not detected in MOR-expressing cells, showing the presence of a neuron-astrocyte signaling pathway. These results illustrate the selective activation of an astrocyte JNK pathway after the stimulation of neuronal MOR, which contributes to ultra-low-dose morphine hyperalgesia.

  9. Effects of acute millimeter wave exposure on the expression of substance P and c-fos in rat spinal cord

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    Yan-wen ZHANG

    2013-04-01

    Full Text Available Objective  To observe the expression changes in substance P (SP and c-fos in rat spinal cord after acute millimeter-wave (MMW exposure, and explore the mechanism of thermal hyperalgesia at the spinal level. Methods  The back skin of SD rats was exposed to 35 GHz MMW (40W/cm2 for 0s (control group, 30s, 1min, or 3min. The corresponding segment of the spinal cord was taken at 0min, 5min, 10min, 1h and 3h after MMW irradiation for total RNA and protein extraction. The expressions of SP and c-fos mRNA were measured by real-time RT-PCR, and the expression of c-fos protein was detected by Western blotting. Results  No significant difference was found between the control group and irradiation groups in SP and c-fos mRNA expression in the corresponding segment of spinal cord after MMW irradiation for 30s. After MMW irradiation for 1min, the SP and c-fos mRNA expressions in the corresponding segment of spinal cord increased significantly at 10min time point, and then decreased to the level of control group. After MMW irradiation for 3min, the SP and c-fos mRNA expression in the corresponding segment of spinal cord increased significantly at 5min, 10min and 1h time points, and decreased to the level of control group at 3h. No significant change was found in c-fos protein expression in the corresponding segment of spinal cord after MMW irradiation for 30s and 1min. After MMW irradiation for 3min, the c-fos protein expression in the corresponding segment of spinal cord increased significantly at 5min and 10min time point, and then decreased to the level of control group. Conclusion  The increase of SP expression in rat skin after MMW irradiation may be related to the increase of SP and c-fos expressions in the corresponding segment of the spinal cord induced by thermal pain stimulation.

  10. A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings

    Institute of Scientific and Technical Information of China (English)

    Katsuyoshi Tamaki; Ichiro Shimizu; Mari Urata; Nao Kohno; Hiroshi Fukuno; Susumu Ito; Nobuya Sano

    2007-01-01

    Although spinal tumors are uncommon, they may reduce survival or cause serious functional disorders in the extremities. Metastatic spinal tumors from malignant tumors can induce symptoms of spinal cord compression, such as paraplegia, quadriplegia, and vesicorectal disturbance, which are aggravated with progression of the diseases and time. We report a patient with hepatocellular carcinoma (HCC) who was suspected of having spinal lesions based on neurological findings, and a metastatic spinal tumor was found by imaging examination. Assuming that metastasis had occurred at the time lumbar pain developed, the patient reached the level of gAlt disturbance within only 4 mo, showing a rapid advancement of symptoms. If early diagnosis had been possible, treatment could be performed before acute myelopathy progressed to complete paralysis. We speculate that the terminal stage of HCC is not only liver fAllure associated with intrahepatic lesions but also metastasis to other regions, treatment for individual pathologies therefore, will be needed, which constitutes an important issue.

  11. Cofelx棘突间动态内固定治疗单节段腰椎管狭窄症%Treatment of Cofelx interspinous implant on patients with single lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    孙红亮

    2013-01-01

    Objective To study the short-term clinical effect of Cofelx interspinous implant on single lumbar spinal stenosis. Methods Twenty-two patients with lumbar spinal stenosis were treated with decompression and Cofelx interspinous implant , the clinical evaluation was concluded by Japanese orthopaedic association (JOA) scores and Oswestry disability index (ODI) , the radiographs were taken to measure the range of motion ( ROM) of operation section and upper adjacent segment. Results The postoperative JOA and ODI scores showed significant improvement compared with preoperative JOA and ODI scores,there were significant differences (P <0.05). The postoperative ROM also showed a significant improvement compared with preoperative ROM at operative segments(P <0.05). But the ROM at the upper adjacent segments was not changed significantly during the follow-up(P >0. 05). Conclusion The Cofelx implant shows a good short-term clinical effect on patients with lumbar spinal stenosis and has few influences on upper adjacent segments, this helps to slow down adjacent segment degeneration.%目的 探讨Cofelx棘突间动态内固定术在单节段腰椎管狭窄症治疗中的短期疗效.方法 22例单节段腰椎管狭窄症患者经后路减压同时行Cofelx内固定术,应用Oswestry功能障碍指数评定(ODI)和日本骨科协会评估治疗分数(JOA)评价临床疗效,在X线片上测量术段及上邻节段的活动度(ROM).结果 术后JOA、ODI评分及手术节段ROM均优于术前,差异有统计学意义(P<0.05);上邻节段ROM术后与术前相比,差异无统计学意义(P>0.05).结论 Cofelx治疗单节段腰椎管狭窄症短期疗效良好,且对上邻节段ROM影响较小,有利于减缓邻近节段退行性变.

  12. Altered spontaneous brain activity in patients with acute spinal cord injury revealed by resting-state functional MRI.

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    Ling Zhu

    Full Text Available Previous neuroimaging studies have provided evidence of structural and functional reorganization of brain in patients with chronic spinal cord injury (SCI. However, it remains unknown whether the spontaneous brain activity changes in acute SCI. In this study, we investigated intrinsic brain activity in acute SCI patients using a regional homogeneity (ReHo analysis based on resting-state functional magnetic resonance imaging.A total of 15 patients with acute SCI and 16 healthy controls participated in the study. The ReHo value was used to evaluate spontaneous brain activity, and voxel-wise comparisons of ReHo were performed to identify brain regions with altered spontaneous brain activity between groups. We also assessed the associations between ReHo and the clinical scores in brain regions showing changed spontaneous brain activity.Compared with the controls, the acute SCI patients showed decreased ReHo in the bilateral primary motor cortex/primary somatosensory cortex, bilateral supplementary motor area/dorsal lateral prefrontal cortex, right inferior frontal gyrus, bilateral dorsal anterior cingulate cortex and bilateral caudate; and increased ReHo in bilateral precuneus, the left inferior parietal lobe, the left brainstem/hippocampus, the left cingulate motor area, bilateral insula, bilateral thalamus and bilateral cerebellum. The average ReHo values of the left thalamus and right insula were negatively correlated with the international standards for the neurological classification of spinal cord injury motor scores.Our findings indicate that acute distant neuronal damage has an immediate impact on spontaneous brain activity. In acute SCI patients, the ReHo was prominently altered in brain regions involved in motor execution and cognitive control, default mode network, and which are associated with sensorimotor compensatory reorganization. Abnormal ReHo values in the left thalamus and right insula could serve as potential biomarkers for

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

    OpenAIRE

    HIRATZKA, JAYME; Rastegar, Farbod; Contag, Alec G.; Norvell, Daniel C.; Anderson, Paul A.; Hart, Robert A

    2015-01-01

    Study Design Systematic review. Objectives (1) To compare the quality of adverse event (AE) methodology and reporting among randomized trials comparing lumbar fusion with lumbar total disk replacement (TDR) using established AE reporting systems; (2) to compare the AEs and reoperations of lumbar spinal fusion with those from lumbar TDR; (3) to make recommendations on how to report AEs in randomized controlled trials (RCTs) so that surgeons and patients have more-detailed and comprehensive inf...

  14. 微创腰椎后路减压融合术与传统全椎板切除术治疗腰椎管狭窄的对照研究%Control study on minimally invasive posterior lumbar decompression and fusion and traditional total laminectomy for lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    周波; 王强

    2013-01-01

    Objective To compare the therapeutic effect and clinical application value of minimally invasive posterior lumbar decompression and fusion and traditional total laminectomy in the treatment of lumbar spinal stenosis.Methods One hundred and thirty-eight patients with lumbar spinal stenosis were divided into observation group (n =68) and control group (n =70).The observation group was given minimally invasive lumbar posterior dencompression and fusion,while the control group was given traditional total laminectomy treatment.The operation situation,visual analogue scale (VAS),oswestry disability index (ODI),Japanese orthopaedic association (JOA) score and incidence of postoperative adverse reactions in two groups were compared.Results The bleeding amount during operation,incision length,hospital stays in the observation group were significantly lower than those in the control group (P < 0.01).The reducing degree of VAS and ODI in the observation group were significantly larger than those in the control group (P < 0.01).The incidences of adverse reaction in both groups had no significant difference (P >0.05).Conclusion Minimally invasive lumbar posterior decompression and fusion in the treatment of lumbar spinal stenosis has small trauma,less bleeding,specific curative effect,lower postoperative pain and reduced operation risk and complications,so it is worthy of clinical application.%目的 比较微创腰椎后路减压融合术与传统全椎板切除术治疗腰椎管狭窄的疗效及临床应用价值.方法 将138例腰椎管狭窄患者随机分为观察组68例及对照组70例.观察组给予微创腰椎后路减压融合术治疗,对照组给予传统全椎板切除术治疗.比较2组手术情况、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)评-及术后不良反应发生率.结果 观察组术中出血量、手术切口长度及住院时间均显著小于对照组(P<0.01).观察组VAS及ODI降低

  15. Value of MRI and DTI as Biomarkers for Classifying Acute Spinal Cord Injury

    Science.gov (United States)

    2014-10-29

    following complete paraplegia . Arch Phys Med Rehabil. 1992 Sep;73(9):784-9. 7. Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery...The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia . 1969 Nov;7...complete spinal cord injury. Paraplegia . 1991 Nov;29(9):573-81. 14. Consortium for Spinal Cord Medicine. Outcomes following traumatic spinal cord injury

  16. The Healing of Bone Marrow-Derived Stem Cells on Motor Functions in Acute Spinal Cord Injury of Mice

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    N Gashmardi

    2016-10-01

    Full Text Available Background & aim: Spinal cord injury is a devastating damage that can cause motor and sensory deficits reducing quality of life and life expectancy of patients. Stem cell transplantation can be one of the promising therapeutic strategies. Bone marrow is a rich source of stem cells that is able to differentiate into various cell types. In this study, bone marrow stem cells were transplanted into mice spinal cord injury model to evaluate the motor function test. Methods: Bone marrow stem cells were isolated from 3 mice. Thirty six mice were randomly divided into 3 groups: the control, sham and experimental. In sham group, mice were subjected to spinal cord compression. In experimental group, one day after lesion, isolated stem cells (200,000 were injected intravenously. Assessment of locomotor function was done by Toyama Mouse Score (TMS after 1, 2, 3, 4, 5 week post-injury. The data were analyzed using one-way Analysis of Variance and Tukey tests and statistical software Graph Pad and SPSS.P > 0/05 was considered as significant difference.  Results: The score of TMS after cell transplantation was higher in cell transplantation group (experimental, while it was significantly higher after fifth week when compared to other groups. Conclusion: The increase in TMS score in cell transplantation group showed that injection of stem cells in acute spinal cord injury can have a therapeutic effect and promote locomotor function.

  17. Effects of recombinant sCR1 on the immune inflammatory reaction in acute spinal cord injury tissue of rats

    Institute of Scientific and Technical Information of China (English)

    李良满; 朱悦; 范广宇

    2005-01-01

    Objective: To determine the effects of recombinant soluble complement receptor type I (sCR1) on the immune inflammatory reaction in acute spinal cord injury tissue of rats and its protective effects. Results: The motor function of rat in sCR1 group at 3 d, 7 d, and 14 d was obviously better than that in NS group (P<0.01, P<0.01, P<0.01). C3c positive expression in sCR1 group at each time point after injury was obviously less than that in NS group (P<0.01). The myeloperoxidase activity in sCR1 group at each time point after injury was obviously less than that in NS group (P<0.01). Conclusions: Recombinant soluble complement receptor type I (sCR1) can lessen the immune inflammatory reaction in acute spinal cord injury tissue and relieve secondary spinal cord injury by inhibiting the activation of the complement system.

  18. Early methylprednisolone impact treatment for sensory and motor function recovery in patients with acute spinal cord injury A self-control study

    Institute of Scientific and Technical Information of China (English)

    Chao Zhuang; Liming Wang; Yan Xu

    2008-01-01

    BACKGROUND: For the treatment of spinal cord injury, any pathological changes of the injured tissue should be primarily corrected or reversed. Any remaining fibrous function and neurons with intact structure should be retained, and the toxic substances caused by ischemia-hypoxia following spinal cord injury, should be eliminated to create a favorable environment that would promote neural functional recovery. OBJECTIVE: This study was designed to investigate the effects of the impact of early methylprednisolone-treatment on the sensory and motor function recovery in patients with acute spinal cord injury. DESIGN: A self-control observation. SETTING: Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. PARTICIPANTS: Forty-three patients with acute spinal cord injury were admitted to the Department of Spine Surgery, First Affiliated Hospital of Nanjing Medical University, between October 2005 and September 2007. These patients were recruited for the present study. The patients comprised 33 males and 10 females, and all met with the inclusive criteria namely, the time between suffering from acute spinal cord injury and receiving treatment was less than or equal to eight hours. METHODS: According to the protocol determined by the State Second Conference of Acute Spinal Cord Injury of USA, all patients received the drop-wise administration of a 30-mg/kg dose of methylprednisolone (H200040339,500mg/bottle, Pharmacia N.V/S.A, Belgium) for 15 minutes within 8 hours post injury. After a 45-minute interval, methylprednisolone was administered at 5.4mg/kg/h for 23 hours. MAIN OUTCOME MEASURES: Prior to and post treatment, acupuncture sense and light touch scoring were performed at 28 dermatomic area key points, including occipital tuberosity and supraclavicular fossa. At the same time, motor scoring of key muscles among 10 pairs of sarcomeres was also performed.RESULTS: All 43 patients participated in the final

  19. 脊柱退行性疾病对腰椎前后位骨密度的影响分析%The impact analysis of degenerative spinal disease on lumbar bone mineral density in the anteroposterior view

    Institute of Scientific and Technical Information of China (English)

    臧渊; 雷伟; 吴子祥

    2012-01-01

    双能X线骨密度仪检测骨密度是诊断骨质疏松症的“金标准”,学者推荐50岁以上人群采用腰椎前后位进行测量.然而骨质疏松症发病率较高的老年人群,常常合并罹患多种脊柱退行性疾病,例如腰椎间盘突出、退行性侧凸、骨赘增生等,这些病理改变可导致腰椎前后位骨密度值准确性降低.因此,提高腰椎骨密度测量准确性,对于骨质疏松症的诊断和治疗具有重要意义.本文就常见的脊柱退行性疾病对腰椎前后位骨密度的影响作一综述,以期帮助临床医生全面评估和诊断骨质疏松症.%Objective Bone mineral density (BMD) detected by dual-energy X-ray absorptiometry can be regarded as the "gold standard" for the diagnosis of osteoporosis. The scholars recommend that all adults over SO years old should conduct the anteroposterior position measurement. However, the elderly population with high incidence of osteoporosis often combines with many degenerative spinal diseases, such as intervertebral disc herniation, degenerative scoliosis, osteophyte formation, etc. These pathological changes in the lumbar spine might reduce the accuracy of BMD in anteroposterior position. So the increase of BMD accuracy is of great significance in diagnosis and treatment of osteoporosis. This article reviews the impacts of spinal degenerative diseases on lumbar bone mineral density and aims to facilitate clinicians to assess and diagnose osteoporosis comprehensively.

  20. [Lumbar hernia].

    Science.gov (United States)

    Teiblum, Sandra Sofie; Hjørne, Flemming Pii; Bisgaard, Thue

    2010-03-22

    Lumbar hernia is a rare condition. Lumbar hernia should be considered a rare differential diagnosis to unexplained back pain. Symptoms are scarce and diffuse and can vary with the size and content of the hernia. As there is a 25% risk of incarceration, operation is indicated even in asymptomatic hernias. We report a case of lumbar hernia in a woman with a slow growing mass in the lumbar region. She presented with pain and a computed tomography confirmed the diagnosis. She underwent open surgery and fully recovered with recurrence within the first half year.

  1. Minimal Access Spinal Technologies (Mast Fusion Procedures For The Treatment Of The Degenerative Lumbar Spine (A Part Of Multicentral Prospective Study

    Directory of Open Access Journals (Sweden)

    Khoshab A.H.

    2014-05-01

    Full Text Available 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, intraoperative 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 twolevel 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 2.1 (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.

  2. Clinical Effect of Small Incision Fenestration in the Treatment of Llumbar Spinal Stenosis and Lumbar Disc Herniation%小切口开窗术治疗腰椎管狭窄症合并腰间盘突出症临床作用分析

    Institute of Scientific and Technical Information of China (English)

    崔化天

    2015-01-01

    Objective Observe the effect of smal incision fenestration in the treatment of lumbar spinal stenosis and lumbar disc herniation. Methods Selected 80 cases of lumbar disc herniation and lumbar spinal stenosis from November 2013 to October 2014 in our hospital and randomly divided into two groups, 40 cases in each group. The control group received conventional excision,the observation group to implement a smal incision fenestration,observed the outcomes. Results The total efficiency of the observation group was 92.50%,higher than 70.00%,comparing the two groups merged lumbar disc herniation treatment of lumbar spinal stenosis differences(P<0.05). Conclusion Smal incision fenestration for the treatment of lumbar spinal stenosis and lumbar disc herniation has significant therapeutic effect.%目的:观察小切口开窗术治疗腰椎管狭窄症合并腰间盘突出症的疗效。方法选择2013年11月~2014年10月在我院治疗腰间盘突出合并腰椎管狭窄症的患者80例,将其随机分为2组,每组各40例。对照组采取传统摘除术,观察组实施小切口开窗术,观察患者的治疗效果。结果观察组的总有效率92.50%,高于对照组70.00%,两组腰间盘突出合并腰椎管狭窄症患者对比疗效的差异有统计学意义(P<0.05)。结论小切口开窗术治疗腰椎管狭窄症、腰间盘突出症,具有显著的治疗效果。

  3. Unnecessary multiple epidural steroid injections delay surgery for massive lumbar disc: Case discussion and review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: Epidural steroid injections (ESI in the lumbar spine are not effective over the long-term for resolving "surgical" lesions. Here, we present a patient with a massive L2-L3 lumbar disk herniation whose surgery was delayed for 4 months by multiple unnecessary ESI, resulting in a cauda equina syndrome. Methods: A 54-year-old male acutely developed increased low back and radiating left leg pain in October of 2014. In December of 2014, a magnetic resonance imaging (MRI scan showed a massive central/left sided disk herniation at the L2-L3 level resulting in marked thecal sac and left L2 foraminal and L3 lateral recess root compression. Despite the marked degree of neural compression, pain management treated him with 3 ESI over the next 3 months. Results: At the end of April of 2015, he presented to spine surgeon with a cauda equina syndrome. When the new MRI scan confirmed the previously documented massive central-left sided L2-L3 disk herniation, the patient emergently underwent an L1-L3 laminectomy with central-left sided L2-L3 lateral/foraminal diskectomy. Postoperatively, the patient was neurologically intact. Conclusions: Pain specialists performed multiple unnecessary lumbar ESI critically delaying spinal surgery for 4 months in this patient with a massive lumbar disk herniation who ultimately developed a cauda equina syndrome. Unfortunately, pain specialists (e.g., radiologists, anesthesiologists, and physiatrists, not specifically trained to perform neurological examinations or spinal surgery, are increasingly mismanaging spinal disease with ESI/variants. It is time for spine surgeons to speak out against this, and "take back" the care of patients with spinal surgical disease.

  4. Rehabilitation nursing experience for acute lumbar sprain%急性腰扭伤的康复护理体会

    Institute of Scientific and Technical Information of China (English)

    吴花梅; 吴玲; 刘岩

    2003-01-01

    @@ TREATMENT EXPERIENCE FOR LUMBAR SPRAIN Massage and traction are often used in treatment of lumbar sprainto alleviate adhesion of muscle and ligament, enlarge intervertebralspace. At the same time, local dialysis, physical therapy might beused, also acupuncture moxibustion. To massage treatment, painpoints at lumbodorsal or lumbosacral part are massaged for 15minutes, thereafter pressed for 10 minutes to promote lumbosacralblood circulation and excite himbosacral nerves. After pain, spasmare relieved, local compression of traditional Chinese medicine isperformed; Prescription includes: club-moss 15 g, burred tuber 12g, zedoary 12 g, large-leaf gentian root 12 g, ledeboriella root 9 g,erythrina bark 12 g, achyranthes root 10 g, chaenomeles fruit 10 g,safflower 10 g, Chinese angelica 10 g, homalomena rhizoma 12 g,sappan wood 10 g, decoted in water for compression on affectedsite.

  5. Clinical efficacy of lumbar spinal fixation system on lumbar spondylolisthesis%通用型脊柱内固定系统治疗腰椎滑脱的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    殷建伟

    2015-01-01

    Objective To evaluate the clinical effects of general spine fixation system (GSS) on the patients with lumbar spondylolisthesis.Methods One hundred and ten patients with lumbar spondylolisthesis were chose.All of spondylolisthesis patients were divided into D1 group (observation group,55 cases) and D2 group (control group,55 cases).The patients in D1 group were treated with GSS method; the patients in D2 Group were given conservative treatment.The treatment effects of the exhibit differences of the two groups were compared.Results The two groups patients with lumbar spondylolisthesis completed the treatment,in terms of therapeutic efficacy,D1 group were significantly better than the D2 group (P < 0.05).Conclusions For patients with lumbar spondylolisthesis,select the GSS method to treat,the treatment effect finally obtained more precise,the clinical manifestations with the higher fusion rate,effectively reflecting the ease of installation,use a shorter and fixed high security features,has the high clinical value.%目的 探讨腰椎滑脱患者实施通用型脊柱内固定系统(GSS)治疗后的临床效果.方法 选取腰椎滑脱症患者110例.通过随机数表法将所有腰椎滑脱症患者分为D1组(观察组55例)与D2组(对照组55例).D1组选择GSS方法给予治疗;D2组选择保守方法治疗.对比两组患者治疗后临床效果的差异性.结果 两组患者完成治疗后,在治疗效果方面,D1组明显优于D2组(P<0.05).结论 针对腰椎滑脱患者,选择GSS方法的治疗效果更为确切,有较高的植骨融合率,具有安装方便、用时较短以及固定安全性较高等特点,具有较高的临床应用价值.

  6. Delayed onset of a spinal epidural hematoma after facet joint injection

    Directory of Open Access Journals (Sweden)

    Mirko Velickovic

    2016-10-01

    Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

  7. The Anatomy Study of Impact on Spinal Canal Through Lumbar Pedicle Extended Laminoplasty%腰椎椎弓根延长椎管扩大成形术对椎管影响的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    杨惠林; 朱若夫; 魏旺; 陈康武; 杨炎; 唐天驷

    2011-01-01

    Objective To explore the variation of L1 to L5 spinal canal dimension with the application of spiral three dimentional CT reconstruction after transpedicle osteotomy so as to provide anatomical evidence for lumbar spinal cannal decompression. Method Ten cadaver specimens of adult lumbarsacral spine ( L1 to L5 ) were prepared for spiral three dimentional CT reconstruction before and after pedicle was recected. The CT screenage datas were measured in respect of the spinal canal dimension when pedicle was intact and when disarticulated pedicle was transferred backward at 2 mm, 4 mm, and 6 mm distance.Results Compared with the intact spinal canal, there were statistically significant dimension change in L1 to L5 when recected pedicle was transferred backward at 4 mm and 6 mm distance( P <0.05 ), and as well as in L1 -3, L5 when disarticulated pedicle was transferred backward at 2 mm distance( P < 0.05 ).Conclusion Transpedicle osteotomy increased spinal canal dimension significantly, which will be a new way for lumbar spinal cannal decompression.%目的 通过经椎弓根截骨延长椎弓根扩大椎管,并应用螺旋CT三维重建测量各节段腰椎截骨椎弓根延长前后椎管面积,为临床进行腰椎管减压提供解剖学依据.方法 10具成人腰椎标本(L1~L5),螺旋CT分别对椎弓根截断前后的腰椎标本进行扫描,对CT重建后的图像进行测量,包括原始腰椎各节段椎管面积,椎弓根截断后椎弓根后移2、4、6 mm后的椎管面积.结果 对椎弓根截断前后椎管面积进行比较,结果显示,L1~L5椎弓根后移4、6 mm,椎弓根截断前后椎管面积对比有统计学差异(P<0.05),L1~L3、L5节段椎弓根后移2 mm,椎弓根截断前后椎管面积对比有统计学差异(P<0.05).结论 经椎弓根截骨椎管扩大成形术,可以明显增加腰椎管的面积,为临床进行腰椎管减压提供一种新的方法.

  8. 胸腰椎骨折伴脊髓损伤手术方式选择%The Selection of operative Procedures for Thoraco-lumbar Fracture Complicated with Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    林本丹; 钟志刚; 邱雪立; 胡奕山; 周来喜

    2001-01-01

    Objective: To explore the effects and indications of anterior or posterior approach operation to treat thoraco-lumbar fracture complicated with spinal cord injury;to discuss the selection of the material of internal fixation.Methods: 53 cases of thoraco-lumbar fracture accompanied with spinal cord injury were operated from Jan.1992 to Apr.2000.43 cases were treated by posterior approach operation and 10 cases by anterior approach.Results:41 cases were followed-up over 6 months.3 cases that ASIA(American Spinal Injary Association)impairment scale of preoperation showed A had no recovery.Others were recovered from 1-3 scale after operation.The level of recovery of spinal cord injury could not be compared between anterior approach and posterior approach.In 43 cases of posterior approach operation,11 cases could not recover the height of vertebral body after operation.In all 10 cases of anterior approach operation,the fracture of vertebral body achieved anatomical reduction.Conclusions:The indications anterior approach and posterior approach operation could be defined according to the segment of injured vertebra,the compressed position of spinal cord that was showed by CT and the impairment scale of spinal cord.That the height of vertebral body lost again could be found in long-term follow-up in the posterior approach operation.The late result of the anterior approach operation was good because it could achieve the biologic fusion in the injured vertebral body.%目的:探讨胸腰椎骨折伴脊髓损伤前后路手术各自的优缺点、适应证以及内固定物的选择。方法:回顾1992年1月~2000年4月手术治疗胸腰椎骨折伴脊髓损伤53例,其中后路手术43例,前路手术10例;总结手术方法及手术疗效。结果:获6个月以上随访41例,脊髓神经功能术前为A级3例,术后均无恢复;其他在术后均有1-3级恢复;前后路手术对神经功能恢复无法做比

  9. Experimental study of effectiveness of local application of electroneurostimulation, cortexin and methylprednisolone in acute spinal cord injury

    Directory of Open Access Journals (Sweden)

    Tsymbaliuk V.I.

    2014-09-01

    Full Text Available The tasks were to investigate the effect of topical electroneurostimulation, cortexin and methy¬lprednisolone in acute spinal cord injury in electrophysiological experiments on laboratory rats. The animals un¬derwent half transection of the spinal cord in the lower-thoracic area to simulate Brown-Sequard’s syndrome. Drugs were administered subdurally once daily in the dose of 0.03 mg for cortexin and 0.7 mg for methylprednisolone during 72 hours. Electrophysiological studies were carried out using standard electrophysiological apparatus. Reliable changes of bioelectric indicators in neuromuscular complex during topical application of electrical stimulation, as well as in administered methylprednisolone, failed to be found. However, local application of cortexin in terms of traumatic spinal cord injury due the antioxidant and neurotrophic effect results in improvement of bioelectrical indicators; this is manifested in reliable (p<0.05 increase of amplitude of the background electromyogram impulses at rest by 33% and increase of spontaneous oscillations frequency by 29.82%.

  10. Spinal vascular endothelial growth factor (VEGF) and erythropoietin (EPO) induced phrenic motor facilitation after repetitive acute intermittent hypoxia.

    Science.gov (United States)

    Dale, Erica A; Mitchell, Gordon S

    2013-02-01

    Vascular endothelial growth factor (VEGF) and erythropoietin (EPO) exert neurotrophic and neuroprotective effects in the CNS. We recently demonstrated that VEGF, EPO and their receptors (VEGF-R2, EPO-R) are expressed in phrenic motor neurons, and that cervical spinal VEGF-R2 and EPO-R activation elicit long-lasting phrenic motor facilitation (pMF). Since VEGF, VEGF-R, EPO, and EPO-R are hypoxia-regulated genes, and repetitive exposure to acute intermittent hypoxia (rAIH) up-regulates these molecules in phrenic motor neurons, we tested the hypothesis that 4 weeks of rAIH (10 episodes per day, 3 days per week) enhances VEGF- or EPO-induced pMF. We confirm that cervical spinal VEGF and EPO injections elicit pMF. However, neither VEGF- nor EPO-induced pMF was affected by rAIH pre-conditioning (4 wks). Although our data confirm that spinal VEGF and EPO may play an important role in respiratory plasticity, we provide no evidence that rAIH amplifies their impact. Further experiments with more robust protocols are warranted.

  11. Palpation and Massage Therapy on Acute Lumbar Sprain%急性腰扭伤触诊检查及按摩手法治疗

    Institute of Scientific and Technical Information of China (English)

    王可

    2014-01-01

    Acute lumbar sprain includes tissue sprain of waist muscle, fascia, ligament, joint and the like, which is difficult to make a definite diagno-sis only with chief complaints of patients and iconography examination, careful palpation, differentiating sprain site of tissue and dialectical manipu-lation treatment are the key to acquire favorable effect.%急性腰扭伤包括腰部肌肉、筋膜、韧带和关节等组织扭伤,仅凭患者主诉和影像学检查难以确诊,通过仔细触诊,辨清组织扭伤部位并辨证手法治疗是取得良好效果的关键。

  12. Correlation of posterior lumbar interbody fusion procedures with spinal and pelvic balance%后正中入路腰椎间融合与脊柱骨盆平衡相关性研究

    Institute of Scientific and Technical Information of China (English)

    汪勇刚; 徐林军; 胡伟; 许永涛

    2016-01-01

    Objective To investigate the effect of posterior lumbar interbody fusion (PLIF) procedures on the sagittal balance of spine and pelvis in treatment of lumbar degenerative diseases. Methods Forty cases of lumbar disc herniation, lumbar spondylolisthesis or lumbar spinal stenosis admitted to our department from February 2011 to June 2012 and treated with PLIF procedures were retrospectively analyzed. The parameters of spinal the pelvic balance (SS, PT, PI, and LL) were measured before and after surgery, one year and two years af⁃ter surgery, respectively. Meanwhile, JOA scores were recorded to assess the improvement of symptoms and signs of low back pain. All the data were analyzed by SPSS 17.0 software package for the significance test. The P value was set at 0.05. Results There was significant difference in LL, SS and PT before and after operation (P<0.05). The lumbar lordosis and sacral slope was increased respectively from 38.6° ± 5.2° , 28.2° ± 6.7° to 46.8°±7.3°, 33.4°±5.3°, and the pelvic incidence was decreased from 21.6°±7.8° to 18.2±9.4°, but there was no significant difference between different postoperative periods. As compared with the preoperation, the JOA scores in 35 patients at the final follow⁃up were increased from (12.5 ± 1.8) to (21.6 ± 3.2) (P<0.05). Conclu⁃sion PLIF procedure can relieve symptoms and improve quality of life of patients. PLIF procedure can effec⁃tively improve lumbar lordosis, and the recovery to lumbar normal lordosis has a positive effect on the mainte⁃nance of sagittal balance of spine and pelvis.%目的:探讨采用经后正中入路腰椎间融合(posterior lumber interbody fusion, PLIF)治疗腰椎退变性疾病时对脊柱骨盆矢状面平衡的影响。方法回顾性分析2011年2月至2012年6月我院通过PLIF治疗腰椎间盘突出症、腰椎滑脱、腰椎管狭窄症的患者40例,以常用的脊柱骨盆平衡参数中的骨盆入射角(pelvic incidence, PI

  13. Clinical efficacy of posterior decompression and fusion and internal fixation for treatment of degenerative lumbar spi-nal stenosis with lumbar segmental instability%后路减压融合内固定术治疗退变性腰椎椎管狭窄合并节段性腰椎不稳的临床疗效

    Institute of Scientific and Technical Information of China (English)

    李新福; 刘勇

    2014-01-01

    目的:观察后路腰椎椎管减压、椎弓根螺钉内固定并椎体间植骨融合术,治疗退变性腰椎椎管狭窄合并节段性腰椎不稳定患者的临床疗效。方法2006年1月~2011年12月收治的82例退变性腰椎椎管狭窄合并节段性腰椎不稳的患者,行后路减压融合内固定术治疗。采用Oswestry功能障碍指数(Oswestry disability index, ODI),疼痛视觉模拟量表(visual analogue scale, VAS)和日本骨科学会(Japanese Orthopaedic Association,JOA)评分评估临床疗效。同时行影像学检查,测量椎间隙高度,用Bridwell方法评价腰椎融合情况。结果平均随访48个月,术后腰痛VAS评分、腿痛VAS评分、JOA评分、ODI、椎间隙高度均较术前明显改善,差异有统计学意义(P<0.01)。末次随访时,根据Bridwell腰椎融合评价标准,Ⅰ级和Ⅱ级为80例(97.5%)。末次随访时,X线片、MRI检查发现4例螺钉松动断裂但已骨性融合(4%),2例植骨未融合,椎间隙高度降低(2%)。疗效评定优24例,良46例,可8例,差5例,优良率为85.4%。结论减压融合固定治疗退变性腰椎椎管狭窄症合并节段性腰椎不稳远期疗效肯定,但应把恢复该节段的稳定作为重点。%Objective To observe the Clinical efficacy of posterior decompression and fusion and internal fixation for treat -ment of degenerative lumbar spinal stenosis with lumbar segmental instability .Methods From 2006 January to 2011 Decem-ber, 82 cases of degenerative lumbar spinal stenosis with lumbar segmental instability were treated with posterior decompres -sion, fusion and internal fixation.Oswestry disability index (ODI), visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA ) scores were used to evaluate the clinical efficacy .Intervertebral height were observed on roentgenographs , and Bridwell method were used to evaluate lumbar fusion .Results The average

  14. Spinal dysraphism: MRI evaluation

    Directory of Open Access Journals (Sweden)

    Ramacharya

    2015-08-01

    Conclusion: Thus we conclude that Spinal dysraphism were common in young females, with commonest anomaly being vertebral anomaly (Spina bifida, commonest location is lumbar region, Diastematomyelia common in young aged female. Magnetic resonance imaging is an accurate, noninvasive, safe and advanced modality for evaluation of the congenital spinal disorders and help in better management of these patients with prompt and accurate diagnosis. [Int J Res Med Sci 2015; 3(8.000: 1937-1941

  15. Recombinant human bone morphogenetic protein 2-induced heterotopic ossification of the retroperitoneum, psoas muscle, pelvis and abdominal wall following lumbar spinal fusion

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Raj K. [The George Washington University School of Medicine, Washington, DC (United States); Moncayo, Valeria M.; Pierre-Jerome, Claude; Terk, Michael R. [Emory University School of Medicine, Radiology Department, Musculoskeletal Division, Atlanta, GA (United States); Smitson, Robert D. [Emory University School of Medicine, Atlanta, GA (United States)

    2010-05-15

    A 45-year-old man presented with vertebral collapse at L5 as an initial manifestation of multiple myeloma and underwent spinal fusion surgery using recombinant human bone morphogenetic protein-2 (rhBMP-2). Subsequent computed tomography (CT) scans and X-rays revealed heterotopic ossification of the left psoas muscle, pelvis, and anterior abdominal wall. While the occurrence of heterotopic ossification has previously been reported when rhBMP-2 has been used for spinal fusion surgery, this case demonstrates that it can occur to a much greater degree than previously seen. (orig.)

  16. The inflammatory cytokine, interleukin-1 beta, mediates loss of astroglial glutamate transport and drives excitotoxic motor neuron injury in the spinal cord during acute viral encephalomyelitis.

    Science.gov (United States)

    Prow, Natalie A; Irani, David N

    2008-05-01

    Astrocytes remove glutamate from the synaptic cleft via specific transporters, and impaired glutamate reuptake may promote excitotoxic neuronal injury. In a model of viral encephalomyelitis caused by neuroadapted Sindbis virus (NSV), mice develop acute paralysis and spinal motor neuron degeneration inhibited by the AMPA receptor antagonist, NBQX. To investigate disrupted glutamate homeostasis in the spinal cord, expression of the main astroglial glutamate transporter, GLT-1, was examined. GLT-1 levels declined in the spinal cord during acute infection while GFAP expression was preserved. There was simultaneous production of inflammatory cytokines at this site, and susceptible animals treated with drugs that blocked IL-1beta release also limited paralysis and prevented the loss of GLT-1 expression. Conversely, infection of resistant mice that develop mild paralysis following NSV challenge showed higher baseline GLT-1 levels as well as lower production of IL-1beta and relatively preserved GLT-1 expression in the spinal cord compared to susceptible hosts. Finally, spinal cord GLT-1 expression was largely maintained following infection of IL-1beta-deficient animals. Together, these data show that IL-1beta inhibits astrocyte glutamate transport in the spinal cord during viral encephalomyelitis. They provide one of the strongest in vivo links between innate immune responses and the development of excitotoxicity demonstrated to date.

  17. Correlation between sagittal spinal and pelvic parameters in degenerative lumbar scoliosis%腰椎退行性侧凸患者脊柱矢状位参数与骨盆参数的相关性

    Institute of Scientific and Technical Information of China (English)

    李方财; 陈其昕; 陈维善; 陈刚

    2013-01-01

    Objective To investigate the correlation between sagittal spinal and pelvic parameters in different types of degenerative lumbar scoliosis (DLS).Methods Standing anteroposterior and lateral radiographs of the whole spine including hip joints were carried out in 70 volunteers without spinal deformity and 110 patients with DLS.The following parameters were measured:thoracic kyphosis (TK),thoracolumbar kyphosis (TL),lumbar lordosis (LL),sagittal vertical axis (SVA),pelvic incidence (PI),pelvic tilt (PT) and sacral slope (SS).According to the sagittal spinal alignment,the patients with DLS were classified into 3 types:type Ⅰ (45 cases),type Ⅱ (48 cases) and type Ⅲ (17 cases).The sagittal spinal and pelvic parameters were compared between control group and different types of DLS group,and the relationship between the sagittal spinal parameters and pelvic parameters in different groups were also investigated.Results PI in type Ⅲ patients was lower than those in other groups; PT in type Ⅱ and Ⅲ patients was higher than those in controls and type Ⅰ patients,and there was a significant difference between type Ⅱ and Ⅲ patients; SS in type Ⅱ and Ⅲ patients was lower than those in controls and type Ⅰ patients,and there was no significant difference between type Ⅱ and Ⅲ patients.Sagittal spinal imbalance was found in 17.8% of type Ⅱ patients and 29.4% of type Ⅲ patients.There were significant correlations in sagittal spinal parameters,pelvic parameters and spinopelvic parameters in controls and type Ⅰ patients.However,in type Ⅱ and Ⅲ patients,the correlations in sagittal spinal parameters and spinopelvic parameters decreased,even disappeared,though significant correlations were still found in pelvic parameters.In any group,SVA showed a significant correlation with LL and PT,especially with PT.Conclusion The sagittal spinal alignment has a ladder-like change in patients with DLS,and the correlations in pelvic parameters and spinopelvic

  18. 手术治疗腰椎间盘突出伴腰椎失稳症疗效分析%Surgical treatment of lumbar disc herniation with spinal instability

    Institute of Scientific and Technical Information of China (English)

    杜怡斌; 裴少保; 刘艺明; 马力

    2012-01-01

    目的 探讨采用后路椎体间植骨融合加后外侧融合术(PLIF+PLF)和经椎间孔入路椎间植骨融合加后外侧融合术(TLIF+PLF)治疗腰椎间盘突出伴腰椎失稳症的临床疗效.方法 对34例经3~6个月保守治疗无效的腰椎间盘突出伴腰椎失稳症的患者采用手术治疗.PLIF+PLF 22例,TLIF+PLF 12例.结果 患者均获随访,时间7~60个月.患者腰痛及下肢痛症状明显缓解,均恢复正常生活和工作.VAS评分:术前为7.47分±0.71分,术后为 3.21分±0.69分,随访6个月时为1.21分±0.59分.两组术后及随访6个月时的VAS评分差异无统计学意义.ODI评分:术前为19.35分±3.73分,随访6个月时为3.85分±1.97分.两组随访6个月时的ODI评分差异无统计学意义.结论 对于保守治疗无效的腰椎间盘突出伴腰椎失稳症,PLIF+PLF与TLIF+PLF均是治疗的有效选择,两种方法的疗效无明显差异.%Objective To explore the effect of posterior lumbar interbody fusion + posterolateral fusion ( PLIF + PLF ) and transforaminal lumbar interbody fusion + posterolateral fusion ( TLIF + PLF ) in treatment of lumbar disc hernia-tion with spinal instability. Methods 34 patients failed conservative treatment for 3~6 months received surgery. 22 cases received PLIF + PLF and 12 cases received TLIF + PLF. Results All the cases were followed up for 7~60 months. All the patients recovered normal social life and work without any symptoms. VAS decreased from 7. 47 ± 0. 71 preoperatively to 3. 21 ± 0. 69 postoperatively, and averaged 1. 21 ± 0. 59 at 6 months after operation. The difference of two groups had no statistical significance at postoperative and 6 months after operation. ODI decreased from 19. 35 ± 3. 73 preoperatively to 3. 85 ± 1. 97 at 6 months postoperatively. The difference of two groups had no statistical significance at 6 months postoperatively. Conclusions PLIF + PLF and TLIF + PLF have a good clinical effect on the lumbar disc herniation with

  19. 射频电疗配合中药热腌包治疗退行性腰椎管狭窄术后疗效不佳的27例患者的临床观察%Clinical observation on treating 27 cases of retrogressive lumbar spinal stenosis with radiofrequency electrotherapy and TCM fomentation sacks

    Institute of Scientific and Technical Information of China (English)

    高杨; 王松; 肖丽; 孔祥波; 田林涛

    2013-01-01

      目的:探讨退行性腰椎管狭窄症患者手术疗效不佳的后期治疗。方法:射频电疗配合中药热腌包治疗退行性腰椎管狭窄术后疗效不佳的27例患者。结果:经治疗大多数患者症状较前明显缓解。结论:射频电疗配合中药热腌包治疗对退行性腰椎管狭窄术后疗效不佳者有较好症状缓解作用。%Objective: To investigate the anaphase efficacy of operation on retrogressive lumbar spinal stenosis. Methods: To treat 27 cases of retrogressive lumbar spinal stenosis with radiofrequency electrotherapy combined with TCM fomentation sacks. Results: Most of the patients improved a lot compared with the pretreatment. Conclusion: Rradiofrequency electrotherapy combined with TCM fomentation sacks had significant effect on retrogressive lumbar spinal stenosis.

  20. Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injur y

    Institute of Scientific and Technical Information of China (English)

    David S. Kushner

    2015-01-01

    Research scientists and clinicians should be aware that missed diagnoses of mild-moderate trau-matic brain injuries in post-acute patients having spinal cord injuries may approach 60–74%with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trau-ma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of va-lidity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

  1. Involvement of brain-derived neurotrophic factor and sonic hedgehog in the spinal cord plasticity after neurotoxic partial removal of lumbar motoneurons.

    Science.gov (United States)

    Gulino, Rosario; Gulisano, Massimo

    2012-07-01

    Adult mammals could spontaneously achieve a partial sensory-motor recovery after spinal cord injury, by mechanisms including synaptic plasticity. We previously showed that this recovery is associated to the expression of synapsin-I, and that sonic hedgehog and Notch-1 could be also involved in plasticity. The role of brain-derived neurotrophic factor and glutamate receptors in regulating synaptic efficacy has been explored in the last decade but, although these mechanisms are now well-defined in the brain, the molecular mechanisms underlying the so called "spinal learning" are still less clear. Here, we measured the expression levels of choline acetyltransferase, synapsin-I, sonic hedgehog, Notch-1, glutamate receptor subunits (GluR1, GluR2, GluR4, NMDAR1) and brain-derived neurotrophic factor, in a motoneuron-depleted mouse spinal lesion model obtained by intramuscular injection of cholera toxin-B saporin. The lesion caused the down-regulation of the majority of analysed proteins. Moreover, we found that in lesioned but not in control spinal tissue, synapsin-I expression is associated to that of both brain-derived neurotrophic factor and sonic hedgehog, whereas GluR2 expression is linked to that of Shh. These results suggest that brain-derived neurotrophic factor and sonic hedgehog could collaborate in modulating synaptic plasticity after the removal of motoneurons, by a mechanism involving both pre- and post-synaptic processes. Interestingly, the involvement of sonic hedgehog showed here is novel, and offers new routes to address spinal cord plasticity and repair.

  2. SU-E-T-355: A Comparative Study of Robotic and Linac-Based Stereotactitc Body Radiation Therapy for Lumbar Spinal Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Bossart, E; Monterroso, M; Couto, M; Ly, B; Mihaylov, I [UniversityMiami, Miami, FL (United States)

    2014-06-01

    Purpose: Dosimetrically compare CyberKnife (CK) and linac-based (LB) stereotactic body radiotherapy (SBRT) plans for lumbar spine. Methods: Ten patient plans with lumbar spine tumors treated with CK were selected and retrospectively optimized using three techniques: CK, volumetric modulated arc (VMAT, three arcs), and 9-field-intensity modulated radiotherapy (IMRT). For the LB plans, the target volume was expanded by 1mm to accommodate additional uncertainty in patient positioning. All plans were optimized to a prescription dose of 27Gy in 3 fractions covering 90% of the PTV. If the dose constraints to the cauda equina (cauda) were not met, the prescription dose was lowered to 24Gy. Parameters evaluated included Paddick Conformity-Index (CI) and Gradient-Index (GI). A two-tailed paired t-test was used to establish statistically significant differences in cauda doses. Results: Target volumes for LB plans were on average 38% larger. In terms of the indices, the closer the index values to unity the steeper the dose falloff and the higher the dose conformity to the target. The results showed that LB plans were in general statistically superior to CK plans. The IMRT plan showed the best average gradient index of 2.995, with VMAT and CK GI values of 3.699 and 5.476, respectively. Similarly, the same trend occurs with the average CI results: 0.821, 0.814, and 0.758, corresponding to IMRT, VMAT, and CK. Notably, in one CK plan the target dose was reduced to 24Gy to meet cauda constraints. Additionally, there was a statistically significant dose difference for the cauda between the CK and LB plans. Conclusion: This study demonstrates that LB plans for lumbar spine SBRT can be as effective or even better than CK plans. Despite the expansion of the target volume, the LB plans did not demonstrate dosimetric inferiority. The LB plans Resultin 2-to-3 fold decrease of treatment time.

  3. Back pain improvement after decompression without fusion or stabilization in patients with lumbar spinal stenosis and clinically significant preoperative back pain.

    Science.gov (United States)

    Crawford, Charles H; Glassman, Steven D; Mummaneni, Praveen V; Knightly, John J; Asher, Anthony L

    2016-11-01

    OBJECTIVE The relief of leg symptoms by surgical decompression for lumbar stenosis is well supported by the literature. Less is known about the effect on back pain. Some surgeons believe that the relief of back pain should not be an expected outcome of decompression and that substantial back pain may be a contraindication to decompression only; therefore, stabilization may be recommended for patients with substantial preoperative back pain even in the absence of well-accepted indications for stabilization such as spondylolisthesis, scoliosis, or sagittal malalignment. The purpose of this study is to determine if patients with lumbar stenosis and substantial back pain-in the absence of spondylolisthesis, scoliosis, or sagittal malalignment-can obtain significant improvement after decompression without fusion or stabilization. METHODS Analysis of the National Neurosurgery Quality and Outcomes Database (N(2)QOD) identified 726 patients with lumbar stenosis (without spondylolisthesis or scoliosis) and a baseline back pain score ≥ 5 of 10 who underwent surgical decompression only. No patient was reported to have significant spondylolisthesis, scoliosis, or sagittal malalignment. Standard demographic and surgical variables were collected, as well as patient outcomes including back and leg pain scores, Oswestry Disability Index (ODI), and EuroQoL 5D (EQ-5D) at baseline and 3 and 12 months postoperatively. RESULTS The mean age of the cohort was 65.6 years, and 407 (56%) patients were male. The mean body mass index was 30.2 kg/m(2), and 40% of patients had 2-level decompression, 29% had 3-level decompression, 24% had 1-level decompression, and 6% had 4-level decompression. The mean estimated blood loss was 130 ml. The mean operative time was 100.85 minutes. The vast majority of discharges (88%) were routine home discharges. At 3 and 12 months postoperatively, there were significant improvements from baseline for back pain (7.62 to 3.19 to 3.66), leg pain (7.23 to 2.85 to

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

    Science.gov (United States)

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

    2014-05-01

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

  5. Nursing intervention affect orthopaedic spinal arthrodesis in patients with lumbar spine disease%护理干预对骨科腰椎疾病脊柱融合术患者的影响

    Institute of Scientific and Technical Information of China (English)

    蒲玉梅

    2013-01-01

    Objective To explore the nursing intervention in patients with lumbar disease clinical effect of spinal fusion surgery and rehabilitation. Methods Spinal fusion for lumbar diseases patients 140 cases, odd-even order divided into experimental group and the control group (n=70),control group routine treatment and nursing, the experimental group on the basis of the control group to give psychological guidance, pain nursing, exercise training intervention, etc. Results Postoperative pain intensity significantly reduced than the control group, experimental group patients physical rehabilitation effect is obviously better than control group, two groups compared significant difference (P<0.01). Conclusion Nursing intervention can significantly reduce postoperative pain in patients, promote patient's rehabilitation, so as to improve patients quality of life.%  目的探讨护理干预在腰椎疾病患者脊柱融合术术后康复中的临床作用。方法将140例有腰椎疾病行脊柱融合术的患者按奇偶顺序分成试验组及对照组各70例,对照组采取常规治疗和护理,试验组在对照组基础上给予心理指导、疼痛护理、运动训练等干预。观察2组患者术后疼痛强度及康复效果。结果试验组患者术后疼痛强度明显比对照组降低,身体康复效果明显优于对照组,2组比较差异显著(P<0.01)。结论护理干预可以明显降低腰椎疾病患者的术后疼痛,促进康复,提高患者的生活质量。

  6. Axial loaded MRI of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Saifuddin, A. E-mail: asaifuddin@aol.com; Blease, S.; MacSweeney, E

    2003-09-01

    Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.

  7. The Outcomes of Minimally Invasive versus Open Posterior Approach Spinal Fusion in Treatment of Lumbar Spondylolisthesis: The Current Evidence from Prospective Comparative Studies

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    2017-01-01

    Full Text Available Purpose. To investigate the evidence of minimally invasive (MI versus open (OP posterior lumbar fusion in treatment of lumbar spondylolisthesis from current prospective literatures. Methods. The electronic literature database of Pubmed, Embase, and Cochrane library was searched at April 2016. The data of operative time, estimated blood loss and length of hospital stay, visual analog scale (VAS of both lower back pain and leg pain, Oswestry disability index (ODI, SF-36 PCS (physical component scores and SF-36 MCS (mental component scores, complications, fusion rate, and secondary surgery were extracted and analyzed by STATA 12.0 software. Results. Five nonrandom prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the MI group had a significantly longer operative time than OP group, less blood loss, and shorter hospital stay. No significant difference was found in back pain, leg pain, ODI, SF-36 PCS, SF-36 MCS, complications, fusion rate, and secondary surgery between MI and OP groups. Conclusion. The prospective evidence suggested that MI posterior fusion for spondylolisthesis had less EBL and hospital stay than OP fusion; however it took more operative time. Both MI and OP fusion had similar results in pain and functional outcomes, complication, fusion rate, and secondary surgery.

  8. The Outcomes of Minimally Invasive versus Open Posterior Approach Spinal Fusion in Treatment of Lumbar Spondylolisthesis: The Current Evidence from Prospective Comparative Studies

    Science.gov (United States)

    Wu, Ai-Min; Chen, Chun-Hui; Shen, Zhi-Hao; Feng, Zhen-Hua; Weng, Wan-Qing; Li, Shu-Min; Chi, Yong-Long; Yin, Li-Hui

    2017-01-01

    Purpose. To investigate the evidence of minimally invasive (MI) versus open (OP) posterior lumbar fusion in treatment of lumbar spondylolisthesis from current prospective literatures. Methods. The electronic literature database of Pubmed, Embase, and Cochrane library was searched at April 2016. The data of operative time, estimated blood loss and length of hospital stay, visual analog scale (VAS) of both lower back pain and leg pain, Oswestry disability index (ODI), SF-36 PCS (physical component scores) and SF-36 MCS (mental component scores), complications, fusion rate, and secondary surgery were extracted and analyzed by STATA 12.0 software. Results. Five nonrandom prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the MI group had a significantly longer operative time than OP group, less blood loss, and shorter hospital stay. No significant difference was found in back pain, leg pain, ODI, SF-36 PCS, SF-36 MCS, complications, fusion rate, and secondary surgery between MI and OP groups. Conclusion. The prospective evidence suggested that MI posterior fusion for spondylolisthesis had less EBL and hospital stay than OP fusion; however it took more operative time. Both MI and OP fusion had similar results in pain and functional outcomes, complication, fusion rate, and secondary surgery. PMID:28154826

  9. [Thyroid cancer metastasis to the lumbar spine successfully treated by embolization and radioiodine. A case report].

    Science.gov (United States)

    Sumimura, J; Nakagawa, K; Kawamura, J; Tayama, M; Takahashi, E; Moritomo, T; Miyata, M

    1990-07-01

    A 82-year-old woman suffered from a metastatic lesion of follicular carcinoma of the thyroid to the fourth lumbar spine, which compressed the spinal nerves and caused lumbar pain and paresthesis of the lower limb. External irradiation, 5200 RAD, was carried out. Total thyroidectomy was done for the preparation of radioiodine(131I) therapy. Two weeks later, embolization of lumbar arteries was performed to prevent the progression of the spinal cord damage during a period waiting for 131I administration. The size of the lumbar lesion decreased, and lumbal pain and spinal cord symptoms disappeared. After administration of 131I, the metastatic lesion became further smaller.

  10. Hyponatremia in Acute Gervical Spinal Cord Injury%颈脊髓损伤患者的低钠血症

    Institute of Scientific and Technical Information of China (English)

    王新亮

    2009-01-01

    目的:探讨颈脊髓损伤患者低钠血症的临床患病情况、发生机制、治疗措施及预后.方法:对256例患者中发生低钠血症的168例患者的血钠值进行回顾性统计学分析.结果:256例患者中发生低钠血症者168例,占全部病例的65.6%.168例低钠血症患者中6例出现神经症状,包括神志淡漠、失眠、昏迷、呼吸抑制等,6例患者均接受静点高渗盐水治疗,其中3例患者并加以脱水和限水治疗,所有患者血钠均回升到120 mmol/L以上,但有1例患者因呼吸抑制、深昏迷抢救无效死亡.其余患者预后良好.结论:颈脊髓损伤患者低钠血症的发生率与患者脊髓损伤的程度有正相关性.其发生与钠盐摄入量减少、过量水负荷、脊髓损伤后肾脏排水保钠能力下降等原因有关.治疗原则以积极预防为主,一旦发生低钠血症,应予补充钠盐并适当限水.必须注意急性重度低钠血症致脑水肿的可能.一旦出现神经精神症状,要尽快静点高渗盐水脱水和严格限水治疗.应注意抗利尿激素不适当分泌综合征的可能.颈脊髓损伤患者低钠血症的一般预后良好,但如果忽视急性重度低钠血症致脑水肿的可能,治疗不及时可导致患者呼吸衰竭、昏迷甚至死亡.%Objective: To investigate the occurrence rate, time course potential etiologic factors, treatments and prognosis of hyponatremia in patients with acute cervical spinal cord injurg. Methods: Analysis of date obtained from a retrospective databases pertaining to 256 patients with acute cervical spinal cord injury. Results: of hypertonic saline for all 6 patients, fluid restriction and dehydration for 3 patients, and the plasma sodium level of all patients recovered uneventfully to 120 mmol/l, but 1 patients died because of respiratory depression and coma:The others were well prognosis. Conclusions: The occurrence rate of hyponatremia in acute cervical spinal cord injury was correlated to the

  11. Parallel Metabolomic Profiling of Cerebrospinal Fluid and Serum for Identifying Biomarkers of Injury Severity after Acute Human Spinal Cord Injury

    Science.gov (United States)

    Wu, Yiman; Streijger, Femke; Wang, Yining; Lin, Guohui; Christie, Sean; Mac-Thiong, Jean-Marc; Parent, Stefan; Bailey, Christopher S.; Paquette, Scott; Boyd, Michael C.; Ailon, Tamir; Street, John; Fisher, Charles G.; Dvorak, Marcel F.; Kwon, Brian K.; Li, Liang

    2016-01-01

    Suffering an acute spinal cord injury (SCI) can result in catastrophic physical and emotional loss. Efforts to translate novel therapies in acute clinical trials are impeded by the SCI community’s singular dependence upon functional outcome measures. Therefore, a compelling rationale exists to establish neurochemical biomarkers for the objective classification of injury severity. In this study, CSF and serum samples were obtained at 3 time points (~24, 48, and 72 hours post-injury) from 30 acute SCI patients (10 AIS A, 12 AIS B, and 8 AIS C). A differential chemical isotope labeling liquid chromatography mass spectrometry (CIL LC-MS) with a universal metabolome standard (UMS) was applied to the metabolomic profiling of these samples. This method provided enhanced detection of the amine- and phenol-containing submetabolome. Metabolic pathway analysis revealed dysregulations in arginine-proline metabolism following SCI. Six CSF metabolites were identified as potential biomarkers of baseline injury severity, and good classification performance (AUC > 0.869) was achieved by using combinations of these metabolites in pair-wise comparisons of AIS A, B and C patients. Using the UMS strategy, the current data set can be expanded to a larger cohort for biomarker validation, as well as discovering biomarkers for predicting neurologic outcome. PMID:27966539

  12. Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes

    OpenAIRE

    Hsieh, Ming-Kai; Chen, Lih-Huei; Niu, Chi-Chien; Fu, Tsai-Sheng; Lai, Po-Liang; Chen, Wen-Jer

    2015-01-01

    Background Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis. Methods...

  13. Distribution of paired immunoglobulin-like receptor B in the nervous system related to regeneration dififculties after unilateral lumbar spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Wan-shu Peng; Chao Qi; Hong Zhang; Mei-ling Gao; Hong Wang; Fei Ren; Xia-qing Li

    2015-01-01

    Paired immunoglobulin-like receptor B (PirB) is a functional receptor of myelin-associated in-hibitors for axonal regeneration and synaptic plasticity in the central nervous system, and thus suppresses nerve regeneration. The regulatory effect of PirB on injured nerves has received a lot of attention. To better understand nerve regeneration inability after spinal cord injury, this study aimed to investigate the distribution of PirB (via immunolfuorescence) in the central nervous system and peripheral nervous system 10 days after injury. Immunoreactivity for PirB increased in the dorsal root ganglia, sciatic nerves, and spinal cord segments. In the dorsal root ganglia and sciatic nerves, PirB was mainly distributed along neuronal and axonal membranes. PirB was found to exhibit a diffuse, intricate distribution in the dorsal and ventral regions. Immunore-activity for PirB was enhanced in some cortical neurons located in the bilateral precentral gyri. Overall, the ifndings suggest a pattern of PirB immunoreactivity in the nervous system after uni-lateral spinal transection injury, and also indicate that PirB may suppress repair after injury.

  14. Hydrogen-rich saline injection into the subarachnoid cavity within 2 weeks promotes recovery after acute spinal cord injur y

    Institute of Scientific and Technical Information of China (English)

    Jian-long Wang; Qing-shan Zhang; Kai-di Zhu; Jian-feng Sun; Ze-peng Zhang; Jian-wen Sun; Ke-xiang Zhang

    2015-01-01

    Hydrogen can relieve tissue-damaging oxidative stress, inlfammation and apoptosis. Injection of hydrogen-rich saline is an effective method for transporting molecular hydrogen. We hypothe-sized that hydrogen-rich saline would promote the repair of spinal cord injury induced by Allen’s method in rats. At 0.5, 1, 2, 4, 8, 12 and 24 hours after injury, then once daily for 2 weeks, 0.25 mL/kg hydrogen-rich saline was infused into the subarachnoid space through a catheter. Results at 24 hours, 48 hours, 1 week and 2 weeks after injury showed that hydrogen-rich saline marked-ly reduced cell death, inlfammatory cell inifltration, serum malondialdehyde content, and caspa se-3 immunoreactivity, elevated serum superoxide dismutase activity and calcitonin gene-related peptide immunoreactivity, and improved motor function in the hindlimb. The present study conifrms that hydrogen-rich saline injected within 2 weeks of injury effectively contributes to the repair of spinal cord injury in the acute stage.

  15. Hydrogen-rich saline injection into the subarachnoid cavity within 2 weeks promotes recovery after acute spinal cord injury

    Directory of Open Access Journals (Sweden)

    Jian-long Wang

    2015-01-01

    Full Text Available Hydrogen can relieve tissue-damaging oxidative stress, inflammation and apoptosis. Injection of hydrogen-rich saline is an effective method for transporting molecular hydrogen. We hypothesized that hydrogen-rich saline would promote the repair of spinal cord injury induced by Allen′s method in rats. At 0.5, 1, 2, 4, 8, 12 and 24 hours after injury, then once daily for 2 weeks, 0.25 mL/kg hydrogen-rich saline was infused into the subarachnoid space through a catheter. Results at 24 hours, 48 hours, 1 week and 2 weeks after injury showed that hydrogen-rich saline markedly reduced cell death, inflammatory cell infiltration, serum malondialdehyde content, and caspase-3 immunoreactivity, elevated serum superoxide dismutase activity and calcitonin gene-related peptide immunoreactivity, and improved motor function in the hindlimb. The present study confirms that hydrogen-rich saline injected within 2 weeks of injury effectively contributes to the repair of spinal cord injury in the acute stage.

  16. 腰椎融合联合Coflex动态固定手术治疗腰椎退行性疾病%Spinal fusion combined with dynamic interspinous fixation with Coflex system for lumbar degenerative disease

    Institute of Scientific and Technical Information of China (English)

    李忠海; 王诗媛; 唐昊; 马辉; 张秋林; 侯铁胜

    2011-01-01

    目的:总结腰椎后路椎间融合术联合Coflex动态固定术治疗腰椎退行性疾病的临床疗效.方法:对2008年3月至2010年3月应用腰椎后路椎间融合术联合Coflex动态固定治疗的18例腰椎退行性疾病患者(均为双节段)的临床资料进行回顾性总结分析.男11例,女7例;年龄41~62岁,平均50.2岁.分析内容包括:ODI指数、腰痛和下肢痛的VAS评分,并通过腰椎动力位X线观察活动度(ROM)、椎间隙高度(DHI)的变化情况.结果:所有患者获得随访,时间6~30个月,平均12个月.在末次随访时.腰痛VAS评分、下肢痛VAS评分及ODI指数均较术前明显改善(P<0.001).腰痛VAS评分术前(7.20±0.90)分.末次随访(1.50±0.90)分;下肢痛VAS评分术前(5.20±0.90)分,末次随访(1.10±0.80)分.ODI指数术前(52.50±5.90)%,未次随访(15.90±5.80)%.Coflex置入节段的DHI术前0.23±O.05,术后0.35±0.06,末次随访0.33±0.04,椎间隙高度未见明显丢失.Coflex置入节段的ROM术前(8.90±1.80)°,术后降至(8.30±1.90)°,末次随访(8.10±1.80)°.与术前差异无统计学意义(P=0.19).Conex置入节段活动度未见明显改变.L2-S1 ROM术前为(20.20±5.60)°,术后(14.40±5.70)°,末次随访(15.50±5.20)°.与术前比较有统计学差异(P=0.01).结论:腰椎后路椎间融合术联合Coflex动态固定治疗双节段腰椎退变性疾病能取得满意的中短期临床疗效,但没有充分证据证明这项技术优于多节段融合术.手术适应证的合理选择十分重要.%Objective:To summarize the effect of the implantation of Coflex interspious stabilization device combined with spinal fusion for the treatment of lumbar degenerative disease.Methods: From March 2008 to March 2010, 1 8 patients with two levels lumbar degenerative disease were treated with spinal fusion and dynamic interspinous fixation with Coflex system. There were 11 males and 7 females. The average age was 50.2 years (range 41 to 62 years). The VAS and the Oswestry

  17. Raquianestesia total após bloqueio do plexo lombar por via posterior: relato de caso Raquianestesia total después del bloqueo del plexo lumbar por vía posterior: relato de caso Total spinal block after posterior lumbar plexus blockade: case report

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2006-10-01

    que continua hasta los espacios peridural y subaracnoideo, para donde la solución anestésica puede se dispersar. A pesar de ofrecer un extenso margen de seguridad, el bloqueo del plexo lumbar demanda del anestesiólogo un conocimiento minucioso de la anatomía, una capacitación en la técnica y una vigilancia constante.BACKGROUND AND OBJECTIVES: Lumbar plexus blockade can be very useful in surgical procedures of the hip, thigh, and knee, but it should be performed by an experienced anesthesiologist due to potential complications. The current report presents a case of total spinal block after posterior lumbar plexus blockade and discusses the possible pathophysiological mechanisms. CASE REPORT: Male patient, 34 years old, 97 kg, physical status ASA I, scheduled for total hip arthroplasty. After general anesthesia, a right posterior lumbar plexus blockade was performed with the adjunct of a peripheral nerve stimulator. The needle was introduced to a depth of 8 cm, perpendicular to the skin, 4 cm from the mid line, on a line perpendicular to the spinal process of L4. After identification of a motor response from the quadriceps, the intensity of the current was reduced to 0.35 mA and 0.5% ropivacaine (39 mL was administered. During the injection, there were intermittent contractions of the quadriceps. After the block, the patient presented apnea, hypotension, and both pupils were dilated. At the end of the surgery, the patient presented motor block of the lower extremities, which reversed only nine hours after the block. In the postoperative period, the patient complained of severe pain; he was discharged 12 days after the surgery without motor or sensitive deficits. CONCLUSIONS: To identify the psoas compartment, where the lumbar plexus blockade is located, the intensity of the current must be between 0.5 and 1 mA. Motor response with low current indicates that the needle may be inside the sheath that surrounds the nervous root and extends to the epidural and

  18. Spinal trauma. An imaging approach

    Energy Technology Data Exchange (ETDEWEB)

    Cassar-Pullicino, V.N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire (United Kingdom). Dept. of Radiology; Imhof, H. [University and General Hospital Vienna (Austria). Dept. of Radiodiagnostics

    2006-07-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  19. 老年退行性腰椎椎管狭窄症手术治疗与随访%Surgical treatment and follow-up outcomes of senile degenerative lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    孙常太; 张良; 王强; 王英民; 张启维; 徐红兵

    2011-01-01

    Objective To determine the effects of surgical decompression and pedicle screw internal fixation for senile degenerative lumbar spinal stenosis. Methods During January 2002 to January 2006, 241 patients of lumbar spinal stenosis ( excluding those with various spondylolisthesis ) received decompression, pedicle screw internal fixation, and posterolateral bone grafting in our department. Postoperative complications and deaths were observed. Oswestry disability index ( ODI ) and visual analogue scale ( VAS ) were used to evaluate the patients' condition preoperatively, 1 year postoperatively and at the end of follow-up. Lumbar reontgenographs were observed immediately, 6 months and 1 year after the operation and at the final follow-up. Trabecular bone formation between adjacent transverse processes was observed to evaluate bone fusion. The postoperative effects were compared between the fusion and non-fusion cases. Results There were 2 cases having cerebral infarction postoperatively, and 1 of them died of brainstem infarction. There were 5 cases of cardiovascular complications, including 2 cases of angina pectoris attacks, 2 cases of myocardial infarction, and 1 case of heart failure. All of them were rehabilitated after corresponding treatment. Eight cases had cerebrospinal fluid leakage, 7 of them were closed soon after the treatment, and the left 1 case had cerebrospinal fluid infection and had rehabilitation after antibiotic treatment. Pedicle screw misplacements were found in 3 cases, and no complication was found except for 1 case had diminished muscle strength of hallux extensor. For 2 segment operation, the operating time was 2. 8 hours aver-agely, and surgical bleeding was 480.4 mL. All patients without complications were able to walk in 1 week after the operation with aid of wearing corset, and resumed daily activity after 3 months. For all 241 cases, at 1 year postoperative and the final follow-up ODI , low back pain and leg pain VAS scores were

  20. Optimizing Hemodynamic Support of Acute Spinal Cord Injury Based on Injury Mechanism

    Science.gov (United States)

    2015-10-01

    cord compression. Our overall objective is therefore to determine how hemodynamic support of mean arterial pressure (MAP) in the presence or absence... tensions (tPO2) and blood flow was performed using the Oxylite system from Oxford Optronics. This probe consisted of a 4-channel composite containing a...anterior/posterior spinal artery . tPO2 is defined as the partial pressure of oxygen in tissue and reflects the availability of oxygen for oxidative

  1. Olprinone Attenuates the Acute Inflammatory Response and Apoptosis after Spinal Cord Trauma in Mice

    Science.gov (United States)

    Esposito, Emanuela; Mazzon, Emanuela; Paterniti, Irene; Impellizzeri, Daniela; Bramanti, Placido; Cuzzocrea, Salvatore

    2010-01-01

    Background Olprinone hydrochloride is a newly developed compound that selectively inhibits PDE type III and is characterized by several properties, including positive inotropic effects, peripheral vasodilatory effects, and a bronchodilator effect. In clinical settings, olprinone is commonly used to treat congestive cardiac failure, due to its inotropic and vasodilating effects. The mechanism of these cardiac effects is attributed to increased cellular concentrations of cAMP. The aim of the present study was to evaluate the pharmacological action of olprinone on the secondary damage in experimental spinal cord injury (SCI) in mice. Methodology/Principal Findings Traumatic SCI is characterized by an immediate, irreversible loss of tissue at the lesion site, as well as a secondary expansion of tissue damage over time. Although secondary injury should be preventable, no effective treatment options currently exist for patients with SCI. Spinal cord trauma was induced in mice by the application of vascular clips (force of 24 g) to the dura via a four-level T5–T8 laminectomy. SCI in mice resulted in severe trauma characterized by edema, neutrophil infiltration, and production of inflammatory mediators, tissue damage, apoptosis, and locomotor disturbance. Olprinone treatment (0.2 mg/kg, i.p.) 1 and 6 h after the SCI significantly reduced: (1) the degree of spinal cord inflammation and tissue injury (histological score), (2) neutrophil infiltration (myeloperoxidase activity), (3) nitrotyrosine formation, (4) pro-inflammatory cytokines, (5) NF-κB expression, (6) p-ERK1/2 and p38 expression and (7) apoptosis (TUNEL staining, FAS ligand, Bax and Bcl-2 expression). Moreover, olprinone significantly ameliorated the recovery of hind-limb function (evaluated by motor recovery score). Conclusions/Significance Taken together, our results clearly demonstrate that olprinone treatment reduces the development of inflammation and tissue injury associated with spinal cord trauma. PMID

  2. Olprinone attenuates the acute inflammatory response and apoptosis after spinal cord trauma in mice.

    Directory of Open Access Journals (Sweden)

    Emanuela Esposito

    Full Text Available BACKGROUND: Olprinone hydrochloride is a newly developed compound that selectively inhibits PDE type III and is characterized by several properties, including positive inotropic effects, peripheral vasodilatory effects, and a bronchodilator effect. In clinical settings, olprinone is commonly used to treat congestive cardiac failure, due to its inotropic and vasodilating effects. The mechanism of these cardiac effects is attributed to increased cellular concentrations of cAMP. The aim of the present study was to evaluate the pharmacological action of olprinone on the secondary damage in experimental spinal cord injury (SCI in mice. METHODOLOGY/PRINCIPAL FINDINGS: Traumatic SCI is characterized by an immediate, irreversible loss of tissue at the lesion site, as well as a secondary expansion of tissue damage over time. Although secondary injury should be preventable, no effective treatment options currently exist for patients with SCI. Spinal cord trauma was induced in mice by the application of vascular clips (force of 24 g to the dura via a four-level T5-T8 laminectomy. SCI in mice resulted in severe trauma characterized by edema, neutrophil infiltration, and production of inflammatory mediators, tissue damage, apoptosis, and locomotor disturbance. Olprinone treatment (0.2 mg/kg, i.p. 1 and 6 h after the SCI significantly reduced: (1 the degree of spinal cord inflammation and tissue injury (histological score, (2 neutrophil infiltration (myeloperoxidase activity, (3 nitrotyrosine formation, (4 pro-inflammatory cytokines, (5 NF-kappaB expression, (6 p-ERK1/2 and p38 expression and (7 apoptosis (TUNEL staining, FAS ligand, Bax and Bcl-2 expression. Moreover, olprinone significantly ameliorated the recovery of hind-limb function (evaluated by motor recovery score. CONCLUSIONS/SIGNIFICANCE: Taken together, our results clearly demonstrate that olprinone treatment reduces the development of inflammation and tissue injury associated with spinal cord

  3. 皮下脂肪厚度对腰椎术后感染的影响%The thickness of subcutaneous fat as a risk factor postoperative infections after lumbar spinal fusion

    Institute of Scientific and Technical Information of China (English)

    张宇鹏; 王晓晶; 李利; 王华东

    2012-01-01

    thickness of the subcutaneous fat (P = 0. 0091 )were found to be significant risk factors for lumbar spinal fusion postoperative infection. Conclusions; In obese patients, the thickness of subcutaneous fat is more predictive of occurrence of postoperative infection after lumbar spinal fusion than BMI, and it deserves more attention in preoperative evaluation.

  4. CYTOMORPHOLOGICAL EVALUATION AND PROGNOSIS OF BRONCHOPULMONARY COMPLICATIONS IN ACUTE AND EARLY PERIODS OF SPINAL CORD TRAUMA

    Directory of Open Access Journals (Sweden)

    I.A. Norkin

    2009-09-01

    Full Text Available There were investigated 50 cytological preparations after fibro-optic bronchoscopy of 10 patients with cervical spinal cord injuries. The dynamics of broncho-pulmonary complications of spinal cord injuries was estimated on the basis of cytological broncho-alveolar lavage fluid investigations. In the work there were used clinico-neurologic methods, radiological (computer tomography and magnetic resonance imaging, endoscopic (fibro-optic bronchoscopy and cytomorphological investigations. Cytomorphological investigations of broncho-alveolar lavage fluid were carried out on the 3-4, 7, 14, 30th days. Cellular composition of the broncho-alveolar wash-out (endopulmonary cytogramme was estimated by calculation of more than 100 cells in 3 fields of the immersion microscope coverage. Quantitative changes of cellular elements were taken into account with respect to normal cell amount. The results were analyzed according to the average out method. Quantitative changes of inflammatory elements in endopulmonary cytogramme were determined by the degree of endobronchitic manifestations and were corresponding to clinico-radiological picture of development of broncho-pulmonary complications in different periods of spinal cord injury

  5. MRI Findings in Spinal Canal Stenosis

    OpenAIRE

    Maryam Barzin

    2010-01-01

    Spinal canal stenosis results from progressive narrowing of the central spinal canal and the lateral recesses. Primary (congenital) lumbar spinal stenosis is associated with achondroplastic dwarfism. The spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposus posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the facet joints, hypertrophy of the ligamentum flavum, epidural fat deposition, spon...

  6. Non-traumatic acute epidural spinal hematomas diagnosed by magnetic resonance; Hematomas espinales epidurales agudos no traumaticos: diagnostico por resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A.; Grive, E.; Pedraza, S.; Capellades, J.; Nos, C.; Alarcon, M.; Rovira, A. [Hospital Universitari Vall d' Hebron. Barcelona (Spain)

    2000-07-01

    The non-traumatic spinal epidural hematoma (NTSEH) is a rare entity that can be the cause of an acute spinal compression syndrome. the objective of this review is to identify the characteristics by MRI and NTSEH and to analyze the factors that influence in its prognosis. In the years 1994 and 1999, 12 patients with NTSEH have been diagnosed in our hospital, and a MRI was performed during the acute phase. the characteristics of the lesions have been analyzed by MRI, with special emphasis on the topographic data and resonance signal and the factors that can influence in the clinical prognosis of the patients. Initially, all of the patients presented pain in the cervical dorsal or interscapular site, followed by a sensitive-motor deficit picture. The MRI showed a lesion of expansive character and posterior epidural location in every case that would produce varying degrees of compression on the spinal cord. The NTSEH should be considered as one of the causes of acute spinal cord compression. The clinical association of intense cervical, dorsal or interscapular pain followed by a sensomotor deficit picture should lead to the suspicion of this entity, that would require an immediate examination with MRI to verify its diagnosis. Both the clinical manifestations as well as the characteristics observed by MRI of the NTSEH have a prognostic value and determine the therapeutic decision. (Author) 34 refs.

  7. Spinal Cord Blood Flow after Ischemic Preconditioning in a Rat Model of Spinal Cord Ischemia

    Directory of Open Access Journals (Sweden)

    David Zvara

    2004-01-01

    Full Text Available Spinal cord blood flow after ischemic preconditioning is poorly characterized. This study is designed to evaluate spinal cord blood flow patterns in animals after acute ischemic preconditioning. Experiment 1: After a laminectomy and placement of a laser Doppler probe over the lumbar spinal cord to measure spinal cord blood flow, 16 male Sprague-Dawley rats were randomized into two groups: ischemic preconditioning (IPC, n = 8, and control (CTRL, n = 8. Rats in the CTRL and the IPC groups were subjected to 12 min of ischemia directly followed by 60 min of reperfusion. IPC rats received 3 min of IPC and 30 min of reperfusion prior to the 12-min insult period. Experiment 2: After instrumentation, the rats were randomized into three groups: control (CTRL, n = 7, ischemic preconditioning (IPC, n = 7, and time control (TC, n = 4. Rats in the CTRL and the IPC groups were subjected to the same ischemia and reperfusion protocol as above. The TC group was anesthetized for the same time period as the CTRL and the IPC groups, but had no ischemic intervention. Microspheres were injected at baseline and at 15 and 60 min into the final reperfusion. All rats were euthanized and tissue harvested for spinal cord blood flow analysis. In Experiment 1, there was a slight, significant difference in spinal cord blood flow during the ischemic period; however, this difference soon disappeared during reperfusion. In experiment 2, there was no difference in blood flow at any experimental time. The results of these experiments demonstrate that IPC slightly enhances blood flow to the spinal cord during ischemia; however, this effect is not sustained during the reperfusion period.

  8. Retrospective analysis of transforaminal lumbar interbody fusion for the treatment of acute and chronic lumbar intervertebral disc injury%经椎间孔椎间融合固定治疗急慢性腰椎间盘损伤回顾性分析

    Institute of Scientific and Technical Information of China (English)

    孙俊; 汪颖峰; 罗俊杰

    2011-01-01

    Objective To summary the effect of treatment of lumbar intervertebral disc in acute and chronic injury by transforaminal lumbar interbody fusion ( transforaminal lumbar interhody fusion , TLIF). Methods From in July 2007 to October 2010 , application of bilateral partial laminectomy decompression underwent TLIF fixation , treatment of lumbar intervertehral disc in 10 cases of acute and chronic injury in a total of 12 segments of 6 males and 4 females , aged 38-72 years , mean age 51 years.Lumbar degenerative changes associated with nerve root canal stenosis in 1 case, 3 cases of chronic lumbar spondylolisthesis , acute traumatic spondylolisthesis with bilateral nerve root injury in 2 , lumbar disc hemiation with lumbar instability in 4 cases. Results All patients with no neurological complications were followed up for 10 (6 to 48 months ) months . according to Denis pain ratings ,JOA score , mean postoperative improvement rate of 90%. Conclusion TLIF method can obtain the full relief under the premise of the immediate stability of the spine bone graft done at the same time , fusion rate and few complications, for lumbar intervertebral disc with acute and chronic injury , the effects are short-term clinical affirm.%目的 总结经椎间孔椎间融合术(TLIF)治疗腰椎间盘急慢性损伤的疗效.方法 2007年7月-2010年10月应用双侧椎板部分切除减压后行TLIF融合固定,治疗腰椎间盘急慢性损伤10例共12个节段,男6例,女4例,年龄38~72岁,平均年龄51岁.腰椎退行性变伴神经根管狭窄1例,慢性腰椎滑脱3例,急性外伤性腰椎滑脱伴双侧神经根损伤2例,腰椎间盘突出合并腰椎失稳4例.结果 全部患者均未出现神经系统并发症,平均随访10(6~48个月)个月,根据Denis疼痛分级、JOA评分法,术后平均改善率90%.结论 TLIF方法 可在充分减压的前提下获得脊柱的即刻稳定同时完成植骨,融合率高,并发症少,用于腰椎间盘急、慢性损伤中、短期随访临床效果肯定.

  9. Methylprednisolone and tetrandrine in combination with direct current electrical field for treating acute spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Ningjiang Shen; Yutian Wang; Ji Cai

    2007-01-01

    BACKGROUND: The direct current electrical field can effectively promote the regeneration of the spinal cord; moreover, methylprednisolone (MP) can relieve secondary edema after spinal cord injury. Tetrandrine (Tet) is an effective component of hanfangji and can protect the effect of spinal cord and axis-cylinder.Whether direct current electrical field combining with MP or Tet has synergic or strengthening effect on treating complete spinal cord injury or not should be studied further.OBJECTIVE:To study the effect of direct current electrical field assisted by MP and Tet on treating spinal cord injury.DESIGN: Randomized controlled animal study.SETTING: People's Hospital of Hainan Province.MATERIALS: A total of 45 healthy hybrid dogs, of both genders, weighing 10 - 12 kg, aged 1.5 - 2 years,were provided by Animal Center of Hainan Province. Somatosensory evoked potential meter (DANTEC Company), IBAS-2.0 imaging analysis meter (Germany), and self-made electronic stimulator.METHODS: The experiment was carried out in Hainan People's Hospital from May 2001 to June 2004. All experimental dogs were randomly divided into 4 groups: control group (n =9), electrostimulating group (n =12), MP + electrostimulating group (n =12) and Tet + electrostimulating group (n =12). ① After anesthesia, Allen WD method was used to induce complete spinal cord injury. The metal bar, which was 10cm in height fell freely and vertically hit the spinal cord to provide a complete spinal cord injury. Dogs in control group and electrostimulating group were implanted electrical stimulators 6 hours after spinal cord injury (no electricity in control group); dogs in MP + electrostimulating group were injected 30 mg/kg MP for 15 minutes at 2 hours after spinal cord injury and electrical stimulators implanted at 6 hours after injury;dogs in Tet + electrostimulating group were intravenously injected with 7.5 mg/kg Tet at 2 hours after spinal cord injury and electrical stimulators implanted at 6 hours

  10. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach.

    Directory of Open Access Journals (Sweden)

    Qian-Shi Zhang

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

  11. 颈椎病与腰椎管狭窄症术后感染的危险因素分析%Related risk factors for postoperative infections in patients with cervical spondylosis or lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    朱修桥; 郭景东; 吕慧; 邵士元

    2014-01-01

    目的:探讨颈椎病与腰椎管狭窄症术后感染的防护措施与相关危险因素,为临床治疗提供依据。方法选取2008-2013年210例颈椎病与200例腰椎管狭窄症患者,全部患者均行手术治疗,回顾性分析导致患者术后感染的相关危险因素及相应的防护措施。结果颈椎病患者术后感染率为5.24%,导致颈椎术后感染的危险因素为手术时间与合并症,手术时间为术后感染的独立危险因素(OR=2.164,P<0.05);腰椎管狭窄症患者术后感染率为4.00%,导致腰椎术后感染的危险因素有手术时间、体质量指数及合并症,其中手术时间与合并症为术后感染的独立危险因素(OR=2.024、2.097,P<0.05);颈椎与腰椎术后感染在感染类型与感染原因之间差异有统计学意义(P<0.05)。结论颈腰椎术后感染的原因与类型虽有显著性差异,但颈腰椎术后感染均与手术时间与合并症密切相关,对颈腰椎等脊柱疾病进行积极的防护有助于改善神经功能,促进康复。%OBJECTIVE To explore the related risk factors for postoperative infections in the patients with cervical spondylosis or lumbar spinal stenosis and put forward the prevention measures so as to provide guidance for the clinical treatment .METHODS From 2008 to through 2013 ,totally 210 patients with cervical spondylosis and 200 patients with lumbar spinal stenosis were recruited in the study ,all the patients received the surgical procedures , then the related risk factors for the postoperative infections were retrospectively analyzed ,and the corresponding prevention measures were put forward .RESULTS The incidence of postoperative infections was 5 .24% in the pa-tients with cervical spondylosis ,the risk factors for the postoperative infections included the operation duration and complications ,and the operation duration was the independent risk factor (OR=2 .164 ,P<0 .05

  12. Expansion duroplasty improves intraspinal pressure, spinal cord perfusion pressure, and vascular pressure reactivity index in patients with traumatic spinal cord injury: injured spinal cord pressure evaluation study.

    Science.gov (United States)

    Phang, Isaac; Werndle, Melissa C; Saadoun, Samira; Varsos, Georgios; Czosnyka, Marek; Zoumprouli, Argyro; Papadopoulos, Marios C

    2015-06-15

    We recently showed that, after traumatic spinal cord injury (TSCI), laminectomy does not improve intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), or the vascular pressure reactivity index (sPRx) at the injury site sufficiently because of dural compression. This is an open label, prospective trial comparing combined bony and dural decompression versus laminectomy. Twenty-one patients with acute severe TSCI had re-alignment of the fracture and surgical fixation; 11 had laminectomy alone (laminectomy group) and 10 had laminectomy and duroplasty (laminectomy+duroplasty group). Primary outcomes were magnetic resonance imaging evidence of spinal cord decompression (increase in intradural space, cerebrospinal fluid around the injured cord) and spinal cord physiology (ISP, SCPP, sPRx). The laminectomy and laminectomy+duroplasty groups were well matched. Compared with the laminectomy group, the laminectomy+duroplasty group had greater increase in intradural space at the injury site and more effective decompression of the injured cord. In the laminectomy+duroplasty group, ISP was lower, SCPP higher, and sPRx lower, (i.e., improved vascular pressure reactivity), compared with the laminectomy group. Laminectomy+duroplasty caused cerebrospinal fluid leak that settled with lumbar drain in one patient and pseudomeningocele that resolved completely in five patients. We conclude that, after TSCI, laminectomy+duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy alone.

  13. 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

  14. Neurological recovery at age 92 after acute trauma and operative spinal decompression

    Directory of Open Access Journals (Sweden)

    Hazem Eltahawy, MD, PhD, FRCS, FACS

    2016-09-01

    Full Text Available People aged > 80 years are among the fastest growing segments of most Western societies. With improved lifestyles and medical care, complex surgical interventions will be increasingly offered to elderly patients. Questions will arise about the value of performing major surgery in patients near their postulated end of life. Here, we describe a near-full neurological recovery from a profound neurological deficit that occurred as a result of a spinal fracture after a fall. To our knowledge, this is the first report of neurological recovery at such an advanced age.

  15. Multiple lumbar arachnoid cysts. Case report.

    Science.gov (United States)

    Pappalardo, S; Cassarino, A; Braidotti, P

    1986-09-01

    Arachnoid cysts are a rare cause of compression of the contents of the lumbar spinal canal; in the literature only about 100 cases are reported. The various methods of diagnosis are discussed in the light of a recent case observed by the authors.

  16. Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B

    2008-01-01

    (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural...... approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior...... cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting. Udgivelsesdato: 2008-Feb...

  17. Two intrathecal transplants of bone marrow mononuclear cells produce motor improvement in an acute and severe model of spinal cord injury

    Directory of Open Access Journals (Sweden)

    Elisa Lettnin Kaminski

    2013-12-01

    Full Text Available OBJECTIVE: We studied transplants of bone marrow mononuclear cells (BMMC by lumbar puncture (LP in a severe model of spinal cord injury (SCI using clip compression. METHODS: BMMCs or saline solution were transplanted by LP 48 hours and 9 days post injury. Motor function was evaluated by BBB scale, histological analysis by Nissl technique and the verification of cell migration by PCR analysis. RESULTS: The BBB had significantly improved in rats treated with BMMCs by LP compared with controls (p<0.001. The histological analysis did not showed difference in the lesional area between the groups. The PCR analysis was able to found BMMCs in the injury site. CONCLUSIONS: two BMMC transplants by LP improved motor function in a severe model of SCI and BMMC was found in the injury site.

  18. Influence of intravascular low level He-Ne laser irradiation on iNOS, total-NOS, and ET-1 in acute spinal cord-injured rabbits

    Science.gov (United States)

    Yin, Zhenchun; Dong, Yinghai; Zhu, Jing

    2005-07-01

    Objective To research the influence of intravascular low level Laser irradiation (ILLLI) on total NOS, iNOS, and ET-1 in spinal cord following acute spinal cord injury (ASCI), and discuss the protective effects of ILLLI on neurons .Methods 72 rabbits were randomly divided into 3 groups: treatment group, injury group and control group. In treatment group and injury group, after laminectomy at the level of T-13, ASCI was performed by using Allen"s method with slight modification (6g×10cm) on rabbits. After injury, rabbits were treated immediately with He-Ne laser (power 5 mW, 1 hour per day for 10 days). At the day of 10th after treatment, total-NOS, iNOS, and ET-1 in spinal cord tissues were measured. Results The expression level of total-NOS, iNOS, and ET-1 in spinal cord in injury group were significantly higher than those in control group (Pspinal cord. It indicates that ILLLI can relieve the overexpression of total-NOS, iNOS, and ET-1 ,and thus can perform protective effects on neurons in the course of secondary spinal cord injury (SSCI) following ASCI

  19. Lumbar Epidural Varix Mimicking Perineural Cyst

    Science.gov (United States)

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

    2013-01-01

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

  20. PRESENT CLINICAL RESEARCH SITUATION OF ADJACENT SEGMENT DEGENERATION AFTER LUMBAR SPINAL FUSION%腰椎融合术后邻近节段退变的临床研究现状

    Institute of Scientific and Technical Information of China (English)

    双峰; 侯树勋

    2013-01-01

    Objective To review the present clinical research situation of adjacent segment degeneration (ASD) after lumbar spinal fusion. Methods The recent literature concerning ASD in the concept, the incidence, the risk factors, and prevention was reviewed. Results The concept of ASD includes radiographic ASD and clinical ASD. The incidences of radiographic ASD and clinical ASD were 8%-100% and 5.2%-18.5%, respectively. The risk factors for ASD include both patient and surgical factors. Patient factors include age, gender, preoperative condition, and so on. Surgical factors include the length of the fusion, mode of fusion, internal fixator, sagittal balance, excessive distraction of disc space, and so on. It can prevent ASD to reduce the length of the fusion, to keep sagittal balance, and to use the non-fusion technology. Conclusion Many researches have proved that the incidence of ASD is increased after lumbar spinal fusion, and it can be reduced by the non-fusion technology. Non-fusion technology has obtained good short-term results. But the long-term results should be further observed because there are some complications.%目的 对腰椎融合术后出现邻近节段退变(adjacent segment degeneration,ASD)的临床研究现状进行综述. 方法 查阅近年关于腰椎融合术后出现ASD的概念、发生率、相关影响因素和预防等方面的文献,并进行综述. 结果 ASD的概念包括影像学ASD和临床症状ASD,腰椎融合术后影像学ASD发生率可达8%~100%,临床症状ASD发生率为5.2%~18.5%.ASD的发生与个体因素(年龄、性别、术前情况等)和手术因素(融合节段长短、融合术式、内固定使用、矢状面平衡、椎间隙过度撑开等)相关.术中减少融合节段、维持矢状面平衡以及非融合技术的应用可预防ASD的发生. 结论 腰椎融合术后ASD发生率增高.非融合技术的应用降低了ASD的发生率,取得了较好的近期临床效果,但也存在一些并发症,

  1. 退行性腰椎管狭窄单纯减压及内固定术疗效观察%The Observation of the Decompression Alone of Degenerative Lumbar Spinal Stenosis and Internal Fixation

    Institute of Scientific and Technical Information of China (English)

    李震; 李国新; 温健; 吴镇权; 李继云; 杨昀焯; 汤晨逢

    2011-01-01

    Objective: To probe into the cure effect of the decompression alone of degenerative lumbar spinal stenosis and internal fixation. Method: To choose 56 patients randomly in our hospital from January 2005 to January 2006, who all received regular conservative treatment but effect were not good. According to the incidence locations and the criteria, the 56 patients were divided into two groups, the decompression alone group and the decompression alone assisted by internal frxation group, then to analysis the cure effective of surgeries. Result: In the postoperative 8 months to 5 years, the patients are follow-up visited. To Analysis the improvement rate of the statistics by Japanese Osteologic methods , we got that the improvement rate of the two groups are 57.4+32.5% and 63.7±24.3% ,and the excellence rate are 65% and 82% o There are no statistical diffence. Conclusion: It can gain an excellence effect in the treatment of Degenerative lumbar spinal stenosis by using the decompression alone and internal fixation, which can be used in clinical treatment for its reliable.%目的:探讨单纯减压及内固定术治疗退行性腰椎管狭窄的疗效.方法:随机抽取2005年1月至2006年1月来我院诊治的退行性腰椎管狭窄患者56例,所有患者均经过正规保守治疗结果不明显.根据腰椎管狭窄的所致的症状部位及分型标准,将56例患者分为两组,即单纯减压组和单纯减压联合内固定术组.并对手术疗效进行回顾性分析.结果:术后随访8个月至5年,将随访反馈的数据采用日本骨科学15分法进行改善率分析得知,两组改善率分别为57.4±32.5%及63.7±24.3%,两组优良率分别为65%及82%,两组数据间无统计学差异.结论:在退行性腰椎管狭窄治疗中,应用单纯减压及内固定术治疗可明显改善患者的临床症状并获得良好的治疗效果,是一种较为可靠的手术方式,值得临床应用.

  2. 显微手术治疗颈胸腰段椎管内硬膜外蛛网膜囊肿%Microsurgical treatment for cervical, thoracic and lumbar spinal extradural arachnoid cysts

    Institute of Scientific and Technical Information of China (English)

    高海浩; 尚爱加; 程诚; 张远征; 乔广宇; 佟怀宇

    2014-01-01

    目的 探讨颈胸腰段椎管内硬膜外蛛网膜囊肿的临床特点和治疗方法.方法 回顾性分析2011年1月至2013年11月收治的有明确症状的15例颈胸腰椎管内硬膜外蛛网膜囊肿患者.其中,1例发生于颈段,12例发生于胸腰段,2例发生于腰段.症状以腰腿疼痛为主,部分患者存在间歇性跛行和感觉功能障碍.结果 15例均行显微手术切除囊肿,术中探查并找到囊肿和硬脊膜囊交通孔予以封闭.术后早期患者症状改善明显.随访1 ~32个月,平均19个月,均未见囊肿复发.其中,11例症状消失,4例症状缓解,不影响正常生活.结论 对有明确症状的椎管内硬膜外蛛网膜囊肿患者,应首选显微手术治疗.手术方法采用囊肿切除、交通孔封闭、椎板复位,临床疗效良好.%Objective To explore the clinical features and surgical treatment of cervical,thoracic and lumbar spinal extradural arachnoid cysts.Methods The clinical data of 15 patients with cervical,thoracic and lumbarspinal extradural arachnoid cysts in our department from Jan 2011 to Nov 2013 were analyzed respectively.Of 15 patients,1 case occurred in cervical segment,12 in thoracolumbar segment,and 2 in lumbar segment.The symptom was given priority to the pain of lumbosacral region,followed by intermittent claudication and sensory dysfunction.Results 15 patients were treated by microsurgical operation to remove the cysts,explore and close the access hole between the cyst and dural sac.In early postoperative period,the symptoms were relieved significantly.15 patients were followed-up from 1 to 32 months (mean duration:19 months) and there was no cyst recurrence.The symptoms of 11 patients were disappeared,and 4 with relief of symptoms and without influence on their daily life.Conclusions Microsurgery was recommended for the patients with spinal extradural arachnoid cysts who suffered from significant symptoms,which included the cyst resection,access hole closure and lamina

  3. Lumbar spine CT scan

    Science.gov (United States)

    CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... your breath for short periods of time. The scan should take only 10 to 15 minutes.

  4. Small Incision Discectomy for Treatment of Lumbar Intervertebral Disc Protrusion of Lumbar Spinal Canal Stenosis and Clinical Research%小切口开窗髓核摘除术治疗腰间盘突出症并腰椎管狭窄临床研究

    Institute of Scientific and Technical Information of China (English)

    管国义

    2013-01-01

      目的:探讨小切口开窗髓核摘除术治疗腰间盘突出症并腰椎管狭窄的临床疗效。方法:选取2009年1月-2012年12月笔者所在医院收治的68例腰间盘突出症并腰椎管狭窄患者,采用双盲法随机分为治疗组和对照组各34例,治疗组行小切口开窗式髓核摘除术,对照组行全椎板、半椎板切除髓核摘除术,比较两组的疗效及预后情况。结果:68例患者均定位精确,无定位错误、硬膜囊撕裂及神经根损伤等情况。治疗组术后的JOA评分、VAS评分及临床优良率均优于对照组(P均0.05);随访6个月~3年,治疗组腰椎间盘突出复发率为2.94%,对照组为11.76%,两组比较差异有统计学意义(P0.05);Were followed up for 6months to 3 years,the treatment group and herniation recurrence rate was 2.94%,control group was 11.76%,compared two groups was statistically significant difference (P<0.05).Conclusion:The small incision fenestration discectomy for treatment of lumbar disc herniation and spinal stenosis can effectively reduce the pain of patients,improve the lumbar vertebral function,maintain the stability of the spine,and the bone damage,is worth the clinical promotion.

  5. A high-fat jelly diet restores bioenergetic balance and extends lifespan in the presence of motor dysfunction and lumbar spinal cord motor neuron loss in TDP-43A315T mutant C57BL6/J mice

    Directory of Open Access Journals (Sweden)

    Karen S. Coughlan

    2016-09-01

    Full Text Available Transgenic transactivation response DNA-binding protein 43 (TDP-43 mice expressing the A315T mutation under control of the murine prion promoter progressively develop motor function deficits and are considered a new model for the study of amyotrophic lateral sclerosis (ALS; however, premature sudden death resulting from intestinal obstruction halts disease phenotype progression in 100% of C57BL6/J congenic TDP-43A315T mice. Similar to our recent results in SOD1G93A mice, TDP-43A315T mice fed a standard pellet diet showed increased 5′ adenosine monophosphate-activated protein kinase (AMPK activation at postnatal day (P80, indicating elevated energetic stress during disease progression. We therefore investigated the effects of a high-fat jelly diet on bioenergetic status and lifespan in TDP-43A315T mice. In contrast to standard pellet-fed mice, mice fed high-fat jelly showed no difference in AMPK activation up to P120 and decreased phosphorylation of acetly-CoA carboxylase (ACC at early-stage time points. Exposure to a high-fat jelly diet prevented sudden death and extended survival, allowing development of a motor neuron disease phenotype with significantly decreased body weight from P80 onward that was characterised by deficits in Rotarod abilities and stride length measurements. Development of this phenotype was associated with a significant motor neuron loss as assessed by Nissl staining in the lumbar spinal cord. Our work suggests that a high-fat jelly diet improves the pre-clinical utility of the TDP-43A315T model by extending lifespan and allowing the motor neuron disease phenotype to progress, and indicates the potential benefit of this diet in TDP-43-associated ALS.

  6. Effect analysis of non-surgical spinal decompression in the treatment of lumbar intervertebral disc herniation%非手术脊柱减压治疗腰椎间盘突出症的效果分析

    Institute of Scientific and Technical Information of China (English)

    黄江湖; 尹晓明; 林飞跃; 徐杨; 许春财; 林蕴硕

    2014-01-01

    目的:探讨非手术脊柱减压治疗腰椎间盘突出症的效果。方法选取2008年7月~2012年10月本院收治的100例腰椎间盘突出症患者为研究对象,将其随机分为观察组和对照组,每组50例。对照组患者采用普通腰椎牵引治疗,观察组患者采用非手术脊柱减压系统进行牵引治疗,治疗结束后,对比两组患者的治疗效果。结果观察组治疗有效率为96.00%,高于对照组的82.00%,差异有统计学意义(P0.05)。治疗后,两组VAS、CODI均降低,观察组降低程度更明显,差异有统计学意义(P0.05).After therapy,VAS score and CODI was decreased respectively,the decreasing level in observation group was more remarkable than that in control group respectively,with statistical difference (P<0.05). Conclusion In comparison with common traction,non-surgical spinal decompression in the treatment of lumbar intervertebral disc herniation can better improve patients’symptoms and signs,help them to get recovery of daily life activity.

  7. A high-fat jelly diet restores bioenergetic balance and extends lifespan in the presence of motor dysfunction and lumbar spinal cord motor neuron loss in TDP-43A315T mutant C57BL6/J mice

    Science.gov (United States)

    Coughlan, Karen S.; Halang, Luise; Woods, Ina

    2016-01-01

    ABSTRACT Transgenic transactivation response DNA-binding protein 43 (TDP-43) mice expressing the A315T mutation under control of the murine prion promoter progressively develop motor function deficits and are considered a new model for the study of amyotrophic lateral sclerosis (ALS); however, premature sudden death resulting from intestinal obstruction halts disease phenotype progression in 100% of C57BL6/J congenic TDP-43A315T mice. Similar to our recent results in SOD1G93A mice, TDP-43A315T mice fed a standard pellet diet showed increased 5′ adenosine monophosphate-activated protein kinase (AMPK) activation at postnatal day (P)80, indicating elevated energetic stress during disease progression. We therefore investigated the effects of a high-fat jelly diet on bioenergetic status and lifespan in TDP-43A315T mice. In contrast to standard pellet-fed mice, mice fed high-fat jelly showed no difference in AMPK activation up to P120 and decreased phosphorylation of acetly-CoA carboxylase (ACC) at early-stage time points. Exposure to a high-fat jelly diet prevented sudden death and extended survival, allowing development of a motor neuron disease phenotype with significantly decreased body weight from P80 onward that was characterised by deficits in Rotarod abilities and stride length measurements. Development of this phenotype was associated with a significant motor neuron loss as assessed by Nissl staining in the lumbar spinal cord. Our work suggests that a high-fat jelly diet improves the pre-clinical utility of the TDP-43A315T model by extending lifespan and allowing the motor neuron disease phenotype to progress, and indicates the potential benefit of this diet in TDP-43-associated ALS. PMID:27491077

  8. 胸腰段长节段硬膜外脊膜囊肿的诊断和治疗%Diagnosis and surgical treatment of spinal extradural meningeal cysts at throco - lumbar spine

    Institute of Scientific and Technical Information of China (English)

    刘振武; 刘利; 颜继英

    2012-01-01

    目的 总结胸腰段硬膜外长节段脊膜囊肿的临床特点、影像学特征和治疗经验.方法 回顾性分析显微手术及病理证实的10例胸腰段硬脊膜囊肿患者的临床资料.本组男4例,女6例,年龄7 - 54岁,平均年龄26.5岁.双下肢麻木无力、大小便功能障碍为主要症状.MRI检查显示T10 -L3水平不同节段区域硬膜囊背侧至双侧椎间孔长T1、长T2囊性信号,囊壁无强化.显微镜下行囊壁切除,脑脊液漏口修补术,术后患者俯卧位7d.结果 手术将囊壁全切或次全切除,病理检查均符合脊膜囊肿,术后患者双下肢无力及大小便功能障碍逐渐恢复,无手术并发症.随访3个月至10年,平均4.1年,所有患者神经功能完好,胸腰椎生理曲度完好,随访期间未见囊肿复发.结论 胸腰段椎管内长节段脊膜囊肿罕见,临床上以慢性脊髓及神经压迫为表现.在MRI上表现为脑脊液信号,囊壁无强化.手术应在显微镜下剥离囊壁,同时修补脑脊液漏口,手术疗效满意.%Objective To summarize the clinical manifestation,imaging characteristic and experience of surgical treatment of extradural meningeal cyst at thoraco - lumbar spine.Methods The authors retrospectively analyzed a series of 10 patients with extradural meningeal cyst at thoraco - lumbar spine surgically treated under microscope from 2001to 2011.There were 4 males and 6 fameles with average age of 26.5 yaers ( rang from 7 to 54 years old ).The weakness of lower extremities,bowl and bladder dysfunction were the main clinical manifestation.MRI inmaging showed the cyst located dorsal to the spinal cord and extending to the neural formen with lower signal in T1and higher signal in T2 seriers without enhancement.The lesions located at thoraco - lumbar spine range from T10 and L3.10 operations had been performed with the cyst resection and fistula repairment under microscope. The patients remained prone position until 7 days post - operition

  9. "INTRAOPERATIVE SPINAL STIFFNESS MEASUREMENT IN MANAGEMENT OF SPINAL CANAL STENOSIS "

    Directory of Open Access Journals (Sweden)

    M. Karami

    2005-08-01

    Full Text Available In this study to determine whether spine stiffness is predictive of clinical results after lumbar spinal fusion for spinal stenosis, a total of 78 patients were measured intraoperatively with Kocher clamp manual distraction technique to determine motion segment stiffness then spinal fusion was performed for any loose segment. ‎Statistical analysis revealed that stiffness measurement correlate with clinical results of surgery. During a minimum of 2 years follow up after surgery, patients who had loose motion segment before or after decompression and were fused had the same level of satisfaction with surgical results as patients without loose segments and fusion. ‎We concluded that intraoperative spinal stiffness measurement provide a good indicator to spine fusion after lumbar canal stenosis ‎surgery.

  10. Role of spinal GABAA receptor reduction induced by stress in rat thermal hyperalgesia.

    Science.gov (United States)

    Ma, Xuelian; Bao, Weiying; Wang, Xiujun; Wang, Zhilong; Liu, Qiaoran; Yao, Zhenyu; Zhang, Di; Jiang, Hong; Cui, Shuang

    2014-11-01

    The mechanisms underlying stress-induced hyperalgesia (SIH) remain poorly understood. Recent findings have provided strong evidence indicating that SIH could be related, at least in part, to alterations in spinal cord GABA activity. In the present study, we first investigated how acute restraint stress impacted pain responses as assessed using the tail flick immersion test. These results showed that rats developed hyperalgesia at 6 h after being subjected to 1-h acute restraint stress. Second, we measured the activation of spinal neurons and alterations in expression of GABAA receptor β2 and β3 subunits as related to stress-induced hyperalgesia. Results from Western blot and immunofluorescence assays showed that c-fos protein increased in the dorsal horn of the lumbar spinal cord and GABAA receptor β2 and β3 subunit proteins decreased significantly at 6 h after exposure to 1 h of acute restraint stress. Finally, the effects of spinal GABAA receptor alteration on SIH were evaluated. These results showed that intrathecal administration of muscimol inhibited hyperalgesia induced by stress while bicuculline enhanced hyperalgesia in the control groups. Taken together, the present data reveal that GABAA receptor β2 and β3 decrease following 1 h of acute restraint stress and may play a critical role in SIH.

  11. COMPARATIVE RETROSPECTIVE STUDY ON ANAESTHESIA APPROACHES FOR LUMBAR SPINE SURGERY

    Directory of Open Access Journals (Sweden)

    Rangalakshmi S

    2016-07-01

    Full Text Available OBJECTIVE Lumbar spinal surgeries have been performed with either spinal or general anaesthesia. In this study, we aimed to evaluate the superiority of either spinal or general anaesthesia on lumbar spine surgery. METHODS After approval of institutional ethical committee, we retrospectively analysed 270 patients (ASA I and II undergoing surgery of lumbar spine from 2009 to 2015 by one surgeon. Of these 150 patients underwent general anaesthesia with controlled ventilation, 120 patients were offered spinal anaesthesia with conscious sedation. Patient records were reviewed to obtain demographic features, type of anaesthesia, baseline heart rate, mean arterial pressure, intraoperative maximum heart rate, mean arterial pressure, duration of surgery, amount of intravenous fluids, intraoperative blood loss, incidence of perioperative complications such as bleeding, nausea, vomiting, hypotension, bradycardia, and postoperative analgesic consumption. RESULTS Patient characteristics including baseline/intraoperative mean arterial pressure and heart rate values did not differ between groups. However, the spinal anaesthesia group experienced significantly shorter durations in the operating room and had a lower incidence of nausea, vomiting. Analgesic consumptions in general anaesthesia group was significantly higher than in spinal anaesthesia group. CONCLUSION The present study revealed that spinal anaesthesia is a safe and effective alternative to general anaesthesia for patients undergoing single level or two level lumbar laminectomy, discectomy, or even instrumentation below L2 level and has the advantage of decreased nausea, antiemetic, analgesic requirements, and fewer complications. It also ensures better postoperative recovery when compared to general anaesthesia

  12. The anatomic study of transferring thoracic nerve roots to lumbar nerve root inside the spinal canal of paraplegia%椎管内胸神经根移位至腰神经根的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    苏庆军; 王志为; 韩娜; 何矫; 王天兵

    2010-01-01

    Objective To study the fundamental anatomy of transferring T9-12 nerve roots to L2-4 nerve root for the quadriceps function recovery inside the spinal canal of paraplegia. Methods Thoracic and lumbar spinal canal and spinal dura mater of 5 adult cadavers (male 2 and female 3) were opened and explored. Investigated including: the position which T9 -L4 nerve root generated from spinal cord; the relation between the position which T9-L4 nerve root generated from spinal cord and T12 vertebrae and L1 vertebrae;The length beginning part of T9-L4 nerve root inside the spinal canal. The diameter of T9-L4 nerve root. The distance between the T9-L4 nerve root separately. The distance between the position which T9-12 nerve root separately generated from dura mater and the middle of L2 vertebrae. Results T9 nerve root generated from the middle part of T9 vertebrae; L4 nerve root generates from middle part of L2 vertebrae. The average length of T9-L4 nerve root inside the spinal canal separately was 16. 12, 22. 97, 30. 43, 43.47, 56. 02, 70. 03,88. 70 and 113.65 mm. The average diameter of T9 -L4 nerve root separately was 2. 45, 2. 04, 1.96, 2. 18,2. 32, 2. 56, 3. 10 and 3.26 mm. The average distance between the beginning part of T9-L4 nerve root separately was 22. 87, 25.08, 28.47, 27.38, 29.78, 31.93 and 31.00 mm. The average distance between the position which T9-12 nerve root separately generated from dura mater and the middle of L2 vertebrae was 118.69, 95.82, 70.74, and 42.27 mm. Conclusions T9-12 nerve root can be used as donor nerve for repair L2-4 nerve root. The level of L2 vertebrae can be anastomose site of the recipient nerve.%目的 了解椎管内T9~12神经根移位修复L2~4神经根、恢复截瘫后股四头肌功能的解剖学基础.方法 5 具成人尸体标本,其中男性2具,女性3具.完全显露胸段及腰段椎管,观察T9~L4神经根在脊髓上发出的部位,T12及L1椎体水平与椎管内各神经根之间的关系;测量T9~L4神

  13. Zastosowanie plastrowania dynamicznego u chorych wieku podeszłym po leczeniu operacyjnym stenozy zwyrodnieniowej kanału kręgowego i dyskopatii lędźwiowej = The application of Kinesio Taping in eldery patients after surgical treatment of lumbar spinal stenosis and disc herniation

    OpenAIRE

    Główczewska-Siedlecka, Emilia; Mądra-Gackowska, Katarzyna; Nowacka, Krystyna; Simińska, Joanna; Siedlecki, Zygmunt; Szostak, Mateusz; Kędziora-Kornatowska, Kornelia

    2016-01-01

    Główczewska-Siedlecka Emilia, Mądra-Gackowska Katarzyna, Nowacka Krystyna, Simińska Joanna, Siedlecki Zygmunt, Szostak Mateusz, Kędziora-Kornatowska Kornelia. Zastosowanie plastrowania dynamicznego u chorych wieku podeszłym po leczeniu operacyjnym stenozy zwyrodnieniowej kanału kręgowego i dyskopatii lędźwiowej = The application of Kinesio Taping in eldery patients after surgical treatment of lumbar spinal stenosis and disc herniation. Journal of Education, Health and Sport. 2016;6(12):222-22...

  14. Modic改变在腰椎间盘退变中的意义%The significance of Modic change in lumbar disc degeneration

    Institute of Scientific and Technical Information of China (English)

    马铮; 丁文元; 杨大龙; 孙亚澎; 张立军

    2013-01-01

    Concerning the Modic change of lumbar spinal endplate, the Modic change types, forming causes, and the relationship between Modic change and degenerative lumbar diseases have been studied from anatomy, pathology, molecular biology and many other aspects at present. The degeneration of lumbar disc is a high risk factor of the Modic change. The degeneration of lumbar disc usually starts from cartilage endplate degeneration. The injury of cartilage endplate could accelerate the degeneration of lumbar disc. This article reviews the significance of Modic change of lumbar spinal endplate in lumbar disc degeneration. The cause of Modic change of the endplate, pathological change, the influence of inflammatory mediators on the endplate and the significance of Modic change in the treatment of degenerative lumbar diseases are summarized to analyze the relationship between the degeneration of lumbar disc and Modic change of endplate and to describe the influence of Modic change in the treatment of degenerative lumbar disc diseases.

  15. Quercetin Inhibits Peripheral and Spinal Cord Nociceptive Mechanisms to Reduce Intense Acute Swimming-Induced Muscle Pain in Mice

    Science.gov (United States)

    Borghi, Sergio M.; Pinho-Ribeiro, Felipe A.; Fattori, Victor; Bussmann, Allan J. C.; Vignoli, Josiane A.; Camilios-Neto, Doumit; Casagrande, Rubia; Verri, Waldiceu A.

    2016-01-01

    The present study aimed to evaluate the effects of the flavonoid quercetin (3,3´,4´,5,7-pentahydroxyflavone) in a mice model of intense acute swimming-induced muscle pain, which resembles delayed onset muscle soreness. Quercetin intraperitoneal (i.p.) treatment dose-dependently reduced muscle mechanical hyperalgesia. Quercetin inhibited myeloperoxidase (MPO) and N-acetyl-β-D- glucosaminidase (NAG) activities, cytokine production, oxidative stress, cyclooxygenase-2 (COX-2) and gp91phox mRNA expression and muscle injury (creatinine kinase [CK] blood levels and myoblast determination protein [MyoD] mRNA expression) as well as inhibited NFκB activation and induced Nrf2 and HO-1 mRNA expression in the soleus muscle. Beyond inhibiting those peripheral effects, quercetin also inhibited spinal cord cytokine production, oxidative stress and glial cells activation (glial fibrillary acidic protein [GFAP] and ionized calcium-binding adapter molecule 1 [Iba-1] mRNA expression). Concluding, the present data demonstrate that quercetin is a potential molecule for the treatment of muscle pain conditions related to unaccustomed exercise. PMID:27583449

  16. von Frey anesthesiometry to assess sensory impairment after acute spinal cord injury caused by thoracolumbar intervertebral disc extrusion in dogs.

    Science.gov (United States)

    Song, R B; Basso, D M; da Costa, R C; Fisher, L C; Mo, X; Moore, S A

    2016-03-01

    Sensory threshold (ST) was measured using an electric von Frey anesthesiometer (VFA) in all limbs of 20 normal dogs and 29 dogs with acute thoracolumbar spinal cord injury (SCI) caused by spontaneous intervertebral disc extrusion. ST values were measured at three separate time points in normal dogs and on days 3, 10 and 30 following decompressive surgery in dogs with SCI. ST values were compared between groups and correlated with locomotor recovery in SCI-affected dogs. ST values were significantly higher (consistent with hypoalgesia) in the pelvic limbs of SCI-affected dogs at day 3, day 10 and day 30 when compared to normal dogs (P dogs over time, consistent with improvement toward normal sensation or development of allodynia. This finding correlated inversely with locomotor score at 3 and 10 days after surgery. A significant decline in ST values across testing sessions was observed for all limbs of normal and SCI-affected dogs and may be related to patient acclimation, operator training effect, or effect of analgesic medications. This study supports the feasibility of VFA to assess differences in ST between normal and SCI-affected dogs. However, future studies must focus on techniques to minimize or compensate for clinical, environmental and behavioral factors which may impact ST values in the clinical setting.

  17. Spontaneous rupture of an infected renal cyst and external drainage through a lumbar surgical scar in a male patient with cervical spinal cord injury: a case report

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2008-05-01

    Full Text Available Abstract Introduction The spontaneous rupture of an infected renal cyst is a rare event. Spontaneous rupture with drainage to the exterior through a surgical scar has not been reported previously. Case presentation A 49-year-old male with tetraplegia had undergone extended right pyelolithotomy in 1999. Deroofing and marsupialisation of a cyst in the upper pole of the right kidney was performed in 2003. Subsequently there was recurrence of a thick-walled cystic space-occupying lesion in the upper pole of the right kidney. Thick pus was aspirated from the renal cyst on six occasions between September 2003 and November 2004. In March 2006, ultrasound examination revealed a cyst measuring 6.2 cm in diameter in the upper pole of the right kidney. Aspiration was planned when the renal cyst reached 7.5 cm in diameter. However, 11 months later, the cyst ruptured spontaneously and drained through the previous surgical scar in the flank, while the patient was recovering from a severe chest infection in the spinal unit. Ultrasound examination showed a fistulous tract running between the renal cyst and the abdominal wall. Repeated minor trauma sustained during turning, hoisting and chest physiotherapy all may have contributed to the rupture of the infected renal cyst and drainage through a weak spot in the abdominal wall. Conclusion In hindsight, we might have prevented rupture of the renal cyst had we considered aspiration of the renal cyst before it reached 7.5 cm in diameter, although this 7.5 cm diameter, as the threshold for percutaneous aspiration, is an arbitrary setting. This patient could have been advised to wear an abdominal corset to protect the right flank from pressure applied unintentionally during turning, hoisting or assisted coughing.

  18. Estenose degenerativa do canal lombar: correlação entre o índice de Oswestry e imagem de ressonância magnética Estenosis degenerativa del canal lumbar: correlación entre el índice de Oswestry y la resonancia magnética Degenerative lumbar spinal stenosis: correlation between Oswestry index and magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Wagner Pasqualini

    2012-12-01

    relationship between the degree of lumbar spinal canal stenosis (LCS, in magnetic resonance imaging (MRI and the severity of disability according to the Oswestry Index in patients with LCS compared to controls without LCS. METHODS: Twenty-three patients with a diagnosis of LCS were compared with a control group of 17 volunteers. All participants underwent MRI and completed the Oswestry questionnaire. Statistical analysis used the Fisher exact test, the Mann-Whitney and the Spearman's tests. RESULTS: Low back pain was the most frequent complaint in both groups. The Oswestry index showed average disability in 45.69% patients and 11.60% controls. MRI revealed that the dural sac cross-sectional area, the diameter of the canal and the lateral recesses and foramina were equally changed in both groups. CONCLUSIONS: There was no correlation between the degree of lumbar canal stenosis and the disability index in both groups.

  19. Effect of Lomoxicam injection by lumbar administration on spinal cord in rabbits%氯诺昔康注射液椎管内给药对家兔脊髓的影响

    Institute of Scientific and Technical Information of China (English)

    胡玲; 易先慧

    2013-01-01

    Objective It is to explore the analgesic effect and side effect of Lomoxicam by epidural administration in rabbit models. Methods Twenty four healthy adult rabbits were randomly divided into three groups: group A, group B and group C. Both group A and group B received epidural catheterization. Group A was given normal saline 2 mL slowly and group B was given Lomoxicam 0. 75 mg/kg( 2 mL in total ) both from epidural cavity. Group C was given Lomoxicam 0.75 mg/kg( 2 mL in total ) by intravenous injection. In 5 minute, 12 hours after Lidocaine administration the degree of resistance to thermal conditions was observed and resistance time t1 and t2 were recorded. At the end of the experiment the animals were killed to get spinal cord to observe its injury degree. Results Compared with that in group A, the resistance time in group B and group C increased obviously, the differences were significant( P <0.05 ). There was significant difference in the time between group B and group C ( P < 0.05 ). t2 was longer than t1 in group C , and the difference was significant ( P < 0.05 ). No damage change was found in spinal specimen in both group A and group C, but the damage changes such as neurodegeneration were found in most section in group B. Conclusion Lomoxicam has a good analgesic effect on hyperalgesia state,but the epidural injection of lomoxicam shows certain harmful effect on spinal cord, so it is unsuited for lumbar administration.%目的 探讨氯诺昔康椎管内给药对家兔的镇痛效果及不良反应.方法 选择健康成年大白兔24只,随机分成A组、B组和C组各8只,A组和B组均行硬膜外置管.A组从硬膜外腔缓慢给生理盐水2mL,B组给氯诺昔康0.75mg/kg(共2mL),C组静脉给氯诺昔康0.75 mg/kg(共2mL).给药5min和术后12min分别观察家兔对热敏度的耐受情况并记录耐受时间t1和t2.实验完毕后处死兔子取出脊髓标本并观察受损情况.结果 与A组比较,B组和C组耐受时间延长(P均<0.05);C

  20. Efficacy Observation on Balance Acupunture Combined with Blood-letting Therapy for Acute Lumbar Sprain%平衡针配合放血疗法治疗急性腰扭伤疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈彦柳

    2014-01-01

    Objective:To observe the efficacy of balance acupuncture combined with blood-letting therapy for acute lumbar sprain. Methods:68 cases of acute lumbar sprain patients were randomly divided into treatment group (34 cases) and control group (34 cases), the treatment group treated by balance acupuncture combined with blood-letting therapy, while control group by conventional body acupuncture, evaluated the efficacy after a course of treatment. Results:The total effective rate of treatment group was 100.00%, which was higher than 88.24%that of control group (P<0.05). Conclusion:Balance acupuncture combined with blood-letting therapy has significant curative effect on acute lumbar sprain.%目的:观察平衡针配合放血疗法治疗急性腰扭伤的疗效。方法:将68例急性腰扭伤患者随机分为治疗组(34例)和对照组(34例),治疗组采用平衡针配合放血疗法治疗,对照组给予常规体针治疗,一个疗程后评定临床疗效。结果:治疗组总有效率为100.00%,高于对照组的88.24%(P<0.05)。结论:平衡针配合放血疗法治疗急性腰扭伤疗效显著。

  1. 腹部手法配合斜搬法治疗急性腰扭伤疗效观察%Observation of Clinical Effect of Abdominal Massage and Oblique Traction for Acute Lumbar Sprain

    Institute of Scientific and Technical Information of China (English)

    赵明宇; 黄桂成; 王凯; 郑伟; 陈振明

    2012-01-01

    Objective : To observe the clinical effect and security of abdominal massage and oblique traction for acute lumbar sprain. Methods :75 patients with acute lumbar sprain were randomly divided into an treatment group of 43 patients, treated with both abdominal massage and oblique traction,and a control group of 32 patients,treated with only oblique traction. Results:In the treatment group 34 patients were cured and 9 showed some improvement,with an effective rate of 100% ; in the control group,8 patients were cured and 13 showed some improvement,with an effective rate of 68. 8%. Conclusion:Abdominal massage combined with oblique traction is more effective and has less pain,less cost and good social benefit in the treatment of acute lumbar sprain.%目的:探讨腹部手法配合斜搬法治疗急性腰扭伤的疗效和安全性.方法:将75例急性腰扭伤患者随机分为治疗组(43例)和对照组(32例),观察组予以腹部手法配合斜搬法治疗;对照组单纯予以斜扳法治疗.对两组患者治疗后疗效.结果:治疗组治愈34例,好转9例,总有效率100%;对照组治愈8例,好转13例,总有效率68.8%.结论:腹部手法配合斜搬法治疗急性腰扭伤其痛苦小,显效快,费用少,有良好的社会效益.

  2. 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 by timing the tap duration of a diagnostic lumbar puncture....

  3. Does surgical treatment within 4 hours after trauma have an influence on neurological remission in patients with acute spinal cord injury?

    Directory of Open Access Journals (Sweden)

    Biglari B

    2016-08-01

    Full Text Available Bahram Biglari,1 Christopher Child,2 Timur Mert Yildirim,2 Tyler Swing,2 Tim Reitzel,1 Arash Moghaddam2 1Department of Paraplegiology and Technical Orthopedics, BG Trauma Centre, Ludwigshafen, Germany; 2Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord injury, Heidelberg University Hospital, Heidelberg, Germany Background: The proper timing for surgery in patients with acute spinal cord injury is controversial. This study was conducted to detect if there is an advantage in early (within the first 4 hours after trauma compared to late (between 4 and 24 hours after trauma surgery on neurological outcome.Methods: In this single institution prospective cohort study, data were analyzed from 51 spinal cord injured patients with an average age of 43.4 (±19.2 years. The influence of early (29 patients within the first 4 hours as opposed to late (22 patients between 4 and 24 hours decompression was evaluated by comparing data for neurological outcome. Patients of the study collectively suffered acute spinal fractures from C2 to L3 (cervical 39.2%, thoracic 29.4%, and lumbal 21.6% or nonosseous lesions (9.8%. American Spinal Injury Association (ASIA Impairment Scale (AIS grades were assessed at time of admission and 6 months after trauma or longer depending on the time of release. Surgical treatment included early stabilization and decompression within 24 hours.Results: No significant difference between improved neurological function, measured with the AIS, and an early or late surgery time can be seen (P=0.402. Furthermore, binary logistic regression shows no significant difference between sex or age, and AIS improvement as possible confounders.Conclusion: In our study, all patients with spinal cord injury were treated with spine stabilization and decompression within the first 24 hours after trauma. Surgical decompression within the first 4 hours after trauma was not associated with improved neurological outcome

  4. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

    OpenAIRE

    Gábor Czigléczki; Zoltán Papp; Csaba Padányi; Péter Banczerowski

    2014-01-01

    Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal. Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients. The purpose of this article is to summarize these procedures and ev...

  5. Concentration of nitric oxide (NO in spinal fluid of chronic spinal disease.

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    Yumite Y

    2001-08-01

    Full Text Available We studied total nitric oxide (nitrite + nitrate (NO levels in cerebrospinal fluid (CSF of chronic spinal diseases in nonsmokers (133 patients: 76 men and 57 women; mean age, 63 years; range, 15-92 years by the Griess method to clarify the role of NO in different spinal diseases. The extent of compression in terms of numbers of disc level at the compressed spinal nerve and neurological evaluation were also assessed according to the Japanese Orthopaedic Association scores. The spinal diseases included cervical myelopathy and radiculopathy (cervical disease group, ossification of yellow ligament (thoracic disease group, and lumbar disc herniation, lumbar canal stenosis and lumbar spondylolisthesis (lumbar disease group. NO levels in the spinal disease groups (4.98+/-2.28 micromol/l: mean +/- SD were significantly higher than that in the control group (2.53+/-0.94 micromol/l. An inverse correlation was detected between the elevated levels of NO and the grade of clinical symptoms in the cervical disorders. The number of disc level at the compressed spinal nerve was positively correlated with elevated NO levels in CSF in the cervical and lumbar disorder groups. These results indicate that nerve compression may elevate NO levels in CSF, and that NO concentration in the CSF might be a useful marker of damage to nervous system in spinal disorders.

  6. An atypical case of segmental spinal dysgenesis

    Energy Technology Data Exchange (ETDEWEB)

    Zana, Elodie; Chalard, Francois; Sebag, Guy [Hopital Robert Debre, Department of Paediatric Imaging, Paris (France); Mazda, Keyvan [Hopital Robert Debre, Department of Paediatric Orthopaedic Surgery, Paris (France)

    2005-09-01

    Spinal segmental dysgenesis is a complex closed dysraphism. The diagnostic criteria are: lumbar or thoracolumbar vertebral dysgenesis causing kyphosis, focal spinal cord narrowing without exiting roots, deformity of the lower limbs and paraplegia or paraparesis. We present a newborn who showed atypical features of bifocal spinal cord narrowing, without any vertebral abnormality at the proximal level. This seems to be a variant of this rare entity, whose early diagnosis is important, as surgical stabilisation of the spine is required. (orig.)

  7. Cardiac arrhythmias the first month after acute traumatic spinal cord injury

    DEFF Research Database (Denmark)

    Bartholdy, Kim; Biering-Sørensen, Tor; Malmqvist, Lasse

    2014-01-01

    of this prospective observational study was to investigate the occurrence of cardiac arrhythmias and cardiac arrests in patients with acute traumatic SCI. METHODS: As early as possible after SCI 24-hour Holter monitoring was performed. Additional Holter recordings were performed 1, 2, 3, and 4 weeks after SCI....... Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks. RESULTS: Thirty patients were included. Bradycardia (heart rate (HR) ... both on 12-lead ECGs obtained shortly after SCI (P = 0.030) and at 4 weeks (P = 0.041). CONCLUSION: Many patients with cervical SCI experience arrhythmias such as bradycardia, sinus node arrest, supraventricular tachycardia, and more rarely cardiac arrest the first month after SCI. Apart from sinus...

  8. The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery.

    Science.gov (United States)

    Singla, Anuj; Yang, Scott; Werner, Brian C; Cancienne, Jourdan M; Nourbakhsh, Ali; Shimer, Adam L; Hassanzadeh, Hamid; Shen, Francis H

    2017-03-14

    OBJECTIVE Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p fusion more than 3 months after LESI. CONCLUSIONS Lumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar

  9. Study on the effect of sequential section of posterior spinal structures on low lumbar stability%后部结构分级切除对下腰椎稳定性影响的实验研究

    Institute of Scientific and Technical Information of China (English)

    马信龙; 骆巍; 张弢; 郑永发; 马剑雄; 王志钢; 张园; 王涛

    2009-01-01

    Objective To study the effect of sequential section of L5.6 posterior spinal structures on lumbar mechanical stability using constant displacement testing method by measuring vertebral segmental motion on 6 degrees of freedom. Methods Forteen fresh segments of L4-L7 were selected as spinal speci-mens from healthy female Small-Tailed Han sheep. The sequences were procedured as follows: Ⅰnormal→Ⅱ total laminectomy→Ⅲ half-resection of left facet joint→Ⅳ fuU-resection of left facet joint→Ⅴ half-resection of right facet joint→Ⅵ full-resection of right facet joint. Instron 8874 was used for testing six sequences. Then the mean stiffness of every sequence were recorded and analyzed. SPSS 11.5 statistical package was used for ANOVA. Results The resection of posterior ligaments as well as left facet joint had some effect on the stability of flexion/extension, but the mechanical instability did not occur (P>0.05). Plus the half-resec-tion of right facet joint, the mechanical instability appeared (P0.05). The resec-tion of posterior ligaments led to the mechanical instability of left/right axial torsion(P<0.05). The mean stiff-ness decreased 26.13% and 26.20% respectively. Facet joints had important sense on torsional stability, es-pecially on the opposite side. Conclusion Under conditions of insuring the field of vision, we must carry out microinvasive operation and preserve the integrity of posterior spinal structures as far as possible during performing posterior approach of lumbar.%目的 探讨小尾寒羊L5,6后部结构分级切除对腰椎稳定性的影响.方法 选取14只小尾寒羊,截取L4~L7脊柱标本.实验前摄正、侧位X线片以排除脊柱疾患,CT定位关节突关节分级切除.对L5,6节段后部结构依次分级切除如下:Ⅰ正常→Ⅱ全椎板减压→Ⅲ左侧关节突切除1/2→Ⅳ左侧关节突全部切除→Ⅴ右侧关节突切除1/2→Ⅵ右侧关节突全部切除→结束.利用Instron 8874液压伺服动

  10. 一期后路脊柱三柱重建治疗严重腰椎爆裂骨折临床疗效观察%One-stage posterior approach spinal reconstruction for severe lumbar burst fracture

    Institute of Scientific and Technical Information of China (English)

    茅剑平; 郎昭; 田伟; 刘波; 李勤; 胡临; 张贵林; 袁强; 行勇刚; 肖斌

    2011-01-01

    Objective To evaluate the clinical therapeutic outcomes for severe burst fracture of lumbar vertebrae via a posterior approach for one-stage spinal "three-column" reconstruction. Methods An retrospective analysis of data was performed for 21 patients with severe burst fracture of lumbar vertebrae undergoing a posterior approach for one-stage spinal "three-column" reconstruction from 2005 to 2010. It was compared with previous 15 cases undergoing a staged anteroposterior approach. The operative duration,volume of blood loss, pre- and post-operative imaging measurements of kyphosis and vertebral height and nerve function recovery were evaluated. Results The values of operative duration and volume of blood loss in the one-stage posterior approach group were significantly less than those of the two-stage anteroposterior approach group [(263 ±72) min vs (439±75) min, t = -5.303, P<0.01; (1143 ±296) ml vs (1471 ±399) ml, t = -2. 169, P = 0. 042 )]. Statistical significance existed in postoperative kyphosis between two groups [(0.5 ±2.0)°vs (3.9 ±2.6)°, t = -3.336, P =0.003]. Vertebral height had no statistical significance pre- and post-operatively between two groups while restoration of vertebral height did [(0.47±0.19) mm vs (0.26±0.15) mm, t=2.669, P=0.015].Conclusion Posterior approach for one-stage vertebral resection, mesh implantation, pedicle screws and rod internal fixation for reconstructing spinal "three-column" structures offers excellent feasibility and safety. And it may avoid complications associated with an anteroposterior approach for two-stage procedures. The median length of hospital stay is also reduced.%目的 评价采用一期后路脊柱三柱重建方法治疗严重腰椎爆裂骨折的临床疗效.方法 回顾性分析2005至2010年一期后路脊柱三柱重建的严重腰椎爆裂骨折患者21例,与既往前后路分期手术15例病例对比,总结手术时间、出血量、手术前后后凸角度、椎体高度测量及

  11. Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

    Directory of Open Access Journals (Sweden)

    Adam R Ferguson

    2012-10-01

    Full Text Available Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI. Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. The mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain pathways in the spinal cord may emerge with certain patterns of activity, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after spinal cord injury. We review these basic phenomena, discuss the cellular and molecular mechanisms, and discuss implications of these findings for improved rehabilitative therapies after spinal cord injury.

  12. Preoperative education for lumbar surgery for radiculopathy

    Directory of Open Access Journals (Sweden)

    A. Louw

    2009-02-01

    Full Text Available To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptiveand inferential statistical tests. Results showed that 100% of the patients and 99% of therapists view preoperative education to be an important component for lumbar surgery for radiculopathy. The most important factors identifiedfor inclusion in preoperative educational programs were reason for surgery, risks associated with surgery, limitations following surgery and more education regarding pain. The preferred method of education delivery was verbal one-on-one education. This study demonstrates that there is a demand for preoperative education for patients who had lumbar surgery.

  13. The degree of acute descending control of spinal nociception in an area of primary hyperalgesia is dependent on the peripheral domain of afferent input.

    Science.gov (United States)

    Drake, Robert A R; Hulse, Richard P; Lumb, Bridget M; Donaldson, Lucy F

    2014-08-15

    Descending controls of spinal nociceptive processing play a critical role in the development of inflammatory hyperalgesia. Acute peripheral nociceptor sensitization drives spinal sensitization and activates spino-supraspinal-spinal loops leading to descending inhibitory and facilitatory controls of spinal neuronal activity that further modify the extent and degree of the pain state. The afferent inputs from hairy and glabrous skin are distinct with respect to both the profile of primary afferent classes and the degree of their peripheral sensitization. It is not known whether these differences in afferent input differentially engage descending control systems to different extents or in different ways. Injection of complete Freund's adjuvant resulted in inflammation and swelling of hairy hind foot skin in rats, a transient thermal hyperalgesia lasting hyperalgesia (≥7 days). Much longer lasting thermal hyperalgesia was apparent in glabrous skin (1 h to >72 h). In hairy skin, transient hyperalgesia was associated with sensitization of withdrawal reflexes to thermal activation of either A- or C-nociceptors. The transience of the hyperalgesia was attributable to a rapidly engaged descending inhibitory noradrenergic mechanism, which affected withdrawal responses to both A- and C-nociceptor activation and this could be reversed by intrathecal administration of yohimbine (α-2-adrenoceptor antagonist). In glabrous skin, yohimbine had no effect on an equivalent thermal inflammatory hyperalgesia. We conclude that acute inflammation and peripheral nociceptor sensitization in hind foot hairy skin, but not glabrous skin, rapidly activates a descending inhibitory noradrenergic system. This may result from differences in the engagement of descending control systems following sensitization of different primary afferent classes that innervate glabrous and hairy skin.

  14. A descriptive study of the usage of spinal manipulative therapy techniques within a randomized clinical trial in acute low back pain.

    Science.gov (United States)

    Hurley, Deirdre A; McDonough, Suzanne M; Baxter, G David; Dempster, Martin; Moore, Ann P

    2005-02-01

    The majority of randomized clinical trials (RCTs) of spinal manipulative therapy have not adequately defined the terms 'mobilization' and 'manipulation', nor distinguished between these terms in reporting the trial interventions. The purpose of this study was to describe the spinal manipulative therapy techniques utilized within a RCT of manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), and a combination of both (CT; n = 80) for people with acute low back pain (LBP). Spinal manipulative therapy was defined as any 'mobilization' (low velocity manual force without a thrust) or 'manipulation' (high velocity thrust) techniques of the spine described by Maitland and Cyriax. The 16 physiotherapists, all members of the Society of Orthopaedic Medicine, utilized three spinal manipulative therapy patterns in the RCT: Maitland Mobilization (40.4%, n = 59), Maitland Mobilization/Cyriax Manipulation (40.4%, n = 59) and Cyriax Manipulation (19.1%, n = 28). There was a significant difference between the MT and CT groups in their usage of spinal manipulative therapy techniques (chi2 = 9.178; df = 2; P = 0.01); subjects randomized to the CT group received three times more Cyriax Manipulation (29.2%, n = 21/72) than those randomized to the MT group (9.5%, n = 7/74; df = 1; P = 0.003). The use of mobilization techniques within the trial was comparable with their usage by the general population of physiotherapists in Britain and Ireland for LBP management. However, the usage of manipulation techniques was considerably higher than reported in physiotherapy surveys and may reflect the postgraduate training of trial therapists.

  15. 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.

  16. Time-Dependent Increases in Protease Activities for Neuronal Apoptosis in Spinal Cords of Lewis Rats During Development of Acute Experimental Autoimmune Encephalomyelitis

    Science.gov (United States)

    Das, Arabinda; Guyton, M. Kelly; Matzelle, Denise D.; Ray, Swapan K.; Banik, Naren L.

    2008-01-01

    Multiple sclerosis (MS) is characterized by axonal demyelination and neurodegeneration, the latter having been inadequately explored in the MS animal model experimental autoimmune encephalomyelitis (EAE). The purpose of this study was to examine the time-dependent correlation between increased calpain and caspase activities and neurodegeneration in spinal cord tissues from Lewis rats with acute EAE. An increase in TUNEL-positive neurons and internucleosomal DNA fragmentation in EAE spinal cords suggested that neuronal death was a result of apoptosis on days 8–10 following induction of EAE. Increases in calpain expression in EAE correlated with activation of pro-apoptotic proteases, leading to apoptotic cell death beginning on day 8 of EAE, which occurred before the appearance of visible clinical symptoms. Increases in calcineurin expression and decreases in phospho-Bad (p-Bad) suggested Bad activation in apoptosis during acute EAE. Increases in the Bax:Bcl-2 ratio and activation of caspase-9 showed the involvement of mitochondria in apoptosis. Further, caspase-8 activation suggested induction of the death receptor–mediated pathway for apoptosis. Endoplasmic reticulum stress leading to caspase-3 activation was also observed, indicating that multiple apoptotic pathways were activated following EAE induction. In contrast, cell death was mostly a result of necrosis on the later day (day 11), when EAE entered a severe stage. From these findings, we conclude that increases in calpain and caspase activities play crucial roles in neuronal apoptosis during the development of acute EAE. PMID:18521931

  17. Contraindications to lumbar puncture as defined by computed cranial tomography.

    OpenAIRE

    Gower, D. J.; Baker, A. L.; Bell, W O; Ball, M R

    1987-01-01

    Papilloedema is not always an adequate predictor of potential complications from lumbar puncture, and many clinicians are using computed tomography (CT) before lumbar puncture in an effort to identify more accurately the "at risk" patient. This paper identifies the following anatomical criteria defined by CT scanning that correlate with unequal pressures between intracranial compartments and predispose a patient to herniation following decompression of the spinal compartment: lateral shift of...

  18. Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases

    Energy Technology Data Exchange (ETDEWEB)

    Chiapparini, L.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milano (Italy); Sghirlanzoni, A.; Pareyson, D. [Department of Neurology, Istituto Nazionale Neurologico, Milano (Italy)

    2000-08-01

    We reviewed the clinical and neuroradiological features in 16 patients with serious neurological complications of lumbar epidural anaesthesia. We observed acute, transient or permanent and delayed complications. Four patients had symptoms immediately after the procedure. One patient developed a subacute flaccid paraparesis. Two other patients had infectious spondylodiscitis at lumbar puncture level. Eight patients had a delayed progressive spastic paraparesis and were found to have subarachnoid cysts and irregularities of the surface of the spinal cord consistent with arachnoiditis; six of them had an extensive, complex syrinx within the cord. One patient had a severe lumbar polyradiculopathy, and MRI showed adhesive arachnoiditis involving the cauda equina. Although epidural anaesthesia is generally considered safe, rare but severe complications, such as radiculopathy, infectious disease, myelopathy from ischemia and arachnoiditis with a syrinx may occur. The patients with arachnoiditis had a relentless progression of the disease and a poor outcome: five are confined to a wheelchair, one is bedridden. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia may be ignored or underestimated when they appear after a delay. Awareness of the possibility of delayed complications is important. (orig.)

  19. Utilización de factores de crecimiento plaquetarios autólogos en artrodesis lumbares posterolaterales Utilização de fatores de crescimento plaquetários autólogos em artrodese lombar póstero-lateral Use of autologous platelet growth factors in posterolateral lumbar spinal fusions

    Directory of Open Access Journals (Sweden)

    Matías Andrés Rojas

    2013-01-01

    dois grupos de 13 pacientes. O grupo que foi usado FCP apresentou fusões radiograficamente sólidos em 61,54%, sem registro, mas com incidência não-união de infecção e sangramento pós-operatório 15,39%, enquanto que no grupo sem o FCP% 69,23 alcançado fusões sólidas com 7,69% de pseudoartrose sem outras complicações relacionadas com a intervenção. CONCLUSÃO: Apesar de o grupo não se apresentar com FCP não sindicalizados, maior incidência de complicações pós-operatórias e menos fusões radiograficamente sólidos. Embora o número de pacientes que não é possível obter resultados estatisticamente significativos isso pode ser o início de um estudo maior.OBJECTIVE: To evaluate quality and rate of pseudoarthrosis in callus formation in instrumented posterolateral lumbar fusion with the use of autologous bone graft enriched with platelet growth factors (PGFs. METHODS: A clinical analytical experimental single blind trial was carried out between June 2007 and June 2009 comparing two groups, one in which PGFs were used in lumbar spinal fusions while in the other the PGFs were not applied, to analyze the following variables: rate of pseudoarthrosis, callus formation and postoperative complications. RESULTS: We evaluated 26 patients, mean age 61.23 years, divided in two groups of 13 patients each. The group in which PGFs were used presented radiographically solid fusions at 61.54% with no record of pseudoarthrosis, although with incidence of infection and postoperative bleeding of 15.39%, while in the group without PGFs 69.23% achieved solid fusions presenting a rate of pseudoarthrosis of 7.69% with no other complications related to the intervention. CONCLUSION: Even though the group without PGFs did not present pseudoarthrosis, a higher incidence of postoperative complications and fewer radiographically solid fusions could be observed. Even though the number of patients is not sufficient to obtain statistically significant results, the present analysis

  20. Effect observation on treating acute lumbar sprain by acupuncture plus bloodletting method%针刺董氏奇穴配合刺血法治疗急性腰扭伤疗效观察

    Institute of Scientific and Technical Information of China (English)

    阙方绪

    2014-01-01

    Objective:Through acupuncture Dongshi Qi points plus bloodletting method on treating acute lumbar sprain to explore the clinical value of it. Methods: Followed by using three edged needle acupuncture bloodletting on Erjiaoming point, Zhongbai point, waist Ashi point, and given cupping jar after acupuncture. Tianzhu point was given acupuncture bloodletting. Results:In 36 patients, 31 cases were cured, improved in 5 cases, the total efficiency was 100%. Conclusion: Acupuncture Dongshi Qi points plus bloodletting method is effective on treating acute lumbar sprain, with high cure rate, worthy of promotion.%目的:通过针刺董氏奇穴配合刺血。、法治疗急性腰扭伤,探讨其临床推广价值方法:依次针刺二角明穴中白穴,。腰部阿是穴用三棱针点刺放血后拔以火罐,天柱穴点刺放血结果:36例患者中,治愈31例,好转者5例,总有效率达100%。

  1. 硬脊膜修补并腰大池置管持续引流:脊柱手术后脑脊液漏合并脑膜炎的治疗%Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery

    Institute of Scientific and Technical Information of China (English)

    周纲; 张玉坤; 黄卫民; 王成伟

    2015-01-01

    BACKGROUND:Traumatic or iatrogenic dural defects can cause persistent cerebrospinal fluid leakage, even progressing to life-threatening purulent meningitis. In patients with meningitis combined with cerebrospinal fluid leakage, most antibiotics are unable to enter the cerebrospinal fluid, as the cerebrospinal fluid is a good medium for bacteria and there is the presence of blood-brain barrier. So meningitis presents with acute onset, rapid development and infection difficult to control. OBJECTIVE:To evaluate the outcome of continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics for postoperative cerebrospinal fluid leakage combined with meningitis after biomaterial repair of dural defects. METHODS: A retrospective study was carried out to review the 12 cases of cerebrospinal fluid leakage combined with meningitis among 126 of 2 266 cases who developed cerebrospinal fluid leakage (5.56%) undergoing spinal surgery from June 2008 to June 2013. During the operation, dural defects were directly sutured or repaired with autologous fascial sheet. Al cases underwent thorough debridement and intravenous injection of sensitive antibiotics folowed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usualy vancomycin), and then the incision was closed at stage I. RESULTS AND CONCLUSION:The cerebrospinal fluid leakage was found in the 12 cases at 24-72 hours after surgery, averagely 48 hours; the infection was found at 812 days days after surgery, averagely 9.5 days. Headache and fever were significantly relieved at the 2nd day of intrathecal administration of antibiotics, and intracranial infection disappeared at 7-14 days after continuous lumbar drainage. Biochemical test of the cerebrospinal fluid and routine examination were done thrice, and the results were al normal. No bacterial growth was found in bacterial culture test, and the drainage tube was removed. There was no intraspinal infection, intracranial

  2. Risk factors for traumatic lumbar punctures in children with acute lymphoblastic leukaemia%急性淋巴细胞白血病患儿创伤性腰椎穿刺的危险因素

    Institute of Scientific and Technical Information of China (English)

    娄珊; 刘玉; 王雪梅; 严媚; 李兆申

    2016-01-01

    Objective To investigate the risk factors for traumatic lumbar punctures in children with acute lymphoblastic leukaemia. Methods 132 children with acute lymphoblastic leukemia totally received 2634 lumbar punctures. The basic data on age, sex, body mass index (BMI), platelet count, interval between two punctures, and presence or absence of ultrasound-guided procedure were collected and analyzed. The risk factors for traumatic lumbar puncture were identified by logistic regression. Results The risk for traumatic lumbar puncture was higher in children younger than 1 year, and it was relatively lower in those aged 1 to 10 years. The risk for traumatic lumbar puncture was slightly higher in children with a BMI index of more than 95. The longer the interval between two punctures, the lower the risk. If lumbar puncture was guided under ultrasound or radiographic images, the risk was much smaller. Conclusions Age of younger than 1 year, BMI index of more than 95, shorter interval between two punctures, and direct puncture can increase the risk for traumatic lumbar puncture.%目的:探讨影响急性淋巴细胞白血病( ALL )患儿做腰椎穿刺时造成创伤性腰椎穿刺的危险因素。方法:132例ALL患儿在诊断及治疗过程中共经历了2634次腰椎穿刺,统计患儿年龄、性别、体质指数(BMI)、血小板数目、距离前一次穿刺的天数以及是否在超声或放射图像引导下进行穿刺,分析其与创伤性腰椎穿刺的关系,并利用Logistic回归模型分析判定危险因素。结果:年龄<1岁的患儿做腰椎穿刺时创伤性腰椎穿刺的风险更高;1~10岁的患儿做腰椎穿刺时创伤性腰椎穿刺的风险相对较低。 BMI >95较BMI <95风险稍高。2次穿刺的间隔时间越长,风险越低。在超声或放射图像引导进行的腰椎穿刺,比直接穿刺造成创伤性腰椎穿刺的风险低。结论:年龄<1岁、BMI >95、2次穿刺的间隔时间短和直

  3. Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2016-01-01

    Conclusion: Reviewing the pros of XLIF (e.g. radiographic, technical, biomechanical vs. the cons (inferiority, increased morbidity/mortality vs. ALIF, TLIF, PLIF, and PLF, we question whether XLIF should remain part of the lumbar spinal surgical armamentarium.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-12-15

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

  5. Evaluation of Facet Joint Arthrosis in Stenotic and Normal Lumbar Spines with MRI

    Directory of Open Access Journals (Sweden)

    Ebru Ozan

    2013-10-01

    Full Text Available Aim: To reveal the prevalence of lumbar facet joint arthrosis in normal and stenotic lumbar spines with magnetic resonance imaging. Material and Method: Study group consisted of 30 patients with complaints and findings of lower back pain, neurologic claudicatio and lumbar spinal stenosis detected at L3-4, L4-5 and/or L5-S1 with magnetic resonance imaging (cross section area of the dural sac

  6. Clinical clerkship course for medical students on lumbar puncture using simulators.

    Science.gov (United States)

    Adachi, Koji; Yoshimura, Akinobu; Aso, Ryoko; Miyashita, Tsuguhiro; Yoshida, Daizo; Teramoto, Akira; Shimura, Toshiro

    2012-01-01

    Lumbar puncture is a medical technique that physicians must learn and is, therefore, considered a basic medical procedure. The lumbar puncture simulators Lumbar-Kun (Lumbar Puncture Simulator) and Lumbar-Kun II (Lumbar Puncture Simulator II) (Kyoto Kagaku, Kyoto, Japan) are teaching aids designed for practicing spinal insertions. We describe and results of a lumbar puncture clerkship course, provided to 5th-year medical students during clinical clerkship activity. The aim of this study was to evaluate the effectiveness of the lumbar puncture clerkship course in the medical education program. Comprehension, technical achievement, and satisfaction were scored by students and instructors using a 6-point Likert scale. Scores for both comprehension and technical achievement were high, but technical achievement scores tended to be higher than comprehension scores. In addition, the scores students gave themselves were higher than the scores they were given by instructors. Student satisfaction was high. The lumbar puncture simulators, Lumbar-Kun and Lumbar-Kun II, achieved excellent overall impressions and represent useful tools for training in lumbar puncture procedures. In addition to the simulators, an appropriate preparatory text and a short lecture before training seemed to increase the educational effect of this lumbar puncture clerkship course for medical students.

  7. Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits A prospective study of 56 consecutive patients

    Directory of Open Access Journals (Sweden)

    Zhe-yuan Huang

    2015-01-01

    Conclusion: Good mid term clinicoradiological results of anterior decompression with D-rod and titanium mesh fixation for suitable patients with mid-lumbar burst fractures with incomplete neurologic deficits can be achieved. The incident rate of complications was low. D-rod is a reliable implant and has some potential advantages in L4 vertebral fractures.

  8. Subarachnoid hemorrhage due to retained lumbar drain.

    Science.gov (United States)

    Guppy, Kern H; Silverthorn, James W; Akins, Paul T

    2011-12-01

    Intrathecal spinal catheters (lumbar drains) are indicated for several medical and surgical conditions. In neurosurgical procedures, they are used to reduce intracranial and intrathecal pressures by diverting CSF. They have also been placed for therapeutic access to administer drugs, and more recently, vascular surgeons have used them to improve spinal cord perfusion during the treatment of thoracic aortic aneurysms. Insertion of these lumbar drains is not without attendant complications. One complication is the shearing of the distal end of the catheter with a resultant retained fragment. The authors report the case of a 65-year-old man who presented with a subarachnoid hemorrhage due to the migration of a retained lumbar drain that sheared off during its removal. To the best of the authors' knowledge, this is the first case of rostral migration of a retained intrathecal catheter causing subarachnoid hemorrhage. The authors review the literature on retained intrathecal spinal catheters, and their findings support either early removal of easily accessible catheters or close monitoring with serial imaging.

  9. 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.

  10. Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety

    Directory of Open Access Journals (Sweden)

    Artner Juraj

    2012-08-01

    Full Text Available Abstract Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011 at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30, coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2, the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31% was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient

  11. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people.

    Science.gov (United States)

    Kasukawa, Yuji; Miyakoshi, Naohisa; Hongo, Michio; Ishikawa, Yoshinori; Noguchi, Hideaki; Kamo, Keiji; Sasaki, Hiroshi; Murata, Katsuyuki; Shimada, Yoichi

    2010-01-01

    Spinal mobility and back extensor strength (BES) are important in determining quality of life (QOL) for elderly people. However, the impact of spinal factors on falls remains unclear. The purpose of this study was to clarify spinal factors related to falls in elderly people, including deformity of spinal curvature, spinal mobility and BES. Subjects comprised 92 elderly people divided into 3 groups: subjects without a history of falls or fear of falls (Non-falls group, n = 40); subjects with a history of fear of falls or requiring any support when walking (Fear of falls group, n = 36); and subjects with a history of falls (Falls group, n = 16). Kyphotic angles and mobility of the thoracic and/or lumbar spine, and spinal inclination were measured using a computer-assisted device. Postural imbalance was evaluated using a computerized stabilometer. Isometric BES was also measured. Angle of lumbar kyphosis, spinal inclination, and postural imbalance were significantly higher in the Falls group (p spinal inclination (p = 0.0378), mobility of lumbar spine (0.027), and mobility of spinal inclination (p = 0.0282) were significantly associated with presence/absence of falls in elderly individuals.

  12. [Lateral lumbar disk hernia].

    Science.gov (United States)

    Monod, A; Desmoineaux, P; Deburge, A

    1990-01-01

    Lateral lumbar disc herniations (L.D.H.) develop in the foramen, and compress the nerve root against the overlying vertebral pedicle. In our study of L.D.H. from the clinical, radiographical, and therapeutical aspects, we reviewed 23 cases selected from the 590 patients treated for discal herniation from 1984 to 1987. The frequency of L.D.H. in this series was 3.8 per cent. The clinical pattern brings out some suggestive signs of L.D.H. (frequency of cruralgia, a seldom very positive Lasegue's test, the paucity of spinal signs, non impulsive pain). Saccoradiculography and discography rarely evidenced the L.D.H.. The T.D.M. was the investigation of choice on condition that it was correctly used. When the image was doubtful, disco-CT confirmation should be proceeded too. This latter method of investigation enabled the possibility of sequestration to be explored. 14 patients were treated by chemonucleolysis, with 9 successful outcomes. The 5 failures were cases where chemonucleolysis should not have been indicated, mainly due to associated osseous stenosis. 9 patients underwent immediate surgery with good results in each case.

  13. MRI Findings in Spinal Canal Stenosis

    Directory of Open Access Journals (Sweden)

    Maryam Barzin

    2010-05-01

    Full Text Available Spinal canal stenosis results from progressive narrowing of the central spinal canal and the lateral recesses. Primary (congenital lumbar spinal stenosis is associated with achondroplastic dwarfism. The spinal canal may become narrowed by bulging or protrusion of the intervertebral disc annulus, herniation of the nucleus pulposus posteriorly, thickening of the posterior longitudinal ligament, hypertrophy of the facet joints, hypertrophy of the ligamentum flavum, epidural fat deposition, spondylosis of the intervertebral disc margins and uncovertebral joint hypertrophy in the neck. The central canal and the neurorecess may be compromised by tumor infiltration, such as metastatic disease, or by infectious spondylitis."nAP diameter of the normal adult cervical canal has a mean value of 17-18 mm at vertebral levels C3-5. The lower cervical canal measures 12-14 mm. Cervical stenosis is associated with an AP diameter of less than 10 mm. The thoracic spinal canal varies from 12 to 14 mm in diameter in the adult. The diameter of the normal lumbar spinal canal varies from 15 to 27 mm. Lumbar stenosis results from a spinal canal diameter of less than 12 mm in some patients; a diameter of 10 mm is definitely stenotic."nSpinal MRI is the most suitable technique for the diagnosis of spinal stenosis. The examination should be performed using thin sections (3 mm and high resolution, including the axial and sagittal planes using T1-weighted, proton-density, and T2-weighted techniques. The bony and osteophytic components are seen best using a T2-weighted gradient-echo technique."nOn MRI, findings of spinal stenosis have a variable presentation depending on the specific disease. The goal of spinal imaging is to localize the site and level of disease and to help differentiate between conditions in which patients require surgery or conservative treatment."nIn this presentation, different kinds of spinal canal stenosis and their MRI findings would be discussed.

  14. A Comparative Study of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spondylolisthesis

    Science.gov (United States)

    Hughes, Alexander P.; Sama, Andrew A.; Girardi, Federico P.; Lebl, Darren R.; Cammisa, Frank P.

    2015-01-01

    Study Design Level 4 retrospective review. Purpose To compare the radiographic and clinical outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) with posterior segmental spinal instrumentation (SSI) for degenerative lumbar spondylolisthesis. Overview of Literature Both PLIF and LLIF have been performed for degenerative spondylolisthesis with good results, but no study has directly compared these two techniques so far. Methods The electronic medical and radiographic records of 78 matched patients were analyzed. In one group, 39 patients underwent PLIF with SSI at 41 levels (L3-4/L4-5), while in the other group, 39 patients underwent the LLIF procedure at 48 levels (L3-4/L4-5). Radiological outcomes such as restoration of disc height and neuroforaminal height, segmental lumbar lordosis, total lumbar lordosis, incidence of endplate fracture, and subsidence were measured. Perioperative parameters were also recorded in each group. Clinical outcome in both groups was assessed by the short form-12, Oswestry disability index and visual analogue scale scores. The average follow-up period was 16.1 months in the LLIF group and 21 months in the PLIF group. Results The restoration of disc height, foraminal height, and segmental lumbar lordosis was significantly better in the LLIF group (p<0.001). The duration of the operation was similar in both groups, but the average blood loss was significantly lower in the LLIF group (p<0.001). However, clinical outcome scores were similar in both groups. Conclusions Safe, effective interbody fusion can be achieved at multiple levels with neuromonitoring by the lateral approach. LLIF is a viable treatment option in patients with new onset symptoms due to degenerative spondylolisthesis who have had previous lumbar spine surgery, and it results in improved sagittal alignment and indirect foraminal decompression. PMID:26435782

  15. Congenital Lumbar Hernia

    Directory of Open Access Journals (Sweden)

    Sanjay Sharma

    2008-01-01

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

  16. A musculoskeletal model for the lumbar spine.

    Science.gov (United States)

    Christophy, Miguel; Faruk Senan, Nur Adila; Lotz, Jeffrey C; O'Reilly, Oliver M

    2012-01-01

    A new musculoskeletal model for the lumbar spine is described in this paper. This model features a rigid pelvis and sacrum, the five lumbar vertebrae, and a rigid torso consisting of a lumped thoracic spine and ribcage. The motion of the individual lumbar vertebrae was defined as a fraction of the net lumbar movement about the three rotational degrees of freedom: flexion-extension lateral bending, and axial rotation. Additionally, the eight main muscle groups of the lumbar spine were incorporated using 238 muscle fascicles with prescriptions for the parameters in the Hill-type muscle models obtained with the help of an extensive literature survey. The features of the model include the abilities to predict joint reactions, muscle forces, and muscle activation patterns. To illustrate the capabilities of the model and validate its physiological similarity, the model's predictions for the moment arms of the muscles are shown for a range of flexion-extension motions of the lower back. The model uses the OpenSim platform and is freely available on https://www.simtk.org/home/lumbarspine to other spinal researchers interested in analyzing the kinematics of the spine. The model can also be integrated with existing OpenSim models to build more comprehensive models of the human body.

  17. The effect of laminectomy spine fixation on restore function in treatment of patients with degenerative lumbar spinal stenosis%全椎板切除脊柱内固定对老年退行性腰椎管狭窄症患者功能恢复的效果评价

    Institute of Scientific and Technical Information of China (English)

    邓红军

    2015-01-01

    目的:探讨全椎板切除脊柱内固定对老年退行性腰椎管狭窄症患者功能恢复的效果。方法收集退行性腰椎管狭窄症患者60例,按照简单随机法分成观察组及对照组各30例。观察组采用全椎板切除减压联合脊柱内固定术,对照组采用部分椎板切除减压联合脊柱内固定术,观察其治疗效果。结果与术前比较,两组术后神经功能恢复情况进行分析,在 A 级、B 级、D 级及 E 级方面差异有统计学意义(χ2=6.392、6.203、7.213、7.382,均 P <0.05)。与对照组比较,观察组在 A 级、B 级、D 级及 E 级方面差异有统计学意义(χ2=6.012、6.102、7.124、7.203,均 P <0.05)。与术前比较,患者术后3个月的椎管直径为(17.2±3.1)mm,末次随访时为(16.8±2.7)mm,差异有统计学意义(t =6.391、7.692,均 P <0.05)。患者术后3个月、末次随访椎管直径差异无统计学意义(t =0.592,P >0.05)。结论手术是治疗老年退行性腰椎管狭窄最为有效的治疗方式。通过后路椎间盘镜采用椎管减压措施,再次进行椎弓根内固定、椎间植骨融合方式,预后良好,值得临床推广使用。%Objective To investigate the effect of laminectomy spine fixation on restore function in treatment of patients with degenerative lumbar spinal stenosis.Methods 60 patients with degenerative lumbar spinal stenosis were selected and divided into the observation group and control group with 30 patitents respectively.Patietns in the observation group were taken with laminectomy decompression of spinal fixation,while patients in the control were treated with part laminectomy decompression of spinal fixation.The treatment effect was observed.Results Compared with the preoperative data,postoperative neurologic recovery of the two groups were analyzed in A grade,B grade,D and E grade level terms after comparison

  18. Serotonergic modulation of post-synaptic inhibition and locomotor alternating pattern in the spinal cord

    OpenAIRE

    Laurent eVinay; Florian eGackière

    2014-01-01

    The central pattern generators (CPGs) for locomotion, located in the lumbar spinal cord, are functional at birth in the rat. Their maturation occurs during the last few days preceding birth, a period during which the first projections from the brainstem start to reach the lumbar enlargement of the spinal cord. Locomotor burst activity in the mature intact spinal cord alternates between flexor and extensor motoneurons through reciprocal inhibition and between left and right sides through commi...

  19. Spinal Cord Infarction and Patent Foramen Ovale: Is There a Link

    Directory of Open Access Journals (Sweden)

    Marcelo Mendonça

    2014-06-01

    Full Text Available Spinal cord infarction (SCI is an uncommon but important cause of acute myelopathy. Nevertheless, contrary to cerebral stroke, the discussion about paradoxical embolism as a cause of cryptogenic SCI remains dubious. We describe the case of a 24-year-old woman who developed sudden-onset back pain followed by upper limb paralysis. T2-weighted MRI demonstrated hyperintense signal, extending from C5 to D1 with corresponding restricted diffusion on diffusion-weighted MRI and reduction of the apparent diffusion coefficient. Diagnostic workup, including lumbar puncture, showed no changes. Transcranial Doppler showed a right-to-left shunt with an uncountable number of microembolic signals after Valsalva maneuvers, and a patent foramen ovale (PFO with an atrial septum aneurysm was identified. We discuss the paucity of evidence of right-to-left shunting in spinal diseases compared to cerebral events and the potential role of paradoxical embolism through PFO as a possible mechanism of SCI.

  20. Lumbar motion changes in chronic low back pain patients

    DEFF Research Database (Denmark)

    Mieritz, Rune M; Hartvigsen, Jan; Boyle, Eleanor;

    2014-01-01

    BACKGROUND CONTEXT: Several therapies have been used in the treatment of chronic low back pain, including various exercise strategies and spinal manipulative therapy. A common belief is that spinal motion changes in particular ways in direct response to specific interventions, such as exercise....../SETTING: Secondary analysis of a subset of participants from a randomized clinical trial. PATIENT SAMPLE: 199 study participants with low back pain of more than six weeks' duration who had spinal motion measures obtained before and after the period of intervention. OUTCOME MEASURES: Lumbar region spinal kinematics......, the motion parameters included in the analysis. The spinal manipulation group changed to a smoother motion pattern (reduced jerk index) while the exercise groups did not. CONCLUSION: This study provides evidence that spinal motion changes can occur in chronic low back pain patients over a 12-week period...

  1. Treatment of lumbar spondylolisthesis with posterior interbody fusion and RF pedicle screw spinal system%RF椎弓根螺钉系统复位内固定并椎间植骨融合术治疗腰椎滑脱症

    Institute of Scientific and Technical Information of China (English)

    陈治权; 王义生

    2010-01-01

    Objective To evaluate the clinical effect of lumbar spondylolisthesis treated by posterior lumbar interbody fusion and RF pedicle screw spinal system. Methods From February 2000 to February 2008,37 cases of lumbar spondylolisthesis were included in this study according to Meyerding classification,roentgengram showed that there were 6 cases of grade Ⅰ,27 cases of grade Ⅱ,4 cases of grade Ⅲ. All patients obtained followed up, were treated with posterior decompression of total laminectomy and bilateral nerve canal, lumbar interbody fusion was done with RF pedicle screw spinal system. Results All the patients were followed up from 12-38 months with an average of 32.7 months. According to standard of Hou Shu-xun and fusion rate after operation,the therapeutic effect was excellent in 31 cases,good in 4 cases, fair in 2 cases,the satisfactory rate was 94.6%. During operation complication occurred in 1 case with the incidence rate of 2.7%. Surgical reduction rate was 88.9%. The bony fusion was seen in all patients. Conclusions Posterior lumbar interbody fusion and RF pedicle screw spinal system provide fixation with satisfactory clinical results and relatively high fusion rate.%目的 探讨RF椎弓根螺钉系统复位内固定并椎间植骨融合术治疗腰椎滑脱症的效果.方法 自2000年2月至2008年2月,采用RF椎弓根螺钉系统复位内固定并椎间植骨融合术治疗并获得随访的真性腰椎滑脱症37例,其中Ⅰ度滑脱6例,Ⅱ度滑脱27例,Ⅲ度滑脱4例.滑脱节段:第3腰椎(L3)滑脱3例,L4滑脱9例,L5滑脱25例.结果 所有患者术后随访12~38个月,平均32.7个月.根据侯树勋等制定的疗效评定标准及融合率:优31例,良4例,可2例,优良率94.6%.术中并发症1例,发生率为2.7%.手术完全复位率88.9%,椎间融合率100%.结论 RF椎弓根螺钉系统复位内固定并椎间植骨融合术能使腰椎滑脱得到较为确实的复位和固定,脊柱融合率高,临床效果满意.

  2. Magnetic resonance imaging analysis and Fisher's linearity discrimination for the selection of fixed and fused segments during treatment of degenerative low lumbar spinal diseases%MRI影像学测量分析及Fisher's线性判别在退变性下腰椎固定融合节段选择中的意义

    Institute of Scientific and Technical Information of China (English)

    杨振东; 解京明; 王迎松; 张颖

    2011-01-01

    BACKGROUND: Studies addressing MRI data and treated segment selection during the treatment of senile lumbar degenerative diseases are rare.OBJECTIVE: To investigate the clinical significance of the MRI in the selection of fixed and fused segments for treatment of degenerative low lumbar spinal diseases in the elderly.METHODS: The clinical data of 152 patients with lumbar degenerative diseases were divided into two groups: operation group and control group. They were followed up for 3, 6, 12, 24 months post treatment. Clinical function of pre and post-treatment of all the cases were determined by using Japanese Orthopaedic Association (JOA) score. The JOA score between the operation group and control group was compared. And using discriminate analysis, we studied the change of MRI, tried to find out the clinical significance of MRI in the selection of treated segment during the treatment of degenerative low lumbar spinal diseases.RESULTS AND CONCLUSION: JOA score was significantly improved post operation in the operation group (P < 0.05).Compared to the control group, JOA score was significantly higher in the operation group (P < 0.05). Discriminant Functions were established depending on the analysis of clinical and imaging information by using statistical software, and proved whose have statistical significance. Discriminant functions were effective to distinguish degenerative low lumbar spinal diseases and institute individualization operation project and choice possible treated segment and gain all-right clinical outcome.%背景:对下腰椎退变的MRI资料与老年人下腰椎退变性疾患中治疗节段选择的相关性报道较少.目的:分析MRI对老年人下腰椎退变性疾病中固定融合节段选择的临床指导意义.方法:选择152例退变性腰椎疾病患者,根据治疗方案分为对照组及固定融合组,对照组47例采用保守治疗,固定融合组105例均采用经腰椎后路全椎板减压、固定

  3. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

    Directory of Open Access Journals (Sweden)

    Gábor Czigléczki

    2014-01-01

    Full Text Available Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal. Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients. The purpose of this article is to summarize these procedures and evaluate their efficacy with comparing them to each other. The applicable methods are presented shortly but the differences between them are discussed in details. Comprehensive examination did not reveal the proven superiority of any techniques and in most cases the less invasive or minimally invasive treatment choices should be individually determined, considering the location and extension of pathology and the familiarity of surgeon with techniques.

  4. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

    Institute of Scientific and Technical Information of China (English)

    Gbor Cziglczki; Zoltn Papp; Csaba Padnyi; Pter Banczerowski

    2014-01-01

    Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal.Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients.The purpose of this article is to summarize these procedures and evaluate their efficacy with comparing them to each other. The applicable methods are presented shortly but the differences between them are discussed in details.Comprehensive examination did not reveal the proven superiority of any techniques and in most cases the less invasive or minimally invasive treatment choices should be individually determined, considering the location and extension of pathology and the familiarity of surgeon with techniques.

  5. Contribution of myelunated fibers from spinal L4, L5 and L6 nerves to the sciatic nerve and its main branches in the adult rat Contribución de fibras mielínicas provenientes de los nervios espinales lumbares L4, L5 y L6 al nervio ciático de rata adulta y sus ramas principales

    Directory of Open Access Journals (Sweden)

    Juan D. Robles

    2000-04-01

    Full Text Available The rat sciatic nerve is composed by the L4, L5 and L6 lumbar spinal nerves. However, the contribution in myelinated fibers originating from these nerves along this nervous trunk has not yet been defined. In the present study, the L4, L5 and L4-L5 spinal nerves were selectively transected. After one week the sciatic, tibial, sural and peroneal nerves were dissected. These samples were fixed and processed for optical microscopy, and both degenerated and normal myelinated fibers were counted in toluidine blue-stained semi-thin sections. L4 contributed with myelinated fibers mainly to the peroneal nerve, and L5 to the sciatic, tibial and sural nerves. In general, the contribution of L6 was smaller and variable along the nervous trunk in comparison to the other two spinal branches. Our results give key information for further studies looking to correlate the contribution of spinal nerves making part of the sciatic nerve and its main branches with hind limb function. El nervio ciático de la rata está formado por los nervios espinales (ne lumbares L4, L5 y L6. Sin embargo, aún no se ha definido el aporte en fibras mielínicas de estos nervios espinales a lo largo del tronco nervioso. En este estudio se transectaron selectivamente los NE L4, L5 y L4-L5. Luego de una semana se disecaron los nervios ciático, tibial, sural y peroneal. Estas muestras se fijaron y procesaron para microscopía óptica y a partir de cortes coloreados con azul de toluidina se contaron las fibras mielínicas degeneradas y normales. L4 contribuyó con fibras mielínicas principalmente al nervio peroneal y L5 a los nervios ciático, tibial y sural. En general, el aporte de L6 fue menor y variable a lo largo del tronco nervioso comparado con las otras dos ramas espinales. Nuestros resultados brindan información valiosa para posteriores estudios que busquen correlacionar la contribución de los nervios espinales que componen el ciático y sus ramas principales con la funci

  6. The application and significance of urine flow dynamic analysis in function evaluation for neurogenic bladder caused by thoracic lumbar spinal cord injury%尿流动力学分析在胸腰段脊髓损伤所致神经源性膀胱功能评估中的应用及意义

    Institute of Scientific and Technical Information of China (English)

    沈峰

    2015-01-01

    目的 探讨尿流动力学分析在胸腰段脊髓损伤所致神经源性膀胱功能评估中的应用及意义.方法 选取80例胸腰段脊髓损伤伴排尿障碍患者为研究对象,分析患者膀胱顺应性、逼尿肌反射、逼尿肌外括约肌协调等指标.结果 80例中64例(80%)出现逼尿肌反射亢进,其中伴尿道外括约肌协调22例,失调42例;16例出现逼尿肌无反射(20%),其中伴尿道外括约肌协调4例,失调4例,去神经化8例.80例中16例(20%)表现为膀胱顺应性增加,64例(80%)表现为膀胱顺应性下降.结论 胸腰段脊髓损伤患者大多表现为逼尿肌反射亢进,仍有部分表现为逼尿肌无反射.并根据尿道括约肌功能进一步分为数种亚型.尿动力学检查在胸腰段脊髓损伤中明确了神经源性膀胱的类型,为治疗及预后判断提供价值.%Objectives To evaluate the application and significance of urine flow dynamic analysis in function evaluation for neurogenic bladder caused by thoracic lumbar spinal cord injury.Methods Selected 80 cases of thoracic lumbar spinal cord injury with urination disorders as the research object.Analyzed the index of bladder compliance,detrusor reflex and detrusor-external sphincter dyssynergia.Results In the total 80 cases,64 cases (80%) of detrusor hyperreflexia,included 22 cases with urethral sphincter coordinate,42 cases with imbalance.16 cases (20%) of detrusor areflexia,included 4 cases with urethral sphincter coordinate,4 cases with imbalance,8 cases with denervation.In total 80 cases,16 cases(20%) of bladder compliance increased,64 cases (80%) with bladder compliance decreased.Conclusions Thoracic lumbar spinal cord injury patients usually show the detrusor hyperreflexia,and there are still a part of detrusor areflexia.According to the urethral sphincter function,neurogenic bladder is further divided into several subtypes.Urine flow dynamic analysis in thoracic lumbar spinal cord injury has been clear

  7. Complex multilevel lumbar spine fractures with transverse sacral fracture

    Directory of Open Access Journals (Sweden)

    Kshitij Chaudhary

    2011-01-01

    Full Text Available We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.

  8. 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

  9. 循证护理在预防腰椎管狭窄症术后常见并发症中的应用%Application of evidence based care in prevention of postoperative common complications of lumbar spinal stenosis patients

    Institute of Scientific and Technical Information of China (English)

    沈虹; 李莉; 秦晓宇

    2015-01-01

    Objective:To probe into the application of evidence based nursing in prevention of postoperative common complications of lumbar spinal stenosis patients. Methods:Evidence based nursing method was used for 45 patients with lumbar spinal stenosis,then to ask some questions,find out informations,formulate measures and implementation in the end.Results:The 45 pa-tients did not get complications such as the pulmonary infection,bedsore,urinary tract infection and so on.The 45 patients recovered very well after operation.Conclusion:Evidence based nursing can enrich nurses'profes-sional knowledge,improve the nursing quality,and to provide more effective nursing service for patients.%[目的]探讨循证护理在预防腰椎管狭窄症术后常见并发症中的应用。[方法]对45例腰椎管狭窄症病人使用循证护理的方法,提出问题,查找资料,制订措施并最终实施。[结果]45例病人无一例发生肺部感染、压疮、泌尿系感染等并发症,术后恢复良好。[结论]循证护理可丰富护理人员的专业知识,提高护理质量,为病人提供更加有效的护理服务。

  10. Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage.

    Science.gov (United States)

    Tsai, Yi-Da; Hsu, Chin-Wang; Hsu, Chia-Ching; Liao, Wen-I; Chen, Sy-Jou

    2016-03-01

    Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. A 21-year-old man visited the emergency department because of chest and back pain along with immobility of bilateral lower limbs immediately after he woke up in the morning. Complete flaccid paraplegia and hypoesthesia in dermatome below bilateral T3 level and pain over axial region from neck to lumbar region were noted. A computed tomography excluded aortic dissection. Magnetic resonance imaging revealed a fusiform lesion involving the anterior epidural space from C7 to T2 level suspected of epidural hemorrhage, causing compression of spinal cord. He started intravenous corticosteroid but refused operation concerning the surgical benefits. Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta. He underwent thoracic endovascular aortic repair uneventfully. The patient was hemodynamically stable but with slow improvement in neurologic recovery of lower limbs. Aortic coarcation can cause paralysis by ruptured vascular aneurysms with spinal hemorrhage and chest pain that mimics acute aortic dissection. A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies. Cautious and prudent evaluation and cross disciplines cares are essential for diagnosis and successful management of the disease.

  11. Changes in Strenght, Sensation, and Prehension in Acute Cervical Spinal Cord Injury: European Multicenter Responsiveness Study of the GRASSP

    NARCIS (Netherlands)

    Velstra, I.; Curt, A.; Frotzler, A.; Abel, R.; Kalsi-Ryan, S.; Rietman, J.S.; Bolliger, M.

    2015-01-01

    Objective: To investigate the internal and external responsiveness and recovery profiles of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) instrument in revealing changes in upper limb function within the first year following cervical spinal cord injury (SCI). Met

  12. Acute Paraplegia After General Anesthesia

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  13. Paraplegia aguda por compressão da medula espinhal torácica causada por tofo gotoso Acute paraplegia resulting from spinal cord compression by tophaceous gout

    Directory of Open Access Journals (Sweden)

    Eduardo Massato Hasegawa

    2007-08-01

    Full Text Available O acometimento axial pela gota é um evento raro, e o envolvimento da coluna torácica foi descrito em apenas 17 casos na literatura. Apresentamos um caso de paciente do sexo masculino de 48 anos com história de gota, sob tratamento irregular com alopurinol e colchicina, que desenvolveu paraplegia aguda decorrente de compressão medular por tofo gotoso. Realizou-se o diagnóstico por meio de ressonância magnética e anatomia patológica. Foi tratado com antiinflamatórios e descompressão cirúrgica com melhora importante, porém parcial. Apesar de o acometimento medular pelo tofo ser um evento raro, deve ser considerado nos casos de síndrome de compressão medular em pacientes com antecedente de gotaAxial gout is a rare condition and the involvement of the thoracic spine has been described only 17 times in the literature. This paper presents the case of a 48 year-old male patient with a history of gout, under irregular treatment with allopurinol and colchicines, who developed acute paraplegia resulting from spinal cord compression by tophaceous gout. The diagnosis was made using magnetic resonance imaging and anatomic pathology. The patient was treated with anti-inflammatory drugs and surgical decompression and showed important, albeit partial, improvement. Thus, although tophi rarely affect the spinal cord, they should be considered as a possibility in cases of spinal cord compression syndrome in patients with a history of gout

  14. 火针点刺反阿是穴治疗急性腰扭伤疗效观察%Therapeutic Observation of Pricking Anti-Ashi Points with Fire Needles for Acute Lumbar Sprain

    Institute of Scientific and Technical Information of China (English)

    张群; 范春兰; 许金海; 莫文

    2016-01-01

    目的:观察火针点刺反阿是穴治疗急性腰扭伤的临床疗效。方法将76急性腰扭伤患者随机分为治疗组和对照组,每组38例。治疗组采用火针点刺反阿是穴治疗,对照组采用温针治疗。两组治疗1、5次后分别采用腰腿痛视觉模拟评分法(VAS)和汉译Roland-Morris腰痛功能障碍问卷表(RMDQ)对患者腰部疼痛及功能障碍进行评定,比较两组临床疗效。结果两组治疗1、5次后VAS评分和汉译RMDQ积分与同组治疗前比较,差异均具有统计学意义(P<0.01)。治疗组治疗1、5次后VAS评分和汉译RMDQ积分与对照组比较,差异均具有统计学意义(P<0.05)。治疗组总有效率和治愈率分别为94.7%和63.2%,对照组分别为86.8%和42.1%,两组比较差异具有统计学意义(P<0.01)。结论火针点刺反阿是穴是一种治疗急性腰扭伤的有效方法,即刻止痛效果明显。%Objective To observe the clinical efficacy of pricking anti-Ashi points with fire needles in treating acute lumbar sprain.Method Seventy-six patients with acute lumbar sprain were randomized into a treatment group and a control group, 38 cases in each group. The treatment group was intervened by pricking anti-Ashi points with fire needles, while the control group was by warm needling. The Visual Analogue Scale (VAS) and Roland-Morris Dysfunction Questionnaire (RMDQ) were adopted to evaluate lumbar pain and dysfunction after 1-day and 5-day treatment, and the clinical efficacies were compared between the two groups.Result Respectively after the first treatment session and 5 treatment sessions, the VAS and RMDQ scores were significantly changed in both groups (P<0.01). Respectively after the first treatment session and 5 treatment sessions, the VAS and RMDQ scores in the treatment group were significantly different from that in the control group (P<0.05). The total effective rate and recovery rate were respectively 94.7% and 63.2% in the treatment

  15. Stress affects a gastrin-releasing peptide system in the spinal cord that mediates sexual function: implications for psychogenic erectile dysfunction.

    Directory of Open Access Journals (Sweden)

    Hir