WorldWideScience

Sample records for acute lumbar spinal

  1. [Anesthetic management of posterior lumbar spinal fusion in a patient suspected of having acute exacerbation of chronic interstitial pneumonia].

    Science.gov (United States)

    Sakai, Mayuko; Takenami, Tamie; Otsuka, Tomohisa; Hayashi, Norito; Yoshino, Kazuhisa; Matsumoto, Shigehiro; Okamoto, Hirotsugu

    2014-02-01

    A patient complicated with interstitial pneumonia required emergency posterior lumbar spinal fusion. The blood gas analysis showed relatively benign values (PaO2 81 torr, PaCO2 44 torr, under room air), but the honeycombing lungs were noted in the bilateral lung fields on CT, and the KL-6 level was high (1,000 U x ml(-1)), for which the acute exacerbation of interstitial pneumonia was suspected. Sivelestat sodium administration was initiated during the surgery and continued postoperatively. During surgery, setting the FIO2 at 0.34, the P/F ratio and intra-airway pressure could be maintained at 500 and 25 mmHg, respectively. To reduce postoperative respiratory complication, anesthesia was maintained with desflurane, which is dissipated easily, and 0.5% ropivacaine 15 ml was subcutaneously injected to the surgical field at the time of wound closure to reduce the total doses of intraoperative fentanyl and postoperative analgesics. After the completion of surgery, the endotracheal tube was removed with head elevated position, and the patient was transported back to the ward. No acute exacerbation occurred thereafter, and the patient was discharged 67 days after surgery. The prediction of acute exacerbation of interstitial pneumonia is difficult. Moreover, there is no established preventive method, although the mortality is high. Therefore, physicians should be thoroughly informed about the currently available evidence, including developmental factors. PMID:24601111

  2. Remote cerebellar hemorrhage after lumbar spinal surgery

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

  3. Costs and effects in lumbar spinal fusion

    DEFF Research Database (Denmark)

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

    2007-01-01

    consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2...... posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life...

  4. Oriental Medical Treatment of Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2003-12-01

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

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

    Science.gov (United States)

    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.

  6. Imaging of lumbar spinal surgery complications

    OpenAIRE

    Malhotra, Ajay; Kalra, Vivek B; Wu, Xiao; Grant, Ryan; Bronen, Richard A; Abbed, Khalid M.

    2015-01-01

    Abstract Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more sensitive than radiographs and play an increasingly important role in evaluation of patients with lumbar spine surgery. Their use in patients with metallic implants is somewhat limited by ar...

  7. Minimal Invasive Decompression for Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    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. The Evaluation of Lumbar Spinal Canal Diameters by MRI

    Directory of Open Access Journals (Sweden)

    Mehrnaz Mashoufi

    2010-05-01

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

  9. Adjacent Segment Pathology after Lumbar Spinal Fusion.

    Science.gov (United States)

    Lee, Jae Chul; Choi, Sung-Woo

    2015-10-01

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

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

    OpenAIRE

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

    1995-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rodrigo Amaral

    2013-01-01

    Full Text Available Burst fractures in acute spinal traumas are a difficult problem to solve. Different approaches and techniques have been utilized, but with high incidence of morbidity and mortality, besides unsatisfactory clinical and radiological results. Mini-open approaches recently emerged and have been shown to be safe and effective in the treatment of several spinal conditions. Here we report a case of acute lumbar burst fracture at L2 treated by minimally invasive true lateral approach posteriorly instrumented with percutaneous pedicle screws. The minimum disruptive access in addition to a rigid construction allowed a lumbar corpectomy without the morbidity of standard open approaches, lowering surgery costs and accelerating the patient recovery with successfully clinical and radiological results.

  12. LUMBAR SPINAL STENOSIS. A REVIEW OF BIOMECHANICAL STUDIES

    Institute of Scientific and Technical Information of China (English)

    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.

  13. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

    Directory of Open Access Journals (Sweden)

    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

  14. Lumbar spinal mobility changes among adults with advancing age

    Directory of Open Access Journals (Sweden)

    Ismaila Adamu Saidu

    2011-01-01

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

  15. Lumbar spinal canal size of sciatica patients

    Energy Technology Data Exchange (ETDEWEB)

    Hurme, M.; Alaranta, H.; Aalto, T.; Knuts, L.R.; Vanharanta, H.; Troup, J.D.G. (Turku City Hospital (Finland). Dept. of Surgery; Social Insurance Institution, Turku (Finland). Rehabilitation Research Centre; Helsinki Univ. (Finland). Dept. of Physical Medicine and Rehabilitation; Liverpool Univ. (UK). Dept. of Orthopaedic and Accident Surgery)

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

  16. 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...

  17. [Acute rupture of lumbar intervertebral disc caused by violent manipulation].

    Science.gov (United States)

    Li, J S

    1989-08-01

    Five cases of acute rupture of lumbar intervertebral disc caused by violent manipulation are reported. After protrusion of the lumbar intervertebral disc were treated by violent manipulation, the lumbo-leg pain were severe suddenly. The operations found that the annulus fibrosus had ruptured and the nerve root or cauda equina was constricted by the nucleus pulposus which had entered into the spinal canal. It must be emphasized that their is in danger of more damaging intervertebral disc degenerated by violent manipulation, then the adhesion of the nerve root will occur gradually. We don't suggest to make violent manipulation for the patient with the nerve root injured. We have acquired good results in treating protrusion of lumbar intervertebral disc by combined therapy and they are introduced in this article. PMID:2620603

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  19. MANAGEMENT OF LUMBAR SPINAL CANAL STENOSIS

    OpenAIRE

    Mukhergee G. S; Kiran Kumar L; Manikumar C. J

    2016-01-01

    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 de...

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

    Science.gov (United States)

    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.

  1. Introducing new implants and imaging techniques for lumbar spinal stenosis

    NARCIS (Netherlands)

    Moojen, Wouter Anton

    2014-01-01

    The main objective of this thesis is to compare bony decompression with implantation of interspinous process devices (IPDs) in patients with intermittent neurogenic claudication (INC) caused by lumbar spinal stenosis (LSS). A national survey among Dutch spine surgeons is presented about the usual ca

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

    DEFF Research Database (Denmark)

    Oestergaard, Lisa G; Christensen, Finn B; Nielsen, Claus V;

    2013-01-01

    , and costs. METHODS: A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group...

  3. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    Directory of Open Access Journals (Sweden)

    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.

  4. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    OpenAIRE

    Koshi Ninomiya; Koichi Iwatsuki; Yu-ichiro Ohnishi; Toshika Ohkawa; Toshiki Yoshimine

    2014-01-01

    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...

  5. Double insurance transfacetal screws for lumbar spinal stabilization

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2014-01-01

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

  6. Acute Sciatic Neuritis following Lumbar Laminectomy

    Directory of Open Access Journals (Sweden)

    Foad Elahi

    2014-01-01

    Full Text Available It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient’s newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy.

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

    Directory of Open Access Journals (Sweden)

    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.

  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

    OpenAIRE

    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. [Surgical treatment of lumbar spinal stenosis in Gabon].

    Science.gov (United States)

    Loembe, P M; Ndong-Launay, M; Chouteau, Y; Mwanyombet-Ompounga, L; Dukuly, L; Bouger, D

    1990-01-01

    The authors report their experiences based on 41 cases operated on for lumbar spinal stenosis between 1981 and 1988. The series included 28 men and 13 women aged between 23 and 63 years (mean age: 48 years). Neurogenic intermittent claudication was the presenting symptom in only 12% of the cases, as opposed to lumbago-sciatica in 78%. Clinical examination did not provide any specific elements. The key to diagnosis was lumbar myelography. Laminectomy was the most important aspect of treatment which, in certain cases, was associated with vertebral stabilization by arthrodesis (3 cases). There were ten minor operative complications. Further surgery was necessary in five cases (12%). Therapeutic results in patients followed from one to eight years (35 cases) were satisfactory. The discussion covers nosologic, clinicoradiologic and therapeutic aspects. PMID:2142258

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

    Directory of Open Access Journals (Sweden)

    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

  11. Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case–Control Study

    OpenAIRE

    Leila Asadian; Kaveh Haddadi; Mohsen Aarabi; Amirhossein Zare

    2016-01-01

    OBJECTIVES This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. STUDY DESIGN This is a cross-sectional study. METHODS This case–control study was performed during 2012–2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 par...

  12. 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

  13. Lumbar spinal loads and muscle activity during a golf swing.

    Science.gov (United States)

    Lim, Young-Tae; Chow, John W; Chae, Woen-Sik

    2012-06-01

    This study estimated the lumbar spinal loads at the L4-L5 level and evaluated electromyographic (EMG) activity of right and left rectus abdominis, external and internal obliques, erector spinae, and latissimus dorsi muscles during a golf swing. Four super VHS camcorders and two force plates were used to obtain three-dimensional (3D) kinematics and kinetics of golf swings performed by five male collegiate golfers. Average EMG levels for different phases of golf swing were determined. An EMG-assisted optimization model was applied to compute the contact forces acting on the L4-L5. The results revealed a mean peak compressive load of over six times the body weight (BW) during the downswing and mean peak anterior and medial shear loads approaching 1.6 and 0.6 BW during the follow-through phases. The peak compressive load estimated in this study was high, but less than the corresponding value (over 8 BW) reported by a previous study. Average EMG levels of different muscles were the highest in the acceleration and follow-through phases, suggesting a likely link between co-contractions of paraspinal muscles and lumbar spinal loads. PMID:22900401

  14. 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

  15. Altered spinal motion in low back pain associated with lumbar strain and spondylosis.

    Science.gov (United States)

    Cheng, Joseph S; Carr, Christopher B; Wong, Cyrus; Sharma, Adrija; Mahfouz, Mohamed R; Komistek, Richard D

    2013-04-01

    Study Design We present a patient-specific computer model created to translate two-dimensional (2D) fluoroscopic motion data into three-dimensional (3D) in vivo biomechanical motion data. Objective The aim of this study is to determine the in vivo biomechanical differences in patients with and without acute low back pain. Current dynamic imaging of the lumbar spine consists of flexion-extension static radiographs, which lack sensitivity to out-of-plane motion and provide incomplete information on the overall spinal motion. Using a novel technique, in-plane and coupled out-of-plane rotational motions are quantified in the lumbar spine. Methods A total of 30 participants-10 healthy asymptomatic subjects, 10 patients with low back pain without spondylosis radiologically, and 10 patients with low back pain with radiological spondylosis-underwent dynamic fluoroscopy with a 3D-to-2D image registration technique to create a 3D, patient-specific bone model to analyze in vivo kinematics using the maximal absolute rotational magnitude and the path of rotation. Results Average overall in-plane rotations (L1-L5) in patients with low back pain were less than those asymptomatic, with the dominant loss of motion during extension. Those with low back pain also had significantly greater out-of-plane rotations, with 5.5 degrees (without spondylosis) and 7.1 degrees (with spondylosis) more out-of-plane rotational motion per level compared with asymptomatic subjects. Conclusions Subjects with low back pain exhibited greater out-of-plane intersegmental motion in their lumbar spine than healthy asymptomatic subjects. Conventional flexion-extension radiographs are inadequate for evaluating motion patterns of lumbar strain, and assessment of 3D in vivo spinal motion may elucidate the association of abnormal vertebral motions and clinically significant low back pain. PMID:24436694

  16. 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.

  17. The acute lumbar disc herniation: imaging diagnosis.

    Science.gov (United States)

    Yussen, P S; Swartz, J D

    1993-12-01

    The acute lumbar herniated nucleus pulposus (HNP) can often be diagnosed on good quality MRI or CT examination. Myelography, discography, and postmyelography/postdiscography CT ordinarily are reserved for equivocal and protracted cases. MRI is recommended as the initial study of choice except for older patients for whom CT may be more valuable because of the high incidence of osteophytosis. Patients with acute herniated nucleus pulposus (HNP) may have varied clinical symptoms depending on the level of the HNP, extent of the annulus tear/depth of penetration of nuclear material, and the direction of the disc herniation. HNP does not necessarily produce radiculopathy and may cause vague low back pain. This article reviews and analyzes the clinical symptoms and problems associated with HNP, as well as the pitfalls and differential diagnostic possibilities in interpretation. PMID:8297631

  18. 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...

  19. 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

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

    OpenAIRE

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

    2011-01-01

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

  1. Acute Hydrocephalus Following Cervical Spinal Cord Injury

    OpenAIRE

    Son, Seong; Lee, Sang Gu; Park, Chan Woo; Kim, Woo Kyung

    2013-01-01

    We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drow...

  2. Value of spinal computed tomography in diagnosis of herniated lumbar discs

    Energy Technology Data Exchange (ETDEWEB)

    Sachsenheimer, W.; Hamer, J. (Heidelberg Univ. (Germany, F.R.). Abt. fuer Neurochirurgie); Mueller, H.A. (Deutsches Krebsforschungszentrum, Heidelberg (Germany, F.R.). Abt. fuer spez. onkologische Diagnostik)

    1982-01-01

    In this study the diagnostic value and topographical accuracy of spinal computed tomography (CT) in the preoperative diagnosis of lumbar disc herniations were tested in 36 patients with surgically proven herniated discs. All patients also underwent metrizamide myelography. CT findings and myelograms were compared and correlated with the surgical observations. Especially in demonstrating exact diagnosis (lateral or more medial protrusion), and in showing the extent of upward and downward displacement of free disc material, CT provides valuable preoperative information. As a non-invasive diagnostic procedure, spinal CT scan may replace lumbar myelography in many patients with radicular lumbar pain.

  3. Spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Bong Guk; Lee, Young Jun; Lee, Ji Young; Park, Chan Kum; Paik, Seung Sam [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Dong Woo [Dept. of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2015-07-15

    Spinal capillary hemangiomas in the epidural space are extremely rare; however, a preoperative radiological diagnosis is very important because of the risk of massive intraoperative hemorrhage. We report a case of a spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces.

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

    OpenAIRE

    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 devices (for example: DePuy Spines Titanium Moss Miami Spinal System). The Memory Metal Spinal System of this study consists of a single square spinal rod made of a nickel titanium alloy (Nitinol) use...

  5. 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.

  6. 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

    OpenAIRE

    Savni R Satoskar; Aimee A Goel; Mehta, Pooja H.; Atul Goel

    2014-01-01

    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 distrac...

  7. 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

  8. 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.

  9. Radiographic changes of lumbar spine and pelvis in chronic spinal injury

    Directory of Open Access Journals (Sweden)

    Shamsa Shariatpanahi

    2014-12-01

    Conclusion: The most frequent cause of chronic spinal injuries of our patients has been the injury by quiver, it seems our results may not be extended to all patients with spinal cord injury. In lumbar spine radiography of the patients, osteophytes, the quiver and psoriasis like ossifications were mostly seen. In the pelvis x-rays the most changes were hip joint narrowing, sacroiliitis and the heterotopic ossification.

  10. 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.

  11. 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.

  12. Development of Lumbar Spinal Stenosis Caused by Lumbar Vertebral Compression Fracture

    Directory of Open Access Journals (Sweden)

    Hidayet Sarı

    2004-12-01

    Full Text Available Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which causes mechanical compression of spinal nerve roots.Diagnosis is made by computerized tomography, myelography, or magnetic resonance (MR imaging. The aim of this case report was to present and discuss a patient with degenerative changes in whom spinal canal stenosis developed due to compression fracture and retropulsion of a fragment into the spinal canal following a simple fall.

  13. 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.

  14. 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

  15. Lumbar Myeloid Cell Trafficking into Locomotor Networks after Thoracic Spinal Cord Injury.

    Science.gov (United States)

    Hansen, Christopher N; Norden, Diana M; Faw, Timothy D; Deibert, Rochelle; Wohleb, Eric S; Sheridan, John F; Godbout, Jonathan P; Basso, D Michele

    2016-08-01

    Spinal cord injury (SCI) promotes inflammation along the neuroaxis that jeopardizes plasticity, intrinsic repair and recovery. While inflammation at the injury site is well-established, less is known within remote spinal networks. The presence of bone marrow-derived immune (myeloid) cells in these areas may further impede functional recovery. Previously, high levels of the gelatinase, matrix metalloproteinase-9 (MMP-9) occurred within the lumbar enlargement after thoracic SCI and impeded activity-dependent recovery. Since SCI-induced MMP-9 potentially increases vascular permeability, myeloid cell infiltration may drive inflammatory toxicity in locomotor networks. Therefore, we examined neurovascular reactivity and myeloid cell infiltration in the lumbar cord after thoracic SCI. We show evidence of region-specific recruitment of myeloid cells into the lumbar but not cervical region. Myeloid infiltration occurred with concomitant increases in chemoattractants (CCL2) and cell adhesion molecules (ICAM-1) around lumbar vasculature 24h and 7days post injury. Bone marrow GFP chimeric mice established robust infiltration of bone marrow-derived myeloid cells into the lumbar gray matter 24h after SCI. This cell infiltration occurred when the blood-spinal cord barrier was intact, suggesting active recruitment across the endothelium. Myeloid cells persisted as ramified macrophages at 7days post injury in parallel with increased inhibitory GAD67 labeling. Importantly, macrophage infiltration required MMP-9. PMID:27191729

  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. 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 patie...... 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.......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...

  18. Diagnosis of Lumbar Spinal Stenosis An Updated Systematic Review of the Accuracy of Diagnostic Tests

    NARCIS (Netherlands)

    de Schepper, Evelien I. T.; Overdevest, Gijsbert M.; Suri, Pradeep; Peul, Wilco C.; Oei, Edwin H. G.; Koes, Bart W.; Bierma-Zeinstra, Sita M. A.; Luijsterburg, Pim A. J.

    2013-01-01

    Study Design. Systematic review of diagnostic studies. Objective. To update our previous systematic review on the diagnostic accuracy of tests used to diagnose lumbar spinal stenosis. Summary of Background Data. A wide range of clinical, radiological, and electrodiagnostic tests are used to diagnose

  19. 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.

  20. 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.

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

    DEFF Research Database (Denmark)

    Westergaard, Lars; Hauerberg, John; Springborg, Jacob B

    2009-01-01

    of the lumbar spine has predictive value for the outcome after decompression. The aim of this study was to investigate this theory in a larger group of patients. METHODS: One hundred forty-six consecutive patients surgically treated for LSS were included in the study. The clinical condition was recorded before...... surgery and at 3, 6, 12, and 24 months after surgery using 3 different scoring systems: Swiss Spinal Stenosis Questionnaire, Neurogenic Claudication Outcome Score, and Oswestry Disability Index. The group of patients with preoperative aggravation of the symptoms by the lumbar extension test, (positive...... extension test), was compared with the group of patients without aggravation by the test, (negative extension test). RESULTS: Before surgery, patients with a positive extension test scored significantly worse on all disability scoring systems than patients with a negative test. However, the extension test...

  2. Lumbar spinal loads vary with body height and weight.

    Science.gov (United States)

    Han, Kap-Soo; Rohlmann, Antonius; Zander, Thomas; Taylor, William R

    2013-07-01

    Knowledge about spinal loading is required for designing and preclinical testing of spinal implants. It is assumed that loading of the spine depends upon body weight and height, as well as on the spine level, but a direct measurement of the loading conditions throughout the spine is not yet possible. Here, computer models can allow an estimation of the forces and moments acting in the spine. The objective of the present study was to calculate spinal loads for different postures and activities at several levels of the thoracolumbar spine for various combinations of body height and weight. A validated musculoskeletal model, together with commercially available software (AnyBody Technology), were used to calculate the segmental loads acting on the centre of the upper endplate of the vertebrae T12 to L5. The body height was varied between 150 and 200 cm and the weight between 50 and 120 kg. The loads were determined for five standard static postures and three lifting tasks. The resultant forces and moments increased approximately linearly with increasing body weight. The body height had a nearly linear effect on the spinal loads, but in almost all loading cases, the effect on spinal loads was stronger for variation of body weight than of body height. Spinal loads generally increased from cranial to caudal. The presented data now allow the estimation of the spinal load during activities of daily living on a subject specific basis, if body height and weight are known. PMID:23040051

  3. 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

    Directory of Open Access Journals (Sweden)

    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.

  4. Visual and quantitative assessment of lateral lumbar spinal canal stenosis with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sipola, Petri; Vanninen, Ritva; Manninen, Hannu (Univ. of Eastern Finland, Faculty of Health Sciences, School of Medicine, Inst. of Clinical Medicine, Dept. of Clinical Radiology, Kuopio (Finland); Kuopio Univ. Hospital, Clinical Imaging Centre, Dept. of Clinical Radiology, Kuopio (Finland)), email: petri.sipola@kuh.fi; Leinonen, Ville (Kuopio Univ. Hospital, Dept. of Neurosurgery, Kuopio (Finland)); Niemelaeinen, Riikka (Kuopio Univ. Hospital, Clinical Imaging Centre, Dept. of Clinical Radiology, Kuopio (Finland); Faculty of Rehabilitation Medicine, Univ. of Alberta, Edmonton, Alberta (Canada)); Aalto, Timo (Kyyhkylae Rehabilitation Center and Hospital, Mikkeli (Finland)); Airaksinen, Olavi (Kuopio Univ. Hospital, Dept. of Physical and Rehabilitation Medicine and Univ. of Eastern Finland, Faculty of Health Sciences, School of Medicine, Inst. of Clinical Medicine, Kuopio (Finland)); Battie, Michele C. (Faculty of Rehabilitation Medicine, Univ. of Alberta, Edmonton, Alberta (Canada))

    2011-11-15

    Background. Lateral lumbar spinal canal stenosis is a common etiology of lumbar radicular symptoms. Quantitative measurements have commonly demonstrated better repeatability than visual assessments. We are not aware of any studies examining the repeatability of quantitative assessment of the lateral canal. Purpose. To evaluate the repeatability of visual assessments and newly developed quantitative measurements of lateral lumbar spinal canal stenosis using magnetic resonance imaging (MRI). Material and Methods. Twenty-eight patients with lateral lumbar spinal canal stenosis or prior spinal surgery with recurrent symptoms were imaged with MRI. A radiologist, a neurosurgeon and a spine research trainee graded visually and quantitatively subarticular (n = 188) and foraminal zones (n = 260) of the lateral spinal canal. Quantitative measurements included the minimal subarticular width and the cross-sectional area of the foramen. Results. The repeatability of visual assessment at the subarticular zone and foraminal zones between raters varied from 0.45-0.59 and 0.42-0.53, respectively. Similarly, the intraclass correlation coefficients for the quantitative measurements varied from 0.67-0.71 and 0.66-0.76, respectively. The intra-rater repeatability for the visual assessments of the subarticular and foraminal zones was 0.70 and 0.62, respectively, while the corresponding intraclass correlation coefficients for quantitative measurements were 0.83 and 0.81, respectively. Conclusion. Inter-rater repeatability of visual assessments of lateral stenosis is moderate, whereas quantitative measurements of both subarticular width and the cross-sectional area of the foramen have substantial reproducibility and may be particularly useful for longitudinal studies and research purposes. The clinical value of these parameters requires further study

  5. ROLE OF EPIDURAL INJECTIONS IN THE MANAGEMENT OF ACUTE LUMBAR DISCOGENIC PAIN

    Directory of Open Access Journals (Sweden)

    Srinivas

    2015-05-01

    Full Text Available INTRODUCTION: The use of epidural injections in the cervical , thoracic and lumbo sacral spine for both diagnostic and therapeutic purposes has developed as an important part of a comprehensive interdisci plinary approach to spinal pain . (1, 2 It is well known that structural abnormalities see n on CT or MRI scans do not always cause pain and diagnostic injections often can help correlate abnormalities on imaging studies with associated pain complaints. Therapeutically , epidural injections can provide significant pain relief during which , time r ecovery of disc and nerve root injuries can occur and patients also can progress their level of physical activity. In acute disc injury with or without radiculopathy , therapeutic injections can help and manage the patient ’ s pain without reliance on oral analgesics. Epidural cortico steroid injections with physical therapy is recommended in conjunction . (1 Mechanism of pain relief is due to potent and anti - inflammatory properties of the cortico steroids . ( 3,2 Aim to know the effic acy and results of the epidural steroid injection in acute lumbar discogenic pain . ( 2 MATERIALS AND METHODS: I have treated 800 patients with lumbar epidural injections for 3 weeks ( W eekly interval since 2005 at Sri Venkata Hospital and pain management ce ntre SP Nagar , Kukatpally , Hyderabad , Telangana. F or the management of Lumbar Discogenic Pain till 2014. RESULTS: E xcellent in 90% of patients and no patient complained of recurrence of symptoms and reached their normal activities without surgery after epidural injection treatment. Lumbar Epidural steroid injection is usually performed in about 6 weeks after the onset of low back pain or radicular pain. Lumbar Epidural steroid injection is appropriate for an outpatient setting provided all necessary resu scitative equipment is available i.e. O 2 , intubation equipment , emergency drugs , IV access and we can avoid the hospitalization . DISCUSSION: LESIs

  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. Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn B

    2006-01-01

    clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers' budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied...... fact that the clinical effects are statistically synonymous, it does not support the use of high-cost techniques. There is a great potential for improvement of methodological quality in economic evaluations of lumbar spinal fusion and further research is imperative.......The goal of this systematic literature review was to assess the evidence for cost-effectiveness of various surgical techniques in lumbar spinal fusion in conformity with the guidelines provided by the Cochrane Back Review Group. As new technology continuously emerges and divergent directions in...

  8. Lumbar neuropathic pain of lower limbs treated by spinal infusion of ziconotide a case – report

    OpenAIRE

    Luca Quadrino

    2008-01-01

    The Author reports the case of a patient with severe lumbar pain unresponsive to NSAIDs. Initial treatment with tramadol gave poor results and a new protocol with hydromorphone – pregabalin was started. The analgesic response was observed only following high hydromorphone doses, associated with unacceptable side effects. A spinal device for continuous intrathecal infusion was then implanted, in order to administer ziconotide, a new opioid drug. Associated therapy included hydromorphone – p...

  9. Incidence of Vascular Complications Arising from Anterior Spinal Surgery in the Thoraco-Lumbar Spine

    OpenAIRE

    Klezl, Zdenek; Swamy, Girish Nanjunda; Vyskocil, Thomas; Kryl, Jan; Stulik, Jan

    2014-01-01

    Study Design Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. Purpose The aim of this study was to give a general overview and identify the incidence of vascular complications. Overview of Literature There is limited l...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    OpenAIRE

    Laxmaiah Manchikanti, Kimberly A. Cash, Vidyasagar Pampati, Bradley W. Wargo, Yogesh Malla

    2013-01-01

    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 deli...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    Sahiba Yadav

    2014-10-01

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

  15. MR imaging of lumbar herniated intervertebral disc and spinal stenosis: Correlation with CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Jae; Park, Kil Sun; Chang, Kee Hyun; Han, Moon Hee; Kim, Hyun Jip; Han, Man Chung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    MR imagings obtained in 40 patients with surgically proven lumbar herniated intervertebral disc (HIVD) and/or spinal stenosis were retrospectively analysed and compared with CT scans, in order to evaluate the MR findings of HIVD and spinal stenosis, and to assess the diagnostic accuracy of MR. The MR imaging was performed on a 2.0 T superconducting unit, using multislice spin echo (SE) and gradient echo (GE) techniques. The results were as follows: 1. The texture of vertebral body with spinal stenosis had the tendency to be more heterogeneous than that with HIVD. 2. The signal intensity of the diseased disc was isointense relative to normal disc in 81 % (60/74) and the remainder (19%) was hypointense on both T1 weighted SE and GE images. There was no significant difference in signal intensity among HIVD, HIVD combined with spinal stenosis and spinal stenosis groups, but there was the tendency of lower signal intensity of the diseased disc in patients with severe degenerative change of spine in both T1 weighted SE imaged and GE image. 3. The diagnostic accuracy of MR was 92%, which was similar to that of CT. 4. T1 weighted SE image appears superior to GE image in evaluation of most of the structural differentiation, but as for differentiating between lumina and ligamentum flavum, and for the vacuum phenomenon, GE image seems to be better than T1 weighted SE image. In conclusion, MR appears to be better than CT as a initial imaging modality in evaluation of the patients with suspected lumbar spinal stenosis or HIVD because MR has the capability of demonstrating rupture of anulus fibrosus in sagittal plane.

  16. TREATMENT OF 20 CASES OF ACUTE LUMBAR DISC PROTRUSION WITH YIN THERAPY FOR YANG DISORDER

    Institute of Scientific and Technical Information of China (English)

    TAO Jing; KANG Ming-fei; ZHAO Rong

    2006-01-01

    @@ Lumbar disc protrusion is one of the common reasons of lumbar and leg pain. How to alleviate acute pain effectively is the major problem encountered in the clinical medicine. From June 2005 to March 2006, yin therapy for yang disorder had been adopted in the treatment of 20 cases of acute lumbar disc protrusion and the significant therapeutic effects had been achieved. The report is as follows.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    Energy Technology Data Exchange (ETDEWEB)

    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. 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

  20. IPD without bony decompression versus conventional surgical decompression for lumbar spinal stenosis: 2-year results of a double-blind randomized controlled trial

    NARCIS (Netherlands)

    W.A. Moojen (Wouter); M.P. Arts (Mark); W. Jacobs (Wouter); E.W. van Zwet (Erik); E. Van den Akker-van Marle (E.); B.W. Koes (Bart); C.L.A.M. Vleggeert-Lankamp (Carmen); W.C. Peul (Wilco)

    2015-01-01

    textabstractPurpose: Interspinous process devices (IPDs) are implanted to treat patients with intermittent neurogenic claudication (INC) based on lumbar spinal stenosis. It is hypothesized that patients with lumbar spinal stenosis treated with IPD have a faster short-term recovery, an equal outcome

  1. The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11-13 year follow-up

    DEFF Research Database (Denmark)

    Andersen, Thomas; Videbaek, Tina S; Hansen, Ebbe S;

    2008-01-01

    INTRODUCTION: Few studies have investigated the long-term effect of posterolateral lumbar spinal fusion on functional outcome. AIM: To investigate the long-term result after posterolateral lumbar spinal fusion with and without pedicle screw instrumentation. METHODS: Questionnaire survey of 129 pa...

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

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

  4. [Pre-hospital care management of acute spinal cord injury].

    Science.gov (United States)

    Hess, Thorsten; Hirschfeld, Sven; Thietje, Roland; Lönnecker, Stefan; Kerner, Thoralf; Stuhr, Markus

    2016-04-01

    Acute injury to the spine and spinal cord can occur both in isolation as also in the context of multiple injuries. Whereas a few decades ago, the cause of paraplegia was almost exclusively traumatic, the ratio of traumatic to non-traumatic causes in Germany is currently almost equivalent. In acute treatment of spinal cord injury, restoration and maintenance of vital functions, selective control of circulation parameters, and avoidance of positioning or transport-related additional damage are in the foreground. This article provides information on the guideline for emergency treatment of patients with acute injury of the spine and spinal cord in the preclinical phase. PMID:27070515

  5. Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation

    Science.gov (United States)

    Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

    2016-01-01

    BACKGROUND: Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. PURPOSE: The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. METHODS: We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. RESULTS: Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they “awaited the result of surgery”, and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. CONCLUSION: The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of

  6. Spinal-cord swelling in acute multiple sclerosis

    International Nuclear Information System (INIS)

    Despite the frequent involvement of the spinal cord by multiple sclerosis, reports concerning neuroradiological findings regarding these lesions have been limited; most of them have demonstrated a normal or small spinal cord. Two cases of acute paraparesis showed evidence of spinal-cord swelling on myelography and CT myelography, initially suggesting the diagnosis of an intramedullary tumor. Spinal-cord swelling was demonstrated more clearly on CT myelography than on conventional myelography. The diagnosis of multiple sclerosis was made with the aid of the CSF findings, the clinical course, and the contracting-cord sign. The ''contracting-cord sign'' means the diminution of the spinal-cord diameter in the chronic stage. Since acute multiple sclerosis may produce spinal-cord swelling simulating a tumor, careful investigations are necessary to avoid unwarranted surgical interventions. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Acute complications of spinal cord injuries.

    Science.gov (United States)

    Hagen, Ellen Merete

    2015-01-18

    The aim of this paper is to give an overview of acute complications of spinal cord injury (SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation. PMID:25621207

  9. Acute spontaneous spinal epidural haematoma in a child

    International Nuclear Information System (INIS)

    Spontaneous spinal epidural haematomas rarely occur. Patients tend to be in their sixties or seventies. Acute spontaneous spinal epidural haematomas in children without a predisposition for bleeding disorders, trauma, vascular malformations or anticoagulant therapy have seldom been described. We present a case of a 4-year-old girl with a spontaneous cervical epidural haematoma diagnosed with MR. (orig.)

  10. Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Gustavo C Machado

    Full Text Available The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis.Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions.Nineteen published reports (17 trials were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1, disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9, or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9. Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0, but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001. There are no differences in the effectiveness between other surgical techniques for our main outcomes.The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices

  11. 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

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

    Directory of Open Access Journals (Sweden)

    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

  13. 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.

  14. Age-related contrast enhancement study of normal bone marrow in lumbar spinal MR imaging

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the degree of contrast enhancement of normal bone marrow in L-spine relating to aging and to determine the range of contrast enhancement in normal bone marrow. We analyzed a total of 120 patients (20 per decade) who had undergone lumbar spinal MRI and who ranged in age from the 2nd decade to more than the 7th. Bone marrow revealed no abnormal pathology. Sagittal T1-weighted spin echo sequences were obtained before and after gadolinium administration. For each sequence, a region of interest was drawn within the L1 vertebral body from the midsagittal slice. Signal intensity (SI) values of each sequence were ascertained and the percentage increase in SI was calculated. After contrast enhancement, lumbar MRI revealed no statistically significant in the percentage increase in SI of normal bone marrow in relation to aging. Most patients (99%) however showed an SI increase of between 10% and 49%. In only four, none of whom were aged over 40, was this increase above 50%. Lumbar MRI, revealed no statistically significant difference in percentage increase in SI in normal bone marrow relating to aging, but when the increase is above 50% in a patient aged over 40, bone marrow pathology should be further investigated

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. A Diagnostic Algorithm for Eosinophilic Granulomatosis with Polyangiitis Initially Diagnosed as Lumbar Disc Hernia or Lumbar Spinal Stenosis: Personal Experience and Review of the Literature.

    Science.gov (United States)

    Nagata, Kosei; Yamamoto, Shinichi; Miyoshi, Kota; Sato, Masaki; Arino, Yusuke; Mikami, Yoji

    2016-08-01

    Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic vasculitis and is difficult to diagnose. EGPA has a number of symptoms including peripheral dysesthesia caused by mononeuropathy multiplex, which is similar to radiculopathy due to lumbar disc hernia or lumbar spinal stenosis. Therefore, EGPA patients with mononeuropathy multiplex often visit orthopedic clinics, but orthopedic doctors and spine neurosurgeons have limited experience in diagnosing EGPA because of its rarity. We report a consecutive series of patients who were initially diagnosed as having lumbar disc hernia or lumbar spinal stenosis by at least 2 medical institutions from March 2006 to April 2013 but whose final diagnosis was EGPA. All patients had past histories of asthma or eosinophilic pneumonia, and four out of five had peripheral edema. Laboratory data showed abnormally increased eosinophil counts, and nerve conduction studies of all patients revealed axonal damage patterns. All patients recovered from paralysis to a functional level after high-dose steroid treatment. We shortened the duration of diagnosis from 49 days to one day by adopting a diagnostic algorithm after experiencing the first case. PMID:27549670

  18. TCM Treatment for 50 Cases of Acute Protrusion of the Lumbar Intervertebral Disc

    Institute of Scientific and Technical Information of China (English)

    梁述元

    2001-01-01

    @@ From January 1998 to August 2000, the author has treated 50 cases of acute protrusion of the lumbar intervertebral disc by Chinese herbs, massotherapy, and functional exercise with satisfactory therapeutic results reported in the following.

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

    Directory of Open Access Journals (Sweden)

    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

  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. 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.

  2. Lumbar neuropathic pain of lower limbs treated by spinal infusion of ziconotide a case – report

    Directory of Open Access Journals (Sweden)

    Luca Quadrino

    2008-09-01

    Full Text Available The Author reports the case of a patient with severe lumbar pain unresponsive to NSAIDs. Initial treatment with tramadol gave poor results and a new protocol with hydromorphone – pregabalin was started. The analgesic response was observed only following high hydromorphone doses, associated with unacceptable side effects. A spinal device for continuous intrathecal infusion was then implanted, in order to administer ziconotide, a new opioid drug. Associated therapy included hydromorphone – pregabalin. At the 4 mcg/die dose ziconotide resulted highly effective (with a VAS reduction pain 6-7 to 2-3 even at 1st day after implantation; in addition at day 10, opioid dose was strongly reduced and pregabalin withdrawn. The treatment was associated with a good tolerability. The encouraging results prompted the Author to test ziconotide in further cases of severe chronic pain.

  3. Pregabalin for Refractory Radicular Leg Pain due to Lumbar Spinal Stenosis: A Preliminary Prospective Study.

    Science.gov (United States)

    Orita, Sumihisa; Yamashita, Masaomi; Eguchi, Yawara; Suzuki, Miyako; Inoue, Gen; Miyagi, Masayuki; Watanabe, Tomoko; Ozawa, Tomoyuki; Kamoda, Hiroto; Ishikawa, Tetsuhiro; Aoki, Yasuchika; Ito, Toshinori; Kubota, Go; Suzuki, Munetaka; Yamauchi, Kazuyo; Hanaoka, Eiji; Sakuma, Yoshihiro; Shimbo, Jun; Oikawa, Yasuhiro; Suzuki, Takane; Takahashi, Kazuhisa; Ohtori, Seiji

    2016-01-01

    We investigated the efficacy of pregabalin (PGB) for neuropathic leg pain in lumbar spinal stenosis (LSS) patients with disturbed activities of daily living (ADL)/quality of life (QOL) in a prospective observational study. Subjects were a total of 104 LSS patients with neuropathic pain (NeP) in leg and neurological intermittent claudication (IMC) refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) for at least a month. NeP was identified using screening tool, Pain DETECT questionnaire. Visual analog scale (VAS) scores and responses to the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and 6 weeks after PGB treatment initiation. Changes in IMC distance and adverse events were also recorded. PGB significantly improved their VAS scores for pain and sleep quality (P pain-related disorders (P pain refractory to NSAIDs in LSS patients, resulting in not only pain control but also improving lower back pain-related ADL/QOL scores. PMID:27445615

  4. Postoperative lumbar spinal stenosis after intertransverse fusion with granules of hydroxyapatite: a case report

    Directory of Open Access Journals (Sweden)

    Inoue Gen

    2012-11-01

    Full Text Available Abstract In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA, bone union was not completed and the patient felt the recurrence of his symptoms within two years. We performed re-decompression with fusion, and in hematoxylin and eosin staining of HA granulation harvested during revision surgery, fibrous tissue with hyaline degeneration surrounded the cavity where the HA had existed. Multinuclear giant cells and lymphocytes infiltrated some parts of the marginal layer of the cavity, and no obvious bony bridge had regenerated from autologous bone. No tartrate-resistant acid phosphate (TRAP -positive osteoclasts could be seen in the new bone, suggesting that the activity of osteoclasts in the new bone decreased during the seven years after the primary surgery. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3483360258050263

  5. 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.

  6. 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).

  7. [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.

  8. 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.

  9. Pregabalin for Refractory Radicular Leg Pain due to Lumbar Spinal Stenosis: A Preliminary Prospective Study

    Directory of Open Access Journals (Sweden)

    Sumihisa Orita

    2016-01-01

    Full Text Available We investigated the efficacy of pregabalin (PGB for neuropathic leg pain in lumbar spinal stenosis (LSS patients with disturbed activities of daily living (ADL/quality of life (QOL in a prospective observational study. Subjects were a total of 104 LSS patients with neuropathic pain (NeP in leg and neurological intermittent claudication (IMC refractory to nonsteroidal anti-inflammatory drugs (NSAIDs for at least a month. NeP was identified using screening tool, Pain DETECT questionnaire. Visual analog scale (VAS scores and responses to the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ were assessed before and 6 weeks after PGB treatment initiation. Changes in IMC distance and adverse events were also recorded. PGB significantly improved their VAS scores for pain and sleep quality (P<0.001. With respect to JOABPEQ, significant improvements were observed with regard to the following dimensions: pain-related disorders (P<0.01, lumbar spine dysfunction (P=0.031, gait disturbance (P=0.028, and psychological disorders (P=0.014. The IMC distance showed an improvement tendency after PGB treatment, albeit with no significance (P=0.063. Minor adverse events such as dizziness were observed. PGB can be effective for neuropathic leg pain refractory to NSAIDs in LSS patients, resulting in not only pain control but also improving lower back pain-related ADL/QOL scores.

  10. Magnetic resonance imaging of lumbar spinal disorders; A comparison of myelography, discography, and magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nojiri, Hajime; Matsui, Norio; Fujiyoshi, Fuminori; Izumida, Makoto; Wakita, Sato; Sekiya, Isato (Nagoya City Univ. (Japan). Faculty of Medicine)

    1991-12-01

    In order to evaluate the stenotic condition of lumbar spinal canal, MRI was compared with myelogram and with discogram in 82 patients, all of whom underwent surgical exploration. Pathologic conditions were studied including herniated nucleus pulposus in 36, lumbar canal stenosis (central, peripheral portion, combined) in 35, and spondylisthesis (degenerative, spondylolytic, dysplastic) in 11. Correlation between T2 mid-sagittal image of the thecal sac and profile view of full-column myelogram was very high, but fine parts such as adhesive change or redundancy or anomalous condition of nerve roots were more clearly observed on myelogram than on MRI. And some of them were not detected on MRI. The stage of disc degeneration was classified in 5 grades according to signal intensity and irregularity of the disc on T2-weighted image. The evaluation of disc degeneration was similar to discogram. But MRI will not replace discography for identifying the source of pain in symptomatic patients. Although MRI is the most important imaging modality to diagnostic screening and to post-operative evaluation of the stenotic condition, determination of the strict indication and the method of the operation will need myelogram and/or discogram and so on. (author).

  11. Management of Acute Lumbar Injuries in the Workplace.

    Science.gov (United States)

    Lurati, Ann Regina

    2016-01-01

    Occupational acute lumbar injuries are a common injury. One intervention that is unique to occupational health is the determination of the amount of physical activity that an injured worker can perform without increasing the risk of further injury. Clinical recommendations suggest that workers continue to stay active; however, it is still the clinician's responsibility to determine the level of activity. The level of work activity is determined on a case-to-case basis and is done by evaluating the physical capacity of an injured worker and the job description. Current evidence-based guidelines suggest that staying active may actually reduce pain levels. The purpose of this evidence-based literature review is to outline the proper assessment and management of workers who have sustained a work-related low back injury. The related literature has been reviewed as well as red flags for more severe neurological conditions that require more in-depth evaluation. Determining the safe level of activity and guided return to work have been discussed. PMID:27187219

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

    Directory of Open Access Journals (Sweden)

    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.

  13. The Current Testing Protocols for Biomechanical Evaluation of Lumbar Spinal Implants in Laboratory Setting: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sabrina A. Gonzalez-Blohm

    2015-01-01

    Full Text Available In vitro biomechanical investigations have become a routinely employed technique to explore new lumbar instrumentation. One of the most important advantages of such investigations is the low risk present when compared to clinical trials. However, the best use of any experimental data can be made when standard testing protocols are adopted by investigators, thus allowing comparisons among studies. Experimental variables, such as the length of the specimen, operative level, type of loading (e.g., dynamic versus quasistatic, magnitude, and rate of load applied, are among the most common variables controlled during spinal biomechanical testing. Although important efforts have been made to standardize these protocols, high variability can be found in the current literature. The aim of this investigation was to conduct a systematic review of the literature to identify the current trends in the protocols reported for the evaluation of new lumbar spinal implants under laboratory setting.

  14. Massive hematothorax after thoracic spinal manipulation for acute thoracolumbar pain

    Directory of Open Access Journals (Sweden)

    Johannes Struewer

    2013-07-01

    Full Text Available Spinal manipulation usually represents a widely used and effective method for physicians in order to relieve acute patient pain and muscular dysbalance. Although life-threatening complications (e.g. pneumothorax, vertebral artery dissection, stroke after manual treatment are reported with regard to actual medical literature millions of patients undergo manual treatment to manage thoracolumbar pain each year. The authors present the case of a 17 year old male patient with a life-threatening hematothorax after thoracic high velocity spinal manipulation for acute thoracolumbar pain. The patient required emergency chest tube thoracostomy and afterwards thoracoscopic haemostasis for an intercostal venous lesion. A massive hematothorax after spinal manipulation represents an extremely rare but life-threatening complication. Physicians are encouraged to promote the benefits of manual/chiropratic therapy on the one hand but on the other hand are obliged to educate about potential serious dangers and adverse events.

  15. Injury-Dependent and Disability-Specific Lumbar Spinal Gene Regulation following Sciatic Nerve Injury in the Rat.

    Directory of Open Access Journals (Sweden)

    Paul J Austin

    Full Text Available Allodynia, hyperalgesia and spontaneous pain are cardinal sensory signs of neuropathic pain. Clinically, many neuropathic pain patients experience affective-motivational state changes, including reduced familial and social interactions, decreased motivation, anhedonia and depression which are severely debilitating. In earlier studies we have shown that sciatic nerve chronic constriction injury (CCI disrupts social interactions, sleep-wake-cycle and endocrine function in one third of rats, a subgroup reliably identified six days after injury. CCI consistently produces allodynia and hyperalgesia, the intensity of which was unrelated either to the altered social interactions, sleep-wake-cycle or endocrine changes. This decoupling of the sensory consequences of nerve injury from the affective-motivational changes is reported in both animal experiments and human clinical data. The sensory changes triggered by CCI are mediated primarily by functional changes in the lumbar dorsal horn, however, whether lumbar spinal changes may drive different affective-motivational states has never been considered. In these studies, we used microarrays to identify the unique transcriptomes of rats with altered social behaviours following sciatic CCI to determine whether specific patterns of lumbar spinal adaptations characterised this subgroup. Rats underwent CCI and on the basis of reductions in dominance behaviour in resident-intruder social interactions were categorised as having Pain & Disability, Pain & Transient Disability or Pain alone. We examined the lumbar spinal transcriptomes two and six days after CCI. Fifty-four 'disability-specific' genes were identified. Sixty-five percent were unique to Pain & Disability rats, two-thirds of which were associated with neurotransmission, inflammation and/or cellular stress. In contrast, 40% of genes differentially regulated in rats without disabilities were involved with more general homeostatic processes (cellular

  16. Injury-Dependent and Disability-Specific Lumbar Spinal Gene Regulation following Sciatic Nerve Injury in the Rat.

    Science.gov (United States)

    Austin, Paul J; Bembrick, Alison L; Denyer, Gareth S; Keay, Kevin A

    2015-01-01

    Allodynia, hyperalgesia and spontaneous pain are cardinal sensory signs of neuropathic pain. Clinically, many neuropathic pain patients experience affective-motivational state changes, including reduced familial and social interactions, decreased motivation, anhedonia and depression which are severely debilitating. In earlier studies we have shown that sciatic nerve chronic constriction injury (CCI) disrupts social interactions, sleep-wake-cycle and endocrine function in one third of rats, a subgroup reliably identified six days after injury. CCI consistently produces allodynia and hyperalgesia, the intensity of which was unrelated either to the altered social interactions, sleep-wake-cycle or endocrine changes. This decoupling of the sensory consequences of nerve injury from the affective-motivational changes is reported in both animal experiments and human clinical data. The sensory changes triggered by CCI are mediated primarily by functional changes in the lumbar dorsal horn, however, whether lumbar spinal changes may drive different affective-motivational states has never been considered. In these studies, we used microarrays to identify the unique transcriptomes of rats with altered social behaviours following sciatic CCI to determine whether specific patterns of lumbar spinal adaptations characterised this subgroup. Rats underwent CCI and on the basis of reductions in dominance behaviour in resident-intruder social interactions were categorised as having Pain & Disability, Pain & Transient Disability or Pain alone. We examined the lumbar spinal transcriptomes two and six days after CCI. Fifty-four 'disability-specific' genes were identified. Sixty-five percent were unique to Pain & Disability rats, two-thirds of which were associated with neurotransmission, inflammation and/or cellular stress. In contrast, 40% of genes differentially regulated in rats without disabilities were involved with more general homeostatic processes (cellular structure

  17. Fusion Rates of Instrumented Lumbar Spinal Arthrodesis according to Surgical Approach: A Systematic Review of Randomized Trials

    OpenAIRE

    Lee, Choon Sung; Hwang, Chang Ju; Lee, Dong-Ho; Kim, Yung-Tae; Lee, Hee Sang

    2011-01-01

    Background Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques. Methods Relevant randomized trials comparing the fusion rates of different surgical approach...

  18. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Evidence-based treatment for acute spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Zhouming Deng; Jiajia Su; Lin Cai; Ansong Ping; Wei Jin; Renxiong Wei; Yan Zhan

    2011-01-01

    OBJECTIVE: To formulate an evidence-based treatment for one patient with acute spinal cord injury and summarize evidence for evaluating acute spinal cord injury treatment. METHODS: Studies related to the treatment for acute spinal cord injury were identified via a search of National Guideline Clearinghouse (NGC, 2000-11), the Cochrane Library (Issue 1, 2011), TRIP Database (2000-11), and PubMed (1966-2011). Treatment strategies were formulated according to three basic principles: best evidence, doctor's professional experience, and wishes of the patient. RESULTS: A total of 34 articles were selected, including 1 NGC guideline, 22 systematic reviews, and 11 randomized controlled trials. Based on our review, we arrived at the following recommendations: no clinical evidence exists definitively to recommend the use of any of neuroprotective pharmaceuticals; surgery should be undertaken early; mechanical compression devices and low-molecular weight heparin should be employed to prevent thrombosis; respiratory muscle training is beneficial for pulmonary function and quality of life; and functional electrical stimulation and acupuncture can promote functional recovery. The patient accordingly underwent surgery 6 hours after trauma without receiving any neuroprotective pharmaceuticals; low-molecular weight heparin and intermittent pneumatic compression were applied to prevent thrombosis. He also underwent respiratory muscle training daily for 8 weeks and received functional electrical stimulation for 15 minutes and acupuncture for 30 minutes every day. After follow-up for 3 months, the above therapeutic regimen was confirmed efficacious for acute spinal cord injury.CONCLUSION: Evidence-based medicine provides an individualized treatment protocol for acute spinal cord injury, which can significantly improve the therapeutic effect and prognosis.

  2. Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review.

    Science.gov (United States)

    Ghobrial, George M; Cadotte, David W; Williams, Kim; Fehlings, Michael G; Harrop, James S

    2015-10-01

    OBJECT The use of intrawound vancomycin is rapidly being adopted for the prevention of surgical site infection (SSI) in spinal surgery. At operative closure, the placement of vancomycin powder in the wound bed-in addition to standard infection prophylaxis-can provide high concentrations of antibiotics with minimal systemic absorption. However, despite its popularity, to date the majority of studies on intrawound vancomycin are retrospective, and there are no prior reports highlighting the risks of routine treatment. METHODS A MEDLINE search for pertinent literature was conducted for studies published between 1966 and May 2015 using the following MeSH search terms: "intrawound vancomycin," "operative lumbar spine complications," and "nonoperative lumbar spine complications." This was supplemented with references and known literature on the topic. RESULTS An advanced MEDLINE search conducted on May 6, 2015, using the search string "intrawound vancomycin" found 22 results. After a review of all abstracts for relevance to intrawound vancomycin use in spinal surgery, 10 studies were reviewed in detail. Three meta-analyses were evaluated from the initial search, and 2 clinical studies were identified. After an analysis of all of the identified manuscripts, 3 additional studies were included for a total of 16 studies. Fourteen retrospective studies and 2 prospective studies were identified, resulting in a total of 9721 patients. A total of 6701 (68.9%) patients underwent treatment with intrawound vancomycin. The mean SSI rate among the control and vancomycin-treated patients was 7.47% and 1.36%, respectively. There were a total of 23 adverse events: nephropathy (1 patient), ototoxicity resulting in transient hearing loss (2 patients), systemic absorption resulting in supratherapeutic vancomycin exposure (1 patient), and culture-negative seroma formation (19 patients). The overall adverse event rate for the total number of treated patients was 0.3%. CONCLUSIONS Intrawound

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

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

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

    International Nuclear Information System (INIS)

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

  5. A single injection of recombinant adeno-associated virus into the lumbar cistern delivers transgene expression throughout the whole spinal cord

    OpenAIRE

    Guo, Yansu; Wang, Dan; Qiao, Tao; Yang, Chunxing; Su, Qin; Gao, Guangping; Xu, Zuoshang

    2015-01-01

    The lack of methods to deliver transgene expression in spinal cord has hampered investigation of gene function and therapeutic targets for spinal cord diseases. Here we report that a single intrathecal injection of recombinant adeno-associated virus rhesus-10 (rAAVrh10) into the lumbar cistern led to transgene expression in sixty to ninety percent of the cells in the spinal cord. The transgene was expressed in all cell types, including neurons, glia, ependymal cells and endothelial cells. Add...

  6. 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.

  7. 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 ...

  8. 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.

  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. Comparative cost effectiveness of Coflex® interlaminar stabilization versus instrumented posterolateral lumbar fusion for the treatment of lumbar spinal stenosis and spondylolisthesis

    Directory of Open Access Journals (Sweden)

    Schmier JK

    2014-03-01

    Full Text Available Jordana Kate Schmier,1 Marci Halevi,2 Greg Maislin,3 Kevin Ong4 1Health Sciences, Exponent Inc., Alexandria, VA, USA; 2Paradigm LLC, New York, NY, USA; 3Biomedical Statistical Consulting, Wynnewood, PA, USA; 4Biomedical Engineering, Exponent Inc., Philadelphia, PA, USA Introduction: Symptomatic chronic low back and leg pain resulting from lumbar spinal stenosis is expensive to treat and manage. A randomized, controlled, multicenter US Food and Drug Administration Investigational Device Exemption clinical trial assessed treatment-related patient outcomes comparing the Coflex® Interlaminar Stabilization Device, an interlaminar stabilization implant inserted following decompressive surgical laminotomy in the lumbar spine, to instrumented posterolateral fusion among patients with moderate to severe spinal stenosis. This study uses patient-reported outcomes and clinical events from the trial along with costs and expected resource utilization to determine cost effectiveness. Methods: A decision-analytic model compared outcomes over 5 years. Clinical input parameters were derived from the trial. Oswestry Disability Index scores were converted to utilities. Treatment patterns over 5 years were estimated based on claims analyses and expert opinion. A third-party payer perspective was used; costs (in $US 2013 and outcomes were discounted at 3% annually. Sensitivity analyses examined the influence of key parameters. Analyses were conducted using Medicare payment rates and typical commercial reimbursements. Results: Five-year costs were lower for patients implanted with Coflex compared to those undergoing fusion. Average Medicare payments over 5 years were estimated at $15,182 for Coflex compared to $26,863 for the fusion control, a difference of $11,681. Mean quality-adjusted life years were higher for Coflex patients compared to controls (3.02 vs 2.97. Results indicate that patients implanted with the Coflex device derive more utility, on average, than

  11. Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis

    Science.gov (United States)

    Li, P.; Qian, L.; Wu, W. D.; Wu, C. F.

    2016-01-01

    Objectives Pedicle-lengthening osteotomy is a novel surgery for lumbar spinal stenosis (LSS), which achieves substantial enlargement of the spinal canal by expansion of the bilateral pedicle osteotomy sites. Few studies have evaluated the impact of this new surgery on spinal canal volume (SCV) and neural foramen dimension (NFD) in three different types of LSS patients. Methods CT scans were performed on 36 LSS patients (12 central canal stenosis (CCS), 12 lateral recess stenosis (LRS), and 12 foraminal stenosis (FS)) at L4-L5, and on 12 normal (control) subjects. Mimics 14.01 workstation was used to reconstruct 3D models of the L4-L5 vertebrae and discs. SCV and NFD were measured after 1 mm, 2 mm, 3 mm, 4 mm, or 5 mm pedicle-lengthening osteotomies at L4 and/or L5. One-way analysis of variance was used to examine between-group differences. Results In the intact state, SVC and NFD were significantly larger in the control group compared with the LSS groups (PCCS>FS>Control. After lengthening at L5 and L4-L5, the percentage increase in SCV (per millimetre) was LRS>FS>CCS>Control. After lengthening at L4 and L4-L5, the percentage increase in NFD (per millimetre) was FS>CCS>LRS>Control. After lengthening at L5, the percentage increase in NFD (per millimetre) was CCS>LRS>control>FS. Conclusions LRS patients are the most suitable candidates for treatment with pedicle-lengthening osteotomy. Lengthening L4 pedicles produced larger percentage increases in NFD than lengthening L5 pedicles (p lumbar spinal stenosis. Bone Joint Res 2016;5:239–246. DOI: 10.1302/2046-3758.56.2000469. PMID:27340140

  12. 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

  13. Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle

    Directory of Open Access Journals (Sweden)

    Ahn Kang

    2010-08-01

    Full Text Available Abstract Background This report describes the methodological approach and clinical application of a minimally invasive intervention to treat lumbar spinal stenosis (LSS. Methods Thirty-four patients with LSS underwent fluoroscopically guided transforaminal epidural dry needling using a specially designed flexed Round Needle. The needle was inserted 8-12 cm lateral to the midline at the level of the stenosis and advanced to a position between the anterior side of the facet joint and pedicle up to the outer-third of the pedicle. The needle was advanced medially and backed laterally within a few millimetres along the canal side of the inferior articular process between the facet joint and pedicle. The procedure was completed when a marked reduction in resistance was felt at the tip of the needle. The procedure was performed bilaterally at the level of the stenosis. Results The average follow-up period was 12.9 ± 1.1 months. The visual analogue scale (VAS pain score was reduced from 7.3 ± 2.0 to 4.6 ± 2.5 points, the Oswestry Disability Index (ODI score decreased from 41.4 ± 17.2 to 25.5 ± 12.6% and the average self-rated improvement was 52.6 ± 33.1%. The VAS scores indicated that 14 (41.2% patients reported a "good" to "excellent" treatment response, while 11 (32.4% had a "good" to "excellent" treatment response on the ODI and 22 (64.7% had a "good" to "excellent" treatment response on the self-rated improvement scale. Conclusions These results suggest that fluoroscopically guided transforaminal epidural dry needling is effective for managing LSS.

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

    Directory of Open Access Journals (Sweden)

    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].

  15. 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.

  16. Automated detection of spinal centrelines, vertebral bodies and intervertebral discs in CT and MR images of lumbar spine

    Science.gov (United States)

    Štern, Darko; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2010-01-01

    We propose a completely automated algorithm for the detection of the spinal centreline and the centres of vertebral bodies and intervertebral discs in images acquired by computed tomography (CT) and magnetic resonance (MR) imaging. The developed methods are based on the analysis of the geometry of spinal structures and the characteristics of CT and MR images and were evaluated on 29 CT and 13 MR images of lumbar spine. The overall mean distance between the obtained and the ground truth spinal centrelines and centres of vertebral bodies and intervertebral discs were 1.8 ± 1.1 mm and 2.8 ± 1.9 mm, respectively, and no considerable differences were detected among the results for CT, T1-weighted MR and T2-weighted MR images. The knowledge of the location of the spinal centreline and the centres of vertebral bodies and intervertebral discs is valuable for the analysis of the spine. The proposed method may therefore be used to initialize the techniques for labelling and segmentation of vertebrae.

  17. Clinical results of posterolateral fusion for degenerative lumbar spinal diseases. A follow-up study of more than 10 years

    Energy Technology Data Exchange (ETDEWEB)

    Kuroki, Hiroshi; Tajima, Naoya; Kubo, Shinichiro [Miyazaki Medical Coll., Kiyotake (Japan)

    2002-07-01

    The objective of this retrospective study was to evaluate the long-term clinical outcomes and the effects on unfused motion segments of posterolateral fusion. This study involved 35 cases (37 intervertebral levels) of posterolateral fusion performed to treat degenerative lumbar spinal diseases. There were 20 male and 15 female patients ranging in age from 30 to 67 years, with a mean age of 49 years. The postoperative period ranged from 10 years to 17 years and 8 months, with a mean period of 13 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for assessment of treatment for low back pain. The effects on unfused motion segments were investigated with radiographic and magnetic resonance (MR) imaging. Postoperative satisfactory improvement (mean recovery rate, 66.9%) reached a plateau at 1 year and was maintained at final follow-up. Radiographically, the union rate was 86.5%. There were few cases of induced instability of unfused motion segments. On MR imaging, increased signal intensity in both T{sub 1}- and T{sub 2}-weighted images was seen in the paravertebral muscles in 15 of 20 cases (75.0%). Posterolateral fusion is a useful technique for the treatment of degenerative lumbar spinal diseases. Clinical outcomes were stable throughout follow-up. Instability of unfused motion segments rarely occurred. (author)

  18. 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.

  19. 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

  20. Minimally invasive transforaminal lumbar interbody fusion aided with computer-assisted spinal navigation system combined with electromyography monitoring

    Institute of Scientific and Technical Information of China (English)

    LUO Wei; ZHANG Fan; LIU Tie; DU Xing-li; CHEN An-ming; LI Feng

    2012-01-01

    Background Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery,because they may have advantage over conventional open surgery in approach-related morbidity.This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring.Methods Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion.A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement.The operative duration,blood loss,complications,and fluoroscopic time were recorded.Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index.Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates.Results The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively.A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan.Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring.The average fluoroscopy time in each patient was 31.8 seconds,which equals to 7.9 seconds per pedicle screw.No patients had instrument related neurological complications,infection,implant failure or revision.Successful fusion was found in all patients.Conclusions The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement.

  1. The value of the dynamic mechanical spinal test in the management of automated percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Objective: To prospectively assess the predictive power of centralization phenomenon in the curative effect of automated PLD. Methods: The survey population was consisted of 109 patients with inclusion heraiation demonstrated by CT/MRI, 74 men and 35 women with average age of 43.1 years(17-75 years). All were complained of low back pain, with varying degrees of lower extremity pain and altered sensation, lasting for more than 2 months; including one symptomatic disc in 99 patients and two symptomatic discs in 10 patients. Patients were undergone dynamic mechanical spinal test and reported whether the test would aggravate their pain. The assessment included forward flexion, extension, rotation of the trunk to the right and left, rotation to the left with right extension, rotation to the right with left extension, and whether straight leg raising in the supine position would aggravate back pain or leg pain. Symptom resposes were categorized into three groups: centralization group (CG), partial-centralization group (PCG) and noncentralization group (NCG). Centralization of pain is the progressive retreat of the most distal extent of the referred or radicular pain toward or to the lumbar midline. Noncentralization of pain is the peripheralization of pain in one or more directions, and no change in the distal-most pain location or intensity. All patients received a single therapy with PLD. Results: A follow-up of 109 patients for 3 to 6 months, including 46 cases with 24 as exellent and 22 as good reaching 100% of excellent good rate in CG by MacNab standards; 43 cases with 5 as exellent, 29 as good, 9 as fair and poor, with total effective rate of 79.1% in PCG. Twenty cases of NCG symptoms showed no improvement and therefore surgery was considered. Conclusions: Centralization phenomenon occurrence during initial mechanical evaluation is a very accurate predictor for successful PLD outcome. Nonoccurrence of centralization would accurately predict poor PLD outcome and

  2. Acute Spinal Cord Ischemia during Aortography Treated with Intravenous Thrombolytic Therapy

    OpenAIRE

    Restrepo, Lucas; Guttin, Jorge F.

    2006-01-01

    Acute anterior spinal cord ischemia is a rare but disastrous complication of endovascular aortic procedures. Although intravenous thrombolysis with recombinant tissue plasminogen activator is an effective treatment for acute brain ischemia, its use for the treatment of spinal cord ischemia has not previously been reported. We report the case of a patient who developed anterior spinal cord ischemia during diagnostic aortography. He was treated with intravenous recombinant tissue plasminogen ac...

  3. 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。

  4. 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.

  5. Freeze-dried fibular allograft in anterior spinal surgery: cervical and lumbar applications.

    OpenAIRE

    Wetzel, F.T.; Hoffman, M. A.; Arcieri, R. R.

    1993-01-01

    Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assi...

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

    OpenAIRE

    Danner, Simon M.; Matthias Krenn; Hofstoetter, Ursula S.; Andrea Toth; Winfried Mayr; Karen Minassian

    2016-01-01

    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...

  7. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  9. 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.

  10. Abnormal growth of the corticospinal axons into the lumbar spinal cord of the hyt/hyt mouse with congenital hypothyroidism.

    Science.gov (United States)

    Hsu, Jung-Yu C; Stein, Stuart A; Xu, Xiao-Ming

    2008-11-01

    Thyroid hormone deficiency may cause severe neurological disorders resulting from developmental deficits of the central nervous system. The mutant hyt/hyt mouse, characterized by fetal-onset, life-long hypothyroidism resulting from a point mutation of the thyroid-stimulating hormone receptor of the thyroid gland, displays a variety of abnormalities in motor behavior that are likely associated with dysfunctions of specific brain regions and a defective corticospinal tract (CST). To test the hypothesis that fetal and neonatal hypothyroidism cause abnormal CST development, the growth of the CST was investigated in hypothyroid hyt/hyt mice and their euthyroid progenitors, the BALB/cByJ mice. Anterograde labeling with biotinylated dextran amine demonstrated a decrease in the number of CST axons in the hyt/hyt mouse at the first lumbar level at postnatal day (P) 10. After retrograde tracing with fast blue (FB), fewer FB-labeled neurons were found in the motor cortex, the red nucleus, and the lateral vestibular nucleus of the hyt/hyt mouse. At the fourth lumbar level, the hyt/hyt mouse also showed smaller CST cross-sectional areas and significantly lower numbers of unmyelinated axons, myelinated axons, and growth cones within the CST during postnatal development. At P10, the hyt/hyt mouse demonstrated significantly lower immunoreactivity of embryonic neural cell adhesion molecule in the CST at the seventh cervical level, whereas the expression of growth-associated protein 43 remained unchanged. Our study demonstrated an abnormal development of the CST in the hyt/hyt mouse, manifested by reduced axon quantity and retarded growth pattern at the lumbar spinal cord. PMID:18543337

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

    Science.gov (United States)

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

    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 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.

  13. [Acute ischemic spinal cord disease. Spinal cord infarction. A clinical study and MRI in 8 cases].

    Science.gov (United States)

    Pau Serradell, A

    1994-01-01

    Acute spinal cord infarction (ASCI) occurs infrequently and may have diverse causes. The diagnosis of ASCI, and particularly of an anterior spinal artery syndrome (ASAS) can be confirmed nowadays by MRI, whereas in the past only necropsy confirmation was possible. Pathophysiology and long-term prognosis may be better known at present and treatments more consistent. We present the longitudinal study and clinical features of 8 patients suffering from ASCI. All of them were personally studied and had MRI examinations, often with sequential studies. three groups must be considered: one included 4 cases of ASAS at cervical level, the second 2 cases of ASAS at thoracic level and the third group with infarction of the conus medullaris (ICM), one of them developed during surgical repair of an infrarenal aortic aneurysm. Motor and sensory sequelae were assessed in each case together with possible etiological factors. In conclusion, recovery after ASAS tends to be dependent on the severity of the initial deficit. At cervical level, clinical and morphological findings argue in favour of an extrinsic selective compression of the C7 right radiculo-medullary artery as responsible for the ASA. At thoracic level, the artery preferentially occluded seems to be the sulco-commisural artery as a consequence of disc compression. Finally, an underlying peculiarity of the pattern of arterial supply is a probable predisposing factor for ICM. Generally, the long-term prognosis of ASCI is not necessarily bad. PMID:7801036

  14. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery

    OpenAIRE

    Jankowitz, Brian T.; Atteberry, Dave S.; Gerszten, Peter C; Karausky, Patricia; Cheng, Boyle C.; Faught, Ryan; Welch, William C.

    2009-01-01

    Approximately one million spinal surgeries are performed in the United States each year. The risk of an incidental durotomy (ID) and resultant persistent cerebrospinal fluid (CSF) leakage is a significant concern for surgeons, as this complication has been associated with increased length of hospitalization, worse neurological outcome, and the development of CSF fistulae. Augmentation of standard dural suture repair with the application of fibrin glue has been suggested to reduce the frequenc...

  15. Spinal surgeons' learning curve for lumbar microendoscopic discectomy:a prospective study of our first 50 and latest 10 cases

    Institute of Scientific and Technical Information of China (English)

    RONG Li-min; XIE Pei-gen; SHI De-hai; DONG Jian-wen; LIU Bin; FENG Feng; CAI Dao-zhang

    2008-01-01

    Background Microendoscopic discectomy (MED) is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation,but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve.We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons'learning curve.Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each:A-E.The control group F was ten MED patients treated later by the same medical team (September-October 2006).All operations were performed by the same team of spinal surgeons with no MED experience before June 2002.We compared groups by operation time,blood loss,complications and need for open surgery after MED failure.Results Operation times by group were:A,(107±14) minutes;B,(85±13) minutes;C,(55±19) minutes;D,(52±12) minutes;E,(51±13) minutes;and F,(49±15) minutes.Blood loss were:A,(131±73) ml;B,(75±20) ml;C,(48±16) ml;D,(44±17) ml;E,(45±18) ml;and F,(45±16) ml.Both operation time and blood loss in groups C,D,E and F were smaller and more stable compared with groups A and B.Japanese Orthopedic Association assessment (JOA) score of each group in improvement rate immediately and one year after operation were as follows (in percentage):A,(79.8±8.8)/(89.8±7.7);B,(78.6±8.5)/(88.5±7.8);C,(80.8±11.3)/(90.8±6.7);D,(77.7±11.4)/(88.9±9.3);E,(84.0±8.7)/(89.6±9.0);and F,(77.8±11.6)/(86.9±8.4).Groups showed no statistical difference in improvement rates.Complications developed in three patients in group A,two in group B,and none in the other groups.Conclusions Spinal surgeons performing MED become proficient after 10-20 operations,when their skill becomes fairly sophisticated.Patients' improvement rate is the same regardless of surgeons' phase of learning curve.

  16. 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.

  17. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery

    Science.gov (United States)

    Balaji, V.; Kaila, R.; Wilson, L.

    2016-01-01

    Objectives We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. Methods The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion. Results A total of six studies (three prospective and three retrospective) reporting on the use of BMP2 met the inclusion criteria (203 patients). Of these, four provided a comparison of BMP2 and bone graft whereas the other two solely investigated the use of BMP2. The primary outcome was seen in 92.3% (108/117) of patients following surgery with BMP2. Although none of the studies showed superiority of BMP2 to bone graft for fusion, its use was associated with a statistically quicker time to achieving fusion. BMP2 did not appear to increase the risk of complication. Conclusion The use of BMP2 is both safe and effective within the revision setting, ideally in cases where bone graft is unavailable or undesirable. Further research is required to define its optimum role. Cite this article: Mr P. Bodalia. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery: A systematic review. Bone Joint Res 2016;5:145–152. DOI: 10.1302/2046-3758.54.2000418. PMID:27121215

  18. 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.

  19. A Study of Measurements of Spinal Canal at the Level of Lower Three Lumbar Vertebra by 16 Slice CT Scanner in Nepalese Population

    OpenAIRE

    Mukesh Mallik; Keshav Paudel; Nuwadatta Subedi; Sanjay Sah; Anish Subedee; Deepak Adhikari

    2015-01-01

    Background and Objective: The study was conducted with the objectives to establish the measurements of spinal canal and lumbar vertebra at L3 to L5 region in Nepalese population. Methodology: It is a cross-sectional study among 36 patients (17 males and 19 females) having age variation from 20-60years whose abdomen was scanned by GE bright speed 16 slice CT scanner with slice thickness 10mm and then reconstructed at 1.2mm for images in different body plains for the measurement of spinal canal...

  20. 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.

  1. 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.

  2. ICF Based Comprehensive Evaluation for Post-Acute Spinal Cord Injury

    OpenAIRE

    Nam, Hyung Seok; Kim, Kwang Dong; Shin, Hyung Ik

    2012-01-01

    Objective To evaluate the feasibility of the ICF for initial comprehensive evaluation of early post-acute spinal cord injury. Method A comprehensive evaluation of 62 early post-acute spinal cord injury (SCI) patients was conducted by rehabilitation team members, such as physicians, physical therapists, occupational therapists, nutritionists, medical social-workers, and nurses. They recorded each of their evaluation according to the ICF first level classification. The contents of the comprehen...

  3. 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

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

    OpenAIRE

    Karen Y.R. Nakagaki; Pâmela A. Lima; Kiyoko U. Utiumi; Marco A.M. Pires; Rosana Zanatta; Fabiana M Boabaid; Edson M. Colodel; Djeison L. Raymundo

    2015-01-01

    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 urin...

  5. 退行性腰椎管狭窄症的治疗进展%Progress on treatment of degenerative lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    穆小平(综述); 韦建勋(审校)

    2015-01-01

    With aging, the number of patients with degenerative lumbar spinal stenosis is going up quickly. Its morbidity ranks only second to lumbar disc herniation among lumbar diseases.There are a myriad of strategies used by orthopedist to treat lumbar spinal stenosis.However, the standard treatment is still unclear and controversial. Currently, the selection of management depends mainly on a doctor′s experience, which raises many great challenges to choose reasonable and effective treatment measures.%随着我国人口老年化的加剧,以退行性改变为主的腰椎管狭窄症患者不断增多。在腰椎疾患中,其发病率仅次于腰椎间盘突出症。虽然对于腰椎管狭窄症的治疗方法很多,但学术界至今未形成清晰统一的治疗标准,主要还是根据医师的经验来选择方案,这就给骨科医生在临床上选择合理有效的治疗方法提出了很大的挑战。该文就退行性腰椎管狭窄症的治疗进展进行综述。

  6. 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.

  7. 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.

  8. Decreased elastic fibers and increased proteoglycans in the ligamentum flavum of patients with lumbar spinal canal stenosis.

    Science.gov (United States)

    Yabe, Yutaka; Hagiwara, Yoshihiro; Tsuchiya, Masahiro; Honda, Masahito; Hatori, Kouki; Sonofuchi, Kazuaki; Kanazawa, Kenji; Koide, Masashi; Sekiguchi, Takuya; Itaya, Nobuyuki; Itoi, Eiji

    2016-07-01

    Elastic fibers and proteoglycans are major components of the extracellular matrix and their changes have been reported in some pathological conditions. Further, recent studies have indicated that some glycosaminoglycans and proteoglycans inhibit elastic fiber assembly. The purpose of this study was to investigate changes of the elastic fibers and proteoglycans in the ligamentum flavum and analyze their relationships to thickening of the ligamentum flavum from lumbar spinal canal stenosis (LSCS). Ligamentum flavum samples were collected from 20 patients with LSCS (thickened flavum group) and 10 patients with lumbar disc herniation (non-thickened flavum group) as a control. Elastica-Masson staining and alcian blue staining were used to compare the relationship between the changes in the elastic fibers and proteoglycans. Gene and protein expressions of the elastic fibers and proteoglycans were analyzed by quantitative reverse transcription polymerase chain reaction and immunohistochemistry. Histological changes indicated that proteoglycans mainly increased on the dorsal side of the ligamentum flavum in accordance with the decreased elastic fibers in the thickened flavum group. The gene and protein expressions of fibrillin-2 and DANCE were significantly lower and decorin, lumican, osteoglycin, and versican were significantly higher in the thickened flavum group. Our study shows that elastic fibers decrease and proteoglycans increase in the thickened ligamentum flavum. Decreased gene expression of elastogenesis and disrupted elastic fiber assembly caused by increased proteoglycans may lead to a loss of elasticity in the thickened ligamentum flavum. Decreased elasticity may cause buckling of the tissue, which leads to thickening of the ligamentum flavum. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1241-1247, 2016. PMID:26679090

  9. Effectiveness of surgery for lumbar spinal stenosis : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Machado, G.C. (Gustavo C.); P.H. Ferreira (P.); Harris, I.A. (Ian A.); Pinheiro, M.B. (Marina B.); B.W. Koes (Bart); M.W. van Tulder (Maurits); Rzewuska, M. (Magdalena); C. Maher (Chris); M.L. Ferreira (Manuela L.)

    2015-01-01

    textabstractBackground: The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the manage

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

    Science.gov (United States)

    Danner, Simon M; Krenn, Matthias; Hofstoetter, Ursula S; Toth, Andrea; Mayr, Winfried; Minassian, Karen

    2016-01-01

    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 recommend conducting

  11. 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

  12. 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.)

  13. 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

  14. Efficacy of laminectomy spinal fixation on degenerative lumbar spinal stenosis%全椎板切除脊柱内固定治疗老年退行性腰椎管狭窄症的疗效

    Institute of Scientific and Technical Information of China (English)

    胡德亚

    2015-01-01

    Objective To investgate the clinical effect and value of laminectomy spinal fixation on degenerative lumbar spinal stenosis .Methods The clinical data of 127 patients with degenerative lumbar spinal stenosis from January 2012 to January 2014 were retrospectively analyzed;the treatment effects were evaluated and compared .Results In using laminectomy spinal fixation experiment treatment group , the scores, patient satisfaction scores for postoperative VAS score , evaluation of postoperative JOA good rate , intervertebral relative distance were significantly better than those of the control group(P0.05 ) .Conclusions Within laminectomy spinal fixation surgery can significantly improve the treatment of degenerative lumbar spinal stenosis and postoperative VAS , JOA score, increase the intervertebral distance and help patients complete decompression , and can also maintain the degenerative lumbar spinal canal stability of the spine stenosis , so it is worth to promote the use in clinical practice .%目的 探讨全椎板切除脊柱内固定治疗老年退行性腰椎管狭窄症的临床效果及应用价值. 方法 回顾性分析晋中市第一人民医院骨科2012年1月至2014年1月收治的127 例老年退行性腰椎管狭窄患者的临床资料,对比观察两组不同治疗方法的治疗效果. 结果 运用全椎板切除脊柱内固定治疗的实验组治疗效果评分、患者满意度评分、术后VAS评分、术后JOA评价优良率、椎间相对距离均明显优于对照组( P0.05 ). 结论 全椎板切除脊柱内固定术能够显著提高老年退行性腰椎管狭窄症患者的治疗效果,改善术后VAS、JOA评分,增加椎间距离,帮助患者彻底减压,还可维持老年退行性腰椎管狭窄症患者的脊柱稳定性,值得在临床上加以推广应用.

  15. 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.

  16. 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.

  17. Lumbar Disc Screening Using Back Pain Questionnaires: Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screening Questionnaire

    OpenAIRE

    Kim, Do Yeon; Oh, Chang Hyun; Yoon, Seung Hwan; Park, Hyung Chun; Park, Chong Oon

    2012-01-01

    Objective To evaluate the usefulness of back pain questionnaires for lumbar disc screening among Korean young males. Methods We carried out a survey for lumbar disc screening through back pain questionnaires among the volunteers with or without back pain. Three types of back pain questionnaire (Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screeing Questionnaire) were randomly assigned to the examinees. The authors reviewed lumbar imaging studies (simple ...

  18. 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.

  19. 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.

  20. Lumbar Disc Screening Using Back Pain Questionnaires: Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screening Questionnaire

    Science.gov (United States)

    Kim, Do Yeon; Oh, Chang Hyun; Park, Hyung Chun; Park, Chong Oon

    2012-01-01

    Objective To evaluate the usefulness of back pain questionnaires for lumbar disc screening among Korean young males. Methods We carried out a survey for lumbar disc screening through back pain questionnaires among the volunteers with or without back pain. Three types of back pain questionnaire (Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screeing Questionnaire) were randomly assigned to the examinees. The authors reviewed lumbar imaging studies (simple lumbar radiographs, lumbar computed tomography, and magnetic resolutional images), and the severity of lumbar disc herniation was categorized according to the guidelines issued by the Korean military directorate. We calculated the relationship between the back pain questionnaire scores and the severity of lumbar disc herniation. Results The scores of back pain questionnaires increased according to the severity of lumbar disc herniation. But, the range of scores was very vague, so it is less predictable to detect lumbar disc herniation using only back pain questionnaires. The sensitivity between the back pain questionnaires and the presence of lumbar disc herniation was low (16-64%). Conclusion Screening of lumbar disc herniation using only back pain questionnaires has limited value. PMID:25983807

  1. Transplantation of an Acutely Isolated Bone Marrow Fraction Repairs Demyelinated Adult Rat Spinal Cord Axons

    OpenAIRE

    SASAKI, MASANORI; HONMOU, OSAMU; Akiyama, Yukinori; Uede,Teiji; Hashi,Kazuo; Kocsis, Jeffery D.

    2001-01-01

    The potential of bone marrow cells to differentiate into myelin-forming cells and to repair the demyelinated rat spinal cord in vivo was studied using cell transplantation techniques. The dorsal funiculus of the spinal cord was demyelinated by x-irradiation treatment, followed by microinjection of ethidium bromide. Suspensions of a bone marrow cell fraction acutely isolated from femoral bones in LacZ transgenic mice were prepared by centrifugation on a density gradient (Ficoll-Paque) to remov...

  2. 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.

  3. Acute vertebral fracture after spinal fusion: a case report illustrating the added value of single-source dual-energy computed tomography to magnetic resonance imaging in a patient with spinal Instrumentation.

    Science.gov (United States)

    Fuchs, M; Putzier, M; Pumberger, M; Hermann, K G; Diekhoff, T

    2016-09-01

    Magnetic resonance imaging (MRI) is degraded by metal-implant-induced artifacts when used for the diagnostic assessment of vertebral compression fractures in patients with instrumented spinal fusion. Dual-energy computed tomography (DECT) offers a promising supplementary imaging tool in these patients. This case report describes an 85-year-old woman who presented with a suspected acute vertebral fracture after long posterior lumbar interbody fusion. This is the first report of a vertebral fracture that showed bone marrow edema on DECT; however, edema was missed by an MRI STIR sequence owing to metal artifacts. Bone marrow assessment using DECT is less susceptible to metal artifacts than MRI, resulting in improved visualization of vertebral edema in the vicinity of fused vertebral bodies. PMID:27270922

  4. Lumbar Stenosis: A Recent Update by Review of Literature.

    Science.gov (United States)

    Lee, Seung Yeop; Kim, Tae-Hwan; Oh, Jae Keun; Lee, Seung Jin; Park, Moon Soo

    2015-10-01

    Degeneration of the intervertebral disc results in initial relative instability, hypermobility, and hypertrophy of the facet joints, particularly at the superior articular process. This finally leads to a reduction of the spinal canal dimensions and compression of the neural elements, which can result in neurogenic intermittent claudication caused by venous congestion and arterial hypertension around nerve roots. Most patients with symptomatic lumbar stenosis had neurogenic intermittent claudication with the risk of a fall. However, although the physical findings and clinical symptoms in lumbar stenosis are not acute, the radiographic findings are comparatively severe. Magnetic resonance imaging is a noninvasive and good method for evaluation of lumbar stenosis. Though there are very few studies pertaining to the natural progression of lumbar spinal stenosis, symptoms of spinal stenosis usually respond favorably to non-operative management. In patients who fail to respond to non-operative management, surgical treatments such as decompression or decompression with spinal fusion are required. Restoration of a normal pelvic tilt after lumbar fusion correlates to a good clinical outcome. PMID:26435805

  5. Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments.

    Science.gov (United States)

    Alexandre, A; Corò, L; Paradiso, R; Dall'aglio, R; Alexandre, A M; Fraschini, F; Spaggiari, P G

    2011-01-01

    Research in spine surgery has proposed new soft and less invasive techniques. These are the results of our experience with oxygen-ozone therapy, which we could experiment within the Italian National Health System over 3 years. A total of 1,920 patients were admitted on the basis of unselected enrolment because of lumbosciatic pain. Patients were divided into three groups: (A) Patients with degenerative disc disease and arthropathy: 509 (26.5%), (B) Patients with failed back surgery syndrome (FBSS): 1,027 (53.489%), and (C) Patients with pure herniated lumbar disc: 384 (20%). The rationale of the treatment for all these different pathologies we have taken into consideration is the biochemical mechanism by which they can engender pain and dysfunction. Treatment for group A: paravertebral injection and phleboclysis (two cycles of 6 sessions, one each 3 days) +endoscopic neurolysis. Treatment for group B: paravertebral injection and phleboclysis (two cycles of 6 sessions, one each 3 days) + endoscopic neurolysis with intradiscal procedure (named percutaneous peridurodiscolysis). Treatment for group C: paravertebral injection (two cycles of 6 sessions, one each 3 days) + percutaneous discolysis.The perceived quality of result for this minimally invasive procedure makes oxygen-ozone therapy an interesting weapon in the hands of doctors. Furthermore, if the technique loses its clinical effectiveness, it can be repeated without harm for the patient, and costs for the health organization are notably very low, above all if compared to surgical procedures.We underline the need that this treatment should be performed in protected structures, in operative rooms, under anesthesiologic control, and in the hands of specialists. PMID:21107949

  6. The use of PRV-Bartha to define premotor inputs to lumbar motoneurons in the neonatal spinal cord of the mouse.

    Directory of Open Access Journals (Sweden)

    Ksenija Jovanovic

    Full Text Available BACKGROUND: The neonatal mouse has become a model system for studying the locomotor function of the lumbar spinal cord. However, information about the synaptic connectivity within the governing neural network remains scarce. A neurotropic pseudorabies virus (PRV Bartha has been used to map neuronal connectivity in other parts of the nervous system, due to its ability to travel trans-neuronally. Its use in spinal circuits regulating locomotion has been limited and no study has defined the time course of labelling for neurons known to project monosynaptically to motoneurons. METHODOLOGY/PRINCIPAL FINDINGS: Here we investigated the ability of PRV Bartha, expressing green and/or red fluorescence, to label spinal neurons projecting monosynaptically to motoneurons of two principal hindlimb muscles, the tibialis anterior (TA and gastrocnemius (GC. As revealed by combined immunocytochemistry and confocal microscopy, 24-32 h after the viral muscle injection the label was restricted to the motoneuron pool while at 32-40 h the fluorescence was seen in interneurons throughout the medial and lateral ventral grey matter. Two classes of ipsilateral interneurons known to project monosynaptically to motoneurons (Renshaw cells and cells of origin of C-terminals were consistently labeled at 40 h post-injection but also a group in the ventral grey matter contralaterally. Our results suggest that the labeling of last order interneurons occurred 8-12 h after motoneuron labeling and we presume this is the time taken by the virus to cross one synapse, to travel retrogradely and to replicate in the labeled cells. CONCLUSIONS/SIGNIFICANCE: The study establishes the time window for virally-labelling monosynaptic projections to lumbar motoneurons following viral injection into hindlimb muscles. Moreover, it provides a good foundation for intracellular targeting of the labeled neurons in future physiological studies and better understanding the functional organization of

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. Axon diameter and myelin sheath thickness in nerve fibres of the ventral spinal root of the seventh lumbar nerve of the adult and developing cat.

    OpenAIRE

    Berthold, C H; Nilsson, I; Rydmark, M

    1983-01-01

    The axon diameter (d) and the number of myelin sheath lamellae (nl) were estimated in electron micrographs of cross sectioned ventral spinal roots of the seventh lumbar nerve of adult cats, kittens and cat fetuses. Myelination started between the 40th and the 45th day after mating (about 3 weeks before birth). From birth onwards the calibre spectrum consisted of a group of small fibres and a group of large fibres. During the first two postnatal months the point distribution of the number of m...

  12. A non-linear finite element model of human L4-L5 lumbar spinal segment with three-dimensional solid element ligaments

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    This paper establishes a non-linear finite element model (NFEM) of L4-L5 lumbar spinal segment with accurate three-dimensional solid ligaments and intervertebral disc. For the purpose, the intervertebral disc and surrounding ligaments are modeled with four-nodal three-dimensional tetrahedral elements with hyper-elastic material properties. Pure moment of 10 N·m without preload is applied to the upper vertebral body under the loading conditions of lateral bending, backward extension, torsion, and forward fle...

  13. Minimally Invasive Lumbar Discectomy

    Medline Plus

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

  14. 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.)

  15. 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.)

  16. Myeloid Sarcoma: An Unusual Presentation of Acute Promyelocytic Leukemia Causing Spinal Cord Compression

    OpenAIRE

    Tay Za Kyaw; Jayaranee A.s. Maniam; Ping Chong Bee; Edmund Fui Min Chin; Veera Sekaran Nadarajan; Hemalatha Shanmugam; Khairul Azmi Abd Kadir

    2012-01-01

    Acute promyelocytic leukemia with concurrent myeloid sarcoma is a rare clinical event. Herein we describe a patient that presented with back pain and bilateral leg weakness caused by spinal cord compression due to extramedullary deposition of leukemic cells. Acute promyelocytic leukemia was suspected based on immunophenotypic findings of malignant cells in bone marrow aspirate. The diagnosis was confirmed by the presence of PML-RARα fusion copies. MRI showed multiple hyperintense changes on t...

  17. 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.

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

    Science.gov (United States)

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

    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 this study is done. Methods The assessment of muscle spasm was made by measuring the finger-to-floor distance (FFD), articular excursion in degrees on performing Lasegue's maneuver and modified Schober's test. Assessment of pain on movement and spontaneous pain (pain at rest) of the lumbar spine was made with the help of visual analogue scale score. Results The improvement in articular excursion on Lasegue's maneuver was significantly greater on day 3 (p = 0.017) and day 7 (p = 0.0001) with Tolperisone as compared to Thiocolchicoside. The reduction in FFD score was greater on day 7 (p = 0.0001) with Tolperisone. However there was no significant difference in improvement in Schober's test score on day 3 (p = 0.664) and day 7 (p = 0.192). The improvement in pain score at rest and on movement was significantly greater with Tolperisone (p = 0.0001). Conclusions Tolperisone is an effective and well tolerated option for treatment of patients with skeletal muscle spasm associated with pain. PMID:22708015

  19. Value of multidetector spiral CT in diagnosis of acute thoracolumbar spinal fracture and fracture-dislocation

    Institute of Scientific and Technical Information of China (English)

    龚静山; 徐坚民

    2004-01-01

    Objective:To investigate the diagnostic value of multidetector spiral CT (MSCT) in acute thoracolumbar spinal fracture and fracture-dislocation.Methods: CT imaging files of 152 consecutive traumatic patients with thoracolumbar fractures were retrospectively reviewed. MSCT scannings were performed with a collimation of 3-5 mm and a pitch of 5.5. The postprocessing included sagittal and coronal multiplannar reconstruction, and 3-D reconstruction.Result: There were 88 cases of compression fracture, 54 cases of burst fracture and 10 cases of fracasdislocation. Transverse images of MSCT could visualize all fractures directly and determine whether spinal canal was intact. Postprocessing image was helpful in depicting the displacement of fragment and orientation of dislocation.Conclusions: MSCT plays an important role in diagnosis and management of acute thoracolumbar spinal fracture and fracture-dislocation.

  20. Spinal manipulative therapy for acute low back pain: an update of the cochrane review

    NARCIS (Netherlands)

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

    2013-01-01

    STUDY DESIGN: Systematic review of interventions. OBJECTIVE: To assess the effects of spinal manipulative therapy (SMT) for acute low back pain. SUMMARY OF BACKGROUND DATA: SMT is one of many therapies for the treatment of low back pain, which is a worldwide, extensively practiced intervention. METH

  1. Spinal manipulative therapy for acute low back pain: an update of the cochrane review

    NARCIS (Netherlands)

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

    2013-01-01

    STUDY DESIGN: Systematic review of interventions. OBJECTIVE: To assess the effects of spinal manipulative therapy (SMT) for acute low back pain. SUMMARY OF BACKGROUND DATA: SMT is one of many therapies for the treatment of low back pain, which is a worldwide, extensively practiced intervention. METH

  2. 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

  3. 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.).

  4. 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。

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. 50例胸腰椎爆裂性骨折并椎管狭窄的临床疗效观察%The Observation of Clinical Effection of 50 Patients with Thoracic Lumbar Spinal Bursting Fracture and ;Spinal Stenosis

    Institute of Scientific and Technical Information of China (English)

    黄毅

    2015-01-01

    Objective:To explore the clinical effect of lumbar anterior secondary resection,titanium cage implantation combined with plate fixation for the treatment of thoracic lumbar spinal bursting fracture and spinal stenosis. Method:50 cases of patients in our hospital from January 2011 to August 2014 were collected,randomly and blindly divided them into observation group and control group ,25 cases in each group,the observation group was given lumbar anterior secondary resection,titanium cage implantation combined with plate fixation for the treatment and the control group was given lumbar anterior secondary resection combined with plate fixation for the treatment,the surgery situations of the two groups as well as the nerve function recovery situation after operation were observed.Result:The nerve function of the observation group before the operation and out of the hospital was obviously better than the control group after surgery,the difference was statistically significant(χ²=8.33,P0.05).Conclusion:Lumbar anterior secondary resection,titanium cage implantation combined with plate fixation for the treatment of thoracic lumbar spinal bursting fracture and spinal stenosis have affirmed effect after operation as well as the nerve function recovery situation after operation.%目的:探讨腰椎前路次切除、钛笼植入联合钢板内固定术治疗腰椎爆裂性骨折并椎管狭窄疗效。方法:选择本院2011年1月-2014年8月间收治50例患者,随机盲取法分为观察组与对照组各25例,观察组采用腰椎前路次切除、钛笼植入联合钢板内固定术治疗,对照组给予前路椎体次切除钢板内固定术治疗,观察两组手术情况、术后神经功能恢复情况。结果:观察组出院前神经功能评定,明显优于治疗前及对照组治疗后,两组比较差异有统计学意义(字2=8.33,P0.05)。结论:腰椎前路次切除、钛笼植入联合钢板内固定术治疗胸腰椎爆裂性骨折

  12. 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.)

  13. 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.

  14. Lumbar paraganglioma.

    Science.gov (United States)

    Dillard-Cannon, Erika; Atsina, Kofi-Buaku; Ghobrial, George; Gnass, Esteban; Curtis, Mark T; Heller, Joshua

    2016-08-01

    Spinal paragangliomas (SP) are benign and overall rare extra-adrenal neuroendocrine tumors often diagnosed during workup for lower back pain. Complete surgical resection achieves both symptomatic relief and cure. We present a 32-year-old man with a longstanding history of lumbago and bilateral lower extremity pain found to have a lumbar paraganglioma at the level of the L3 vertebrae. The clinical, histopathological, and radiological characteristics are described, including the rare finding of superficial siderosis on MRI of the brain. A laminectomy with microscopic dissection of the intradural mass achieved complete debulking without evidence of residual tumor. Excellent prognosis can be achieved with complete surgical resection of SP without the need for adjuvant therapy. Therefore, care should be taken to distinguish these spinal tumors from those that appear similar but are more aggressive. As such, the radiological finding of superficial siderosis should raise the suspicion for SP when a vascular intradural extramedullary spinal tumor is observed. PMID:27032749

  15. PROPELLER Diffusion-Weighted Magnetic Resonance Imaging of Acute Spinal Epidural Hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, H.; Oki, K.; Momoshima, S.; Kuribayashi, S. [Keio Univ. School of Medicine (Japan). Dept. of Diagnostic Radiology and Dept. of Neurology

    2005-08-01

    We present the case of an 86-year-old female with spontaneous spinal epidural hematoma. Although T1- and T2-weighted images showed the dilated posterior epidural space at the cervical spine, this finding was non-specific on conventional magnetic resonance imaging obtained 15 h after the onset of symptoms. Diffusion-weighted imaging with the use of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER), which clearly revealed the high intensity hematoma, was useful for detection and diagnosis of acute spinal epidural hematoma.

  16. [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

  17. 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

  18. 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

    2016-06-01

    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

  19. 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.

  20. Injury potentials associated with severity of acute spinal cord injury in an experimental rat model

    Institute of Scientific and Technical Information of China (English)

    Suying Pan; Guanghao Zhang; Xiaolin Huo; Jinzhu Bai; Tao Song

    2011-01-01

    To investigate characteristics of injury potentials after different degrees of spinal cord injury in rats, the present study established models of spinal cord contusion with severe, moderate, and mild degrees of injury. Injury potential was measured in vivo using a direct current voltage amplification system. Results revealed that in the first 4 hours after acute spinal cord injury, initial amplitude of injury potential was greatest after severe injury, followed by moderate and mild injuries. Amplitude of injury potential decreased gradually with injury time, and the recession curve was logarithmic. Under the same degree of injuries, amplitude of rostral injury potential was generally less than caudal injury potential. Results suggested that injury potential reflected injury severity, because large initial amplitude of injury potential during the early injury stage implied severe injury.

  1. Spinal intramedullary hamartoma with acute presentation in a 13-month old infant: case report.

    Science.gov (United States)

    Samak, Eslam M; Abdel Latif, Assem M; Ghany, Walid Abdel; Hewedi, Iman H; Amer, Aboubakr; Moharram, Hussein

    2016-08-01

    True hamartomas of the spinal cord are very rare, and although several have been reported in the literature, there are few detailed radiological and pathological descriptions of the condition. There is also considerable overlap with other entities, the most common being spinal cord teratomas. The authors report the case of a 13-month-old child with a supragluteal sacral dimple who presented with acute neurological deterioration. MRI of the spine revealed a big intramedullary lesion with heterogeneous signal intensity. A near-total resection was performed, and histopathological examination demonstrated findings consistent with a spinal cord hamartoma. The authors believe that careful preoperative evaluation and rigorous pathological examination are mandatory to establish diagnosis and direct further management of cases in which such a lesion is suspected. PMID:27127875

  2. 虚拟仿真手术在腰椎转移性肿瘤中的应用%Application of virtual simulation surgery in lumbar spinal metastases

    Institute of Scientific and Technical Information of China (English)

    贺小兵; 刘登均; 王明贵; 殷浩; 王海; 李争艳; 李旭

    2015-01-01

    目的:通过探索虚拟现实技术来寻找一种施行经前后路联合治疗腰椎转移性肿瘤的途径。方法基于腰椎64排螺旋CT连续薄层二维图像,Mimics软件分别重建正常腰椎、破坏病椎、腹主动脉及双侧肾脏的三维可视化结构,在三维模型拟行经过前路病灶清除、钛网骨水泥支撑和后路椎弓根螺钉内固定术。结果基于Dicom格式数据进行三维重建图像结构清晰,可真实再现病椎和邻近脏器的结构,整个虚拟仿真手术真实直观。结论虚拟仿真手术可准确重建腰椎恶性肿瘤及邻近结构的三维立体结构,明确病椎清除范围,经后路重建脊柱序列,能为患者个体化治疗方案提供客观依据。%Objective Through the exploration of virtual simulation surgery to find a way to treat lumbar spinal metastases. Methods Based on 64 row spiral CT continuous 2-dimensional images of lumbar segments, normal lumbar vertebral, destruction of disease, abdominal aorta and kidneys were reconstructed by the Mimics software. 3D visualization structure was contemplated by anterior lesions clear, titanium mesh of bone cement support, and posterior pedicle screw fixation. Results The three-dimensional reconstruction distinctly displayed the structures of lumbar and its adjacent organs, and the entire virtual simulation surgery was intuitive. Conclusion The application of virtual simulation surgery ensures more accurate 3D model of lumbar establishment and its adjacent organs, and it provides an objective basis for in-dividualized treatment programs.

  3. 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.

  4. Validation of the Polish language version of the SF-36 Health Survey in patients suffering from lumbar spinal stenosis

    Directory of Open Access Journals (Sweden)

    Michał Kłosiński

    2014-11-01

    Full Text Available [b]introduction and objective[/b]. Patient-reported outcome (PRO questionnaires have become the standard measure for treatment effectiveness after spinal surgery. One of the most widely used generic PROs is the SF-36 Health Survey. The aim of this study was to specifically focus on validating the SF-36 Health Survey to confirm that the tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish patients with spinal stenosis. [b]materials and methods[/b]. Patients were eligible if they were above 18 years of age and had been qualified for spine surgery of the lumbar region due to either discopathy or non-traumatic spinal stenosis. All patients filled-in the Polish version of the SF-36 and a demographic questionnaire. Standard validity and reliability analyses were performed. [b]results.[/b] 192 patients (83 women – 43.2% agreed to take part in the study (mean age: 57.5±11.4 years. In 47 patients (24.5%, using MRI, ossification of the ligamenta flava were found. Cronbach’s alpha coefficients showed positive internal consistency (0.70–0.92. Interclass correlations for the SF-36 ranged from 0.72 – 0.86 and proved appropriate test-retest reliability. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. [b]conclusions.[/b] The Polish version of the SF-36 is a reliable and valid tool for measuring HRQoL in patients with spinal stenosis. It can be recommended for use in clinical and epidemiological settings in the Polish population. However, caution is warranted when interpreting the results of the ‘role limitations due to physical health problems’ and the ‘role limitations due to emotional problems’ scales because of floor and ceiling effects.

  5. 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

  6. Ultrasound guided, painful electrical stimulation of lumbar facet joint structures: an experimental model of acute low back pain.

    Science.gov (United States)

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

    2009-07-01

    Quantitative sensory testing has indicated generalized muscle hyperalgesia in patients with chronic low back pain. The temporal development of such hyperalgesia is not well understood. The aim of the present study was to demonstrate whether generalized muscle hyperalgesia can develop within minutes of acute low back pain using a new experimental model of lumbar facet joint pain. Thirteen healthy volunteers were included and baseline pressure pain thresholds were assessed at eight separate sites, outside the area of evoked low back and referred pain. Using ultrasonography, two electrode needles were placed either side of a lumbar facet joint (right L3-4) and used to induce experimental low back pain for 10 min with continuous stimulation. Thresholds, stimulus-response relationships, distribution and quality of the electrically induced pain were recorded. Electrical facet joint stimulation induced low back pain and pain referral into the anterior leg, ipsilaterally, proximal to the knee, similar to what is observed clinically. Pressure pain thresholds did not change significantly before, during and after facet joint stimulation. In conclusion, we describe a novel model of acute experimental low back pain and demonstrate that generalized hyperalgesia did not develop within minutes of acute low back pain. PMID:19376652

  7. 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.

  8. 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

  9. 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.

  10. Overexpression of BDNF Increases Excitability of the Lumbar Spinal Network and Leads to Robust Early Locomotor Recovery in Completely Spinalized Rats

    OpenAIRE

    Ewelina Ziemlińska; Sebastian Kügler; Melitta Schachner; Iwona Wewiór; Julita Czarkowska-Bauch; Małgorzata Skup

    2014-01-01

    Strategies to induce recovery from lesions of the spinal cord have not fully resulted in clinical applications. This is a consequence of a number of impediments that axons encounter when trying to regrow beyond the lesion site, and that intraspinal rearrangements are subjected to. In the present study we evaluated (1) the possibility to improve locomotor recovery after complete transection of the spinal cord by means of an adeno-associated (AAV) viral vector expressing the neurotrophin brain-...

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

    Directory of Open Access Journals (Sweden)

    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

  12. 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

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

    Directory of Open Access Journals (Sweden)

    Thomas Platz

    2016-01-01

    Full Text Available 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.

  14. 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. PMID:27610382

  15. 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...... stabilizing lumbar surgery with metallic implants. The SPECT/CT findings were compared with observations from subsequent surgical reexploration. RESULTS: In 6 of 9 patients, the SPECT/CT fully or partially detected the vertebral level of loose pedicle screws. Of 9 cases, 2 were considered inconclusive...

  16. 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...

  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. Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration: a magnetic resonance imaging study in young Finnish male conscripts.

    Science.gov (United States)

    Visuri, Tuomo; Ulaska, Jaana; Eskelin, Marja; Pulkkinen, Pekka

    2005-11-01

    The objective of this magnetic resonance imaging study was to evaluate the role of degenerative changes, developmental spinal stenosis, and compression of spinal nerve roots in chronic low back (CLBP) and radicular pain in Finnish conscripts. The degree of degeneration, protrusion, and herniation of the intervertebral discs and stenosis of the nerve root canals was evaluated, and the midsagittal diameter and cross-sectional area of the lumbar vertebrae canal were measured in 108 conscripts with CLBP and 90 asymptomatic controls. The midsagittal diameters at L1-L4 levels were significantly smaller in the patients with CLBP than in the controls. Moreover, degeneration of the L4/5 disc and protrusion or herniation of the L5/S1 disc and stenosis of the nerve root canals at level L5/S1 were more frequent among the CLBP patients. Multifactorial analysis of the magnetic resonance imaging findings provided a total explanatory rate of only 33%. Narrowing of the vertebral canal in the anteroposterior direction was more likely to produce CLBP and radiating pain than intervertebral disc degeneration or narrowing of the intervertebral nerve root canals. PMID:16450819

  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

    Directory of Open Access Journals (Sweden)

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

    Directory of Open Access Journals (Sweden)

    Endres Stefan

    2011-11-01

    Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients

  1. The treatment of degenerative lumbar spinal stenosis with Coflex system%Coflex系统治疗退行性腰椎管狭窄症

    Institute of Scientific and Technical Information of China (English)

    隋福革; 赵丛然; 汪群; 韩秀英; 周冰; 李恒; 王强; 何晓峰

    2011-01-01

    Objective To investigate the clinical value of spinal nonfusion interspinous Coflex system for the degenerative lumbar spinal stenosis.Methods From March 2008 to August 2009,26 patients with degenerative lumbar spinal stenosis were treated by decompression with posterior spinous process and interspinous implant Coflex folder method,including 11 males and 15 females,with the mean age of 65.4years(range,45-78 years).L3,4 segment in 7 cases,L4,5 segment in 13 cases,concomitant L3,4,L4,5 segment stenosis in 6 cases.Patients were scanned by MRI and CT confirmed L3,4 and(or)L4,5 segments of the ligamentum flavum thickening,proliferation of small-joint bone,merger disc herniation causing central tube and lateral fossae stricture,nerve root or coccygeal plexus compression.Lumbar anteroposterior,lateral and flexion-extension X-ray films preoperatively,and at follow-up were used to measure the following parameters by eFilm and CAD software:the anterior and posterior disc space height,the range of motion at surgical level,and the segment of the spinal canal area of responsibility.Postoperative standard Japanese Orthopaedic Association(JOA)score for preoperative and postoperative scores.Results Patients were followed up 12-24months.The pain relieved in all patients.The JOA scores improved from(15.46 ±4.30)preoperatively to (24.50±1.58)postoperatively,the vertebral canal area of the affected segment was(218.4±16.2)mm2 before the operation,(264.6±9.9)mm2 after the operation.Single segment anterior disc space height did not change significantly,the difference was not statistically significant.The disc space posterior height increased compared with the preoperative height,and gradually decreased with time.No patients suffered Coflex loosening,fracture and emerge.Conclusion The treatment of lumbar spinal stenosis with Coflex system has satisfactory effect in minimal invasiveness and high security,which provides a safe and effective therapy for degenerative lumbar spinal

  2. Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration

    International Nuclear Information System (INIS)

    The objective of this study was to demonstrate lumbosacral interspinous ligament rupture, with or without related acute intrinsic spinal muscle degeneration. This study consisted of a prospective imaging analysis of consecutive 100 MRI studies in adult patients (mean age 56 years) presenting with low back pain. Alterations from the normal in the inter- and perispinal structures of the spine and perispinal soft tissues (e.g., spinal ligaments, perispinal muscles) were sought based upon studies on young volunteers without low back pain (n=10; mean age 23 years). Compared with the group without low back pain, many index cases (n=71, 71%) demonstrated hyperintensity (i.e., sprain or frank ligamentous rupture) of the interspinous ligament(s) on T2-weighted, fat-suppressed MRI studies at one (20 of 71, 28%) or multiple (51 of 71, 72%) levels. Associated intrinsic spinal muscle (e.g., interspinalis, multifidus muscles) degeneration was observed in a minority of cases overall (n=7, 7%), but was only seen in association with cases also demonstrating interspinous ligament degeneration/rupture (7 of 71, 10%). Lumbosacral interspinous ligament sprain or frank rupture, as well as related acute-subacute autotraumatic intrinsic spinal muscle rupture/degeneration, may be overlooked by many observers if fat-suppressed, T2-weighted MRI is not acquired. These musculoligamentous alterations are on occasion the only abnormalities recognized on MRI of the lumbosacral spine and may theoretically be sources of low back morbidity that potentially may respond to specific therapy. Because this study was an observational one, based solely upon medical imaging, future research must focus upon the correlation of the relevance of these findings with an age-matched asymptomatic control group and longitudinal clinicoradiologic therapeutic trials. (orig.)

  3. Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration

    Energy Technology Data Exchange (ETDEWEB)

    Jinkins, Randy J. [Neuroimaging Research, Department of Radiologic Sciences, Medical College of Pennsylvania-Hahnemann, Drexel University, 245 North 15th Street-Mail Stop 206, Philadelphia, PA 19102-1192 (United States)

    2002-09-01

    The objective of this study was to demonstrate lumbosacral interspinous ligament rupture, with or without related acute intrinsic spinal muscle degeneration. This study consisted of a prospective imaging analysis of consecutive 100 MRI studies in adult patients (mean age 56 years) presenting with low back pain. Alterations from the normal in the inter- and perispinal structures of the spine and perispinal soft tissues (e.g., spinal ligaments, perispinal muscles) were sought based upon studies on young volunteers without low back pain (n=10; mean age 23 years). Compared with the group without low back pain, many index cases (n=71, 71%) demonstrated hyperintensity (i.e., sprain or frank ligamentous rupture) of the interspinous ligament(s) on T2-weighted, fat-suppressed MRI studies at one (20 of 71, 28%) or multiple (51 of 71, 72%) levels. Associated intrinsic spinal muscle (e.g., interspinalis, multifidus muscles) degeneration was observed in a minority of cases overall (n=7, 7%), but was only seen in association with cases also demonstrating interspinous ligament degeneration/rupture (7 of 71, 10%). Lumbosacral interspinous ligament sprain or frank rupture, as well as related acute-subacute autotraumatic intrinsic spinal muscle rupture/degeneration, may be overlooked by many observers if fat-suppressed, T2-weighted MRI is not acquired. These musculoligamentous alterations are on occasion the only abnormalities recognized on MRI of the lumbosacral spine and may theoretically be sources of low back morbidity that potentially may respond to specific therapy. Because this study was an observational one, based solely upon medical imaging, future research must focus upon the correlation of the relevance of these findings with an age-matched asymptomatic control group and longitudinal clinicoradiologic therapeutic trials. (orig.)

  4. 后路内窥镜下髓核摘除术联合椎间融合固定治疗腰椎退变失稳性椎间盘突出症%Posterior endoscopic discectomy combined with lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability

    Institute of Scientific and Technical Information of China (English)

    焦峰; 张强; 纪玉清; 丛伟; 韩磊祥

    2012-01-01

    Objective To discuss the clinical efficacy of posterior endoscopic discectomy combined with expandable spinal spacer (B-Twin) lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability. Methods 22 patients with lumbar intervertebral disc protrusion and degenerative lumbar spinal instability in our hospital from November 2007 to November 2009 were selected. All the patients were treated with posterior endoscopic discectomy combine with B-Twin lumbar interbody fusion. JOA score was used to evaluation before operation, one week after operation and the last follow-up, recovery rate was calculated. Conditions of interbody fusion and disc height height change were observed by X-line and CT during reexamination. Results All 22 patients were smoothly finished operation. The operation time was 70-110 min, average of 83 min; amount of bleeding was 200-400 mL, average of 280 mL. All the patients were followed up for 16-40 months, average of 34.3 months. Average JOA score of before operation was 14.8 scores, which of the last time follow-up was 27.6 scores,the improvement rate was 75%-100%. The reexamination of X-line and CT showed that the height of intervertebral lost rate was 18% (4/22) and the lumbar interbody fusion rate is 86% (19/22). There was no complication, such as infection, hematoma, nerve injury, B-twin falling off. Conclusion Application of posterior endoscopic discectomy combined with B-Twin lumbar interbody fusion in the treatment of lumbar intervertebral disc protrusion with degenerative lumbar spinal instability has little trauma and bleeding, and the recent follow-up results are satisfactory.%目的 探讨后路内窥镜下髓核摘除术联合可膨胀脊柱融合器(B-Twin)椎间融合治疗腰椎退变失稳性椎间盘突出症的疗效.方法 选择2007年11月~2009年11月我院收治的退行性腰椎间盘突出症合并腰椎失稳患者22例,均采用后路内窥镜下髓核摘除

  5. Spinal granulocytic sarcoma (chloroma presenting as acute cord compression in a nonleukemic patient

    Directory of Open Access Journals (Sweden)

    Kalayci Murat

    2005-01-01

    Full Text Available The case of a previously healthy 24-year-old man diagnosed with extradural thoracic granulocytic sarcoma with no evidence of bone marrow or other hematological involvement is described. The tumor was removed totally by microsurgery. The histopathological examination was consistent with granulocytic sarcoma. Granulocytic sarcomas are most commonly found in the context of an acute myelogenous leukemia or in chronic myelogenous leukemia. They rarely have been reported in otherwise healthy patients without any evidence of systemic disease. A review of the literature revealed only 14 more nonleukaemic cases with granulocytic sarcoma causing thoracic spinal cord compression.

  6. 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

  7. 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

  8. A Study of Measurements of Spinal Canal at the Level of Lower Three Lumbar Vertebra by 16 Slice CT Scanner in Nepalese Population

    Directory of Open Access Journals (Sweden)

    Mukesh Mallik

    2015-07-01

    Full Text Available Background and Objective: The study was conducted with the objectives to establish the measurements of spinal canal and lumbar vertebra at L3 to L5 region in Nepalese population. Methodology: It is a cross-sectional study among 36 patients (17 males and 19 females having age variation from 20-60years whose abdomen was scanned by GE bright speed 16 slice CT scanner with slice thickness 10mm and then reconstructed at 1.2mm for images in different body plains for the measurement of spinal canal. Results: Almost all the parameters increase from L3 to L4 to L5 but the difference is more between L4 and L5 than between L3 and L4 except in vertebral body width (VBW where it increases smoothly, however canal body ratio (CBR remained constant at 0.6. All the parameters were larger in males than in females except antero-posterior dimension of canal in transverse section (APT which is larger in females. It also shows that none of the parameters vary significantly depending upon sex except vertebral body width (VBW at L3 which is 39.041 ± 4.1334 in males and 36.474 ± 2.8509 in females (p=0.036. Conclusion: Antero- posterior dimension in trans-verse and sagittal is almost identical but the chances of measurement error is higher in transverse due to trigonal shape of canal so AP diameter should be done in sagittal section as this is consistent and measures 14mm at L3, 14mm at L4 and 15 mm at L5 hence defining average antero-posterior canal dimension in sagittal section to be 14 mm but CBR constant at 0.6. DOI: http://dx.doi.org/10.3126/jcmsn.v10i4.12971 JCMS Nepal 2014; 10(4:6-11

  9. 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.

  10. Intraoperative Targeted Temperature Management in Acute Brain and Spinal Cord Injury.

    Science.gov (United States)

    Kraft, Jacqueline; Karpenko, Anna; Rincon, Fred

    2016-02-01

    Acute brain and spinal cord injuries affect hundreds of thousands of people worldwide. Though advances in pre-hospital and emergency and neurocritical care have improved the survival of some to these devastating diseases, very few clinical trials of potential neuro-protective strategies have produced promising results. Medical therapies such as targeted temperature management (TTM) have been trialed in traumatic brain injury (TBI), spinal cord injury (SCI), acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH), but in no study has a meaningful effect on outcome been demonstrated. To this end, patient selection for potential neuro-protective therapies such as TTM may be the most important factor to effectively demonstrate efficacy in clinical trials. The use of TTM as a strategy to treat and prevent secondary neuronal damage in the intraoperative setting is an area of ongoing investigation. In this review we will discuss recent and ongoing studies that address the role of TTM in combination with surgical approaches for different types of brain injury. PMID:26759319

  11. 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.

  12. 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.)

  13. 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

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

    Science.gov (United States)

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

    2015-12-01

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

  15. 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

  16. 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。

  17. 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.

  18. 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.

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

    OpenAIRE

    Schmidt Oliver; Strasser Sergej; Kaufmann Victoria; Strasser Ewald; Gahr Ralf

    2007-01-01

    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 poly...

  20. A Comparison of the Effect of Kettlebell Swings and Isolated Lumbar Extension Training on Acute Torque Production of the Lumbar Extensors.

    Science.gov (United States)

    Edinborough, Luke; Fisher, James P; Steele, James

    2016-05-01

    The aim of this study was to use a fatigue response test to measure the muscular fatigue (defined as a reduction in torque production) sustained by the lumbar extensors after a single set of kettlebell swings (KBS) in comparison with isolated lumbar extensions (ILEX) and a control condition (CON). The purpose of which is to measure the physiological response of KBS against an already established modality. Subsequent data provide insight of the efficacy of kettlebells swings in strengthening the lumbar muscles and lower back pain treatment. Eight physically active males participated in a repeated measures design where participants completed all conditions. There were statistically significant reductions in maximal torque, reported as strength index (SI), after both KBS and ILEX exercise. A statistically significant difference was found for reductions in maximal torque between CON and both KBS (p = 0.005) and ILEX (p = 0.001) and between KBS and ILEX (p = 0.039). Mean reduction and effect sizes were -1824 ± 1127.12 (SI) and -1.62 for KBS and -4775.6 ± 1593.41 (SI) and -3.00 for ILEX. In addition, a statistically significant difference was found between KBS and ILEX for rate of perceived exertion (p = 0.012). Data suggest that both KBS and ILEX were able to fatigue the lumbar extensors. Isolated lumbar extension was able to generate a greater level of fatigue. However, contrary to previous research, the KBS was able to elicit a physiological response, despite the lack of pelvic restraint supporting the potential to strengthen the lumbar extensors. PMID:26439790

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

    International Nuclear Information System (INIS)

    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.

  2. 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.

  3. Effect of neurotrophin-3 on SOD and MDA in rats after acute spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    GUO Shu-zhang; REN Xian-jun; JIANG Tao; OUYANG Zhong

    2007-01-01

    Objective: To investigate the effect of neurotrophin-3 on the expressions of SOD and MDA in the injured spinal cord of rats. Methods:Totally 105 SD rats were randomly divided into 3 groups (n=35): sham group, control group and experimental group. Animal model of acute spinal cord was inflicted with Allen's method by a thin plastic tube situated in subarachnoid space below the injury level for perfusion. Rats in experimental group received 20 μl NT-3 (200 ng) from the tube at 0,4,8,12,24 h and 3,7 d after injury, and those in control group got the equal volume of normal saline at the same time points.The animals in sham group only received opening vertebral plate and putting tube in subarachnoid space.The rats were sacrificed at 4,8,12,24 h, and 3,7,14 d postinjury (n=5). And the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in blood were observed with colorimetric method. Results: The serum level of SOD reduced obviously and the level of MDA raised obviously in rats after the injury,and the activity of SOD reached the lowest on day 3 and the concentratioh of MDA reached peak at the 7 d.In the experimental group, the SOD level was obviously higher (P<0.01), and MDA level was lower than the control (P<0.01). Conclusion: NT-3 can mitigate secondary injury of spinal cord in vivo. One of mechanisms is that inhibits abnormal expression of MDA and elevates the activity of SOD, thus the injury of free radical and lipid peroxidation is attenuated.

  4. 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.

  5. Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study. Differences in scores based on age, sex, and type of disease

    International Nuclear Information System (INIS)

    The Japanese Orthopaedic Association (JOA) has investigated the JOA Back Pain Evaluation Questionnaire (JOABPEQ) to evaluate several aspects of low back pain in patients. The score includes five categories (25 items) selected from the Roland Morris Disability Questionnaire and Short Form 36, and a visual analogue scale. Japanese physicians have recently used these scores to evaluate back pain; however, the efficacy has not been fully explored in large-scale studies. In the current study, we used the JOABPEQ to evaluate lumbar spinal disease in 555 patients (with lumbar disc herniation, lumbar spinal stenosis, and lumbar disc degeneration/spondylosis) in multiple spine centers and compared the results based on age, sex, and type of disease. A total of 555 patients who had low back or leg pain were selected in 22 hospitals in Chiba Prefecture. Spine surgeons diagnosed their disease type based on symptoms, physical examination, radiography images, and magnetic resonance imaging. In all, 486 patients were diagnosed with spinal stenosis (239 patients), disc degeneration/spondylosis (143 patients), or disc herniation (104 patients). The other 69 patients were diagnosed with spondylolysis (16 patients) or other diseases (53 patients). The pain score in all patients was evaluated using the JOABPEQ (from 0 to 100, with 0 indicating the worst pain). The age of the patients was 56.1±13.3 years (mean±standard deviation (SD)); the age of patients in the disc herniation and disc degeneration/spondylosis group was significantly lower than that in the spinal stenosis group. The average JOABPEQ scores in all patients were, for low back pain, 47.1; lumbar function, 53.6; walking ability, 54.8; social life function, 48.7; and mental health, 48.3. The low back pain score in men was significantly worse than that in women. In contrast, the mental health score in women was significantly higher than that in men. The low back pain score in patients 65 years old were significantly lower

  6. 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.

  7. Erythropoietin plus methylprednisolone or methylprednisolone in the treatment of acute spinal cord injury: a preliminary report.

    Directory of Open Access Journals (Sweden)

    Ehsanali Alibai

    2014-04-01

    Full Text Available Recent studies in animal models indicate that recombinant human erythropoietin (rhEPO is very effective in enhancing neurological recovery after spinal cord injury (SCI. We aimed to evaluate the effect of rhEPO plus methylprednisolone sodium succinate (MPSS compared to MPSS alone to improve neurological function of patients after SCI in a randomized clinical trial. During a 15-month period 30 patients presenting to emergency departments of two university affiliated hospitals within less than 6 hours after acute SCI were randomized to two groups. Both groups received MPSS 30 mg/kg initially and 5.4 mg/kg every hour till 23 hours if admitted within 3 hours and till 47 hours if recruited within 3-6 hours after injury. Group EPO also received 500 unit/kg rhEPO on admission and another 500 unit/kg 24 hours later instead of placebo in group MPSS. Neurologic evaluation was performed on admission, 24, 48, 72 hours and one and 6 months later. Range of patients' age was 18-65 years. There was no significant difference between patients receiving two types of treatment in neurological exam on admission (P=0.125, 24 hours after admission (P=0.108 and 48 hours after admission (P=0.085. However, one week (P=0.046, one month (P=0.021 and six months (P=0.018 after admission these differences were significant. MPSS plus rhEPO started within 6 hours after acute spinal injury may be more effective than MPSS plus placebo in improvement of neurologic dysfunction. More studies with larger sample sizes are warranted.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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

    Glucocorticoids have attracted increasing attention as adjuvants in the treatment of acute postoperative pain. Furthermore, anecdotal reports may support glucocorticoids for preventing sustained postoperative pain. We explored preoperative dexamethasone combined with paracetamol and ibuprofen on ...

  13. 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.

  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. Coflex棘突间动态内固定系统治疗退行性腰椎管狭窄症%The treatment of degenerative lumbar spinal stenosis with Coflex interspinous dynamic inter- nal fixation system

    Institute of Scientific and Technical Information of China (English)

    黄益奖; 彭茂秀; 何少奇; 戴鸣海; 汤呈宣

    2015-01-01

    Objective To investigate the recent clinical efficacy of spinal non-fusion interspinous Coflex system for the degenerative lumbar spinal stenosis. Methods 23 cases with degenerative lumbar spinal stenosis were treated by decompression with posterior spinous process and interspinous dynamic internal fixation with Coflex system. All cases were scanned by MRI and CT to confirm the segments with degenerative lumbar spinal stenosis. Lumbar anteroposteri-or, lateral and flexion-extension X-ray films preoperatively, and at follow-up time were used to measure the following parameters:the anterior and posterior disc space height, foraminal height, the range of motion at surgical level. VAS scores and JOA scores for preoperative and postoperative were used for functional assessment. Results All patients were followed up for 15~24 months. Patients with low back pain and intermittent claudication were significantly alle-viated postoperatively and activities of daily living were improved. The time in three months,12 months and last follow-up postoperatively compared with the preoperative VAS score decreased significantly. The last follow-up compared with three months and 12 months postoperatively decline,and there was no statistically significant (P0. 05 ) . The operative segment still keep a range of motion after surgery, but the motion decreased significantly (P0.05);手术节段仍保持一定活动度,但较术前有明显下降(P<0.05)。所有患者均未出现Coflex系统松动、断裂、脱出及相应棘突的骨折等并发症。结论 Coflex棘突间动态内固定系统治疗退行性腰椎管狭窄症可较好地维持相应节段的稳定性、手术节段椎间隙、椎间孔的高度及活动度,近期疗效满意。

  16. Three-dimensional analysis of the vascular system in the rat spinal cord with scanning electron microscopy of vascular corrosion casts. Part 2: Acute spinal cord injury.

    Science.gov (United States)

    Koyanagi, I; Tator, C H; Lea, P J

    1993-08-01

    The purpose of this study was to investigate the vascular mechanisms involved in the pathophysiology of acute spinal cord injury. Vascular corrosion casts of traumatized rat spinal cords at C7-T1 were inspected by scanning electron microscopy. Nineteen rats were subjected to a 51g acute clip compression at C8-T1 and then underwent transcardial perfusion with polyester resin at 15 minutes, 4 hours, or 24 hours after injury. The injured spinal cord appeared almost avascular at the compression site, although the large vessels on the surface of the spinal cord were all intact. The sulcal arteries at the injury site frequently showed constriction, and the impressions of endothelial nuclei were more slender and less distinct in the constricted arterial casts. Extravasation of the injected resin at the injury site was observed most frequently in the 15-minute group. Poorly filled distal branches of the sulcal arteries were seen at the injury site in every group. Indeed, it was concluded that the disruption and occlusion of the sulcal arteries and their branches accounted for a considerable amount of the posttraumatic ischemia of the cord. Occlusion of the sulcal arteries in the anterior median sulcus at the injury site was more frequently observed in the 24-hour group than in earlier groups. This observation suggests that there was a progressive circulatory disturbance of the damaged sulcal arteries at the injury site. The 4- and 24-hour groups showed avascular areas extending longitudinally from the injury site in the posterior columns, probably the result of hemorrhage and venous obstruction. PMID:8367052

  17. 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.

  18. Relative Contribution of Upper and Lower Lumbar Spinal Segments to Flexion/Extension: Comparison between Normal Spines and Spines with Disc Disease in Asian Patients

    OpenAIRE

    Bali, Tarun; Kumar, Malhar N.

    2015-01-01

    Study Design Prospective cohort study. Purpose To evaluate the contribution of upper and lower lumbar segments to flexion and extension of the lumbar spine in normal and diseased spines. Overview of Literature The specific contributions of upper and lower lumbar segments during flexion/extension have rarely been reported. Furthermore, no comparisons between the flexion/extension behaviors of normal and diseased spines have been reported until now. Methods Flexion and extension lateral radiogr...

  19. A diagnostic support tool for lumbar spinal stenosis: a self-administered, self-reported history questionnaire

    Directory of Open Access Journals (Sweden)

    Yokoyama Toru

    2007-10-01

    Full Text Available Abstract Background There is no validated gold-standard diagnostic support tool for LSS, and therefore an accurate diagnosis depends on clinical assessment. Assessment of the diagnostic value of the history of the patient requires an evaluation of the differences and overlap of symptoms of the radicular and cauda equina types; however, no tool is available for evaluation of the LSS category. We attempted to develop a self-administered, self-reported history questionnaire as a diagnostic support tool for LSS using a clinical epidemiological approach. The aim of the present study was to use this tool to assess the diagnostic value of the history of the patient for categorization of LSS. Methods The initial derivation study included 137 patients with LSS and 97 with lumbar disc herniation who successfully recovered following surgical treatment. The LSS patients were categorized into radicular and cauda equina types based on history, physical examinations, and MRI. Predictive factors for overlapping symptoms between the two types and for cauda equina symptoms in LSS were derived by univariate analysis. A self-administered, self-reported history questionnaire (SSHQ was developed based on these findings. A prospective derivation study was then performed in a series of 115 patients with LSS who completed the SSHQ before surgery. All these patients recovered following surgical treatment. The sensitivity of the SSHQ was calculated and clinical prediction rules for LSS were developed. A validation study was subsequently performed on 250 outpatients who complained of lower back pain with or without leg symptoms. The sensitivity and specificity of the SSHQ were calculated, and the test-retest reliability over two weeks was investigated in 217 patients whose symptoms remained unchanged. Results The key predictive factors for overlapping symptoms between the two categories of LSS were age > 50, lower-extremity pain or numbness, increased pain when walking

  20. 急性发病的椎管内硬膜外占位的治疗策略及疗效评估%Acute spinal epidural space-occupying: treatment strategies and efficacy evaluation

    Institute of Scientific and Technical Information of China (English)

    王立; 蒋健

    2012-01-01

    Objective; To investigate early diagnosis, emergent treatment and therapeutic effect of acute onset spinal epidural space-occupying. Methods; The data included 10 patients(6 male and 4 female, averaging 46 y) who had acute spinal epidural space-occupying in different spinal segment was collected from 2008 to 2010, follow-ups lasting three months to two years were reviewed. Preoperative patients and postoperative patients were scored by ASIA standard, respectively, followed by the statistical analysis of the scores. Results; The causes of acute spinal epidural space-occupying were hematoma in 7 cases, abscess in 2 cases, tumor in 1 case . Clinical symptoms were improved and the scores raised after emergency surgery; motor scores raised 30. 7 points and sensory scores 65. 8 points on average. Prognosis was closely related with the timing of surgery, oppressed segments of spinal cord, preoperative hormone treatment and the disease course, also the active rehabilitation after surgery was critical to the long-term prognosis. Conclusions; Acute spinal epidural space-occupying disease is diagnosed based on careful physical examination and imaging( MRI and three-dimensional reconstruction of CT). Emergency surgery, useful for spinal cord recovery, can remove the space-occupying and relieve spinal cord compression. Different oppressed segments of spinal cord affects prognosis, for example, oppressed thoracic segment IV often had a poor prognosis, on the contrary oppressed cervical and lumbar spine had a better one.%目的:探讨突然发病来院急诊的椎管内硬脊膜外占位的早期诊断、急诊处理及治疗效果.方法:2008至2010年收治的177例脊髓脊柱疾病患者中,10例患者急性发病来院急诊,通过手术切除占位.随访3个月~2年,应用美国脊髓损伤学会(ASIA)评分标准对患者进行评分,并行统计学分析.结果:占位原因:血肿7例,脓肿2例,肿瘤1例.所有患者经手术切除椎管内占位,临床症状均

  1. Spinal Manipulative Therapy for Acute Low Back Pain: A Clinical Perspective

    Science.gov (United States)

    Hancock, Mark J.; Maher, Christopher G.; Latimer, Jane

    2008-01-01

    Low back pain (LBP) is an extremely common cause of pain and disability. While many treatments for acute LBP exist, one of the most widely used, but also most controversial, is spinal manipulative therapy (SMT). This therapy includes both high-velocity manipulative techniques and low-velocity mobilization techniques. The literature regarding the use of SMT is often conflicting, which explains the difference in recommendations regarding SMT in international LBP guidelines. The lack of a clear tissue diagnosis in the majority of patients with LBP combined with the unknown mechanism of action of SMT adds to the difficulty for clinicians in providing SMT in a logical and effective manner. Despite these limitations, the existing literature does provide some assistance to clinicians on when to provide SMT and how to provide it in an optimal way. This review aims to summarize the key research literature investigating SMT in LBP in order to help clinicians make informed decisions about the use of SMT for their patients with acute LBP. PMID:19771190

  2. Bone marrow stromal cells elicit tissue sparing after acute but not delayed transplantation into the contused adult rat thoracic spinal cord.

    NARCIS (Netherlands)

    Tewarie, R.D.; Hurtado, A.; Ritfeld, G.J.; Rahiem, S.T.; Wendell, D.F.; Barroso, M.M.; Grotenhuis, J.A.; Oudega, M.

    2009-01-01

    Bone marrow stromal cells (BMSC) transplanted into the contused spinal cord may support repair by improving tissue sparing. We injected allogeneic BMSC into the moderately contused adult rat thoracic spinal cord at 15 min (acute) and at 3, 7, and 21 days (delayed) post-injury and quantified tissue s

  3. (-)-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.

  4. 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.

  5. Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

    OpenAIRE

    Zha, Yunfei; Li, Maojin; YANG, JIANYONG

    2010-01-01

    Objective To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies. Materials and Methods Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic m...

  6. 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

  7. 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.

  8. Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report

    International Nuclear Information System (INIS)

    Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis. CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma

  9. 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

  10. Spinal angiography. Anatomy, technique and indications

    International Nuclear Information System (INIS)

    Spinal angiography is a diagnostic modality requiring detailed knowledge of spinal vascular anatomy. The cervical spinal cord is supplied by the vertebral arteries while segmental arteries which are preserved from fetal anatomy, supply the thoracic and lumbar regions. As spinal angiography carries the risk of paraplegia the indications have to be considered very carefully. Nevertheless, spinal angiography should be performed if there is reason to suspect a spinal vascular malformation from magnetic resonance imaging (MRI). (orig.)

  11. Spinal trauma. An imaging approach

    International Nuclear Information System (INIS)

    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.)

  12. 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.

  13. 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).

  14. 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.

  15. 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

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  18. 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.

  19. 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.

  20. 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

  1. 臭氧治疗椎间盘突出合并腰椎管狭窄症的临床研究%Clinical study of oxygen-ozone therapy in the treatment of patients with lumbar disc herniation complicated with lumbar spinal stenosis

    Institute of Scientific and Technical Information of China (English)

    童立苗; 姚丰产; 刘红书

    2013-01-01

    Objective To study the clinical effects of oxygen-ozone therapy in the treatment of patients with lumbar disc herniation complicated with lumbar spinal stenosis.Methods Forty-six patients with lumbar disc herniation complicated with lumbar spinal stenosis were treated with oxygen-ozone therapy.All the patients were followed up for 6 months.The clinical efficacy was evaluated by modified MacNab method one week,3 months and 6 months after treatment.The degree of pain was evaluated using Visual Analogue Scale (VAS).The therapeutic effects at different time points were compared.Results The significant effective rate and total effective rate were 80.4% (37/46) and 93.5% (43/46) one week after treatment,76.1% (35/46) and 91.3% (42/46) 3 months after treatment,76.1% (35/46) and 89.1% (41/46) 6 months after treatment,with no statistically significant difference between the three time points (P>0.05).The VAS 3 months after treatment was significantly lower than before treatment (P<0.01),and the VAS 6 months after treatment was significantly lower than that 3 months after treatment (P<0.01).There were 2 cases with adverse reactions,but no complications occurred.Conclusion Oxygen-ozone therapy has a positive effect in patients with lumbar disc herniation combined with lumbar spinal stenosis,with ideal long-term effects,which is safe,reliable,and worthy of promotion.%目的 探讨臭氧在椎间盘突出合并腰椎管狭窄患者中的治疗效果.方法 回顾性分析我院骨科采用臭氧经皮注射治疗46例椎间盘突出合并腰椎管狭窄患者的临床资料.所有患者术后均进行严密随访6个月,并分别于术后1周、术后3个月及6个月时采用MacNab改良方法进行疗效评价,疼痛程度采用视觉模拟评分法(VAS)进行评分,比较不同时点的治疗效果.结果 术后1周时显效率为80.4% (37/46),总有效率为93.5% (43/46);术后3个月时显效率为76.1% (35/46),总有效率为91.3% (42/46);术后6

  2. Ruptured Anterior Spinal Artery Aneurysm Associated with Coarctation of Aorta: Case Report and Literature Review

    OpenAIRE

    Jiarakongmun, P.; Chewit, P.; Pongpech, S.

    2002-01-01

    A 39-year-old man presented with acute headache and neck pain, followed by quadriparesis and quadriparesthesia, accompanied by urinary and bowel incontinence. Lumbar puncture showed subarachnoid haemorrhage. Angiogram via a right axillary approach revealed severe coarctation of the aorta, between the left common carotid artery and left subclavian artery. Multiple collateral circulation including an enlarged anterior spinal arterial axis bridging the stenosed arch provided collateral circulati...

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

    OpenAIRE

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Malmqvist, Lasse; Biering-Sørensen, Tor; Bartholdy, Kim;

    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 rat...

  5. An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

    Institute of Scientific and Technical Information of China (English)

    Zhicheng Zhang; Fang Li; Tiansheng Sun

    2013-01-01

    This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab-lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item);pre-hospital care (one item);evalu-ation and diagnosis (13 items);treatment (23 items); prevention and treatment of major complica-tions (12 items);and rehabilitation (four items). This is the first time that Chinese experts have pub-lished a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the recommenda-tion among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with “1” corre-sponding to neutrality and“5”representing maximum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After al of the votes were col ected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom-mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thoracol-umbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treat-ment strategy for acute thoracolumbar spine and spinal cord injury in China.

  6. The evaluation of fat saturation fast spin-echo T2WI for patients with acute spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Gyu; Lee, Chang Jun [National Medical Center, Seoul (Korea, Republic of); Lee, Myung Joon; Kang, Ik Won [Hanyang Sacred Heart Hospital, Seoul (Korea, Republic of); Yoo, Jeong Hyun [Ewha Womans University Dongdaemun Hospital, Seoul (Korea, Republic of)

    2002-12-01

    To determine the usefulness of fat saturation fast spin-echo T2WI for patients with mild acute trauma of the spine. Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2W1, and additional fat-saturation fast spin-echo T2W1 were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2W1 is useful the evaluation of patients with mild acute spinal trauma without neurological impairment.

  7. The evaluation of fat saturation fast spin-echo T2W1 for patients with acute spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Gyu; Lee, Chang Jun [National Medical Center, Seoul (Korea, Republic of); Lee, Myung Joon; Kang, Ik Won [Hangang Sacred Heart Hospital, Seoul (Korea, Republic of); Yoo, Jeong Hyun [Ewha Womans University Dongdaemun Hospital, Seoul (Korea, Republic of)

    2002-12-01

    To determine the usefulness of fat saturation fast spin-echo T2W1 for patients with mild acute trauma of the spine. Between July 1998 and June 2002, 36 patients with acute spinal trauma underwent MRI within four months of injury. One, whose clinal symptoms indicated neurological paralysis, was excluded form our study. A superconductive 1.0-T MRI scanner was used, and conventional T1W1, T2W1, and additional fat-saturation fast spin-echo T2W1 were performed. Two radiologists compared conventional T2-weighted sagittal imaging and fat-saturation T2-weighted sagittal imaging in terms of the extension of increased high signal intensities in soft tissue and vertebral bodies, bone marrow signal change, disk herniation, and signal change of the disk. The detection rate of focal high signal intensities in soft tissue and bone marrow was significantly higher at fat-saturation fast spin-echo T2W1 than at conventional T2W1. Fat-saturation fast spin-echo T2W1 is useful for the evaluation of patients with mild acute spinal trauma without neurological impairment.

  8. 人工腰椎间盘置换术恢复脊柱运动和载荷能力的意义%Significance of recovering spinal motion and carrying ability by artificial lumbar intervertebral disc replacement

    Institute of Scientific and Technical Information of China (English)

    苏培强; 黄东生; 李春海; 马若凡; 彭焰; 刘尚礼

    2003-01-01

    Aim To introduce and apply artificial lumbar interverte-brai disc replacement for the treatment of lumbar disc degenerative diseasesand lumbar disc herniation accompanying evident disc space narrowing andinvestigate the regulation of its recovering spinal motion and carrying a-bility. Methods Thirty-one cases (37 discs) of artificial lumbar disc re-placement were performed using SB Charite Ⅲ from April 1998 to April2000. Among them, disc degenerative diseases were in 16 cases (18discs), disc herniation accompanying evident disc space narrowing in 13cases ( 17 discs), rec urrent dise herniation in 2 cases. The rehabilitationtraining was done under postoperative instructions. Results All the caseswere followed up from 17 to 41 months (averagely 26 months) untilSeptember 2001. The clinical outcomes were excellent in 23 cases, goodin 6 cases, fair in 2 cases. The mobility of the operated level had 4.0°anterior flexion and 5. 1° posterior extension after operation and 9.1° ontotal mobility. Meanwhile, the operated intervertebral space got an average4. 2 mm higher than that before. Because of technical problem, a slightdisplacement of the core occurred in one case without any clinical symp-toms and signs. Conclusion Artificial lumbar disc replacement can re-covery spinal motion and carrying capacity and provides a new kind ofoperation for the treatment of lumbar disc degenerative diseases and discherniation accompanying evident disc space narrowing.%目的应用人工腰椎间盘置换术治疗腰椎间盘退行性变疾病,探讨恢复脊柱运动功能和载荷能力的规律性.方法1998-04/2000-04,应用改良型SB ChariteⅢ型人工腰椎间盘行腰椎间盘置换术共31例37个间隙,其中腰椎间盘退变16例18个间隙、合并椎间隙狭窄的腰椎间盘突出症13例17间隙、复发性腰椎间盘突出症2例,术后指导进行康复训练.结果随访率100%,截止至2001-09,随访17~41个月(平均26个月).临床评价优23例,良6

  9. 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.

  10. Spinal and locus coeruleus noradrenergic lesions abolish the analgesic effects of 5-methoxy-N,N-dimethyltryptamine.

    Science.gov (United States)

    Danysz, W; Jonsson, G; Minor, B G; Post, C; Archer, T

    1986-07-01

    Two experiments were performed on Sprague-Dawley rats to study the effects of noradrenaline and 5-hydroxytryptamine depletion upon the antinociceptive effects of acute 5-methoxy-N,N-dimethyltryptamine (5-MeODMT) administration. 6-Hydroxydopamine-induced lesions following microinjections to either the locus coeruleus or the spinal cord (lumbar) abolished completely 5-MeODMT-induced analgesia in the tail-flick, hot-plate, and shock titration tests whereas 5,7-dihydroxytryptamine-induced lesions of the nucleus raphe magnus and the lumbar spinal cord attenuated 5-MeODMT analgesia in the tail-flick and shock titration tests. Thus, the experiments serve to demonstrate an important interaction between descending noradrenergic and serotonergic pathways, possibly at a spinal locus. PMID:3015120

  11. 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。

  12. 全椎板切除脊柱内固定用于老年退行性腰椎管狭窄症治疗中临床观察%The clinical observation for laminectomy removal of spinal fixation for degenerative lumbar spinal stenosis treatment

    Institute of Scientific and Technical Information of China (English)

    马方全

    2012-01-01

      Objective To observe the clinical effects of laminectomy spinal fixation for degenerative lumbar spinal stenosis. Methods The clinical data for 68 cases of degenerative lumbar spinal stenosis treated with laminectomy spinal fixation was analyzed retrospectively. The Oswestry score, postoperative complications and quality of life improvement were taken for statistics. The pros and cons of the surgical procedures for degenerative lumbar spinal stenosis treatment and precautions were taken for comprehensive assessment. Results 68 patients were successful, and the Oswestry scoring before and after surgery were respectively (60.23±12.75) and (16.31±8.72). The quality of life scores before surgery were respectively (750.43±54.69) and (895.06±48.37). The differences for the two indicators compared before and after surgery were significant(P<0.05). The postoperative complication rate after surgery was 26.47%. After conservative treatment, they all alleviate. Conclusion The application of laminectomy spinal fixation for degenerative lumbar canal stenosis can effectively improve the patient's daily living, improve the quality of life, but we should pay attention to the prevention and treatment of perioperative complications.%  目的观察全椎板切除脊柱内固定术治疗老年退行性腰椎管狭窄症的临床效果.方法回顾性分析我院收治的68例老年退行性腰椎管狭窄患者采用全椎板切除脊柱内固定术治疗的临床资料,对该68例患者手术前后的Oswestry评分、术后并发症及生活质量改善情况进行统计,综合评定该术式用于老年退行性腰椎管狭窄症治疗的优劣及注意事项.结果68例患者手术均获成功,Oswestry评分手术前后分别为(60.23±12.75)和(16.31±8.72),手术前后生活质量评分分别为(750.43±54.69)和(895.06±48.37),两个指标手术前后相比差异具有显著性(P<0.05).术后并发症发生率26.47%,经保守治疗均获缓解.结论采用全椎

  13. Preemptive Gabapentin vs Pregabalin for Acute Postoperative Pain after Surgery under Spinal Anaesthesia

    Directory of Open Access Journals (Sweden)

    V Saraswat

    2008-01-01

    Gabapentin and pregabalin, both have been effective in prolongation of post-spinal analgesia, Pregabalin more than Gabapentin and either can be used as part of multimodal therapy if not as sole analgesic.

  14. Biocompatibility of reduced graphene oxide nanoscaffolds following acute spinal cord injury in rats

    Directory of Open Access Journals (Sweden)

    Ali H Palejwala

    2016-01-01

    Conclusions: Graphene is a nanomaterial that is biocompatible with neurons and may have significant biomedical application. It may provide a scaffold for the ingrowth of regenerating axons after spinal cord injury.

  15. The Effects of NMDA Antagonists on Neuronal Activity in Cat Spinal Cord Evoked by Acute Inflammation in the Knee Joint.

    Science.gov (United States)

    Schaible, Hans-Georg; Grubb, Blair D.; Neugebauer, Volker; Oppmann, Maria

    1991-01-01

    In alpha-chloralose-anaesthetized, spinalized cats we examined the effects of NMDA antagonists on the discharges of 71 spinal neurons which had afferent input from the knee joint. These neurons were rendered hyperexcitable by acute arthritis in the knee induced by kaolin and carrageenan. They were located in the deep dorsal and ventral horn and some of them had ascending axons. The N-methyl-d-aspartate (NMDA) antagonists ketamine and d-2-amino-5-phosphonovalerate (AP5), were administered ionophoretically, and ketamine was also administered intravenously. In some of the experiments the antagonists were tested against the agonists NMDA and quisqualate. The effects of the NMDA antagonists consisted of a significant reduction in the resting activity of neurons and/or the responses of the same neurons to mechanical stimulation of the inflamed knee. Intravenous ketamine was most effective in suppressing the resting and mechanically evoked activity in 25 of 26 neurons tested. Ionophoretically applied ketamine had a suppressive effect in 11 of 21 neurons, and AP5 decreased activity in 17 of 24 cells. The reduction in the resting and/or the mechanically evoked discharges was achieved with doses of the antagonists which suppressed the responses to NMDA but not those to quisqualate. These results suggest that NMDA receptors are involved in the enhanced responses and basal activity of spinal neurons induced by inflammation in the periphery. PMID:12106256

  16. 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%.

  17. 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.

  18. 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.

  19. Clinical research of surgical treatment of degenerative lumbar spinal stenosis disease%退变性腰椎管狭窄手术治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    胡祥怀; 高宏斌; 徐宏光

    2011-01-01

    Objective To analyze and summarize surgical indications, operation methods selection and complications of treatment in degenerative lumbar spinal stenosis disease (LSS) . Methods Totally 32 cases with lumbar spinal stenosis merger instability lumbar degenerative spondylolisthesis choose omni -posterior excision, side fossae and intervertebral foramen decompression, vertebral pedicle screw, small joints between vertebral bodies and the poster lateral using bone graft, follow - up and evluat operation effect. Results All cases were followed up for 8 months to 6 years. The results were evaluated in accordance with the standard of Amundsen, which were excellent in 21 cases, good in 8, fair in 3, no difference magnitude cases. Conclusions According to the clinical symptoms, signs and considering its diagnostic imaging and its complications to choose the scope and surgical decompression of bone fusion and (or) inside fixed or not, so as to improve the clinical symptoms, improve their quality of life.%目的 探讨退变性腰椎管狭窄症(ISS)手术指征、手术方式的选择及合并症的处理.方法 对32例腰椎管狭窄合并不稳定性腰椎退变性滑脱选择全椎板切除、侧隐窝及椎间孔减压、椎弓根螺钉固定、椎体间及小关节后外侧植骨术,术后随访,评价手术效果.结果 32例均获随访,时间8个月~6年.采用参照Amundsen评分标准评价术后疗效,优21例,良8例,可3例,无差级病例.结论 根据患者的临床症状、体征及影像学综合考虑其诊断及其合并症来选择手术减压的范围和植骨融合和(或)内固定与否,从而改善临床症状,提高其生活质量.

  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. The clinical observation of laminectomy and spinal internal fixation treatment for older degenerative lumbar spinal stenosis disease%全椎板切除脊柱内固定用于老年退行性腰椎管狭窄症治疗的临床观察

    Institute of Scientific and Technical Information of China (English)

    王冰

    2012-01-01

    目的 观察全椎板切除脊柱内固定术治疗老年退行性腰椎管狭窄症的临床疗效.方法 选取2007年5月~2011年12月我院收治54例老年退行性腰椎管狭窄症患者为研究对象,所有患者均行全椎板切除加脊柱内固定手术治疗,观察患者手术后疗效以及X线表现的改变.结果 ①本组术后1个月时椎体间相对距离为0.812±0.048,与术前比较有所增加,差异有统计学意义(P<0.05);椎体间矢状面活动角度、椎体间冠状面活动角度和椎体间水平面活动角度手术前后变化不明显,差异无统计学意义(P>0.05).②术后疗效,优29例,良18例,中7例,优良率为87.04%.术后随访1~3个月,X线检查显示植骨均融合,内固定未见松动或断裂.结论 全椎板切除减压脊柱内固定术治疗老年退行性腰椎管狭窄症,在正确掌握适应症的情况下,可获得满意的效果,既可实现彻底减压的目的,又能维持术后脊柱稳定性.%Objective To observe the clinical effects of lamineetomy and spinal internal fixation treatment for older degenerative lumbar spinal stenosis disease. Methods From May 2007 to December 2011, 54 cases of elder patients with degenerative lumbar spinal stenosis disease were selected as the research object, all of patients were given laminectomy and spinal internal fixation treatment, with observing the curative effect and X-ray performance change after surgery. Results (1)one month after surgery, the relative distance of adjacen vertebral bodies was 0. 812 ±0. 048 which was higher than the preoperative, the comparing difference was statistical significance (P <0. 05) , The difference of vertebral activities angle at the sagittal view, coronal plane and horizontal plane before and after operation was not change significantly, comparative differences was not statistically significant (P >0. 05). (2)In this group of patients, the optimal curative effect was 29 cases, the good curative effect was

  2. 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.

  3. Application of expandable spinal spacer in lumbar degenerative disease%可膨胀性椎间融合器在腰椎退行性疾病治疗中的临床应用

    Institute of Scientific and Technical Information of China (English)

    王宏波; 燕军; 刘世学; 赵有春; 彭军; 李春华

    2011-01-01

    Objective: To explore the clinical therapeutic effect of expandable spinal spacer in lumbar degenerative disease. Methods: 50 patients in lumbar degenerative disease were treated with expandable spinal spacer from April 2009 to May 2010 in our hospital, of which there were 41 cases who obtained the microscopic posterior disc operation treatment, 9 cases who obtained the lateral percutaneous wear treatment. The clinical data of treatment effect, fusion rate, bone graft height and complications were analyzed retrospectively. Results: In the follow-up time for 8-38 months, the effects were evaluated according to the standard of Odom. The results showed that, 36 cases were excellent, accounting for 72%; 9 cas -es were well, accounted for 18%; 4 cases were common, accounted for 8%; 1 case was inferior, accounted for 2%. The symptoms of patients improved obviously, its good rate could amount to 90%. CT image showed that there was no disc her-niation and vertebra canal stenosis, and also no shift phenomenon between vertebra and expandable spinal spacer, the bone had merged, bone graft height had not obviously decreased. Patients were followed up with the results of only 3 cases of complications with the incidence rate was 6%. Conclusion: Expandable spinal spacer applied to treat the lumbar degenerative disease has small trauma, high safety, fusion rate high, good restore and other advantages, which has a good applica -tion prospect and is worthy of clinical application.%目的:探讨可膨胀性椎间融合器治疗腰椎退行性疾病的效果.方法:2009 年4 月~2010 年5 月我院对50 例患者采用可膨胀性椎间融合器治疗腰椎退行性疾病,其中采用后路椎间盘镜下操作治疗的有41 例,采用后外侧经皮穿治疗的有9 例.回顾性分析其临床资料,对其治疗效果、植骨融合率、椎间隙高度及并发症等进行分析.结果:术后随访时间8~38 个月,平均16 个月,按照Odom 标准对治疗效

  4. 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

  5. Acute Subdural Hematoma Following Spinal Cerebrospinal Fluid Drainage in a Patient with Freezing of Gait

    OpenAIRE

    Kim, Han-Joon; Cho, Yong-Jin; Cho, Joong-Yang; Lee, Dong-Ha; Hong, Keun-Sik

    2009-01-01

    Background Headache is a common complication of lumbar puncture (LP). Although in most cases post-LP headaches are not severe and have a benign course, they can also be a manifestation of a potentially life-threatening complication such as subdural hematoma (SDH). Case Report We describe a patient in whom a massive SDH developed after LP and cerebrospinal fluid (CSF) drainage, which were performed during the diagnostic evaluation of freezing of gait. Conclusions SDH should not be excluded fro...

  6. Neuropathological characterization of spinal motor neuron degeneration processes induced by acute and chronic excitotoxic stimulus in vivo.

    Science.gov (United States)

    Ramírez-Jarquín, Uri Nimrod; Tapia, Ricardo

    2016-09-01

    Motor neuron (MN) diseases are characterized by progressive cell degeneration, and excitotoxicity has been postulated as a causal factor. Using two experimental procedures for inducing excitotoxic spinal MN degeneration in vivo, by acute and chronic overactivation of α-amino-3-hydroxy-5-methyl-4-isoxazoleacetic acid (AMPA) receptors, we characterized the time course of the neuropathological changes. Electron transmission microscopy showed that acute AMPA perfusion by microdialysis caused MN swelling 1.5h after surgery and lysis with membrane rupture as early as 3h; no cleaved caspase 3 was detected by immunochemistry. Chronic AMPA infusion by osmotic minipumps induced a slow degeneration process along 5days, characterized by progressive changes: endoplasmic reticulum swelling, vacuolization of cytoplasm, vacuole fusion and cell membrane rupture. Quantification of these ultrastructural alterations showed that the increase of vacuolated area was at the expense of the nuclear area. Caspase 3 cleavage was observed since the first day of AMPA infusion. We conclude that acute AMPA-induced excitotoxicity induces MN loss by necrosis, while the progress of degeneration induced by chronic infusion is slow, starting with an early apoptotic process followed by necrosis. In both the acute and chronic procedures a correlation could be established between the loss of MN by necrosis, but not by caspase 3-linked apoptosis, and severe motor deficits and hindlimb paralysis. Our findings are relevant for understanding the mechanisms of neuron death in degenerative diseases and thus for the design of pharmacological therapeutic strategies. PMID:27320208

  7. 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。

  8. Extramedullary relapse in lumbar spine of patient with acute promyelocytic leukemia after remission for 16 years: a case report and literature review.

    Science.gov (United States)

    He, Zhengmei; Tao, Shandong; Deng, Yuan; Chen, Yue; Song, Lixiao; Ding, Banghe; Chen, Kankan; Yu, Liang; Wang, Chunling

    2015-01-01

    Acute promyelocytic leukemia (APL) is a common myeloid leukemia. At the newly diagnosed stage, it can be fatal because of the serious complication-disseminated intravascular coagulation. With the advent and early application of all-trans retinoic acid, most APL patients can achieve a long-term survival, and only a minority of patients will develop extramedullary relapse after remission. The most common site of extramedullary relapse is central nervous system, while other sites are relatively rare. Here, we report a particularly rare APL patient who experienced extramedullary relapse with lumbar spine as the isolated site after a rather long time of remission for 16 years. At the time of relapse, the main clinical manifestations of the patient are obvious low back pain, weakness in lower limbs and limitation of activity. After treatment of local radiotherapy combined with ATRA and arsenic trioxide, the patient achieved and maintained a second complete remission by now. PMID:26885224

  9. 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

  10. 脊柱术后急性感染的治疗%Treatment of acute infection after spinal surgery

    Institute of Scientific and Technical Information of China (English)

    张中伟; 陆惠根; 徐红伟

    2011-01-01

    目的 探讨脊柱术后急性感染的治疗措施.方法回顾性分析10例脊柱术后急性感染患者的治疗经过,7例患者采用清创引流,2例患者采取清创换药,1例患者采用VSD高负压封闭引流,通过以上病例总结合理的治疗方法.结果 10例患者均得到治愈,清创负压引流较单纯清创换药治疗时间短,平均7 d;VSD高负压封闭引流因治疗经验较少尚难以评价;无一例患者取出内固定.结论脊柱术后感染是一种严重并发症,一旦发生需高度重视;早期彻底清创是关键,结合合理使用抗菌药物及全身营养支持是有效的方法,对于脊柱术后感染,不必常规取出内固定.%OBJECTIVE To study the treatment of acute infection after spinal surgery. METHODS The treatment procedures of 10 cases with acute infection after spinal surgery were retrospectively reviewed. Seven cases were performed the debridement and drainage, 2 cases were performed debridement and dressing change and 1 case was adopted VSD. RESULTS All the 10 cases were cured, the treatment time of debridement and drainaging was shorter than that of singal debridement and dressing with the average time of 7d; VCD was hard to evaluate because of lack of treatment experience; no cases was taken out of the internal fixation. CONCLUSION The postoperative infection after spinal surgery is a serious complication. Thorough debridement in the early stage is the key point, reasonable use of antimicrobials combining with nutrition supportive for the whole body is an effective method. as for the postoperative infection of spinal surgery. It is unnecessary to remove the internal fixation.

  11. 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.

  12. Neurons in the lateral part of the lumbar spinal cord show distinct novel axon trajectories and are excited by short propriospinal ascending inputs.

    Science.gov (United States)

    Antal, Zs; Luz, L L; Safronov, B V; Antal, M; Szücs, Peter

    2016-05-01

    The role of spinal dorsal horn propriospinal connections in nociceptive processing is not yet established. Recently described, rostrocaudally oriented axon collaterals of lamina I projection and local-circuit neurons (PNs and LCNs) running in the dorsolateral funiculus (DLF) may serve as the anatomical substrate for intersegmental processing. Putative targets of these axons include lateral dendrites of superficial dorsal horn neurons, including PNs, and also neurons in the lateral spinal nucleus (LSN) that are thought to be important integrator units receiving, among others, visceral sensory information. Here we used an intact spinal cord preparation to study intersegmental connections within the lateral part of the superficial dorsal horn. We detected brief monosynaptic and prolonged polysynaptic excitation of lamina I and LSN neurons when stimulating individual dorsal horn neurons located caudally, even in neighboring spinal cord segments. These connections, however, were infrequent. We also revealed that some projection neurons outside the dorsal grey matter and in the LSN have distinct, previously undescribed course of their projection axon. Our findings indicate that axon collaterals of lamina I PNs and LCNs in the DLF rarely form functional connections with other lamina I and LSN neurons and that the majority of their targets are on other elements of the dorsal horn. The unique axon trajectories of neurons in the dorsolateral aspect of the spinal cord, including the LSN do not fit our present understanding of midline axon guidance and suggest that their function and development differ from the neurons inside lamina I. These findings emphasize the importance of understanding the connectivity matrix of the superficial dorsal horn in order to decipher spinal sensory information processing. PMID:25912439

  13. 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.)

  14. Spinal injury in sport

    International Nuclear Information System (INIS)

    Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible. The aim of this article is to review the wide spectrum of spinal injuries related to sport activity, with special regard to imaging finding

  15. Spinal injury in sport

    Energy Technology Data Exchange (ETDEWEB)

    Barile, Antonio [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy)]. E-mail: antonio.barile@cc.univaq.it; Limbucci, Nicola [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy); Splendiani, Alessandra [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy); Gallucci, Massimo [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy); Masciocchi, Carlo [Department of Radiology, University of L' Aquila, S. Salvatore Hospital, Via Vetoio, Coppito, 67100 L' Aquila (Italy)

    2007-04-15

    Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible. The aim of this article is to review the wide spectrum of spinal injuries related to sport activity, with special regard to imaging finding.

  16. [Spinal and spinal cord injuries. Therapeutic approach in Gabon].

    Science.gov (United States)

    Loembe, P M; Bouger, D; Dukuly, L; Ndong-Launay, M

    1991-01-01

    The authors present their experience with 81 cases (66.4%) of acute cervical spine injuries (C.S.I.) and 41 cases (33.6%) of acute thoracolumbar spine injuries (T.L.S.I.) treated by a multidisciplinary approach, at Jeanne Ebori Hospital (Libreville, Gabon) between the years 1981 and 1987. Traffic accidents were the leading cause of injury. The largest group consisted of patients in their third decade. The anatomic localizations were: upper cervical spine: 22 cases (27%); lower cervical spine: 56 (69%); upper thoracic spine: 11 (26.8%); lower thoracic spine or thoracolumbar area: 19 (46.3%); lumbar spine: 7 (17%). There were osteoligamental lesions in 3 cases (3.7%) of C.S.I. and 4 (9.7%) of T.L.S.I. Clinically, 44 patients (54.3%) with C.S.I. and 37 (90.2%) with T.L.S.I. had neurological deficits. Surgical indications depended upon the osseous as well as neurologic lesions. There were five important steps in the treatment of spinal injuries associated with neurological deficit: (1) immobilization, (2) medical stabilization, (3) spinal alignment (skeletal traction), (4) operative decompression if there was proven cord compression, and (5) spinal stabilization. Twenty patients (24.6%) with cervical injuries were treated conservatively (traction, collar, kinesitherapy); 53 (65.4%) underwent a surgical intervention (anterior approach - 21, posterior fusion - 30, combined approach - 2); and in 8 patients (9.8%) refraining from surgery seemed the best alternative. After lengthy multidisciplinary discussion, the authors elected not to operate on tetraplegic patients with respiratory problems that necessitated assisted ventilation, because of its fatal outcome. Of injuries to the thoracolumbar spine, 13 (31.7%) were treated conservatively (bedrest, orthopedic treatment). Twenty-eight patients (68.2%) with unstable thoracic and lumbar fractures associated with neurologic deficit required acute surgical intervention (stabilization with or without decompression of the neural

  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. The application value of CoflexTM interspinous process device in the treatment of degenerative lumbar spinal stenosis%Coflex棘突间固定装置在治疗腰椎管狭窄症中的价值

    Institute of Scientific and Technical Information of China (English)

    郑晓青; 昌耘冰; 李梦远; 何宇翔; 郑秋坚

    2015-01-01

    目的:评价Coflex棘突间固定装置治疗腰椎管狭窄症的应用价值。方法回顾性分析临床随访期>5年的手术治疗腰椎管狭窄症患者115例,其中Coflex组54例,融合组61例。比较两组围手术期指标及术前和末次随访时JOA、ODI、VAS、SF-36评分;比较两组术前及末次随访时邻近节段椎间活动度增加量、椎间隙高度丢失量及Pfirrmann分级评定。结果两组间临床观察指标无统计学差异(P>0.05)。两组椎间活动度增加量对比无统计学差异(P>0.05);融合组椎间隙高度丢失量较Coflex组明显(P0.05). The range of increase of intervertebral motion of adjacent segments revealed no statistical difference (P> 0.05).The range of loss of intervertebral height of adjacent segments was greater in the fusion group, showing statistical difference (P<0.01) between the two groups. The adjacent segment disc Pfirrmann grading progressed more obviously in the fusion group, demonstrating statistical difference (P< 0.05) between the two groups. Conclusion The coflex implant and lumbar fusion have equivalent efficacy in the treatment of degenerative lumbar spinal stenosis, and the coflex implant can delay the adjacent segment pathology in radiology.

  20. SHORT-TERM EFFECTIVENESS OF INTERLAMINAR LUMBAR INSTRUMENTED FUSION THROUGH A SMALL INCISION FOR LUMBAR SPINAL STENOSIS%小切口椎板间插装融合技术治疗腰椎管狭窄症的近期疗效

    Institute of Scientific and Technical Information of China (English)

    王少飞; 晁建虎; 卫建民; Fernando G.Diaz

    2012-01-01

    Objective To evaluate the short-term effectiveness of local laminectomy and interlaminar lumbar instrumented fusion (ILIF) through a small incision for lumbar spinal stenosis. Methods Between November 2009 and January 2011, 16 patients with lumbar spinal stenosis were treated by local laminectomy and ILIF through a small incision. There were 7 males and 9 females with an average age of 52.8 years (range, 49-67 years). Sixteen patients had lumbar degenerative stenosis with an average disease duration of 4 years and 7 months (range, 2 years-9 years and 4 months). Four cases complicated by lateral recessus stenosis, 3 by lumbar disc herniation. Involved segments included L3,4 in 2 cases, L4,5 in 4 cases, L5, S1 in 4 cases, L3,4 and L4,5 (double segments) in 2 cases, L4,5 and L5, S1 (double segments) in 4 cases. The effectiveness was evaluated with the pre- and post-operative Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI). The cross-sectional areas of spinal canal were measured by CT scanning and were compared between pre- and post-operation. Results The average operative time was 47 minutes (range, 35-80 minutes); the average blood loss was 145 mL (range, 120-350 mL); and the average hospitalization days were 7.8 days (range, 4-15 days). Cerebrospinal fluid leakage occurred in 1 case, and healing of incisions by first intention was achieved in the others. The patients were followed up 12-22 months (mean, 14.8 months). CT scanning showed interspinous fusion in 14 cases and possible fusion in 2 cases after operation, with an average fusion time of 4.6 months (range, 3-10 months). The postoperative VAS score, ODI, and cross-sectional area were significantly improved when compared with preoperative values (P < 0.05). Conclusion The ILIF can promote fusion between spinous processes, provide spine stabilization, and protect the spinal cord. The procedure has small incision, simple method of fixation and fusion.%目的 探讨经小切口局部椎板

  1. Magnetic resonance signal alterations in the acute onset of heterotopic ossification in patients with spinal cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Wick, L.; Berger, M.; Knecht, H. [Schweizerisches Paraplegikerzentrum, Radiologie, Nottwil (Switzerland); Gluecker, T.; Ledermann, H.P. [University of Basel, Institute of Diagnostic Radiology, Basel (Switzerland)

    2005-09-01

    The purpose of our study was to evaluate magnetic resonance (MR) signal characteristics of acutely forming heterotopic ossification (HO) in paralyzed patients. Fourteen patients with spinal cord injury (female n=2, male n=12, mean age 38.3 years) and acute onset of radiographically proven HO had contrast-enhanced 1.5-T MRI within 13.4{+-}18.3 days of clinical onset of symptoms. MR signal alterations of affected muscles, fascia, subcutaneous tissue, skin and adjacent bone were evaluated. A diffuse T2-hyperintense signal of multiple muscle groups was seen in all patients (bilateral in 12) involving quadriceps (n=13, 93%), adductors (n=13, 93%) and iliopsoas (n=12, 86%) with contrast enhancement in n=11 (79%), n=8 (57%) and n=8 (57%) patients. All patients had nonenhancing areas (mean size 2 x 3.5 x 5.8 cm) within diffusely enhancing muscles. HO formation occurred around these nonenhancing areas in four patients with computed tomography follow-up. Other MR findings included fascial edema (n=14, 100%), fascial enhancement (n=13, 93%), subcutaneous edema (n=13, 93%), subcutaneous enhancement (n=12, 86%), bone marrow edema (n=5, 36%), and joint effusion (n=12, 86%). MRI reveals mostly bilateral edema and enhancement of muscles, fascia and subcutaneous tissue during acute onset of HO. HO develops in the periphery of well-defined areas of no enhancement. (orig.)

  2. 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.

  3. 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.

  4. Diagnostic value of MR imaging in acute spinal traumas; Wertigkeit der Magnetresonanztomographie (MRT) in der Akutdiagnostik von spinalen Traumen

    Energy Technology Data Exchange (ETDEWEB)

    Kress, B.; Baehren, W. [Bundeswehrkrankenhaus Ulm (Germany). Abt. Radiologie

    2001-07-01

    MR imaging is a helpful, sometimes even pathfinding complementary diagnostic tool for assessment of acute spinal trauma and often yields the decisive information in respect of the prediction of pathologic changes of neurological conditions. (orig./CB) [German] Die Kernspintomographie stellt in der Akutdiagnostik des spinalen Traumas eine sinnvolle, mitunter wegweisende Ergaenzung der Primaerdiagnostik dar und erbringt oftmals die entscheidende Aussage in bezug auf die Prognose neurologischer Veraenderungen. Die Indikation zur Kernspintomographie in der Akutdiagnostik besteht bei intubierten Patienten mit nachgewiesenen Wirbelkoerperfrakturen, Patienten mit instabilen Wirbelkoerperfrakturen, Patienten mit neurologischer Symptomatik in Folge des Traumas, bei Asymmetrien des Atlantoaxialgelenkes auch ohne eindeutigen Frakturnachweis. In diesen Faellen sollte unmittelbar nach der Primaerdiagnostik die MRT angeschlossen werden, dies bedingt jedoch eine organisatorisch schwierig zu loesende Bereitschaft des aerztlichen- und Assistenzpersonals. (orig.)

  5. Complications in lumbar spine surgery: A retrospective analysis

    OpenAIRE

    Luca Proietti; Laura Scaramuzzo; Giuseppe R Schiro; Sergio Sessa; Carlo A Logroscino

    2013-01-01

    Background: Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate. Materials and Metho...

  6. Symptomatic Pneumocephalus after Lumbar Disc Surgery: a Case Report

    OpenAIRE

    Zahir Kizilay; Ali Yilmaz; Ozgur Ismailoglu

    2015-01-01

    Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient...

  7. Traumatic Intradural Lumbar Disc Herniation without Bone Injury

    OpenAIRE

    Lee, Hyun-Woo; Kwon, Young-Min

    2013-01-01

    Intradural lumbar disc herniation is a rare disease. According to the reports of intradural lumbar disc herniations, most cases have developed as a chronic degenerative disc diseases. Traumatic intradural lumbar disc herniations are even rarer. A 52-year-old man visited our emergency center with numbness in his left calf and ankle after falling accident. Initial impression by radiologic findings was a spinal subdural hematoma at the L1 level. A follow up image two weeks later, however, did no...

  8. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty

    OpenAIRE

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

    2015-01-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly re...

  9. 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.

  10. Intraparenchymal Myeloid Sarcoma and Subsequent Spinal Myeloid Sarcoma for Acute Myeloblastic Leukemia

    OpenAIRE

    Eom, Ki Seong; Kim, Tae Young

    2011-01-01

    Myeloid sarcoma is a solid, extramedullary tumor composed of leukemic myeloblasts or immature myeloid cells. Intraparenchymal myeloid sarcoma without the involvement of the skull or meninges is extremely rare. Here, we present the case of a 49-year-old man who developed intraparenchymal myeloid sarcoma on the left cerebellum after allogeneic bone marrow transplantation (BMT). He received radiotherapy after complete removal of intraparenchymal myeloid sarcoma, but he was diagnosed spinal myelo...

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. Perioperative Risk Factors Related to Lumbar Spine Fusion Surgery in Korean Geriatric Patients

    OpenAIRE

    Lee, Jung-Hyun; Chun, Hyoung-Joon; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung

    2012-01-01

    Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complic...

  16. 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.

  17. 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

  18. Analysis of concurrent severe sciatica without pressure cause following lumbar spinal surgery%腰椎管术后并发无致压因素剧烈坐骨神经痛的剖析

    Institute of Scientific and Technical Information of China (English)

    倪凤民; 宋恒平; 王平均; 张皓; 陈睿; 杨小龙

    2013-01-01

    Objective To explore the reasons of concurrent severe sciatica without pressure cause following lumbar spinal surgery in a short term,to provide ideas for processing. Methods The patient characteristics and treatment of 12 cases of concurrent severe sciatica following lumbar spinal surgery shortly which appeared between October 2004 to August 2011 lumbar are reviewed, analyze the possible factors,and evaluate the effectiveness of treatment measures. Results The males in 12 cases are 3 cases, females are 9 cases,2 cases broke out after anesthesia disappear hours latter, the others for 1-2 days after the operations,presented lower limb pain just like which were tored or were cut by knife, pure sick limb pain are 10 cases,only healthy limb pain in 1,1 case of sick limb pain with healthy limb. Nothing had been found to pressure roots during the healing process. Calm、diminish inflammation、 dehydration,nourish nerve and so on,all patients get rid of their pain during staying be in hospital, the longest condition lasted 1 month,follow-up half year-2 years, did not see the repetition symptoms. Conclusion The physique factors, segmental aseptic inflammation around nerve root, root sensitization and root reaction caused by the sudden change of roots pathological environment and so on may be the reasons which lead to their emergency response sciatica.%目的 探讨腰椎管手术后短期内出现无椎管内致压因素的剧烈坐骨神经痛的原因,为处理提供思路.方法 对2004-10-2011-08月腰椎术后短期内发生剧烈坐骨神经痛的12例患者的病情特点及治疗进行回顾,分析产生症状的可能因素,评价处置措施的有效性.结果 12例中男3例,女9例,2例术后麻醉消失数小时后发作,其他为术后1~2 d发作,呈现撕裂样、刀割样下肢串痛,单纯患肢痛10例,单纯健肢痛1例,伴有健肢痛1例.治疗过程中未发现手术节段有任何致压物.镇静、消炎、脱水、神经营养神经治疗后,

  19. 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

  20. 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.

  1. 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.

  2. Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

    OpenAIRE

    Saleem, Shafaq; Aslam, Hafiz Muhammad; Rehmani, Muhammad Asim Khan; Raees, Aisha; Alvi, Arsalan Ahmad; Ashraf, Junaid

    2013-01-01

    Study Design Cross sectional and observational. Purpose To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. Overview of Literature Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration ...

  3. Comparison of clinical efficacies of single segment transforaminal lumbar interbody fusion with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis: a prospective randomized controlled study%椎间融合器植入与单纯自体颗粒骨植骨治疗退变性腰椎管狭窄症的比较

    Institute of Scientific and Technical Information of China (English)

    刘培盛; 刘小臻; 乔雪静; 都文楠; 罗大伟; 郑修军

    2014-01-01

    Objective To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion (TLIF) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis.Methods A total of 87 patients undergoing single segment TLIF were randomly divided into 2 groups.A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients.Operative duration,blood loss,length of stay and cost of hospitalization of two groups were recorded.They were followed up at 1 week,12,24 months post-operation.Oswestry disability index (ODI),visual analogue scale (VAS) fusion rates,intervertebral space and foramen height restoration,lumbar lordosis and postoperative complications were compared between two groups.Results No significant inter-group difference existed in operative duration,blood loss or length of stay.However,the average hospitalization cost in group A were 18% higher than that of group B (P < 0.05).Both groups achieved excellent clinical outcomes within 2 years.ODI,VAS score improvement rates and postoperative complication rates were not statistically different.Lumbar fusion rate was 86.7% in group A versus 85.7% in group B after 2 years.And there was no significant difference (P > 0.05).The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B.Both groups had similar improvements of lumbar lordosis.Conclusion For degenerative lumbar spinal stenosis,usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft.However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective.Two grafting methods yield similar overall clinical outcomes.%目的 比较单节段经椎间孔腰椎椎间融合术(TLIF)手术中椎间融合器植入或单纯自体颗粒骨植骨两种融合方式治疗退变性腰椎管

  4. 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

  5. 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

  6. Development of topical BAPN delivery system for acute spinal cord injury in dogs.

    Science.gov (United States)

    Chvapil, M; Weinstein, P R; Misiorowski, R L; Telles, D; Rankin, L; Stoy, V

    1984-09-01

    Topical sustained release of various medications by a subdurally implantable device at the site of spinal cord injury is considered advantageous in the treatment of early symptoms of tissue damage. A typical case is the interference with collagenous scar by beta-aminopropionitrile, inhibiting collagen polymerization. Four materials, silicone, polyethylene, polytetrafluoroethylene (PTFE), and polyacrylonitrile-based hydrogel were evaluated for biocompatibility in subcutaneous implantations. The hydrogel, the least reactive, was then compared with silicone sheets as subcural implants. The histology favored the hydrogel as the most inert material, which was then used for the construction of soft, pliable pouches, releasing the drug through the hydrated wall at a rate controlled by an osmotic pump. PMID:6544776

  7. Benign fibrous histiocytoma of the lumbar vertebrae

    Energy Technology Data Exchange (ETDEWEB)

    Demiralp, Bahtiyar; Oguz, Erbil; Sehirlioglu, Ali [Gulhane Military Medical Academy, Department of Orthopedics and Traumatology, Ankara (Turkey); Kose, Ozkan [Diyarbakir Education and Research Hospital, Department of Orthopedics and Traumatology, Diyarbakir (Turkey); Ataslar Serhat Evleri, Diclekent Bulvari, Diyarbakir (Turkey); Sanal, Tuba [Gulhane Military Medical Academy, Department of Radiology, Ankara (Turkey); Ozcan, Ayhan [Gulhane Military Medical Academy, Department of Pathology, Ankara (Turkey)

    2009-02-15

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

  8. Magnetic Resonance Imaging (MRI): Lumbar Spine

    Science.gov (United States)

    ... performed to assess the anatomy of the lumbar spine, to help plan surgery on the spine, or to monitor changes in the spine after ... For example, it can find areas of the spine where the spinal canal (which ... narrowed and might require surgery. It can assess the disks to see whether ...

  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. Lumbar myelography in 79 dogs, using different puncture sites

    International Nuclear Information System (INIS)

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

  11. Brain and spinal cord MR imaging in a case of acute disseminated encephalomyelitis

    International Nuclear Information System (INIS)

    We describe a case of acute disseminated encephalomyelitis following varicella infection presenting as transverse myelitis. Magnetic resonance imaging revealed diffuse cord swelling and signal increase without gadolinium enhancement and several silent brain lesions, all of which completely resolved at follow-up. (orig.). With 1 fig

  12. Brain and spinal cord MR imaging in a case of acute disseminated encephalomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Feydy, A. [Service d`Imagerie Medicale, Hopital Raymond Poincare, Garches (France); Carlier, R. [Service d`Imagerie Medicale, Hopital Raymond Poincare, Garches (France); Mompoint, D. [Service d`Imagerie Medicale, Hopital Raymond Poincare, Garches (France); Clair, B. [Service de Reanimation Neurologique, Hopital Raymond Poincare, Garches (France); Chillet, P. [Service de Reanimation Neurologique, Hopital Raymond Poincare, Garches (France); Vallee, C. [Service d`Imagerie Medicale, Hopital Raymond Poincare, Garches (France)

    1997-04-01

    We describe a case of acute disseminated encephalomyelitis following varicella infection presenting as transverse myelitis. Magnetic resonance imaging revealed diffuse cord swelling and signal increase without gadolinium enhancement and several silent brain lesions, all of which completely resolved at follow-up. (orig.). With 1 fig.

  13. In vivo intracellular recordings from spinal lumbar motoneurones in P0-deficient mice indicate an activity-dependent axonal conduction failure in otherwise functional motoneurones

    DEFF Research Database (Denmark)

    Lehnhoff, Janna; Moldovan, Mihai; Hedegaard, Anne;

    2014-01-01

    anaesthetized with Hypnorm (0.315 mg/mL fentanyl-citrate + 10 mg/mL fluanisone), Midazolam (5 mg/mL), and sterile water, mixed in the ratio 1:1:2 (induction: 0.15mL/25g, maintenance: 0.05 mL/20 minutes, S.C.). Anaesthesia during surgery was assessed by the lack of reflexes to a short noxious pinch on the hind...... monitoring of the heart rate. Intracellular recordings with sharp microelectrodes were made from identified spinal motoneurones (for detailed methods see Meehan et al. 2010). After end experiments, animals received an overdose of anesthesia and were perfused intracardially with 4% paraformaldehyde. Mean...

  14. Diagnostic value of lasik test for detection of lumbar discopathy in patients attending emergency department with acute low back pain

    Science.gov (United States)

    Aala, Alireza; Alizadeh Shahri, Saeid; Meshkini, Ali; Shams Vahdati, Samad

    2012-01-01

    Abstract: Background: Low back pain is one of the most important health problems. Disk herniation is one of the common causes of low back pain. Accurate examination is the best and simplest diagnostic methods. Physical examination, Straight leg raise (SLR) and neurologic tests as well as other tests are usually used to locate the exact place of herniation. Paraclinical studies such as magnetic resonance imaging (MRI) should be used because of the low diagnostic efficiency of physical examination. Methods: 100 patients attended the emergency unit because of back pain or radicular pain, were enrolled in the study. SLR, Reverse- SLR (R-SLR) and Crossed-SLR (C-SLR) tests were performed for all patients. Then, the patients were referred to the neurosurgery unit for treatment. Lumbar MRI was taken for all patients. Then, all patients were followed up and these data were collected. Results: Sensitivity and specificity of SLR test, C-SLR, and R-SLR tests was 77.52% and 36.36%, 29.21% and 90.9%, and 88.89% and 10.94%, respectively. There was no significant relationship between MRI and positive discopathy in the physical examination and SLR (P=0.11). Conclusions: SLR test has high sensitivity and low specificity. If the SLR test was accompanied by with physical examination the resulting sensitivity and specificity will increase. Findings of this study showed that SLR test has more sensitivity, while C-SLR has more specificity in low back pain diagnosis. Keywords: SLR test, Low Back Pain, Discopathy, Straight leg raise

  15. 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,

  16. 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

  17. Spontaneous resolution of lumbar vertebral eosinophilic granuloma.

    Science.gov (United States)

    Bavbek, M; Atalay, B; Altinörs, N; Caner, H

    2004-02-01

    Eosinophilic granuloma (EG) is a rare disease but is more common in adults than children. It's often self-limiting. Spinal involvement is rare. It is the localized and most benign form of Langerhans' cell histiocytosis (previously known as histiocytosis X), characterised by lytic lesions in one or more bones. Spontaneous resolution of vertebral body lesions is very rare. In this case, the patient had one EG in a cervical vertebra and a similar lesion in a lumbar vertebra. This case is important because it featured a symptomatic lesion in the cervical spine accompanied by an asymptomatic lesion in a lumbar vertebra. We treated the cervical lesion by surgical fusion and followed the lumbar lesion up conservatively, with the patient in a corset. After 8 years of follow-up, control MRI showed that the lumbar lesion had spontaneously resolved. PMID:14963750

  18. 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

  19. 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

  20. 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.

  1. Exogenous Neuritin Promotes Nerve Regeneration After Acute Spinal Cord Injury in Rats.

    Science.gov (United States)

    Gao, Rui; Li, Xingyi; Xi, Shaosong; Wang, Haiyan; Zhang, Hong; Zhu, Jingling; Shan, Liya; Song, Xiaoming; Luo, Xing; Yang, Lei; Huang, Jin

    2016-07-01

    Insufficient local levels of neurotrophic factor after spinal cord injury (SCI) are the leading cause of secondary injury and limited axonal regeneration. Neuritin belongs to a family of neurotrophic factors that promote neurite outgrowth, maintain neuronal survival, and provide a favorable microenvironment for the regeneration and repair of nerve cells after injury. However, it is not known whether the exogenously applied neuritin protein has a positive effect on nerve repair after SCI. This was investigated in the present study using purified human recombinant neuritin expressed in and purified from Pichia pastoris, which was tested in a rat SCI model. A recombinant neuritin concentration of 60 μg/ml induced the recovery of hind limb motor function and stimulated nerve regeneration in rats with SCI. Continuous administration of neuritin at this dose at an early stage after SCI inhibited poly ADP ribose polymerase (PARP) protein degradation and decreased neuronal apoptosis. In addition, during the critical postinjury period of axonal regeneration, exogenous neuritin treatment increased the expression of neurofilament 200 and growth-associated protein 43 in the damaged tissue, which was associated with the restoration of hind limb movement. These results suggest that neuritin creates an environment that promotes nerve cell survival and neurite regeneration after SCI, which contribute to nerve regeneration and the recovery of motor function. PMID:27009445

  2. 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.

  3. 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.

  4. Lumbar epidural varices: An unusual cause of lumbar claudication

    Directory of Open Access Journals (Sweden)

    Meenakshisundaram Subbiah

    2016-01-01

    Full Text Available Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP. However as the magnetic resonance imaging (MRI in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings.

  5. 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

  6. 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

  7. Posterior lumbar interbody fusion using B-Twin expandable spinal spacer with microendoscopic discectomy for lumbar disc herniation accompanying degenerative instability%椎间盘镜下B-Twin椎间融合治疗腰椎间盘突出症伴腰椎不稳

    Institute of Scientific and Technical Information of China (English)

    王博; 杨群; 张德强; 王宏; 吴春明; 马凯; 唐开; 刘阳

    2011-01-01

    Objective To explore the clinical outcomes of posterior lumbar interbody fusion using BTwin expandable spinal spacer with microendoscopic discectomy (MED) for lumbar disc herniation accompanying degenerative instability.Methods From March 2006 to May 2010,87 patients with lumbar disc heniation (only one level) accompanying degenerative instability were managed with posterior lumbar interbody fusion using B-Twin with MED,includeing 49 males and 38 females with an average of 47.6 years (range,37-65).Objective level located in L3,4 in 2 cases,L4,5 in 43,and L5S1 in 41.The patients were treated with single BTwin (Single group,n=51) and double B-Twin (Double group,n=36).Clinical outcomes were evaluated with surgical time,blood loss,visual analogue scale (VAS) scores,Oswestry disability questionnaire (ODI),and the pre- and post-operative disk space heights.Results The patients were followed up for an average of 35.8months (range,12-46).All the patients felt the low back pain and radiation pain disappeared or relieved apparently.The mean preoperative ODI and VAS scores decreased from 78%±3% to 18%±3%,and (8.70±11.3)to (0.65±10.48) at the final follow-up respectively.Disc space increased from a pre-operative height of (8.76±1.3) mm to a post-operative of (11.8±0.6) mm.ODI,VAS and the disk space heights in all patient showed statistical significance,which revealed no statistical significance between the two groups.However,the operation time,blood loss were statistical difference between the two groups.All the patients achieved solid union or probable union at a mean time of 5.6 months (range,3.9-8.6).Conclusion Posterior lumbar interbody fusion using B-Twin with MED can obtain satisfactory outcomes in the treatment of lumbar disc herniation accompanying degenerative instability.Single B-Twin can get similar clinical outcomes,but shorter surgical time,less blood loss,and less medical costs.%目的 探讨椎间盘镜下减压、B-Twin融合器植骨融合术治

  8. Concentration of nitric oxide (NO in spinal fluid of chronic spinal disease.

    Directory of Open Access Journals (Sweden)

    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.

  9. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... a few minutes. Lumbar surgery, particularly from the micro-lumbar discectomy style, it is a very common ... used for cervical spine problems? Yeah. We perform micro-lumbar surgical procedures in the cervical spine routinely. ...

  10. Efficacy of osthole for inducing penile erection in rabbits with acute spinal cord injury%蛇床子素诱导急性脊髓损伤家兔阴茎勃起的实验研究

    Institute of Scientific and Technical Information of China (English)

    周福荣; 孙建鹰; 周稳; 文莉东

    2012-01-01

    Objective The aim of this study was to investigate the effects of Osthole (OST) on inducing penile e-rection in rabbits with an acute spinal cord injury (ASCI). Methods OST was given intravenously (3 or 10mg/kg) to conscious male albino rabbits with a surgical transection of the spinal cord at the L2-L4 lumbar vertebra. Erection was e-valuated in a time-course manner by measuring the length of the uncovered penile mucosa. Results The efficacy of OST was potentiated by an intravenous injection of sodium nitroprusside, a nitric oxide donor. Potentiation of the effect by nitric oxide donor implies that QST can enhance the erectile activity during sexual arousal. Conclusion These results suggest that OST may be useful for treating erectile dysfunction.%目的 探讨蛇床子素诱导家兔阴茎勃起的作用及其机制.方法 检测蛇床子素对磷酸二酯酶5 (PDE5)的抑制活性;检测蛇床子素对离体阴茎海绵体组织产生cGMP的诱导活性;建立急性脊髓损伤家兔模型,蛇床子素静脉注射给药(3mg/kg或10mg/kg),通过测量暴露的阴茎粘膜长度评价蛇床子素体内诱导勃起的功能.结果 蛇床子素对PDE5直接抑制活性IC50为88.9nmol/L;对离体阴茎海绵体cGMP诱导活性ED50为58.2μmol/L;在一氧化氮供体硝普钠存在条件下,静脉注射蛇床子素对ASCI家兔模型具有剂量依赖性促进阴茎勃起作用.结论 蛇床子素对勃起功能障碍具有治疗价值.

  11. Lumbar spondylolysis and spondylolytic spondylolisthesis: who should be have surgery? An algorithmic approach.

    Science.gov (United States)

    Omidi-Kashani, Farzad; Ebrahimzadeh, Mohamad Hossein; Salari, Saman

    2014-12-01

    Lumbar spondylolysis and spondylolisthesis are common spinal disorders that most of the times are incidental findings or respond favorably to conservative treatment. In a small percentage of the patients, surgical intervention becomes necessary. Because too much attention has been paid to novel surgical techniques and new modern spinal implants, some of fundamental concepts have been forgotten. Identifying that small but important number of patients with lumbar spondylolysis or spondylolisthesis who would really benefit from lumbar surgery is one of those forgotten concepts. In this paper, we have developed an algorithmic approach to determine who is a good candidate for surgery due to lumbar spondylolysis or spondylolisthesis. PMID:25558333

  12. 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...

  13. 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.

  14. 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.

  15. Observing hemodynamic changes in the spinal cord after acute spinal cord injury%大鼠脊髓急性损伤后血流动力学变化的光学监测

    Institute of Scientific and Technical Information of China (English)

    苏昊; 郑启新; 骆清铭

    2009-01-01

    Objective To observe any changes in spinal cord hemodynamics after spinal cord injury and to investigate their mechanism. Methods Twenty female Sprague-Dawley rats were divided into a control group and a moderate injury group,10 rats in each group.A rat model of spinal cord injury caused by moderate compression was established using Nystrom's method.Changes in the velocity and volume of blood flow and in the diameters of vessels of the spinal cord were monitored for 6 hours using laser speckle imaging. Results No changes in the velocity or volume of blood flow or in the diameter of vessels were observed in the control group,but all of these indices diminished significantly in the injury group. Conclusions Laser speckle imaging can be used to monitor changes in spinal cord hemodynamics.Such changes after acute spinal cord injury indicate progressive post-injury ischemia.The occlusion of veins may be an important contributor to post-injury ischemia.%目的 观察脊髓损伤后血流动力学的变化,探讨脊髓损伤的血流动力学机制.方法 雌性SD大鼠20只,分为对照组和损伤组,每组10只.Nystrom法制造大鼠脊髓(T10-11)中度压迫性损伤模型.利用激光散斑成像系统监测大鼠脊髓损伤后第10分钟、30分钟、1小时、2小时、3小时、6小时背部血管内的血流速度和血流量以及血管管径的变化.结果 对照组大鼠各时间点血管内的血流速度、血流量以及血管管径均较稳定,无明显波动.损伤组大鼠各项指标均低于对照组.结论 激光散斑成像技术可以用于监测脊髓血流动力学的变化;急性脊髓损伤后血流动力学的变化提示进行性的"创伤后缺血",静脉回流受阻可能是引起创伤后缺血的一个重要因素.

  16. Partial Facetectomy for Lumbar Foraminal Stenosis

    Directory of Open Access Journals (Sweden)

    Kevin Kang

    2014-01-01

    Full Text Available Background. Several different techniques exist to address the pain and disability caused by isolated nerve root impingement. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, aggressive treatment often causes spinal instability or may require fusion for satisfactory results. We describe a novel technique for decompression of the lumbar nerve root and demonstrate its effectiveness in relief of radicular symptoms. Methods. Partial facetectomy was performed by removal of the medial portion of the superior facet in patients with lumbar foraminal stenosis. 47 patients underwent the procedure from 2001 to 2010. Those who demonstrated neurogenic claudication without spinal instability or central canal stenosis and failed conservative management were eligible for the procedure. Functional level was recorded for each patient. These patients were followed for an average of 3.9 years to evaluate outcomes. Results. 27 of 47 patients (57% reported no back pain and no functional limitations. Eight of 47 patients (17% reported moderate pain, but had no limitations. Six of 47 patients (13% continued to experience degenerative symptoms. Five of 47 patients (11% required additional surgery. Conclusions. Partial facetectomy is an effective means to decompress the lumbar nerve root foramen without causing spinal instability.

  17. 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.

  18. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Evaniew, Nathan; Belley-Côté, Emilie P; Fallah, Nader; Noonan, Vanessa K; Rivers, Carly S; Dvorak, Marcel F

    2016-03-01

    Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from randomized, controlled trials (RCTs) and controlled observational studies separately and used the Grades of Recommendation, Assessment, Development, and Evaluation approach to evaluate confidence. We included four RCTs and 17 observational studies. MPS was not associated with an increase in long-term motor score recovery (two RCTs: 335 participants; mean difference [MD], -1.11; 95% confidence interval [CI], -4.75 to 2.53; p = 0.55, low confidence; two observational studies: 528 participants; MD, 1.37; 95% CI, -3.08 to 5.83; p = 0.55, very low confidence) or improvement by at least one motor grade (three observational studies: 383 participants; risk ratio [RR], 0.84; 95% CI, 0.53-1.33; p = 0.46, very low confidence). Evidence from two RCTs demonstrated superior short-term motor score improvement if MPS was administered within 8 h of injury (two RCTs: 250 participants; MD, 4.46; 95% CI, 0.97-7.94; p = 0.01, low confidence), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (nine studies: 2857 participants; RR, 2.18; 95% CI, 1.13-4.19; p = 0.02, very low confidence), but RCTs did not. Pooled evidence does not demonstrate a significant long-term benefit for MPS in patients with acute TSCIs and suggests it may be associated with increased gastrointestinal bleeding. These findings support current guidelines against

  19. 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

  20. The prevalence and distribution of thoracic and lumbar vertebral numerical variation in the juveniles and adolescents without spinal deformities in Han population of Jiangsu%358例无脊柱畸形汉族儿童与青少年胸、腰椎脊椎数目的变异率及其分布

    Institute of Scientific and Technical Information of China (English)

    张文; 刘臻; 朱泽章; 徐磊磊; 汪飞; 邱勇

    2014-01-01

    目的:分析江苏省3~18岁无脊柱畸形汉族儿童与青少年胸椎、腰椎脊椎数目变异的发生率及分布情况,增强脊柱外科医生对胸、腰椎脊椎数目变异的认识。方法:对我科2006年1月~2014年2月收集的358例江苏省3~18岁无脊柱畸形汉族儿童与青少年的站立位全脊柱正侧位X线片进行回顾性分析。其中男性176例,女性182例。对所有入选者的站立位全脊柱正侧位X线片上的胸椎和腰椎脊椎数目进行计数,并记录所有入选者脊椎数目变异的分布情况,以统计其发生率。将胸椎和腰椎中不同变异类型的发生率行统计学分析以明确是否存在差异。结果:共33例无脊柱畸形汉族儿童与青少年存在胸椎和腰椎脊椎数目变异,发生率为9.2%(33/358)。其中存在胸椎脊椎数目变异者19例(5.3%),18例(5.0%)为11节胸椎,1例(0.2%)为13节胸椎;存在腰椎脊椎数目变异者18例(5.0%),17例(4.7%)为6节腰椎,1例(0.2%)为4节腰椎。经卡方检验,11节胸椎和6节腰椎的发生率分别较13节胸椎和4节腰椎的发生率高(均P<0.05)。胸椎+腰椎合计16节的变异率为3.9%(14/358),胸椎+腰椎合计18节的变异率为4.2%(15/358)。4例(1.1%)为混合型脊椎数目变异,均表现为11节胸椎和6节腰椎。结论:在江苏省无脊柱畸形汉族儿童与青少年中,9.2%的人群存在胸腰椎脊椎数目变异,其中11节胸椎及6节腰椎这两种变异情况比较多见。%Objectives: To detect the prevalence and distribution of thoracic and lumbar vertebral numerical variation in the juveniles and adolescents without spinal deformities in Jiangsu, and thus to increase aware-ness of vertebral numerical variation among the spine surgeons. Methods: A retrospective review of radio-graphs of 358 juveniles and adolescents without spinal deformities and aged between 3 and 18 in Jiangsu was performed. The

  1. Automatic Lumbar Spondylolisthesis Measurement in CT Images.

    Science.gov (United States)

    Liao, Shu; Zhan, Yiqiang; Dong, Zhongxing; Yan, Ruyi; Gong, Liyan; Zhou, Xiang Sean; Salganicoff, Marcos; Fei, Jun

    2016-07-01

    Lumbar spondylolisthesis is one of the most common spinal diseases. It is caused by the anterior shift of a lumbar vertebrae relative to subjacent vertebrae. In current clinical practices, staging of spondylolisthesis is often conducted in a qualitative way. Although meyerding grading opens the door to stage spondylolisthesis in a more quantitative way, it relies on the manual measurement, which is time consuming and irreproducible. Thus, an automatic measurement algorithm becomes desirable for spondylolisthesis diagnosis and staging. However, there are two challenges. 1) Accurate detection of the most anterior and posterior points on the superior and inferior surfaces of each lumbar vertebrae. Due to the small size of the vertebrae, slight errors of detection may lead to significant measurement errors, hence, wrong disease stages. 2) Automatic localize and label each lumbar vertebrae is required to provide the semantic meaning of the measurement. It is difficult since different lumbar vertebraes have high similarity of both shape and image appearance. To resolve these challenges, a new auto measurement framework is proposed with two major contributions: First, a learning based spine labeling method that integrates both the image appearance and spine geometry information is designed to detect lumbar vertebrae. Second, a hierarchical method using both the population information from atlases and domain-specific information in the target image is proposed for most anterior and posterior points positioning. Validated on 258 CT spondylolisthesis patients, our method shows very similar results to manual measurements by radiologists and significantly increases the measurement efficiency. PMID:26849859

  2. Aquaporin 1 - a novel player in spinal cord injury.

    Science.gov (United States)

    Nesic, O; Lee, J; Unabia, G C; Johnson, K; Ye, Z; Vergara, L; Hulsebosch, C E; Perez-Polo, J R

    2008-05-01

    The role of water channel aquaporin 1 (AQP-1) in uninjured or injured spinal cords is unknown. AQP-1 is weakly expressed in neurons and gray matter astrocytes, and more so in white matter astrocytes in uninjured spinal cords, a novel finding. As reported before, AQP-1 is also present in ependymal cells, but most abundantly in small diameter sensory fibers of the dorsal horn. Rat contusion spinal cord injury (SCI) induced persistent and significant four- to eightfold increases in AQP-1 levels at the site of injury (T10) persisting up to 11 months post-contusion, a novel finding. Delayed AQP-1 increases were also found in cervical and lumbar segments, suggesting the spreading of AQP-1 changes over time after SCI. Given that the antioxidant melatonin significantly decreased SCI-induced AQP-1 increases and that hypoxia inducible factor-1alpha was increased in acutely and chronically injured spinal cords, we propose that chronic hypoxia contributes to persistent AQP-1 increases after SCI. Interestingly; AQP-1 levels were not affected by long-lasting hypertonicity that significantly increased astrocytic AQP-4, suggesting that the primary role of AQP-1 is not regulating isotonicity in spinal cords. Based on our results we propose possible novel roles for AQP-1 in the injured spinal cords: (i) in neuronal and astrocytic swelling, as AQP-1 was increased in all surviving neurons and reactive astrocytes after SCI and (ii) in the development of the neuropathic pain after SCI. We have shown that decreased AQP-1 in melatonin-treated SCI rats correlated with decreased AQP-1 immunolabeling in the dorsal horns sensory afferents, and with significantly decreased mechanical allodynia, suggesting a possible link between AQP-1 and chronic neuropathic pain after SCI. PMID:18248364

  3. 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.)

  4. Minimally invasive discectomy versus microdiscectomy/ discectomy for symptomatic lumbar disc herniation

    OpenAIRE

    Rahimi-Movaghar, Vafa; Rasouli, Mohammad; Shokraneh, Farhad; Moradi-lakeh, Maziyar; Vakaro, Alex; Sadeghi-Naini, Mohsen

    2012-01-01

    Abstract: Background: Lumbar discectomy is a surgery to remove all or part of a disc cushion that helps protect the spinal column. These cushions, called disks, separate the spinal vertebrae/bones. When one of the disks herniates (moves out of place) in patients with protruded disc, the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of the spinal column. The lumbar discectomy procedure remained basically ...

  5. The microendoscopic decompression of lumbar stenosis: a review of the current literature and clinical results.

    Science.gov (United States)

    Wong, Albert P; Smith, Zachary A; Lall, Rohan R; Bresnahan, Lacey E; Fessler, Richard G

    2012-01-01

    Lumbar stenosis is a well-defined pathologic condition with excellent surgical outcomes. Empiric evidence as well as randomized, prospective trials has demonstrated the superior efficacy of surgery compared to medical management for lumbar stenosis. Traditionally, lumbar stenosis is decompressed with open laminectomies. This involves removal of the spinous process, lamina, and the posterior musculoligamentous complex (posterior tension band). This approach provides excellent improvement in symptoms, but is also associated with potential postoperative spinal instability. This may result in subsequent need for spinal fusion. Advances in technology have enabled the application of minimally invasive spine surgery (MISS) as an acceptable alternative to open lumbar decompression. Recent studies have shown similar to improved perioperative outcomes when comparing MISS to open decompression for lumbar stenosis. A literature review of MISS for decompression of lumbar stenosis with tubular retractors was performed to evaluate the outcomes of this modern surgical technique. In addition, a discussion of the advantages and limitations of this technique is provided. PMID:22900163

  6. 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.

  7. Lumbar peritoneal shunt

    Directory of Open Access Journals (Sweden)

    Yadav Yad

    2010-01-01

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

  8. 脊柱内窥镜下治疗极外侧型腰椎间盘突出症的临床疗效探讨%Clinical efficacy of spinal endoscopic treatment for extreme lateral lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    李星晨; 周红刚; 马海军; 胡李辉; 王必胜; 杨贺军

    2016-01-01

    Objective To analyze the clinical efficacy of spinal endoscopic technique for extreme lateral lumbar disc herniation. Methods Thirty⁃two patients with extreme lateral disc herniation treated by percutaneous endoscopic spine surgery were collected. The patients were assessed by visual analogue scale (VAS) score and Oswestry disability index (ODI) at 1st day, 1st week, 3rd month and 6th month. The Macnab criteria were used to evaluate the clinical efficacy. Results There were no complications such as vascular nerve injury. The operation time of single section was 20 min (10⁃35 min), the hospital stay was 5 days (3⁃7 days). During the follow⁃up periods of 1 day, 1 week, 3 months, and 6 months post⁃surgery, the VAS scores were 2.53±0.61, 1.50±0.43, 1.48±0.35, and 1.47±0.31 respectively, significantly lower than be⁃fore surgery (8.81±0.42, all P<0.05). The ODI at 1st day, 1st week, 3rd month, and 6th month post⁃surgery were (18.01 ± 6.42)%, (17.54 ± 5.53)%, (16.33 ± 6.42)%, and (16.04 ± 6.51)% respectively, significantly lower than before surgery [(76.51 ± 13.25)%, all P<0.05]. Excellent and good rate was 93.75% according to Macnab (19 in excellent, 9 in good, and 2 in fair). Conclusion Percutaneous endoscopic technique via the spinal lateral approach for extreme lateral lumbar disc herniation has the advantages of shorter operative time, less trauma, quicker recovery and better curative effectiveness.%目的:探讨侧路脊柱内窥镜下治疗极外侧型腰椎间盘突出症的临床疗效。方法采用经皮脊柱内窥镜侧路手术治疗极外侧型椎间盘突出症患者32例,分别于术后1 d、1周、3个月、6个月采用疼痛视觉模拟量表(visual analogue scale, VAS)评分和Oswestry功能障碍指数(Oswestry disability index, ODI)评价疼痛及功能障碍情况,末次随访时采用Macnab标准评价临床疗效。结果术中未出现血管神经损伤等并发症,单节手术时间为20 min(10~35 min

  9. The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis

    DEFF Research Database (Denmark)

    Madsen, Rasmus; Jensen, Tue Secher; Pope, Malcolm;

    2007-01-01

    STUDY DESIGN: A method comparison study. OBJECTIVE: To investigate the effect of body position and axial load of the lumbar spine on disc height, lumbar lordosis, and dural sac cross-sectional area (DCSA). SUMMARY OF BACKGROUND DATA.: The effects of flexion and extension on spinal canal diameters...... or not. Extensionwas the dominant cause rather than compression in reducing DCSA. Axial load was not considered to have a clinically relevant effect on spinal canal diameters....

  10. 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

  11. Symptomatic Pneumocephalus after Lumbar Disc Surgery: a Case Report

    Directory of Open Access Journals (Sweden)

    Zahir Kizilay

    2015-03-01

    Full Text Available Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.

  12. 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 exam...

  13. 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

  14. Adolescent lumbar disc herniation: a case report

    OpenAIRE

    King, Laurie; Mior, Silvano A.; Devonshire-Zielonka, Kim

    1996-01-01

    Lumbar spine disc herniations in children are a relatively rare condition reported to occur in less than 3% of those presenting with low back pain. Unlike the adult, the etiology and clinical picture often provides few clues to making the diagnosis. Although conservative management is the treatment of choice, surgical intervention may be required in some cases. The role of spinal manipulation in these cases may be of limited value. A case report is presented that illustrates the difficulty in...

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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. PMID:26275629

  3. Minimally Invasive Lumbar Discectomy

    Medline Plus

    Full Text Available ... Lumbar surgery, particularly from the micro-lumbar discectomy style, it is a very common procedure. Many patients ... have been around for a while, but the learning curve is quite steep. It takes some specialized ...

  4. Herniated Lumbar Disc

    Science.gov (United States)

    Herniated Lumbar Disc What is a herniated disc? Nonsurgical treatment Medication and pain management Surgery What can I expect after ... at and just below the waist. A herniated lumbar disc can press on the nerves in the spine ...

  5. Minimally Invasive Lumbar Discectomy

    Medline Plus

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

  6. 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. PMID:21318374

  7. Clinical study of “three-dimensional minimally invasive” therapy aiming at degenerative lumbar spinal stenosis%退行性腰椎管狭窄症的“立体微创”治疗

    Institute of Scientific and Technical Information of China (English)

    丁宇; 乔晋琳; 付本升; 向东东; 张建军; 崔洪鹏; 钟毓贤; 刘倩; 杜薇

    2014-01-01

    ObjectiveTo put forward the treatment concept of “three-dimensional minimally invasive (TDMI)” therapy aiming at degenerative lumbar spinal stenosis (DLSS), and meanwhile, to explore the related clinical outcome.Methods A retrospective study was conducted. Forty-seven patients with DLSS were treated with TDMI therapy. Combining with radiofrequency, oxygen-ozone and needle knife techniques, we performed minimally invasive surgery against the different sites of the anterior, middle and posterior column of the lumbar spine. All patients were followed-up regularly, and the clinical efficiency was evaluated at both six months after the surgery and the final time point. Scores of Visual Analogue Scale (VAS), JOA, Oswestry Disability Index (ODI) and SF-36 were calculated and recorded. These scores at different time points were analyzed and compared, and also, the clinical treatment efficiency was calculated.Results The mean follow-up period was (14.4±8.4) months. The total effective rate was 91.49% at six months after TDMI surgery, while was 89.36% at the final follow-up. The follow-up data showed that the scores of VAS, JOA, ODI and SF-36 could maintained at a well-pleasing level, which presented significant difference compared with the scores preoperatively(P<0.05). The clinical outcome was satisfied, with the improvement of low back and leg pain, quality of the daily life and adaptability of the social activity. No serious complication occurred.ConclusionTDMI therapy has a positive effect in patients with DLSS. It broadens the clinical indications for minimally invasive spine surgery, which is safe, reliable and worthy of promotion.%目的:提出针对退行性腰椎管狭窄症(DLSS)“立体微创”治疗理念,并探讨其临床疗效。方法回顾性分析海军总医院疼痛诊疗中心采用“立体微创”治疗47例DLSS患者的临床资料。联合应用射频、臭氧、针刀等治疗技术,针对DLSS腰椎前、中、后柱不同部位

  8. 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

  9. 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

  10. 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。

  11. Spinal manipulative-oriented therapy for lumbar disc herniation:quantitative X-ray analysis on the involved vertebral segment%脊柱手法为主治疗腰椎间盘突出症:受累椎体X射线量化分析

    Institute of Scientific and Technical Information of China (English)

    韩磊; 赵平; 王飞; 卫杰; 郭伟

    2014-01-01

    背景:腰椎功能性侧凸是腰椎间盘突出症的重要体征之一,其发生原因除外神经根性刺激,还与病变节段结构生物力学紊乱密切相关。  目的:分析脊柱手法等保守治疗对腰椎间盘突出症引发脊柱功能性侧凸畸形的力学影响。  方法:选择腰椎间盘突出症伴功能性侧凸患者56例,使用冯氏脊柱关节手法配合常规方法治疗,1个疗程结束后,通过美国Logan脊柱X射线软件系统量化分析椎体的旋转值和侧弯角,同时记录采用日本骨科协会腰痛疾患评分及腰腿痛目测类比评分变化。  结果与结论:Logan 测量中发现,受累椎体恰为力学耦合反常的椎体,即“失代偿椎体”或“椎体位移”,且与脊柱手法触诊定位发现的问题移位椎体一致性很高;经手法治疗后“失代偿椎体”旋转值发生明显逆向改变,转化为力学耦合正常的“代偿椎体”,全腰椎侧弯角亦出现明显的改善,这两个指标的变化情况与日本骨科协会腰痛疾患评分评分、目测类比评分改善程度均显著相关。结果表明腰椎间盘突出症患者受累椎体的力学代偿恢复与症状学改变显著相关。提示脊柱手法以纠正“失代偿椎体”(所谓“椎体位移”征象)为原则、以恢复脊柱代偿平衡为目的的基本认识具有重要的临床意义。%BACKGROUND:Functional lumbar scoliosis is a major symptom of lumbar disc herniation. The reason for its occurrence was strongly associated with the disorder of biomechanics of affected segment structure besides nerve root stimulus. OBJECTIVE:To analyze the mechanical impact of spinal manipulative therapy and other conservative treatment on functional scoliosis caused by lumbar disc herniation. METHODS:A total of 56 cases of lumbar disc herniation with functional scoliosis were consecutively selected in the study. The samples were mainly treated by spinal

  12. RNA-seq characterization of spinal cord injury transcriptome in acute/subacute phases: a resource for understanding the pathology at the systems level.

    Directory of Open Access Journals (Sweden)

    Kenian Chen

    Full Text Available Spinal cord injury (SCI is a devastating neurological disease without effective treatment. To generate a comprehensive view of the mechanisms involved in SCI pathology, we applied RNA-Sequencing (RNA-Seq technology to characterize the temporal changes in global gene expression after contusive SCI in mice. We sequenced tissue samples from acute and subacute phases (2 days and 7 days after injury and systematically characterized the transcriptomes with the goal of identifying pathways and genes critical in SCI pathology. The top enriched functional categories include "inflammation response," "neurological disease," "cell death and survival" and "nervous system development." The top enriched pathways include LXR/RXR Activation and Atherosclerosis Signaling, etc. Furthermore, we developed a systems-based analysis framework in order to identify key determinants in the global gene networks of the acute and sub-acute phases. Some candidate genes that we identified have been shown to play important roles in SCI, which demonstrates the validity of our approach. There are also many genes whose functions in SCI have not been well studied and can be further investigated by future experiments. We have also incorporated pharmacogenomic information into our analyses. Among the genes identified, the ones with existing drug information can be readily tested in SCI animal models. Therefore, in this study we have described an example of how global gene profiling can be translated to identifying genes of interest for functional tests in the future and generating new hypotheses. Additionally, the RNA-Seq enables splicing isoform identification and the estimation of expression levels, thus providing useful information for increasing the specificity of drug design and reducing potential side effect. In summary, these results provide a valuable reference data resource for a better understanding of the SCI process in the acute and sub-acute phases.

  13. Transplantation of Mesenchymal Stem Cells for Acute Spinal Cord Injury in Rats: Comparative Study between Intralesional Injection and Scaffold Based Transplantation.

    Science.gov (United States)

    Kim, Yoon Chung; Kim, Young Hoon; Kim, Jang Woon; Ha, Kee Yong

    2016-09-01

    Experimental stem cell therapy for spinal cord injury (SCI) has been extensively investigated. The selection of effective cell transplantation route is also an important issue. Although various types of scaffold have been widely tried as a carrier of stem cells to the injured spinal cord, there was little comparative study to investigate the efficacy of transplantation comparing with conventional transplantation route. A total of 48 Sprague-Dawley rats were subjected to standardized SCI, followed by transplantation of allogeneic mesenchymal stem cells (MSCs), either via intralesional injection (IL group), or via the poly (lactic-co-glycolic acid) (PLGA) scaffold (IP group) or chitosan scaffold (IC group). Engraftment and differentiation of the transplanted cells, expression of neurotrophic factors in the injured spinal cord, and functional recovery were compared with those of the control group. The mean numbers of engrafted MSCs in the IL, IP, and IC groups were 20.6 ± 0.7, 25.6 ± 1.7 and 26.7 ± 1.8 cells/high power filed (HPF), respectively. Results showed higher success rate of MSCs engraftment in the scaffold groups compared to the IL group. Expression of neuroprotective growth factors in the SCI lesions showed no significant differences between the IL, IP, and IC groups. The mean Basso, Beattie and Bresnahan locomotor scales at 6 weeks post-transplantation in the IL, IP, IC, and control groups were 7.9 ± 1.1, 7.9 ± 2.1, 8.7 ± 2.1, and 2.9 ± 1.0, respectively. The functional improvement was most excellent in the IC group. The scaffold based MSC transplantation for acute SCI presented the better cell engraftment and neuroprotective effect compared to the intralesional injection transplantation. PMID:27510379

  14. “White Cord Syndrome” of Acute Tetraplegia after Anterior Cervical Decompression and Fusion for Chronic Spinal Cord Compression: A Case Report

    Directory of Open Access Journals (Sweden)

    Kingsley R. Chin

    2013-01-01

    Full Text Available Paralysis is the most feared postoperative complication of ACDF and occurs most often due to an epidural hematoma. In the absence of a clear etiology, inadequate decompression or vascular insult such as ischemia/reperfusion injury are the usual suspects. Herewith we report a case of complete loss of somatosensory evoked potentials (SSEPs during elective ACDF at C4-5 and C5-6 followed by postoperative C6 incomplete tetraplegia without any discernible technical cause. A postoperative MRI demonstrated a large area of high signal changes on T2-weighted MRI intrinsic to the cord “white cord syndrome” but no residual compression. This was considered consistent with spinal cord gliosis with possible acute edema. The acute decompression of the herniated disc resulted in cord expansion and rush-in reperfusion. We postulate that this may have led to disruption in the blood brain barrier (BBB and triggered a cascade of reperfusion injuries resulting in acute neurologic dysfunction. At 16 months postoperatively our patient is recovering slowly and is now a Nurick Grade 4.

  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)

    Hirotaka Sakamoto

    Full Text Available BACKGROUND: Many men suffering from stress, including post-traumatic stress disorder (PTSD, report sexual dysfunction, which is traditionally treated via psychological counseling. Recently, we identified a gastrin-releasing peptide (GRP system in the lumbar spinal cord that is a primary mediator for male reproductive functions. METHODOLOGY/PRINCIPAL FINDINGS: To ask whether an acute severe stress could alter the male specific GRP system, we used a single-prolonged stress (SPS, a putative rat model for PTSD in the present study. Exposure of SPS to male rats decreases both the local content and axonal distribution of GRP in the lower lumbar spinal cord and results in an attenuation of penile reflexes in vivo. Remarkably, pharmacological stimulation of GRP receptors restores penile reflexes in SPS-exposed males, and induces spontaneous ejaculation in a dose-dependent manner. Furthermore, although the level of plasma testosterone is normal 7 days after SPS exposure, we found a significant decrease in the expression of androgen receptor protein in this spinal center. CONCLUSIONS/SIGNIFICANCE: We conclude that the spinal GRP system appears to be a stress-vulnerable center for male reproductive functions, which may provide new insight into a clinical target for the treatment of erectile dysfunction triggered by stress and psychiatric disorders.

  16. FAQs about Spinal Cord Injury (SCI)

    Science.gov (United States)

    ... of Care? Emergency Medical Services Hospital (Acute) Care Rehabilitation More FAQs about Spinal Cord Injury (SCI) If you or a loved one is ... spinal cord injury? What recovery is expected following spinal cord injury? Where is the ... on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SI5005). NIDILRR is a ...

  17. Can acute low back pain result from segmental spinal buckling during sub-maximal activities? A review of the current literature.

    Science.gov (United States)

    Preuss, Richard; Fung, Joyce

    2005-02-01

    This paper provides a review of the current literature supporting the hypothesis that segmental spine buckling resulting in tissue damage may be a primary cause of sudden onset low back pain, even during activities that are sub-maximal with respect to loading and muscle activation. While a temporal link exists, it is supported primarily by anecdotal and clinical reports. More pertinent to this review is the biological plausibility of segmental spine buckling as a mechanism of acute injury, supported by modelling studies as well as current knowledge of tissue mechanics and neurophysiology. One antithesis, however, is the low incidence of low back injuries reported during sub-maximal tasks. In order to account for this discrepancy, several predisposing factors are addressed, both constant and situation-dependent, which may contribute to the occurrence of segmental spinal buckling during sub-maximal activities. PMID:15681264

  18. Modeling the patient journey from injury to community reintegration for persons with acute traumatic spinal cord injury in a Canadian centre.

    Directory of Open Access Journals (Sweden)

    Argelio Santos

    Full Text Available BACKGROUND: A patient's journey through the health care system is influenced by clinical and system processes across the continuum of care. METHODS: To inform optimized access to care and patient flow for individuals with traumatic spinal cord injury (tSCI, we developed a simulation model that can examine the full impact of therapeutic or systems interventions across the care continuum for patients with traumatic spinal cord injuries. The objective of this paper is to describe the detailed development of this simulation model for a major trauma and a rehabilitation centre in British Columbia (BC, Canada, as part of the Access to Care and Timing (ACT project and is referred to as the BC ACT Model V1.0. FINDINGS: To demonstrate the utility of the simulation model in clinical and administrative decision-making we present three typical scenarios that illustrate how an investigator can track the indirect impact(s of medical and administrative interventions, both upstream and downstream along the continuum of care. For example, the model was used to estimate the theoretical impact of a practice that reduced the incidence of pressure ulcers by 70%. This led to a decrease in acute and rehabilitation length of stay of 4 and 2 days, respectively and a decrease in bed utilization of 9% and 3% in acute and rehabilitation. CONCLUSION: The scenario analysis using the BC ACT Model V1.0 demonstrates the flexibility and value of the simulation model as a decision-making tool by providing estimates of the effects of different interventions and allowing them to be objectively compared. Future work will involve developing a generalizable national Canadian ACT Model to examine differences in care delivery and identify the ideal attributes of SCI care delivery.

  19. Management of postoperative spinal infections

    OpenAIRE

    Hegde, Vishal; Meredith, Dennis S; Kepler, Christopher K.; Huang, Russel C.

    2012-01-01

    Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the or...

  20. Therapeutic effects of NogoA vaccine and olfactory ensheathing glial cell implantation on acute spinal cord injury

    Directory of Open Access Journals (Sweden)

    Zhang Z

    2013-10-01

    Full Text Available Zhicheng Zhang, Fang Li, Tiansheng Sun, Dajiang Ren, Xiumei Liu PLA Institute of Orthopedics, Beijing Army General Hospital, Beijing, People's Republic of China Background: Many previous studies have focused on the effects of IN-1, a monoclonal antibody that neutralizes Nogo (a neurite growth inhibitory protein, on neurologic regeneration in spinal cord injury (SCI. However, safety problems and the short half-life of the exogenous antibody are still problematic. In the present study, the NogoA polypeptide was used as an antigen to make a therapeutic NogoA vaccine. Rats were immunized with this vaccine and were able to secrete the polyclonal antibody before SCI. The antibody can block NogoA within the injured spinal cord when the antibody gains access to the spinal cord due to a compromised blood–spinal cord barrier. Olfactory ensheathing glial cell transplantation has been used in a spinal cord contusion model to promote the recovery of SCI. The present study was designed to verify the efficacy and safety of NogoA polypeptide vaccine, the effects of immunotherapy with this vaccine, and the synergistic effects of the vaccine and olfactory ensheathing glial cells in repair of SCI. Methods: A 13-polypeptide fragment of NogoA was synthesized. This fragment was then coupled with keyhole limpet hemocyanin to improve the immunogenicity of the polypeptide vaccine. Immunization via injection into the abdominal cavity was performed in rats before SCI. The serum antibody level and ability of the vaccine to bind with Nogo were detected by enzyme-linked immunosorbent assay. The safety of the vaccine was evaluated according to the incidence and severity of experimental autoimmune encephalomyelitis. Olfactory ensheathing glia cells were obtained, purified, and subsequently implanted into a Wistar rat model of thoracic spinal cord contusion injury. The rats were divided into four groups, ie, an SCI model group, an olfactory ensheathing glia group, a vaccine

  1. Spinal myxopapillary ependymoma in an adult male presenting with recurrent acute low back pain: a case report

    OpenAIRE

    Petersen, Dean; Lystad, Reidar P

    2016-01-01

    Background Spinal intramedullary ependymomas are very rare and occur more commonly in the cervical and upper thoracic regions. These neoplasms tend to manifest in young adulthood, and patients typically present with mild clinical symptoms without objective evidence of neurologic deficits. The mean duration of symptoms is 40 months until the lesion is diagnosed. Case Presentation A 48-year-old male police officer was referred to a chiropractic clinic by a general practitioner for the evaluatio...

  2. 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

  3. Lumbar spondylolysis: a review

    International Nuclear Information System (INIS)

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

  4. Efeito da prednisona em lesão medular aguda experimental em ratos Effect of prednisone on acute experimental spinal cord injury in rats

    Directory of Open Access Journals (Sweden)

    C.M.O. Silva

    2008-06-01

    rootlets, necrosis, inflammatory foci, and reactive gliosis, with no significant differences among the treated groups. The administration of high dosages of prednisone to animals with acute spinal cord injury had no deleterious effects on neurological recovery, even when used late.

  5. Diagnosis and surgery of lumbar disc herniation sequestrating to upper spinal canal: analysis of 17 cases%游离至上位椎管内的腰椎间盘突出症的诊断与手术治疗

    Institute of Scientific and Technical Information of China (English)

    崔子健; 张学利

    2008-01-01

    Objective To summarize the experience in diagnosis and surgery of lumbar disc herniation sequestrating to upper spinal canal.Methods Seventeen patients,9 males and 8 females,aged 41(27~54),with the diseased intervertebral discs herniated and upward sequestrated that were confirmed by lumbar MRI,all with definite clinical manifestations of nerve root compression,underwent operation,including 14 cases undergoing semi-laminectomy and discectomy and 3 cases undergoing laminectomy,discectomy,and fusion.Japanese Orthopedic Association(JOA)(29 scores)evaluation standard was used to before the operation and 14 days and 3 months after the operation to evaluate the curative effects.Results The average operation time was 80 min 50~180 min),and the average blood loss was 170 ml(20~350 ml).Cerebrospinal fluid leakage occurred after operation in 2 cases.The JOA score was 6.7 preoperationally,and then rose to 24.2 14 days and 26.5 3 months post-operationally.The clinical effect was satisfied.Conclusion Lumbar disc herniation sequestrating tO upper spinal canal is often misdiagnosed as intraspinal tumor.Confirmed diagnosis depends on the operators'experience and intensive MRI.Operation is necessary for this type of lumbar disc herniation.Lumbar stability must be considered during decompression and discectomy.%目的 总结游离至上位椎管内的腰椎间盘突出症的诊断与手术治疗经验.方法 17例向上游离的腰椎间盘突出症患者,男9例,女8例;年龄27~54岁,平均41岁.全部患者均有明确的神经根受压的临床表现,腰椎MRI表现为病变椎间盘突出后向上游离至上位椎管内,挤压马尾神经.14例患者行病侧上位腰椎半椎板开窗减压、间盘切除术;3例患者行上位全椎板减压、间盘切除、椎弓根系统内固定、植骨术.并使用29分法(JOA)评分检查术前、术后14 d和3个月治疗效果.结果 手术时间50~180 min,平均80 min;出血量20~350 ml,平均170 ml.2例

  6. 轴向加载对腰椎结核模型稳定性影响的三维有限元研究%Axial Load Effect on the Stability of Lumbar Spinal Tuberculosis in a Three-dimensional Finite Element Model

    Institute of Scientific and Technical Information of China (English)

    费骏; 赖震; 魏威; 石仕元; 沈健; 廖胜辉

    2013-01-01

    Objective:To study the influence of axial load on lumbar spine tuberculosis stability with a three-dimen-sional finite element model, and to provide the necessary biomechanical theoretical basis for the treatment of spinal tuberculosis. Methods:A normal material FE model of L2~L5 Lumbar model and 5 different types of tuberculosis models were generated by using specially designed modeling system after CT data collected from a volunteer sub-ject and then the same axial loading conditions were applied to do comparison. Results:After axial loading,lumbar tuberculosis stability was affected by tuberculosis:the average stiffness of A,B,C,D,and E lumbar spinal tuberculo-sis models were 233,239,275,253,and 217 N/mm,with a 22% reduction at most when compared to 277 N/mm of the normal model. For stress result, tuberculosis located in the cortical bone brought serious impact, with large stress concentration. Tuberculosis also seriously influenced the mechanical conduction of the intervertebral disc. Conclusion:Tuberculosis can affect lumbar stability;different locations of tuberculosis produces the corresponding stress concentration. These findings may have guiding significance on the clinical diagnosis.%目的:研究轴向加载对腰椎结核三维有限元模型稳定性的影响,为临床治疗腰椎结核提供生物力学理论依据。方法:选取自愿者采集CT数据,采用专用生物力学软件建立正常材质的L2~L5节段腰椎模型和5种不同的结核模型,在相同的轴向加载条件下进行分析。结果:通过轴向加载发现,正常腰椎的平均刚度为277N/mm,A、B、C、D、E五型结核腰椎的平均压缩刚度分别为233N/mm、239N/mm、275N/mm、253N/mm和217N/mm。腰椎结核模型平均刚度比正常模型最大减小近22%;在应力方面,结核破坏区域位于骨皮质时影响最大,出现大的应力集中情况;同时,结核破坏对于椎间盘的力学传导有很大影响。结论:腰椎结

  7. Risk factors for urinary tract infections in patients with lumbar spinal cord injuries during rehabilitation period%腰椎脊髓损伤患者康复期医院尿路感染的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    万春霞; 刘静; 杨春霞

    2015-01-01

    目的:探讨腰椎脊髓损伤患者康复期医院尿路感染的相关危险因素,对患者康复期治疗及尿路感染的预防起到一定指导作用。方法回顾性分析2012年6月-2013年6月62例腰椎脊髓损伤住院患者的临床资料,选择可能导致尿路感染的因素,比较尿路感染发生率,单因素分析影响尿路感染发生的相关因素,多因素 logistic回归分析影响尿路感染发生的独立危险因素。结果脊髓损伤患者发生尿路感染27例,感染率为43.5%;脊髓损伤程度、尿管留置时间、膀胱冲洗频率、尿路感染前抗菌药物使用、有低蛋白血症是影响脊髓损伤住院患者康复期尿路感染的危险因素;脊髓损伤程度、尿管留置时间和尿路感染前使用抗菌药物是影响脊髓损伤住院患者康复期尿路感染发生的独立危险因素。结论采取相应的预防措施,可有效地减少患者尿路感染的发生率,提高患者康复期间的治疗效果。%OBJECTIVE To explore the related risk factors for nosocomial infections in patients with lumbar spinal cord injuries during the rehabilitation period so as to provide guidance for prevention of urinary tract infections during the rehabilitation period .METHODS The clinical data of 62 patients with lumbar spinal cord injuries who were hospitalized from Jun 2012 to Jun 2013 were retrospectively analyzed ,then the risk factors for the urinary tract infections were analyzed ,the incidence of the urinary tract infections was observed ,the univariate analysis was conducted for the related influencing factors for the urinary tract infections ,and the multivariate logistic re‐gression analysis was performed for the independent risk factors for the urinary tract infections .RESULTS The uri‐nary tract infections occurred in 27 patients with spinal cord injuries ,with the infection rate of 43 .5% .The degree of spinal cord injuries ,catheter indwelling time ,frequency

  8. 人工椎间盘置换术后脊柱节段运动范围及有关参数变化的相关评价%Correlated evaluation on the spinal segment motion scope and the alteration of the corre sponding parameters after artificial lumbar intervertebral disc replacement

    Institute of Scientific and Technical Information of China (English)

    徐义春; 刘尚礼; 黄东生; 沈慧勇; 李春海; 马若凡

    2004-01-01

    destroyed by physiological aging and pathological damages. The results may cause not only disc degenerative diseases, but also serial changes of spinal biomechanics because intervertebral discs are key structures in the spinal motion segment. So it is better to reconstruct the normal function of the destroyed disc, which not only can treat disc degenerative diseases but also restore its function partly.OBJECTIVE: To explore the motion scope and the alterations of the corresponding parameters of the corresponding spinal segment after artificial disc replacement(ADR) in patients with degenerative diseases of lumbar intervertebral disc.DESIGN: A before-after controlled study.SETTING: Department of Orthopaedics, the Third Affiliated Hospital and Department of Orthopaedics, the Second Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: The study was principally performed in the Department of Orthopaedics of the Second Affiliated Hospital of Sun Yat-sen University. Thirty-four patients diagnosed with degenerative diseases of lumbar intervertebral disc were selected for our study during February 1999 to June 2002. Artificial disc replacement was performed in 41 intervertebral discs. All patients completed the whole process of the study according to the postoperative requirement.METHODS: All the patients received ADR with SB Charite Ⅲ artificial lumbar intervertebral disc(AID) made by Link Company, Germany, made through an anterior extraperitoneal approach under endotracheal anaesthesia after pararectal incision, and relative evaluations as well.tor segment, motor scope of the intervertebral articulation, the height of inpostoperative clinical effectivenessRESULTS: Single segment replacement was performed in 2 cases of I3-44, 18cases of L4-5, and 7 cases of L6S1, and two-segment replacement was performed in 1 case of L3-4 combined with L4-5 and 6 cases of L4-5 combined with L6S1. All patients received postoperative follow-up for a period of 3 to 38 months(average of 18

  9. 应用改良AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折%The Application of Improved AF Spinal Internal Fixation System With Percutaneous Minimally Invasive Internal Fixation for the Treatment of Thoracic and Lumbar Vertebral Compression Fracture

    Institute of Scientific and Technical Information of China (English)

    李晓龙; 王志军

    2015-01-01

    Objective To explore the efficacy of the AF spinal internal fixation system with percutaneous minimally invasive internal fixation for the treatment of thoracic and lumbar vertebral compression fracture. Methods Collected in our hospital 48 cases of thoracolumbar compression fractures, application of improved percutaneous minimally invasive internal fixation of AF spinal internal fixation system in the treatment of thoracolumbar compression fractures, postoperative review X-ray for curative effect analysis. Results 48 cases of compression injury vertebral height of vertebral body than preoperative obviously restoration, 90%of the average recovery to normal height of vertebral body Conclusion Application of improved percutaneous minimally invasive internal ifxation of AF spinal internal fixation system in the treatment of thoracolumbar compression fractures curative effect is distinct.%目的:探讨应用AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折的疗效。方法收集本院48例胸腰椎压缩骨折,应用改良AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折,术后复查X片进行疗效分析。结果48例压缩的伤椎椎体高度比术前明显得到恢复,平均恢复至正常椎体高度的90%。结论应用改良AF脊柱内固定系统经皮微创内固定治疗胸腰椎压缩骨折疗效显著。

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

    OpenAIRE

    Leute, Philip Johannes Felix; Hammad, Ahmed; Hoffmann, Isabel; Hoppe, Sebastian; Klinger, Hans-Michael; Lakemeier, Stefan

    2015-01-01

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

  11. [Acute non-traumatic myelopathy in children and adolescents].

    Science.gov (United States)

    Arroyo, Hugo A

    2013-09-01

    The term 'acute myelopathies'--referred to a spinal cord dysfunction--represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. The objective of this review is to discuss the non-traumatic acute myelopathies. Acute myelopathy can be due to several causes as infective agents or inflammatory processes, such as in acute myelitis, compressive lesions, vascular lesions, etc. The clinical presentation is often dramatic with tetraparesis or paraparesis, sensory disturbances and bladder and/or bowel dysfunction. History and physical examination are used to localize the lesion to the root or specific level of the cord, which can guide imaging. Different syndromes are recognized: complete transverse lesion, central grey matter syndrome, anterior horn syndrome, anterior spinal artery syndrome, etc). The first priority is to rule out a compressive lesion. If a myelopathy is suspected, a gadolinium-enhanced MRI of the spinal cord should be obtained as soon as possible. If there is no structural lesion such as epidural blood or a spinal mass, then the presence or absence of spinal cord inflammation should be documented with a lumbar puncture. The absence of pleocytosis would lead to consideration of non inflammatory causes of myelopathy such as arteriovenous malformations, fibrocartilaginous embolism, or possibly early inflammatory myelopathy. In the presence of an inflammatory process (defined by gadolinium enhancement, cerebrospinal fluid pleocytosis, or elevated cerebrospinal fluid immunoglobulin index), one should determine whether there is an inflammatory or an infectious cause. Different virus, bacterias, parasites and fungi have to be considered as autoimmune and inflammatory diseases that involve the central nervous system. PMID:23897140

  12. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients.

    Science.gov (United States)

    Wang, J C; Bohlman, H H; Riew, K D

    1998-12-01

    We reviewed the results of acute management of patients who had sustained a dural tear during an operation on the lumbar spine, and we attempted to determine the long-term sequelae of this complication. In the five years from July 1989 to July 1994, 641 consecutive patients had a decompression of the lumbar spine, performed by the senior one of us; of these patients, eighty-eight (14 percent) sustained a dural tear, which was repaired during the operation. The duration of follow-up ranged from two to eight years (average, 4.3 years). Postoperative management consisted of closed suction wound drainage for an average of 2.1 days and bed rest for an average of 2.9 days. Of the eighty-eight procedures that resulted in a dural tear, forty-five were revisions; these revisions were performed after an average of 2.2 previous operations on the lumbar spine, all of which resulted in a scar adherent to the dura. Only eight patients had headaches related to the spinal procedure and photophobia in the postoperative period; these symptoms resolved in all but two patients, both of whom had had a revision operation. Each of the two patients had symptoms of a persistent leak of spinal fluid and needed a reoperation for repair. Overall, seventy-six patients had a good or excellent result and twelve had a poor or satisfactory result with some residual back pain. One patient had arachnoiditis, and another had symptoms of viral meningitis one month postoperatively. A dural tear that occurs during an operation on the lumbar spine can be treated successfully with primary repair followed by bed rest. Such a tear does not appear to have any long-term deleterious effects or to increase the risk of postoperative infection, neural damage, or arachnoiditis. Closed suction wound drainage does not seem to aggravate the leak and can be used safely in the presence of a dural repair.

  13. A Systematic Review of Experimental Strategies Aimed at Improving Motor Function after Acute and Chronic Spinal Cord Injury.

    Science.gov (United States)

    Gomes-Osman, Joyce; Cortes, Mar; Guest, James; Pascual-Leone, Alvaro

    2016-03-01

    While various approaches have been proposed in clinical trials aimed at improving motor function after spinal cord injury in humans, there is still limited information regarding the scope, methodological quality, and evidence associated with single-intervention and multi-intervention approaches. A systematic review performed using the PubMed search engine and the key words "spinal cord injury motor recovery" identified 1973 records, of which 39 were selected (18 from the search records and 21 from reference list inspection). Study phase ( clinicaltrials.org criteria) and methodological quality (Cochrane criteria) were assessed. Studies included proposed a broad range of single-intervention (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) and multi-intervention approaches (that combined more than one strategy). The highest evidence level was for Phase III studies supporting the role of multi-intervention approaches that contained a rehabilitation component. Quality appraisal revealed that the percentage of selected studies classified with high risk of bias by Cochrane criteria was as follows: random sequence generation = 64%; allocation concealment = 77%; blinding of participants and personnel = 69%; blinding of outcome assessment = 64%; attrition = 44%; selective reporting = 44%. The current literature contains a high proportion of studies with a limited ability to measure efficacy in a valid manner because of low methodological strength in all items of the Cochrane risk of bias assessment. Recommendations to decrease bias are discussed and include increased methodological rigor in the study design and recruitment of study participants, and the use of electrophysiological and imaging measures that can assess functional integrity of the spinal cord (and may be sufficiently sensitive to detect changes that occur in response to therapeutic

  14. Central nociceptive sensitization vs. spinal cord training: Opposing forms of plasticity that dictate function after complete spinal cord injury

    Directory of Open Access Journals (Sweden)

    Adam R Ferguson

    2012-10-01

    Full Text Available The spinal cord demonstrates several forms of plasticity that resemble brain-dependent learning and memory. Among the most studied form of spinal plasticity is spinal memory for noxious (nociceptive stimulation. Numerous papers have described central pain as a spinally-stored memory that enhances future responses to cutaneous stimulation. This phenomenon, known as central sensitization, has broad relevance to a range of pathological conditions. Work from the spinal cord injury (SCI field indicates that the lumbar spinal cord demonstrates several other forms of plasticity, including formal learning and memory. After complete thoracic SCI, the lumbar spinal cord can be trained by delivering stimulation to the hindleg when the leg is extended. In the presence of this response-contingent stimulation the spinal cord rapidly learns to hold the leg in a flexed position, a centrally mediated effect that meets the formal criteria for instrumental (response-outcome learning. Instrumental flexion training produces a central change in spinal plasticity that enables future spinal learning on both the ipsilateral and contralateral leg. However, if stimulation is given in a response-independent manner, the spinal cord develops central maladaptive plasticity that undermines future spinal learning on both legs. The present paper tests for interactions between spinal cord training and central nociceptive sensitization after complete spinal cord transection. We found that spinal training alters future central sensitization by intradermal formalin (24 h post-training. Conversely intradermal formalin impaired future spinal learning (24 h post-injection. Because the NMDA receptor has been implicated in formalin-induced central sensitization, we tested whether pretreatment with NMDA affects spinal learning. We found intrathecal NMDA impaired learning in a dose-dependent fashion, and that this effect endures for at least 24h. These data provide strong evidence for an

  15. Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature

    Directory of Open Access Journals (Sweden)

    Akbary Kutbuddin

    2014-06-01

    Full Text Available Objective: Paraplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures. Treatment modalities for such fractures, such as stabilization, have no effect on the neurological recovery. Thus, various pharmacological and biological treatment modalities have been used. The more recent trend of using autologous stem cells from the iliac crest has been used in some clinical trials with varying success. Thus, more clinical studies are required to study the effect of this novel approach Methods: This is a prospective hospital-based cohort study (level IV. The study was conducted in the Dept. of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi from November 2010 to March 2012. Ten patients who had sustained traumatic dorsolumbar vertebral fractures with complete paraplegia were recruited for this study. Under suitable anaesthesia, at the beginning of surgery, 100 ml of bone marrow was aspirated. This was centrifuged and buffy coat isolated and then transferred into a sterile tube and sent to the operating room on ice packs. After surgical decompression and stabilization, the buffy coat isolate was injected into the dural sleeve at the site of the injury using a 21G needle. All the patients were evaluated for neurological improvement using the American Spinal Injury Association (ASIA score and Frankel grade at 6 weeks and 3 months postoperatively. Results: The evaluation at 6 weeks showed some improvement in terms of the ASIA scores in 2 patients but no improvements in their Frankel Grade. The other 8 patients showed no improvements in their ASIA scores or their Frankel Grades. The current pilot study has shown that there has been no improvement in most of the recipients of the transplant (n=8. Some patients (n=2 who did show some improvement in their sensory scores proved to be of no signifi cant functional value as depicted by no change in their Frankel Grades. Conclusion

  16. Acute visual loss with ophthalmoplegia after spinal surgery: Report of a case and review of the literature

    Directory of Open Access Journals (Sweden)

    Bipasha Mukherjee

    2014-01-01

    Full Text Available We report a case of a 15-year-old boy who presented with profound visual loss and complete ophthalmoplegia after an uneventful spinal surgery for removal of cervical osteoblastoma. Postoperative visual loss following nonocular surgery is, fortunately rare, yet a devastating complication. The most common cause is ischemic optic neuropathy, but it can also be due to central retinal occlusion or cortical blindness. Visual loss in conjunction with ophthalmoplegia is rarely seen, and there are very few reports in the literature. We also review the related literature and highlight the mechanism and preventive measures.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-04-01

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

  18. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

    Science.gov (United States)

    Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

    2016-09-01

    Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research. PMID:27349468

  19. Transverse myelitis following spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Jha Sanjeev

    2006-01-01

    Full Text Available Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.

  20. Evaluation of the survival of bone marrow-derived mononuclear cells and the growth factors produced upon intramedullary transplantation in rat models of acute spinal cord injury.

    Science.gov (United States)

    Arai, Kiyotaka; Harada, Yasuji; Tomiyama, Hiroyuki; Michishita, Masaki; Kanno, Nobuo; Yogo, Takuya; Suzuki, Yoshihisa; Hara, Yasushi

    2016-08-01

    Intramedullary bone marrow-derived mononuclear cell (BM-MNC) transplantation has demonstrated neuroprotective effects in the chronic stage of spinal cord injury (SCI). However, no previous study has evaluated its effects in the acute stage, even though cell death occurs mainly within 1week after injury in all neuronal cells. Moreover, the mechanism underlying these effects remains unclear. We aimed to investigate the survival of intramedullary transplanted allogeneic BM-MNCs and the production of growth factors after transplantation to clarify the therapeutic potential of intramedullary transplanted BM-MNCs and their protective effects in acute SCI. Sprague-Dawley rats were subjected to traumatic SCI and received intramedullary transplantation of EGFP(+)BM-MNCs (n=6), BM-MNCs (n=10), or solvent (n=10) immediately after injury. To evaluate the transplanted BM-MNCs and their therapeutic effects, immunohistochemical evaluations were performed at 3 and 7days post-injury (DPI). BM-MNCs were observed at the injected site at both 3 (683±83 cells/mm(2)) and 7 DPI (395±64 cells/mm(2)). The expression of hepatocyte growth factor was observed in approximately 20% transplanted BM-MNCs. Some BM-MNCs also expressed monocyte chemotactic protein-1 or vascular endothelial growth factor. The demyelinated area and number of cleaved caspase-3-positive cells were significantly smaller in the BM-MNC-transplanted group at 3 DPI. Hindlimb locomotor function was significantly improved in the BM-MNC-transplanted group at 7 DPI. These results suggest that intramedullary transplantation of BM-MNCs is an efficient method for introducing a large number of growth factor-producing cells that can induce neuroprotective effects in the acute stage of SCI. PMID:27473980

  1. Continuation of medically necessary platelet aggregation inhibitors - acetylsalicylic acid and clopidogrel - during surgery for spinal degenerative disorders: Results in 100 patients

    Directory of Open Access Journals (Sweden)

    Reza Akhavan-Sigari

    2014-01-01

    Full Text Available Background: Patients undergoing spinal surgery while under anticoagulation therapy are at risk of developing bleeding complications, even though lower incidences have been reported for joint arthroplasty surgery. There is a gap in the medical literature examining the incidence of postoperative spinal bleeding in patients who were under anticoagulation medication at the time of surgery. Methods: We prospectively followed a consecutive cohort of 100 patients (58 male, 42 female undergoing spinal surgery. The average patient age was 48.7 years and the minimum follow up time was 12 months. Diagnosis was lumbar spinal stenosis in 20, herniated lumbar discs in 63, degenerative cervical disc disease in 3, and cervical disc herniation in 14 cases. In our study, platelet aggregation inhibitors (clopidogrel and/or acetylsalicylic acid were given for the treatment of cardiovascular and cerebrovascular thrombotic events, to reduce risk of stroke in patients who have had transient ischemia of the brain or acute coronary syndrome, and as secondary prevention of atherosclerotic events (fatal or nonfatal myocardial infarction (MI. A cessation of anticoagulants (acetylsalicylic acid or clopidogrel in our patients in the peri- and postoperative period was contraindicated. Results: Sixty-three patients were on both clopidogrel and acetylsalicylic acid and 37 on acetylsalicylic acid only. None of the patients suffered any postoperative bleeding complication. Three patients suffered postoperative wound dehiscence and one patient had an infection that required reoperation. Conclusion: The question of whether preoperative platelet aggregation inhibitors must be stopped before elective spinal surgery has never been answered in the literature. In our prospective series, we have found no increase in the risk of postoperative spinal bleeding with the use of clopidogrel or acetylsalicylic acid. This finding suggests that spine surgery can be done without stopping

  2. Spinal Subdural Staphylococcus Aureus Abscess: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Fligou Fotini

    2009-08-01

    Full Text Available Abstract Background Only 65 cases (including our case of spinal subdural abscesses have been reported to the literature, mostly to the lumbar spine. Staphylococcus aureus is the most common bacterial. The symptoms are not caracteristic and contrast – enhanced magnetic resonance imaging scan (MRI is the imaging method of choice. The early diagnosis is crucial for the prognosis of the patient. Case presentation We present a patient 75 years old who had a history of diabetes and suffered acute low back pain in the region of the lumbar spine for the last 4 days before his admission to the hospital. He also experienced lower leg weakness, fever and neck stiffness. After having a brain CT scan and a lumbar puncture the patient hospitalized with the diagnosis of meningitis. Five days after his admission the diagnosis of subdural abscess secured with contrast – enhanced MRI but meanwhile the condition of the patient impaired with respiratory failure and quadriplegia and he was admitted to the ICU. A laminectomy was performed eight days after his admission into the hospital but unfortunately the patient died. Conclusion Early diagnosis and treatment are very important for the good outcome in patients with subdural abscess. Although morbidity and mortality are very high, surgical and antibiotic treatment should be established as soon as possible after the diagnosis has secured.

  3. Degenerative Pathways of Lumbar Motion Segments

    DEFF Research Database (Denmark)

    Jensen, Rikke K.; Kjaer, Per; Jensen, Tue S.;

    2016-01-01

    the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical...... into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical...... samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. CONCLUSIONS: It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing...

  4. Hemophilic pseudotumor of the first lumbar vertebra

    Directory of Open Access Journals (Sweden)

    Gurusamy Nachimuthu

    2014-01-01

    Full Text Available Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases.

  5. 类固醇激素治疗急性颈髓损伤的临床观察%The clinical study of steroid hormone on the treatment in acute cervical spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    张建宏; 范建中; 杨哲

    2002-01-01

    Objective To observe the therapeutic effect of methylprednisolone and dexamethasone on acute cervical spinal cord injury, and to explore the function and mechanism of steroid. Methods 59 patients with cervical spinal cord injury and post operation were divided into the methylprednisolone group (19 cases), the dexamethasone group (25 cases) and routine treatment group (15 cases). Based on the neural and functional grade standard of spinal cord injury, the degree of damage were assessed and the clinical data and complications were recorded. Results The function of sensory and motor in the three groups were all improved remarkably (P< 0.05). The sensory improvement of the methylprednisolone group was better than the other two groups and the motor improvement of the methylprednisolone group was better than routine treatment group. There was no difference in the treatment effect between the dexamethasone group and routine treatment group. There was no different in the complications among the three groups. Conclusion The steroid hormone can improve the function of sensory and motor in the patients with acute spinal cord injury. The theraputic effect of the methylprednisolone was better than that of the dexamethasone.

  6. Evaluation of early and late effects into the acute spinal cord injury of an injectable functionalized self-assembling scaffold.

    Directory of Open Access Journals (Sweden)

    Daniela Cigognini

    Full Text Available The complex physiopathological events occurring after spinal cord injury (SCI make this devastating trauma still incurable. Self-assembling peptides (SAPs are nanomaterials displaying some appealing properties for application in regenerative medicine because they mimic the structure of the extra-cellular matrix (ECM, are reabsorbable, allow biofunctionalizations and can be injected directly into the lesion. In this study we evaluated the putative neurorigenerative properties of RADA16-4G-BMHP1 SAP, proved to enhance in vitro neural stem cells survival and differentiation. This SAP (RADA16-I has been functionalized with a bone marrow homing motif (BMHP1 and optimized via the insertion of a 4-glycine-spacer that ameliorates scaffold stability and exposure of the biomotifs. We injected the scaffold immediately after contusion in the rat spinal cord, then we evaluated the early effects by semi-quantitative RT-PCR and the late effects by histological analysis. Locomotor recovery over 8 weeks was assessed using Basso, Beattie, Bresnahan (BBB test. Gene expression analysis showed that at 7 days after lesion the functionalized SAP induced a general upregulation of GAP-43, trophic factors and ECM remodelling proteins, whereas 3 days after SCI no remarkable changes were observed. Hystological analysis revealed that 8 weeks after SCI our scaffold increased cellular infiltration, basement membrane deposition and axon regeneration/sprouting within the cyst. Moreover the functionalized SAP showed to be compatible with the surrounding nervous tissue and to at least partially fill the cavities. Finally SAP injection resulted in a statistically significant improvement of both hindlimbs' motor performance and forelimbs-hindlimbs coordination. Altogether, these results indicate that RADA16-4G-BMHP1 induced favourable reparative processes, such as matrix remodelling, and provided a physical and trophic support to nervous tissue ingrowth. Thus this biomaterial

  7. 加巴喷丁联合非甾体消炎药治疗腰椎管狭窄症的疗效评价%CLINICAL EFFICACY OF COMBINATION OF GABAPENTIN AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS FOR PATIENTS WITH LUMBAR SPINAL STENOSIS

    Institute of Scientific and Technical Information of China (English)

    王昕辉; 易红蕾; 李红霞; 王谦; 孙海燕

    2012-01-01

    Objective: To evaluate the efficacy and safety of the combination of gabapentin and non-steroidal anti-inflammatory drugs in the treatment of patients with mild to moderate lumbar spinal stenosis. Methods: In this prospective nonrandomized control study, 54 patients with mild to moderate lumbar spinal stenosis were divided into the control group (n = 30) administered with non-steroidal anti-inflammatory drugs only, and the experimental group (n = 24) administered with gabapentin and non-steroidal anti-inflammatory drugs. The dose of gabapentin was titrated from 300 mg/d to 1800 mg/d. The visual analogue scale (VAS) of low back and leg pain, walking distance and side effects were measured every month. Results: All the patients were followed up for 12 weeks. Compared with the control group, the walking distance of the experimental group increased (P < 0.01), low back and leg pain VAS scores decreased (P < 0.05) and sensory deficit improved (P < 0.05). Three patients taking gabapentin had side effects, such as drowsiness, dizziness and ataxia. However, the symptoms relieved or disappeared after rest. Conclusion: Combination of gabapentin and non-steroidal anti-inflammatory drugs can improve the symptoms of lumbar spinal stenosis safely and effectively, its short-term efficacy and safety is reliable.%目的:观察加巴喷丁联合非甾体消炎药治疗轻至中度腰椎管狭窄症患者的有效性和安全性.方法:采用前瞻性对照研究,选择轻至中度症状的腰椎管狭窄症患者54例为研究对象,其中对照组30例仅口服非甾体消炎药;试验组24例,口服加巴喷丁+非甾体消炎药物.加巴喷丁剂量从300 mg/d逐步滴定至1800 mg/d.随访期间,每月分别统计腰腿痛评分、行走距离、副作用等.结果:所有病例随访12周.与对照组比较,试验组治疗后步行距离增加(P<0.01),腰腿痛评分下降(P<0.05),感觉功能障碍恢复(P<0.05).试验组3人出现嗜睡、头晕、共济失调

  8. Spinal infections

    Energy Technology Data Exchange (ETDEWEB)

    Tali, E. Turgut E-mail: turguttali@gazi.edu.tr

    2004-05-01

    Spinal infections can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy and myelitis. Radiological evaluations have gained importance in the diagnosis, treatment planning, treatment and treatment monitoring of the spinal infections. Conventional radiographs are usually the initial imaging study. The sensitivity and specificity of the plain radiographs are very low. The sensitivity of CT is higher while it lacks of specificity. Conventional CT has played minor role for the diagnosis of early spondylitis and disc space infection and for follow-up, researches are going on the value of MDCT. MRI is as sensitive, specific and accurate as combined nuclear medicine studies and the method of choice for the spondylitis. Low signal areas of the vertebral body, loss of definition of the end plates and interruption of the cortical continuity, destruction of the cortical margins are typical on T1WI whereas high signal of affected areas of the vertebral body and disc is typical on T2WI. Contrast is mandatory and increases conspicuity, specificity, and observer confidence in the diagnosis and facilitates the treatment planning. Contrast enhancement is the earliest sign and pathognomonic in the acute inflammatory episode and even in the subtle infection then persists to a varying degree for several weeks or months. The outcome of the treatment is influenced by the type of infection and by the degree of neurologic compromise before treatment. There is an increasing move away from surgical intervention towards conservative therapy, percutaneous drainage of abscess or both. It is therefore critical to monitor treatment response, particularly in the immuno-deficient population.

  9. Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: a battle of time and pressure.

    Directory of Open Access Journals (Sweden)

    Peter E Batchelor

    Full Text Available The use of early decompression in the management of acute spinal cord injury (SCI remains contentious despite many pre-clinical studies demonstrating benefits and a small number of supportive clinical studies. Although the pre-clinical literature favours the concept of early decompression, translation is hindered by uncertainties regarding overall treatment efficacy and timing of decompression.We performed meta-analysis to examine the pre-clinical literature on acute decompression of the injured spinal cord. Three databases were utilised; PubMed, ISI Web of Science and Embase. Our inclusion criteria consisted of (i the reporting of efficacy of decompression at various time intervals (ii number of animals and (iii the mean outcome and variance in each group. Random effects meta-analysis was used and the impact of study design characteristics assessed with meta-regression.Overall, decompression improved behavioural outcome by 35.1% (95%CI 27.4-42.8; I(2=94%, p<0.001. Measures to minimise bias were not routinely reported with blinding associated with a smaller but still significant benefit. Publication bias likely also contributed to an overestimation of efficacy. Meta-regression demonstrated a number of factors affecting outcome, notably compressive pressure and duration (adjusted r(2=0.204, p<0.002, with increased pressure and longer durations of compression associated with smaller treatment effects. Plotting the compressive pressure against the duration of compression resulting in paraplegia in individual studies revealed a power law relationship; high compressive forces quickly resulted in paraplegia, while low compressive forces accompanying canal narrowing resulted in paresis over many hours.These data suggest early decompression improves neurobehavioural deficits in animal models of SCI. Although much of the literature had limited internal validity, benefit was maintained across high quality studies. The close relationship of compressive

  10. Spinal pain

    International Nuclear Information System (INIS)

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  11. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  12. Relationship between bulbocavernosus reflex, patellar reflex and rehabilitation during acute stage of cervical spinal injury%颈髓损伤急性期球海绵体反射、膝反射与康复的关系

    Institute of Scientific and Technical Information of China (English)

    杨茂伟; 朱悦; 吕刚; 范广宇; 薛明

    2003-01-01

    AIM: To investigate the relationship between bulbocavemous refiex(BTR),patallar reflex(PTR) and rehabilitation during acute stage of cervical spinalinjury. METHODS: 73 cases of a class frankel cervical spinal injury patientswere examined with BTR and PTR and recorded the time of the two reflexes,then follow-up after 6 months to monitor recovery situation. RESUULTS: Therewere 28 cases of positive BCR within the first 72 h (38%), 7 cases of improvedcondifions(25% ); there were 13 cases of PTR positive (17%), 13 cases ofimproved status(100% ). CONCLUSION: BCR and PTR are the sign of ima-proved status and better rehabilitation during the acute stage.

  13. Bifocal Spinal Cord Injury without Radiographic Abnormalities in a 5-Year Old Boy: A Case Report

    Directory of Open Access Journals (Sweden)

    K. G. Snoek

    2012-01-01

    Full Text Available We present the extremely unusual case of a 5-year-old boy with a bifocal (cervical as well as lumbar spinal cord injury without radiographic abnormalities (SCIWORAs. The MRI showed cord oedema at the level of C2 and T10. We propose that during the motor vehicle crash severe propulsion of the head with a flexed lumbar region resulted in a traction injury to the lower thoracic and lumbar spine and maximum flexion caused SCIWORA in C2.

  14. Spinal cord motion. Influence of respiration and cardiac cycle

    Energy Technology Data Exchange (ETDEWEB)

    Winklhofer, S. [RWTH Aachen University Hospital (Germany). Dept. of Neuroradiology; University Hospital Zurich (Switzerland). Inst. of Diagnostic and Interventional Radiology; Schoth, F. [RWTH Aachen University Hospital (Germany). Dept. of Diagnostic Radiology; Stolzmann, P. [University Hospital Zurich (Switzerland). Inst. of Diagnostic and Interventional Radiology; Krings, T. [Toronto Western Hospital, ON (Canada). Div. of Neuroradiology; Mull, M.; Wiesmann, M. [RWTH Aachen University Hospital (Germany). Dept. of Neuroradiology; Stracke, C.P. [RWTH Aachen University Hospital (Germany). Dept. of Neuroradiology; Alfried-Krupp-Hospital, Essen (Germany). Dept. of Neuroradiology

    2014-11-15

    To assess physiological spinal cord motion during the cardiac cycle compared with the influence of respiration based on magnetic resonance imaging (MRI) measurements. Anterior-posterior spinal cord motion within the spinal canal was assessed in 16 healthy volunteers (median age, 25 years) by cardiac-triggered and cardiac-gated gradient echo pulse sequence MRI. Image acquisition was performed during breath-holding, normal breathing, and forced breathing. Normal spinal cord motion values were computed using descriptive statistics. Breathing-dependent differences were assessed using the Wilcoxon signed-rank test and compared with the cardiac-based cord motion. A normal value table was set up for the spinal cord motion of each vertebral cervico-thoracic-lumbar segment. Significant differences in cord motion were found between cardiac-based motion while breath-holding and the two breathing modalities (P < 0.01 each). Spinal cord motion was found to be highest during forced breathing, with a maximum in the lower cervical spinal segments (C5; mean, 2.1 mm ± 1.17). Image acquisition during breath-holding revealed the lowest motion. MRI permits the demonstration and evaluation of cardiac and respiration-dependent spinal cord motion within the spinal canal from the cervical to lumbar segments. Breathing conditions have a considerably greater impact than cardiac activity on spinal cord motion.

  15. Why should we use atraumatic needles in lumbar puncture?

    Directory of Open Access Journals (Sweden)

    Sandro Luiz de Andrade Matas

    2013-09-01

    Full Text Available Diagnostic lumbar puncture is essential to the diagnosis of central nervous system infections, subarachnoid haemorrhage and others neurological diseases. Myeloradicular involvement or life-threatening adverse events due to the procedure are rare, but less severe complications are more frequent. Post-lumbar puncture headache is the most common complication, by spinal fluid leakage due to delayed closure of a dural defect. Therefore, the development of fine needles, with differentiated atraumatic bevel, has contributed to minimize that problem. These generically called atraumatic needles cause less deformation of the dura mater then the Quincke® ones. So, why don't we use these atraumatic needles?

  16. [Lumbar spine injuries in pediatric and adolescent athletes].

    Science.gov (United States)

    Berk, R Haluk

    2004-01-01

    During the past two decades, there has been a significant increase in sports participation by pediatric athletes. Spinal injuries thus have become a great concern. The unique nature of the pediatric spine should be well-recognized and low back pain in a pediatric athlete should therefore be taken seriously and evaluated thoroughly. In this review article, sports-related lumbar spine problems will be covered including overuse injuries, spondylolysis, pars stress fractures, spondylolysthesis, and lumbar disc herniation. Early identification of these problems will eventually minimize these injuries. PMID:15187460

  17. Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice.

    Science.gov (United States)

    Flynn, Timothy W; Wainner, Robert S; Fritz, Julie M

    2006-08-01

    Spinal manipulation for low back complaints is an intervention supported by randomized clinical trials and its use recommended by clinical practice guidelines. Physical therapists in this country and internationally have used thrust spinal manipulation at much lower-than-expected rates, despite evidence supporting its efficacy for the treatment of acute low back pain (LBP). The purpose of this clinical commentary is to describe a physical therapist professional degree curriculum in thrust spinal manipulation and outline a method of monitoring ongoing student performance during the clinical education experience. Increased emphasis on evidence-based decision making and on the psychomotor skills of thrust spinal manipulation was introduced into a physical therapist professional degree curriculum. As part of ongoing student performance monitoring, physical therapy students on their first full-time (8-week) clinical education experience, collected practice pattern and outcome data on individuals with low back complaints. Eight of 18 first-year students were in outpatient musculoskeletal clinical settings and managed 61 individuals with low back complaints. Patients were seen for an average (+/-SD) of 6.2 +/- 4.0 visits. Upon initial visit the student therapists employed spinal manipulation at a rate of 36.2% and spinal mobilization at 58.6%. At the final visit, utilization of manipulation and mobilization decreased (13% and 37.8%, respectively), while the utilization of exercise interventions increased, with 75% of patients receiving some form of lumbar stabilization training. Physical therapist students used thrust spinal manipulation at rates that are more consistent with clinical practice guidelines and substantially higher then previously reported by practicing physical therapists. Education within an evidence-based framework is thought to contribute to practice behaviors and outcomes that are more consistent with best practice guidelines. PMID:16915979

  18. Laparoscopic lumbar hernia repair.

    Science.gov (United States)

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  19. The histological evaluation of the effect of autologous bone marrow in osteogenous inducement in lumbar intertransverse spinal fusion in rabbits%自体骨髓在兔腰椎横突间融合中诱导成骨的组织学评估

    Institute of Scientific and Technical Information of China (English)

    苏旻罡; 刘志国; 夏铁成; 郝建学; 张建鹏

    2012-01-01

    Objective To investigate the effect of autologous bone marrow augmentation in osteogenous inducement in lumbar intertransverse spinal fusion in rabbits. Methods 24 Chinese white rabbits with skeletal maturation ( 3.0 ~3.5kg) were enrolled in the study. A single - level posterolateral intertransverse process lumbar spine fusion was performed at L5 ~ 6, and corticocancellous bone graft was placed equally in the each side of intertransverse process bed. The 2ml autogenous bone marrow in experimental group was taken out from another iliac crest. The rabbits were killed after 4,8 and 12 weeks,and the spine specimens were excised and analyzed by histological method. Results Intramembranous ossification and endochondral ossification could be observed at different time points both in experimental group and control group. The intramembranous ossification was predominant in experimental group,however,more endochondral ossification was found in control group,with more fibrous tissues showed in sections. Conclusion Autogenous bone marrow is a reliable and effective bone transplantation extender in the animal model of posterolateral intertransverse lumbar spine fusion in rabbits, which can acquire preferable fusion result,with the application of limited autoallergic iliac bone graft.%目的 研究自体骨髓在兔腰椎横突间融合中的诱导成骨作用.方法 骨骼成熟的中国白兔24只,行双侧腰5~6椎体横突间植骨融合.实验组除植入髂骨外,取2 ml自体骨髓植入融合区.不同时期处死动物,脊柱标本应用组织学方法分析.结果 各时期组织学检查显示:实