Lumbosacral myelocystocele: A Case report

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Mittal R.S.

2014-06-01

Full Text Available Myelocystocele is a rare variety of spinal dysraphism that presents as a skin covered, midline, lumbosacral mass. Many a time it is associated with other congenital anomalies but isolated myelocystocele is rarely associated with neurological deficit. MRI is the modality of choice for preoperative diagnosis. A 3 years old female child presented with skin covered lumbosacral mass since birth. There was no associated neurological deficit. MRI revealed single cyst, which was continuous with central canal of spinal cord. Peroperatively, myelocystocele was found with tethering of cord. Untethering of cord and repair of myelocystocele was performed with uneventful recovery.

Influence of Radiographic Positioning on Canine Sacroiliac and Lumbosacral Angle Measurements.

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Jones, Susan; Savage, Mason; Naughton, Brian; Singh, Susheela; Robertson, Ian; Roe, Simon C; Marcellin-Little, Denis J; Mathews, Kyle G

2018-01-01

 To evaluate the influence of radiographic malpositioning on canine sacroiliac and lumbosacral inclination angles.  Using canine cadavers, lateral pelvic radiographs were acquired with the radiographic beam in a neutral position and then rotated 5, 10 and 15° to mimic rotational malpositioning. The focal point of the beam was then focused over the abdomen and again over mid-diaphysis of the femur to mimic an abdominal or femoral radiographic study.  Five degrees of rotational malpositioning did not influence measurements of sacroiliac or lumbosacral inclination, but malpositioning by more than 5° led to a significant decrease in both sacroiliac and lumbosacral angles. Moving the focal point to the femur significantly decreased the measured lumbosacral angle. Abdominally centred radiographs had no effect on lumbosacral and sacroiliac angle measurements.  When evaluating canine lumbosacral and sacroiliac angles radiographically, pelvic rotation of more than 5° should be avoided as should the use of lateral radiographs centred over the femur. Schattauer GmbH Stuttgart.

Lumbosacral Transitional Vertebra: Possible Role in the Pathogenesis of Adolescent Lumbar Disc Herniation.

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Zhang, Bangke; Wang, Liang; Wang, Haibin; Guo, Qunfeng; Lu, Xuhua; Chen, Deyu

2017-11-01

To investigate the role of lumbosacral transitional vertebra (LSTV) in the pathogenesis of adolescent lumbar disc herniation (ALDH) and the association between LSTV type and the herniation level of ALDH. This study was a retrospective case-control analysis of roentgenographic images. All adolescent patients who received surgical treatment for L4/5 or L5/S1 single level lumbar disc herniation in our department from 2010 to 2015 were eligible for the ALDH group. All adolescent patients admitted to our hospital during the same period and who had ever undergone a plain anteroposterior radiologic examination of the abdomen and met the inclusion criteria that ensured the absence of any spinal disorders were selected into the control group. The anteroposterior lumbar or abdomen roentgenograms were collected to identify the LSTV. The incidence of LSTV in the ALDH group and the control group were compared. Among the ALDH group, the association between LSTV type (sacralization or lumbarization) and the herniation level of ALDH were evaluated. A total of 80 adolescent patients were included in the ALDH group and 92 asymptomatic adolescents were included in the control group. LSTV was found in 24 patients (30%) in ALDH group compared with 7 patients (7.6%) in the control group (P adolescent patients with sacralization, the L4/5 disc herniation was significantly more common than L5/S1 (81.3% vs. 18.7%; P = 0.019). The LSTV is associated with LDH in adolescents and the sacralization of L5 may contribute to the L4/5 disc herniation in adolescent patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Lumbosacral stenosis in Labrador retriever military working dogs - an exomic exploratory study.

Science.gov (United States)

Mukherjee, Meenakshi; Jones, Jeryl C; Yao, Jianbo

2017-01-01

Canine lumbosacral stenosis is defined as narrowing of the caudal lumbar and/or sacral vertebral canal. A risk factor for neurologic problems in many large sized breeds, lumbosacral stenosis can also cause early retirement in Labrador retriever military working dogs. Though vital for conservative management of the condition, early detection is complicated by the ambiguous nature of clinical signs of lumbosacral stenosis in stoic and high-drive Labrador retriever military working dogs. Though clinical diagnoses of lumbosacral stenosis using CT imaging are standard, they are usually not performed unless dogs present with clinical symptoms. Understanding the underlying genomic mechanisms would be beneficial in developing early detection methods for lumbosacral stenosis, which could prevent premature retirement in working dogs. The exomes of 8 young Labrador retriever military working dogs (4 affected and 4 unaffected by lumbosacral stenosis, phenotypically selected by CT image analyses from 40 dogs with no reported clinical signs of the condition) were sequenced to identify and annotate exonic variants between dogs negative and positive for lumbosacral stenosis. Two-hundred and fifty-two variants were detected to be homozygous for the wild allele and either homozygous or heterozygous for the variant allele. Seventeen non-disruptive variants were detected that could affect protein effectiveness in 7 annotated (SCN1B, RGS9BP, ASXL3, TTR, LRRC16B, PTPRO, ZBBX) and 3 predicted genes (EEF1A1, DNAJA1, ZFX). No exonic variants were detected in any of the canine orthologues for human lumbar spinal stenosis candidate genes. TTR (transthyretin) gene could be a possible candidate for lumbosacral stenosis in Labrador retrievers based on previous human studies that have reported an association between human lumbar spinal stenosis and transthyretin protein amyloidosis. Other genes identified with exonic variants in this study but with no known published association with lumbosacral

Symptomatic lumbosacral transitional vertebra

DEFF Research Database (Denmark)

Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus

2017-01-01

Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion...

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

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Kocyigit, Burhan Fatih; Berk, Ejder

2018-01-01

Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

Osseous anatomy of the lumbosacral spine in Marfan syndrome.

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Sponseller, P D; Ahn, N U; Ahn, U M; Nallamshetty, L; Rose, P S; Kuszyk, B S; Fishman, E K

2000-11-01

This study examines pedicle widths, laminar thicknesses, and scalloping values for lumbosacral spine elements in Marfan volunteers. Comparisons were made between these measurements and norms as well as measurements between Marfan patients with and without dural ectasia. To determine if the lumbosacral vertebral elements are altered in the patient with Marfan syndrome. Several abnormalities have been noted in Marfan lumbar spine, including pedicular attenuation and widened interpediculate distances. This may be due to abnormalities of growth or presence of dural ectasia. Given the large numbers of Marfan patients requiring spinal surgery and the high postoperative failure rate, better understanding of the bony anatomy of Marfan lumbar spine is necessary, especially if use of instrumentation is anticipated. Thirty-two volunteers with Marfan syndrome based on the Ghent criteria underwent spiral computed tomography of the lumbosacral spine. Images were evaluated for dural ectasia, and measurements of pedicle width, laminar thickness, and vertebral scalloping were made. Pedicle widths and laminar thicknesses were significantly smaller in Marfan patients at all levels (Plaminar thickness from L5-S2 and pedicle widths at all lumbar levels were significantly reduced (Plaminar thickness are significantly reduced in Marfan individuals. Those with dural ectasia demonstrate increased bony erosion of anterior and posterior elements of lumbosacral spine. Preoperative planning and routine computed tomography scans are recommended when operating on Marfan lumbosacral spine.

Lumbosacral Corsets Improve the Outcome of Patients with Non ...

African Journals Online (AJOL)

extreme trunk motion and offering tactile biofeedback. (5). There is paucity of data on the use of lumbosacral corset for acute low back pain. Existing literature on the use of lumbosacral corset is deficient of high quality randomized trials assessing the importance of this modality of treatment on acute low back pain with regard ...

Conjoined lumbosacral nerve roots

International Nuclear Information System (INIS)

Kyoshima, Kazumitsu; Nishiura, Iwao; Koyama, Tsunemaro

1986-01-01

Several kinds of the lumbosacral nerve root anomalies have already been recognized, and the conjoined nerve roots is the most common among them. It does not make symptoms by itself, but if there is a causation of neural entrapment, for example, disc herniation, lateral recessus stenosis, spondylolisthesis, etc., so called ''biradicular syndrome'' should occur. Anomalies of the lumbosacral nerve roots, if not properly recognized, may lead to injury of these nerves during operation of the lumbar spine. Recently, the chance of finding these anomalous roots has been increased more and more with the use of metrizamide myelography and metrizamide CT, because of the improvement of the opacification of nerve roots. We describe the findings of the anomalous roots as revealed by these two methods. They demonstrate two nerve roots running parallel and the asymmetrical wide root sleeve. Under such circumstances, it is important to distinguish the anomalous roots from the normal ventral and dorsal roots. (author)

The transition zone above a lumbosacral fusion.

Science.gov (United States)

Hambly, M F; Wiltse, L L; Raghavan, N; Schneiderman, G; Koenig, C

1998-08-15

The clinical and radiographic effect of a lumbar or lumbosacral fusion was studied in 42 patients who had undergone a posterolateral fusion with an average follow-up of 22.6 years. To examine the long-term effects of posterolateral lumbar or lumbosacral fusion on the cephalad two motion segments (transition zone). It is commonly held that accelerated degeneration occurs in the motion segments adjacent to a fusion. Most studies are of short-term, anecdotal, uncontrolled reports that pay particular attention only to the first motion segment immediately cephalad to the fusion. Forty-two patients who had previously undergone a posterolateral lumbar or lumbosacral fusion underwent radiographic and clinical evaluation. Rate of fusion, range of motion, osteophytes, degenerative spondylolisthesis, retrolisthesis, facet arthrosis, disc ossification, dynamic instability, and disc space height were all studied and statistically compared with an age- and gender-matched control group. The patient's self-reported clinical outcome was also recorded. Degenerative changes occurred at the second level above the fused levels with a frequency equal to those occurring in the first level. There was no statistical difference between the study group and the cohort group in the presence of radiographic changes within the transition zone. In those patients undergoing fusion for degenerative processes, 75% reported a good to excellent outcome, whereas 84% of those undergoing fusion for spondylolysis or spondylolisthesis reported a good to excellent outcome. Radiographic changes occur within the transition zone cephalad to a lumbar or lumbosacral fusion. However, these changes are also seen in control subjects who have had no surgery.

Electrophysiologic evaluation of lumbosacral single nerve roots using compound muscle action potentials.

Science.gov (United States)

Ogura, Taku; Shikata, Hideto; Hase, Hitoshi; Mori, Masaki; Hayashida, Taturo; Osawa, Toru; Mikami, Yasuo; Kubo, Toshikazu

2003-10-01

Transcutaneous electrical stimulation applied to the vertebral column produces compound muscle action potentials (CMAPs) from the leg muscles. Using this method, we evaluated the efferent pathways of the lumbosacral nerve roots. The subjects were 26 healthy volunteers and 31 patients with lumbar disc herniation (LDH). CMAP recordings were obtained from the bilateral vastus medialis, tibialis anterior, extensor digitorum brevis, and abductor hallucis muscles using low-output-impedance stimulation. In normal subjects, the CMAP latency increased linearly with the distance between the stimulating electrode and the recording electrode, with little difference in latency between the left and the right sides in each subject. The CMAP amplitude was significantly lower in the patients with LDH, and the latency was also prolonged when the stimulating electrode was placed above the lesion. This technique may thus be a useful noninvasive method for assessing lumbosacral nerve root function in patients with LDH.

Occult radiological effects of lipomatosis of the lumbosacral plexus

Energy Technology Data Exchange (ETDEWEB)

Mahan, Mark A. [Barrow Neurological Institute, Phoenix, AZ (United States); Howe, B.M.; Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Spinner, Robert J. [Mayo Clinic, Department of Neurosurgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States)

2014-07-15

Lipomatosis of nerve (LN) is a condition of massive peripheral nerve enlargement frequently associated with hypertrophy within the distribution of the nerve, and most commonly affecting the distal limbs. We sought to understand if LN of the lumbosacral plexus would be associated with the trophic effects of LN on surrounding tissue within the pelvis, which may be clinically occult, but present on MRI. Fifty-one cases of LN, confirmed by pathology or pathognomonic appearance on MRI, were reviewed. Patients with LN of the sciatic nerve were investigated for radiological signs suggestive of overgrowth. Five patients had involvement of the sciatic nerve, 4 of whom had MR imaging of the pelvis. Three patients had LN involving the lumbosacral plexus, and one patient had isolated involvement of the sciatic nerve. All patients with involvement of the lumbosacral plexus demonstrated previously unrecognized evidence of nerve territory overgrowth in the pelvis, including: LN, profound adipose proliferation, muscle atrophy and fatty infiltration, and bone hypertrophy and ankylosis. The patient with LN involving the intrapelvic sciatic nerve, but not the lumbosacral plexus did not demonstrate any radiological evidence of pelvic overgrowth. LN is broader in anatomical reach than previously understood. Proximal plexal innervation may be involved, with a consequent effect on axial skeleton and intrapelvic structures. (orig.)

Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain.

Science.gov (United States)

Brault, J S; Smith, J; Currier, B L

2001-01-15

Case report of surgically treated mechanical low back pain from the facet joint contralateral to a unilateral anomalous lumbosacral articulation (Bertolotti's syndrome). To describe the clinical presentation, diagnostic evaluation, and management of facet-related low back pain in a 17-year-old cheerleader and its successful surgical treatment with resection of a contralateral anomalous articulation. Lumbosacral transitional vertebrae are common in the general population. Bertolotti's syndrome is mechanical low back pain associated with these transitional segments. Little is known about the pathophysiology and mechanics of these vertebral segments and their propensity to be pain generators. Treatment of this syndrome is controversial, and surgical intervention has been infrequently reported. A retrospective chart analysis and radiographic review were performed. Repeated fluoroscopically guided injections implicated a symptomatic L6-S1 facet joint contralateral to an anomalous lumbosacral articulation. Eventually, a successful surgical outcome was achieved with resection of the anomalous articulation. Clinicians should consider the possibility that mechanical low back pain may occur from a facet contralateral to a unilateral anomalous lumbosacral articulation, even in a young patient. Although reports of surgical treatment of Bertolotti's syndrome are infrequent, resection of the anomalous articulation provided excellent results in this patient, presumably because of reduced stresses on the symptomatic facet.

Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients

Directory of Open Access Journals (Sweden)

Tunio M

2014-12-01

Full Text Available Mutahir Tunio,1 Mushabbab Al Asiri,1 Yasser Bayoumi,2 Ali Abdullah O Balbaid,1 Majed AlHameed,3 Stanciu Laura Gabriela,1 Ahmad Amir O Ali1 1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2National Cancer Institute, Cairo University, Cairo, Egypt; 3Neurology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia Background: To evaluate the dose distribution to the lumbosacral plexus (LSP and its correlation with radiation-induced lumbosacral plexopathy (RILSP in patients with cervical cancer treated with intensity-modulated radiotherapy (IMRT and high-dose-rate brachytherapy.Materials and methods: After meeting eligibility criteria, 50 patients with cervical cancer were selected who were treated with IMRT and high-dose-rate brachytherapy, and the LSP was contoured. Mean volume; percentages of LSP volume absorbing 40, 50, 55, and 60 Gy (V30, V40, V50, V55, and V60 and point doses (P1, P2, P3, P4, P5, P6, P7, P8, P9, and P10; and RILSP incidence were calculated.Results: At 60 months of follow-up, four patients (8% were found to have grade 2/3 RILSP. The mean maximal LSP dose in patients with RILSP was 59.6 Gy compared with 53.9 Gy in patients without RILSP (control; P=0.04. The mean values of V40, V50, V55, and V60 in patients with RILSP versus control were 61.8% versus 52.8%, 44.4% versus 27.7%, 8.0% versus 0.3% and 1.8% versus 0%, respectively (P=0.01, 0.001, 0.001, and 0.001, respectively.Conclusion: The delineation of the LSP during IMRT planning may reduce the risk for RILSP. The mean values of V40, V50, V55, and V60 for LSP should be less than 55%, 30%, 5%, and 0.5%, respectively; however, further studies are warranted.Keywords: cervical cancer, intensity-modulated radiation therapy, lumbosacral plexus delineation, radiation-induced lumbosacral plexopathy, dosimetric analysis

The effect of lumbosacral manipulation on growing pains

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Dawid de Beer

2015-10-01

Objective: The aim of this study was to determine whether lumbosacral manipulations have an effect on growing pain symptoms. Methods: Thirty participants with growing pains between the ages of 4 and 12 years were recruited. The participants were placed into two groups of 15 participants each. Group 1 received lumbosacral manipulations to restricted joints as determined by motion palpation, while Group 2 never received any professional intervention. Often parent(s/guardian(s of children who suffer from growing pains will rub the child's legs and offer verbal reassurance in an attempt to console their children. Parent(s/guardian(s of both groups were encouraged to continue to do this throughout the duration of the trial. Instructions were given to the parents so that the same rubbing technique and rubbing cream (aqueous cream were used. Subjective changes were tracked using a pain diary that the parent(s/guardian(s were asked to complete, a six-week post-study follow-up question regarding children's growing pains and the Oucher self-report pain scale. Objective measures consisted of pressure algometer readings of the tibialis anterior muscle belly. Results: The statistical data was analysed using the Friedman test, Manne—Whitney test and the Wilcoxon Signed-Rank test. The results demonstrated that both groups responded favourably to their specific treatment over time. However, the group that received lumbosacral manipulations proved to show a quicker response to treatment; and the post study follow-up of this same group showed markedly more positive feedback than the group that did not receive the treatment. These results highlighted the positive effects of chiropractic manipulation on growing pain symptoms. Conclusion: The results from this study, specifically the feedback from parent(s/guardians(s and the pain diaries, indicated that spinal manipulation is beneficial in the treatment of growing pains. The results also showed that other methods of treating growing

Nucleus retroambiguous projections to lumbosacral motoneuronal cell groups in the male cat

NARCIS (Netherlands)

Vanderhorst, VGJM; Holstege, G

1997-01-01

Recently, in the female cat, nucleus retroambiguus (NRA) projections have been described as distinct motoneuronal cell groups in the lumbar enlargement, possibly involved in lordosis behavior. The present study deals with the NRA-lumbosacral pathway in the male cat, Lumbosacral injections of wheat

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis.

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Tellegen, Anna R; Willems, Nicole; Tryfonidou, Marianna A; Meij, Björn P

2015-12-07

Degenerative lumbosacral stenosis is a common problem in large breed dogs. For severe degenerative lumbosacral stenosis, conservative treatment is often not effective and surgical intervention remains as the last treatment option. The objective of this retrospective study was to assess the middle to long term outcome of treatment of severe degenerative lumbosacral stenosis with pedicle screw-rod fixation with or without evidence of radiological discospondylitis. Twelve client-owned dogs with severe degenerative lumbosacral stenosis underwent pedicle screw-rod fixation of the lumbosacral junction. During long term follow-up, dogs were monitored by clinical evaluation, diagnostic imaging, force plate analysis, and by using questionnaires to owners. Clinical evaluation, force plate data, and responses to questionnaires completed by the owners showed resolution (n = 8) or improvement (n = 4) of clinical signs after pedicle screw-rod fixation in 12 dogs. There were no implant failures, however, no interbody vertebral bone fusion of the lumbosacral junction was observed in the follow-up period. Four dogs developed mild recurrent low back pain that could easily be controlled by pain medication and an altered exercise regime. Pedicle screw-rod fixation offers a surgical treatment option for large breed dogs with severe degenerative lumbosacral stenosis with or without evidence of radiological discospondylitis in which no other treatment is available. Pedicle screw-rod fixation alone does not result in interbody vertebral bone fusion between L7 and S1.

Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis

OpenAIRE

Zhong-jun Hou; Yong Huang; Zi-wen Fan; Xin-chun Li; Bing-yi Cao

2015-01-01

Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging (DTI) for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy v...

Measurement of light penetration of near-infrared laser at the lumbosacral nerves in rats

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Ishibashi, Naoya; Shimoyama, Hiroshi; Kawase, Yuki; Motohara, Shosaku; Okayama, Takamitsu; Niwa, Daisuke; Koyama, Jun

2018-02-01

Photobiomodulation or low level laser therapy (LLLT) has been utilized in various areas of medical practice including pain relief, wound healing, and inflammation treatment. Some recent animal studies have reported that near-infrared laser irradiation to the lumbosacral nerves transcutateously relieves neuropathic pain by controlling activity of lumbosacral nerves. However, transcutaneous laser penetration to the nerves has not yet been fully elucidated. Our aim is to determine the light penetration to lumbosacral nerves when near-infrared laser was irradiated transcutateously to lumbosacral nerves. We implanted photodiodes near the lumbosacral nerves of rats and connected the photodiodes to an oscilloscope through an amplifier. Near-infrared lasers (wavelengths: 808 nm and 830 nm) were irradiated through the skin at 2, 5 and 10 W pulses (Duty 10%, 5 Hz) and outputs of photodiodes were collected. After irradiation, the depth of the photodiodes and the nerves from the skin surface were determined by micro-CT device. The result showed that the fluence rate at the lumbosacral nerves was 179+/-19.2 mW/cm2 and 232+/-20.7 mW/cm2 when the 808-nm and 830-nm laser was irradiated at 10 W respectively. These findings would be beneficial for following study of photobiomodulation.

Assessment of dose received by organ in lumbosacral examination

International Nuclear Information System (INIS)

Eltyeib, Nashwa Kheirallah

2014-11-01

The biological damage produced by radiation is closely related to the amount of energy absorbed in the case x- rays. Measurement of produced ionizing provides a useful assessment of the total energy absorbed. This study was performed in Khartoum Teaching Hospital in period of January to June 2014. This study was performed to assess the effective dose (ED) received in lumbosacral radiography examination and to analyze effective dose distributions among radiological department under study. The study was performed in Khartoum Teaching Hospital, covering two x-ray units and a sample of 50 patients. The following parameters were recorded: age weight, height, body mass index (BMI) derived from mass (kg) and (height. (m)) and exposure factors. The dose was measured for lumbosacral x- rays examination. For effective dose calculation, the entrance surface dose (ESD) values were estimated from the x-ray tube output parameters for lumbosacral spine A P and lateral examinations. The ED values were then calculated from the obtained ESD values using IAEA calculation methods. Effective doses were than calculated from energy imported using ED conversion factors by IAEA. The results of ED values calculated showed that patient exposures were within the normal range of exposure. The mean ED values calculated were (2.49 ±0.03) mGy and (5.5.60 ± 0.0.22) mGy for Lumbosacral spine A P and lateral examinations, respectively. Further studies are recommended with more number of patients and using more modalities for comparison.(Author)

Sex-related differences in the anteroposterior diameter of the foetal cisterna magna

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Tao, G. [Department of Ultrasound, Qilu hospital of Shandong University, Jinan (China); Yew, D.T. [Department of Anatomy, Chinese University of Hong Kong (Hong Kong); Gu, T.; Liu, S.; Ma, Z.; Zhan, X.; Cheng, L. [Department of Ultrasound, Qilu hospital of Shandong University, Jinan (China); Li, C. [Department of Ultrasound, Qilu hospital of Shandong University, Jinan (China)], E-mail: chuanfuli2006@hotmail.com

2008-09-15

Aim: To measure the anteroposterior diameter of the foetal cisterna magna and observe whether there are differences according to sex. Materials and methods: Three hundred and thirty-seven Chinese women with low-risk pregnancies and a singleton foetus between 22 and 38 weeks' gestational age were included in this retrospective study. Informed consent of the volunteer subjects and hospital authority approval were first obtained. Double-blinded for gender, the anteroposterior diameter of the cisterna magna of the foetuses was measured by transabdominal sonography. Magnetic resonance imaging (MRI) was used for those foetuses with mega cisterna magna. All of the foetuses were healthy by prenatal and postnatal examination, including physical and imaging examination. Results: The mean anteroposterior diameter of the cisterna magna of all foetuses was 8.01 {+-} 1.79 mm. The anteroposterior diameter of the cisterna magna had no obvious correlation with the gestational age. The mean anteroposterior diameter of the cisterna magna of 179 male foetuses was 8.63 {+-} 2.16 mm, and the mean anteroposterior diameter of the cisterna magna of 158 female foetuses was 7.87 {+-} 1.74 mm. The size difference was statistically significant (p < 0.001). In the 33 foetuses with mega cisterna magna, the number of male foetuses was greater than female foetuses, and the proportion of the foetuses with mega cisterna magna in the male group was significantly higher than the foetuses in the female group (p < 0.05). Conclusion: Male foetuses had slightly larger anteroposterior diameters of the cisterna magna than female foetuses. The study would be useful for creating normal range values for the cisterna magna of male and female foetuses.

Comparative sonographic evaluation of the anteroposterior ...

African Journals Online (AJOL)

Background: The pancreas is an insulin‑producing gland and is prone to varying degrees of destruction and change in patients with diabetes mellitus (DM). Various morphological changes including reduction in the pancreas dimensions have been described in DM. Objectives: To determine pancreatic anteroposterior (AP) ...

Radiofrequency sensory ablation as a treatment for symptomatic unilateral lumbosacral junction pseudarticulation (Bertolotti's syndrome): a case report.

Science.gov (United States)

Burnham, Robert

2010-06-01

Describe the clinical presentation, diagnostic evaluation, and successful treatment of a case of symptomatic unilateral lumbosacral junction pseudarticulation using a novel radiofrequency nerve ablation technique. A 56-year-old female patient who had suffered with low back and right upper buttock pain for 16 years experienced incomplete relief with L4/5 facet joint radiofrequency ablation. She was found to have an elongated right L5 transverse process that articulated with the sacral ala (Bertolotti's syndrome). Fluoroscopically guided local anesthetic/corticosteroid injection into the pseudarthrosis eliminated her residual right buttock pain for the duration of the local anesthetic only. Complete pain relief was achieved by injecting local anesthetic circumferentially around the posterior pseudarthrosis articular margin. Accordingly, bipolar radiofrequency strip thermal lesions were created at the same locations. Complete pain relief and full restoration of function was achieved for 16 months postprocedure. This case report describes a novel radiofrequency technique for treating symptomatic lumbosacral junction pseudarticulation that warrants further evaluation.

Lumbosacral arachnoid cyst with tethered cord: A rare case report

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S K Jain

2012-01-01

Full Text Available Arachnoid cysts are cerebrospinal fluid collections in the spine that can present with neurological symptoms or be discovered accidentally. Intradural location of such cysts especially in the lumbosacral region is relatively rare. The association of such cysts with other congenital anomalies such as tethered cord lends evidence to the developmental origin of arachnoid cysts. We report a case of lumbosacral arachnoid cyst with tethered cord in a 6-year-old male child and discuss the etiopathogenesis and management options.

Image quality in the anteroposterior cervical spine radiograph: Comparison between moving, stationary and non-grid techniques in a lamb neck

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Keating, Michelle [School of Health and Social Care, Faculty of Health and Life Sciences, University of the West of England, Stapleton, Bristol BS16 1DD (United Kingdom); Grange, Stuart, E-mail: Stuart2.Grange@uwe.ac.u [School of Health and Social Care, Faculty of Health and Life Sciences, University of the West of England, Stapleton, Bristol BS16 1DD (United Kingdom)

2011-05-15

Background: Cervical spine radiography is a commonly employed examination for degenerative disease and trauma in the cervical spine. Traditionally, the anteroposterior projection is undertaken with the use of an anti-scatter grid. Some practitioners appear to have rejected this practice in favour of a non-grid technique, possibly because of the dose saving it affords. It is necessary to determine if image quality in the cervical spine is significantly degraded and whether the omission of the grid is justified. Method: Using a slaughtered lamb neck as a model of the human neck triplicate radiographs were obtained using a non-grid, a stationary grid and a moving grid technique. Entrance surface dose and dose area product was measured for these techniques. Image quality in terms of contrast, sharpness and overall acceptability was evaluated by 9 independent and blinded observers. Results: A significant reduction in measured dose was observed when the non-grid technique was compared to stationary or moving grid techniques. A statistically significant reduction in image contrast, sharpness and acceptability was also seen in the non-grid compared to grid techniques. Conclusion: These results show evidence of significantly greater image quality in the presence of either a moving or stationary grid in the lamb model. As such they support the continued use of scatter rejection methods such as the anti-scatter grid in AP radiography of the human cervical spine, to optimise radiographic image quality in this critical structure.

Image quality in the anteroposterior cervical spine radiograph: Comparison between moving, stationary and non-grid techniques in a lamb neck

International Nuclear Information System (INIS)

Keating, Michelle; Grange, Stuart

2011-01-01

Background: Cervical spine radiography is a commonly employed examination for degenerative disease and trauma in the cervical spine. Traditionally, the anteroposterior projection is undertaken with the use of an anti-scatter grid. Some practitioners appear to have rejected this practice in favour of a non-grid technique, possibly because of the dose saving it affords. It is necessary to determine if image quality in the cervical spine is significantly degraded and whether the omission of the grid is justified. Method: Using a slaughtered lamb neck as a model of the human neck triplicate radiographs were obtained using a non-grid, a stationary grid and a moving grid technique. Entrance surface dose and dose area product was measured for these techniques. Image quality in terms of contrast, sharpness and overall acceptability was evaluated by 9 independent and blinded observers. Results: A significant reduction in measured dose was observed when the non-grid technique was compared to stationary or moving grid techniques. A statistically significant reduction in image contrast, sharpness and acceptability was also seen in the non-grid compared to grid techniques. Conclusion: These results show evidence of significantly greater image quality in the presence of either a moving or stationary grid in the lamb model. As such they support the continued use of scatter rejection methods such as the anti-scatter grid in AP radiography of the human cervical spine, to optimise radiographic image quality in this critical structure.

Pedicle screw-rod fixation : a feasible treatment for dogs with severe degenerative lumbosacral stenosis

NARCIS (Netherlands)

Tellegen, Anna R; Willems, Nicole; Tryfonidou, Marianna A; Meij, Björn P

2015-01-01

BACKGROUND: Degenerative lumbosacral stenosis is a common problem in large breed dogs. For severe degenerative lumbosacral stenosis, conservative treatment is often not effective and surgical intervention remains as the last treatment option. The objective of this retrospective study was to assess

Developmental feature of the lumbosacral vertebral arch in childhood

International Nuclear Information System (INIS)

Yoshifuji, Kazuhisa; Morota, Nobuhito; Ihara, Satoshi

2007-01-01

We investigated a developmental feature of the lumbosacral vertebral arch in childhood that has rarely been reported previously. Sixty-seven patients underwent functional posterior rhizotomy from September 2000 to June 2006 at National Center for Child Health and Development. Sixty of these patients, who had no deformity in their lumbosacral spine, were included in this study and their Computed Tomography (CT) images were analyzed retrospectively. There were 36 boys and 24 girls, aged from 2-12 years. The rate and mean number of non-union vertebral arches between L1 and S3 were 78.3% (95% CI, 65.8-87.9%) and 1.7 (standard deviation (SD), 1.3). The non-union arch was most frequently found at the S1 level, and was more significantly observed in the younger age group (2-5 years of age). The S4 and S5 arches, which often remained open as the sacral hiatus, were constantly open in childhood. This study demonstrates that the vertebral arches of the lumbosacral spine in normal development are often not fused during childhood. It is important to differentiate normal non-union arches from pathological spina bifida. (author)

Magnetic resonance imaging in the diagnosis of degenerative lumbosacral stenosis in four dogs

International Nuclear Information System (INIS)

Haan, J.J. de; Shelton, S.B.; Ackerman, N.

1993-01-01

Magnetic resonance imaging was used to diagnose degenerative lumbosacral stenosis in four dogs that had physical and neurologic signs consistent with a cauda equina lesion. Nerve root displacement by protruding disc material and loss of epidural fat were identified. In all dogs, the diagnosis was confirmed by dorsal laminectomy of the lumbosacral area

A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome.

Science.gov (United States)

Jancuska, Jeffrey M; Spivak, Jeffrey M; Bendo, John A

2015-01-01

Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. A Pubmed search using the specific key words "LSTV," "lumbosacral transitional vertebrae," and "Bertolotti's Syndrome" was performed. The resulting group of manuscripts from our search was evaluated. LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a "false joint" susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential sources of low back pain. Further studies with larger

Scalloping at the lumbosacral canal

International Nuclear Information System (INIS)

Reinhardt, R.

1987-01-01

Scalloping is an indentation of the dorsal side of the vertebral body (anterior wall of the lumbosacral or sacral canal) which typically involves several adjacent lumbal vertebral body segments and the anterior wall of the canalis sacralis. Occurrence without underlying disease is rare; it occurs most frequently with chondrodystrophy, neurofibromatosis, Morquio's syndrome, Hurler's syndrome, acromegaly, Ehlers-Danlos syndrome, Marfan's syndrome, cysts, tumors and in peridural lipomas. (orig.) [de

Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options.

Science.gov (United States)

Yoshihara, Hiroyuki

2014-07-01

Numerous surgical procedures and instrumentation techniques for lumbosacral fusion (LSF) have been developed. This is probably because of its high mechanical demand and unique anatomy. Surgical options include anterior column support (ACS) and posterior stabilization procedures. Biomechanical studies have been performed to verify the stability of those options. The options have their own advantage but also disadvantage aspects. This review article reports the surgical options for lumbosacral fusion, their biomechanical stability, advantages/disadvantages, and affecting factors in option selection. Review of literature. LSF has lots of options both for ACS and posterior stabilization procedures. Combination of posterior stabilization procedures is an option. Furthermore, combinations of ACS and posterior stabilization procedures are other options. It is difficult to make a recommendation or treatment algorithm of LSF from the current literature. However, it is important to know all aspects of the options and decision-making of surgical options for LSF needs to be tailored for each patient, considering factors such as biomechanical stress and osteoporosis.

Feasibility For Measuring Transverse Area Ratios And Asymmetry Of Lumbosacral Region Paraspinal Muscles In Working Dogs Using Computed Tomography

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Bethany eCain

2016-05-01

Full Text Available Objectives: Describe computed tomographic (CT anatomy of canine lumbosacral paraspinal muscles, a method for measuring paraspinal muscle transverse area ratios and asymmetry using CT, and application of this method in a small sample of working dogs with versus without lumbosacral pain.Methods: Published anatomy references and atlases were reviewed and discrepancies resolved by examination of anatomic specimens and multi-planar reformatted images to describe transverse CT anatomy of lumbosacral region paraspinal muscles. Sixteen Belgian malinois military working dogs were retrospectively recruited and assigned to lumbosacral pain positive versus negative groups based on medical record entries. A single observer unaware of dog group measured CT transverse areas of paraspinal muscles and adjacent vertebral bodies, in triplicate, for L5-S1 vertebral locations. A statistician compared muscle transverse area ratios and asymmetry at each vertebral location between groups. Results: The relative co-efficient of variation for triplicate CT area measurements averaged 2.15% (N=16. Multifidus lumborum (L6-7, psoas/iliopsoas (L5-6, L6-7, and sacrocaudalis dorsalis lateralis (L6-7, L7-S1 transverse area ratios were significantly smaller in dogs with lumbosacral pain (n=11 vs. without lumbosacral pain (n=5 (p< 0.05. Muscle asymmetry values were not significantly greater in dogs with vs. without lumbosacral pain. Clinical relevance: Computed tomographic morphometry of lumbosacral region paraspinal muscles is a feasible objective method for use in future evidence-based research studies in working dogs. Potential future research applications include determining whether decreased paraspinal muscle area ratios and/or increased paraspinal muscle asymmetry could be used as markers for preclinical lumbosacral pain in stoic dogs or risk factors for other injuries in high performance canine athletes; or determining whether core muscle strengthening exercise prescriptions

CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction

Energy Technology Data Exchange (ETDEWEB)

Matsumoto, Tomohiro, E-mail: t-matsu@tokai-u.jp; Mine, Takahiko, E-mail: mine@tsc.u-tokai.ac.jp; Hayashi, Toshihiko, E-mail: t.hayashi@tokai.ac.jp [Tokai University School of Medicine, Department of Radiology, Tokai University Hachioji Hospital (Japan); Kamono, Masahiro, E-mail: kamono@tsc.u-tokai.ac.jp; Taoda, Akiko, E-mail: acco@is.icc.u-tokai.ac.jp; Higaki, Megumu, E-mail: higaki@hachioji-hosp.tokai.ac.jp [Tokai University School of Medicine, Department of General Internal Medicine, Tokai University Hachioji Hospital (Japan); Hasebe, Terumitsu, E-mail: hasebe@tokai-u.jp [Tokai University School of Medicine, Department of Radiology, Tokai University Hachioji Hospital (Japan)

2017-01-15

PurposeTo retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques—CT-guided bone biopsy and abscess drainage.Materials and methodsThree patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment.ResultsSuccessful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17–33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment.ConclusionsCT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques—CT fluoroscopy-guided bone biopsy and abscess drainage.

Luxación facetaria unilateral lumbosacra postraumática. [ Post-traumatic lumbosacral unilateral facet dislocation].

Directory of Open Access Journals (Sweden)

Manuel González Murillo

2016-08-01

Full Text Available In the literature have been reported around fifty cases of lumbosacral dislocations; treated most bilateral facet dislocations. We report the case of a female 42 year old with unilateral lumbosacral facet dislocation of one month duration after accident. Circumferential instrumented fusion L5-S1 with interbody cage and pedicle screws L5-S1 was performed.   The lumbosacral dislocation is a rare injury that occurs due to the combination of a high-energy mechanism predisposing anatomical factors. Recent publications advocate the surgical reduction and stabilization with instrumentation as standard treatment.

Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.

Science.gov (United States)

Isley, Michael R; Zhang, Xiao-Feng; Balzer, Jeffrey R; Leppanen, Ronald E

2012-06-01

justification" of intraoperative neuromonitoring"... is the perception that the safety and efficacy of pedicle screw fixation are enhanced..." (Resnick et al. 2005b). However in summarizing a massive (over 1000 papers taken from the National Library of Medicine), contemporary, literature review spanning nearly a decade (1996 to 2003), this invited panel (Resnick et al. 2005b) recognized that the evidence-based documents contributing to the parts related to pedicle screw fixation and neuromonitoring were "... full of potential sources of error ..." and lacked appropriate, randomized, prospective studies for formulating rigid standards and guidelines. Nevertheless, current trends support the routine use and clinical utility of these neuromonitoring techniques. In particular free-run and triggered EMG have been well recognized in numerous publications for improving both the accuracy and safety of pedicle screw implantation. Currently, treatment with pedicle screw instrumentation routinely involves all levels of the spine - lumbosacral, thoracic, and cervical. Significant historical events, various neuromonitoring modalities, intraoperative alarm criteria, clinical efficacy, current trends, and caveats related to pedicle screw stimulation along the entire vertebral column will be reviewed.

Chronicity and a low anteroposterior gradient of cerebral blood flow in schizophrenia

International Nuclear Information System (INIS)

Mathew, R.J.; Wilson, W.H.

1990-01-01

Regional cerebral blood flow (CBF) was measured with the 133xenon inhalation technique in 27 patients with schizophrenia of less than 5 years' duration and in 27 patients with schizophrenia of more than 12 years' duration, under resting conditions. Similar measurements were also performed in 54 normal control subjects matched for age and sex. Patients with schizophrenia of long duration had lower anteroposterior gradients of CBF than patients with schizophrenia of short duration and matched control subjects. Covarying out age and end-tidal levels of CO2 did not alter the results

Vertical foramina in the lumbosacral region: CT appearance

International Nuclear Information System (INIS)

Beers, G.J.; Carter, A.P.; McNary, W.F.

1984-01-01

Several computed tomographic (CT) examples of vertically oriented foramina in the neural arches of the lumbosacral vertebrae are presented. The literature is reviewed briefly, and the possible clincal and embryologic significance of these foramina is discussed

Scalloping at the lumbosacral canal

Energy Technology Data Exchange (ETDEWEB)

Reinhardt, R.

1987-07-01

Scalloping is an indentation of the dorsal side of the vertebral body (anterior wall of the lumbosacral or sacral canal) which typically involves several adjacent lumbal vertebral body segments and the anterior wall of the canalis sacralis. Occurrence without underlying disease is rare; it occurs most frequently with chondrodystrophy, neurofibromatosis, Morquio's syndrome, Hurler's syndrome, acromegaly, Ehlers-Danlos syndrome, Marfan's syndrome, cysts, tumors and in peridural lipomas.

Lumbar paraspinal muscle transverse area and symmetry in dogs with and without degenerative lumbosacral stenosis.

Science.gov (United States)

Henderson, A L; Hecht, S; Millis, D L

2015-10-01

To investigate whether dogs with degenerative lumbosacral stenosis have decreased lumbar paraspinal muscle transverse area and symmetry compared with control dogs. Retrospective cross-sectional study comparing muscles in transverse T2-weighted magnetic resonance images for nine dogs with and nine dogs without degenerative -lumbosacral stenosis. Mean transverse area was measured for the lumbar multifidus and sacrocaudalis dorsalis lateralis muscles bilaterally and the L7 vertebral body at the level of the caudal endplate. Transverse areas of both muscle groups relative to L7 and asymmetry indices were compared between study populations using independent t tests. Mean muscle-to-L7 transverse area ratios were significantly smaller in the degenerative lumbosacral stenosis group compared with those in the control group in both lumbar multifidus (0·84 ±0·26 versus 1·09 ±0·25; P=0·027) and sacrocaudalis dorsalis lateralis (0·5 ±0·15 versus 0·68 ±0·12; P=0·005) muscles. Mean asymmetry indices were higher for both muscles in the group with degenerative lumbosacral stenosis than in the control group, but highly variable and the difference was not statistically significant. These findings suggest that dogs with degenerative lumbosacral stenosis have decreased lumbar paraspinal muscle mass that may be a cause or consequence of the -syndrome. Understanding altered paraspinal muscle characteristics may improve understanding of the -pathophysiology and management options for degenerative lumbosacral stenosis. © 2015 British Small Animal Veterinary Association.

Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging

International Nuclear Information System (INIS)

Mürtz, P.; Kaschner, M.; Lakghomi, A.; Gieseke, J.; Willinek, W.A.; Schild, H.H.; Thomas, D.

2015-01-01

Highlights: •DW MRN of brachial and lumbosacral plexus at 1.5 T and at 3.0 T was compared. •For lumbosacral plexus, nerve conspicuity on MIP images was superior at 3.0 T, also visible length and mean sharpness of the nerves. •For brachial plexus, nerve conspicuity at 3.0 T was rather inferior, nerve length was not significantly different, mean sharpness was superior at 3.0 T. -- Abstract: Purpose: To compare intraindividually the nerve conspicuity of the brachial and lumbosacral plexus on diffusion-weighted (DW) MR neurography (MRN) at two different field strengths. Materials and methods: 16 healthy volunteers were investigated at 3.0 T and 1.5 T applying optimized variants of a DW spin-echo echo-planar imaging sequence with short TI inversion recovery fat suppression. Full-volume (FV) and curved sub-volume (CSV) maximum intensity projection (MIP) images were reconstructed and nerve conspicuity was visually assessed. Moreover, visible length and sharpness of the nerves were quantitatively analyzed. Results: On FV MIP images, nerve conspicuity at 3.0 T compared to 1.5 T was worse for brachial plexus (P = 0.00228), but better for lumbosacral plexus (P = 0.00666). On CSV MIP images, nerve conspicuity did not differ significantly for brachial plexus, but was better at 3.0 T for lumbosacral plexus (P = 0.00091). The visible length of the analyzed nerves did not differ significantly with the exception of some lumbosacral nerves, which were significantly longer at 3.0 T. The sharpness of all investigated nerves was significantly higher at 3.0 T by about 40–60% for cervical and 97–169% for lumbosacral nerves. Conclusion: DW MRN imaging at 3.0 T compared to 1.5 T is superior for lumbosacral plexus, but not for brachial plexus

Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging

Energy Technology Data Exchange (ETDEWEB)

Mürtz, P., E-mail: petra.muertz@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Kaschner, M., E-mail: Marius.Kaschner@med.uni-duesseldorf.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Lakghomi, A., E-mail: Asadeh.Lakghomi@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Gieseke, J., E-mail: juergen.gieseke@ukb.uni-bonn.de [Philips Healthcare, Lübeckertordamm 5, 20099 Hamburg (Germany); Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Willinek, W.A., E-mail: winfried.willinek@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Schild, H.H., E-mail: hans.schild@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Thomas, D., E-mail: daniel.thomas@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany)

2015-04-15

Highlights: •DW MRN of brachial and lumbosacral plexus at 1.5 T and at 3.0 T was compared. •For lumbosacral plexus, nerve conspicuity on MIP images was superior at 3.0 T, also visible length and mean sharpness of the nerves. •For brachial plexus, nerve conspicuity at 3.0 T was rather inferior, nerve length was not significantly different, mean sharpness was superior at 3.0 T. -- Abstract: Purpose: To compare intraindividually the nerve conspicuity of the brachial and lumbosacral plexus on diffusion-weighted (DW) MR neurography (MRN) at two different field strengths. Materials and methods: 16 healthy volunteers were investigated at 3.0 T and 1.5 T applying optimized variants of a DW spin-echo echo-planar imaging sequence with short TI inversion recovery fat suppression. Full-volume (FV) and curved sub-volume (CSV) maximum intensity projection (MIP) images were reconstructed and nerve conspicuity was visually assessed. Moreover, visible length and sharpness of the nerves were quantitatively analyzed. Results: On FV MIP images, nerve conspicuity at 3.0 T compared to 1.5 T was worse for brachial plexus (P = 0.00228), but better for lumbosacral plexus (P = 0.00666). On CSV MIP images, nerve conspicuity did not differ significantly for brachial plexus, but was better at 3.0 T for lumbosacral plexus (P = 0.00091). The visible length of the analyzed nerves did not differ significantly with the exception of some lumbosacral nerves, which were significantly longer at 3.0 T. The sharpness of all investigated nerves was significantly higher at 3.0 T by about 40–60% for cervical and 97–169% for lumbosacral nerves. Conclusion: DW MRN imaging at 3.0 T compared to 1.5 T is superior for lumbosacral plexus, but not for brachial plexus.

Prevalence and clinical features of sports-related lumbosacral stress injuries in the young.

Science.gov (United States)

Kaneko, Hideto; Murakami, Mototsune; Nishizawa, Kazuya

2017-05-01

Stress injuries (stress fractures and stress reactions) of the lumbosacral region are one of the causes of sports-related lower back pain in young individuals. These injuries can be detected by bone marrow edema lesion on MRI. However, little is known about the prevalence and clinical features of early stage lumbosacral stress injuries. This study aimed to evaluate the epidemiology of lumbosacral stress injuries. A total of 312 patients (under 18 years of age) who complained of sports-related lower back pain that had lasted for ≥7 days underwent magnetic resonance imaging (MRI) scans. We reviewed patients' records retrospectively. MRI showed that 33.0% of the patients had lumbar stress injuries and 1.6% had sacral stress injuries. Lumbar stress injuries were more common in males than in females and were found in 30% of 13- to 18-year-old patients. About 50% of the patients that participated in soccer or track and field were diagnosed with lumbar stress injuries. No clinical patterns in the frequencies of sacral stress injuries were detected due to the low number of patients that suffered this type of injury. Plain radiography is rarely able to detect the early stage lesions associated with lumbosacral stress injuries, but such lesions can be detected in the caudal-ventral region of the pars interarticularis on sagittal computed tomography scans. Thirty-three percent of young patients that complained of sports-related lower back pain for ≥7 days had lumbar stress injuries, while 1.6% of them had sacral stress injuries. Clinicians should be aware of the existence of these injuries. MRI is useful for diagnosing lumbosacral stress injuries.

Is lumbosacral plexus blockade effective and safe for surgical anesthesia in total hip replacement?

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Larsen, Jens Rolighed; Børglum, Jens

Background and Aims Patients scheduled for total hip replacement often presents cardiovascular comorbidity, which increases perioperative risk of complications. This pilot study aimed to compare lumbosacral plexus blockade with continuous and single-dose spinal anesthesia for surgical anesthesia...... had lumbosacral plexus blockade (lumbar plexus block, sacral plexus block and fascia transversalis plane block) with ropivacaine. Group 2 had continuous spinal anesthesia with repeated bupivacaine-doses. Group 3 had single-dose spinal anesthesia with bupivacaine. Hemodynamic data were recorded during...... vascular resistance, and arterial and central venous pressures. (table 1) No patients in group 1 achieved complete surgical anesthesia due to lack of anesthesia of the cranial part of the surgical incision. Conclusions Neither lumbosacral plexus block nor continuous spinal anesthesia affected any...

Estrogen induces axonal outgrowth in the nucleus retroambiguus-lumbosacral motoneuronal pathway in the adult female cat

NARCIS (Netherlands)

VanderHorst, VGJM; Holstege, G

1997-01-01

In 1995, we discovered a new pathway in the cat, which originates from the nucleus retroambiguus (NRA) and terminates in a distinct set of lumbosacral hindlimb, axial, and pelvic floor motoneuronal cell groups [VanderHorst VG.JM, Holstege G (1995) Caudal medullary pathways to lumbosacral

Quantitative evaluation of normal lumbosacral plexus nerve by using diffusion tensor imaging

International Nuclear Information System (INIS)

Shi Yin; Wang Chuanbing; Liu Wei; Zong Min; Sa Rina; Shi Haibin; Wang Dehang

2014-01-01

Objective: To observe the lumbosacral plexus nerves by diffusion tensor tractography (DTT) and quantitatively evaluate them by using diffusion tensor imaging (DTI) in healthy volunteers. Methods: A total of 60 healthy volunteers (30 males and 30 females) underwent DTI scanning. Mean FA values of the lumbosacral plexus nerves (both sides of lumbar roots L3 to S1, proximal and distal to the lumbar foraminal zone) were quantified. Differences among various segments of lumbar nerve roots were compared with ANOVA test and SNK test. Differences between two sides of the lumbar nerve roots at the same lumbar segment were compared with paired-samples t test. Differences between the proximal and the distal nerve to the the lumbar foraminal zone at the same lumbar segment were compared with paired-samples t test. The lumbosacral plexus nerve was visualized with tractography. Results: (1) The lumbosacral plexus nerve was clearly visualized with tractography. (2) Mean FA values of the lumbar nerve roots L3 to S1 were as followings: proximal to the left lumbar foraminal zone 0.202 ± 0.021, 0.201 ± 0.026, 0.201 ± 0.027, 0.191 ±0.016, distal to the left lumbar foraminal zone 0.222 ± 0.034, 0.250 ± 0.028, 0.203 ± 0.026, 0.183 ± 0.020, proximal to the right lumbar foraminal zone 0.200 ± 0.023, 0.202 ± 0.023, 0.205 ± 0.027, 0.191 ± 0.017, distal to the right lumbar foraminal zone 0.225 ± 0.032, 0.247 ± 0.027, 0.205 ± 0.033, 0.183 ± 0.021. Mean FA values were significantly different between the proximal nerve to the distal nerve in lumbar nerve roots L3, L4, S1 (t=-9.114-2.366, P<0.05), but not significantly different in L5 (P>0.05). Differences were not found between the right and left side nerves at the same lumbar segment (P>0.05). (3) The whole length of the lumbar roots nerve L3 to S1 can be visualized clearly by using DTT. Conclusions: Diffusion tensor imaging and tractography can show and provide quantitative information of human lumbosacral plexus nerves. DTI

The lumbosacral plexus of the red-rumped agouti (Dasyprocta leporina Linnaeus, 1758 (Rodentia: Caviidae

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Gleidson Benevides de Oliveira

2016-12-01

Full Text Available The red-rumped agouti is a small-sized wild rodent, belonging to the Dasyproctidae family, with great zootechnical potential, and it adapts well to captivity. In order to contribute to the species biology, this study describes the origin of the nerves forming the lumbosacral plexus. Twelve animals (six males and six females were used, from previous experiments. The animals were fixed in a 10% formaldehyde aqueous solution and eviscerated after 72 hours. Then, the major and minor psoas muscles were retracted, exposing the nerves forming the plexus. Cotton soaked with 20-volume hydrogen peroxide was placed on these nerves, remaining for 12 hours straight for bleaching and subsequent dissection. The topographical relations of the lumbosacral plexus were grouped into tables and arranged in terms of simple percentage. In 7 cases (58.34%, the lumbosacral plexus in the red-rumped agouti stemmed from the ventral roots of the last 4 lumbar nerves and the first 3 sacral nerves (Type I – L4-S3, in 4 animals (33.33% it stemmed from L5-S3 (Type II, and in 1 case (8.33% it stemmed from L5-S4 (Type III. The nerves participating of the lumbosacral plexus in the red-rumped agouti were: lateral femoral cutaneous, genitofemoral, femoral, obturator, sciatic, cranial gluteal, caudal gluteal, and pudendal nerve. The origin of the lumbosacral plexus and the spinal nerves making up this plexus in red-rumped agoutis were similar to that described in other rodents, such as rock cavy, lowland paca and spix's yellow-toothed cavy.

Functional interrelations between the lumbosacral, sacroiliac and coxofemoral complex in dogs as denoted by degenerative joint diseases

International Nuclear Information System (INIS)

Kuenzel, W.; Breit, S.; Knaus, I.

2002-01-01

Functional interrelations between coxofemoral joint, sacroiliac joint and the lumbosacral junction were investigated in Rottweilers, Golden Retriever and German Shepherd dogs. The study was based on sample of 120 ventrodorsal radiographs of the pelvis, which was assessed for evidence of hip dysplasia, alterations of the synovial and extrasynovial components of the sacroiliac joints, and osteophyte formation at the lumbosacral junction. Alteration of the extrasynovial component of the sacroiliac joint was the disease most commonly observed. Such degenerative alterations of the sacroiliac joint were noted to be associated with osteophyte formation at the lumbosacral junction. Both diseases were associated with age and German Shepherd dogs were most frequently affected. Results obtained by the additional evaluation of the coxofemoral joints suggest two mechanisms inducing degenerative alterations at the joint complex investigated. Based on changes in collagen composition, congenitally determined insufficiency of the supporting connective tissue may be responsible for the coincidence of alterations of all joint components of the lumbosacral - sacroilia - coxofemoral complex as noted in one group of dogs. In contrast, pre-dominant affection of the sacroiliac amphiarthosis and the lumbosacral intervertebral disc space is supposed to result from cumulative overloading. (author)

Lumbosacral pain in ballet school students. Pilot study.

Science.gov (United States)

Drężewska, Marlena; Śliwiński, Zbigniew

2013-01-01

The unique biomechanical demands placed on ballet students predispose to injury and pain. The aim of this study was to evaluate the prevalence of lumbosacral pain in ballet school students and to identify possible risk factors for the pain. The study group comprised 71 ballet school students, including 45 females and 26 males, aged 15-18 years (mean 16.5 years). In order to identify possible risk factors for pain, a survey was conducted, the angle of sacral bone inclination was measured using a mechanical inclinometer and the BMI was calculated. A VAS scale was used for a subjective assessment of pain intensity. Low back pain was reported by 44 patients (62%). A comparison of sacral inclination angles in a position with the feet placed parallel and in the turnout position showed statistically significant changes in the angle among respondents reporting pain (p ballet school stu dents can increase the risk of lumbosacral pain.

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

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Yılmaz, Tevfik; Turan, Yahya; Gülşen, İsmail; Dalbayrak, Sedat

2014-01-01

Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury. PMID:25210343

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

Directory of Open Access Journals (Sweden)

Tevfik Yilmaz

2014-01-01

Full Text Available Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

Do neurosurgeons subscribe to the guideline lumbosacral radicular syndrome?

NARCIS (Netherlands)

P.A.J. Luijsterburg (Pim); A.P. Verhagen (Arianne); S. Braak (Sigrid); C.J.J. Avezaat (Cees); B.W. Koes (Bart)

2004-01-01

textabstractBackground: This study presents a survey of the opinion of neurosurgeons on the multidisciplinary clinical guideline 'lumbosacral radicular syndrome'. The aim was to describe to what extent neurosurgeons in the Netherlands endorse the content of this guideline. The guideline was issued

Retrospective review of lumbosacral dissociations in blast injuries.

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Helgeson, Melvin D; Lehman, Ronald A; Cooper, Patrick; Frisch, Michael; Andersen, Romney C; Bellabarba, Carlo

2011-04-01

Retrospective review of medical records and radiographs. We assessed the clinical outcomes of lumbosacral dissociation (LSD) after traumatic, combat-related injuries, and to review our management of these distinct injuries and report our preliminary follow-up. LSD injuries are an anatomic separation of the pelvis from the spinal column, and are the result of high-energy trauma. A relative increase in these injuries has been seen in young healthy combat casualties subjected to high-energy blast trauma. We performed a retrospective review of inpatient/outpatient medical records and radiographs for all patients treated at our institution with combat-related lumbosacral dissociations. Twenty-three patients met inclusion criteria of combat-related lumbosacral dissociations with one-year follow-up. Patients were treated as follows: no fixation (9), sacroiliac screw fixation (8), posterior spinal fusion (5) and sacral plate (1). All patients with radiographic evidence of a zone III sacral fracture, in addition to associated lumbar fractures indicating loss of the iliolumbar ligamentous complex integrity were included. In 15 patients, the sacral fracture were an H or U type zone III fracture, whereas in the remaining nine, the sacral fracture was severely comminuted and unable to classify (six open fractures). There was no difference in visual analog scale (VAS) between treatment modalities. Two open injuries had residual infections. One patient treated with an L4-ilium posterior spinal fusion with instrumentation required instrumentation removal for infection. At a mean follow-up of 1.71 years (range, 1-4.5), 11 patients (48%) still reported residual pain and the mean VAS at latest follow-up was 1.7 (range, 0-7). Operative stabilization promoted healing and earlier mobilization, but carries a high-postoperative risk of infection. Nonoperative management should be considered in patients whose comorbidities prevent safe stabilization.

Navigation-aided visualization of lumbosacral nerves for anterior sacroiliac plate fixation: a case report.

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Takao, Masaki; Nishii, Takashi; Sakai, Takashi; Sugano, Nobuhiko

2014-06-01

Anterior sacroiliac joint plate fixation for unstable pelvic ring fractures avoids soft tissue problems in the buttocks; however, the lumbosacral nerves lie in close proximity to the sacroiliac joint and may be injured during the procedure. A 49 year-old woman with a type C pelvic ring fracture was treated with an anterior sacroiliac plate using a computed tomography (CT)-three-dimensional (3D)-fluoroscopy matching navigation system, which visualized the lumbosacral nerves as well as the iliac and sacral bones. We used a flat panel detector 3D C-arm, which made it possible to superimpose our preoperative CT-based plan on the intra-operative 3D-fluoroscopic images. No postoperative complications were noted. Intra-operative lumbosacral nerve visualization using computer navigation was useful to recognize the 'at-risk' area for nerve injury during anterior sacroiliac plate fixation. Copyright © 2013 John Wiley & Sons, Ltd.

[An adult case of intradural lumbo-sacral lipoma].

Science.gov (United States)

Hatayama, T; Sakoda, K; Tokuda, Y; Uozumi, T

1992-10-01

A rare case of lumbo-sacral lipoma in an adult case is reported. A 55-year-old male was admitted to the Department of Neurosurgery, Mazda Hospital, after a history of one year of urinary incontinence. Neurologically, no motor or sensory disturbance of the lower extremities was found in this patient. MRI showed a mass with high signal intensity on T2-weighted image, located between L3 to S2 vertebral segments. Metrizamide-CT scan demonstrated the outline of this hypodense mass at the same location as shown on MRI image. A L3 through L5 laminectomy was performed and the tumor was subtotally removed. Microscopic examination revealed that the tumor mass was made up of mature lipoma cells. Postoperative course of the patient was uneventful. The urinary incontinence was improved slightly. No motor or sensory deficit was found. We thought that MRI was useful for the correct diagnosis of lumbosacral lipoma. And it is best managed by operative removal of the tumor as early as possible after it is diagnosed.

CT diagnosis of lumbosacral conjoined nerve roots

International Nuclear Information System (INIS)

Torricelli, P.; Martinelli, C.; Spina, V.

1987-01-01

The authors report the observations derived from CT evaluation of 19 cases of lumbosacral conjoined nerve roots; 11 of these have been confirmed by lumbar myelography and/or at surgery. They conclude that CT without intrathecal metrizamide allows the recognition in most cases the presence of conjoined nerve roots and to differentiate them from a herniated disk fragment; this is especially usefull avoid surgical damage of anomalous roots. (orig.)

Imaging of the lumbosacral plexus. Diagnostics and treatment planning with high-resolution procedures; Bildgebung des Plexus lumbosacralis. Diagnostik und Therapieplanung mithilfe hochaufgeloester Verfahren

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Jengojan, S.; Schellen, C.; Bodner, G.; Kasprian, G. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

2017-03-15

Technical advances in magnetic resonance (MR) and ultrasound-based neurography nowadays facilitate the radiological assessment of the lumbosacral plexus. Anatomy and imaging of the lumbosacral plexus and diagnostics of the most common pathologies. Description of the clinically feasible combination of magnetic resonance imaging (MRI) and ultrasound diagnostics, case-based illustration of imaging techniques and individual advantages of MRI and ultrasound-based diagnostics for various pathologies of the lumbosacral plexus and its peripheral nerves. High-resolution ultrasound-based neurography (HRUS) is particularly valuable for the assessment of superficial structures of the lumbosacral plexus. Depending on the examiner's experience, anatomical variations of the sciatic nerve (e. g. relevant in piriformis syndrome) as well as more subtle variations, for example as seen in neuritis, can be sonographically depicted and assessed. The use of MRI enables the diagnostic evaluation of more deeply located nerve structures, such as the pudendal and the femoral nerves. Modern MRI techniques, such as peripheral nerve tractography allow three-dimensional depiction of the spatial relationship between nerves and local tumors or traumatic alterations. This can be beneficial for further therapy planning. The anatomy and pathology of the lumbosacral plexus can be reliably imaged by the meaningful combination of MRI and ultrasound-based high resolution neurography. (orig.) [German] Durch technische Fortschritte im Bereich der magnetresonanz- (MR-) und ultraschallbasierten Neurographie ist der Plexus lumbosacralis heute der radiologischen Abklaerung zugaenglich. Anatomie und Bildgebung des Plexus lumbosacralis, Abklaerung der haeufigsten Pathologien. Erlaeuterung der klinisch sinnvollen Kombination von MR- und Ultraschalldiagnostik, Darstellung der Untersuchungstechniken und der jeweiligen Vorteile von MRT und Ultraschall anhand fallbasierter Praesentation unterschiedlicher

Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report

Science.gov (United States)

Uvaraj, Nalli R.; Bosco, Aju; Gopinath, Nalli R.

2014-01-01

Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability. Instrumentation at the lumbosacral junction is technically demanding due to the complex local anatomy, the unique biomechanics, and the difficult fixation in the surrounding diseased bone. Methods We report a 21-year-old woman with tuberculosis from L1 to S2 with back pain and spinal instability. The radiographs showed a kyphosis of the lumbar spine. The magnetic resonance imaging and computed tomography scans revealed extensive destruction of the lumbar and lumbosacral spine. Spinopelvic stabilization combined with anterior debridement and reconstruction with free fibular strut graft was performed. Results The radiographs at follow-up showed a good correction of the kyphosis and excellent graft incorporation and fusion. Conclusions Anterior column reconstruction with a fibular strut graft helps restore and maintain the vertebral height. Posterior stabilization with spinopelvic fixation can be an effective surgical option for reconstructing the spine in extensive lumbosacral tuberculosis with sacral body destruction, requiring long fusions to the sacrum. It augments spinal stability, prevents graft-related complications, and accelerates the graft incorporation and fusion, thereby permitting early mobilization and rehabilitation. In spinal tuberculosis, antitubercular therapy may have to be prolonged in cases with large disease load, based on the clinicoradiographic and laboratory

Subjective assessment of the effectiveness of physiotherapeutic methods in lumbosacral discogenic pain syndrome

Directory of Open Access Journals (Sweden)

Michał Grzegorczyk

2018-03-01

Full Text Available Aging society, lack of habit shaping attitude to correct posture among children and youth and a lifestyle that often requires excessive effort make lumbosacral discogenic pain syndrome a social disease. It is essential that effective methods for the prevention and treatment of these changes go hand in hand with the frequently occurring pains of the lumbosacral spine. Aim of the study: Comparison of the subjective assessment of the patient's feelings related to the lumbosacral discogenic pain. Material and method: The research group included 60 people diagnosed with a lumbosacral discogenic pain. All patients were divided into three groups of 20 people. Each group was subjected to a different type of rehabilitation, depending on the method analyzed - PNF, manual therapy, and physical treatments. The questionnaire was used as the research tool, it was filled in by the respondents. Results: The patients, before and after the treatments, regardless of the type of rehabilitation to which they were subjected, declared that the most common pain is in the buttock, thigh and calf. Before the rehabilitation, the most frequent additional complaints of the examined patients were numbness and muscle weakness, after rehabilitation it was muscle weakness. After the rehabilitation, the number of painkillers taken by the respondents decreased. Only in the case of patients who underwent physiotherapeutic procedures, the number of people taking medication increased. Conclusions: The best results from the analyzed therapies were obtained after manual therapy. The second most effective was PNF therapy, while the weakest result was achieved by physiotherapeutic procedures.

Lumbosacral multiradiculopathy responsive to antibiotic therapy: description of four patients with lumbar spondylosis and a superimposed Lyme disease.

Science.gov (United States)

Luigetti, Marco; Vollaro, Stefano; Corbetto, Marzia; Salomone, Gaetano; Dicuonzo, Giordano; Scoppettuolo, Giancarlo; Di Lazzaro, Vincenzo

2014-12-01

Lyme disease is a diffuse zoonosis caused by spirochaetes of the Borrelia burgdorferi species complex. Neurological manifestations of the disease, involving central or peripheral nervous system, are common. This study describes four consecutive patients with an MRI-proven lumbosacral spondylosis, who complained of progressive worsening of symptoms in the last months in which serological evaluation suggested a superimposed B. Burgdorferi infection. Four patients, all from the Lazio region, were admitted to the Department of Neurology. Extensive laboratory studies and clinical, anamnestic and neurophysiological evaluation were performed in all cases. In all cases, anamnesis revealed a previous diagnosis of lumbosacral foraminal stenosis. Clinical and neurophysiological findings were consistent with a lumbosacral multiradiculopathy. Considering serological evaluation suggestive of a superimposed B. burgdorferi infection a proper antibiotic therapy was started. All cases showed a marked improvement of symptoms. Clinicians should be aware that in all cases of lumbosacral multiradiculopathy, even if a mechanical cause is documented, B. burgdorferi may be a simply treatable condition.

Three-dimensional motion pattern of the caudal lumbar and lumbosacral portions of the vertebral column of dogs.

Science.gov (United States)

Benninger, Monika I; Seiler, Gabriela S; Robinson, Leanne E; Ferguson, Stephen J; Bonél, Harald M; Busato, André R; Lang, Johann

2004-05-01

To evaluate the 3-dimensional motion pattern including main and coupled motions of the caudal lumbar and lumbosacral portions of the vertebral column of dogs. Vertebral columns of 9 German Shepherd Dogs (GSDs) and 16 dogs of other breeds with similar body weights and body conditions. Main and coupled motions of the caudal lumbar and lumbosacral portions of the vertebral column (L4 to S1) were determined by use of a testing apparatus that permitted precise application of known pure moments to the vertebral column. Motion was compared between GSDs and dogs of other breeds. All specimens had a similar motion pattern consisting of main motion and a certain amount of coupled motion including translation. Vertebral columns of GSDs had significantly less main motion in all directions than that of dogs of other breeds. Translation was similar in GSDs and dogs of other breeds and was smallest at the lumbosacral motion segment. Results indicated that motion in the caudal lumbar and lumbosacral portions of the vertebral column of dogs is complex and provided a basis for further studies evaluating abnormal vertebral columns.

High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants

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Ahlawat, Shivani; Fritz, Jan [The Johns Hopkins Medical Institutions, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Stern, Steven E. [Bond University, Bond Business School, Gold Coast, QLD (Australia); Belzberg, Allan J. [Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD (United States)

2017-07-15

To assess the quality and accuracy of metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) for the diagnosis of lumbosacral neuropathies in patients with metallic implants in the pelvis. Twenty-two subjects with lumbosacral neuropathy following pelvic instrumentation underwent 1.5-T MARS MRI including optimized axial intermediate-weighted and STIR turbo spin echo sequences extending from L5 to the ischial tuberosity. Two readers graded the visibility of the lumbosacral trunk, sciatic, femoral, lateral femoral cutaneous, and obturator nerves and the nerve signal intensity of nerve, architecture, caliber, course, continuity, and skeletal muscle denervation. Clinical examination and electrodiagnostic studies were used as the standard of reference. Descriptive, agreement, and diagnostic performance statistics were applied. Lumbosacral plexus visibility on MARS MRI was good (4) or very good (3) in 92% of cases with 81% exact agreement and a Kendall's W coefficient of 0.811. The obturator nerve at the obturator foramen and the sciatic nerve posterior to the acetabulum had the lowest visibility, with good or very good ratings in only 61% and 77% of cases respectively. The reader agreement for nerve abnormalities on MARS MRI was excellent, ranging from 95.5 to 100%. MARS MRI achieved a sensitivity of 86%, specificity of 67%, positive predictive value of 95%, and negative predictive value of 40%, and accuracy of 83% for the detection of neuropathy. MARS MRI yields high image quality and diagnostic accuracy for the assessment of lumbosacral neuropathies in patients with metallic implants of the pelvis and hips. (orig.)

High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants.

Science.gov (United States)

Ahlawat, Shivani; Stern, Steven E; Belzberg, Allan J; Fritz, Jan

2017-07-01

To assess the quality and accuracy of metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) for the diagnosis of lumbosacral neuropathies in patients with metallic implants in the pelvis. Twenty-two subjects with lumbosacral neuropathy following pelvic instrumentation underwent 1.5-T MARS MRI including optimized axial intermediate-weighted and STIR turbo spin echo sequences extending from L5 to the ischial tuberosity. Two readers graded the visibility of the lumbosacral trunk, sciatic, femoral, lateral femoral cutaneous, and obturator nerves and the nerve signal intensity of nerve, architecture, caliber, course, continuity, and skeletal muscle denervation. Clinical examination and electrodiagnostic studies were used as the standard of reference. Descriptive, agreement, and diagnostic performance statistics were applied. Lumbosacral plexus visibility on MARS MRI was good (4) or very good (3) in 92% of cases with 81% exact agreement and a Kendall's W coefficient of 0.811. The obturator nerve at the obturator foramen and the sciatic nerve posterior to the acetabulum had the lowest visibility, with good or very good ratings in only 61% and 77% of cases respectively. The reader agreement for nerve abnormalities on MARS MRI was excellent, ranging from 95.5 to 100%. MARS MRI achieved a sensitivity of 86%, specificity of 67%, positive predictive value of 95%, and negative predictive value of 40%, and accuracy of 83% for the detection of neuropathy. MARS MRI yields high image quality and diagnostic accuracy for the assessment of lumbosacral neuropathies in patients with metallic implants of the pelvis and hips.

High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants

International Nuclear Information System (INIS)

Ahlawat, Shivani; Fritz, Jan; Stern, Steven E.; Belzberg, Allan J.

2017-01-01

To assess the quality and accuracy of metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) for the diagnosis of lumbosacral neuropathies in patients with metallic implants in the pelvis. Twenty-two subjects with lumbosacral neuropathy following pelvic instrumentation underwent 1.5-T MARS MRI including optimized axial intermediate-weighted and STIR turbo spin echo sequences extending from L5 to the ischial tuberosity. Two readers graded the visibility of the lumbosacral trunk, sciatic, femoral, lateral femoral cutaneous, and obturator nerves and the nerve signal intensity of nerve, architecture, caliber, course, continuity, and skeletal muscle denervation. Clinical examination and electrodiagnostic studies were used as the standard of reference. Descriptive, agreement, and diagnostic performance statistics were applied. Lumbosacral plexus visibility on MARS MRI was good (4) or very good (3) in 92% of cases with 81% exact agreement and a Kendall's W coefficient of 0.811. The obturator nerve at the obturator foramen and the sciatic nerve posterior to the acetabulum had the lowest visibility, with good or very good ratings in only 61% and 77% of cases respectively. The reader agreement for nerve abnormalities on MARS MRI was excellent, ranging from 95.5 to 100%. MARS MRI achieved a sensitivity of 86%, specificity of 67%, positive predictive value of 95%, and negative predictive value of 40%, and accuracy of 83% for the detection of neuropathy. MARS MRI yields high image quality and diagnostic accuracy for the assessment of lumbosacral neuropathies in patients with metallic implants of the pelvis and hips. (orig.)

Comparison of histopathologic changes following X-irradiation of mid-thoracic and lumbosacral levels of neonatal rat spinal cord

International Nuclear Information System (INIS)

Heard, J.K.; Gilmore, S.A.

1985-01-01

Light microscopic changes were studied in the dorsal funiculi of spinal cords from rats irradiated (4000 R) at 3 days of age and killed from 9-60 days postirradiation (P-I). The irradiated site was limited to a 5-mm length of mid-thoracic spinal cord (T only) in one group of rats, to a 5-mm length of lumbosacral spinal cord (L only) in a second group, and to 5-mm lengths of both mid-thoracic and lumbosacral spinal cord (T/L) in the third group. Changes in the lumbosacral regions were essentially the same in both L only and T/L irradiated groups. These changes included a decreased neuroglial population and a concurrent state of hypomyelination from 9-30 days P-I. In contrast, in the mid-thoracic regions of T only and T/L irradiated groups the decrease in the neuroglial population was obvious only through 13 days P-I, and by 30 days this population resembled that of the controls. The irradiated mid-thoracic areas were hypomyelinated, with the fasciculus gracilis showing a greater degree of hypomyelination than the fasciculus cuneatus. By 25 days P-I, myelination appeared to be normal in these areas. Scattered hemorrhages were noted in both lumbosacral and mid-thoracic regions, but necrotic areas occurred only at the lumbosacral level. In general, the mid-thoracic area appeared to be less sensitive to x-radiation at 3 days of age than the lumbosacral area. These data suggest that there may be marked differences in the developmental states of cells at these two levels at 3 days of age

Patterning of anteroposterior body axis displayed in the expression of Hox genes in sea cucumber Apostichopus japonicus.

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Kikuchi, Mani; Omori, Akihito; Kurokawa, Daisuke; Akasaka, Koji

2015-09-01

The presence of an anteroposterior body axis is a fundamental feature of bilateria. Within this group, echinoderms have secondarily evolved pentameral symmetric body plans. Although all echinoderms present bilaterally symmetric larval stages, they dramatically rearrange their body axis and develop a pentaradial body plan during metamorphosis. Therefore, the location of their anteroposterior body axis in adult forms remains a contentious issue. Unlike other echinoderms, sea cucumbers present an obvious anteroposterior axis not rearranged during metamorphosis, thus representing an interesting group to study their anteroposterior axis patterning. Hox genes are known to play a broadly conserved role in anteroposterior axis patterning in deuterostomes. Here, we report the expression patterns of Hox genes from early development to pentactula stage in sea cucumber. In early larval stages, five Hox genes (AjHox1, AjHox7, AjHox8, AjHox11/13a, and AjHox11/13b) were expressed sequentially along the archenteron, suggesting that the role of anteroposterior patterning of the Hox genes is conserved in bilateral larvae of echinoderms. In doliolaria and pentactula stages, eight Hox genes (AjHox1, AjHox5, AjHox7, AjHox8, AjHox9/10, AjHox11/13a, AjHox11/13b, and AjHox11/13c) were expressed sequentially along the digestive tract, following a similar expression pattern to that found in the visceral mesoderm of other bilateria. Unlike other echinoderms, pentameral expression patterns of AjHox genes were not observed in sea cucumber. Altogether, we concluded that AjHox genes are involved in the patterning of the digestive tract in both larvae and metamorphosis of sea cucumbers. In addition, the anteroposterior axis in sea cucumbers might be patterned like that of other bilateria.

Abnormality of the spinal column in pediatric patients with lumbosacral spinal lipoma with special reference to CT findings of the lamina defects

International Nuclear Information System (INIS)

Yoshifuji, Kazuhisa; Ochi, Satoko; Koyanagi, Izumi; Houkin, Kiyohiro

2009-01-01

Lumbosacral spinal lipomas are usually associated with occult spinal dysraphism at the lumbosacral spine. During childfood, posterior arch defects in the lumbosacral spine are considered normal computed tomography (CT) findings because of the presence of interlaminar synchondrosis. In this study, we investigated the CT findings of the lumbosacral spine in the pediatric patients with lumbosacral spinal lipomas. We aimed to characterize the radiological features of the abnormal spinal column in case of spinal lipomas. Twenty-one patients (age, 1 month to 3 years) were enrolled in this study: 11 patients had conus lipoma; 10 patients, filum lipoma. All patients showed lamina defects of the lumbosacral spine on 3D-CT. The number of the defective laminae was significantly larger in the patients with conus lipomas than in those with filum lipomas. Although the appearance of lamina defects in the patients with filum lipoma was similar to the reported findings of defective laminae in normal children, these patients were characterized by mild scoliosis and asymmetry of the posterior arches localized in the lower sacrum and coccyx. On the other hand, the patients with conus lipoma were characterized by wider lamina defects that extended rostrally, 'open-door like' deformity of lamina, vertebral dysgenesis, thoracolumber scoliosis and heterotopic ossification. Such CT characterization of the abnormality of the lumbosacral spine in lipoma patients will be useful to differentiate the pathological spina bifida from the normal open posterior arches in childhood. (author)

Dural ectasia and conventional radiography in the Marfan lumbosacral spine

International Nuclear Information System (INIS)

Ahn, N.U.; Nallamshetty, L.; Ahn, U.M.; Buchowski, J.M.; Kebaish, K.M.; Sponseller, P.D.; Rose, P.S.; Garrett, E.S.

2001-01-01

Objective. To determine how well conventional radiographic findings can predict the presence of dural ectasia in Marfan patients.Design and patients. Twelve Marfan patients without dural ectasia and 21 Marfan patients with dural ectasia were included in the study. Five radiographic measurements were made of the lumbosacral spine: interpediculate distance, scalloping value, sagittal canal diameter, vertebral body width, and transverse process width.Results. The following measurements were significantly larger in patients with dural ectasia: interpediculate distances at L3-L4 levels (P 38.0 mm, sagittal diameter at S1 >18.0 mm, or scalloping value at L5 >5.5 mm.Conclusion. Dural ectasia in Marfan syndrome is commonly associated with several osseous changes that are observable on conventional radiographs of the lumbosacral spine. Conventional radiography can detect dural ectasia in patients with Marfan syndrome with a very high specificity (91.7%) but a low sensitivity (57.1%). (orig.)

[Modern treatments for degenerative disc diseases of the lumbosacral spine. A literature review].

Science.gov (United States)

Konovalov, N A; Nazarenko, A G; Asyutin, D S; Zelenkov, P V; Onoprienko, R A; Korolishin, V A; Cherkiev, I U; Martynova, M A; Zakirov, B A; Timonin, S Yu; Kosyr'kova, A V; Pimenova, L F; Pogosyan, A L; Batyrov, A A

Many researchers consider degenerative diseases of the spine as a pandemic of the XXIst century. Herniated intervertebral discs of the lumbosacral spine occur in 61% of patients with degenerative spine diseases. Of these, 15% of patients have herniated discs at the LII-LIII level, 10% of patients at the LIII-LIV level, and 40% of patients at the LIV-LV and LV-SI levels. A high cost of conservative treatment of degenerative spine disease symptoms and its low efficacy in reducing the intensity and duration of pain necessitate the development of new methods of surgical treatment. In this paper, we analyze the literature data on minimally invasive spine surgery and demonstrate the main advantages of percutaneous endoscopic surgical techniques.

Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A retrospective database of 40 consecutive treated cases and literature review.

Science.gov (United States)

Millimaggi, Daniele Francesco; DI Norcia, Valerio; Luzzi, Sabino; Alfiero, Tommaso; Galzio, Renato Juan; Ricci, Alessandro

2017-04-12

To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique. Forty patients with radiological findings of degenerative lumbosacral spine disease were undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay. Average operative time was of 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation. MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disk herniations.

The effect of lumbosacral manipulation on growing pains | de Beer ...

African Journals Online (AJOL)

The results demonstrated that both groups responded favourably to their specific treatment over time. However, the group that received lumbosacral manipulations proved to show a quicker response to treatment; and the poststudy follow-up of this same group showed markedly more positive feedback than the group that ...

Neurosurgeons' management of lumbosacral radicular syndrome evaluated against a clinical guideline

NARCIS (Netherlands)

P.A.J. Luijsterburg (Pim); A.P. Verhagen (Arianne); S. Braak (Sigrid); A. Oemraw (Anushka); C.J.J. Avezaat (Cees); B.W. Koes (Bart)

2004-01-01

textabstractTo establish to what extent neurosurgeons subscribe to the lumbosacral radicular syndrome (LRS) guideline, and to evaluate their current management of patients with LRS against the guideline. All active neurosurgeons in the Netherlands (n=92) were mailed a questionnaire about the

Prevalence of lumbosacral transitional vertebrae in Korean

International Nuclear Information System (INIS)

Cho, Hyun Chang; Bae, Geum Dong; Lee, Yong Chul; Kim, Kun Sang

1990-01-01

Controversy exists about the lumbosacral transitional vertebrae(LSTV) causing low back pain and lumbar disk abnormalities such as herniated nucleus pulposus(HNP), early disk degeneration or annulus bulging. The prevalence of the lumbosacral transitional vertebrae were evaluated. The classification of LSTV is presented based upon the radiomorphological changes of transverse process of the last presacral vertebra. The type I is dysplastic transverse process, type II is incomplete lumbarization/ sacralization, type III is complete lumbarization/ sacralization, and type IV is mixed is mixed (type II and type III). Simple radiographic findings of (804 patients including) 300 patients without low back pain. 400 patients with low back pain and 104 patients with disk abnormalities on CT scan have been analyzed. The prevalence of LSTV were 51.5% in normal control group, 40.8% in low back pain group and 46.2% in disk abnormality group. The type I is regarded as the forerunner of a true transitional vertebra and the prevalence of the true LSTB (type II, III, IV) were 11.6%, 18.3% and 13.5% on each groups. The type II and III in low back pain group and type II in disk abnormality group were relatively increased in incidence of LSTV than in normal control group. A patient with the type II or III of the LSTV may show low back pain more frequently than a patient without such a LSTV. The type II of LSTV may cause lumbar disk abnormalities more frequently

Skeletal anteroposterior discrepancy and vertical type effects on lower incisor preoperative decompensation and postoperative compensation in skeletal Class III patients.

Science.gov (United States)

Ahn, Hyo-Won; Baek, Seung-Hak

2011-01-01

To determine the initial compensation, preoperative decompensation, and postoperative compensation of the lower incisors according to the skeletal anteroposterior discrepancy and vertical type in skeletal Class III patients. The samples consisted of 68 skeletal Class III patients treated with two-jaw surgery and orthodontic treatment. Lateral cephalograms were taken before preoperative orthodontic treatment (T0) and before surgery (T1) and after debonding (T2). According to skeletal anteroposterior discrepancy/vertical type (ANB, criteria  =  -4°; SN-GoMe, criteria  =  35°) at the T0 stage, the samples were allocated into group 1 (severe anteroposterior discrepancy/hypodivergent vertical type, N  =  17), group 2 (moderate anteroposterior discrepancy/hypodivergent vertical type, N  =  17), group 3 (severe anteroposterior discrepancy/hyperdivergent vertical type, N  =  17), or group 4 (moderate anteroposterior discrepancy/hyperdivergent vertical type, N  =  17). After measurement of variables, one-way analysis of variance with Duncan's multiple comparison test, crosstab analysis, and Pearson correlation analysis were performed. At T0, groups 3 and 2 exhibited the most and least compensated lower incisors. In group 2, good preoperative decompensation and considerable postoperative compensation resulted in different values for T0, T1, and T2 (IMPA, T0 lower incisors in Class III patients.

MR imaging of the lumbosacral spine in asymptomatic pregnant and nonpregnant women

International Nuclear Information System (INIS)

Weinreb, J.C.; Wolbarsht, L.B.; Brown, C.; Cohen, J.M.; Erdman, W.A.; Maravilla, K.R.

1986-01-01

Back discomfort is a common complaint during pregnancy. In the past, back discomfort was commonly attributed to exaggeration of the normal lumbar lordosis. Recently, however, claims have been made that there is an increased incidence of lumbar disk disease during pregnancy. To evaluate this claim and determine its significance, we compared MR images of the spines of pregnant and asymptomatic nonpregnant women. Sagittal MR images (0.35 T, spin-echo technique) of the lumbosacral spines of 50 pregnant and 50 nonpregnant women were evaluated for intervertebral disk desiccation, bulge, and herniation. The nonpregnant subjects were divided into two groups: nulliparous and parous. The authors found no statistically significant difference among the three groups. Thus, there is no evidence for an increased prevalence of disk disease in pregnant women

Lumbosacral transitional anatomy types and disc degenerative changes

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Chabukovska-Radulovska Jasminka

2014-07-01

Full Text Available Background and purpose: The relationship between presence of lumbosacral transitional vertebra (LSTV and disc degenerative changes is unclear. The aim of the study was to examine the relation between different types of LSTV and disc degenerative changes at the transitional and the adjacent cephalad segment. Material and methods: Sixty-three patients (mean age 51.48 ± 13.51 out of200 adults with low back pain who performed MRI examination of the lumbosacral spine, classified as positive for LSTV, were included in the study. Annular tears, disc degeneration according to Phirmann classification and disc herniations were evaluated and graded at transitional and adjacent cephalad level. Results: The severity of disc degeneration at the transitional level and the adjacent level correlated with the types of LSTV. Severe disc degenerative changes were most frequent in articulated connection LSTV types and in combined LSTV type at the transitional level and in osseus connection LSTV types at the adjacent cephalad level. These changes were more frequent in unilateral articulated connection LSTV subtype (64% vs 54%; and in unilateral osseus connection LSTV subtype (25% vs no patients at transitional level, and in bilateral osseus connection LSTV subtype (100% vs 50% at the level above. High prevalence of disc herniations was observed in articulated connection LSTV types as well as in unilateral osseus connection LSTV subtype at transitional and the adjacent cephalad level. At the transitional level higher prevalence of disc herniations was characteristic for unilateral articulated connection LSTV subtype (46%vs 41% and for unilateral osseus connection LSTV subtype (50% vs no patients. At the adjacent level higher prevalence of disc herniations was observed in bilateral articulated connection LSTV subtype (38% vs 27% and in bilateral osseus connection LSTV subtype (50% vs 25%. Conclusions: The compact osseus connection (osseus bridging vs articular

Agreement between computed tomography, magnetic resonance imaging, and surgical findings in dogs with degenerative lumbosacral stenosis.

Science.gov (United States)

Suwankong, Niyada; Voorhout, George; Hazewinkel, Herman A W; Meij, Björn P

2006-12-15

To assess the extent of agreement between computed tomography (CT), magnetic resonance imaging (MRI), and surgical findings in dogs with degenerative lumbosacral stenosis. Observational study. 35 dogs with degenerative lumbosacral stenosis. Results of preoperative CT and MRI were compared with surgical findings with respect to degree and location of disk protrusion, position of the dural sac, amount of epidural fat, and swelling of spinal nerve roots. A lumbosacral step was seen on radiographic images from 22 of 32 (69%) dogs, on CT images from 23 of 35 (66%) dogs, and on MR images from 21 of 35 (60%) dogs. Most dogs had slight or moderate disk protrusion that was centrally located. There was substantial or near perfect agreement between CT and MRI findings in regard to degree of disk protrusion (kappa, 0.88), location of disk protrusion (0.63), position of the dural sac (0.89), amount of epidural fat (0.72), and swelling of spinal nerve roots (0.60). The degree of agreement between CT and surgical findings and between MRI and surgical findings was moderate in regard to degree and location of disk protrusion (kappa, 0.44 to 0.56) and swelling of spinal nerve roots (0.40 and 0.50). Results indicate that there is a high degree of agreement between CT and MRI findings in dogs with degenerative lumbosacral stenosis but that the degree of agreement between diagnostic imaging findings and surgical findings is lower.

Antero-posterior patterning of the vertebrate digestive tract: 40 years after Nicole Le Douarin's PhD thesis.

Science.gov (United States)

Grapin-Botton, Anne

2005-01-01

This review is dedicated to the work on chick digestive tract organogenesis that Nicole Le Douarin performed as a PhD student under the direction of Etienne Wolf. I discuss how she laid the grounds for future work by establishing fate maps at somitic stages, by describing morphogenetic movements between germ layers and by pointing to signaling events between endoderm and mesoderm. Her inspiring work was extended by others, in particular at the molecular level, leading to a better understanding of antero-posterior patterning in the digestive tract. Antero-posterior patterning of endoderm is initiated at gastrulation when future anterior and posterior endoderm ingress at different times and accordingly express different genes. Plasticity is however maintained at somite stages and even later, when organ primordia can be delineated. There is a cross-talk between endoderm and mesoderm and the two layers exchange instructive signals that induce specific antero-posterior identities as well as permissive signals required for organogenesis from previously patterned fields. Recent experiments suggest that several signaling molecules involved in neural tube antero-posterior patterning are also instrumental in the digestive tract including retinoic acid and FGF4.

The lumbosacral radiographs in the initial screening of low back pain

African Journals Online (AJOL)

Background: Radiological imaging is mandatory, when investigating patients with low back pain (LBP). A minimum of three plain radiographic views of lumbosacral spine are routinely requested for by the attending clinicians. Objective: This study is therefore carried out to determine if only one view will be sufficient in the ...

Sirenomelia with an angiomatous lumbosacral myelocystocele in a full-term infant.

Science.gov (United States)

Browne, Marybeth; Fitchev, Philip; Adley, Brian; Crawford, Susan E

2004-05-01

Sirenomelia, also known as the mermaid syndrome, is a rare congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations. In this report, we describe the first case of an infant with sirenomelia and a massive angiomatous lumbosacral myelocystocele.

Lumbosacral Plexus Injury and Brachial Plexus Injury Following Prolonged Compression

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Chung-Lan Kao

2006-11-01

Full Text Available We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.

Selective plasticity of primary afferent innervation to the dorsal horn and autonomic nuclei following lumbosacral ventral root avulsion and reimplantation in long term studies.

Science.gov (United States)

Wu, Lisa; Wu, Jun; Chang, Huiyi H; Havton, Leif A

2012-02-01

Previous studies involving injuries to the nerves of the cauda equina and the conus medullaris have shown that lumbosacral ventral root avulsion in rat models results in denervation and dysfunction of the lower urinary tract, retrograde and progressive cell death of the axotomized motor and parasympathetic neurons, as well as the emergence of neuropathic pain. Root reimplantation has also been shown to ameliorate several of these responses, but experiments thus far have been limited to studying the effects of lesion and reimplantation local to the lumbosacral region. Here, we have expanded the region of investigation after lumbosacral ventral root avulsion and reimplantation to include the thoracolumbar sympathetic region of the spinal cord. Using a retrograde tracer injected into the major pelvic ganglion, we were able to define the levels of the spinal cord that contain sympathetic preganglionic neurons innervating the lower urinary tract. We have conducted studies on the effects of the lumbosacral ventral root avulsion and reimplantation models on the afferent innervation of the dorsal horn and autonomic nuclei at both thoracolumbar and lumbosacral levels through immunohistochemistry for the markers calcitonin gene-related peptide (CGRP) and vesicular glutamate transporter 1 (VGLUT1). Surprisingly, our experiments reveal a selective and significant decrease of CGRP-positive innervation in the dorsal horn at thoracolumbar levels that is partially restored with root reimplantation. However, no similar changes were detected at the lumbosacral levels despite the injury and repair targeting efferent neurons, and being performed at the lumbosacral levels. Despite the changes evident in the thoracolumbar dorsal horn, we find no changes in afferent innervation of the autonomic nuclei at either sympathetic or parasympathetic segmental levels by CGRP or VGLUT1. We conclude that even remote, efferent root injuries and repair procedures can have an effect on remote and non

Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration

International Nuclear Information System (INIS)

Jinkins, Randy J.

2002-01-01

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.)

Evaluation of Outcome of Posterior Decompression and Instrumented Fusion in Lumbar and Lumbosacral Tuberculosis.

Science.gov (United States)

Jain, Akshay; Jain, Ravikant; Kiyawat, Vivek

2016-09-01

For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach. Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively. The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°. Posterior decompression with instrumented

Complete Cranial Iliac Osteotomy to Approach the Lumbosacral Foramen

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Barbara Dyall

2017-05-01

Full Text Available An approach using a complete cranial iliac osteotomy (CCIO to access the lumbosacral (LS foramen in dogs from lateral was developed using cadavers and applied in a clinical patient with degenerative lumbosacral stenosis (DLSS. The foraminal enlargement in the cadavers and the patient was documented on postoperative CT scans. The preoperative CT scan of the patient showed moderate cranial telescoping of the sacral roof and a moderate central disk protrusion, leading to moderate to severe compression of the cauda equina. In addition, there was lateral spondylosis with consequential stenosis of the right LS foramen. The right L7 nerve had lost its fat attenuation and appeared thickened. After a routine L7S1 dorsal laminectomy with a partial discectomy, a CCIO was performed, providing good access to the LS foramen and the adhesions around the proximal L7 nerve caudoventral to the foramen. The osteotomy was stabilized with a locking plate and a cerclage wire. The dog recovered well from the procedures and after 36 h, the dog walked normally and was discharged from the hospital. Eight and 16 weeks later, the signs of the DLSS had markedly improved. From these data, it can be concluded that the CCIO is a useful approach to the LS foramen and intervertebral disk in selected patients with DLSS, giving good access to the structures around the LS foramen.

Ultrasound/Magnetic Resonance Image Fusion Guided Lumbosacral Plexus Block – A Clinical Study

DEFF Research Database (Denmark)

Strid, JM; Pedersen, Erik Morre; Søballe, Kjeld

2014-01-01

in a double-blinded randomized controlled trial with crossover design. MR datasets will be acquired and uploaded in an advanced US system (Epiq7, Phillips, Amsterdam, Netherlands). All volunteers will receive SSPS blocks with lidocaine added gadolinium contrast guided by US/MR image fusion and by US one week......Background and aims Ultrasound (US) guided lumbosacral plexus block (Supra Sacral Parallel Shift [SSPS]) offers an alternative to general anaesthesia and perioperative analgesia for hip surgery.1 The complex anatomy of the lumbosacral region hampers the accuracy of the block, but it may be improved...... by guidance of US and magnetic resonance (MR) image fusion and real-time 3D electronic needle tip tracking.2 We aim to estimate the effect and the distribution of lidocaine after SSPS guided by US/MR image fusion compared to SSPS guided by ultrasound. Methods Twenty-four healthy volunteers will be included...

Transarticular facet screw stabilization and dorsal laminectomy in 26 dogs with degenerative lumbosacral stenosis with instability.

Science.gov (United States)

Hankin, Elyshia J; Jerram, Richard M; Walker, Alexander M; King, Michael D; Warman, Christopher G A

2012-07-01

To describe outcome after transarticular facet screw stabilization and dorsal laminectomy for treatment of dynamic degenerative lumbosacral stenosis (DLS) in 26 dogs. Retrospective case series. Dogs (n = 26) with dynamic DLS. Medical records (2004-2009) of dogs treated with transarticular facet screw stabilization and dorsal laminectomy were reviewed. Dogs (n = 26) were available for immediate postoperative follow-up, 21 dogs at 6 weeks, and 15 at greater than 6 months. Dogs were evaluated by radiographic assessment and owner questionnaire. Lumbosacral (LS) intervertebral disc (IVD) spaces were measured on pre and postoperative 6-week and 6-month radiographs. In 23 dogs, improvement in clinical signs occurred within 7 days of surgery. Overall postsurgical complication rate directly related to the surgical procedure was 15.4%. LS IVD space measurements taken immediately postoperatively, at 6 weeks, and ≥ 6 months were all significantly increased compared with preoperative measurements. All working dogs (4) returned to full work within 14 months. Most owners (85%) reported their dog was ambulating normally at 6 months with no perceptible lameness during normal activity. All owners perceived their dog's ability to walk, run, and jump after surgery to be improved. Transarticular facet screw stabilization and dorsal laminectomy maintains distraction of the LS IVD space for medium-to-large breed dogs with dynamic DLS with a high degree of owner satisfaction, and is comparable to other reported surgical techniques for DLS. © Copyright 2012 by The American College of Veterinary Surgeons.

Dural ectasia and conventional radiography in the Marfan lumbosacral spine

Energy Technology Data Exchange (ETDEWEB)

Ahn, N U [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); Johns Hopkins Outpatient Center, Dept. of Orthopaedic Surgery, Baltimore, MD (United States); Nallamshetty, L; Ahn, U M; Buchowski, J M; Kebaish, K M; Sponseller, P D [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); Rose, P S [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (United States); Garrett, E S [Dept. of Oncology, Division of Biostatistics, Johns Hopkins University School of Medicine, Baltimore (United States)

2001-06-01

Objective. To determine how well conventional radiographic findings can predict the presence of dural ectasia in Marfan patients.Design and patients. Twelve Marfan patients without dural ectasia and 21 Marfan patients with dural ectasia were included in the study. Five radiographic measurements were made of the lumbosacral spine: interpediculate distance, scalloping value, sagittal canal diameter, vertebral body width, and transverse process width.Results. The following measurements were significantly larger in patients with dural ectasia: interpediculate distances at L3-L4 levels (P<0.03); scalloping values at the L1 and L5 levels (P<0.05); sagittal diameters of the vertebral canal at L5-S1 (P<0.03); transverse process to width ratios at L2 (P<0.03). Criteria were developed for diagnosis of dural ectasia in Marfan patients. These included presence of one of the following: interpediculate distance at L4 >38.0 mm, sagittal diameter at S1 >18.0 mm, or scalloping value at L5 >5.5 mm.Conclusion. Dural ectasia in Marfan syndrome is commonly associated with several osseous changes that are observable on conventional radiographs of the lumbosacral spine. Conventional radiography can detect dural ectasia in patients with Marfan syndrome with a very high specificity (91.7%) but a low sensitivity (57.1%). (orig.)

Postirradiation lumbosacral radiculopathy following seminoma treatment presenting as flaccid neuropathic bladder: a case report

LENUS (Irish Health Repository)

Raheem, Omer A

2011-04-14

Abstract Introduction Postirradiation lumbosacral syndrome is a radiculopathy induced by radiation injury to the spinal cord. Its usual presentation is motor deficit and or sensory loss involving the lower limbs. Visceral involvement has not been reported previously. Case presentation We describe a case of severe hypotonic bladder caused by radiation-induced spinal cord injury following treatment of stage Ι testicular seminoma in a 38-year-old Caucasian man who had undergone radical orchidectomy and prophylactic paraaortic lymph node irradiation for stage Ι seminoma. Three years later he had clinical and urodynamic findings of hypotonic bladder. The magnetic resonance imaging results suggested a radiation-induced injury. Conclusion Such an unusual presentation of the syndrome of postirradiation lumbosacral radiculopathy can impose a clinical challenge to practicing clinicians. Future studies are required to further delineate the mechanism of injury and further management plans.

Postirradiation lumbosacral radiculopathy following seminoma treatment presenting as flaccid neuropathic bladder: a case report.

LENUS (Irish Health Repository)

Raheem, Omer A

2012-02-01

INTRODUCTION: Postirradiation lumbosacral syndrome is a radiculopathy induced by radiation injury to the spinal cord. Its usual presentation is motor deficit and or sensory loss involving the lower limbs. Visceral involvement has not been reported previously. CASE PRESENTATION: We describe a case of severe hypotonic bladder caused by radiation-induced spinal cord injury following treatment of stage Iota testicular seminoma in a 38-year-old Caucasian man who had undergone radical orchidectomy and prophylactic paraaortic lymph node irradiation for stage Iota seminoma. Three years later he had clinical and urodynamic findings of hypotonic bladder. The magnetic resonance imaging results suggested a radiation-induced injury. CONCLUSION: Such an unusual presentation of the syndrome of postirradiation lumbosacral radiculopathy can impose a clinical challenge to practicing clinicians. Future studies are required to further delineate the mechanism of injury and further management plans.

Conservative treatment in patients with an acute lumbosacral radicular syndrome: design of a randomised clinical trial [ISRCTN68857256

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Peul Wilco C

2004-11-01

Full Text Available Abstract Background The objective is to present the design of randomised clinical trial (RCT on the effectiveness of physical therapy added to general practitioners management compared to general practitioners management only in patients with an acute lumbosacral radicular syndrome (also called sciatica. Methods/Design Patients in general practice diagnosed with an acute (less than 6 weeks lumbosacral radicular syndrome and an age above 18 years are eligible for participation. The general practitioners treatment follows their clinical guideline. The physical therapy treatment will consist of patient education and exercise therapy. The primary outcome measure is patients reported global perceived effect. Secondary outcome measures are severity of complaints, functional status, health status, fear of movement, medical consumption, sickness absence, costs and treatment preference. The follow-up is 52 weeks. Discussion Treatment by general practitioners and physical therapists in this study will be transparent and not a complete "black box". The results of this trial will contribute to the decision of the general practitioner regarding referral to physical therapy in patients with an acute lumbosacral radicular syndrome.

[Ways to optimize the treatment of patients with discogenic-venous lumbosacral radiculomyeloischemia].

Science.gov (United States)

Skoromets, А А; Bubnova, Е V; Endalceva, S М; Kapitonov, D S; Lalayan, Т V; Perfilev, S V; Smolko, D G; Skoromets, А P; Skoromets, Т А; Sukhatskaya, О V; Shmonin, А А

2015-01-01

Treatment of patients with neurological manifestations of degenerative-dystrophic lesions of the spine must be integrated and optimized from the perspective of pathogenesis. Antiedematous therapy is an important moment that takes into account the development of localized swelling affected the spinal structures. We studied the efficacy of L-lysine aescinat in the treatment of patients with discogenic-venous lumbosacral radiculomyelopathy. We analyzed the therapeutic efficacy of antitumor therapy with the drug L-lysine aescinat in 40 patients with discogenic-venous lumbosacral radiculomyelopathy in comparison with a control group of 40 patients treated with conventional therapy in a neurological hospital. The age of the patients ranged from 30 to 60 years. In total, there were 36 (45 %) women and 44 (55%) men. Herniated discs were visualized by MRI in all patients, attention was drawn to the condition of radicular veins of the cauda equina. We assessed muscle strength of lumbosacral myotomes, their trophicity and state of segmental-conductor apparatus sensitivity with the quantitative determination of the time of vibration of a tuning fork. The comparison of neurological status dynamics during treatment of inpatients has shown that neurological symptoms reduce more effectively in patients treated with L - lysine aescinat (by 75% during the first 3-5 days) and in a greater number of the patients (77.5% vs 55% in the control group). The authors' experience has shown that venous micro- and macro-circulation disorders play an important role in the pathogenesis of lower lumbar disk hernia. Clinical manifestations of these disorders are segmental and conductive spinal motor disorders in myotomes and sensitivity. Quantitative determination of vibration sensitivity (tuning fork test) is pathognomonic for radiculomyeloischemia. Vein tonics and antiedemics, including L - lysine aescinat as one of the most effective drugs, exert a pathogenetic effect on spondylic and discogenic

Retrospective Cohort Study of the Prevalence of Lumbosacral Transitional Vertebra in a Wide and Well-Represented Population

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Demet Uçar

2013-01-01

Full Text Available Purpose. The aim of this study is to determine the prevalence of lumbosacral transitional vertebra (LSTV in a well-represented general population. Methods. For a retrospective cohort study, abdominal radiographs of adult subjects were queried with clear visibility of the vertebral body articulation of the last rib, all lumbar transverse processes, and complete sacral wings. Exclusion criteria included any radiologic evidence of previous lumbosacral surgery that would block our view. A total of 6200 abdominal films were reviewed, and 3607 were identified as being suitable for the measurement of the desired parameters. Results. A total of 3607 subjects were identified as eligible for the study, and 683 (18.9% were classified as positive for a lumbosacral transitional vertebra. The prevalence of sacralization and lumbarization was found as 17.2% and 1.7%, respectively. The average age at the time of the study was 39.5±15.2 years (18–86 years. Conclusions. As a result of different opinions, LSTV retains its controversial status. Our prevalence study of the general population will provide assistance for resolution of the controversy. Prevalence studies of the general population with a wide participation will shed light on comparative studies.

Overview of the frontal sinus anteroposterior size based on against lateral cephalometric radiographs chronological age as forensic identification

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Georgiana Marsya

2017-08-01

Full Text Available Introduction: One part of the most important individual identification procedure is approximate age can be done on an individual living or dead. Judging from some of the methods that have been there, have not found a method forecasts age through the frontal sinuses, particularly research conducted in Indonesia. The frontal sinus can be used for identification because the frontal sinuses began to evolve and look at radiographs at the age of 7 years and did not change after the age of 20 years, it reveals the existence of differences in the size of the frontal sinuses with age. The onbjectives of this study was to asses of the frontal sinus anteroposterior size based on against lateral cephalometric radiographs chronological age as forensic identification. Methods: A number of samples are 502 lateral cephalometric patient data from secondary data of patients aged 7-20 years, 335 pieces of lateral cephalometric Purpose of study is to asses of the frontal sinus anteroposterior size chronological age as forensic identification. radiograph female patients and 167 pieces in male patients. Data anteroposterior size of the frontal sinus is obtained by pulling the longest line perpendicular to the line of Sh-Sl. Results: the results showed that at the age of 7 years the average size of the frontal sinus anteroposterior 4.20 mm and 5.05 mm which is the smallest size, while the average size of the biggest, by 8.46 mm in women and men at the age of 11.37 mm 20 years. Conclusions: In women, the fastest increase occurred at the age of 7-8 years, males at the age of 16-18 years. The frontal sinuses anteroposterior size increases with age, both men, and women.

CT of the canine lumbosacral spine in extension - flexion rotation; part I: bony window

International Nuclear Information System (INIS)

Henninger, W.; Werner, G.

2002-01-01

The canine lumbosacral spine is examined radiographically in extended and flexed lateral position as well as ventrodorsally. Superimposition of bones hinders exact evaluation of the lumbosacral intervertebral foramen in case of cauda equina syndrome, especially when degenerative changes overlap. CT or MRI are more and more indicated to get reliable findings because myelography is not always of diagnostic value. For this study twelve dogs (7 German Shepherd dogs, 4 Cross-breds, and 1 Rottweiler) of different age and sex were taken which had been referred for CT examination of the lumbosacral area. Plain radiographs did not show abnormalities. The anaesthetized dogs were positioned in dorsal recumbency with the legs firstly extended and secondly flexed according to flexion-extension radiography. Slice thickness was 2 mm, the CT images were evaluated in both bony and soft tissue windows. Bony window easily showed vertebral bodies, vertebral canal, pedicles, vertebral laminae, and articular processes of L7 and S1. Median height of the vertebral canal did not change during extension or flexion at the level of L7 and the sacrum. Height and width of the intervertebral foramen and width of the interarcual foramen changed markedly from extension to flexion. Lateral recessus of the vertebral canal always could be observed as ventrolateral widening. In sagittal CT scans of the lumbosacral specimen of a normal German Shepherd dog cranial articular processes of the sacrum were detected to be responsible for maximum height or width of the intervertebral foramen. Evolving from the lateral recessus the intervertebral foramen was initially oval-shaped and got rounded and narrowed by the cranial articular process of the sacrum. Position and shape of the cranial articular processes of the sacrum were evaluated. Surface of the cranial articular processes of S1 were found even with articular spaces congruent, but some also appeared slightly concave or convex where incongruity of the

Ground reaction forces produced by two different hockey skating arm swing techniques.

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Hayward-Ellis, Julie; Alexander, Marion J L; Glazebrook, Cheryl M; Leiter, Jeff

2017-10-01

The arm swing in hockey skating can have a positive effect on the forces produced by each skate, and the resulting velocity from each push off. The main purpose of this study was to measure the differences in ground reaction forces (GRFs) produced from an anteroposterior versus a mediolateral style hockey skating arm swing. Twenty-four elite-level female hockey players performed each technique while standing on a ground-mounted force platform, and all trials were filmed using two video cameras. Force data was assessed for peak scaled GRFs in the frontal and sagittal planes, and resultant GRF magnitude and direction. Upper limb kinematics were assessed from the video using Dartfish video analysis software, confirming that the subjects successfully performed two distinct arm swing techniques. The mediolateral arm swing used a mean of 18.38° of glenohumeral flexion/extension and 183.68° of glenohumeral abduction/adduction while the anteroposterior technique used 214.17° and 28.97° respectively. The results of this study confirmed that the mediolateral arm swing produced 37% greater frontal plane and 33% less sagittal plane GRFs than the anteroposterior arm swing. The magnitudes of the resultant GRFs were not significantly different between the two techniques; however, the mediolateral technique produced a resultant GRF with a significantly larger angle from the direction of travel (44.44°) as compared to the anteroposterior technique (31.60°). The results of this study suggest that the direction of GRFs produced by the mediolateral arm swing more closely mimic the direction of lower limb propulsion during the skating stride.

What progress has been made in the understanding and treatment of degenerative lumbosacral stenosis in dogs during the past 30 years?

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Jeffery, Nick D; Barker, Andrew; Harcourt-Brown, Tom

2014-07-01

An association between degenerative changes in the lumbosacral region of the vertebral column and clinical signs of pain and pelvic limb dysfunction has long been recognized in dogs and has become known as degenerative lumbosacral stenosis syndrome. Over the past two decades, methods of imaging this condition have advanced greatly, but definitive criteria for a reliable diagnosis using physical examination, imaging and electrodiagnostics remain elusive. Available treatment options have changed little over more than 30 years but, more importantly, there is a lack of comparative studies and little progress has been made in providing evidence-based recommendations for the treatment of affected dogs. This review provides an overview of the changes in diagnosis, understanding and treatment of lumbosacral disease in dogs over the past 30 years. Approaches to address the unanswered questions regarding treatment choice are also proposed. Copyright © 2014 Elsevier Ltd. All rights reserved.

HISTOMORPHOLOGICAL STUDY OF THORACOLUMBAR FASCIA IN PATIENTS WITH LUMBOSACRAL DISCOPATHY

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Z BEHDADIPOOR

2000-03-01

Full Text Available Introduction. Thoracolumbar fascia has neural ends in normal positions. It has sensory role and by inhibitory and or excitatory reflexes helps to protect vertebral column. In this research, it has been studied neural ends in thoracolumbar fascia in 42 cases. Our aim was to compare the presence of neural ends in normal individuals and those with lumbosacral discopathy. Methods. The samples were taken from one centimeter of midline at the level of L4-L5 vertebrae, since in this region the posterior layer of thoracolumbar fascia is thicker. Seven of the cases were normal and 35 were patients with lumbosacral discopathy. The samples were processed and serial sections were prepared. Six hundred and thirty sections from the serial sections were selected and 90 percent of these were stained with H&E and the rest of them were stained with Bielschowsky method. The sections were studied by light microscopy. Findings. Unlike the normal individuals, nerve corpuscles were not seen in none of our patients with lumbosacraldiscopathy.UsingBielschowsky,nerveendingswerepresentin normal individuals but they were not visible in patients with discopathy. Conclusion. It is concluded that thoracolumbar fascia in patients with discopathy had insufficient neural ends. Loss of these neural ends may be cause of decreasing proprioceptive information to nervous system and can be an initiating factor to damage the bones, ligaments and muscles.

Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy.

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Suwankong, N; Meij, B P; Voorhout, G; de Boer, A H; Hazewinkel, H A W

2008-01-01

The medical records of 156 dogs with degenerative lumbosacral stenosis (DLS) that underwent decompressive surgery were reviewed for signalment, history, clinical signs, imaging and surgical findings. The German Shepherd Dog (GSD) was most commonly affected (40/156, 25.6%). Pelvic limb lameness, caudal lumbar pain and pain evoked by lumbosacral pressure were the most frequent clinical findings. Radiography showed lumbosacral step formation in 78.8% (93/118) of the dogs which was associated with elongation of the sacral lamina in 18.6% (22/118). Compression of the cauda equina was diagnosed by imaging (epidurography, CT, or MRI) in 94.2% (147/156) of the dogs. Loss of the bright nucleus pulposus signal of the L7-S1 disc was found on T2-weighted MR images in 73.5% (25/34) of the dogs. The facet joint angle at L7-S1 was significantly smaller, and the tropism greater in GSD than in the other dog breeds. The smaller facet joint angle and higher incidence of tropism seen in the GSD may predispose this breed to DLS. Epidurography, CT, and MRI allow adequate visualization of cauda equina compression. During surgery, disc protrusion was found in 70.5% (110/156) of the dogs. Overall improvement after surgery was recorded in the medical records in 79.0% (83/105) of the dogs. Of the 38 owners that responded to questionnaires up to five years after surgery, 29 (76%) perceived an improvement.

Outcomes of bilateral sacroiliac joint fusions and the importance of understanding potential coexisting lumbosacral pathology that might also require surgical treatment.

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Dall, Bruce E; Eden, Sonia V

2015-06-01

Only one study in the literature describes performing a bilateral sacroiliac joint fusion, and the results were poor. Many patients needing a bilateral sacroiliac joint fusion frequently have had previous lumbosacral surgeries and present with lumbosacral pain as well. This study reviews our results in consecutive patients having had a bilateral sacroiliac joint fusion over a five-year period. Fifteen patients had bilateral sacroiliac joint fusions with 13 having concurrent lumbosacral fusions. The modified posterior midline fascial splitting approach, first described by Belanger was utilized. Patients were followed for an average of 30.3 months. There were no infections, neurovascular injuries, lasting morbidity or deaths. One non-union of a sacroiliac joint (7%) occurred, which after revision was satisfactory. There was a statistically significant drop in pain (p=0.01488) using the VAS, and patient satisfaction rates were 86%. With all those patients saying they would have the surgery again for the same result. There was no significant increase in functionality. Patients needing bilateral sacroiliac joint fusions frequently fall into the "failed back" category, and it is important to evaluate both the sacroiliac joints and the lumbosacral spine for potential pain generators. This study shows that by treating all the pain generators in both areas there were significant decreases in pain, low complications, low re-operation rates, and high patient satisfaction scores. Overall functionality, however, was not positively affected.

[Study on the area of pain and numbness in cases with lumbosacral radiculopathy].

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Kuraishi, Keita; Hanakita, Junya; Takahashi, Toshiyuki; Minami, Manabu; Watanabe, Mizuki; Uesaka, Toshio; Honda, Fumiaki

2012-10-01

In the clinical diagnosis of lumbosacral radicular symptoms, dermatome maps are commonly used, by which the segmental location of the affected nerve can be determined. However, the diagnosis is often difficult because the pattern of sensory disturbance does not necessarily match the patterns of classical dermatomes, and there are many dermatome maps made by different methods. The author examined the area of pain and numbness in cases of lumbosacral radiculopathy. Clinical features of pain and numbness in consecutive seventy three cases of lumbosacral radiculopathy were investigated (L3: n=13, L4-S1: n=20). Patients of L3 radiculopathy showed symptoms at the upper buttock and ventral surface of the thighs, knees and upper ventral surface of the legs. Patients of L4 radiculopathy showed symptoms at the ventro-lateral surfaces of the thigh and leg. The distinctive region, defined as the region having 100% superimposition, of L4 radiculopathy was the lateral part of the shin. Patients of L5 radiculopathy showed symptoms at the lateral surfaces of the thigh and leg. The distinctive region was the upper buttock. Patients of S1 radiculopathy showed symptoms at the lower buttock, dorso-lateral part of the leg and lateral part of the foot. The distinctive region was the lateral part of the calf. It was found that the regions of pain and numbness formed a continuous band-like zone from thigh to leg in 8% of L3, 45% of L4 and L5, and 35% of S1 radiculopathy. Using a visual analogue scale, the degree of leg pain was more severe than low back pain in 68% of the patients, but in 5% of patients, low back pain was more severe.

A case of post-irradiation lumbosacral radioculopathy successfully treated with corticosteroid and warfarin

Energy Technology Data Exchange (ETDEWEB)

Anezaki, Toshiharu; Harada, Takashi; Kawachi, Izumi; Sanpei, Kazuhiro; Soma, Yoshiaki; Tsuji, Shoji [Niigata Univ. (Japan). Brain Research Inst

1999-08-01

A 33-year-old man underwent post-operative radiation therapy for the left testicular anaplastic seminoma. One year later, the patient developed muscle weakness and sensory disturbance in the left lower extremity, and muscle weakness in the right lower extremity. MRI demonstrated linear and focal gadolinium (Gd) enhancement of the anterior portion of the lumbosacral roots within the cauda equina. The neurological symptoms improved after administration of corticosteroid and warfarin. Radiation myelopathy of this type was classified as ''selective anterior horn cell injury or amyotrophy'' by Reagan, and the site of the lesion was considered to be the lower motor neurons. However, based on the clinical and MRI findings, we proposed that the disease process was injury to the spinal nerve roots rather than the lower motor neurons. Recent neuropathological studies of this syndrome have demonstrated degeneration of the proximal spinal nerve roots. We consider that primary lesions of this syndrome occur in spinal nerve roots rather than in lower motor neurons, and ''lumbosacral radiculopathy'' is a more appropriate term for this condition. (author)

A case of post-irradiation lumbosacral radioculopathy successfully treated with corticosteroid and warfarin

International Nuclear Information System (INIS)

Anezaki, Toshiharu; Harada, Takashi; Kawachi, Izumi; Sanpei, Kazuhiro; Soma, Yoshiaki; Tsuji, Shoji

1999-01-01

A 33-year-old man underwent post-operative radiation therapy for the left testicular anaplastic seminoma. One year later, the patient developed muscle weakness and sensory disturbance in the left lower extremity, and muscle weakness in the right lower extremity. MRI demonstrated linear and focal gadolinium (Gd) enhancement of the anterior portion of the lumbosacral roots within the cauda equina. The neurological symptoms improved after administration of corticosteroid and warfarin. Radiation myelopathy of this type was classified as ''selective anterior horn cell injury or amyotrophy'' by Reagan, and the site of the lesion was considered to be the lower motor neurons. However, based on the clinical and MRI findings, we proposed that the disease process was injury to the spinal nerve roots rather than the lower motor neurons. Recent neuropathological studies of this syndrome have demonstrated degeneration of the proximal spinal nerve roots. We consider that primary lesions of this syndrome occur in spinal nerve roots rather than in lower motor neurons, and ''lumbosacral radiculopathy'' is a more appropriate term for this condition. (author)

Radiological and functional outcomes of high-grade spondylolisthesis treated by intrasacral fixation, dome resection and circumferential fusion: a retrospective series of 20 consecutive cases with a minimum of 2 years follow-up.

Science.gov (United States)

Ferrero, E; Ilharreborde, B; Mas, V; Vidal, C; Simon, A-L; Mazda, K

2018-01-20

Major concern during surgery for high-grade spondylolisthesis (HGS) is to reduce lumbosacral kyphosis and restore sagittal alignment. Despite the numerous methods described, lumbosacral fixation in HGS is a challenging technique associated with high complication rate. Few series have described outcomes and most of the results are limited to lumbosacral correction without global sagittal alignment analysis. This study aims at analyzing clinical and radiological outcomes of HGS patients treated with intrasacral rods on full spine radiographs. HGS patients (Meyerding III or higher) operated between 2004 and 2014 were reviewed. All patients underwent full spine stereoradiographic images. After L5 and S1 decompression, reduction and circumferential fusion with intrasacral rod fixation and fusion up to L4 were performed under fluoroscopy. The entry points for S1 screws were located 3-5 mm above and 5 mm lateral to the first sacral hole, toward the promontory. The two short distal fusion rods were then positioned into the sacrum guided by anteroposterior fluoroscopy using Jackson's technique. Then, sacral dome resection was performed and a PEEK cage was impacted in L5S1 after reduction. Postoperatively, the hip and knee were kept flexed at 45° for 1 week and extended progressively. Preoperative, 3 months postoperative and last follow-up (> 2 years minimum) clinical and radiographic data were collected. Sagittal parameters included lumbosacral angle (LSA), olisthesis, T1 spinopelvic inclination (T1SPi) and spinopelvic parameters. 20 HGS patients were included (8 ptosis, 5 Meyerding IV). The mean age was 14 years. At final FU (7.2 years ± 3), LSA kyphosis and olisthesis were reduced (65° ± 14 vs 99° ± 11, p motor deficit that occurred when patients were put in standing position. However, all recovered before 3 months postoperatively. Intrasacral rod fixation appears to be an effective technique to correct LSA kyphosis, compensatory hyperlordosis and

Anomalous rostral lumbosacral root emergence from the thecal sac

International Nuclear Information System (INIS)

Peyster, R.G.; Parghi, A.; Siegal, T.; Hershey, B.L.; Yablon, J.; Jaffe, S.

1989-01-01

Anomalous rostral lumbosacral root emergence (AARE) has important clinical implications and has received little attention. The authors have studied the occurrence of this anomaly and presentation of cases in which it was paramount in causing radiculopathy. AARE was noted with the following occurrence rates in 500 cases: L3, 0%; L4, 1%; L5, 9%, and S1, 16%. In ARRE, the roots lie laterally between the superior facet and the annulus and are subject to compression by minimal disk bulging or facet hypertrophy. One must track the individual nerve roots on lumbar CT and MR imaging to detect this subtle condition

Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.

Science.gov (United States)

Jain, Amit; Hassanzadeh, Hamid; Strike, Sophia A; Menga, Emmanuel N; Sponseller, Paul D; Kebaish, Khaled M

2015-09-16

Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Tibial nerve somatosensory evoked potentials in dogs with degenerative lumbosacral stenosis.

Science.gov (United States)

Meij, Björn P; Suwankong, Niyada; van den Brom, Walter E; Venker-van Haagen, Anjop J; Hazewinkel, Herman A W

2006-02-01

To determine somatosensory evoked potentials (SEPs) in dogs with degenerative lumbosacral stenosis (DLS) and in healthy dogs. Clinical and experimental study. Dogs with DLS (n = 21) and 11 clinically normal dogs, age, and weight matched. Under anesthesia, the tibial nerve was stimulated at the caudolateral aspect of the stifle, and lumbar SEP (LSEP) were recorded percutaneously from S1 to T13 at each interspinous space. Cortical SEP (CSEP) were recorded from the scalp. LSEP were identified as the N1-P1 (latency 3-6 ms) and N2-P2 (latency 7-13 ms) wave complexes in the recordings of dogs with DLS and control dogs. Latency of N1-P1 increased and that of N2-P2 decreased as the active recording electrode was moved cranially from S1 to T13. Compared with controls, latencies were significantly delayed in DLS dogs: .8 ms for N1-P1 and 1.7 ms for the N2-P2 complex. CSEP were not different between groups. Surface needle recording of tibial nerve SEP can be used to monitor somatosensory nerve function of pelvic limbs in dogs. In dogs with DLS, the latency of LSEP, but not of CSEP, is prolonged compared with normal dogs. In dogs with lumbosacral pain from DLS, the cauda equina compression is sufficient to affect LSEP at the lumbar level.

Is Lumbosacral Plexus Block an Effective and Safe Alternative as Surgical Anesthesia for Total Hip Replacement?

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Larsen, Jens Rolighed; Børglum, Jens

BACKGROUND An increasing number of patients for total hip replacement presents with cardiovascular comorbidities, that render them fragile to traditional methods of anesthesia. The aim of this intended study is to compare lumbosacral plexus blockade with continuous spinal anesthesia for surgical ...

Comparison between computed tomographic and surgical findings in nine large-breed dogs with lumbosacral stenosis

International Nuclear Information System (INIS)

Jones, J.C.; Sorjonen, D.C.; Simpson, S.T.; Coates, J.R.; Lenz, S.D.; Hathcock, J.T.; Agee, M.W.; Bartels, J.E.

1996-01-01

In a three-year prospective study, computed tomographic (CT) and surgical findings were compared for nine large breed dogs with lumbosacral stenosis. Surgically-excised tissue was examined histologically in seven dogs and additional necropsy evaluation was performed in one dog. The CT abnormalities observed at sites of confirmed cauda equina compression were: loss of epidural fat, increased soft tissue opacity, bulging of the intervertebral disc margin, spondylosis, thecal sac displacement, narrowed intervertebral foramen, narrowed vertebral canal, thickened articular process, articular process subluxation, articular process osteophyte, and telescoped sacral lamina. The CT characteristics of lumbosacral degenerative disease and discospondylitis were similar to those described in humans. In three dogs, CT findings at the site of cauda equina compression were consistent with congenital or developmental spinal stenosis, but the method of surgical exposure precluded confirmation. Epidural fibrosis (eight dogs) and multi-level CT abnormalities (six dogs) were identified but the cause(s) and significance were unknown

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults.

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Yin, Jin; Peng, Bao-Gan; Li, Yong-Chao; Zhang, Nai-Yang; Yang, Liang; Li, Duan-Ming

2016-05-20

Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage spondylolysis group and the control group with independent-sample t- test. There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P spondylolysis group than those in the control group, but STA was lower (P spondylolysis group. Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

A follow-up study of neurologic and radiographic findings in working German Shepherd Dogs with and without degenerative lumbosacral stenosis.

Science.gov (United States)

Steffen, Frank; Hunold, Katharina; Scharf, Gernot; Roos, Malgorzata; Flückiger, Mark

2007-11-15

To identify radiographic abnormalities associated with degenerative lumbosacral stenosis (DLSS) in German Shepherd Dogs (GSDs) and determine whether specific radiographic abnormalities could be used to identify dogs at risk of developing DLSS. Cohort study. 33 GSDs working as police dogs. Results of physical, neurologic, and orthopedic examinations were used to identify dogs with DLSS. Survey radiography of the lumbosacral junction was performed, and radiographs were compared with radiographs obtained 3 years earlier. DLSS was diagnosed in 15 of the 33 (45%) dogs. Thirteen of the 15 dogs with DLSS and 14 of the 18 dogs without DLSS had radiographic abnormalities of the lumbosacral junction. Twenty-two (67%) dogs were able to perform unrestricted duties, including 3 dogs with suspected DLSS. Six (18%) dogs had been excluded from active duty during the period of surveillance because of DLSS. Significant progression in specific clinical and radiographic signs was detected, but multiple logistic regression analysis did not identify any radiographic signs that could be used to predict the development of DLSS. Results suggested that survey radiography cannot be used to predict development of DLSS in working GSDs.

Is a pulling sensation in the anteroposterior direction associated with otolith dysfunction?

Science.gov (United States)

Saka, Naoki; Seo, Toru; Ohta, Shigeto; Sakagami, Masafumi

2014-03-01

A pulling sensation in the anteroposterior direction is suggested to originate from a dysfunction of the otolith organs. Previous study with vestibular evoked myogenic potential (VEMP) confirmed that a falling sensation (in an up or down direction) and a lateral tilt sensation (in a right or left direction) were caused by otolith lesions. The purpose of this study was to clarify whether a pulling sensation in the anteroposterior (forward or backward) direction originates from otolith dysfunction. The otolith function was assessed by cervical and ocular VEMPs (cVEMPs and oVEMPs) in 12 patients who complained of a forward or backward pulling sensation. cVEMPs were evaluated by the asymmetry ratio (AR) of the amplitude of the p13-n23 wave and the peak latencies of the p13 and n23 waves. oVEMPs were evaluated by the AR of the amplitude of the n1-p1 wave and the peak latency of the n1 and p1 waves. Abnormal ARs on cVEMP were observed in 7 of 12 patients. Nine of 12 patients had abnormal oVEMP results including 3 bilateral absent responses. Most (10 of 12) patients had abnormal cVEMP and/or oVEMP results. The latency of each detected wave was within the normal ranges.

Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy.

Science.gov (United States)

Muffly, Tyler M; Diwadkar, Gouri B; Paraiso, Marie Fidela R

2010-12-01

We report on the transabdominal resection of infected lumbosacral bone, synthetic mesh, and sinus tract following sacral colpopexy. A 45-year-old nulliparous patient who had undergone transvaginal mesh followed by robot-assisted sacral colpopexy presented with increasing back pain and foul-smelling vaginal drainage. An epidural abscess required surgical intervention, including diskectomy, sacral debridement, and mesh removal to drain the abscess and vaginal sinus tract. Recognized complications of open prolapse procedures also manifest following minimally invasive approaches. Osteomyelitis of the sacral promontory following sacral colpopexy may require gynecologic and neurosurgical management.

Anteroposterior diameter of the infrarenal abdominal aorta is higher in women with polycystic ovary syndrome

Directory of Open Access Journals (Sweden)

Marco Matteo Ciccone

2009-06-01

Full Text Available Marco Matteo Ciccone1, Stefano Favale1, Anish Bhuva4, Pietro Scicchitano1, Vito Caragnano1, Cristina Lavopa2, Giovanni De Pergola3, Giuseppe Loverro21Department of Cardiology; 2Department of Gynecology and Obstetrics; 3Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari, DETO, Italy; 4University College of London, London, UKBackground: Women affected by polycystic ovary syndrome (PCOS are known to be at higher risk of cardiovascular disease. The aim of this study was to identify the artery that first is affected by early pre-atherosclerotic changes in PCOS. Methods: Twenty-nine women with PCOS aged 17 to 27 years and 26 healthy nonhyperandrogenic volunteers with regular menses (control women aged 16 to 28 years were enrolled. All PCOS patients were overweight or obese (body mass index [BMI] ≥ 25. Diagnosis of PCOS was performed in line with the 2003 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Accordingly, PCOS was defined when at least two of the following three features were present after exclusion of other etiologies: 1 oligomenorrhea and or anovulation; 2 hyperandrogenism and/or hyperandrogenemia; and 3 polycystic ovaries visible at ultrasound. Androgen excess or related disorders were excluded. The intima-media thickness (IMT of common carotid arteries and common femoral arteries and the anteroposterior diameter of the infrarenal abdominal aorta were measured by ultrasound. Lutenizing hormone (LH, follicle-stimulating hormone (FSH, estradiol, total testosterone, androstenedione, and sex hormone-binding globulin (SHBG serum levels were measured between the 3rd and the 6th day of spontaneous or progestin-induced menstrual cycle. Our study was performed in the absence of any medical treatment. Results: Women with PCOS showed a higher LH to FSH ratio (p < 0.01, increased fasting insulin (p < 0.001, total testosterone (p < 0.001, and androstenedione (p < 0.001 levels, and lower

Magnetic Resonance Neurography in Chronic Lumbosacral and Pelvic Pain: Diagnostic and Management Impact-Institutional Audit.

Science.gov (United States)

Dessouky, Riham; Xi, Yin; Scott, Kelly M; Khaleel, Mohammed; Gill, Kevin; Jones, Stephanie; Khalifa, Dalia N; Tantawy, Hazim I; Aidaros, Magdy A; Chhabra, Avneesh

2018-06-01

Low back and pelvic pain are among the most prevalent conditions worldwide, with major social and economic costs. The aim of this study was to evaluate the role of magnetic resonance neurography (MRN) of lumbosacral plexus in the management and outcomes of these patients with chronic pain. Consecutive patients with chronic lumbosacral and pelvic pain referred for MRN over a year were included. Preimaging and postimaging clinical diagnosis and treatment, pain levels, and location were recorded. Pain-free survival was compared between treatments using a Cox proportional hazards model. A total of 202 patients with mean age 53.7 ± 14.8 years and a male/female ratio of 1:1.53 were included. Of these patients, 115 presented with radiculopathy (57%), 56 with pelvic pain (28%), and 31 with groin pain (15%). Mean initial pain level was 6.9 ± 1.9. Mean symptom duration was 4.21 ± 5.86 years. Of these patients, 143 (71%) had a change in management because of MRN. After MRN, reduction in pain levels was observed in 21 of 32 patients receiving conservative treatment (66%), 42 of 67 receiving injections (63%), and 27 of 33 receiving surgery (82%). Follow-ups were available in 131 patients. Median pain-free survival was 12 months. Patients treated with surgery had significantly lower pain recurrence than patients receiving other treatments in the same time frame (hazard ratio, 3.6; 95% confidence interval, 1.4-9.2; P = 0.0061). MRN use in chronic lumbosacral and pelvic pain led to a meaningful change in diagnosis and treatment. After MRN, conservative treatment and injections provided pain relief; however, patients benefited more from surgery than from any other treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Epidural steroid injection for lumbosacral radiculopathy

International Nuclear Information System (INIS)

Sung, Mi Sook

2006-01-01

Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections

Epidural steroid injection for lumbosacral radiculopathy

Energy Technology Data Exchange (ETDEWEB)

Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

2006-06-15

Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy.

NARCIS (Netherlands)

Baron, R.; Freynhagen, R.; Tolle, T.R.; Cloutier, C.; Leon, T.; Murphy, T.K.; Phillips, K.; Vissers, K.C.P.; et al.,

2010-01-01

We evaluated the efficacy of pregabalin in patients with chronic lumbosacral radiculopathy. This randomized, controlled, withdrawal trial included five phases: screening (4-18 days); run-in (4-10 days) to screen out placebo responders; single-blind (28 days) to identify pregabalin responders;

Concurrent lumbosacral and sacrococcygeal fusion; a rare etiology of low back pain and coccygodynia?

Science.gov (United States)

Kapetanakis, Stylianos; Gkasdaris, Grigorios; Pavlidis, Pavlos; Givissis, Panagiotis

2017-09-21

Sacrum is a triangular bone placed in the base of the spine and formed by the synostosis of five sacral vertebrae (S1-S5). Its upper part is connected with the inferior surface of the body of L5 vertebra forming the lumbosacral joint, while its lower part is connected with the base of the coccyx forming the sacrococcygeal symphysis, an amphiarthrodial joint. The existence of four pairs of sacral foramen in both anterior and posterior surface of the sacrum is the most common anatomy. Nevertheless, supernumerary sacral foramina are possible to be created by the synostosis of lumbosacral joint or sacrococcygeal symphysis. We present a case of an osseous cadaveric specimen of the sacrum belonging to a 79-year-old Caucasian woman. A rare variation of the anatomy of the sacrum is reported; in which, the simultaneous fusion of the sacrum with both the L5 vertebra and the coccyx has created six pairs of sacral foramen. This variation should be taken into serious consideration, especially in the domain of radiology, neurosurgery, orthopaedics and spine surgery, because low back pain, coccygodynia and other neurological symptoms may emerge due to mechanical compression.

Correlation Between Lumbopelvic and Sagittal Parameters and Health-Related Quality of Life in Adults With Lumbosacral Spondylolisthesis.

Science.gov (United States)

Gussous, Yazeed; Theologis, Alexander A; Demb, Joshua B; Tangtiphaiboontana, Jennifer; Berven, Sigurd

2018-02-01

Secondary analysis of prospective, multicenter data. To evaluate impact of sagittal parameters on health-related quality of life (HRQoL) in adults with lumbosacral spondylolisthesis. Adults with unoperated lumbosacral spondylolisthesis were identified in the Spinal Deformity Study Group database. Pearson's correlations were calculated between SF-12 (Short Form-12)/Scoliosis Research Society-30 (SRS-30) scores and radiographic parameters (C7 sagittal vertical axis [SVA] deviation, T1 pelvic angle, pelvic tilt [PT], pelvic incidence, sacral slope, slip angle, Meyerding slip grade, Labelle classification). Main effects linear regression models measured association between individual health status measures and individual radiographic predictor variables. Forty-five patients were analyzed (male, 15; female, 30; average age 40.5 ± 18.7 years; 14 low-grade, 31 high-grade). For low-grade slips, SVA had strong negative correlations with SF-12 mental component score (MCS), SRS-30 appearance, mental, and satisfaction domains ( r = -0.57, r = -0.60, r = -0.58, r = -0.53, respectively; P grade slips, slip angle had a moderate negative correlation with SF-12 MCS ( r = -0.36; P = .05) and SVA had strong negative correlations with SF-12 physical component score (PCS), SRS-30 appearance and activity domains ( r = -0.48, r = -0.48, r = -0.45; P point decrease in SRS appearance, 0.05-point decrease in SRS activity, 0.06-point decrease in SRS satisfaction, and 0.04-point decrease in SRS total score ( P grade slips. Improvement of sagittal parameters is an important goal of surgery for adults with lumbosacral spondylolisthesis.

Periodic modulation of repetitively elicited monosynaptic reflexes of the human lumbosacral spinal cord

OpenAIRE

Hofstoetter, Ursula S.; Danner, Simon M.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-01-01

In individuals with motor-complete spinal cord injury, epidural stimulation of the lumbosacral spinal cord at 2 Hz evokes unmodulated reflexes in the lower limbs, while stimulation at 22–60 Hz can generate rhythmic burstlike activity. Here we elaborated on an output pattern emerging at transitional stimulation frequencies with consecutively elicited reflexes alternating between large and small. We analyzed responses concomitantly elicited in thigh and leg muscle groups bilaterally by epidural...

Suitability of cerebrospinal fluid as a signal-intensity reference on MRI: evaluation of signal-intensity variations in the lumbosacral dural sac

International Nuclear Information System (INIS)

Luoma, E.K.; Luukkonen, R.; Riihimaeki, H.A.; Raininko, R.; Manninen, H.I.; Nummi, P.J.

1997-01-01

The suitability of the cerebrospinal fluid (CSF) in the lumbosacral dural sac as an internal signal-intensity reference was studied on magnetic resonance imaging (MRI) of the lumbar spine using a surface coil and motion artefact suppression technique. A signal-intensity reference is needed when signal is compared between images, studies or subjects. Homogeneity of the CSF was estimated visually on T2-weighted images of 60 subjects at 1.5 T and of another 60 subjects at 0.1 T. Spines with a severely narrowed dural sac or marked scoliosis were excluded from the study to avoid partial volume effect. CSF was homogeneous in 82% and 73% of the examinations at 1.5 T and 0.1 T, respectively. The type and location of the local inhomogeneities did not relate to local narrowings of the dural sac. The signal intensity of CSF was measured in 108 examinations at 0.1 T after correcting the spatially-dependent signal-intensity nonuniformities with a phantom-based method. The signal-intensity difference between the CSF in the upper and lower lumbar dural sac was less than 10% in 73% of the examinations. The CSF in the lumbosacral dural sac can be a useful signal-intensity reference for estimation of the signal of the adjacent structures in patients without severe narrowing of the dural sac or marked scoliosis. It may contribute to assessing spinal disease processes. (orig.). With 1 fig., 3 tabs

Activin- and Nodal-related factors control antero-posterior patterning of the zebrafish embryo.

Science.gov (United States)

Thisse, B; Wright, C V; Thisse, C

2000-01-27

Definition of cell fates along the dorso-ventral axis depends on an antagonistic relationship between ventralizing transforming growth factor-beta superfamily members, the bone morphogenetic proteins and factors secreted from the dorsal organizer, such as Noggin and Chordin. The extracellular binding of the last group to the bone morphogenetic proteins prevents them from activating their receptors, and the relative ventralizer:antagonist ratio is thought to specify different dorso-ventral cell fates. Here, by taking advantage of a non-genetic interference method using a specific competitive inhibitor, the Lefty-related gene product Antivin, we provide evidence that cell fate along the antero-posterior axis of the zebrafish embryo is controlled by the morphogenetic activity of another transforming growth factor-beta superfamily subgroup--the Activin and Nodal-related factors. Increasing antivin doses progressively deleted posterior fates within the ectoderm, eventually resulting in the removal of all fates except forebrain and eyes. In contrast, overexpression of activin or nodal-related factors converted ectoderm that was fated to be forebrain into more posterior ectodermal or mesendodermal fates. We propose that modulation of intercellular signalling by Antivin/Activin and Nodal-related factors provides a mechanism for the graded establishment of cell fates along the antero-posterior axis of the zebrafish embryo.

Estrogen receptor-immunoreactive neurons in the lumbosacral cord projecting to the periaqueductal gray in the ovariectomized female cat

NARCIS (Netherlands)

VanderHorst, Veronique G.J.M.; Meijer, Ellie; Schasfoor, Fabienne C.; Leeuwen, Fred W. van; Holstege, Gert

1997-01-01

The periaqueductal gray (FAG) plays a crucial role in reproductive behavior. The present study investigates whether lumbosacral FAG-projecting neurons contain estrogen receptors. In four ovariectomized adult female cats, injections with cholera toxin subunit (CTb) were made into the FAG to

A Double-Blind, Placebo-Controlled, Parallel-Group Pilot Study of Milnacipran for Chronic Radicular Pain (Sciatica) Associated With Lumbosacral Disc Disease

OpenAIRE

Marks, David M.; Pae, Chi-Un; Patkar, Ashwin A.

2014-01-01

Objective: The current study investigates whether milnacipran, an equipotent serotonin-norepinephrine reuptake inhibitor, is effective in reducing chronic radicular pain in patients (N = 11) with lumbosacral disc disease.

Asymmetric Anterior Distraction for Transversely Distorted Maxilla and Midfacial Anteroposterior Deficiency in a Patient With Cleft Lip/Palate: Two-Stage Surgical Approach.

Science.gov (United States)

Hirata, Kae; Tanikawa, Chihiro; Aikawa, Tomonao; Ishihama, Kohji; Kogo, Mikihiko; Iida, Seiji; Yamashiro, Takashi

2016-07-01

The present report describes a male patient with a unilateral cleft lip and palate who presented with midfacial anteroposterior and transverse deficiency. Correction involved a two-stage surgical-orthodontic approach: asymmetric anterior distraction of the segmented maxilla followed by two-jaw surgery (LeFort I and bilateral sagittal splitting ramus osteotomies). The present case demonstrates that the asymmetric elongation of the maxilla with anterior distraction is an effective way to correct a transversely distorted alveolar form and midfacial anteroposterior deficiency. Furthermore, successful tooth movement was demonstrated in the new bone created by distraction.

Estimation of pelvic tilt on anteroposterior X-rays - a comparison of six parameters

International Nuclear Information System (INIS)

Tannast, M.; Murphy, S.B.; Langlotz, F.; Anderson, S.E.; Siebenrock, K.A.

2006-01-01

To compare six different parameters described in literature for estimation of pelvic tilt on an anteroposterior pelvic radiograph and to create a simple nomogram for tilt correction of prosthetic cup version in total hip arthroplasty. Simultaneous anteroposterior and lateral pelvic radiographs are taken routinely in our institution and were analyzed prospectively. The different parameters (including three distances and three ratios) were measured and compared to the actual pelvic tilt on the lateral radiograph using simple linear regression analysis. One hundred and four consecutive patients (41 men, 63 women with a mean age of 31.7 years, SD 9.2 years, range 15.7-59.1 years) were studied. The strongest correlation between pelvic tilt and one of the six parameters for both men and women was the distance between the upper border of the symphysis and the sacrococcygeal joint. The correlation coefficient was 0.68 for men (P<0.001) and 0.61 for women (P<0.001). Based on this linear correlation, a nomogram was created that enables fast, tilt-corrected cup version measurements in clinical routine use. This simple method for correcting variations in pelvic tilt on plain radiographs can potentially improve the radiologist's ability to diagnose and interpret malformations of the acetabulum (particularly acetabular retroversion and excessive acetabular overcoverage) and post-operative orientation of the prosthetic acetabulum. (orig.)

Avaliação cefalométrica das alterações verticais e anteroposteriores associadas ao uso do expansor maxilar com cobertura oclusal Cephalometric evaluation of vertical and anteroposterior changes associated with the use of bonded rapid maxillary expansion appliance

Directory of Open Access Journals (Sweden)

Moara De Rossi

2010-06-01

Full Text Available INTRODUÇÃO: os aparelhos expansores maxilares com cobertura oclusal têm sido sugeridos para controlar o aumento na dimensão vertical da face após a expansão rápida da maxila, porém ainda não há um consenso na literatura sobre seus reais efeitos. OBJETIVO: o objetivo deste trabalho foi avaliar as alterações cefalométricas verticais e anteroposteriores associadas à expansão da maxila realizada com o aparelho expansor com cobertura oclusal. MÉTODOS: a amostra foi composta por 25 crianças, de ambos os gêneros, com idades entre 6 e 10 anos, portadoras de mordida cruzada posterior esquelética. Após a expansão maxilar, o próprio aparelho expansor foi utilizado como contenção fixa. Foram analisadas telerradiografias em norma lateral tomadas antes do início do tratamento e após a remoção do aparelho expansor. CONCLUSÃO: com base nos resultados, pôde-se concluir que o uso do aparelho expansor com cobertura oclusal não alterou significativamente as medidas cefalométricas verticais e anteroposteriores das crianças.INTRODUCTION: Bonded rapid maxillary expansion appliances have been suggested to control increases in the vertical dimension of the face after rapid maxillary expansion but there is still no consensus in the literature concerning its actual effectiveness. OBJECTIVE: The purpose of this study was to evaluate the vertical and anteroposterior cephalometric changes associated with maxillary expansion performed using bonded rapid maxillary expansion appliances. METHODS: The sample consisted of 25 children of both genders, aged between 6 and 10 years old, with skeletal posterior crossbite. After maxillary expansion, the expansion appliance itself was used for fixed retention. Were analyzed lateral teleradiographs taken prior to treatment onset and after removal of the expansion appliance. CONCLUSION: Based on the results, it can be concluded that the use of bonded rapid maxillary expansion appliance did not significantly

Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy.

Science.gov (United States)

Rapp, Martin; Ley, Charles J; Hansson, Kerstin; Sjöström, Lennart

2017-03-20

To describe postoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings in dogs with degenerative lumbosacral stenosis (DLSS) treated by dorsal laminectomy and partial discectomy. Prospective clinical case study of dogs diagnosed with and treated for DLSS. Surgical and clinical findings were described. Computed tomography and low field MRI findings pre- and postoperatively were described and graded. Clinical, CT and MRI examinations were performed four to 18 months after surgery. Eleven of 13 dogs were clinically improved and two dogs had unchanged clinical status postoperatively despite imaging signs of neural compression. Vacuum phenomenon, spondylosis, sclerosis of the seventh lumbar (L7) and first sacral (S1) vertebrae endplates and lumbosacral intervertebral joint osteoarthritis became more frequent in postoperative CT images. Postoperative MRI showed mild disc extrusions in five cases, and in all cases contrast enhancing non-discal tissue was present. All cases showed contrast enhancement of the L7 spinal nerves both pre- and postoperatively and seven had contrast enhancement of the lumbosacral intervertebral joints and paraspinal tissue postoperatively. Articular process fractures or fissures were noted in four dogs. The study indicates that imaging signs of neural compression are common after DLSS surgery, even in dogs that have clinical improvement. Contrast enhancement of spinal nerves and soft tissues around the region of disc herniation is common both pre- and postoperatively and thus are unreliable criteria for identifying complications of the DLSS surgery.

Magnetic resonance imaging of the lumbosacral spine in children with chronic constipation or non-retentive fecal incontinence: A prospective study

NARCIS (Netherlands)

Bekkali, N.; Hagebreuk, E. E. O.; Bongers, E. M.; van Rijn, R. R.; van Wijk, M. P.; Benninga, M. A.

2010-01-01

Objective To determine the prevalence of lumbosacral spine (LSS) abnormalities in children with defecation disorders, intractable constipation, or non-retentive fecal incontinence (NRFI) and evaluate whether LSS abnormalities on magnetic resonance imaging (MRI) are clinically detected by neurologic

MRI spectrum of findings in lumbosacral epidural lipomatosis

International Nuclear Information System (INIS)

Borre, Daniel G.; Borre, Guillermo E.; Palmieri, Gladys N.; Aude, Flavio A.; Lassalle, Eduardo

2004-01-01

Lumbosacral epidural lipomatosis (LEL) has been defined as a disease produced by excessive fat deposition within the spinal canal. In the pre MRI-era, this entity has been commonly overlooked. While a mild (or moderate) epidural fat hypertrophy is basically asymptomatic, severe LEL represents the symptomatic end-stage of this disease, conducing in many cases to surgical fat debulking. Since LEL may be concurrent with other substantial spinal abnormalities (e.g. disk herniation) MRI exams may increase our awareness of this condition to avoid its underestimation. MRI enables a reliable LEL characterization and may show its eventual reversibility in obese or corticosteroid receiving patients. This pictorial essay illustrates the usefulness of MRI to demonstrate the ongoing process of epidural fat accumulation in mild, moderate and severe LEL. The different morphologic patterns of the thecal sac produced by advanced LEL are analyzed. LEL and concurrent spinal disorders with superimposed neurological symptoms and signs are illustrated. (author)

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis.

Science.gov (United States)

Abulizi, Yakefu; Liang, Wei-Dong; Muheremu, Aikeremujiang; Maimaiti, Maierdan; Sheng, Wei-Bin

2017-07-14

Spinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis. From February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria. The mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months' follow-up. VAS and ODI scores were significantly improved (P brucellosis.

Periodic modulation of repetitively elicited monosynaptic reflexes of the human lumbosacral spinal cord

Science.gov (United States)

Danner, Simon M.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-01-01

In individuals with motor-complete spinal cord injury, epidural stimulation of the lumbosacral spinal cord at 2 Hz evokes unmodulated reflexes in the lower limbs, while stimulation at 22–60 Hz can generate rhythmic burstlike activity. Here we elaborated on an output pattern emerging at transitional stimulation frequencies with consecutively elicited reflexes alternating between large and small. We analyzed responses concomitantly elicited in thigh and leg muscle groups bilaterally by epidural stimulation in eight motor-complete spinal cord-injured individuals. Periodic amplitude modulation of at least 20 successive responses occurred in 31.4% of all available data sets with stimulation frequency set at 5–26 Hz, with highest prevalence at 16 Hz. It could be evoked in a single muscle group only but was more strongly expressed and consistent when occurring in pairs of antagonists or in the same muscle group bilaterally. Latencies and waveforms of the modulated reflexes corresponded to those of the unmodulated, monosynaptic responses to 2-Hz stimulation. We suggest that the cyclical changes of reflex excitability resulted from the interaction of facilitatory and inhibitory mechanisms emerging after specific delays and with distinct durations, including postactivation depression, recurrent inhibition and facilitation, as well as reafferent feedback activation. The emergence of large responses within the patterns at a rate of 5.5/s or 8/s may further suggest the entrainment of spinal mechanisms as involved in clonus. The study demonstrates that the human lumbosacral spinal cord can organize a simple form of rhythmicity through the repetitive activation of spinal reflex circuits. PMID:25904708

Does Tibial Slope Affect Perception of Coronal Alignment on a Standing Anteroposterior Radiograph?

Science.gov (United States)

Schwartz, Adam J; Ravi, Bheeshma; Kransdorf, Mark J; Clarke, Henry D

2017-07-01

A standing anteroposterior (AP) radiograph is commonly used to evaluate coronal alignment following total knee arthroplasty (TKA). The impact of coronal alignment on TKA outcomes is controversial, perhaps due to variability in imaging and/or measurement technique. We sought to quantify the effect of image rotation and tibial slope on coronal alignment. Using a standard extramedullary tibial alignment guide, 3 cadaver legs were cut to accept a tibial tray at 0°, 3°, and 7° of slope. A computed tomography scan of the entire tibia was obtained for each specimen to confirm neutral coronal alignment. Images were then obtained at progressive 10° intervals of internal and external rotation up to 40° maximum in each direction. Images were then randomized and 5 blinded TKA surgeons were asked to determine coronal alignment. Continuous data values were transformed to categorical data (neutral [0], valgus [L], and varus [R]). Each 10° interval of external rotation of a 7° sloped tibial cut (or relative internal rotation of a tibial component viewed in the AP plane) resulted in perception of an additional 0.75° of varus. The slope of the proximal tibia bone cut should be taken into account when measuring coronal alignment on a standing AP radiograph. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of Lumbosacral Angle (LSA and its Impact on Patients with Lumbar Disc Herniation

Directory of Open Access Journals (Sweden)

Abdurrahman Aycan

2016-04-01

Full Text Available Aim: One of the most common causes of low back pain is lumbar disc herniation (LDH. One of the treatments for patients with LDH is a surgical operation. Changes in the lumbar lordosis angle have a negative impact on patients, clinically. The significance of changes in the lordosis-sacral inclination angle that are associated with muscle spasms and are seen after LDH surgery is known. In this study, we would like to examine the clinical impact on patients due to changes in the lumbosacral angle measured before and after surgical operations in patients with LDH. Material and Method: Between 2005%u20132007, preoperative and postoperative lumbosacral angles of 139 patients operated on for a diagnosis of lumbar disc herniation were measured. Patients were evaluated with the Oswestry Scale, Visual Analogue Scale, Narcotic Score, and Patient Satisfaction Evaluation. Lumbar lordosis angle, sacral inclination angle, and disc height were calculated by direct radiography. Statistical analysis was performed with GraphPad Prisma V.3 software package. Results: In this study, increases of lordosis angles and sacral inclination angles have been observed, postoperatively. It has been shown that these have a positive impact on the clinical course. Discussion: The clinical effects of the biomechanics of angles of patients with LDH are clear. Biomechanical parameters should be considered at preoperative treatment, postoperative treatment, and postoperative controls. The patient%u2019s lordosis angle, neighboring disc structure, and relationship with the sacrum must be carefully evaluated for surgical decision.

Diagnostic yield of lumbosacral magnetic resonance imaging requested by paediatric urology consultations.

Science.gov (United States)

Fernández-Ibieta, M; Rojas Ticona, J; Villamil, V; Guirao Piñera, M J; López García, A; Zambudio Carmona, G

2017-11-01

In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism. A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0. We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints). The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps») can experience a greater diagnostic yield or positive predictive value. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

OpenAIRE

Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

2011-01-01

Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a tru...

A methodological reappraisal of non invasive high voltage electrical stimulation of lumbosacral nerve roots.

Science.gov (United States)

Troni, Walter; Di Sapio, Alessia; Berra, Eliana; Duca, Sergio; Merola, Aristide; Sperli, Francesca; Bertolotto, Antonio

2011-10-01

To describe a neurophysiological method to locate the optimal stimulation site (OSS) over the vertebral column, customized to the individual subject, to achieve maximal activation of lumbosacral roots by means of non-invasive high voltage electrical stimulation (HVES). OSS was located in 30 volunteers by testing different stimulation points of a surface multi-electrode array placed over the dorso-lumbar junction of the vertebral column. The dorso-ventral stimulating montage was used (Troni et al., 1996). Motor responses to root stimulation (rCMAPs) were bilaterally recorded from Vastus Medialis (VM), Tibialis Anterior (TA), Soleus (SL) and Flexor Hallucis Brevis (FHB) muscles. The direct nature of rCMAPs was tested by delivering two maximal stimuli 50 ms apart. Except for a few subjects with large girth, maximal rCMAPs could be obtained from all muscles with a stimulating current intensity up to 550 V (1050 mA). Maximal double HVES excluded any reflex component in the recorded rCMAPs. The procedure was well tolerated and no side effects were observed. A single maximal electric shock delivered at the proper vertebral level by means of the dorso-ventral montage is able to safely achieve synchronous, bilateral maximal activation of several roots, from L3 to S1. Maximal activation of lumbosacral roots at their origin, unattainable with magnetic stimulation, is the essential requirement for direct detection of proximal nerve conduction slowing and block in lower limbs. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Displacement pattern of the anterior segment using antero-posterior lingual retractor combined with a palatal plate

OpenAIRE

Seo, Kyung-Won; Kwon, Soon-Yong; Kim, Kyung A; Park, Ki-Ho; Kim, Seong-Hun; Ahn, Hyo-Won; Nelson, Gerald

2015-01-01

Objective To evaluate and compare the effects of two appliances on the en masse retraction of the anterior teeth anchored by temporary skeletal anchorage devices (TSADs). Methods The sample comprised 46 nongrowing hyperdivergent adult patients who planned to undergo upper first premolar extraction using lingual retractors. They were divided into three groups, based on the lingual appliance used: the C-lingual retractor (CLR) group (group 1, n = 16) and two antero-posterior lingual retractor (...

CAUDAL MEDULLARY PATHWAYS TO LUMBOSACRAL MOTONEURONAL CELL GROUPS IN THE CAT - EVIDENCE FOR DIRECT PROJECTIONS POSSIBLY REPRESENTING THE FINAL COMMON PATHWAY FOR LORDOSIS

NARCIS (Netherlands)

VANDERHORST, VGJM; HOLSTEGE, G

1995-01-01

The nucleus retroambiguus (NRA) projects to distinct brainstem and cervical and thoracic cord motoneuronal cell groups. The present paper describes NRA projections to distinct motoneuronal cell groups in the lumbar enlargement. Lumbosacral injections of wheat germ agglutinin-horseradish peroxidase

Caudal Medullary Pathways To Lumbosacral Motoneuronal Cell Groups In The Cat; Evidence For Direct Projections Possibly Representing The Final Common Pathway For Lordosis.

NARCIS (Netherlands)

VanderHorst, Veronique G.J.M.; Holstege, Gert

1995-01-01

The nucleus retroambiguus (NRA) projects to distinct brainstem and cervical and thoracic cord motoneuronal cell groups. The present paper describes NRA projections to distinct motoneuronal cell groups in the lumbar enlargement. Lumbosacral injections of wheat germ agglutinin-horseradish peroxidase

A comparison of the analgesic efficacy of transforaminal methylprednisolone alone and with low doses of clonidine in lumbo-sacral radiculopathy.

Science.gov (United States)

Tauheed, Nazia; Usmani, Hammad; Siddiqui, Anwar Hasan

2014-01-01

Although transforaminal epidural steroid injections under fluoroscopic guidance have become a common mode of treatment of lumbosacral radiculopathy due to herniated disc, the efficacy of steroid with low doses of clonidine has not been compared yet. Comparison of the analgesic efficacy of methylprednisolone alone and with low doses of clonidine for transforaminal injection in lumbosacral radiculopathy. A randomized, double-blind trial. This study was performed at the Pain Clinic under the Department of Anaesthesiology, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India. One hundred and eighty ASA grade I and II patients aged between 18 and 55 years were allocated into groups I, II and III to receive methylprednisolone 60 mg alone or methylprednisolone 60 mg with or without low doses of clonidine (0.5 mcg/kg or 1 mcg/kg) as transforaminal epidural injection. Pain relief and patient's satisfaction were evaluated with the global pain scale. Follow-up visits were advised at 1, 2, 4, 6 and 12 weeks and then at 6 months after injection. Associated complications were recorded. Maximum pain relief was observed at 2 weeks after injection in all the three groups, with no difference in complication rate among the three groups. The most common complication observed was paresthesia in the nerve distribution. Greater than 60% improvement in pain scores was seen in 40% of the patients in group I, 50% of the patients in group II and 75% of the patients in group III. This study is limited by the lack of a placebo group. Adding 1 mcg/kg clonidine to 60 mg methylprednisolone in transforaminal epidural injections provided better pain relief than 60 mg methylprednisolone with 0.5 mcg/kg clonidine or 60 mg methylprednisolone alone in patients suffering from lumbosacral radiculopathy, with practically no significant side-effects.

Computed tomographic anatomy of the canine lumbosacral spine

International Nuclear Information System (INIS)

Jones, J.C.; Cartee, R.E.; Bartels, J.E.

1995-01-01

The lumbosacral spine (L5–S3) was examined by high resolution computed tomography (CT) in five canine cadaver specimens and one anesthetized dog using 5mm thick transverse slices at 5mm intervals. In each dog, anatomic features observed on CT images were confirmed by comparison with corresponding 5 mm thick anatomic transverse sections and section radiographs. CT anatomic features visualized in all dogs included the vertebral bodies, pedicles, laminae, articular processes, spinous processes, transverse processes, mammillary processes, basivertebral venous canals, vertebral foramina, intervertebral foramina, sacral wings, median sacral crest, intermediate sacral crests, lateral sacral crests, articular process joints, sacroiliac joints, internal vertebral venous plexus, epidural fat, thecal sac, L5–S3 nerve roots, and spinal nerves. Spinal ganglia, yellow ligaments, and portions of the intervertebral discs were visible in some dogs. The spinal cord, intrathecal nerve roots, dorsal and ventral longitudinal ligaments, spinal arteries, and radicular vessels were not distinguishable. Accessory processes were identified on the caudal L5 pedicles in most dogs, an observation that differed from descriptions in standard anatomy texts. Previously undescribed osseous grooves, termed “lateral recesses,” were identified in the caudal L7 vertebral foramen of all dogs

Three-dimensional radiotherapy planning system for esophageal tumors: comparison of treatment techniques and analysis of probability of complications; Planejamento tridimensional para radioterapia de tumores de esofago: comparacao de tecnicas de tratamento e analise de probabilidade de complicacoes

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Justino, Pitagoras Baskara; Carvalho, Heloisa de Andrade; Ferauche, Debora; Ros, Renato [Sao Paulo Uni., SP (Brazil). Hospital das Clinicas. Instituto de Radioterapia (InRad)]. E-mail: pitagorasb@hotmail.com

2003-06-01

Radiotherapy techniques for esophageal cancer were compared using a three-dimensional planning system. We studied the following treatment techniques used for a patient with squamous cell carcinoma of the middle third of the esophagus: two antero-posterior and two latero-lateral parallel opposed fields, three fields ('Y' and 'T'), and four fields ('X'). Dose-volume histograms were obtained considering spinal cord and lungs as organs at risk. Analysis was performed comparing doses in these organs as recommended by the Normal Tissue Complication Probability (NTCP) and Tumor Control Probability (TCP). When only the lungs were considered the best technique was two antero-posterior parallel opposed fields. The spinal cord was best protected using latero-lateral fields. We suggest the combination of at least two treatment techniques: antero-posterior fields with 'Y' or 'T' techniques, or latero-lateral fields in order to balance the doses in the lungs and the spinal cord. Another option may be the use of any of the three-field techniques during the whole treatment. (author)

Significant clinical improvement in radiation-induced lumbosacral poly-radiculopathy by a treatment combining pentoxifylline, tocopherol, and clodronate (Pentoclo)

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Delanian, S. [Hop St Louis, Serv Oncol Radiotherapie, APHP, F-75010 Paris, (France); Lefaix, J.L. [CEA-LARIA, CIRIL-GANIL, Caen, (France); Maisonobe, T. [Hop La Pitie Salpetriere, Federat Neurophysiol Clin, APHP, Paris, (France)

2008-07-01

Radiation-induced (RI) peripheral neuropathy is a rare and severe delayed complication of radiotherapy that is spontaneously irreversible, with no standard of treatment. We previously developed a successful antioxidant treatment in RI fibrosis and necrosis. Two patients with progressive worsening RI lumbosacral poly-radiculopathy experienced over several years a significant clinical improvement in their neurological sensorimotor symptoms with long-term pentoxifylline-tocopherol-clodronate treatment, and good safety. (authors)

Reliability and Validity Measurement of Sagittal Lumbosacral Quiet Standing Posture with a Smartphone Application in a Mixed Population of 183 College Students and Personnel

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George A. Koumantakis

2016-01-01

Full Text Available Accurate recording of spinal posture with simple and accessible measurement devices in clinical practice may lead to spinal loading optimization in occupations related to prolonged sitting and standing postures. Therefore, the purpose of this study was to establish the level of reliability of sagittal lumbosacral posture in quiet standing and the validity of the method in differentiating between male and female subjects, establishing in parallel a normative database. 183 participants (83 males and 100 females, with no current low back or pelvic pain, were assessed using the “iHandy Level” smartphone application. Intrarater reliability (3 same-day sequential measurements was high for both the lumbar curve (ICC2,1: 0.96, SEM: 2.13°, and MDC95%: 5.9° and the sacral slope (ICC2,1: 0.97, SEM: 1.61°, and MDC95%: 4.46° sagittal alignment. Data analysis for each gender separately confirmed equally high reliability for both male and female participants. Correlation between lumbar curve and sacral slope was high (Pearson’s r=0.86, p<0.001. Between-gender comparisons confirmed the validity of the method to differentiate between male and female lumbar curve and sacral slope angles, with females generally demonstrating greater lumbosacral values (p<0.001. The “iHandy Level” application is a reliable and valid tool in the measurement of lumbosacral quiet standing spinal posture in the sagittal plane.

Magnetic resonance imaging of presumptive lumbosacral discospondylitis in a dog

International Nuclear Information System (INIS)

Kraft, S.L.; Mussman, J.M.; Smith, T.; Biller, D.S.; Hoskinson, J.J.

1998-01-01

three-year-old male Boxer dog had hyperesthesia, symmetrical epaxial, gluteal and hind limb muscular atrophy and rear limb ataxia. Neurological deficits included decreased conscious proprioception of the left hind limb, decreased withdrawal and increased patellar reflexes of both hind limbs. The dog had a urinary tract infection with positive culture for Staphylococcus intermedius. On survey radiography of the lumbosacral spine there was active bone proliferation spanning the L7 S1 intervertebral disc space with an epidural filling defect at the ventral aspect of the vertebral canal on epidurography. On magnetic resonance imaging (MRI), findings were similar to those described for human diskospondylitis including altered signal intensity and nonuniform contrast enhancement of the L7-S1 intervertebral disc, adjacent vertebral end plates and epidural and sublumbar soft tissues. Although skeletal radiography is usually sufficient to reach a diagnosis of discospondylitis, MRI of this patient made it possible to reach a presumptive diagnosis of discospondylitis prior to development of definitive radiographic abnormalities

Degenerative lumbosacral stenosis in working dogs: current concepts and review.

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Worth, A J; Thompson, D J; Hartman, A C

2009-12-01

Degenerative lumbosacral stenosis (DLSS) is characterised by intervertebral disc degeneration, with secondary bony and soft-tissue changes leading to compression of the cauda equina. Large-breed, active and working dogs are the most commonly affected by DLSS. Specific manipulative tests allow the clinician to form a high suspicion of DLSS, and initiate investigation. Changes seen using conventional radiography are unreliable, and although contrast radiography represents an improvement, advanced imaging is accepted as the diagnostic method of choice. Treatment involves decompression and/or stabilisation procedures in working dogs, although conservative management may be acceptable in pet dogs with mild signs. Prognosis for return to work is only fair, and there is a high rate of recurrence following conventional surgery. Stabilisation procedures are associated with the potential for failure of the implant, and their use has not gained universal acceptance. A new surgical procedure, dorsolateral foramenotomy, offers a potential advance in the management of DLSS. everal aspects of the pathogenesis, heritability and optimal treatment approach remain uncertain.

Control of anterior segment using an antero-posterior lingual sliding retraction system: a preliminary cone-beam CT study

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Min Hwang

2018-01-01

Full Text Available Abstract Background This study was performed to evaluate the treatment effects of the antero-posterior lingual retractor (APLR, focusing on the 3-dimensional (3D tooth movement of the maxillary anterior teeth and their alveolar bone levels. Methods En masse retraction was performed using either the C-lingual retractor (CLR, C-group, n = 9 or the antero-posterior lingual retractor (APLR, AP-group, n = 8. We evaluated 3D movement of the maxillary anterior teeth and alveolar bone levels, root length of the central incisors, long axes of the maxillary canines, and occlusal plane changes from CBCT images. Results After retraction, the central incisors were more significantly intruded and their root apex was more retracted in the AP-group. The long axis of the canine was well maintained in the AP-group. There were no differences in the steepness of occlusal plane and the incidence of alveolar bone loss or of root resorption during en masse retraction with the two retractors. Conclusions The clockwise bowing effect of the anterior segment was less with the APLR, which prevented unwanted canine movement.

[Combined lumbosacral and vaginal physiotherapy in the treatment of overactive bladder in postmenopausal women].

Science.gov (United States)

Neĭmark, B A; Neĭmark, A I; Raĭgorodskiĭ, Iu M; Tishchenko, G E; Gol'braĭkh, G E

2011-01-01

Efficacy of combined application of physical factors including lumbosacral magnetotherapy and vaginal vibromagnetic impact is shown in 48 postmenopausal women (mean age 62.5 +/- 1.6 years) with overactive bladder (OAB). Choice of this combination is explained by a multifactorial OAB pathogenesis and degenerative spinal diseases often encountered in postmenopausal women (70.8% in this study). The exposures of the spine and the bladder (vaginal) were made one after the other with duration of the first stage 10-15 min, of the second--5-7 min, the course consisted of 10-12 procedures. The results of the treatment were assessed by urination rhythm, volume, number of incontinence episodes. Quality of life was evaluated according to special questionnaires. Trophic function of the spinal cord and innervation of the bladder were studied by n. tibialis conduction measured by electroneuromyography (ENMG). The following results were obtained: reduction of urinations for 24 hours by 36.9%, urgent episodes--by 44%, urgent incontinence--by 59.7%. Voiding volume significantly increased (by 26%). A total score of anxiety related to OAB fell by 51.3%. M-response amplitude in ENMG rose 1.5-fold, while velocity of the impulse conduction along the n. tibialis enhanced 1.2-fold. The technique was accomplished with AMUS-01-Intramag device and attachment to it Rectomassager made in Russia.

Effects of anatomic conformation on three-dimensional motion of the caudal lumbar and lumbosacral portions of the vertebral column of dogs.

Science.gov (United States)

Benninger, Monika I; Seiler, Gabriela S; Robinson, Leanne E; Ferguson, Stephen J; Bonél, Harald M; Busato, André R; Lang, Johann

2006-01-01

To determine the association between the 3-dimensional (3-D) motion pattern of the caudal lumbar and lumbosacral portions of the canine vertebral column and the morphology of vertebrae, facet joints, and intervertebral disks. Vertebral columns of 9 German Shepherd Dogs and 16 dogs of other breeds with similar body weights and body conditions. Different morphometric parameters of the vertebral column were assessed by computed tomography (CT) and magnetic resonance imaging. Anatomic conformation and the 3-D motion pattern were compared, and correlation coefficients were calculated. Total range of motion for flexion and extension was mainly associated with the facet joint angle, the facet joint angle difference between levels of the vertebral column in the transverse plane on CT images, disk height, and lever arm length. Motion is a complex process that is influenced by the entire 3-D conformation of the lumbar portion of the vertebral column. In vivo dynamic measurements of the 3-D motion pattern of the lumbar and lumbosacral portions of the vertebral column will be necessary to further assess biomechanics that could lead to disk degeneration in dogs.

Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation

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Chien-Yuan Huang

2018-01-01

Full Text Available Objectives: Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach. Materials and Methods: From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS and the patient's Oswestry Disability Index (ODI score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films. Results: The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases. Conclusion: The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.

Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction. A radioanatomic analysis of the nondiskal structures of the spinal column and perispinal soft tissues.

Science.gov (United States)

Jinkins, J R

2001-01-01

In earlier evolutionary times, mammals were primarily quadrupeds. However, other bipeds have also been represented during the course of the Earth's several billion year history. In many cases, either the bipedal stance yielded a large tail and hypoplastic upper extremities (e.g., Tyrannosaurus rex and the kangaroo), or it culminated in hypoplasia of the tail and further development and specialization of the upper extremities (e.g., nonhuman primates and human beings). In the human species this relatively recently acquired posture resulted in a more or less pronounced lumbosacral kyphosis. In turn, certain compensatory anatomic features have since occurred. These include the normal characteristic posteriorly directed wedge-shape of the L5 vertebral body and the L5-S1 intervertebral disk; the L4 vertebral body and the L4-L5 disk may be similarly visibly affected. These compensatory mechanisms, however, have proved to be functionally inadequate over the long term of the human life span. Upright posture also leads to increased weight bearing in humans that progressively causes excess stresses at and suprajacent to the lumbosacral junction. These combined factors result in accelerated aging and degenerative changes and a predisposition to frank biomechanical failure of the subcomponents of the spinal column in these spinal segments. One other specific problem that occurs at the lumbosacral junction that predisposes toward premature degeneration is the singular relationship that exists between a normally mobile segment of spine (i.e., the lumbar spine) and a normally immobile one (i.e., the sacrum). It is well known that mobile spinal segments adjacent to congenitally or acquired fused segments have a predilection toward accelerated degenerative changes. The only segment of the spine in which this is invariably normally true is at the lumbosacral junction (i.e., the unfused lumbar spine adjoining the fused sacrum). Nevertheless, biomechanical failures of the human spine

Short-term and long-term effects of a minimally invasive transilial vertebral blocking procedure on the lumbosacral morphometry in dogs measured by computed tomography.

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Müller, Friedrich; Schenk, Henning C; Forterre, Franck

2017-04-01

To determine the effects of a minimally invasive transilial vertebral (MTV) blocking procedure on the computed tomographic (CT) appearance of the lumbosacral (L7/S1) junction of dogs with degenerative lumbosacral stenosis (DLSS). Prospective study. 59 client-owned dogs with DLSS. Lumbosacral CT images were acquired with hyperextended pelvic limbs before and after MTV in all dogs. Clinical follow-up was obtained after 1 year, including a neurologic status classified in 4 grades, and if possible, CT. Morphometric measurements (Mean ± SEM) including foraminal area, endplate distance at L7/S1 and LS angle were obtained on sets of reformatted parasagittal and sagittal CT images. The mean foraminal area (ForL) increased from 32.5 ± 1.7 mm 2 to 59.7 ± 1.9 mm 2 on the left and from 31.1 ± 1.4 mm 2 to 59.1 ± 2.0 mm 2 on the right (ForR) side after MTV. The mean endplate distance (EDmd) between L7/S1 increased from 3.7 ± 0.1 mm to 6.0 ± 0.1 mm, and mean lumbosacral angle (LSa) from 148.0 ± 1.1° to 170.0 ± 1.1° after MTV. CT measurements were available 1 year postoperatively in 12 cases: ForL: 41.2 ± 3.1 mm 2 ; ForR: 37.9 ± 3.1 mm 2 ; EDmd: 4.3 ± 0.4 mm, and LSa 157.6 ± 2.1° (values are mean and standard error of mean =  SEM). All 39 dogs with long-term follow-up improved by at least 1 neurologic grade, 9/39 improving by 3 grades, 15/39 by 2 grades, and 15/39 by 1 grade. MTV results in clinical improvement and morphometric enlargement of the foraminal area in dogs with variable degrees of foraminal stenosis. MTV may be a valuable minimally invasive option for treatment of dogs with DLSS. © 2017 The American College of Veterinary Surgeons.

Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography

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Chon, Sung Bin; Oh, Won Sup; Cho, Jun Hwi; Kim, Sam Soo

2011-01-01

Cardiothoracic ratio (CTR), the ratio of cardiac diameter (CD) to thoracic diameter (TD), is a useful screening method to detect cardiomegaly, but is reliable only on posteroanterior chest radiography (chest PA). We performed this cross-sectional 3-phase study to establish reliable CTR from anteroposterior chest radiography (chest AP). First, CDChest PA/CDChest AP ratios were determined at different radiation distances by manipulating chest computed tomography to simulate chest PA and AP. CDChest PA was inferred from multiplying CDChest AP by this ratio. Incorporating this CD and substituting the most recent TDChest PA, we calculated the 'corrected' CTR and compared it with the conventional one in patients who took both the chest radiographies. Finally, its validity was investigated among the critically ill patients who performed portable chest AP. CDChest PA/CDChest AP ratio was {0.00099 × (radiation distance [cm])} + 0.79 (n = 61, r = 1.00, P chest AP with an available previous chest PA. This might help physicians detect congestive cardiomegaly for patients undergoing portable chest AP. PMID:22065900

Analysis of radiological characteristics distribution in the vertebral bodies of the lumbosacral spine of competitive rowers

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M.B. Ogurkowska

2010-09-01

Full Text Available Unfavorable biomechanical situations, usually related to the performance of a profession and competitive sports practice, promote formation of overloads. This problem may be particularly perceptible among sportsmen that practice strength and stamina sports. The present study deals with rowing. The purpose of this study is to evaluate the degree of degenerative changes of the lumbosacral spine in competitive rowers, on the basis of an analysis of changes in the cancellous structure of vertebral bodies. This has been achieved on the basis of radiological density acquired from a CT test.

Clinical correlates of decreased anteroposterior metabolic gradients in positron emission tomography (PET) of schizophrenic patients

International Nuclear Information System (INIS)

DeLisi, L.E.; Buchsbaum, M.S.; Holcomb, H.H.

1985-01-01

The finding in schizophrenic patients of a reversal of the normal frontal to posterior pattern of brain metabolic activity with positron emission tomography (PET) is of interest, but its relevance to psychopathology is unknown. Using PET, the authors studied 21 patients with chronic schizophrenia and 21 age- and sex-matched control subjects. Although eight of the 21 patients and only one of the control subjects showed a relatively lower anteroposterior metabolic gradient, no clinical correlates of this finding were noted. In addition, cerebral atrophy, as determined by CAT scan, was not associated with this aberrant metabolic pattern

Effect of meniscus replacement fixation technique on restoration of knee contact mechanics and stability.

Science.gov (United States)

D'Lima, D D; Chen, P C; Kessler, O; Hoenecke, H R; Colwell, C W

2011-06-01

The menisci are important biomechanical components of the knee. We developed and validated a finite element model of meniscal replacement to assess the effect of surgical fixation technique on contact behavior and knee stability. The geometry of femoral and tibial articular cartilage and menisci was segmented from magnetic resonance images of a normal cadaver knee using MIMICS (Materialise, Leuven, Belgium). A finite element mesh was generated using HyperWorks (Altair Inc, Santa Ana, CA). A finite element solver (Abaqus v6.9, Simulia, Providence, RI) was used to compute contact area and stresses under axial loading and to assess stability (reaction force generated during anteroposterior translation of the femur). The natural and surgical attachments of the meniscal horns and peripheral rim were simulated using springs. After total meniscectomy, femoral contact area decreased by 26% with a concomitant increase in average contact stresses (36%) and peak contact stresses (33%). Replacing the meniscus without suturing the horns did little to restore femoral contact area. Suturing the horns increased contact area and reduced peak contact stresses. Increasing suture stiffness correlated with increased meniscal contact stresses as a greater proportion of tibiofemoral load was transferred to the meniscus. A small incremental benefit was seen of simulated bone plug fixation over the suture construct with the highest stiffness (50 N/mm). Suturing the rim did little to change contact conditions. The nominal anteroposterior stiffness reduced by 3.1 N/mm after meniscectomy. In contrast to contact area and stress, stiffness of the horn fixation sutures had a smaller effect on anteroposterior stability. On the other hand suturing the rim of the meniscus affected anteroposterior stability to a much larger degree. This model emphasizes the importance of the meniscus in knee biomechanics. Appropriate meniscal replacement fixation techniques are likely to be critical to the clinical

High-grade spondylolisthesis: gradual reduction using Magerl's external fixator followed by circumferential fusion technique and long-term results.

Science.gov (United States)

Karampalis, Christos; Grevitt, Michael; Shafafy, Masood; Webb, John

2012-05-01

To report the results of a cohort of patients treated with this technique high lighting radiological and functional outcomes, discussing also benefits arising from a gradual reduction procedure compared with other techniques. We evaluated nine patients who have undergone high-grade listhesis reduction and circumferential fusion at our institution from 1988 to 2006. Average length of follow-up was 11 years (5-19). Functional outcomes and radiological measurements were recorded and reported. Slip magnitude was reduced by an average of 2.9 grades (Meyerding classification). Slip angle improved by an average of 66% (p = 0.0001), lumbosacral angle by 47% (p = 0.0002), sacral rotation by 51% (p = 0.0068) and sacral inclination by 47% (p = 0.0055). At the latest follow-up 88.9% had achieved solid fusion. Post-operative 10-point Visual Analogue Score (VAS) for back pain had improved by 70% (p Average postoperative Oswestry Disability Index for all patients was 8% (range 0-16%) and that for Low Back Outcome Scores was 56.6 (range 44-70). All components of Short Form 36 Health Survey were greater than 80%. Overall patients' expectations were met in 100%. This is an effective and safe technique which addresses the lumbosacral kyphosis and cosmetic deformity without the neurological complications which accompany other reduction and fusion techniques for high-grade spondylolisthesis.

The natural history and management of patients with congenital deficits associated with lumbosacral lipomas.

Science.gov (United States)

Tu, Albert; Hengel, Ross; Cochrane, D Douglas

2016-04-01

Many patients with lumbosacral lipoma are asymptomatic; however, a significant proportion will have neurological deficits present at birth. Implication of these deficits with respect to natural history and management are not well understood. A retrospective review of all infants with lumbosacral lipoma seen at BCCH between 1997 and 2013 was carried out. The study population was stratified on the presence of a congenital, non-progressive deficit and subdivided on treatment approach. The subsequent developments of deficits resulting in untethering procedures were recorded. Of the 44 infants in this study, 24 patients had no neurologic deficit while 20 patients had a fixed, non-progressive deficit evident at birth. Ten of 24 patients without a neurological deficit at birth underwent a prophylactic untethering with 3 eventually requiring repeat untethering after, on average, 62.7 months. Eleven of 14 asymptomatic, monitored patients required untethering for clinical deterioration. Two required a second untethering procedure after 48.7 months. Ten of 20 infants with congenital deficits present at birth underwent prophylactic untethering, and 4 required further surgery after 124 months. Ten patients underwent observation with 8 eventually requiring surgery. Two required repeat untethered after 154 months. The complication rates and operative burden for patients are similar whether prophylactic or delayed surgery is performed. The presence of congenital neurologic deficit does not affect the likelihood of deterioration in patients managed expectantly; prophylactic detethering of these patients did not prevent delayed neurologic deterioration. Comparing the need for repeat surgery in prophylactically untethered patients with initial untethering of patients operated upon at the time of deterioration, prophylactic untethering may confer a benefit with respect to subsequent symptomatic tethering if complication rates are low. However, in a setting with multidisciplinary

Diagnostic utility of selective nerve root blocks in the diagnosis of lumbosacral radicular pain: systematic review and update of current evidence.

Science.gov (United States)

Datta, Sukdeb; Manchikanti, Laxmaiah; Falco, Frank J E; Calodney, Aaron K; Atluri, Sairam; Benyamin, Ramsin M; Buenaventura, Ricardo M; Cohen, Steven P

2013-04-01

  Lumbosacral selective nerve root blocks and/ or transforaminal epidural injections are used for diagnosis and treatment of different disorders causing low back and lower extremity pain. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the validity of this procedure as a diagnostic tool is not clear. To evaluate and update the accuracy of selective nerve root injections in diagnosing lumbar spinal disorders. A systematic review of selective nerve root blocks for the diagnosis of low back and lower extremity pain. Methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or limited or poor based on the quality of evidence grading scale developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. In this review, we evaluated studies in which controlled local anesthetic blocks were performed using at least 50% pain relief as the reference standard. There is limited evidence for the accuracy of selective nerve root injections as a diagnostic tool for lumbosacral disorders. There is limited evidence for their use in the preoperative evaluation of patients with negative or inconclusive imaging studies. The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of lumbar radicular pain. There is limited evidence for selective nerve root injections as a diagnostic tool in

Neuroblast migration along the anteroposterior axis of C. elegans is controlled by opposing gradients of Wnts and a secreted Frizzled-related protein

NARCIS (Netherlands)

Harterink, M.; Kim, D.H.; Middelkoop, T.C.; Doan, T.D.; van Oudenaarden, A.; Korswagen, H.C.

2011-01-01

The migration of neuroblasts along the anteroposterior body axis of C. elegans is controlled by multiple Wnts that act partially redundantly to guide cells to their precisely defined final destinations. How positional information is specified by this system is, however, still largely unknown. Here,

Transpedicular fixation and fusion-arthrodesis circumferential for the treatment of lumbosacral spondylolisthesis of high degree - Multi centric experience

International Nuclear Information System (INIS)

Javier Matta Ibarra; Mauricio Rozo Franco; Francisco Restrepo Suarez

2004-01-01

The objective is to present the high-grade lumbosacral spondylolisthesis surgical experience. Spondylolisthesis causes chronic disabling pain, postural alteration and/or motor and sensory deficits in the lower extremities. Surgical stabilization is recommended in symptomatic adult and even in children or adolescents without symptoms because of the deformity progression potential. Stabilization can be done with or without reduction of the slippage; reduction implies neurological damage risk, bone (loosening) or implant (rupture) failure. Many authors recommended to do an in situ circumferential fusion arthrosis (inter body and inter transverse) associated with a transpedicular fixation in order to minimize the described risk. Eight patients were operated from 1993 to 2002. spondylolisthesis was analyzed according to clinical presentation, neurological dysfunction, postural alterations (slip angle, sacral inclination) complications and follow up. During follow up solid fusion was obtained with a better neurological function in all cases. One patient presented with a drop foot that reverted posteriorly; other patient had a superficial infection of the wound that was controlled. Slip angle improved between 8 - 42 and sacral inclination to 20 degrades. Present technique is recommended because it can be done a circumferential in situ arthrodesis in a single stage operation

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention

OpenAIRE

Holm Emil Kongsted; Bünger Cody; Foldager Casper Bindzus

2017-01-01

Bertolotti’s syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English st...

Clinical signs and outcome of dogs treated medically for degenerative lumbosacral stenosis: 98 cases (2004-2012).

Science.gov (United States)

De Decker, Steven; Wawrzenski, Lauren A; Volk, Holger A

2014-08-15

To compare clinical signs of dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assess outcome after medical treatment. Retrospective case series. Client-owned dogs treated medically (n = 49) or surgically (49) for DLSS. Medical records from 2004 to 2012 were reviewed. Dogs were included if they had clinical signs, clinical examination findings, and MRI abnormalities consistent with DLSS. Several variables were compared between surgically and medically treated dogs: age, sex, duration of clinical signs, presence or absence of neurologic deficits, urinary and fecal incontinence, concurrent medical conditions, and medical treatment before referral. Medical treatment after obtaining a final diagnosis of DLSS consisted of restricted exercise in combination with anti-inflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy. Outcome for medically treated dogs was obtained via a standardized questionnaire. Neurologic deficits were observed significantly more often in surgically treated dogs. Surgically treated dogs had unsuccessful medical treatment before referral significantly more often than did medically treated dogs. Thirty-one of 49 (63.3%) medically treated dogs were available for follow-up evaluation. Of these 31 dogs, 17 (55%) were managed successfully, 10 (32.3%) were managed unsuccessfully and underwent surgical treatment, 3 (9.7%) were euthanized because of progression of clinical signs, and 1 (3.2%) was alive but had an increase in severity of clinical signs after medical management. Clinical signs differed in dogs treated medically or surgically for DLSS. Medical treatment for dogs with DLSS was associated with a fair prognosis.

Perianal pain as a presentation of lumbosacral neurofibroma: a case report.

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Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

2014-12-01

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly.

Quantitative evaluation of the lumbosacral sagittal alignment in degenerative lumbar spinal stenosis

Science.gov (United States)

Makirov, Serik K.; Jahaf, Mohammed T.; Nikulina, Anastasia A.

2015-01-01

Goal of the study This study intends to develop a method of quantitative sagittal balance parameters assessment, based on a geometrical model of lumbar spine and sacrum. Methods One hundred eight patients were divided into 2 groups. In the experimental group have been included 59 patients with lumbar spinal stenosis on L1-5 level. Forty-nine healthy volunteers without history of any lumbar spine pathlogy were included in the control group. All patients have been examined with supine MRI. Lumbar lordosis has been adopted as circular arc and described either anatomical (lumbar lordosis angle), or geometrical (chord length, circle segment height, the central angle, circle radius) parameters. Moreover, 2 sacral parameters have been assessed for all patients: sacral slope and sacral deviation angle. Both parameters characterize sacrum disposition in horizontal and vertical axis respectively. Results Significant correlation was observed between anatomical and geometrical lumbo-sacral parameters. Significant differences between stenosis group and control group were observed in the value of the “central angle” and “sacral deviation” parameters. We propose additional parameters: lumbar coefficient, as ratio of the lordosis angle to the segmental angle (Kl); sacral coefficient, as ratio of the sacral tilt (ST) to the sacral deviation (SD) angle (Ks); and assessment modulus of the mathematical difference between sacral and lumbar coefficients has been used for determining lumbosacral balance (LSB). Statistically significant differences between main and control group have been obtained for all described coefficients (p = 0.006, p = 0.0001, p = 0.0001, accordingly). Median of LSB value of was 0.18 and 0.34 for stenosis and control groups, accordingly. Conclusion Based on these results we believe that that spinal stenosis is associated with an acquired deformity that is measureable by the described parameters. It's possible that spinal stenosis occurs in patients with an

Lumbosacral transitional vertebra causing Bertolotti's syndrome: a case report and review of the literature.

Science.gov (United States)

Paraskevas, Georgios; Tzaveas, Alexandros; Koutras, Georgios; Natsis, Konstantinos

2009-07-06

Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti's syndrome. We report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum. In young patients with back pain the possibility of Bertolotti's syndrome should always be taken in account.

Post-irradiation lumbosacral radiculopathy associated with multiple cavernous malformations of the cauda equina: Case report and review of the literature

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Drazin, Doniel; Kappel, Ari; Withrow, Stefan; Perry, Tiffany; Chu, Ray; Phuphanich, Surasak

2017-01-01

Background: Multiple radiation-induced cavernous malformations of the cauda equina are extremely rare. A review of the literature suggested that the post-irradiation lumbosacral radiculopathy in our patient was most likely associated with a diagnosis of multiple radiation-induced cavernous malformations of the cauda equina. Case Description: A 76-year-old man with a remote history of abdominal radiation therapy presented with a 6-month history of progressively worsening right foot drop and...

The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups.

Science.gov (United States)

Jeon, Ji Young; Jeong, Yu Mi; Lee, Sheen-Woo; Kim, Jeong Ho; Choi, Hye-Young; Ahn, Yong

2018-01-01

Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. A retrospective evaluation. A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). This study reveals several limitations including the

A Study of Radiation Incidence Angle in Anteroposterior Cervical Vertebra Examination

International Nuclear Information System (INIS)

Jeung, Seung Woon; Lim, Cheong Hwan; Jung, Hong Ryang; Joo, Yeong Cheol; Park, Mi Ja; Han, Beon Hee

2012-01-01

In anteroposterior projection for cervical vertebra, it is general that the incidence angle of X-ray is 15 degrees to 20 degrees to head in order to prevent overlap of mandible and occipital bone and to observe array of cervical interbody and shapes of joints. However, the angle is appropriate for foreigners that was determined by foreign literature review long ago, and there have been few researches of incidence angle for Koreans' body type. The purpose of in this study are to identify the incidence angle appropriate for Koreans and to present methodology. In order to measure the incidence angle, 1,044 patients who visited S Hospital located in Seosan were selected and measured of average length of cervical vertebra, OID, axis angle, and FID. The incidence angle was calculated from the applied formula by measuring average values per age groups and sex (see Formula 1 and 2). The average length of cervical vertebra was 6cm: the length was increased from teenagers to twenties but was decreased since thirties. The difference between males and females was around 1cm (p<.01). The OID was almost the same regardless of age groups and sex. As for axis angle, the slope was increased in teenagers and twenties, but was decreased since thirties. The difference between males and females was around 2 degrees (p<.01). The FID measurements were almost the same regardless of age groups and sex, and when the incidence angle was measured from these values, the teenagers were 15.9 degrees, the twenties were 16.9 degrees, the thirties were 16.6 degrees, the forties were 16.2 degrees, the fifties were 15.9 degrees, and the sixties were 14.5 degrees, indicating that the angle was increased from teenagers to the twenties but decreased since the thirties. While the angles of males and females were measured to be the same in the teenagers, the angle was different between males and females by 2 degrees. When the incidence angle statistically analyzed with measurement of average length of

A Study of Radiation Incidence Angle in Anteroposterior Cervical Vertebra Examination

Energy Technology Data Exchange (ETDEWEB)

Jeung, Seung Woon; Lim, Cheong Hwan; Jung, Hong Ryang; Joo, Yeong Cheol; Park, Mi Ja [Dept. of Radiological Science, Hanseo University, Seosan (Korea, Republic of); Han, Beon Hee [Dept. of Radiological Science, Seonam University, Namwon (Korea, Republic of)

2012-06-15

In anteroposterior projection for cervical vertebra, it is general that the incidence angle of X-ray is 15 degrees to 20 degrees to head in order to prevent overlap of mandible and occipital bone and to observe array of cervical interbody and shapes of joints. However, the angle is appropriate for foreigners that was determined by foreign literature review long ago, and there have been few researches of incidence angle for Koreans' body type. The purpose of in this study are to identify the incidence angle appropriate for Koreans and to present methodology. In order to measure the incidence angle, 1,044 patients who visited S Hospital located in Seosan were selected and measured of average length of cervical vertebra, OID, axis angle, and FID. The incidence angle was calculated from the applied formula by measuring average values per age groups and sex (see Formula 1 and 2). The average length of cervical vertebra was 6cm: the length was increased from teenagers to twenties but was decreased since thirties. The difference between males and females was around 1cm (p<.01). The OID was almost the same regardless of age groups and sex. As for axis angle, the slope was increased in teenagers and twenties, but was decreased since thirties. The difference between males and females was around 2 degrees (p<.01). The FID measurements were almost the same regardless of age groups and sex, and when the incidence angle was measured from these values, the teenagers were 15.9 degrees, the twenties were 16.9 degrees, the thirties were 16.6 degrees, the forties were 16.2 degrees, the fifties were 15.9 degrees, and the sixties were 14.5 degrees, indicating that the angle was increased from teenagers to the twenties but decreased since the thirties. While the angles of males and females were measured to be the same in the teenagers, the angle was different between males and females by 2 degrees. When the incidence angle statistically analyzed with measurement of average length

The role of Gd-enhanced three-dimensional MRI fast low-angle shot (FLASH) in the evaluation of symptomatic lumbosacral nerve roots

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Kikkawa, Ichiro; Sugimoto, Hideharu; Saita, Kazuo; Ookami, Hitoshi; Nakama, Sueo; Hoshino, Yuichi [Jichi Medical School, Minamikawachi, Tochigi (Japan)

2001-07-01

In the field of lumbar spine disorders, three-dimensional (3-D) magnetic resonance imaging (MRI) can clearly depict a lumbar nerve root from the distal region to the dorsal root ganglion. In this study, we used a gadoliniumdiethylenetriaminepentaacetic acid (Gd-DTPA) enhanced-three-dimensional (3-D) fast low-angle shot (FLASH) sequence when examining lumbosacral disorders. The subjects were 33 patients (14 men and 19 women) in whom lumbosacral neural compression had been diagnosed clinically. Twenty-one patients had lumbar disc herniation, 11 had lumbar spinal stenosis, and 1 had lumbar radiculopathy caused by rheumatoid arthritis. Five subjects with low back pain were also studied as a control group. In all patients and in all 5 of the controls, the dorsal root ganglion of every root was enhanced clearly. There was no root enhancement in the 5 controls. Enhancement of the symptomatic nerve roots, caused by compression, was found in 11 of the 33 patients. All 11 patients had rediculopathy, and muscle weakness was more frequent in patients with enhanced nerve roots than in those without enhancement. There was no enhancement of the cauda equina, even in the patients with cauda syndrome. The enhancement effect may reflect some pathological condition of the compressed nerve root and needs to be studied further. (author)

The role of Gd-enhanced three-dimensional MRI fast low-angle shot (FLASH) in the evaluation of symptomatic lumbosacral nerve roots

International Nuclear Information System (INIS)

Kikkawa, Ichiro; Sugimoto, Hideharu; Saita, Kazuo; Ookami, Hitoshi; Nakama, Sueo; Hoshino, Yuichi

2001-01-01

In the field of lumbar spine disorders, three-dimensional (3-D) magnetic resonance imaging (MRI) can clearly depict a lumbar nerve root from the distal region to the dorsal root ganglion. In this study, we used a gadoliniumdiethylenetriaminepentaacetic acid (Gd-DTPA) enhanced-three-dimensional (3-D) fast low-angle shot (FLASH) sequence when examining lumbosacral disorders. The subjects were 33 patients (14 men and 19 women) in whom lumbosacral neural compression had been diagnosed clinically. Twenty-one patients had lumbar disc herniation, 11 had lumbar spinal stenosis, and 1 had lumbar radiculopathy caused by rheumatoid arthritis. Five subjects with low back pain were also studied as a control group. In all patients and in all 5 of the controls, the dorsal root ganglion of every root was enhanced clearly. There was no root enhancement in the 5 controls. Enhancement of the symptomatic nerve roots, caused by compression, was found in 11 of the 33 patients. All 11 patients had rediculopathy, and muscle weakness was more frequent in patients with enhanced nerve roots than in those without enhancement. There was no enhancement of the cauda equina, even in the patients with cauda syndrome. The enhancement effect may reflect some pathological condition of the compressed nerve root and needs to be studied further. (author)

Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques.

Science.gov (United States)

Dimar, John R; Glassman, Steven D; Vemuri, Venu M; Esterberg, Justin L; Howard, Jennifer M; Carreon, Leah Y

2011-11-09

A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. Parameters measured included anterior and posterior disk space height, lumbar lordosis from L3 to S1, and surgical level lordosis.No significant difference in demographics existed among the 4 groups. All preoperative parameters were similar among the 4 groups. Lumbar lordosis at final follow-up showed no difference between the anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cage groups, although the posterolateral fusion group showed a significant loss of lordosis (-10°) (Plordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages. Copyright 2011, SLACK Incorporated.

Effect of modified lumbosacral orthoses on treatment of patients with spondylolysis

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Mahmoud Bahramizadeh

2009-08-01

Full Text Available Introduction: In this study, the effect of modified lumbo sacral orthoses on lordosis andlumbosacral angle and reliving pain and functional disability was investigated.Materials and Methods: 30 patients (19 females, 11 males with spondylolysis (aged between 22-57 years were sampled in a simple randomized manner. They had a history of low back pain for 30.7(in average months. Modified lumbo sacral orthoses was prescribed for 3 months (23 hours daily.The brace was unique, bridged between xyphoid process to pubic symphysis anteriorly and seventhlumbar vertebrae to gluteal prminency posteriorly.Results: Our results show that 3-months using the modified lumbo sacral orthoses resulted insignificant decrement in pain and improvement in functional ability of patients. Although lordosis andlumbosacral angles decreased to 2.21 and 0.92 degrees, respectively, but these changes were notsignificant. Finally, patients with the lower duration of low back pain showed better results.Conclusion: Our findings indicate that the modified lumbosacral orthoses, as a non-invasiveprocedure, can be used for conservative treatments in spondylolysis patients.

Comparison of the effect of labiolingual inclination and anteroposterior position of maxillary incisors on esthetic profile in three different facial patterns

Science.gov (United States)

Chirivella, Praveen; Singaraju, Gowri Sankar; Mandava, Prasad; Reddy, V Karunakar; Neravati, Jeevan Kumar; George, Suja Ani

2017-01-01

Objective: To test the null hypothesis that there is no effect of esthetic perception of smiling profile in three different facial types by a change in the maxillary incisor inclination and position. Materials and Methods: A smiling profile photograph with Class I skeletal and dental pattern, normal profile were taken in each of the three facial types dolichofacial, mesofacial, and brachyfacial. Based on the original digital image, 15 smiling profiles in each of the facial types were created using the FACAD software by altering the labiolingual inclination and anteroposterior position of the maxillary incisors. These photographs were rated on a visual analog scale by three panels of examiners consisting of orthodontists, dentists, and nonprofessionals with twenty members in each group. The responses were assessed by analysis of variance (ANOVA) test followed by post hoc Scheffe. Results: Significant differences (P esthetics. The result of the ANOVA showed differences among the three groups for certain facial profiles. Conclusion: The hypothesis was rejected. The esthetic perception of labiolingual inclination and anteroposterior of maxillary incisors differ in different facial types, and this may effect in formulating treatment plans for different facial types. PMID:28197396

Duplication of Inferior Gluteal Artery and Course of Superior Gluteal Artery Through the Lumbosacral Trunk

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Satheesha Nayak B

2017-07-01

Full Text Available Internal iliac artery (IIA shows great deal of variations in its branching pattern. The knowledge of its variant branches is required for successful surgical, orthopedic, plastic surgery and radiological procedures. We observed variations of some of the branches of right IIA in an adult male cadaver. The iliolumbar artery originated from the main trunk of the IIA. After this, IIA divided into anterior and posterior divisions. The posterior division gave lateral sacral and superior gluteal arteries. Superior gluteal artery pierced the lumbosacral trunk before leaving the pelvis. The anterior division further divided into anterior and posterior trunks. Anterior trunk gave rise to superior vesical, inferior vesical, middle rectal and obturator arteries. The posterior trunk gave two inferior gluteal arteries and an internal pudendal artery.

Feasibility and limitation of constructive interference in steady-state (CISS) MR imaging in neonates with lumbosacral myeloschisis

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Hashiguchi, Kimiaki; Morioka, Takato; Yoshida, Fumiaki; Miyagi, Yasushi; Nagata, Shinji; Sasaki, Tomio [Kyushu University, Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka (Japan); Mihara, Futoshi; Yoshiura, Takashi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan)

2007-07-15

The aim of this study was to evaluate three-dimensional Fourier transformation-constructive interference in steady-state (CISS) imaging as a preoperative anatomical evaluation of the relationship between the placode, spinal nerve roots, CSF space, and the myelomeningocele sac in neonates with lumbosacral myeloschisis. Five consecutive patients with lumbosacral myeloschisis were included in this study. Magnetic resonance (MR) CISS, conventional T1-weighted (T1-W) and T2-weighted (T2-W) images were acquired on the day of birth to compare the anatomical findings with each sequence. We also performed curvilinear reconstruction of the CISS images, which can be reconstructed along the curved spinal cord and neural placode. Neural placodes were demonstrated in two patients on T1-W images and in three patients on T2-W images. T2-W images revealed a small number of nerve roots in two patients, while no nerve roots were demonstrated on T1-W images. In contrast, CISS images clearly demonstrated neural placodes and spinal nerve roots in four patients. These findings were in accordance with intraoperative findings. Curvilinear CISS images demonstrated the neuroanatomy around the myeloschisis in one slice. The resulting images were degraded by a band artifact that obstructed fine anatomical analysis of the nerve roots in the ventral CSF space. The placode and nerve roots could not be visualized in one patient in whom the CSF space was narrow due to the collapse of the myelomeningocele sac. MR CISS imaging is superior to T1-W and T2-W imaging for demonstrating the neural placode and nerve roots, although problems remain in terms of artifacts. (orig.)

Lumbosacral transitional vertebra causing Bertolotti’s syndrome: a case report and review of the literature

Science.gov (United States)

Koutras, Georgios; Natsis, Konstantinos

2009-01-01

Introduction Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti’s syndrome. Case presentation We report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum. Conclusion In young patients with back pain the possibility of Bertolotti’s syndrome should always be taken in account. PMID:19830065

Early detection of thoracic spine fracture in the multiple-trauma patient: Findings on the initial anteroposterior chest radiograph

International Nuclear Information System (INIS)

Lawrason, J.N.; Novelline, R.A.; Rhea, J.T.; DeLuca, S.A.; Sacknoff, R.

1987-01-01

In the unconscious, multiple-trauma patient, thoracic spine fractures may be initially overlooked due to a combination of immediate concern given to more obvious injuries and a failure to carefully scrutinize the initial, often anteroposterior (AP) and portable chest radiograph. In a recent review of their cases the authors retrospectively identified primary or secondary signs of thoracic spine fracture in 80% of the initial chest radiographs of multiple-trauma patients with this injury. This paper reviews these obvious and subtle, bony and soft-tissue AP chest radiograph signs of thoracic spine fracture and compare them with matching spine radiographs, tomography, and CT

Relationship between transitional lumbosacral vertebrae and eight lumbar vertebrae in a breeding colony of Labrador Retrievers and Labrador Crosses.

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Moeser, C F; Wade, C M

2017-01-01

Transitional lumbosacral vertebrae (TLSV) is a hereditary malformation of the spinal column diagnosed in various dog breeds. The aim of this study was to explore whether different lumbosacral phenotypes have an inherited basis. Radiographs of all dogs within a breeding colony were performed and assessed. A comparison of the incidence of TLSV, eight lumbar vertebrae (8LV), and fusion of the first caudal vertebrae to the sacrum or near fusion of this area was made between litters of normal parentage and litters where one or both of the parents had an anomaly. Of the 119 puppies included in the study, 69 had normal conformation, 9 had 8LV, 9 had TLSV and 32 had fusion of the first caudal vertebra (Ca1) to the caudal sacral segment or a reduced joint space in this area. Results indicated that all the abnormal types likely had common underlying genetic causes. Compared with the population as a whole, significantly more progeny were observed to have abnormalities of the sacral region when both parents were affected by either fusion of Ca1 to the third sacral vertebra (S3) and/or had 8LV. Significantly more progeny were normal compared with the entire study population when both parents were normal. Strong similarity between parental and progeny phenotypes suggested that the characteristics were heritable and likely influenced by major gene effects. When performing screening radiographs for TLSV, assessment for 8LV and fusion of Ca1 to S3 should be included. © 2017 Australian Veterinary Association.

Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

Directory of Open Access Journals (Sweden)

Rafael DeRossi

2012-02-01

Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

GFAP and Fos immunoreactivity in lumbo-sacral spinal cord and medulla oblongata after chronic colonic inflammation in rats

Science.gov (United States)

Sun, Yi-Ning; Luo, Jin-Yan; Rao, Zhi-Ren; Lan, Li; Duan, Li

2005-01-01

AIM: To investigate the response of astrocytes and neurons in rat lumbo-sacral spinal cord and medulla oblongata induced by chronic colonic inflammation, and the relationship between them. METHODS: Thirty-three male Sprague-Dawley rats were randomly divided into two groups: experimental group (n = 17), colonic inflammation was induced by intra-luminal administration of trinitrobenzenesulfonic acid (TNBS); control group (n = 16), saline was administered intra-luminally. After 3, 7, 14, and 28 d of administration, the lumbo-sacral spinal cord and medulla oblongata were removed and processed for anti-glial fibrillary acidic protein (GFAP), Fos and GFAP/Fos immunohistochemistry. RESULTS: Activated astrocytes positive for GFAP were mainly distributed in the superficial laminae (laminae I-II) of dorsal horn, intermediolateral nucleus (laminae V), posterior commissural nucleus (laminae X) and anterolateral nucleus (laminae IX). Fos-IR (Fos-immunoreactive) neurons were mainly distributed in the deeper laminae of the spinal cord (laminae III-IV, V-VI). In the medulla oblongata, both GFAP-IR astrocytes and Fos-IR neurons were mainly distributed in the medullary visceral zone (MVZ). The density of GFAP in the spinal cord of experimental rats was significantly higher after 3, 7, and 14 d of TNBS administration compared with the controls (50.4±16.8, 29.2±6.5, 24.1±5.6, P0.05). CONCLUSION: Astrocytes in spinal cord and medulla oblongata can be activated by colonic inflammation. The activated astrocytes are closely related to Fos-IR neurons. With the recovery of colonic inflammation, the activity of astrocytes in the spinal cord and medulla oblongata is reduced. PMID:16097052

Entrance doses during lateral lumbar spine and antero-posterior abdomen examinations: generator waveform dependence

International Nuclear Information System (INIS)

Morrison, G.D.; Underwood, A.C.

1995-01-01

In North Trent, UK, an entrance dose survey of lateral lumbar spine and antero-posterior (AP) abdomen examinations has been carried out in 17 radiology departments. The survey comprised 294 lateral lumbar spine and 322 AP abdomen entrance dose measurements. The mean entrance doses were found to be approximately half of the relevant national reference entrance dose levels of 30 mGy and 10 mGy, respectively. The effect of generator waveform on entrance dose was studied by separating the generators into two types: ''pulsating potential'' (PP) generators and ''constant potential'' (CP) generators for each examination. PP generators comprised 23% of the total number of examinations. The mean entrance dose and radiographic exposure factors from CP generators were found to be significantly lower than those from PP generators. The use of CP type generators, together with low attenuation components can significantly reduce patient entrance doses for these examinations. (author)

Intracranial Epidural Haematoma following Surgical Removal of a Giant Lumbosacral Schwannoma: A Case Report and Literature Review.

Science.gov (United States)

Nemir, Jakob; Peterković, Vjerislav; Trninić, Ines; Domazet, Ivan; Barić, Hrvoje; Vukić, Miroslav

2018-01-01

Postoperative intracranial epidural haematoma (EDH) is an extremely rare complication following spinal surgery, with only a handful of cases described in the literature. We report the case of a 16-year-old girl who underwent a successful subtotal resection of a giant lumbosacral schwannoma (L2-S2 level). Recovery from general anaesthesia was uneventful; however, her neurological status deteriorated rapidly within 24 h after surgery. A head computed tomography scan revealed a large right frontoparietal EDH with midline shift. An immediate frontotemporoparietal osteoplastic craniotomy and evacuation of the EDH were performed. At 1 year postoperatively, the patient regained full neurological recovery with no radiological signs of growth of the residual tumour. © 2017 S. Karger AG, Basel.

Magnetic resonance imaging study of lumbosacral spinal cord nerves before artificial somatic-central nervous system-autonomic reflex pathway establish ment

International Nuclear Information System (INIS)

Deng Xianbo; Kong Xiangquan; Feng Gansheng; Han Ping; Liu Dingxi; Ma Hui

2005-01-01

Objective: To investigate the value of MRI as imaging technique for lumbosacral spinal nerves before artificial somatic-central nervous system-autonomic reflex pathway establish ment. Methods: Conventional MRI and T 2 W CISS 3D were performed in 10 patients with neurogenic bladder planned for the operation of artificial somatic-central nervous system-autonomic reflex pathway. The Three-dimensional data were then constructed into composite images using a standard multiple planar reformation (MPR). Results: Five patients showed tethered spinal cord syndrome, whose spinal cord nerves were circuitous distributed and had abnormity number when penetrated the dura. Of these 5 patients, one patient was accompanied by spinal cord vas malformation. Four patients had vertebral fracture and spinal injury, and the other one patients demonstrated tumor in vertebral canal on MRI examinations. The spinal cord nerves in these 5 patients floated down river and had normal number of spinal cord nerves. Conclusion: Conventional MRI and T 2 W CISS 3D MRI were essential for the pre-operative planning of artificial somatic-central nervous system-autonomic reflex pathway, especially in patients with tethered spinal cord syndrome. Spinal cord nerves distribute and anterior and posterior roots array can be clearly showed by MPR. (authors)

New arthroscopic assisted technique for ankle instability

International Nuclear Information System (INIS)

Gerstner Garces, Juan Ricardo

2004-01-01

An assisted arthroscopic technique for chronic ankle instability is presented by the author, together with his results for 27 patients treated between January 2000 and February 2004, with a minimum follow-up of six months. Indications for his technique, according to the rehabilitation protocol of the Medical Centre, included patients with chronic subjective and objective ankle instability, anteroposterior instability, associated anteromedical impingement syndromes, non competitive athletes, patients not displaying defects in the alignment of the axis of foot and ankle, or systemic disorders such as diabetes mellitus, collagenisis or hyperelasticity. Patients were evaluated according to the AOFAS scale for the outcome of ankle procedures, and followed up for a minimum period of six months. Positive results confirm an efficient and effective technique, simple and easy to reproduce, that does not hinder future open anatomical or non-anatomical reconstruction, and in which complications are minimal

Preliminary Report of Instrumentation in Tuberculous Lumbosacral Spine

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T Zin-Naing

2014-11-01

Full Text Available The aims of spinal tuberculosis treatment are to eradicate the disease, to prevent the development of paraplegia and kyphotic deformity, to manage the existing deformity and neurological deficit, to allow early ambulation and to return the patient back to daily life. Methods for the treatment of tuberculosis of vertebra are still controversial. Conservative treatment includes medical therapy as well as external supports and surgery is indicated for deformity of spine, severe pain, or neurological compromise conditions. Most cases in our country were late presentations with disc space already infected, and after débridement there was a large gap needing bone graft to enhance bony fusion and anterior column support. Although the spine was infected, instrumentation posed no additional hazard in terms of tuberculous discitis. Oga et al. reported that M. tuberculosis has low adhesion capability and forms only a few microcolonies surrounded by a biofilm. Moon et al. stated that interbody fusion performed with classical anterior radical surgery per se was ineffective in the correction of kyphosis and did not prevent the increase in kyphosis angle. The present study focuses on collected clinical and radiographic outcomes in ten patients who underwent Posterior Lumbar Interbody Fusion (PLIF for tuberculous lumbosacral spine. All the cases had instability with kyphotic deformity or loss of lordosis. Clinical outcomes were measured by Visual Analogue Scale (VAS, modified MacNab Criteria, and radiographic outcomes (segmental kyphotic angle and total lumbar lordotic, TLL, angle on follow-up to six months. The mean VAS back scores showed decrease, and kyphotic angles and lordotic angles improved. Three cases had excellent results, six good and one fair using the modified MacNab criteria.

The posture of adolescent male handball players: A two-year study.

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Grabara, Małgorzata

2018-02-06

Young athletes at the stage of growth acceleration tend to exhibit increased susceptibility to postural abnormalities, especially in the trunk region. The aim of this study was to assess and compare the posture in male adolescent handball players over two years of regular training sessions. The study group comprised 21 handball players. At the start of the study 15 participants were aged 14 and 6 participants were aged 15 (mean 14.25 ± 0.58). The measurements were repeated three times. Posture was assessed with a photogrammetric method based on the moiré phenomenon. The analysis of posture relative to symmetry in the frontal and transverse planes did not reveal any significant differences between posture indicators obtained during the successive measurements. Sagittal plane posture indicators revealed significant changes in torso forward inclination angle and the shape of anteroposterior spinal curvatures. The latter consisted of significant deepening of the upper thoracic curve (angle α) and flattening of the lumbosacral curve (angle γ). A two-year period of handball training did not result in posture asymmetries in young male handball players. The observed changes in the shape of anteroposterior spinal curvatures might be related both to sports training and somatic parameters.

Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis

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Guilherme Carlos Brech

2013-10-01

Full Text Available OBJECTIVE: The aims of this study were to evaluate the anteroposterior displacement behavior of the center of pressure without any visual reference and determine its relationship with knee muscle strength and reports of falls in postmenopausal women. Among those with osteoporosis, the specific objective was to evaluate the correlation of thoracic kyphosis and vitamin D with center of pressure displacement. METHODS: This was a cross-sectional observational study without intervention. The assessments were performed on 126 postmenopausal women (aged 55-65 years who were grouped according to their lumbar bone density into osteoporosis and control groups. Center of pressure was evaluated on a force platform (100 Hz frequency and 10 Hz filter, with the subjects standing on both feet with eyes closed for 60 seconds. Knee muscle strength was evaluated using an isokinetic dynamometer in concentric/concentric mode at a velocity of 60°/s. In the osteoporosis group, vitamin D was assayed, and the thoracic spine was radiographed. RESULTS: In the control group, there was a correlation between the center of pressure and knee strength (r = 0.37; p<0.003. Reports of falls were not associated with center of pressure displacement (p = 0.056. In the osteoporosis group, thoracic kyphosis and vitamin D levels were not correlated with the center of pressure. CONCLUSION: Anteroposterior center of pressure displacement without visual influence was not associated with falls, thoracic kyphosis or vitamin D in the osteoporosis group. Only knee muscle strength was associated with center of pressure displacement in the control group.

Evaluation of the rostral projection of the sacral lamina as a component of degenerative lumbosacral stenosis in German shepherd dogs.

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Saunders, Harvey; Worth, Andrew J; Bridges, Janis P; Hartman, Angela

2018-05-20

To determine the association between a greater rostral projection of the sacral lamina and clinical signs of cauda equina syndrome (CES) in German shepherd dogs (GSD) with presumptive degenerative lumbosacral disease (DLSS). Retrospective cohort study. One hundred forty-three GSD (125 police dogs and 18 pet dogs) presenting for either CES or prebreeding evaluation. Fifty-five were classified as affected by CES and diagnosed with DLSS, and 88 were classified as unaffected on the basis of clinical and imaging findings. The position of the rostral edge of the sacral lamina was measured from radiographs and/or computed tomography (CT) scans. This position was compared between affected and unaffected dogs. In dogs that underwent both radiography and CT scanning, the agreement between sacral lamina localization using each imaging modality was determined. Owners/handlers were contacted to determine whether dogs subsequently developed clinical signs compatible with CES at a mean of 29 months (unaffected). The sacral lamina did not extend as far rostrally in affected dogs, compared to unaffected dogs (P = .04). Among the 88 dogs unaffected by CES at initial evaluation, 2 developed clinical signs consistent with CES at follow-up. Rostral projection of the sacral lamina, previously proposed as a potential risk factor in dogs with CES due to lumbosacral degeneration, was not associated with a diagnosis of DLSS in this study; the opposite was true. Rostral projection of the sacral lamina may not be a predisposing factor in the development of CES due to DLSS in GSD. © 2018 The American College of Veterinary Surgeons.

Role of Duloxetine in management of cervical or lumbosacral neuralgia of unknown etiology: A preliminary study

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Digambar P Nawani

2013-01-01

Full Text Available Background: Duloxetine is a selective serotonin reuptake inhibitor (SSRI used for treatment of neuropathic pain associated with diabetic neuropathy and fibromyalgia. Use of duloxetine for idiopathic neuropathic pain is not known. We present our experience for treatment of such painful conditions. Materials and Methods: Twenty patients, either sex, aged 30-65 years presenting for cervical and lumbosacral pain were administered duloxetine 40 mg/day in two divided doses. They were followed for a total period of 20 weeks and pain was assessed periodically using Numerical scale and Facies scale. Results: Fifteen patients showed complete resolution of pain. No major side effects were seen. No patient showed less than 50% resolution of pain. Conclusion: Duloxetine 40 mg/day is effective for control of painful neuropathic condition in our Indian setup.

Breast-conserving radiation therapy using combined electron and intensity-modulated radiotherapy technique

International Nuclear Information System (INIS)

Li, J.G.; Williams, S.S.; Goffinet, D.R.; Boer, A.L.; Xing, L.

2000-01-01

An electron beam with appropriate energy was combined with four intensity modulated photon beams. The direction of the electron beam was chosen to be tilted 10-20 laterally from the anteroposterior direction. Two of the intensity-modulated photon beams had the same gantry angles as the conventional tangential fields, whereas the other two beams were rotated 15-25' toward the anteroposterior directions from the first two photon beams. An iterative algorithm was developed which optimizes the weight of the electron beam as well as the fluence profiles of the photon beams for a given patient. Two breast cancer patients with early-stage breast tumors were planned with the new technique and the results were compared with those from 3D planning using tangential fields as well as 9-field intensity-modulated radiotherapy (IMRT) techniques. The combined electron and IMRT plans showed better dose conformity to the target with significantly reduced dose to the ipsilateral lung and, in the case of the left-breast patient, reduced dose to the heart, than the tangential field plans. In both the right-sided and left-sided breast plans, the dose to other normal structures was similar to that from conventional plans and was much smaller than that from the 9-field IMRT plans. The optimized electron beam provided between 70 to 80% of the prescribed dose at the depth of maximum dose of the electron beam. The combined electron and IMRT technique showed improvement over the conventional treatment technique using tangential fields with reduced dose to the ipsilateral lung and the heart. The customized beam directions of the four IMRT fields also kept the dose to other critical structures to a minimum. (author)

[The use of acupuncture in combined balneotherapy of erectile dysfunction in patients with lumbosacral osteochondrosis].

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Zhuravlev, I E; Tereshin, A T

2010-01-01

The objective of the present study was to elucidate effects of therapeutic and preventive measures on restoration of compromised erectile function in patients with osteochondrosis of the lumbosacral spine segment (LSSS). The patients were treated using corporal and auricular acupuncture, Narzan mineral water baths, manual therapy, remedial gymnastics, and psychotherapeutic correction of sexual dysadaptation. This combined treatment resulted in the elimination of algic syndrome in 77.5% of the patients, restoration of sexual function in 62.5%, and normalization of hemodynamics in cavernous bodies in 65.2%. The functional activity of the hypothalamo-pituitary-testicular axis was normalized in 65% of the LSSS patients of strong and moderate sexual constitution. Introduction of acupuncture in the combined medicamentous therapy increased its efficiency by 15%. In 57.5% of the patients with strong and moderate sexual constitution, the restored sexual function persisted for at least 12 months.

Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E.

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E.V. Podchufarova

2014-01-01

Full Text Available Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom.Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan, or magnetic resonance imaging (MRI, general blood and urine tests are required when marked neurological and somatic disorders are present.Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as

The anteroposterior axis of the tibia in Korean patients undergoing total knee replacement.

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Kim, C W; Seo, S S; Kim, J H; Roh, S M; Lee, C R

2014-11-01

The aim of this study was to find anatomical landmarks for rotational alignment of the tibial component in total knee replacement (TKR) in a CT-based study. Pre-operative CT scanning was performed on 94 South Korean patients (nine men, 85 women, 188 knees) with osteoarthritis of the knee joint prior to TKR. The tibial anteroposterior (AP) axis was defined as a line perpendicular to the femoral surgical transepicondylar axis and passing through the centre of the posterior cruciate ligament (PCL). The angles between the defined tibial AP axis and anatomical landmarks at various levels of the tibia were measured. The mean values of the angles between the defined tibial AP axis and the line connecting the anterior border of the proximal third of the tibia to the centre of the PCL was -0.2° (-17 to 14.1, sd 4.1). This was very close to the defined tibial axis, and remained so regardless of lower limb alignment and the degree of tibial bowing. Therefore, AP axis defined as described, is a reliable anatomical landmark for rotational alignment of tibial components. ©2014 The British Editorial Society of Bone & Joint Surgery.

Prevalence of extraforaminal nerve root compression below lumbosacral transitional vertebrae.

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Porter, Neil A; Lalam, Radhesh K; Tins, Bernhard J; Tyrrell, Prudencia N M; Singh, Jaspreet; Cassar-Pullicino, Victor N

2014-01-01

Although pathology at the first mobile segment above a lumbosacral transitional vertebra (LSTV) is a known source of spinal symptoms, nerve root compression below an LSTV, has only sporadically been reported. Our objective was to assess the prevalence of nerve root entrapment below an LSTV, review the causes of entrapment, and correlate with presenting symptoms. A retrospective review of MR and CT examinations of the lumbar spine was performed over a 5.5-year period in which the words "transitional vertebra" were mentioned in the report. Nerve root compression below an LSTV was assessed as well as the subtype of transitional vertebra. Correlation with clinical symptoms at referral was made. MR and CT examinations were also reviewed to exclude any other cause of symptoms above the LSTV. One hundred seventy-four patients were included in the study. Neural compression by new bone formation below an LSTV was demonstrated in 23 patients (13%). In all of these patients, there was a pseudarthrosis present on the side of compression due to partial sacralization with incomplete fusion. In three of these patients (13%), there was symptomatic correlation with no other cause of radiculopathy demonstrated. A further 13 patients (57%) had correlating symptoms that may in part be attributable to compression below an LSTV. Nerve root compression below an LSTV occurs with a prevalence of 13% and can be symptomatic in up to 70% of these patients. This region should therefore be carefully assessed in all symptomatic patients with an LSTV.

Má oclusão Classe III de Angle com discrepância ântero-posterior acentuada Angle Class III malocclusion with severe anteroposterior disharmony

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Marcos Alan Vieira Bittencourt

2009-02-01

Full Text Available A má oclusão Classe III de Angle é caracterizada por uma discrepância dentária ântero-posterior, que pode ou não estar acompanhada por alterações esqueléticas. Em geral, o aspecto facial fica bastante comprometido, sendo justamente esse fator, na maioria das vezes, que motiva o paciente a procurar pelo tratamento. Este caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO, representando a categoria 4, ou seja, uma má oclusão com discrepância ântero-posterior acentuada, Classe III, com ANB menor ou igual a -2º, como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.Angle Class III malocclusion is characterized by an anteroposterior dental discrepancy which may or may not be accompanied by skeletal changes. In general, distressed by a significantly compromised facial aspect, patients tend to seek treatment. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO, as representative of Category 4, i.e., a malocclusion with severe anteroposterior discrepancy, Class III, and ANB Angle equal to or smaller than -2º, as part of the requirements for obtaining the BBO Diploma.

Anatomic investigation of the lumbosacral nerve roots and dorsal root ganglia by MRI

International Nuclear Information System (INIS)

Hasegawa, Toru; Fuse, Kenzo; Mikawa, Yoshihiro; Watanabe, Ryo

1995-01-01

The morphology of the lumbosacral nerve roots and dorsal root ganglia (DRG) was examined by using magnetic resonance imaging (MRI) in 11 healthy male volunteers aged 20-40 years. One hundred and twenty-three nerve roots (15 at the L1 level, 22 each at the L2-L5 levels, and 20 at the S1 level) were examined in terms of the position and angle of the bifurcation of the nerve roots, length of the nerve root, and the position and width of DRG. The nerve roots at the lower levels showed more cephalad position and smaller angle of bifurcation on MRI. The distance from the bifurcation of nerve roots to the cephalad edge of DRG was significantly longer in the upper root levels and was significantly shorter in the L5 roots than the S1 roots. The positions of DRG at the S1 level tended to become cephalad. DRG that was positioned toward more caudal direction was larger and more elliptic. MRI provided useful information concerning morphology and anatomical position of nerve roots and DRG, thereby allowing accurate diagnosis and the determination of surgical indications. (N.K.)

Transitional lumbosacral vertebral anomaly in the dog: a radiographic study

International Nuclear Information System (INIS)

Morgan, J.P.

1999-01-01

Transitional lumbosacral vertebral anomalies have for some time been suggested as a possible cause of cauda equina syndrome (especially in the German shepherd dog [GSD]), a condition recently thought to be inherited. The frequency of this condition within a large clinical population and the radiographic features used in its detection are reported. In a group of 143 patients, the sexes were similarly represented and the GSD was greatly over represented. The anomaly is characterised by separation of the first sacral segment that was identified on the lateral view by the presence of a radiolucent disc space between what are normally the first and second sacral segments. On the ventrodorsal view, the anomaly was characterised by separation of the spinous processes between what are normally the first and second sacral segments. In the presence of the transitional segment, the nature of the sacroiliac joint at the level of the anomalous segment varies from a strong ilial attachment, with the presence of a wing-like lateral process, to a weakened ilial attachment because of the presence of a lateral process, shaped as that seen on a lumbar segment. These patterns were present unilaterally or bilaterally and result in symmetrical or asymmetrical patterns. The effect of the weakening of the sacroiliac attachment was thought to result in premature disc degeneration, which, together with spinal canal stenosis, resulted in potential compression of the overlying spinal nerves and creation of a cauda equina syndrome. The condition is thought to have clinical significance and should be selected against in breeding, especially in the GSD

Uniform dose compensation using field within a field technique in T-shaped irradiation for esophageal cancer

International Nuclear Information System (INIS)

Murakami, Ryuji; Sugahara, Takeshi; Baba, Yuji; Yamashita, Yasuyuki

2003-01-01

We devised a uniform compensation method to improve dose distribution using the field within a field technique in T-shaped irradiation for esophageal cancer. Isodose curves and dose volume histograms (DVH) of the esophagus in the treatment volume were examined in ten patients treated for esophageal cancers. For the DVH analysis, the prescription dose was 40 Gy to the center of the treatment volume, and the volume ratio of the esophagus receiving within ±5% of the prescription dose (38-42 Gy) was regarded as an index of dose homogeneity (V±5%). The peak dose in the conventional antero-posterior opposed fields irradiation existed at the clavicular level, and the 90% isodose curve crossing the esophagus almost corresponded to the top level of the aortic arch. When 40 Gy is irradiated, the maximum dose of the esophagus and V±5% were 45.55±0.55 Gy and 59.7±13.2% respectively. The dose distribution of the esophagus became relatively homogeneous when a 10% dose was added using the field within a field technique to the area under the bottom level of the aortic arch, and the maximum dose and V±5% were 42.53±0.94 Gy and 91.7±7.1% respectively. A 10% and more overdose area existed at the clavicular level in the conventional antero-posterior opposed fields irradiation. A relatively homogeneous dose distribution could be obtained using the field within a field technique. (author)

Exploration of clinical changes following a novel mobilisation technique for treatment of chronic low back pain: A single cohort design.

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Hanson, Gail C; Jones, Bruce; Bacon, Catherine J; Moran, Robert W

2016-07-01

To explore clinical changes following a novel manual mobilisation technique, 24 participants who experienced 'moderate' to 'severe' chronic low back pain were recruited from new patients attending a suburban osteopathy clinic. The intervention was a previously undescribed side-lying mobilisation technique targeting the lumbosacral spine (median of 6 treatment sessions). After 8 weeks reductions were shown in Oswestry Disability Index of 15 points (95% CI: 9.3, 22.7; p pain intensity, disability and function improved in most participants following treatment. Further investigation is indicated using more robust research designs to compare this approach with other treatment approaches and usual care for the treatment of chronic low back pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

Changes in galanin immunoreactivity in rat lumbosacral spinal cord and dorsal root ganglia after spinal cord injury.

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Zvarova, K; Murray, E; Vizzard, M A

2004-08-02

Alterations in the expression of the neuropeptide galanin were examined in micturition reflex pathways 6 weeks after complete spinal cord transection (T8). In control animals, galanin expression was present in specific regions of the gray matter in the rostral lumbar and caudal lumbosacral spinal cord, including: (1) the dorsal commissure; (2) the superficial dorsal horn; (3) the regions of the intermediolateral cell column (L1-L2) and the sacral parasympathetic nucleus (L6-S1); and (4) the lateral collateral pathway in lumbosacral spinal segments. Densitometry analysis demonstrated significant increases (P < or = 0.001) in galanin immunoreactivity (IR) in these regions of the S1 spinal cord after spinal cord injury (SCI). Changes in galanin-IR were not observed at the L4-L6 segments except for an increase in galanin-IR in the dorsal commissure in the L4 segment. In contrast, decreases in galanin-IR were observed in the L1 segment. The number of galanin-IR cells increased (P < or = 0.001) in the L1 and S1 dorsal root ganglia (DRG) after SCI. In all DRG examined (L1, L2, L6, and S1), the percentage of bladder afferent cells expressing galanin-IR significantly increased (4-19-fold) after chronic SCI. In contrast, galanin expression in nerve fibers in the urinary bladder detrusor and urothelium was decreased or eliminated after SCI. Expression of the neurotrophic factors nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) was altered in the spinal cord after SCI. A significant increase in BDNF expression was present in spinal cord segments after SCI. In contrast, NGF expression was only increased in the spinal segments adjacent and rostral to the transection site (T7-T8), whereas spinal segments (T13-L1; L6-S1), distal to the transection site exhibited decreased NGF expression. Changes in galanin expression in micturition pathways after SCI may be mediated by changing neurotrophic factor expression, particularly BDNF. These changes may contribute to

Measurement of the angle formed between the thalamostriate vein and internal cerebral vein in anteroposterior projection: A method of estimating the size of the lateral ventricle

International Nuclear Information System (INIS)

Choi, Il Soon; Yoo, Ho Joon; Kim, Myung Sung; Park, Kwang Joo

1974-01-01

The size and shape of the lateral ventricle are frequently altered by intracranial lesions, and this may be reflected on cerebral angiogram. The size and dilatation of the lateral ventricle may be estimate by the course of the thalamostirate vein (TSV) and the distance between the midline and the TSV in frontal projection, the course of the pericallosal artery and the distance between the venous angle and subependymal veins in lateral projection. However, little description can be found in the literature about the method of expressing the size and degree of dilatation of the lateral ventricle on cerebral angiogram. The authors have attempted to find out an easy way of precisely estimating the size of the lateral ventricle and to observe how it can be applied in the patients with various expanding intracranial lesions. We measured the angle formed between the internal cerebral vein (ICV) and the TSV in the anteroposterior roentgenograms of venous phase in normal group composed of 61 patients in whom no significant abnormality could be detected neurologically or by other methods, and in 18 patients with expanding intracranial lesions. The results obtained are as follows: 1. In the normal group, the average angle formed between the ICV and TSV on the anteroposterior angiogram obtained with the central beam projected making an angle of 10 to 15 .deg with the orbitomeatal line was 25.7 ± 3.9 .deg, ranging from 19 to 34 .deg. The angle measured from 20 to 30 in 85% of the normal group. There was no significant difference between the male and the female as well as between the children and adults. 2. The measurement of the angle was found to reflect faithfully the size of the lateral ventricle on the side examined, increasing as the lateral ventricle dilated. When the angle measures more than 33.deg. the lateral ventricle would certainly be dilated. The lateral ventricle can be taken as moderately dilated when the measurement exceeds 40.deg and as severely dilated when

A computerized method for automated identification of erect posteroanterior and supine anteroposterior chest radiographs

International Nuclear Information System (INIS)

Kao, E-Fong; Chou, Ming-Chung; Lin, Wei-Chen; Hsu, Jui-Sheng; Jaw, Twei-Shiun; Liu, Gin-Chung

2011-01-01

A computerized scheme was developed for automated identification of erect posteroanterior (PA) and supine anteroposterior (AP) chest radiographs. The method was based on three features, the tilt angle of the scapula superior border, the tilt angle of the clavicle and the extent of radiolucence in lung fields, to identify the view of a chest radiograph. The three indices A scapula , A clavicle and C lung were determined from a chest image for the three features. Linear discriminant analysis was used to classify PA and AP chest images based on the three indices. The performance of the method was evaluated by receiver operating characteristic analysis. The proposed method was evaluated using a database of 600 PA and 600 AP chest radiographs. The discriminant performances Az of A scapula , A clavicle and C lung were 0.878 ± 0.010, 0.683 ± 0.015 and 0.962 ± 0.006, respectively. The combination of the three indices obtained an Az value of 0.979 ± 0.004. The results indicate that the combination of the three indices could yield high discriminant performance. The proposed method could provide radiologists with information about the view of chest radiographs for interpretation or could be used as a preprocessing step for analyzing chest images.

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

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Cohen Anders

2011-09-01

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

Transarticular fixation with cortical screws combined with dorsal laminectomy and partial discectomy as surgical treatment of degenerative lumbosacral stenosis in 17 dogs: clinical and computed tomography follow-up.

Science.gov (United States)

Golini, Lorenzo; Kircher, Patrick R; Lewis, Fraser I; Steffen, Frank

2014-05-01

To describe clinical outcome and technical outcome assessed using computed tomography (CT) in dogs with degenerative lumbosacral stenosis (DLSS) treated by dorsal laminectomy, partial discectomy, and transarticular screw fixation. Retrospective observational case series. Dogs with DLSS (n = 17). Dogs with neurologic and magnetic resonance imaging (MRI) findings compatible with DLSS treated by dorsal laminectomy, partial discectomy and transarticular screw fixation were enrolled. Pre- and postoperative neurologic status was compared. Lumbosacral (LS) angle in extension and misalignment in preoperative MRI were compared with the postoperative CT. Residual mobility of the LS joint after fixation was also evaluated. Status of screws, presence of new bone formation over screw heads/articular facets and presence of adjacent segment disease (ASD) were assessed. Median CT follow-up was 12 months. Clinical improvement was seen in 13 dogs, 2 dogs had intermittent LS pain, and 2 dogs needed revision surgery. In 5 dogs, screws were either pulled out or broken. Reduction of LS angle in extension and misalignment was achieved. Residual mobility of the LS segment was present and ASD was not recognized. Transarticular screw fixation in dogs with DLSS is associated with a considerable number of technical failures and does not result in rigid stabilization; however, this did not significantly adversely influence clinical outcome. © Copyright 2014 by The American College of Veterinary Surgeons.

Gonad protection for the antero-posterior projection of the pelvis in diagnostic radiography in Dublin hospitals

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Doolan, Aoife; Brennan, Patrick C. E-mail: patrick.brennan@ucd.ie; Rainford, Louise A.; Healy, Jan

2004-02-01

Gonad shielding during diagnostic X-ray procedures is an effective way of reducing radiation dose to patients' reproductive organs and reduces the risk of genetic effects in future generations. The utilisation of gonad shielding, the availability of shields and the existence of written protocols for the use of radiation shielding for antero-posterior projections of the male and female pelvis were examined in four major Dublin hospitals. A retrospective study of 198 pelvic radiographs revealed that only 2% (n=4) of images had evidence of gonad shielding. All four images that demonstrated shielding showed that the shield was malpositioned with either important bony anatomy obscured or gonads not sufficiently protected. Some of the hospitals surveyed had inadequate supplies of gonad shields in the general radiography rooms and no written protocols were available. The results of this study indicate that patients in the hospitals investigated are receiving avoidable gonad irradiation due to the omission, or malpositioning of gonad shields during pelvis examinations. In line with recent EC recommendations appropriate shielding of the gonads during pelvis AP examinations should be encouraged.

Gonad protection for the antero-posterior projection of the pelvis in diagnostic radiography in Dublin hospitals

International Nuclear Information System (INIS)

Doolan, Aoife; Brennan, Patrick C.; Rainford, Louise A.; Healy, Jan

2004-01-01

Gonad shielding during diagnostic X-ray procedures is an effective way of reducing radiation dose to patients' reproductive organs and reduces the risk of genetic effects in future generations. The utilisation of gonad shielding, the availability of shields and the existence of written protocols for the use of radiation shielding for antero-posterior projections of the male and female pelvis were examined in four major Dublin hospitals. A retrospective study of 198 pelvic radiographs revealed that only 2% (n=4) of images had evidence of gonad shielding. All four images that demonstrated shielding showed that the shield was malpositioned with either important bony anatomy obscured or gonads not sufficiently protected. Some of the hospitals surveyed had inadequate supplies of gonad shields in the general radiography rooms and no written protocols were available. The results of this study indicate that patients in the hospitals investigated are receiving avoidable gonad irradiation due to the omission, or malpositioning of gonad shields during pelvis examinations. In line with recent EC recommendations appropriate shielding of the gonads during pelvis AP examinations should be encouraged

Characteristics of anteroposterior curvatures of the spine in soccer and futsal players

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Chromik Krystyna

2017-12-01

Full Text Available Purpose. The aim of the study was to determine differences in anteroposterior spine curvatures between futsal players, soccer players, and non-training students. The results may contribute to the development of present-day knowledge of posturometry, and its implementation in training can help reduce the risk of body posture disorders in athletes. Methods. The examined group consisted of 48 athletes and 38 non-training college students. Body posture parameters were measured with the use of Posturometr-S. The normality of distribution was checked with the Shapiro-Wilk test, and the differences between the groups were measured with ANOVA and the Bonferroni post-hoc test. The level of statistical significance was set at p < 0.05. Results. The analysis of angle values revealed the widest and most similar measurements in the group of futsal players and soccer players. The analysis of variance proved statistically significant differences between the soccer players and futsal players (p = 0.003. The difference between the soccer players and non-training students was statistically significant. The highest γ angular value was measured in non-training students, followed by futsal players and soccer players. The statistical analysis revealed significant differences between the non-training students and futsal players, as well as non-training students and soccer players (p < 0.001. Conclusions. A complex assessment of athletes’ body posture is crucial in injury prevention. Training overloads may often lead to disorders of the organ of locomotion and affect the correct body posture in athletes. This, in turn, may result in pains and injuries.

‘Inverted Y’ field radiotherapy planning with multi-leaf collimator: A single isocentric technique using multiple fields

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Puja Sahai

2015-01-01

Full Text Available The purpose of our study is to describe a planning technique using multi-leaf collimator and asymmetric fields for irradiating an ‘inverted Y’ shaped geometry in a patient with testicular seminoma. The entire target area covering the para-aortic, pelvic, and inguinal nodal regions was split into three fields. Single isocenter half-beam block technique was employed. The fields were planned with antero-posterior and postero-anterior portals with a differential weightage. The dose was prescribed at the respective reference points of the fields. A uniform dose distribution for the entire portal was achieved without any under- or over-dosing at the field junctions.  

LUMBOSACRAL TRANSITIONAL ANATOMY TYPES AND DISC DEGENERATIVE CHANGES

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Chabukovska Radulovska Jasminka

2014-07-01

bridging of the lumbosacral transitional vertebra with the sacrum protects the disc at the transitional level and produces greater stress to adjacent cephalad segment. Bilateral osseus bridging seems to be most protective to the disc at the transitional level, but this type of LSTV produces great stress to the adjacent cephalad level.

Lumbosacral transitional vertebrae in dogs: classification, prevalence, and association with sacroiliac morphology.

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Damur-Djuric, Natascha; Steffen, Frank; Hässig, Michael; Morgan, Joe P; Flückiger, Mark A

2006-01-01

The prevalence of lumbosacral transitional vertebrae (LTV) was determined by reviewing the pelvic radiographs of 4000 medium- and large-breed dogs of 144 breeds routinely screened for canine hip dysplasia. An LTV was seen in 138 (3.5%) dogs. The prevalence was higher in German Shepherd dogs and Greater Swiss Mountain dogs than in the other breeds, suggesting a genetic predisposition. There was no gender predisposition. The transverse processes of the LTV were divided into three types based on their morphological characteristics: lumbar type or type 1; intermediate type or type 2; and sacral type or type 3. In a symmetric LTV, both transverse processes are of the same type, while in an asymmetric LTV they are not. The frequency of occurrence of symmetric and asymmetric LTV was similar. In symmetric LTV, intermediate-type transverse processes predominated. Most of the asymmetric LTV had an intermediate-type transverse process combined with a lumbar or sacral type, respectively. Highly asymmetric LTV were often angled relative to the adjacent vertebrae. We hypothesize that an LTV is not the result of transformation of a lumbar into a sacral vertebra or vice versa, but rather is an autonomous intermediate type of vertebra. It occurs when the point of contact of the pelvis with the vertebral column is slightly cranial or caudal to its normal position. The resulting formative stimulus on the vertebral ossification centers, sagittally still separated, causes the various morphologies seen in LTV including the asymmetric variations.

Effect of total lumbar disc replacement on lumbosacral lordosis.

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Kasliwal, Manish K; Deutsch, Harel

2012-10-01

Original article : To study effect of lumbar disc replacement on lumbosacral lordosis. There has been a growing interest in total disc replacement (TDR) for back pain with the rising concern of adjacent segment degeneration. Lumbar fusion surgery has been shown to lead to decrease in lumbar lordosis, which may account for postfusion pain resulting in less acceptable clinical outcome after successful fusion. TDR has recently emerged as an alternative treatment for back pain. There have been very few studies reporting lumbar sagittal outcome after TDR. Retrospective study of radiographic data of 17 patients who underwent TDR for single level degenerative disc disease at the author's institution was carried out. Study included measurement of preoperative and postoperative segmental and global lumbar lordosis and angle of lordosis. Patients age varied from 19 to 54 (mean, 35) years. Follow-up ranged from 12 to 24 months. TDR was performed at L4-5 level in 3 patients and L5-S1 level in 14 patients. The average values for segmental lordosis, global lordosis, and angle of lordosis at the operated level before and after surgery were 17.3, 49.7, and 8.6 degrees and 21.6, 54, and 9.5 degrees, respectively. There was a trend toward significant (P=0.02) and near significant (P=0.057) increase in segmental and global lordosis, respectively after TDR. Although prosthesis increased angle of lordosis at the level implanted in majority of the patients, the difference in preoperative and postoperative angle of lordosis was not significant (P=0.438). In addition, there was no correlation between the angle of implant of chosen and postoperative angle of lordosis at the operated level. The effect of TDR on sagittal balance appears favorable with an increase in global and segmental lumbar lordosis after single level TDR for degenerative disc disease. The degree of postoperative angle of lordosis was not affected by the angle of implant chosen at the operated level and varied

Crossed-swords, capsule-pinch technique for capsulotomy in pediatric and/or loose lens cataract extraction.

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Snyder, Michael E; Lindsell, Luke B

2010-02-01

Puncturing the anterior capsule in a patient with a very soft lens, an elastic capsule, and/or deficient zonular countertraction can be challenging even with a sharp needle or blade. The crossed-swords, capsule-pinch technique capitalizes on opposing forces from 2 needles directed toward each other with a "pinch" of the capsule between their tips. This affords a controlled and facile puncture of the capsule without creating stress on the zonules or anteroposterior displacement of the lens. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

MAGNETIC RESONANCE IMAGING IN FAILED BACK SURGERY SYNDROME

OpenAIRE

SEN, KK; SINGH, AMARJIT

1999-01-01

The failed back surgery syndrome (FBSS) is a severe, long-lasting, disabling and relatively frequent (5-10%) complication of lumbosacral spine surgery. Wrong level surgery, inadequate surgical techniques, vertebral instability, recurrent disc herniation, and lumbosacral fibrosis are the most frequent causes of FBSS. The results after repeated surgery on recurrent disc herniations are comparable to those after the first intervention, whereas repeated surgery for fibrosis gives only 30-35% succ...

Comparison of conversion coefficients for equivalent dose in terms of air kerma using a sitting and standing female adult voxel simulators exposure to photons in antero-posterior irradiation geometry

International Nuclear Information System (INIS)

Cavalcante, F.R.; Galeano, D.C.; Carvalho Júnior, A.B.; Hunt, J.

2014-01-01

Due to the difficulty in implementing invasive techniques for calculations of dose for some exposure scenarios, computational simulators have been created to represent as realistically as possible the structures of the human body and through radiation transport simulations to obtain conversion coefficients (CCs) to estimate dose. In most published papers simulators are implemented in the standing posture and this may not describe a real scenario of exposure. In this work we developed exposure scenarios in the Visual Monte Carlo (VMC) code using a female simulator in standing and sitting postures. The simulator was irradiated in the antero-posterior (AP) geometry by a plane source of monoenergetic photons with energy from 10 keV to 2 MeV. The conversion coefficients for equivalent dose in terms of air kerma (H T /K air ) were calculated for both scenarios and compared. The results show that the percentage difference of CCs for the organs of the head and thorax was not significant (less than 5%) since the anatomic position of the organs is the same in both postures. The percentage difference is more significant to the ovaries (71% for photon energy of 20 keV), to the bladder (39% at 60 keV) and to the uterus (37% at 100 keV) due to different processes of radiation interactions in the legs of the simulator when its posture is changed. For organs and tissues that are distributed throughout the entire body, such as bone (21% at 100 keV) and muscle (30% at 80 keV) the percentage difference of CCs reflects a reduction of interaction of photons with the legs of the simulator. Therefore, the calculation of conversion coefficients using simulators in the sitting posture is relevant for a more accurate dose estimation in real exposures to radiation. - Highlights: ► Scenarios of external photon exposures were performed in VMC code. ► The FAX simulator was irradiated in sitting and standing postures. ► The irradiation geometry used was the antero-posterior (AP). ► The

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

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Omar Hesham R

2011-09-01

Full Text Available Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

Science.gov (United States)

Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

2011-09-27

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

Improved techniques in radionuclides imaging of prostatic lymph nodes

International Nuclear Information System (INIS)

Gardiner, R.A.; Fitzpatrick, J.M.; Constable, A.R.; Cranage, R.W.; O'Donoghue, E.P.N.; Wickham, J.E.A.

1979-01-01

Further improvements were made in the techniques of human prostatic lymphoscintigraphy, allowing better anatomical localisation of the areas of uptake of activity. A single median injection into the capsule of sup(99m)Tc labelled antimony sulphide colloid was found to give as good imaging as 2 injections on either side of the midline. By placing markers on the umbilicus, pubic symphysis and both anterior superior iliac spines, a 'pelvic grid' could be superimposed on the antero-posterior view. Further help with accurate localisation may be attained by taking 3 views; anterio-posterior, postero-anterior and lateral. In 9 instances, prostatic injection was performed without any sedation or anaesthesia. The resulting scintigrams were indistinguishable in quality from those of anaesthetised patients. (author)

A simple planning technique of craniospinal irradiation in the eclipse treatment planning system

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Hemalatha Athiyaman

2014-01-01

Full Text Available A new planning method for Craniospinal Irradiation by Eclipse treatment planning system using Field alignment, Field-in-Field technique was developed. Advantage of this planning method was also studied retrospectively for previously treated five patients of medulloblastoma with variable spine length. Plan consists of half beam blocked parallel opposed cranium, and a single posterior cervicospine field was created by sharing the same isocenter, which obviates divergence matching. Further, a single symmetrical field was created to treat remaining Lumbosacral spine. Matching between a inferior diverging edge of cervicospine field and superior diverging edge of a Lumbosacral field was done using the field alignment option. ′Field alignment′ is specific option in the Eclipse Treatment Planning System, which automatically matches the field edge divergence as per field alignment rule. Multiple segments were applied in both the spine field to manage with hot and cold spots created by varying depth of spinal cord. Plan becomes fully computerized using this field alignment option and multiple segments. Plan evaluation and calculated mean modified Homogeneity Index (1.04 and 0.1 ensured that dose to target volume is homogeneous and critical organ doses were within tolerance. Dose variation at the spinal field junction was verified using ionization chamber array (I′MatriXX for matched, overlapped and gap junction spine fields; the delivered dose distribution confirmed the ideal clinical match, over exposure and under exposure at the junction, respectively. This method is simple to plan, executable in Record and Verify mode and can be adopted for various length of spinal cord with only two isocenter in shorter treatment time.

Extra-skeletal Ewing sarcoma of the lumbosacral region in an adult pregnant patient: a case report.

Science.gov (United States)

Al Khawaja, Darweesh; Vescovi, Cristina; Dower, Ashraf; Thiruvilangam, Vallapan; Mahasneh, Tamadur

2017-03-01

Extra-skeletal Ewing sarcoma in pregnancy is rare. There is thus limited scientific evidence to guide clinicians in its complicated management, particularly within the context of early gestation. We therefore share our successful outcome in a 32-year-old pregnant patient, following a unique management strategy of complete aggressive surgical resection prior to neo-adjuvant therapy. The case involved a 2-month history of right-sided back and gluteal pain, with associated paraesthesia. Lumbosacral magnetic resonance imaging (MRI) revealed an approximate 40×50 mm indeterminate mass in the lower right paraspinal musculature. The mass extended into the first right sacral foramen and the central canal; and also impinged on the S2 exiting nerve. After considering the patients' rapid deterioration, pregnant status and other clinical factors, it was elected to proceed with complete surgical resection prior to any other therapeutic modality. Following surgery, the patient experienced immediate resolution of her pain and by 6 weeks was able to cease the use of all analgesics. At 32-weeks' gestation she underwent an uncomplicated vaginal delivery. At 9 months follow up, she remains disease free and has experienced complete resolution of her back pain and radiculopathy.

Image and dose quality in selected studies of conventional radiology in designed hospitals

International Nuclear Information System (INIS)

Cardenas H, J.; Martinez G, A.; Machado T, A.; Mora M, R. de la; Pedroso, L.; Villa Z, R.; Sotolongo C, J.A.; Rodriguez S, R.M.; Martinez A, U.; Figueroa G, L.M.

2006-01-01

The medical exposures have a significant contribution to the received doses by the population. As they generally contribute to the patient's direct benefit during a lot of time has been paid smaller attention that to other exposure forms, in spite of existing potentialities of reducing dose to the patients as consequence of these applications. In such sense in the last years the scientific community and international organizations have defined requirements to contribute to that the doses to the patients are the minimum ones necessary to achieve its diagnostic objective. The work exposes the results obtained in the evaluation of the image quality and dose in studies of radiology of thorax posteroanterior and of lumbosacral column anteroposterior and lateral, carried out in 2 university hospitals of La Havana, as well as the contribution of this investigation to the establishment of guidance levels in our country. (Author)

Image and dose quality in selected studies of conventional radiology in designed hospitals; Calidad de imagen y dosis en estudios seleccionados de radiologia convencional en hospitales designados

Energy Technology Data Exchange (ETDEWEB)

Cardenas H, J.; Martinez G, A. [CPHR, Calle 20 No. 4113 e/41 y 47 Playa, C.P. 11300 La Habana (Cuba); Machado T, A.; Mora M, R. de la [Centro de Control Estatal de Equipos Medicos (Cuba); Pedroso, L. [Grupo Asesor del Ministerio de Salud Publica en materia de radiologia (Cuba); Villa Z, R. [Programa de Seguridad Radiologica del Ministerio de Salud Publica (Cuba); Sotolongo C, J.A.; Rodriguez S, R.M. [Hospital Universitario Clinico Quirurgico ' Luis Diaz Soto' (Cuba); Martinez A, U.; Figueroa G, L.M. [Hospital Universitario Clinico Quirurgico ' Miguel Enriquez' (Cuba)]. e-mail: cardenas@cphr.edu.cu

2006-07-01

The medical exposures have a significant contribution to the received doses by the population. As they generally contribute to the patient's direct benefit during a lot of time has been paid smaller attention that to other exposure forms, in spite of existing potentialities of reducing dose to the patients as consequence of these applications. In such sense in the last years the scientific community and international organizations have defined requirements to contribute to that the doses to the patients are the minimum ones necessary to achieve its diagnostic objective. The work exposes the results obtained in the evaluation of the image quality and dose in studies of radiology of thorax posteroanterior and of lumbosacral column anteroposterior and lateral, carried out in 2 university hospitals of La Havana, as well as the contribution of this investigation to the establishment of guidance levels in our country. (Author)

The effect of the descent technique and truck cabin layout on the landing impact forces.

Science.gov (United States)

Patenaude, S; Marchand, D; Samperi, S; Bélanger, M

2001-12-01

The majority of injuries to truckers are caused by falls during the descent from the cab of the truck. Several studies have shown that the techniques used to descend from the truck and the layout of the truck's cabin are the principal cause of injury. The goal of the present study was to measure the effects of the descent techniques used by the trucker and the layout of the truck's cabin on the impact forces absorbed by the lower limbs and the back. Kinematic data, obtained with the aid of a video camera, were combined with the force platform data to allow for calculation of the lower limb and L5-S1 torques as well as L5-S1 compressive forces. The trucker descended from two different conventional tractor cabin layouts. Each trucker descended from cabin using either "facing the truck" (FT) or "back to the truck" (BT) techniques. The results demonstrate that the BT technique produces greater ground impact forces than the FT technique, particularly when the truck does not have a handrail. The BT technique also causes an increase in the compressive forces exerted on the back. In conclusion, the use of the FT technique along with the aids (i.e., handrails and all the steps) help lower the landing impact forces as well as the lumbosacral compressive forces.

Radiographic assessment of lower third molar eruption in different anteroposterior skeletal patterns and age-related groups.

Science.gov (United States)

Jakovljevic, Aleksandar; Lazic, Emira; Soldatovic, Ivan; Nedeljkovic, Nenad; Andric, Miroslav

2015-07-01

To analyze radiographic predictors for lower third molar eruption among subjects with different anteroposterior skeletal relations and of different age groups. In total, 300 lower third molars were recorded on diagnostic digital orthopantomograms (DPTs) and lateral cephalograms (LCs). The radiographs were grouped according to sagittal intermaxillary angle (ANB), subject age, and level of lower third molar eruption. The DPT was used to analyze retromolar space, mesiodistal crown width, space/width ratio, third and second molar angulation (α, γ), third molar inclination (β), and gonion angle. The LC was used to determine ANB, angles of maxillar and mandibular prognathism (SNA, SNB), mandibular plane angle (SN/MP), and mandibular lengths. A logistic regression model was created using the statistically significant predictors. The logistic regression analysis revealed a statistically significant impact of β angle and distance between gonion and gnathion (Go-Gn) on the level of lower third molar eruption (P third molar impaction rate was significantly higher in the adult subgroup with the Class II (62.3%) compared with Class III subjects (31.7%; P third molar eruption were measured in Class III subjects. For valid estimation of mandibular third molar eruption, certain linear and angular measures (β angle, Go-Gn), as well as the size of the retromolar space, need to be considered.

Finding the neck-trunk boundary in snakes: anteroposterior dissociation of myological characteristics in snakes and its implications for their neck and trunk body regionalization.

Science.gov (United States)

Tsuihiji, Takanobu; Kearney, Maureen; Rieppel, Olivier

2012-09-01

The neck and trunk regionalization of the presacral musculoskeletal system in snakes and other limb-reduced squamates was assessed based on observations on craniovertebral and body wall muscles. It was confirmed that myological features characterizing the neck in quadrupedal squamates (i.e., squamates with well-developed limbs) are retained in all examined snakes, contradicting the complete lack of the neck in snakes hypothesized in previous studies. However, the posterior-most origins of the craniovertebral muscles and the anterior-most bony attachments of the body wall muscles that are located at around the neck-trunk boundary in quadrupedal squamates were found to be dissociated anteroposteriorly in snakes. Together with results of a recent study that the anterior expression boundaries of Hox genes coinciding with the neck-trunk boundary in quadrupedal amniotes were dissociated anteroposteriorly in a colubrid snake, these observations support the hypothesis that structures usually associated with the neck-trunk boundary in quadrupedal squamates are displaced relative to one another in snakes. Whereas certain craniovertebral muscles are elongated in some snakes, results of optimization on an ophidian cladogram show that the most recent common ancestor of extant snakes would have had the longest craniovertebral muscle, M. rectus capitis anterior, that is elongated only by several segments compared with that of quadrupedal squamates. Therefore, even such a posteriorly displaced "cervical" characteristic plesiomorphically lies fairly anteriorly in the greatly elongated precloacal region of snakes, suggesting that the trunk, not the neck, would have contributed most to the elongation of the snake precloacal region. A similar dissociation of structures usually associated with the neck-trunk boundary in quadrupedal squamates is observed in limb-reduced squamates, suggesting that these forms and snakes may share a developmental mechanism producing modifications in the

Dutch Multidisciplinary Guideline for Invasive Treatment of Pain Syndromes of the Lumbosacral Spine.

Science.gov (United States)

Itz, Coen J; Willems, Paul C; Zeilstra, Dick J; Huygen, Frank J

2016-01-01

When conservative therapies such as pain medication or exercise therapy fail, invasive treatment may be indicated for patients with lumbosacral spinal pain. The Dutch Society of Anesthesiologists, in collaboration with the Dutch Orthopedic Association and the Dutch Neurosurgical Society, has taken the initiative to develop the guideline "Spinal low back pain," which describes the evidence regarding diagnostics and invasive treatment of the most common spinal low back pain syndromes, that is, facet joint pain, sacroiliac joint pain, coccygodynia, pain originating from the intervertebral disk, and failed back surgery syndrome. The aim of the guideline is to determine which invasive treatment intervention is preferred for each included pain syndrome when conservative treatment has failed. Diagnostic studies were evaluated using the EBRO criteria, and studies on therapies were evaluated with the Grading of Recommendations Assessment, Development and Evaluation system. For the evaluation of invasive treatment options, the guideline committee decided that the outcome measures of pain, function, and quality of life were most important. The definition, epidemiology, pathophysiological mechanism, diagnostics, and recommendations for invasive therapy for each of the spinal back pain syndromes are reported. The guideline committee concluded that the categorization of low back pain into merely specific or nonspecific gives insufficient insight into the low back pain problem and does not adequately reflect which therapy is effective for the underlying disorder of a pain syndrome. Based on the guideline "Spinal low back pain," facet joint pain, pain of the sacroiliac joint, and disk pain will be part of a planned nationwide cost-effectiveness study. © 2015 World Institute of Pain.

Identification of the sexually dimorphic gastrin-releasing peptide system in the lumbosacral spinal cord that controls male reproductive function in the mouse and Asian house musk shrew (Suncus murinus).

Science.gov (United States)

Tamura, Kei; Kobayashi, Yasuhisa; Hirooka, Asuka; Takanami, Keiko; Oti, Takumi; Jogahara, Takamichi; Oda, Sen-Ichi; Sakamoto, Tatsuya; Sakamoto, Hirotaka

2017-05-01

Several regions of the brain and spinal cord control male reproductive function. We previously demonstrated that the gastrin-releasing peptide (GRP) system, located in the lumbosacral spinal cord of rats, controls spinal centers to promote penile reflexes during male copulatory behavior. However, little information exists on the male-specific spinal GRP system in animals other than rats. The objective of this study was to examine the functional generality of the spinal GRP system in mammals using the Asian house musk shrew (Suncus murinus; suncus named as the laboratory strain), a specialized placental mammal model. Mice are also used for a representative model of small laboratory animals. We first isolated complementary DNA encoding GRP in suncus. Phylogenetic analysis revealed that suncus preproGRP was clustered to an independent branch. Reverse transcription-PCR showed that GRP and its receptor mRNAs were both expressed in the lumbar spinal cord of suncus and mice. Immunohistochemistry for GRP demonstrated that the sexually dimorphic GRP system and male-specific expression/distribution patterns of GRP in the lumbosacral spinal cord in suncus are similar to those of mice. In suncus, we further found that most GRP-expressing neurons in males also express androgen receptors, suggesting that this male-dominant system in suncus is also androgen-dependent. Taken together, these results indicate that the sexually dimorphic spinal GRP system exists not only in mice but also in suncus, suggesting that this system is a conserved property in mammals. J. Comp. Neurol. 525:1586-1598, 2017. © 2016 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Changes in the substance P-containing innervation of the lumbosacral spinal cord in male Wistar rats as a consequence of ageing.

Science.gov (United States)

Ranson, Richard N; Priestley, David J; Santer, Robert M; Watson, Alan H D

2005-03-02

Quantitative image analysis was used to determine age-related changes in the substance P-containing innervation of autonomic and somatic nuclei in the lumbosacral spinal cord, which are associated with the control of micturition and sexual reflexes. In the upper lumbar segments (L1-L2), significant declines in the distribution density of substance P-containing processes were observed in the dorsal grey commissure, the intermediolateral cell column and the ventral horn. More caudally, at levels corresponding to L5 through S1, significant reductions were seen in the dorsal grey commissure and within the sacral parasympathetic nucleus. In contrast to these observations, the substance P-immunoreactive innervation of the dorsolateral nucleus remained robust in aged animals and was not significantly different from young adults. It is possible that these distinct age-related patterns of change in substance P-containing innervation, are reflected in the urinary/sexual dysfunction's in aged animals.

Anteroposterior axis patterning by early canonical Wnt signaling during hemichordate development

Science.gov (United States)

Darras, Sébastien; Fritzenwanker, Jens H.; Uhlinger, Kevin R.; Farrelly, Ellyn; Pani, Ariel M.; Hurley, Imogen A.; Norris, Rachael P.; Osovitz, Michelle; Terasaki, Mark; Wu, Mike; Aronowicz, Jochanan; Kirschner, Marc; Gerhart, John C.

2018-01-01

The Wnt family of secreted proteins has been proposed to play a conserved role in early specification of the bilaterian anteroposterior (A/P) axis. This hypothesis is based predominantly on data from vertebrate embryogenesis as well as planarian regeneration and homeostasis, indicating that canonical Wnt (cWnt) signaling endows cells with positional information along the A/P axis. Outside of these phyla, there is strong support for a conserved role of cWnt signaling in the repression of anterior fates, but little comparative support for a conserved role in promotion of posterior fates. We further test the hypothesis by investigating the role of cWnt signaling during early patterning along the A/P axis of the hemichordate Saccoglossus kowalevskii. We have cloned and investigated the expression of the complete Wnt ligand and Frizzled receptor complement of S. kowalevskii during early development along with many secreted Wnt modifiers. Eleven of the 13 Wnt ligands are ectodermally expressed in overlapping domains, predominantly in the posterior, and Wnt antagonists are localized predominantly to the anterior ectoderm in a pattern reminiscent of their distribution in vertebrate embryos. Overexpression and knockdown experiments, in combination with embryological manipulations, establish the importance of cWnt signaling for repression of anterior fates and activation of mid-axial ectodermal fates during the early development of S. kowalevskii. However, surprisingly, terminal posterior fates, defined by posterior Hox genes, are unresponsive to manipulation of cWnt levels during the early establishment of the A/P axis at late blastula and early gastrula. We establish experimental support for a conserved role of Wnt signaling in the early specification of the A/P axis during deuterostome body plan diversification, and further build support for an ancestral role of this pathway in early evolution of the bilaterian A/P axis. We find strong support for a role of cWnt in

Effect of lordosis angle change after lumbar/lumbosacral fusion on sacrum angular displacement: a finite element study.

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Mao, Ningfang; Shi, Jian; He, Dawei; Xie, Yang; Bai, Yushu; Wei, Xianzhao; Shi, Zhicai; Li, Ming

2014-11-01

To assess and characterize the sacrum angular displacements in response to lumbar lordosis after lumbar/lumbosacral fusion. A finite element model of the lower lumbar spine-pelvis was established and used to simulate the posterior fusion at L3-L5 and L4-S1. The lordosis angle in the fusion segments was set to five different conditions with respect to the intact model: 10° less than intact, 5° less than intact, same as intact, 5° more than intact, and 10° more than intact. Variations of the sacrum angular displacements with lordosis changes were analyzed under loading setting of axial compression, flexion, extension, lateral bending, and axial rotation. Compared with the intact lordosis, both increased and decreased lumbar lordosis angles caused the sacrum angular displacements to be increased. The lordosis angle increased by 10° induced the most substantial increase in sacrum angular displacements. In addition, the sacrum angular displacements of the L4-S1 fusion model at different lordosis angles were higher than those of the L3-L5 fusion model. The sacrum angular displacements occur as a result of the fusion surgery (L4-S1) and the changes in lumbar lordosis.

Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension.

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Tripathi, Manjul; Deo, Rama Chandra; Suri, Ashish; Srivastav, Vinkle; Baby, Britty; Kumar, Subodh; Kalra, Prem; Banerjee, Subhashis; Prasad, Sanjiva; Paul, Kolin; Roy, Tara Sankar; Lalwani, Sanjeev

2015-07-01

The surgical corridor to the upper third of the clivus and ventral brainstem is hindered by critical neurovascular structures, such as the cavernous sinus, petrous apex, and tentorium. The traditional Kawase approach provides a 10 × 5-mm fenestration at the petrous apex of the temporal bone between the 5th cranial nerve and internal auditory canal. Due to interindividual variability, sometimes this area proves to be insufficient as a corridor to the posterior cranial fossa. The authors describe a modification to the technique of the extradural anterior petrosectomy consisting of additional transcavernous exploration and medial mobilization of the cisternal component of the trigeminal nerve. This approach is termed the modified Dolenc-Kawase (MDK) approach. The authors describe a volumetric analysis of temporal bones with 3D laser scanning of dry and drilled bones for respective triangles and rhomboid areas, and they compare the difference of exposure with traditional versus modified approaches on cadaver dissection. Twelve dry temporal bones were laser scanned, and mesh-based volumetric analysis was done followed by drilling of the Kawase triangle and MDK rhomboid. Five cadaveric heads were drilled on alternate sides with both approaches for evaluation of the area exposed, surgical freedom, and angle of approach. The MDK approach provides an approximately 1.5 times larger area and 2.0 times greater volume of bone at the anterior petrous apex compared with the Kawase's approach. Cadaver dissection objectified the technical feasibility of the MDK approach, providing nearly 1.5-2 times larger fenestration with improved view and angulation to the posterior cranial fossa. Practical application in 6 patients with different lesions proves clinical applicability of the MDK approach. The larger fenestration at the petrous apex achieved with the MDK approach provides greater surgical freedom at the Dorello canal, gasserian ganglion, and prepontine area and better

Anteroposterior glide versus rotating platform low contact stress (LCS knee arthroplasty: a randomised controlled trial

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Wynn-Jones Charles

2007-08-01

Full Text Available Abstract Background Fifty thousand knee replacements are performed annually in the UK at an estimated cost of £150 million. Post-operative improvement depends on a number of factors including implant design and patient associated factors. To our knowledge there are no published study's comparing the results of AP glide and rotating platform designs of LCS knee arthroplasty. Therefore we feel that a study is required to investigate and compare the effects of two types of LCS total knee arthroplasty on joint proprioception and range of motion. Methods/Design Patients will be randomised to receive either a LCS AP glide or Rotating platform prosthesis. Clinical scores (Oxford knee score, American knee society score, EuroQol, range of motion and proprioception will be assessed prior to and at 3,6, 12 and 24 months after the operation. Proprioception will be assessed in terms of absolute error angle (mean difference between the target angle and the response angle. Knee angles will be measured in degrees using an electromagnetic tracking device, Polhemus 3Space Fastrak that detects positions of sensors placed on the test limb. Student's t-test will be used to compare the mean of two groups. Discussion Evidence is lacking concerning the best prosthesis to use for patients undergoing total knee replacement. This pragmatic randomised trial will test the null hypothesis that anteroposterior glide LCS knee arthroplasty does not result in better post operative knee motion and proprioception as compared to rotating platform LCS knee. Trial Registration ISRCTN52943804

The normal radiological anteroposterior alignment of the lower limb in children

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Popkov, Dmitry; Popkov, Arnold [Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan (Russian Federation); Lascombes, Pierre [University of Geneva, Division of Pediatric Orthopaedics, Geneva (Switzerland); Berte, Nicolas; Hetzel, Laurent; Baptista, Bruno Ribeiro; Journeau, Pierre [Children' s Hospital of Nancy, Department of Pediatric Orthopaedics, Nancy (France)

2014-07-05

The development of reconstructive surgery of the lower limbs aimed at multilevel correction demands a precise knowledge of the physiological variations in general radiological parameters of the lower limbs in children of various age groups. It is crucial in systemic skeletal diseases, when deformities affect limbs and the surgeon does not have an intact limb as a reference. The aim of this retrospective study was to establish the normal radiological values of lower limb parameters used in the surgical correction of deformities in children of various age groups. Teleradiographs of the lower limbs taken in children with unilateral congenital or posttraumatic deformity were retrospectively reviewed. Weight-bearing full-length anteroposterior radiographs of the entire lower extremities were taken in a standing position. The study involved 215 extremities of 208 children (93 girls and 115 boys); the ages ranged from 2 years 1 month to 15 years 11 months old. Key variables included the anatomic medial proximal femoral angle (aMPFA), anatomic lateral distal femoral angle (aLDFA), anatomic medial proximal tibial angle (aMPTA), anatomic lateral distal tibial angle (aLDTA), mechanical axis deviation (MAD), the angle formed by the femoral anatomical axis and the mechanical axis of the lower limb. The means and dynamics of variations, standard deviations (SD) and 95 % confidence intervals of each parameter were calculated for each age and gender group. Simple regression analysis was performed to determine the relationship between the patient's age and the magnitude of aMPFA, aLDFA, aMPTA and aLDTA. Simple regression analysis showed a significant inverse correlation between patient age and the magnitude of aMPFA: the correlation coefficient was -0.77. A statistically significant inverse correlation between the MAD and the angle between the anatomic femoral axis and mechanical limb axis was found: the correlation coefficient was -0.53. In general, the received values were

Application of split field technique with 42 MeV betatron bremsstrahlung

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Spurny, V; Caha, A; Krystof, V; Ott, O [Vyzkumny Ustav Klinicke a Experimentalni Onkologie, Brno (Czechoslovakia)

1977-03-01

The split field technique of external irradiation in oncology is described. A 120x28x79 mm lead shielding block was manufactured for a bremsstrahlung radiation with 42 MeV maximum energy. The block was secured to a holder whose design corresponded to tube holders. The block shielding capacity was tested by phantom measurements at a focal depth of 130 mm and at a distance of the block from the phantom surface of 990 mm. For the 42 MeV bremsstrahlung the reduction was found to be 15% of the focal dose in the 20x20 cm/sup 2/ field in the focal depth at a distance of 1200 mm from the bremsstrahlung focus. Dose distribution was established by using two opposite fields in combination as well as by the courses of the maximum and the relative doses in variation with the female patient's antero-posterior diameter. The results show that the split field technique permits a short adjustment time, is simple and reproducible. As against cobalt application, the beam characteristics permit reducing the integral dose.

Required coefficient of friction in the anteroposterior and mediolateral direction during turning at different walking speeds.

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Yamaguchi, Takeshi; Suzuki, Akito; Hokkirigawa, Kazuo

2017-01-01

This study investigated the required coefficient of friction (RCOF) and the tangent of center of mass (COM)-center of pressure (COP) angle in the mediolateral (ML) and anteroposterior (AP) directions during turning at different walking speeds. Sixteen healthy young adults (8 males and 8 females) participated in this study. The participants were instructed to conduct trials of straight walking and 90° step and spin turns to the right at each of three self-selected speeds (slow, normal, and fast). The ML and AP directions during turning gait were defined using the orientation of the pelvis to construct a body-fixed reference frame. The RCOF values and COM-COP angle tangent in the ML direction during turning at weight acceptance phase were higher than those during straight walking, and those values increased with increasing walking speed. The ML component of the RCOF and COM-COP tangent values during weight acceptance for step turns were higher than those for spin turns. The mean centripetal force during turning tended to increase with an increase in walking speed and had a strong positive correlation with the RCOF values in the ML direction (R = 0.97 during the weight acceptance phase; R = 0.95 during the push-off phase). Therefore, turning, particularly step turn, is likely to cause lateral slip at weight acceptance because of the increased centripetal force compared with straight walking. Future work should test at-risk population and compare with the present results.

Required coefficient of friction in the anteroposterior and mediolateral direction during turning at different walking speeds.

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Takeshi Yamaguchi

Full Text Available This study investigated the required coefficient of friction (RCOF and the tangent of center of mass (COM-center of pressure (COP angle in the mediolateral (ML and anteroposterior (AP directions during turning at different walking speeds. Sixteen healthy young adults (8 males and 8 females participated in this study. The participants were instructed to conduct trials of straight walking and 90° step and spin turns to the right at each of three self-selected speeds (slow, normal, and fast. The ML and AP directions during turning gait were defined using the orientation of the pelvis to construct a body-fixed reference frame. The RCOF values and COM-COP angle tangent in the ML direction during turning at weight acceptance phase were higher than those during straight walking, and those values increased with increasing walking speed. The ML component of the RCOF and COM-COP tangent values during weight acceptance for step turns were higher than those for spin turns. The mean centripetal force during turning tended to increase with an increase in walking speed and had a strong positive correlation with the RCOF values in the ML direction (R = 0.97 during the weight acceptance phase; R = 0.95 during the push-off phase. Therefore, turning, particularly step turn, is likely to cause lateral slip at weight acceptance because of the increased centripetal force compared with straight walking. Future work should test at-risk population and compare with the present results.

Evaluation of the relationship between anteroposterior translation of a posterior cruciate ligament-retaining total knee replacement and functional outcome.

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Seah, R B; Pang, H N; Lo, N N; Chong, H C; Chin, P L; Chia, S L; Yeo, S J

2012-10-01

The success of total knee replacement (TKR) depends on optimal soft-tissue balancing, among many other factors. The objective of this study is to correlate post-operative anteroposterior (AP) translation of a posterior cruciate ligament-retaining TKR with clinical outcome at two years. In total 100 patients were divided into three groups based on their AP translation as measured by the KT-1000 arthrometer. Group 1 patients had AP translation  10 mm. Outcome assessment included range of movement of the knee, the presence of flexion contractures, hyperextension, knee mechanical axes and functional outcome using the Knee Society score, Oxford knee score and the Short-Form 36 questionnaire. At two years, patients in Group 2 reported significantly better Oxford knee scores than the other groups (p = 0.045). A positive correlation between range of movement and AP translation was noted, with patients in group 3 having the greatest range of movement (mean flexion: 117.9° (106° to 130°)) (p 10° (p = 0.01). In this study, the best outcome for cruciate-ligament retaining TKR was achieved in patients with an AP translation of 5 mm to 10 mm.

Modelling in pinnacle for distance extended source-patient and verification with film EBT2 technique; Modelizacion en pinnacle para tecnica de distancia fuente-paciente extendida y verificacion con peliculas EBT2

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Perucha Ortega, M.; Luis simon, J.; Rodriguez Alarcon, C.; Baeza Trujillo, M.; Sanchez Carmona, G.; Vicente Granado, D.; Gutierrez Ramos, S.; Herrador Cordoba, M.

2013-07-01

The objective of this work is modelled on the Pinnacle Scheduler the geometry used in our Center for the technique of Total body irradiation which consists of radiate to the patient, whose middle line is 366 cm from the source, in positions lateral decubitus, with 2 fields anteroposterior of 40 x 40 cm{sup 2}, rotated collimator 45 degree centigrade interposing a screen of methacrylate 1 cm thick to 29 cm ahead of the middle line. (Author)

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

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Szu-Yuan Chen

2015-06-01

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

Are spinal or paraspinal anatomic makers helpful for vertebral numbering and diagnosing lumbosacral transitional vertebrae?

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Tokgoz, Nil; Ucar, Murat; Erdogan, Aylin Billur; Killic, Koray; Ozcan, Cahide [Dept. of Radiology, Gazi University School of Medicine, Ankara (Turkmenistan)

2014-04-15

To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.

Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis

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Kang, Chang Ho [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Korea University College of Medicine, Department of Radiology, Anam Hospital, Seoul (Korea); Shin, Myung Jin; Kim, Sung Moon; Lee, Sang Hoon; Kim, Hee Kyung; Ryu, Jeong Ah [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Lee, Choon-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Orthopedic Surgery, Seoul (Korea); Kim, Sam Soo [Kangwon National University College of Medicine, Department of Radiology, Kangwon (Korea)

2008-03-15

The objective was to determine the importance of the ''sagittal shoulder sign'' on magnetic resonance (MR) images for the diagnosis of conjoined lumbosacral nerve roots (CLNR) that are compromised by herniated disks. Magnetic resonance images of 11 patients (6 men and 5 women; age range, 25-71 years; average age, 48.7 years) with surgically proven CLNR, which was compromised by herniated disks, were retrospectively evaluated by two musculoskeletal radiologists. MR images were evaluated for the presence or absence of the sagittal shoulder sign - a vertical structure connecting two consecutive nerve roots and overlying disk on the sagittal MR images. The radiologists noted the type of accompanying disk herniation and bony spinal canal changes, as well as other characteristic MR features of CLNR, the common passage of two consecutive nerve roots through the neural foramen on axial MR images. The sagittal shoulder sign was identified with a mean frequency of 90.9% by the two observers (in 10 of 11 patients). The common passage of two consecutive nerve roots through the neural foramen on axial MR images was identified with a mean frequency of 59.1% (in 7 and 6 out of 11 patients, by observers 1 and 2, respectively). Good interobserver agreement for the sagittal shoulder sign was present (k = 0.621, p < 0.05). Observation of the sagittal shoulder sign may prove helpful for diagnosing CLNR in patients with disk herniation. In particular, this sign appears to be useful when there is no evidence of CLNR on axial MR images. (orig.)

Age-dependent trigeminal and female-specific lumbosacral increase in herpes zoster distribution in the elderly.

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Shiraki, Kimiyasu; Toyama, Nozomu; Shiraki, Atsuko; Yajima, Misako

2018-05-01

Varicella-zoster virus causes herpes zoster (HZ) along specific dermatomes, but the effects of age and sex on HZ distribution are unclear. We investigated the age- and sex-dependent distribution characteristics of HZ. Patients with HZ were monitored by members of the Miyazaki Dermatologist Society. Questionnaires containing information on age, sex, and dermatome distribution and lesion specimens from 2730 patients were collected, and 2508 PCR-diagnosed cases were analyzed. The ratio of lesions in the thoracic area to lesions in the whole body decreased with age, whereas those of other areas increased. HZ incidence increased with age to about four times that of the basic incidence in the dermatome areas at age 0-29 years; the incidence in the trigeminal area in both sexes increased 11-fold, and the incidence in the thoracic and lumbosacral areas increased in females more than in males. Furthermore, the fact that the highest incidence was found along the first branch of the trigeminal nerve suggests an association with long-term ultraviolet ray exposure. Segmental dermatomes comprising thoracic 10-lumbar 1/sacral 2-4 and thoracic 5-6 were significantly more frequently affected in female patients at age 50-59 years and are consistent with areas of obstetric anesthesia for childbirth and of breastfeeding, respectively. HZ incidence increased with age; moreover, exposure to ultraviolet rays, childbirth, and breastfeeding might increase the incidence at specific dermatomes in older individuals. This study provides important information on the etiology of HZ. Copyright © 2018 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

Drilling the femoral tunnel during ACL reconstruction: transtibial versus anteromedial portal techniques.

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Tudisco, Cosimo; Bisicchia, Salvatore

2012-08-01

Incorrect bone tunnel position, particularly on the femoral side, is a frequent cause of failed anterior cruciate ligament reconstruction. Several studies have reported that drilling the femoral tunnel through the anteromedial portal allows a more anatomical placement on the lateral femoral condyle and higher knee stability than does transtibial reconstruction.In the current study, the femoral tunnel was drilled with transtibial (n=6) and anteromedial (n=6) portal techniques in 12 cadaveric knees. With appropriate landmarks inserted into bone tunnels, the direction and length of the tunnels were determined on anteroposterior and lateral radiographs. Knee stability was evaluated with a KT1000 arthrometer (MEDmetric Corporation, San Diego, California) and pivot shift test, comparing the pre- and postoperative values of both techniques. Finally, all knees were dissected to enhance vision of the insertion of the reconstructed ligament. The anteromedial portal technique led to better placement of the femoral tunnel in the coronal and sagittal planes, with higher knee stability according to the pivot shift test but not the KT1000 arthrometer. Anatomical and clinical results reported in the literature on transtibial and anteromedial portal techniques are controversial, but most of studies report better results with the anteromedial portal technique, especially regarding rotational stability. The current cadaveric study showed that the anteromedial portal technique provided better tunnel placement on the lateral femoral condyle in the coronal and sagittal planes, with an improvement in the rotational stability of the knee. Copyright 2012, SLACK Incorporated.

Patient radiation exposure during different kyphoplasty techniques.

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Panizza, Denis; Barbieri, Massimo; Parisoli, Francesco; Moro, Luca

2014-01-01

The scope of this study was to quantify patient radiation exposure during two different techniques of kyphoplasty (KP), which differ by a cement delivery method, in order to assess whether or not one of the two used methods can reduce the patient dose. Twenty patients were examined for this investigation. One X-ray fluoroscopy unit was used for localization, navigation and monitoring of cement delivery. The patient biometric data, the setting of the fluoroscope, the exposure time and the kerma-area product (KAP) were monitored in all the procedures for anteroposterior (AP) and lateral (LL) fluoroscopic projections in order to assess the range of radiation doses imparted to the patient. Theoretical entrance skin dose (ESD) and effective dose (E) were calculated from intraoperatively measured KAP. An average ET per procedure was 1.5±0.5 min for the manual injection technique (study A) and 1.4±0.4 min for the distance delivery technique (study B) in the AP plane, while 3.2±0.7 and 5.1±0.6 min in the lateral plane, respectively. ESD was estimated as an average of 0.10±0.06 Gy for study A and 0.13±0.13 Gy for study B in the AP or/and 0.59±0.46 and 1.05±0.36 Gy in the lateral view, respectively. The cumulative mean E was 1.9±1.0 mSv procedure(-1) for study A and 3.6±0.9 mSv procedure(-1) for study B. Patient radiation exposure and associated effective dose from KP may be considerable. The technique of distance cement delivery appears to be slower than the manual injection technique and it requires a more protracted fluoroscopic control in the lateral projection, so that this system entails a higher amount of dose to the patient.

Determination of lumbosacral transitional vertebrae in kidney urinary bladder x-ray films in the Saudi population

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Khalid G. Khashoggi

2017-08-01

Full Text Available Objectives: To investigated the rate of occurrence of lumbosacral transitional vertebrae (LSTV, spinal variant, in kidney urinary bladder (KUB plain radiographs in a Saudi population. Methods: Between January 2012 to January 2015, KUB plain films obtained from patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed, and the presence or absence of LSTV was documented and classified as incomplete or complete. Patients who had evidence of spinal surgery that would obscure the view were excluded. Results: A total of 2078 patients underwent KUB examinations during the study period; LSTV anomalies were detected in 158 of these. Sacralization was present in 153 (96.8% of this cohort, while lumbarization was present in 5 (3.2%. A total of 136 (86.1% of the sacralized segments were of the incomplete type, whereas 17 (10.7% were complete. Of the lumbarized vertebrae, 3 (1.8% were incomplete, and 2 (1.2% were complete. The most frequent type in men was type Ib (28.5% for sacralized segments, and type IIb for lumbarized segments (0.6%. In women, type Ia was the most common form of sacralized segments (11.3% and type IIb was the most common form of lumbarized segments (2.8%. Conclusion: The prevalence of LSTV in Saudi patients is 7.6%, with a higher incidence of sacralization than lumbarization. Further studies with larger sample sizes and longer follow-up time are needed to demonstrate the clinical significance thereof.

R-spondin 3 regulates dorsoventral and anteroposterior patterning by antagonizing Wnt/β-catenin signaling in zebrafish embryos.

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Xiaozhi Rong

Full Text Available The Wnt/β-catenin or canonical Wnt signaling pathway plays fundamental roles in early development and in maintaining adult tissue homeostasis. R-spondin 3 (Rspo3 is a secreted protein that has been implicated in activating the Wnt/β-catenin signaling in amphibians and mammals. Here we report that zebrafish Rspo3 plays a negative role in regulating the zygotic Wnt/β-catenin signaling. Zebrafish Rspo3 has a unique domain structure. It contains a third furin-like (FU3 domain. This FU3 is present in other four ray-finned fish species studied but not in elephant shark. In zebrafish, rspo3 mRNA is maternally deposited and has a ubiquitous expression in early embryonic stages. After 12 hpf, its expression becomes tissue-specific. Forced expression of rspo3 promotes dorsoanterior patterning and increases the expression of dorsal and anterior marker genes. Knockdown of rspo3 increases ventral-posterior development and stimulates ventral and posterior marker genes expression. Forced expression of rspo3 abolishes exogenous Wnt3a action and reduces the endogenous Wnt signaling activity. Knockdown of rspo3 results in increased Wnt/β-catenin signaling activity. Further analyses indicate that Rspo3 does not promote maternal Wnt signaling. Human RSPO3 has similar action when tested in zebrafish embryos. These results suggest that Rspo3 regulates dorsoventral and anteroposterior patterning by negatively regulating the zygotic Wnt/β-catenin signaling in zebrafish embryos.

Computer-assisted three-dimensional reconstructions of [14C]-2-deoxy-D-glucose metabolism in cat lumbosacral spinal cord following cutaneous stimulation of the hindfoot

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Crockett, D.P.; Smith, W.K.; Proshansky, E.; Kauer, J.S.; Stewart, W.B.; Woodward, D.J.; Schlusselberg, D.S.; Egger, M.D.

1989-01-01

We report on computer-assisted three-dimensional reconstruction of spinal cord activity associated with stimulation of the plantar cushion (PC) as revealed by [14C]-2-deoxy-D-glucose (2-DG) serial autoradiographs. Moderate PC stimulation in cats elicits a reflex phasic plantar flexion of the toes. Four cats were chronically spinalized at about T6 under barbiturate anesthesia. Four to 11 days later, the cats were injected (i.v.) with 2-DG (100 microCi/kg) and the PC was electrically stimulated with needle electrodes at 2-5 times threshold for eliciting a reflex. Following stimulation, the spinal cord was processed for autoradiography. Subsequently, autoradiographs, representing approximately 8-18 mm from spinal segments L6-S1, were digitized for computer analysis and 3-D reconstruction. Several strategies of analysis were employed: (1) Three-dimensional volume images were color-coded to represent different levels of functional activity. (2) On the reconstructed volumes, virtual sections were made in the horizontal, sagittal, and transverse planes to view regions of 2-DG activity. (3) In addition, we were able to sample different regions within the grey and white matter semi-quantitatively (i.e., pixel intensity) from section to section to reveal differences between ipsi- and contralateral activity, as well as possible variation between sections. These analyses revealed 2-DG activity associated with moderate PC stimulation, not only in the ipsilateral dorsal horn as we had previously demonstrated, but also in both the ipsilateral and contralateral ventral horns, as well as in the intermediate grey matter. The use of novel computer analysis techniques--combined with an unanesthetized preparation--enabled us to demonstrate that the increased metabolic activity in the lumbosacral spinal cord associated with PC stimulation was much more extensive than had heretofore been observed

Planejamento tridimensional para radioterapia de tumores de esôfago: comparação de técnicas de tratamento e análise de probabilidade de complicações Three-dimensional radiotherapy planning system for esophageal tumors: comparison of treatment techniques and analysis of probability of complications

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Pitágoras Báskara Justino

2003-06-01

Full Text Available Para comparar diversas técnicas de irradiação para o câncer de esôfago, foi utilizado sistema de planejamento tridimensional. Em um paciente com carcinoma espinocelular de esôfago médio, foram estudadas as seguintes técnicas de tratamento: dois campos ântero-posteriores e dois campos látero-laterais paralelos e opostos, três campos em "Y" e em "T" e quatro campos em "X". Foram obtidos os histogramas dose-volume, considerando como órgãos de risco medula espinhal e pulmões. Os resultados foram analisados de acordo com as recomendações da Normal Tissue Complication Probability (NTCP e Tumor Control Probability (TCP. Quanto às doses de irradiação em pulmão, a melhor opção foi a técnica em dois campos ântero-posteriores paralelos e opostos. A medula foi mais poupada quando se utilizaram campos látero-laterais. Sugerimos a combinação de pelo menos duas técnicas de tratamento: ântero-posterior e as técnicas com campos em "Y", "T" ou látero-laterais, para o balanceamento das doses em pulmões e medula espinhal. Ou, ainda, a utilização de técnicas de três campos durante todo o tratamento.Radiotherapy techniques for esophageal cancer were compared using a three-dimensional planning system. We studied the following treatment techniques used for a patient with squamous cell carcinoma of the middle third of the esophagus: two antero-posterior and two latero-lateral parallel opposed fields, three fields ("Y" and "T", and four fields ("X". Dose-volume histograms were obtained considering spinal cord and lungs as organs at risk. Analysis was performed comparing doses in these organs as recommended by the Normal Tissue Complication Probability (NTCP and Tumor Control Probability (TCP. When only the lungs were considered the best technique was two antero-posterior parallel opposed fields. The spinal cord was best protected using latero-lateral fields. We suggest the combination of at least two treatment techniques: antero-posterior

An analysis of general surgery-related complications in a series of 412 minilaparotomic anterior lumbosacral procedures.

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Kang, Byung-Uk; Choi, Won-Chul; Lee, Sang-Ho; Jeon, Sang Hyeop; Park, Jong Dae; Maeng, Dae Hyeon; Choi, Young-Geun

2009-01-01

Anterior lumbar surgery is associated with certain perioperative visceral and vascular complications. The aim of this study was to document all general surgery-related adverse events and complications following minilaparotomic retroperitoneal lumbar procedures and to discuss strategies for their management or prevention. The authors analyzed data obtained in 412 patients who underwent anterior lumbosacral surgery between 2003 and 2005. The series comprised 114 men and 298 women whose mean age was 56 years (range 34-79 years). Preoperative diagnoses were as follows: isthmic spondylolisthesis (32%), degenerative spondylolisthesis (24%), instability/stenosis (15%), degenerative disc disease (15%), failed-back surgery syndrome (7%), and lumbar degenerative kyphosis or scoliosis (7%). A single level was exposed in 264 patients (64%), 2 in 118 (29%), and 3 or 4 in 30 (7%). The average follow-up period was 16 months. Overall, 52 instances of complications and adverse events occurred in 50 patients (12.1%), including sympathetic dysfunction in 25 (6.06%), vascular injury repaired with/without direct suture in 12 (2.9%), ileus lasting > 3 days in 5 (1.2%), pleural effusion in 4 (0.97%), wound dehiscence in 2 (0.49%), symptomatic retroperitoneal hematoma in 2 (0.49%), angina in 1 (0.24%), and bowel laceration in 1 patient (0.24%). There was no instance of retrograde ejaculation in male patients, and most complications had no long-term sequelae. This report presents a detailed analysis of complications related to anterior lumbar surgery. Although the incidence of complications appears low considering the magnitude of the procedure, surgeons should be aware of these potential complications and their management.

Functional anatomy of the caudal thoracolumbar and lumbosacral spine in the horse.

Science.gov (United States)

Stubbs, N C; Hodges, P W; Jeffcott, L B; Cowin, G; Hodgson, D R; McGowan, C M

2006-08-01

Research in spinal biomechanics and functional anatomy has advanced back pain research in man. Yet, despite the performance limiting nature of back pain in horses, there are few data for the equine spine. To describe aspects of functional anatomy of the equine thoracolumbar and lumbosacral (LS) spine and potential effects on performance. The first study investigated variations in LS vertebral formula by post mortem examination of 120 horses. Midline vertebral transection was carried out on 65 Thoroughbred (TB), 24 Standardbred (SB) and 31 other breeds. The second study investigated morphology and biomechanics of the deep stabilising epaxial muscles of 13 horses using MRI (n = 3), anatomical dissection (n = 11) and biomechanical analysis (n = 6). The spinous process angular orientation relative to the vertebral body, was analysed at vertebrae T13, T18, L3, L5, L6 and S1. LS variations were found in 33.3% of the total group, 40.0% TB and 45.2% others, but 0% SB. Sacralisation of lumbar vertebra (L) 6 with LS motion between L5 and L6 occurred in 32.3% TB and 29.0% others. Five segmental multifidus fascicles were identified originating from spinous processes and vertebral laminae running craniocaudally onto the mammillary processes and lateral border of the sacrum, crossing between 1-5 intervertebral discs. Sacrocaudalis dorsalis (SCD) lateralis muscle was an extension of multifidus from L4, L5 and L6 depending on the vertebral formula whereas SCD medialis mm originated from S3. Both inserted on caudal vertebrae. Based on the location and direction of fibres, the principal action of the deep epaxial muscles was dorsoventral sagittal rotation. This action was dependent on vertebral spinous process/body orientation. We hypothesise that equine multifidus and SCD lateralis muscles act as caudal sagittal rotators of their vertebra of origin, as is the case in man, allowing dynamic stabilisation during dorsoventral motion. Equine multifidus anatomy and function are

Effect of different impression materials and techniques on the dimensional accuracy of implant definitive casts.

Science.gov (United States)

Ebadian, Behnaz; Rismanchian, Mansor; Dastgheib, Badrosadat; Bajoghli, Farshad

2015-01-01

Different factors such as impression techniques and materials can affect the passive fit between the superstructure and implant. The aim of this study was to determine the effect of different impression materials and techniques on the dimensional accuracy of implant definitive casts. Four internal hex implants (Biohorizons Ø4 mm) were placed on a metal maxillary model perpendicular to the horizontal plane in maxillary lateral incisors, right canine and left first premolar areas. Three impression techniques including open tray, closed tray using ball top screw abutments and closed tray using short impression copings and two impression materials (polyether and polyvinyl siloxane) were evaluated (n = 60). The changes in distances between implant analogues in mediolateral (x) and anteroposterior (y) directions and analogue angles in x/z and y/z directions in the horizontal plane on the definitive casts were measured by coordinate measuring machine. The data were analyzed by multivariate two-way analysis of variance and one sample t-test (α = 0.05). No statistical significant differences were observed between different impression techniques and materials. However, deviation and distortion of definitive casts had a significant difference with the master model when short impression copings and polyvinyl siloxane impression material were used (P impression materials (P impression techniques; however, less distortion and deviation were observed in the open tray technique. In the closed tray impression technique, ball top screw was more accurate than short impression copings.

Prevalence of dural ectasia in Loeys-Dietz syndrome: comparison with Marfan syndrome and normal controls.

Directory of Open Access Journals (Sweden)

Atsushi K Kono

Full Text Available BACKGROUND AND PURPOSE: Dural ectasia is well recognized in Marfan syndrome (MFS as one of the major diagnostic criteria, but the exact prevalence of dural ectasia is still unknown in Loeys-Dietz syndrome (LDS, which is a recently discovered connective tissue disease. In this study, we evaluated the prevalence of dural ectasia in LDS according by using qualitative and quantitative methods and compared our findings with those for with MFS and normal controls. MATERIAL AND METHODS: We retrospectively studied 10 LDS (6 males, 4 females, mean age 36.3 years and 20 MFS cases (12 males, 8 females, mean age 37.1 years and 20 controls (12 males, 8 females, mean age 36.1 years both qualitatively and quantitatively using axial CT images and sagittal multi-planar reconstruction images of the lumbosacral region. For quantitative examination, we adopted two methods: method-1 (anteroposterior dural diameter of S1> L4 and method-2 (ratio of anteroposterior dural diameter/vertebral body diameter>cutoff values. The prevalence of dural ectasia among groups was compared by using Fisher's exact test and the Tukey-Kramer test. RESULTS: In LDS patients, the qualitative method showed 40% of dural ectasia, the quantitative method-1 50%, and the method-2 70%. In MFS patients, the corresponding prevalences were 50%, 75%, and 85%, and in controls, 0%, 0%, and 5%. Both LDS and MFS had a significantly wider dura than controls. CONCLUSIONS: While the prevalence of dural ectasia varied depending on differences in qualitative and quantitative methods, LDS as well as MFS, showed, regardless of method, a higher prevalence of dural ectasia than controls. This finding should help the differentiation of LDS from controls.

Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?

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Craiovan, B; Weber, M; Worlicek, M; Schneider, M; Springorum, H R; Zeman, F; Grifka, J; Renkawitz, T

2016-06-01

The aim of this prospective study is to validate a vector arithmetic method for measuring acetabular cup orientation after total hip arthroplasty (THA) and to verify the clinical practice. We measured cup anteversion and inclination of 123 patients after cementless primary THA twice by two examiners on AP pelvic radiographs with a vector arithmetic method and compared with a 3D-CT based reconstruction model within the same radiographic coronal plane. The mean difference between the radiographic and the 3D-CT measurements was - 1.4° ± 3.9° for inclination and 0.8°± 7.9° for anteversion with excellent correlation for inclination (r = 0.81, p cup position after THA on pelvic radiographs by this vector arithmetic method, there is a need for a correct postoperative ap view, with special regards to the pelvic tilt for the future. • Measuring acetabular cup orientation on anteroposterior radiographs of the hip after THA is a helpful procedure in everyday clinical practice as a first-line imaging modality• CT remains the golden standard to accurately determine acetabular cup position.• Future measuring on radiographs for cup orientation after THA should account for integration of the pelvic tilt in order to maximize the measurement accuracy. Citation Format: • Craiovan B, Weber M, Worlicek M et al. Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?. Fortschr Röntgenstr 2016; 188: 574 - 581. © Georg Thieme Verlag KG Stuttgart · New York.

Patient radiation exposure during different kyphoplasty techniques

International Nuclear Information System (INIS)

Panizza, D.; Barbieri, M.; Parisoli, F.; Moro, L.

2014-01-01

The scope of this study was to quantify patient radiation exposure during two different techniques of kyphoplasty (KP), which differ by a cement delivery method, in order to assess whether or not one of the two used methods can reduce the patient dose. Twenty patients were examined for this investigation. One X-ray fluoroscopy unit was used for localization, navigation and monitoring of cement delivery. The patient bio-metric data, the setting of the fluoroscope, the exposure time and the kerma-area product (KAP) were monitored in all the procedures for anteroposterior (AP) and lateral (LL) fluoroscopic projections in order to assess the range of radiation doses imparted to the patient. Theoretical entrance skin dose (ESD) and effective dose (E) were calculated from intraoperatively measured KAP. An average ET per procedure was 1.5±0.5 min for the manual injection technique (study A) and 1.4±0.4 min for the distance delivery technique (study B) in the AP plane, while 3.2±0.7 and 5.1±0.6 min in the lateral plane, respectively. ESD was estimated as an average of 0.10±0.06 Gy for study A and 0.13±0.13 Gy for study B in the AP or/and 0.59±0.46 and 1.05±0.36 Gy in the lateral view, respectively. The cumulative mean E was 1.9±1.0 mSv procedure -1 for study A and 3.6±0.9 mSv procedure -1 for study B. Patient radiation exposure and associated effective dose from KP may be considerable. The technique of distance cement delivery appears to be slower than the manual injection technique and it requires a more protracted fluoroscopic control in the lateral projection, so that this system entails a higher amount of dose to the patient. (authors)

Angiographic Assessment of the Right Hepatic Artery for Encasement by Hilar Cholangiocarcinoma: Comparison Between Antero-Posterior and Right Anterior Oblique Projections

International Nuclear Information System (INIS)

Furukawa, Hiroyoshi; Iwata, Ryoko; Moriyama, Noriyuki

2001-01-01

Purpose: To evaluate the usefulness of right anterior oblique (RAO) arteriography for evaluating encasement of the right hepatic artery (RHA) by hilar cholangiocarcinoma.Methods: Celiac arteriography was performed in both the antero-posterior (AP) and RAO projection in ten patients with cholangiocarcinoma. The lengths of the arteries between the bifurcation of the anterior and posterior branch of the liver and the following points were measured: (a) the bifurcation of the left and right hepatic artery (AP-LR), (b) the bifurcation of the proper hepatic artery and the gastroduodenal artery (AP-PG). Additionally, image quality in investigating the invasion of the RHA was evaluated.Results: On the AP images, the average lengths of AP-LR and AP-PG were 24.5 ± 5.1 mm and 30.0 ± 4.9 mm, respectively. On RAO images, the lengths were 28.2 ± 4.6 mm and 32.7 ± 4.8 mm, respectively. Every length was different between the two projections (p < 0.01). In 6 of 10 patients with hilar cholangiocarcinoma, images in RAO projections were superior to AP images for evaluation of encasement.Conclusion: We conclude that angiography obtained in the RAO projection yields images that are superior to those obtained in the conventional AP projection for assessment of RHA encasement

The suprasacral parallel shift vs lumbar plexus blockade with ultrasound guidance in healthy volunteers - a randomised controlled trial

DEFF Research Database (Denmark)

Bendtsen, T F; Pedersen, E M; Haroutounian, S

2014-01-01

-guided blockade of the lumbar plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal lumbar plexus nerves compared with a lumbar plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included...

Biomechanical Comparison of an Intramedullary and Extramedullary Free-Tissue Graft Reconstruction of the Acromioclavicular Joint Complex

Science.gov (United States)

Garg, Rishi; Javidan, Pooya; Lee, Thay Q.

2013-01-01

Background Several different surgical techniques have been described to address the coracoclavicular (CC) ligaments in acromioclavicular (AC) joint injuries. However, very few techniques focus on reconstructing the AC ligaments, despite its importance in providing stability. The purpose of our study was to compare the biomechanical properties of two free-tissue graft techniques that reconstruct both the AC and CC ligaments in cadaveric shoulders, one with an extramedullary AC reconstruction and the other with an intramedullary AC reconstruction. We hypothesized intramedullary AC reconstruction will provide greater anteroposterior translational stability and improved load to failure characteristics than an extramedullary technique. Methods Six matched cadaveric shoulders underwent translational testing at 10 N and 15 N in the anteroposterior and superoinferior directions, under AC joint compression loads of 10 N, 20 N, and 30 N. After the AC and CC ligaments were transected, one of the specimens was randomly assigned the intramedullary free-tissue graft reconstruction while its matched pair received the extramedullary graft reconstruction. Both reconstructed specimens then underwent repeat translational testing, followed by load to failure testing, via superior clavicle distraction, at a rate of 50 mm/min. Results Intramedullary reconstruction provided significantly greater translational stability in the anteroposterior direction than the extramedullary technique for four of six loading conditions (p < 0.05). There were no significant differences in translational stability in the superoinferior direction for any loading condition. The intramedullary reconstructed specimens demonstrated improved load to failure characteristics with the intramedullary reconstruction having a lower deformation at yield and a higher ultimate load than the extramedullary reconstruction (p < 0.05). Conclusions Intramedullary reconstruction of the AC joint provides greater stability in the

Larynx-sparing techniques using intensity-modulated radiation therapy for oropharyngeal cancer

Energy Technology Data Exchange (ETDEWEB)

Bar Ad, Voichita, E-mail: voichita.bar-ad@jeffersonhospital.org [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Lin, Haibo [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Hwang, Wei-Ting [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (United States); Deville, Curtiland [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Dutta, Pinaki R. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (United States); Tochner, Zelig; Both, Stefan [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

2012-01-01

The purpose of the current study was to explore whether the laryngeal dose can be reduced by using 2 intensity-modulated radiation therapy (IMRT) techniques: whole-neck field IMRT technique (WF-IMRT) vs. junctioned IMRT (J-IMRT). The effect on planning target volumes (PTVs) coverage and laryngeal sparing was evaluated. WF-IMRT technique consisted of a single IMRT plan, including the primary tumor and the superior and inferior neck to the level of the clavicular heads. The larynx was defined as an organ at risk extending superiorly to cover the arytenoid cartilages and inferiorly to include the cricoid cartilage. The J-IMRT technique consisted of an IMRT plan for the primary tumor and the superior neck, matched to conventional antero-posterior opposing lower neck fields at the level of the thyroid notch. A central block was used for the anterior lower neck field at the level of the larynx to restrict the dose to the larynx. Ten oropharyngeal cancer cases were analyzed. Both the primary site and bilateral regional lymphatics were included in the radiotherapy targets. The averaged V95 for the PTV57.6 was 99.2% for the WF-IMRT technique compared with 97.4% (p = 0.02) for J-IMRT. The averaged V95 for the PTV64 was 99.9% for the WF-IMRT technique compared with 98.9% (p = 0.02) for J-IMRT and the averaged V95 for the PT70 was 100.0% for WF-IMRT technique compared with 99.5% (p = 0.04) for J-IMRT. The averaged mean laryngeal dose was 18 Gy with both techniques. The averaged mean doses within the matchline volumes were 69.3 Gy for WF-MRT and 66.2 Gy for J-IMRT (p = 0.03). The WF-IMRT technique appears to offer an optimal coverage of the target volumes and a mean dose to the larynx similar with J-IMRT and should be further evaluated in clinical trials.

A new corrective technique for adolescent idiopathic scoliosis (Ucar′s convex rod rotation

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Bekir Yavuz Ucar

2014-01-01

Full Text Available Study Design: Prospective single-center study. Objective: To analyze the efficacy and safety of a new technique of global vertebral correction with convex rod rotation performed on the patients with adolescent idiopathic scoliosis. Summary of Background Data: Surgical goal is to obtain an optimal curve correction in scoliosis surgery. There are various correction techniques. This report describes a new technique of global vertebral correction with convex rod rotation. Materials and Methods: A total of 12 consecutive patients with Lenke type I adolescent idiopathic scoliosis and managed by convex rod rotation technique between years 2012 and 2013 having more than 1 year follow-up were included. Mean age was 14.5 (range = 13-17 years years at the time of operation. The hospital charts were reviewed for demographic data. Measurements of curve magnitude and balance were made on 36-inch standing anteroposterior and lateral radiographs taken before surgery and at most recent follow up to assess deformity correction, spinal balance, and complications related to the instrumentation. Results: Preoperative coronal plane major curve of 62° (range = 50°-72° with flexibility of less than 30% was corrected to 11.5°(range = 10°-14° showing a 81% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. No complications were found. Conclusion: The new technique of global vertebral correction with Ucar′s convex rod rotation is an effective technique. This method is a vertebral rotation procedure from convex side and it allows to put screws easily to the concave side.

Selective posterior lumbosacral rhizotomy for the management ...

African Journals Online (AJOL)

tion in 95% of cases. The majority showed ... selective posterior rhizotomy technique whereby the cauda equina ... assessed pre- and postoperatively by means of clinical examination ... were attending cerebral palsy schools and receiving spe- cialised ... root sections on cats demonstrated clearly that posterior root section ...

Immediate effect of a single anteroposterior talus mobilization on dorsiflexion range of motion in participants with orthopedic dysfunction of the ankle and foot.

Science.gov (United States)

Teixeira, Luciana Mundim; Pires, Tatiana; Silva, Rafael Duarte; de Resende, Marcos Antônio

2013-01-01

The purpose of this study was to determine the immediate effects of a single anteroposterior mobilization of the talus on the active dorsiflexion range of motion (ROM) in participants with different orthopedic foot and ankle injuries. This study included 30 male and female participants aged 18 to 50 years with unilateral orthopedic foot and ankle dysfunction. All participants underwent 3 sets of active dorsiflexion ROM measurement in both ankles. Measurements included baseline, post-first treatment, and post-second treatment values. Participants received either joint mobilization or manual contact (control) on the affected ankle. Active dorsiflexion ROM was assessed using a biplanar goniometer with participants in the prone position and 90° of knee flexion. Both groups (joint mobilization and manual contact) showed increased active dorsiflexion ROM. However, the mean difference of dorsiflexion measurements before and after mobilization was greater than before and after control treatment. A single session of articular mobilization of the talus did not significantly increase dorsiflexion ROM in participants with orthopedic dysfunctions of the ankle and foot compared with a manual contact procedure. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Managing low back pain second edition

International Nuclear Information System (INIS)

Kirkaldy-Willis, W.H.

1988-01-01

This book contains 26 chapters. Some of the titles are: Magnetic resonance imaging of the lumbar spine; Diagnostic techniques; The site and nature of the lesion; The anatomy of the lumbosacral spine; The perception of pain; Differential diagnosis of low back pain; and A comprehensive outline of treatment

Morphometry of lower lumbar vertebrae as seen on CT scans: newly recognized characteristics

International Nuclear Information System (INIS)

van Schaik, J.J.P.; Verbiest, H.; van Schaik, F.D.J.

1985-01-01

Transaxial computed tomographic (CT) sections represent a new approach to vertebral morphometry, allowing certain measurements to be made in vivo for the first time. The cross-sectional morphology of the bodies and pedicles of L3, L4, and L5 was studied in a series of 213 vertebrae. This revealed that the pedicles of L5 arise more laterally from the body of L5 than from L3. Further, the lateral surfaces of the L5 body are inclined obliquely, unlike those of L3. L4 is transitional in form between L3 and L5, more closely resembling the former. This morphology explains the fact, hitherto unnoticed, that the lateral outlines of the pedicles and the lateral borders of the body of L5 are not normally imaged on plain anteroposterior radiographs. It is evident that pathologic changes of the lateral borders of the body of L5 may be invisible also. In cases of transitional vertebrae in the lumbosacral region the presence or absence of the lateral outlines of the pedicles and of the lateral borders of the vertebral body may be of help in identifying the vertebrae on conventional projections

Posterior tibial slope impacts intraoperatively measured mid-flexion anteroposterior kinematics during cruciate-retaining total knee arthroplasty.

Science.gov (United States)

Dai, Yifei; Cross, Michael B; Angibaud, Laurent D; Hamad, Cyril; Jung, Amaury; Jenny, Jean-Yves

2018-02-23

Posterior tibial slope (PTS) for cruciate-retaining (CR) total knee arthroplasty (TKA) is usually pre-determined by the surgeon. Limited information is available comparing different choices of PTS on the kinematics of the CR TKA, independent of the balancing of the extension gap. This study hypothesized that with the same balanced extension gap, the choice of PTS significantly impacts the intraoperatively measured kinematics of CR TKA. Navigated CR TKAs were performed on seven fresh-frozen cadavers with healthy knees and intact posterior cruciate ligament (PCL). A custom designed tibial baseplate was implanted to allow in situ modification of the PTS, which altered the flexion gap but maintained the extension gap. Knee kinematics were measured by performing passive range of motion (ROM) tests from full extension to 120° of flexion on the intact knee and CR TKAs with four different PTSs (1°, 4°, 7°, and 10°). The measured kinematics were compared across test conditions to assess the impact of PTS. With a consistent extension gap, the change of PTS had significant impact on the anteroposterior (AP) kinematics of the CR TKA knees in mid-flexion range (45°-90°), but not so much for the high-flexion range (90°-120°). No considerable impacts were found on internal/external (I/E) rotation and hip-knee-ankle (HKA) angle. However, the findings on the individual basis suggested the impact of PTS on I/E rotation and HKA angle may be patient-specific. The data suggested that the choice of PTS had the greatest impact on the mid-flexion AP translation among the intraoperatively measured kinematics. This impact may be considered while making surgical decisions in the context of AP kinematics. When using a tibial component designed with "center" pivoting PTS, a surgeon may be able to fine tune the PTS to achieve proper mid-flexion AP stability.

Chronic low back pain after lumbosacral fracture due to sagittal and frontal vertebral imbalance.

Science.gov (United States)

Boyoud-Garnier, L; Boudissa, M; Ruatti, S; Kerschbaumer, G; Grobost, P; Tonetti, J

2017-06-01

Over time, some patients with unilateral or bilateral lumbosacral injuries experience chronic low back pain. We studied the sagittal and frontal balance in a population with these injuries to determine whether mismatch in the pelvic and lumbar angles are associated with chronic low back pain. Patients with posterior pelvic ring fractures (Tile C1, C2, C3 and A3.3) that had healed were included. Foreign patients and those with an associated spinal or acetabular fracture or nonunion were excluded. The review consisted of subjective questionnaires, a clinical examination, and standing A/P and lateral stereoradiographic views. The pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), measured lumbar lordosis (LLm), T9 sagittal offset, leg discrepancy (LD) and lateral curvature (LC). The expected lumbar lordosis (LLe) was calculated using the formula LLe=PI+9°. We defined lumbopelvic mismatch (LPM) as the difference between LLm and LLe being equal or greater than 25% of LLe. Fifteen patients were reviewed after an average follow-up of 8.8 years [5.4-15]. There were four Tile C1, five Tile C2, five Tile C3 and one Tile A3.3 fracture. Ten of the 15 patients had low back pain. The mean angles were: LLm 49.6° and LLe 71.9° (P=0.002), PT 21.3°, SS 44.1°, PI 62.9° in patients with low back pain and LLm 57.4° and LLe 63.2° (P=0.55), PT 13°, SS 43.1°, PI 54.2° in those without. LPM was present in 9 patients, 8 of who had low back pain (P=0.02). Six patients, all of whom had low back pain, had a mean LC of 7.5° [4.5-23] (P=0.02). The mean LD was 0.77cm. The findings of this small study suggest that patients who experience low back pain after their posterior arch of the pelvic ring fracture has healed, have a lumbopelvic mismatch. Early treatment of these patients should aim to reestablish the anatomy of the pelvic base relative to the frontal and sagittal balance. IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Undisturbed stance control in healthy adults is achieved differently along anteroposterior and mediolateral axes: evidence from visual feedback of various signals from center of pressure trajectories.

Science.gov (United States)

Rougier, Patrice R

2009-05-01

Provided through the screen of a monitor, the participant's resultant center of pressure (CPRes) movements from a force platform device, modified the postural performance of a healthy individual. However, these effects could largely vary with the axis that researchers consider (mediolateral [ML] or anteroposterior [AP]), because they know these controls are involved in 2 distinct ankle and hip mechanisms. To demonstrate this organization, the author tested a group of healthy adults in several conditions that gave the whole or some part of the information in the CPRes displacements. Compared with the CPRes feedback, left and right plantar CP or body weight distribution feedback deteriorated the control of the vertically projected center of gravity (CGv) along the ML and AP axes, whose amplitudes increased, respectively. These data highlight the primary role of loading or unloading and pressure variations in the achievement of postural control along each ML or AP axis, respectively. It is interesting that merging these 2 pieces of information (CPRes displacements) helped participants optimize their postural performance.

Getting in shape: Reconstructing three-dimensional long-track speed skating kinematics by comparing several body pose reconstruction techniques.

Science.gov (United States)

van der Kruk, E; Schwab, A L; van der Helm, F C T; Veeger, H E J

2018-03-01

In gait studies body pose reconstruction (BPR) techniques have been widely explored, but no previous protocols have been developed for speed skating, while the peculiarities of the skating posture and technique do not automatically allow for the transfer of the results of those explorations to kinematic skating data. The aim of this paper is to determine the best procedure for body pose reconstruction and inverse dynamics of speed skating, and to what extend this choice influences the estimation of joint power. The results show that an eight body segment model together with a global optimization method with revolute joint in the knee and in the lumbosacral joint, while keeping the other joints spherical, would be the most realistic model to use for the inverse kinematics in speed skating. To determine joint power, this method should be combined with a least-square error method for the inverse dynamics. Reporting on the BPR technique and the inverse dynamic method is crucial to enable comparison between studies. Our data showed an underestimation of up to 74% in mean joint power when no optimization procedure was applied for BPR and an underestimation of up to 31% in mean joint power when a bottom-up inverse dynamics method was chosen instead of a least square error approach. Although these results are aimed at speed skating, reporting on the BPR procedure and the inverse dynamics method, together with setting a golden standard should be common practice in all human movement research to allow comparison between studies. Copyright © 2018 Elsevier Ltd. All rights reserved.

Normal measurement of spinal cord and dural sac by CT myelography

International Nuclear Information System (INIS)

Yun, Ku Sub; Choi, Yo Won; Han, Moon Hee; Chang, Kee Hyun

1988-01-01

The data on the normal measurement of spinal cord are essential for an objective assessment of equivocal change of spinal cord size in the various clinical settings. The present study was therefore undertaken to evaluate normal range of spinal cord dimensions in Koreas. CT myelography of the cervical and thoracic region was performed in 60 patients who had symptoms referable to lumbosacral region and then computed tomographic measurement of spinal cord and dural sac was performed. The results are as follows: 1. The anteroposterior diameter of spinal cord was maximum at C1 level (8.6±1.4mm) and minimum at T6 level (6.4±1.7mm). 2. The transverse diameter of spinal cord was maximum at C4 and C5 levels (13.3±1.6mm) and minimum at T8 (8.1±1.9mm) and T10 (8.1±1.3mm) levels. 3. The area of spinal cord was maximum at C5 level (76±16mm 2 ) and minimum at T6 (40±24mm 2 ) and T8 (40±23mm 2 ) levels. 4. The ratio of anteroposterior diameter/transverse diameter of spinal cord was smallest at C4 (0.57±0.11) and C5 (0.57±0.09) levels and largest at T12 (0.9±0.17) level. 5. The ratio of anteroposterior diameter of spinal cord/dural sac was maximum at C4 level (0.73±0.14) and minimum at T12 level (0.52±0.15). The ratio of transverse diameter of spinal cord/dural sac was maximum at C3 (0.66±0.10) and C4 (0.66±0.14) levels and minimum at T12 level (0.46±0.18). The ratio of area of spinal cord/dural sac was maximum at C3 level (0.48±0.13) and minimum at T12 level (0.29±0.20). 6. The location of cervical cord in dural sac was mainly ventral (56%) at C1 level, middle (40-73%) from C2 to C6 level and dorsal (44%) at C7 level. The location of thoracic cord in dural sac was chiefly middle (61%) at T2 level and lower thoracic level (T10: 60% and T12: 51%) and mainly ventral (59-84%) at other levels.

A dosimetric comparison of whole-lung treatment techniques in the pediatric population

International Nuclear Information System (INIS)

Bosarge, Christina L.; Ewing, Marvene M.; DesRosiers, Colleen M.; Buchsbaum, Jeffrey C.

2016-01-01

To demonstrate the dosimetric advantages and disadvantages of standard anteroposterior-posteroanterior (S-AP/PA_A_A_A), inverse-planned AP/PA (IP-AP/PA) and volumetry-modulated arc (VMAT) radiotherapies in the treatment of children undergoing whole-lung irradiation. Each technique was evaluated by means of target coverage and normal tissue sparing, including data regarding low doses. A historical approach with and without tissue heterogeneity corrections is also demonstrated. Computed tomography (CT) scans of 10 children scanned from the neck to the reproductive organs were used. For each scan, 6 plans were created: (1) S-AP/PA_A_A_A using the anisotropic analytical algorithm (AAA), (2) IP-AP/PA, (3) VMAT, (4) S-AP/PA_N_O_N_E without heterogeneity corrections, (5) S-AP/PA_P_B using the Pencil-Beam algorithm and enforcing monitor units from technique 4, and (6) S-AP/PA_A_A_A_[_F_M_] using AAA and forcing fixed monitor units. The first 3 plans compare modern methods and were evaluated based on target coverage and normal tissue sparing. Body maximum and lower body doses (50% and 30%) were also analyzed. Plans 4 to 6 provide a historic view on the progression of heterogeneity algorithms and elucidate what was actually delivered in the past. Averages of each comparison parameter were calculated for all techniques. The S-AP/PA_A_A_A technique resulted in superior target coverage but had the highest maximum dose to every normal tissue structure. The IP-AP/PA technique provided the lowest dose to the esophagus, stomach, and lower body doses. VMAT excelled at body maximum dose and maximum doses to the heart, spine, and spleen, but resulted in the highest dose in the 30% body range. It was, however, superior to the S-AP/PA_A_A_A approach in the 50% range. Each approach has strengths and weaknesses thus associated. Techniques may be selected on a case-by-case basis and by physician preference of target coverage vs normal tissue sparing.

A dosimetric comparison of whole-lung treatment techniques in the pediatric population

Energy Technology Data Exchange (ETDEWEB)

Bosarge, Christina L., E-mail: cbosarge@umail.iu.edu; Ewing, Marvene M.; DesRosiers, Colleen M.; Buchsbaum, Jeffrey C.

2016-07-01

To demonstrate the dosimetric advantages and disadvantages of standard anteroposterior-posteroanterior (S-AP/PA{sub AAA}), inverse-planned AP/PA (IP-AP/PA) and volumetry-modulated arc (VMAT) radiotherapies in the treatment of children undergoing whole-lung irradiation. Each technique was evaluated by means of target coverage and normal tissue sparing, including data regarding low doses. A historical approach with and without tissue heterogeneity corrections is also demonstrated. Computed tomography (CT) scans of 10 children scanned from the neck to the reproductive organs were used. For each scan, 6 plans were created: (1) S-AP/PA{sub AAA} using the anisotropic analytical algorithm (AAA), (2) IP-AP/PA, (3) VMAT, (4) S-AP/PA{sub NONE} without heterogeneity corrections, (5) S-AP/PA{sub PB} using the Pencil-Beam algorithm and enforcing monitor units from technique 4, and (6) S-AP/PA{sub AAA[FM]} using AAA and forcing fixed monitor units. The first 3 plans compare modern methods and were evaluated based on target coverage and normal tissue sparing. Body maximum and lower body doses (50% and 30%) were also analyzed. Plans 4 to 6 provide a historic view on the progression of heterogeneity algorithms and elucidate what was actually delivered in the past. Averages of each comparison parameter were calculated for all techniques. The S-AP/PA{sub AAA} technique resulted in superior target coverage but had the highest maximum dose to every normal tissue structure. The IP-AP/PA technique provided the lowest dose to the esophagus, stomach, and lower body doses. VMAT excelled at body maximum dose and maximum doses to the heart, spine, and spleen, but resulted in the highest dose in the 30% body range. It was, however, superior to the S-AP/PA{sub AAA} approach in the 50% range. Each approach has strengths and weaknesses thus associated. Techniques may be selected on a case-by-case basis and by physician preference of target coverage vs normal tissue sparing.

Comparison of conversion coefficients for equivalent dose in terms of air kerma for photons using a male adult voxel simulator in sitting and standing posture with geometry of irradiation antero-posterior

International Nuclear Information System (INIS)

Galeano, D.C.; Cavalcante, F.R.; Carvalho, A.B.; Hunt, J.

2014-01-01

The dose conversion coefficient (DCC) is important to quantify and assess effective doses associated with medical, professional and public exposures. The calculation of DCCs using anthropomorphic simulators and radiation transport codes is justified since in-vivo measurement of effective dose is extremely difficult and not practical for occupational dosimetry. DCCs have been published by the ICRP using simulators in a standing posture, which is not always applicable to all exposure scenarios, providing an inaccurate dose estimation. The aim of this work was to calculate DCCs for equivalent dose in terms of air kerma (H/Kair) using the Visual Monte Carlo (VMC) code and the VOXTISS8 adult male voxel simulator in sitting and standing postures. In both postures, the simulator was irradiated by a plane source of monoenergetic photons in antero-posterior (AP) geometry. The photon energy ranged from 15 keV to 2 MeV. The DCCs for both postures were compared and the DCCs for the standing simulator were higher. For certain organs, the difference of DCCs were more significant, as in gonads (48% higher), bladder (16% higher) and colon (11% higher). As these organs are positioned in the abdominal region, the posture of the anthropomorphic simulator modifies the form in which the radiation is transported and how the energy is deposited. It was also noted that the average percentage difference of conversion coefficients was 33% for the bone marrow, 11% for the skin, 13% for the bone surface and 31% for the muscle. For other organs, the percentage difference of the DCCs for both postures was not relevant (less than 5%) due to no anatomical changes in the organs of the head, chest and upper abdomen. We can conclude that is important to obtain DCCs using different postures from those present in the scientific literature. - Highlights: • Scenarios of external photon exposures were performed in VMC code. • The VOXTISS8 simulator was irradiated in standing and sitting postures. �

Coronal plane radiographic evaluation of the single TightRope technique in the treatment of acute acromioclavicular joint injury.

Science.gov (United States)

Yi, Young; Kim, Jeong Woo

2015-10-01

This study aimed to demonstrate the technical aspects of the single TightRope (Arthrex, Naples, FL, USA) procedure for acute acromioclavicular-coracoclavicular joint dislocation, identify the predictive factors influencing its outcome, and assess and validate the significance of specific radiologic parameters. We reviewed true anteroposterior shoulder radiographs of 62 consecutive patients who had undergone surgical reconstruction using TightRope for an acute acromioclavicular-coracoclavicular injury. All patients were followed up for at least 12 months between October 2009 and March 2012 and were divided into dissociated or nondissociated groups according to their surgical outcome. We measured the clavicle tunnel anteroposterior angle, distal clavicular tunnel placement, and tunnel-to-medial coracoid ratio, and compared the parameters in each group after a satisfactory intraclass correlation coefficient reliability test result. The angles of patients in the dissociated group were more acute compared with the angles of those in the nondissociated group, which were perpendicular, as verified statistically using the paired t test. The difference in the distal clavicular tunnel placement and tunnel-to-medial coracoid ratio between the groups was not significant. Therefore, tunnel placement is not influenced by coracoclavicular dissociation. The clavicle tunnel anteroposterior angle can be used as a predictor of surgical outcome in coracoclavicular augmentation surgery. The surgeon should strive to place a perpendicular hole from the clavicle to the coracoid process for the TightRope fixation to enable a successful reconstruction of the acute acromioclavicular-coracoclavicular injury. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Measurement of Lumbosacral Angle in Normal Radiographs: A ...

African Journals Online (AJOL)

hyper.lordosis; most of the data in use in medical practice are based on studies on other races. Aim: To quantify the normal LSA in our population. Subjects and Methods: LSA was measured by the Fergusonfs technique and the data analyzed with SPSS Statistics version 17.0 (Chicago IL, USA). Results: LSA varied between ...

Intrasacral rod fixation for pediatric lumbopelvic fusion.

Science.gov (United States)

Ilharreborde, Brice; Mazda, Keyvan

2014-07-01

This paper reports the authors' 19 years experience with pediatric intrasacral rod fixation. After insertion of two cannulated screws in S1 with and an original template guiding them into the anterior third of the endplate, two short fusion rods were inserted into the sacrum according to Jackson's technique distally to S3. In neuromuscular scoliosis, pelvic obliquity was reduced by connecting the proximal and distal constructs, distraction or compression, and in situ rod bending. In children with high-grade spondylolisthesis, lumbosacral kyphosis was reduced by rotation of the sacrum and in situ bending. There were no direct neurological or vascular injuries. The main complication was infection (7%). No pseudarthrosis or significant loss of correction at the lumbosacral junction was observed during follow-up. Intrasacral rod fixation appears to be safe and reliable for lumbopelvic fusion in pediatric patients.

Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.

Science.gov (United States)

Wilkerson, R Gentry; Stone, Michael B

2010-01-01

Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention

Directory of Open Access Journals (Sweden)

Holm Emil Kongsted

2017-01-01

Full Text Available Bertolotti’s syndrome (BS refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV, and low back pain (LBP. Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I–V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II. The remainders were case series (level IV. Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient’s symptoms, especially patients diagnosed with “far out syndrome” treated with laminectomy. Clinical outcomes were more heterogenetic for patient’s treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient’s clinical outcome over time, whereas steroid injection only improves the patient’s symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS.

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention.

Science.gov (United States)

Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus

2017-01-01

Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I-V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient's symptoms, especially patients diagnosed with "far out syndrome" treated with laminectomy. Clinical outcomes were more heterogenetic for patient's treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient's clinical outcome over time, whereas steroid injection only improves the patient's symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS. © The Authors, published by EDP Sciences, 2017.

A comparative study of the detectability of TMJ radiographic techniques for artificial mandibular condylar lesions

International Nuclear Information System (INIS)

Jeong, Hee Jeong; Jung, Yeon Hwa; Cho, Bong Hae

1997-01-01

The purpose of this study was to evaluate the detectability of various radiographic techniques for mandibular condylar lesions. Erosive lesion, osteophyte and flattening were formed on the artificial mandibular condyle, and panoramic, transcranial, transorbital radiography, lateral and frontal tomography were taken. The results were as follows; 1. The detectability for erosive lesions was superior in the order of frontal tomography (96%), lateral tomography (78%), transorbital (59%), transcranial (56%) and panoramic (48%) radiography. 2. The location of erosive lesion that showed the highest detectability was the medial third in panoramic, the lateral third in transcranial, the central portion of anteroposterior direction in transorbital, the central portion of mediolateral direction and the posterior third in lateral tomography. Frontal tomography disclosed all erosive lesions except one anterolateral lesion. 3. The detectability of osteophyte was 100% in lateral tomography, 78% in transcranial and 56% in panoramic radiography. 4. For flattening, lateral tomography showed the flattened condyle, but both panoramic and transcranial views showed only decreased bone density without the change of condylar shape.

Why looking at the whole hippocampus is not enough – a critical role for anteroposterior axis, subfield and activation analyses to enhance predictive value of hippocampal changes for Alzheimer’s disease diagnosis.

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Aleksandra eMaruszak

2014-03-01

Full Text Available The hippocampus is one of the earliest affected brain regions in Alzheimer´s disease (AD and its dysfunction is believed to underlie the core feature of the disease- memory impairment. Given that hippocampal volume is one of the best AD biomarkers, our review focuses on distinct subfields within the hippocampus, pinpointing regions that might enhance the predictive value of current diagnostic methods. Our review presents how changes in hippocampal volume, shape, symmetry and activation are reflected by cognitive impairment and how they are linked with neurogenesis alterations. Moreover, we revisit the functional differentiation along the anteroposterior longitudinal axis of the hippocampus and discuss its relevance for AD diagnosis. Finally, we indicate that apart from hippocampal subfield volumetry, the characteristic pattern of hippocampal hyperactivation associated with seizures and neurogenesis changes is another promising candidate for an early AD biomarker that could become also a target for early interventions.

Helical tomotherapy as a new treatment technique for whole abdominal irradiation

Energy Technology Data Exchange (ETDEWEB)

Rochet, N.; Sterzing, F.; Jensen, A.; Herfarth, K.; Schubert, K.; Debus, J.; Harms, W. [Heidelberg Univ. (Germany). Dept. of Radiation Oncology; Dinkel, J. [German Cancer Research Center (dkfz), Heidelberg (Germany). Dept. of Radiology; Eichbaum, M.; Schneeweiss, A.; Sohn, C. [Heidelberg Univ. (Germany). Dept. of Gynecology and Obstetrics

2008-03-15

Purpose: To describe a new intensity-modulated radiotherapy (IMRT) technique using helical tomotherapy for whole abdominal irradiation (WAI) in patients with advanced ovarian cancer. Material and Methods: A patient with radically operated ovarian cancer FIGO stage IIIc was treated in a prospective clinical trial with WAI to a total dose of 30 Gy in 1.5-Gy fractions as an additional therapy after adjuvant platinum-based chemotherapy. The planning target volume (PTV) included the entire peritoneal cavity. PTV was adapted according to breathing motion as detected in a four-dimensional respiratory-triggered computed tomography (4D-CT). Inverse treatment planning was done with the Hi-Art tomotherapy planning station. Organs at risk (OARs) were kidneys, liver, bone marrow, spinal cord, thoracic and lumbosacral vertebral bodies, and pelvic bones. Daily control of positioning accuracy was performed with megavoltage computed tomography (MV-CT). Results: Helical tomotherapy enabled a very homogeneous dose distribution with excellent sparing of OARs and coverage of the PTV (V90 of 93.1%, V95 of 86.9%, V105 of 1.9%, and V110 of 0.01%). Mean liver dose was 21.57 Gy and mean kidney doses were 9.75 Gy and 9.14 Gy, respectively. Treatment could be performed in 18.1 min daily and no severe side effects occurred. Conclusion: Helical tomotherapy is feasible and fast for WAI. Tomotherapy enabled excellent coverage of the PTV and effective sparing of liver, kidneys and bone marrow. (orig.)

Helical tomotherapy as a new treatment technique for whole abdominal irradiation

International Nuclear Information System (INIS)

Rochet, N.; Sterzing, F.; Jensen, A.; Herfarth, K.; Schubert, K.; Debus, J.; Harms, W.; Dinkel, J.; Eichbaum, M.; Schneeweiss, A.; Sohn, C.

2008-01-01

Purpose: To describe a new intensity-modulated radiotherapy (IMRT) technique using helical tomotherapy for whole abdominal irradiation (WAI) in patients with advanced ovarian cancer. Material and Methods: A patient with radically operated ovarian cancer FIGO stage IIIc was treated in a prospective clinical trial with WAI to a total dose of 30 Gy in 1.5-Gy fractions as an additional therapy after adjuvant platinum-based chemotherapy. The planning target volume (PTV) included the entire peritoneal cavity. PTV was adapted according to breathing motion as detected in a four-dimensional respiratory-triggered computed tomography (4D-CT). Inverse treatment planning was done with the Hi-Art tomotherapy planning station. Organs at risk (OARs) were kidneys, liver, bone marrow, spinal cord, thoracic and lumbosacral vertebral bodies, and pelvic bones. Daily control of positioning accuracy was performed with megavoltage computed tomography (MV-CT). Results: Helical tomotherapy enabled a very homogeneous dose distribution with excellent sparing of OARs and coverage of the PTV (V90 of 93.1%, V95 of 86.9%, V105 of 1.9%, and V110 of 0.01%). Mean liver dose was 21.57 Gy and mean kidney doses were 9.75 Gy and 9.14 Gy, respectively. Treatment could be performed in 18.1 min daily and no severe side effects occurred. Conclusion: Helical tomotherapy is feasible and fast for WAI. Tomotherapy enabled excellent coverage of the PTV and effective sparing of liver, kidneys and bone marrow. (orig.)

Estudo do relacionamento ântero-posterior entre os arcos dentários decíduos, de crianças nipo-brasileiras, dos dois aos seis anos de idade Study of the anteroposterior relationship between deciduous dental arches of Japanese-Brazilian children, from 2 to 6 years of age

Directory of Open Access Journals (Sweden)

Dirce Yamada Kataoka

2006-10-01

Full Text Available OBJETIVO: verificar as prevalências dos diferentes tipos de relacionamentos ântero-posteriores entre os arcos dentários decíduos, bem como o possível dimorfismo sexual, em crianças nipo-brasileiras na faixa etária dos dois aos seis anos de idade. METODOLOGIA: foram avaliadas por inspeção visual 310 crianças nipo-brasileiras, matriculadas em 19 escolas do estado de São Paulo, sendo 154 do gênero masculino e 156 do feminino. Os resultados foram submetidos ao teste do qui-quadrado e revelaram ausência de dimorfismo sexual para a maioria dos relacionamentos analisados, permitindo apresentar os resultados conjuntamente para ambos os gêneros. RESULTADOS: as prevalências dos relacionamentos entre os segundos molares decíduos foram: 47,4% para o degrau mesial, 41,3% para o plano terminal reto, 5,5% para o degrau distal e 5,8% para os casos com assimetrias. Para os relacionamentos entre os caninos decíduos, conforme Foster e Hamilton, constataram-se prevalências de 77,4% para a Classe 1, 6,8% para a Classe 2, 6,8% para a Classe 3 e 9% para as relações assimétricas. Apenas a Classe 2 apresentou dimorfismo sexual, sendo de 3,9% para o feminino e de 9,7% para o masculino. Quanto à sobressaliência verificaram-se prevalências de 71,3% para a normal, 14,2% para a aumentada, 7,4% para a mordida cruzada anterior e 7,1% para a mordida topo-a-topo. RESULTADOS: concluiu-se que a maioria das crianças nipo-brasileiras avaliadas neste estudo, apresentaram um relacionamento ântero-posterior normal entre os arcos decíduos, merecendo atenção uma ligeira tendência para o desenvolvimento da Classe 3.AIM: the purpose of this cross-sectional study was to verify the prevalences of different types of anteroposterior relationships between deciduous dental arches and its possible sexual dimorphism, in Japanese-Brazilian children from 2 to 6 years of age. METHODS: a total of 310 Japanese-Brazilian children from 19 schools in São Paulo, Brazil

SU-E-J-39: Comparison of PTV Margins Determined by In-Room Stereoscopic Image Guidance and by On-Board Cone Beam Computed Tomography Technique for Brain Radiotherapy Patients

International Nuclear Information System (INIS)

Ganesh, T; Paul, S; Munshi, A; Sarkar, B; Krishnankutty, S; Sathya, J; George, S; Jassal, K; Roy, S; Mohanti, B

2014-01-01

Purpose: Stereoscopic in room kV image guidance is a faster tool in daily monitoring of patient positioning. Our centre, for the first time in the world, has integrated such a solution from BrainLAB (ExacTrac) with Elekta's volumetric cone beam computed tomography (XVI). Using van Herk's formula, we compared the planning target volume (PTV) margins calculated by both these systems for patients treated with brain radiotherapy. Methods: For a total of 24 patients who received partial or whole brain radiotherapy, verification images were acquired for 524 treatment sessions by XVI and for 334 sessions by ExacTrac out of the total 547 sessions. Systematic and random errors were calculated in cranio-caudal, lateral and antero-posterior directions for both techniques. PTV margins were then determined using van Herk formula. Results: In the cranio-caudal direction, systematic error, random error and the calculated PTV margin were found to be 0.13 cm, 0.12 cm and 0.41 cm with XVI and 0.14 cm, 0.13 cm and 0.44 cm with ExacTrac. The corresponding values in lateral direction were 0.13 cm 0.1 cm and 0.4 cm with XVI and 0.13 cm, 0.12 cm and 0.42 cm with ExacTrac imaging. The same parameters for antero-posterior were for 0.1 cm, 0.11 cm and 0.34 cm with XVI and 0.13 cm, 0.16 cm and 0.43 cm with ExacTrac imaging. The margins estimated with the two imaging modalities were comparable within ± 1 mm limit. Conclusion: Verification of setup errors in the major axes by two independent imaging systems showed the results are comparable and within ± 1 mm. This implies that planar imaging based ExacTrac can yield equal accuracy in setup error determination as the time consuming volumetric imaging which is considered as the gold standard. Accordingly PTV margins estimated by this faster imaging technique can be confidently used in clinical setup

End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes

International Nuclear Information System (INIS)

Chung, Christine B.; Vande Berg, Bruno C.; Malghem, Jacques; Tavernier, Thierry; Cotten, Anne; Laredo, Jean-Denis; Vallee, Christian

2004-01-01

To investigate the frequency and distribution of end plate marrow signal intensity changes in an asymptomatic population and to correlate these findings with patient age and degenerative findings in the spine. MR imaging studies of the lumbosacral (LS) spine in 59 asymptomatic subjects were retrospectively reviewed by 2 musculoskeletal radiologists to determine the presence and location of fat-like and edema-like marrow signal changes about the end plates of the L1-2 through L5-S1 levels. The presence of degenerative changes in the spine was recorded as was patient age. Descriptive statistics were utilized to determine the frequency and associations of end plate findings and degenerative changes in the spine. Interobserver variability was determined by a kappa score. Binomial probability was used to predict the prevalence of the end plate changes in a similar subject population. The Fisher exact test was performed to determine statistical significance of the relationship of end plate changes with degenerative changes in the spine, superior versus inferior location about the disc and age of the patient population. Focal fat-like signal intensity adjacent to the vertebral end-plate was noted in 15 out of 59 subjects by both readers, and involved 38 and 36 out of 590 end plates by readers 1 and 2, respectively. Focal edema-like signal intensity adjacent to the vertebral end plate was noted in 8 out of 59 subjects by both readers and involved 11 and 10 out of 590 end plates by readers 1 and 2, respectively. Either fat or edema signal intensity occurred most often at the anterior (p<.05) aspects of the mid-lumbar spine and was seen in an older sub-population of the study (p<.05). End plate marrow signal intensity changes are present in the lumbar spine of some asymptomatic subjects with a characteristic location along the spine and in vertebral end plates. (orig.)

Introducer Curving Technique for the Prevention of Tilting of Transfemoral Gunther Tulip Inferior Vena Cava Filter

International Nuclear Information System (INIS)

Xiao, Liang; Shen, Jing; Tong, Jia Jie; Huang, De Sheng

2012-01-01

To determine whether the introducer curving technique is useful in decreasing the degree of tilting of transfemoral Tulip filters. The study sample group consisted of 108 patients with deep vein thrombosis who were enrolled and planned to undergo thrombolysis, and who accepted transfemoral Tulip filter insertion procedure. The patients were randomly divided into Group C and Group T. The introducer curving technique was Adopted in Group T. The post-implantation filter tilting angle (ACF) was measured in an anteroposterior projection. The retrieval hook adhering to the vascular wall was measured via tangential cavogram during retrieval. The overall average ACF was 5.8 ± 4.14 degrees. In Group C, the average ACF was 7.1 ± 4.52 degrees. In Group T, the average ACF was 4.4 ± 3.20 degrees. The groups displayed a statistically significant difference (t = 3.573, p = 0.001) in ACF. Additionally, the difference of ACF between the left and right approaches turned out to be statistically significant (7.1 ± 4.59 vs. 5.1 ± 3.82, t = 2.301, p = 0.023). The proportion of severe tilt (ACF ≥ 10 degree) in Group T was significantly lower than that in Group C (9.3% vs. 24.1%, X 2 = 4.267, p = 0.039). Between the groups, the difference in the rate of the retrieval hook adhering to the vascular wall was also statistically significant (2.9% vs. 24.2%, X 2 = 5.030, p = 0.025). The introducer curving technique appears to minimize the incidence and extent of transfemoral Tulip filter tilting.

Introducer Curving Technique for the Prevention of Tilting of Transfemoral Gunther Tulip Inferior Vena Cava Filter

Energy Technology Data Exchange (ETDEWEB)

Xiao, Liang; Shen, Jing; Tong, Jia Jie [The First Hospital of China Medical University, Shenyang (China); Huang, De Sheng [College of Basic Medical Science, China Medical University, Shenyang (China)

2012-07-15

To determine whether the introducer curving technique is useful in decreasing the degree of tilting of transfemoral Tulip filters. The study sample group consisted of 108 patients with deep vein thrombosis who were enrolled and planned to undergo thrombolysis, and who accepted transfemoral Tulip filter insertion procedure. The patients were randomly divided into Group C and Group T. The introducer curving technique was Adopted in Group T. The post-implantation filter tilting angle (ACF) was measured in an anteroposterior projection. The retrieval hook adhering to the vascular wall was measured via tangential cavogram during retrieval. The overall average ACF was 5.8 {+-} 4.14 degrees. In Group C, the average ACF was 7.1 {+-} 4.52 degrees. In Group T, the average ACF was 4.4 {+-} 3.20 degrees. The groups displayed a statistically significant difference (t = 3.573, p = 0.001) in ACF. Additionally, the difference of ACF between the left and right approaches turned out to be statistically significant (7.1 {+-} 4.59 vs. 5.1 {+-} 3.82, t = 2.301, p = 0.023). The proportion of severe tilt (ACF {>=} 10 degree) in Group T was significantly lower than that in Group C (9.3% vs. 24.1%, X{sup 2} = 4.267, p = 0.039). Between the groups, the difference in the rate of the retrieval hook adhering to the vascular wall was also statistically significant (2.9% vs. 24.2%, X{sup 2} = 5.030, p = 0.025). The introducer curving technique appears to minimize the incidence and extent of transfemoral Tulip filter tilting.

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures.

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Dong, Wen-Wei; Shi, Zeng-Yuan; Liu, Zheng-Xin; Mao, Hai-Jiao

2016-12-01

To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

C. elegans fmi-1/flamingo and Wnt pathway components interact genetically to control the anteroposterior neurite growth of the VD GABAergic neurons.

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Huarcaya Najarro, Elvis; Ackley, Brian D

2013-05-01

Directed axonal growth is essential to establish neuronal networks. During the early development of the VD neurons, an anterior neurite that will become the VD axon extends along the anteroposterior (A/P) axis in the ventral nerve cord (VNC) in Caenorhabditis elegans. Little is known about the cellular and molecular mechanisms that are important for correct neurite growth in the VNC. In fmi-1/flamingo mutant animals, we observed that some postembryonically born VD neurons had a posterior neurite instead of a normal anterior neurite, which caused aberrant VD commissure patterning along the A/P axis. In addition, VD anterior neurites had underextension defects in the VNC in fmi-1 animals, whereas VD commissure growth along the dorsoventral (D/V) axis occurred normally in these animals, suggesting that fmi-1 is important for neurite growth along the A/P axis but not the D/V axis. We also uncovered unknown details of the early development of the VD neurons, indicating that the neurite defects arose during their early development. Interestingly, though fmi-1 is present at this time in the VNC, we did not observe FMI-1 in the VD neurons themselves, suggesting that fmi-1 might be working in a cell non-autonomous fashion. Furthermore, fmi-1 appears to be working in a novel pathway, independently from the planar cell polarity pathway and in parallel to lin-17/frizzled and dsh-1/dishevelled, to determine the direction of neurite growth. Our findings indicate that redundant developmental pathways regulate neurite growth in the VNC in C. elegans. Copyright © 2013 Elsevier Inc. All rights reserved.

Effect of intra-abdominal volume increment technique for the treatment of intra-abdominal hypertension on the liver after resuscitation of hemorrhagic shock in pig

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Zheng-gang WANG

2012-02-01

Full Text Available Objective  To observe the effect of vacuum sealing drainage (VSD assisted intra-abdominal volume increment (IAVI technique on the liver in the treatment of intra-abdominal hypertension (IAH following hemorrhagic shock resuscitation in pigs. Methods  Twelve healthy mini-pigs (Bama, Guangxi were selected for bloodletting from the femoral artery to reproduce hemorrhagic shock model (mean arterial blood pressure, 50mmHg, 1h, and IAH model was successfully reproduced in eight pigs by partial occlusion of portal vein. The eight pigs were randomly divided into the intra-abdominal volume increment treatment (IT group (n=4 and sham operation control (SC group (n=4. Vesical pressure (VP and inferior vena cava pressure (IVCP were observed before shock, 2h after IAH, and 22h after IAVI treatment. Aspartate aminotransferase (AST and alanine aminotransferase (ALT were measured. In addition, the ratio of the abdominal anteroposterior diameter to the transverse diameter was assessed, and the liver CT values were measured after enhanced CT scanning. The pigs were sacrificed 26h after operation. Liver specimens were collected to measure the ratio of wet weight to dry weight and pathological examination. Results  The VP in 8 IAH pigs was 21.16±4.63mmHg. The ratio of abdominal anteroposterior diameter to the transverse diameter increased remarkably 2h after IAH compared with that before shock (1.22±1.41 vs 0.96±0.08, PPvs 42.73±4.92HU, PPPvs 5.14±0.71, PConclusions  The established model could better reproduce the symptoms of IAH after hemorrhagic shock and fluid resuscitation, accompanied by liver damage. IAVI helps to relieve liver functional disturbance after IAH, which is related to decreased intra-abdominal pressure and hypoxia-ischemia of the liver.

Can dosimetric parameters predict acute hematologic toxicity in rectal cancer patients treated with intensity-modulated pelvic radiotherapy?

International Nuclear Information System (INIS)

Wan, Juefeng; Liu, Kaitai; Li, Kaixuan; Li, Guichao; Zhang, Zhen

2015-01-01

To identify dosimetric parameters associated with acute hematologic toxicity (HT) in rectal cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. Ninety-three rectal cancer patients receiving concurrent capecitabine and pelvic intensity-modulated radiation therapy (IMRT) were analyzed. Pelvic bone marrow (PBM) was contoured for each patient and divided into three subsites: lumbosacral spine (LSS), ilium, and lower pelvis (LP). The volume of each site receiving 5–40 Gy (V 5, V10, V15, V20, V30, and V40, respectively) as well as patient baseline clinical characteristics was calculated. The endpoint for hematologic toxicity was grade ≥ 2 (HT2+) leukopenia, neutropenia, anemia or thrombocytopenia. Logistic regression was used to analyze correlation between dosimetric parameters and grade ≥ 2 hematologic toxicity. Twenty-four in ninety-three patients experienced grade ≥ 2 hematologic toxicity. Only the dosimetric parameter V40 of lumbosacral spine was correlated with grade ≥ 2 hematologic toxicity. Increased pelvic lumbosacral spine V40 (LSS-V40) was associated with an increased grade ≥ 2 hematologic toxicity (p = 0.041). Patients with LSS-V40 ≥ 60 % had higher rates of grade ≥ 2 hematologic toxicity than did patients with lumbosacral spine V40 < 60 % (38.3 %, 18/47 vs.13 %, 6/46, p =0.005). On univariate and multivariate logistic regression analysis, lumbosacral spine V40 and gender was also the variable associated with grade ≥ 2 hematologic toxicity. Female patients were observed more likely to have grade ≥ 2 hematologic toxicity than male ones (46.9 %, 15/32 vs 14.8 %, 9/61, p =0.001). Lumbosacral spine -V40 was associated with clinically significant grade ≥ 2 hematologic toxicity. Keeping the lumbosacral spine -V40 < 60 % was associated with a 13 % risk of grade ≥ 2 hematologic toxicity in rectal cancer patients undergoing concurrent chemoradiotherapy

Frequencies of different peripheral nervous system pathologies among Cases of Lumbar Radicular Pain using Electrodiagnostic Studies

International Nuclear Information System (INIS)

Ayaz, S.; Waheed, A.; Ali, L.

2014-01-01

Objective: to discover the spectrum of diagnoses on nerve conduction studies/ Electromyography in patients with lumbar radicular pain, test preponderance of the commonest pathology and correlate commonest pathology with age > 50 years, gender and unilateral involvement. Study design: A descriptive cross-sectional study of 539 patients. Place and Duration of the study: the department of Electrodiagnostic studies, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from January 2012 to December 2012. Material and methods: using non-probability consecutive sampling 539 patients referred with complaints of lumbar radicular pain were subjected to electrodiagnostic evaluation for presence of lumbosacral radiculopathy, polyneuropathy, sciatic nerve injury or a combination of these. The preponderance of commonest pathology was tested statistically. The frequencies were then related statistically to age > 50 years, gender and unilateral or bilateral involvement. Result: A total of 539 patients (age:18-85 years) were registered. 355 (66% ) were males and 261 (48.4%) patients were > 50 years. Nerve conduction studies/Electromyography findings were abnormal in 386 (77.6%) patients. The commonest diagnosis was lumbosacral radiculopathy in 65% followed by polyneuropathy with superimposed lumbosacral radiculopathy in 7%. The preponderance of lumbosacral radiculopathy was statistically found significant (p 50 years. Conclusion: Lumbosacral radiculopathy is highly expected to be found on nerve conduction studies /electromyography in patients who present with lumbar radicular pain. The lumbosacral radiculopathy is more common in individuals of age 50 years and above. (author)

The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws.

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Chiu, C K; Kwan, M K; Chan, C Y W; Schaefer, C; Hansen-Algenstaedt, N

2015-08-01

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location. ©2015 The British Editorial Society of Bone & Joint Surgery.

Effective dose per unit fluence calculated for adults and a 7 year old girl in broad antero-posterior beams of monoenergetic electrons of 0.1 to 10 MeV

International Nuclear Information System (INIS)

Schultz, F.W.; Zoetelief, J.

1997-01-01

For broad antero-posterior beams of monoenergetic (0.1-10 MeV) electrons, organ doses per unit fluence were computed through Monte Carlo simulation with reference to male and female adult and a 7 year old girl. Effective doses (E) per unit fluence were calculated for the three phantoms and for an average adult. E increases from about 8 x 10 -14 to about 1.2 x 10 -10 Sv.cm 2 with increasing electron energy. Uncertainties were (often much) better than 6% for the adults, and 18% for the child. E as calculated for the average adult may be used for both males and females as under- or overestimations stay within 25% from E for the average adult. The child's radiation risk is underestimated for electron energies in the range of 0.6 to 3 MeV. This underestimation up to a factor of about 20 is unacceptable for radiological protection purposes. The present results were compared with literature data on operational quantities associated with radiation hazard from weakly penetrating radiation. Neither directional nor personal dose equivalent appears to be a realistic quantity in this case. Both would yield an unnecessarily large safety factor for radiological protection. (author)

MODIFICATION OF AGILITY RUNNING TECHNIQUE IN REACTION TO A DEFENDER IN RUGBY UNION

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Keane W. Wheeler

2010-09-01

Full Text Available Three-dimensional kinematic analysis examined agility running technique during pre-planned and reactive performance conditions specific to attacking ball carries in rugby union. The variation to running technique of 8 highly trained rugby union players was compared between agility conditions (pre-planned and reactive and also agility performance speeds (fast, moderate and slow. Kinematic measures were used to determine the velocity of the centre of mass (COM in the anteroposterior (running speed and mediolateral (lateral movement speed planes. The position of foot-strike and toe-off was also examined for the step prior to the agility side- step (pre-change of direction phase and then the side-step (change of direction phase. This study demonstrated that less lateral movement speed towards the intended direction change occurred during reactive compared to pre-planned conditions at pre-change of direction (0.08 ± 0.28 m·s-1 and 0.42 ± 0.25 m·s-1, respectively and change of direction foot-strikes (0.25 ± 0.42 m·s-1 and 0.69 ± 0.43 m·s-1, respectively. Less lateral movement speed during reactive conditions was associated with greater lateral foot displacement (44.52 ± 6.10% leg length at the change of direction step compared to pre-planned conditions (41.35 ± 5.85%. Importantly, the anticipation abilities during reactive conditions provided a means to differentiate between speeds of agility performance, with faster performances displaying greater lateral movement speed at the change of direction foot- strike (0.52 ± 0.34 m·s-1 compared to moderate (0.20 ± 0.37 m·s-1 and slow (-0.08 ± 0.31 m·s-1. The changes to running technique during reactive conditions highlight the need to incorporate decision-making in rugby union agility programs

Introducer curving technique for the prevention of tilting of transfemoral Günther Tulip inferior vena cava filter.

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Xiao, Liang; Huang, De-sheng; Shen, Jing; Tong, Jia-jie

2012-01-01

To determine whether the introducer curving technique is useful in decreasing the degree of tilting of transfemoral Tulip filters. The study sample group consisted of 108 patients with deep vein thrombosis who were enrolled and planned to undergo thrombolysis, and who accepted transfemoral Tulip filter insertion procedure. The patients were randomly divided into Group C and Group T. The introducer curving technique was Adopted in Group T. The post-implantation filter tilting angle (ACF) was measured in an anteroposterior projection. The retrieval hook adhering to the vascular wall was measured via tangential cavogram during retrieval. The overall average ACF was 5.8 ± 4.14 degrees. In Group C, the average ACF was 7.1 ± 4.52 degrees. In Group T, the average ACF was 4.4 ± 3.20 degrees. The groups displayed a statistically significant difference (t = 3.573, p = 0.001) in ACF. Additionally, the difference of ACF between the left and right approaches turned out to be statistically significant (7.1 ± 4.59 vs. 5.1 ± 3.82, t = 2.301, p = 0.023). The proportion of severe tilt (ACF ≥ 10°) in Group T was significantly lower than that in Group C (9.3% vs. 24.1%, χ(2) = 4.267, p = 0.039). Between the groups, the difference in the rate of the retrieval hook adhering to the vascular wall was also statistically significant (2.9% vs. 24.2%, χ(2) = 5.030, p = 0.025). The introducer curving technique appears to minimize the incidence and extent of transfemoral Tulip filter tilting.

Plasticity of Select Primary Afferent Projections to the Dorsal Horn after a Lumbosacral Ventral Root Avulsion Injury and Root Replantation in Rats

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Allison J. Bigbee

2017-07-01

Full Text Available Injuries to the conus medullaris and cauda equina portions of the spinal cord result in neurological impairments, including paralysis, autonomic dysfunction, and pain. In experimental studies, earlier investigations have shown that a lumbosacral ventral root avulsion (VRA injury results in allodynia, which may be ameliorated by surgical replantation of the avulsed ventral roots. Here, we investigated the long-term effects of an L6 + S1 VRA injury on the plasticity of three populations of afferent projections to the dorsal horn in rats. At 8 weeks after a unilateral L6 + S1 VRA injury, quantitative morphological studies of the adjacent L5 dorsal horn showed reduced immunoreactivity (IR for the vesicular glutamate transporter, VGLUT1 and isolectin B4 (IB4 binding, whereas IR for calcitonin gene-related peptide (CGRP was unchanged. The IR for VGLUT1 and CGRP as well as IB4 binding was at control levels in the L5 dorsal horn at 8 weeks following an acute surgical replantation of the avulsed L6 + S1 ventral roots. Quantitative morphological studies of the L5 dorsal root ganglia (DRGs showed unchanged neuronal numbers for both the VRA and replanted series compared to shams. The portions of L5 DRG neurons expressing IR for VGLUT1 and CGRP, and IB4 binding were also the same between the VRA, replanted, and sham-operated groups. We conclude that the L5 dorsal horn shows selective plasticity for VGLUT1 and IB4 primary afferent projections after an L6 + S1 VRA injury and surgical repair.

CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

International Nuclear Information System (INIS)

Wang Ganggang; Chen Long; Yang Chao; Ni Caifang

2013-01-01

Objective: To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by 'double needle' technique to treat sacral cyst. Methods: Clinical data of 20 cases with 'double-needle' injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed. All patients had varying degrees of sacral nerve root compression symptoms. The treatment for sacral cyst was carried out after clear diagnosis was made. On the basis of CT-guided percutaneous injection of fibrin glue, the improved CT-guided percutaneous injection of fibrin glue by 'double-needle' technique was used to treat these patients. The average dose of fibrin glue was (5.9 ± 2.4) ml. The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months. The assessment criteria were as follows: excellent, complete resolution of signs and symptoms, with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up, good, symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region, which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up), fair, no improvement in clinical symptoms, but a decrease in cyst size on the imaging study, poor, no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results: Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Nine patients reported excellent recovery, 8 reported good recovery, 2 reported fair recovery, and 1 reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 85%. No serious postoperative complications were discovered. Conclusions: CT guided percutaneous injection of the fibrin glue by

Anatomical variations of the iliolumbar vein with application to the anterior retroperitoneal approach to the lumbar spine: a cadaver study.

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Unruh, Kenneth P; Camp, Christopher L; Zietlow, Scott P; Huddleston, Paul M

2008-10-01

Objectives of this study include identification of lumbosacral venous variations, designation of a critical area of dissection for surgical exposure, and comparison between both male/female and right/left-sided anatomy. Attempts were made to provide anatomic nomenclature that accurately describes these structures. Thirty-eight iliolumbar venous systems in 20 cadavers (11 females/9 males) were dissected. Each system was identified as one of three patterns of variation: common venous trunk (combining ascending lumbar and iliolumbar venous systems) with distal veins, common venous trunk without distal veins, and venous systems without a common venous trunk. Dimensions including distances to the inferior vena cava (IVC) confluence, the obturator nerve, and the lumbosacral trunk, and venous stem length were obtained to aid surgical dissection. Differences between males and females and those between right and left sides were compared. Anterior lumbosacral venous variations could be organized into three groups. A Type 1 venous system (common venous trunk with distal veins) was most common (53% of systems). The anatomical name "lateral lumbosacral veins" adequately describes the anatomical location of these veins and does not assume a direction of venous flow or the lack of individual distal veins. A critical area bordered by the obturator nerve anteriorly, the psoas muscle laterally, the spinal column medially, and sacrum posteriorly within 8.2 cm of the IVC confluence should be defined to adequately dissect the lateral lumbosacral veins. Differences in male and female lateral lumbosacral venous anatomy do not alter surgeon's approach to the anterior lumbar spine. (c) 2008 Wiley-Liss, Inc.

ANTROPOMETRI SENDI PERGELANGAN KAKI ETNIS MINANGKABAU

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Hafni Marsil

2015-09-01

Full Text Available AbstrakPenelitian ini bertujuan mengukur antropometri sendi pergelangan kaki etnis Minangkabau. Penelitian cross sectional dilakukan pada 50 orang mahasiswa kedokteran etnis Minangkabau berusia 21-25 tahun di lingkungan RS. dr. M Djamil Padang. Dilakukan pemeriksaan ROM, rontgen ankle proyeksi anteroposterior, lateral dan mortise. Hasil penelitian didapatkan ROM plantarfleksi 48,920±5,820, ROM dorsofleksi 31,300±4,070, inversi 10,320±2,280, eversi 5,940±1,200, talocrural angel anteroposterior 76,530± 2,530 dan mortise 77,380±2,270, tibiofibular overlap anteroposterior 7,51±2,64 mm dan mortise 4,71±2,45 mm, tibiofibular clear space anteroposterior 3,6±1,18 mm dan mortise 3,85±1,09 mm, talar tilt anteroposterior 0,140±0,100 dan mortise 0,190±0,150, medial malleolar length anteroposterior 13,88±1,99 mm dan mortise 14,03±1,69 mm, lateral malleolar length anteroposterior 25,71±2,83 mm dan mortise 26,70±3,40 mm, johnson angle anteroposterior 87,770±1,710 dan mortise 87,570±1,840, medial clear space 2,97±0,75 mm, anteroposterior inclination angle 7,470±2,700, anterior distal tibial angle 82,530± 2,700, dan anteroposterior gap 3,50±1,43 mm.Terdapat perbedaan ukuran antropometri sendi pergelangan kaki mahasiswa kedokteran beretnis Minangkabau di lingkungan RS. Dr. M. Djamil Padang dengan kepustakaan, namun masih dalam rentang normal.AbstractThis study aimed to measure anthropometric of ankle joint of Minangkabau ethnic group. Cross sectional study has been done in 50 Minangkabau ethnic medical students, aged 21-25 years in RSUP. Dr. M Djamil Padang. ROM, anteroposterior, lateral, and mortise X-ray projections of ankle were examined. ROM plantarflexion was 48.920±5.820, ROM dorsiflexion was 4.070±31.300, inversion was 10.320±2.280, eversion was 5.940±1.200, talocrural angel anteroposterior was 76.530±2.530 and mortise was 77.380±2.270, tibiofibular overlapp anteroposterior was 7.51±2,64 mm and mortise was 4.71±2,45 mm

Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica.

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Capek, Stepan; Amrami, Kimberly K; Howe, Benjamin M; Collins, Mark S; Sandroni, Paola; Cheville, John C; Spinner, Robert J

2016-03-01

Endometriosis of the nerve often remains an elusive diagnosis. We report the first case of intraneural lumbosacral plexus endometriosis with sequential imaging at different phases of the menstrual cycle: during the luteal phase and menstruation. Compared to the first examination, the examination performed during the patient's period revealed the lumbosacral plexus larger and hyperintense on T2-weighted imaging. The intraneural endometriosis cyst was also larger and showed recent hemorrhage. Additionally, this case represents another example of perineural spread of endometriosis from the uterus to the lumbosacral plexus along the autonomic nerves and then distally to the sciatic nerve and proximally to the spinal nerves.

On the sinus lumbosacralis, spina bifida occulta, and status dysraphicus in birds

NARCIS (Netherlands)

Jelgersma, H.C.

1951-01-01

The sinus rhomboidalis sacralis or sinus lumbosacralis as it is named by Ariens Kappers (1920) is an interesting anatomical part of the lumbosacral region of the avian spinal medulla. It is found in birds only and neither in reptiles nor in mammals. Fig. 1 shows the lumbosacral part of the spinal

Enhancement of the intrinsic defecation reflex by mosapride, a 5-HT4 agonist, in chronically lumbosacral denervated guinea pigs.

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Kojima, Yu; Fujii, Hisao; Katsui, Renta; Nakajima, Yoshiyuki; Takaki, Miyako

2006-10-01

The defecation reflex is composed of rectal distension-evoked rectal (R-R) reflex contractions and synchronous internal anal sphincter (R-IAS) reflex relaxations in guinea pigs. These R-R and R-IAS reflexes are controlled via extrinsic sacral excitatory nerve pathway (pelvic nerves), lumbar inhibitory nerve pathways (colonic nerves) and by intrinsic cholinergic excitatory and nitrergic inhibitory nerve pathways. The effect of mosapride (a prokinetic benzamide) on the intrinsic reflexes, mediated via enteric 5-HT(4) receptors, was evaluated by measuring the mechanical activity of the rectum and IAS in anesthetized guinea pigs using an intrinsic R-R and R-IAS reflex model resulting from chronic (two to nine days) lumbosacral denervation (PITH). In this model, the myenteric plexus remains undamaged and the distribution of myenteric and intramuscular interstitial cells of Cajal is unchanged. Although R-R and R-IAS reflex patterns markedly changed, the reflex indices (reflex pressure or force curve-time integral) of both the R-R contractions and the synchronous R-IAS relaxations were unchanged. The frequency of the spontaneous R and IAS motility was also unchanged. Mosapride (0.1-1.0 mg/kg) dose-dependently increased both intrinsic R-R (maximum: 1.82) and R-IAS reflex indices (maximum: 2.76) from that of the control (1.0) 6-9 days following chronic PITH. The dose-response curve was similar to that in the intact guinea pig, and had shifted to the left from that in the guinea pig after acute PITH. A specific 5-HT(4) receptor antagonist, GR 113808 (1.0 mg/kg), decreased both reflex indices by approximately 50% and antagonized the effect of mosapride 1.0 mg/kg. This was quite different from the result in the intact guinea pig where GR 113808 (1.0 mg/kg) did not affect either of the reflex indices. The present results indicate that mosapride enhanced the intrinsic R-R and R-IAS reflexes and functionally compensated for the deprivation of extrinsic innervation. The actions of

Utilization of Facet Joint and Sacroiliac Joint Interventions in Medicare Population from 2000 to 2014: Explosive Growth Continues!

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Manchikanti, Laxmaiah; Hirsch, Joshua A; Pampati, Vidyasagar; Boswell, Mark V

2016-10-01

Increasing utilization of interventional techniques in managing chronic spinal pain, specifically facet joint interventions and sacroiliac joint injections, is a major concern of healthcare policy makers. We analyzed the patterns of utilization of facet and sacroiliac joint interventions in managing chronic spinal pain. The results showed significant increase of facet joint interventions and sacroiliac joint injections from 2000 to 2014 in Medicare FFS service beneficiaries. Overall, the Medicare population increased 35 %, whereas facet joint and sacroiliac joint interventions increased 313.3 % per 100,000 Medicare population with an annual increase of 10.7 %. While the increases were uniform from 2000 to 2014, there were some decreases noted for facet joint interventions in 2007, 2010, and 2013, whereas for sacroiliac joint injections, the decreases were noted in 2007 and 2013. The increases were for cervical and thoracic facet neurolysis at 911.5 % compared to lumbosacral facet neurolysis of 567.8 %, 362.9 % of cervical and thoracic facet joint blocks, 316.9 % of sacroiliac joints injections, and finally 227.3 % of lumbosacral facet joint blocks.

A STUDY OF POSTERIOR LUMBAR INTERBODY FUSION WITH LOCALLY HARVESTED SPINOLAMINECTOMY BONE GRAFT AND PEDICLE SCREW FIXATION IN SPONDYLOLISTHESIS

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Pardhasaradhi M

2017-08-01

Full Text Available BACKGROUND Posterior Lumbar Interbody Fusion (PLIF and Transforaminal Lumbar Interbody Fusion (TLIF create intervertebral fusion by means of a posterior approach. Successful results have been reported with allograft, various cages (for interbody support, autograft and recombinant human bone morphogenetic protein‐2. Interbody fusion techniques facilitate reduction and enhance fusion. Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate. PLIF with cage gives better fusion on radiology than PLIF with iliac bone graft, but no statistical difference in the clinical outcome. Cage use precludes complications associated with iliac bone harvesting. The reported adjacent segment degeneration was 40.5% and reoperation was 8.1% after 10 years of follow up. MATERIALS AND METHODS 30 cases of spondylolisthesis who attended the Orthopaedic Outpatient Department of Andhra Medical College, Visakhapatnam, from 2014 to 2016 were taken up for study. All the cases were examined clinically and confirmed radiologically. The patient’s age, sex, symptoms and duration were noted and were examined clinically for the status of the spine. Straight leg raising test was done and neurological examination of the lower limbs performed. All the patients were subjected to the radiological examination of the lumbosacral spine by taking anteroposterior, lateral (flexion and extension views, oblique views to demonstrate spondylolysis and spondylolisthesis. MRI and x-rays studies were done in all the cases to facilitate evaluation of the root compression disk changes and spinal cord changes. RESULTS In our study, we followed all the 30 patients after the surgery following procedure of removal of loose lamina, spinous process and fibrocartilaginous mass, PLIF with only the laminectomy bone mass and CD screw system fixation up to 2 years. 12 patients (40% had excellent

Lateral topography for reducing effective dose in low-dose chest CT.

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Bang, Dong-Ho; Lim, Daekeon; Hwang, Wi-Sub; Park, Seong-Hoon; Jeong, Ok-man; Kang, Kyung Wook; Kang, Hohyung

2013-06-01

The purposes of this study were to assess radiation exposure during low-dose chest CT by using lateral topography and to compare the lateral topographic findings with findings obtained with anteroposterior topography alone and anteroposterior and lateral topography combined. From November 2011 to February 2012, 210 male subjects were enrolled in the study. Age, weight, and height of the men were recorded. All subjects were placed into one of three subgroups based on the type of topographic image obtained: anteroposterior topography, lateral topography, and both anteroposterior and lateral topography. Imaging was performed with a 128-MDCT scanner. CT, except for topography, was the same for all subjects. A radiologist analyzed each image, recorded scan length, checked for any insufficiencies in the FOV, and calculated the effective radiation dose. One-way analysis of variance and multiple comparisons were used to compare the effective radiation exposure and scan length between groups. The mean scan length in the anteroposterior topography group was significantly greater than that of the lateral topography group and the combined anteroposterior and lateral topography group (p topography group (0.735 ± 0.033 mSv) was significantly lower than that for the anteroposterior topography group (0.763 ± 0.038 mSv) and the combined anteroposterior and lateral topography group (0.773 ± 0.038) (p < 0.001). Lateral topographic low-dose CT was associated with a lower effective radiation dose and scan length than either anteroposterior topographic low-dose chest CT or low-dose chest CT with both anteroposterior and lateral topograms.

An Investigation into the Relation between the Technique of Movement and Overload in Step Aerobics

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Alicja Rutkowska-Kucharska

2017-01-01

Full Text Available The aim of this research was to determine the features of a step workout technique which may be related to motor system overloading in step aerobics. Subjects participating in the research were instructors (n=15 and students (n=15 without any prior experience in step aerobics. Kinematic and kinetic data was collected with the use of the BTS SMART system comprised of 6 calibrated video cameras and two Kistler force plates. The subjects’ task was to perform basic steps. The following variables were analyzed: vertical, anteroposterior, and mediolateral ground reaction forces; foot flexion and abduction and adduction angles; knee joint flexion angle; and trunk flexion angle in the sagittal plane. The angle of a foot adduction recorded for the instructors was significantly smaller than that of the students. The knee joint angle while stepping up was significantly higher for the instructors compared to that for the students. Our research confirmed that foot dorsal flexion and adduction performed while stepping up increased load on the ankle joint. Both small and large angles of knee flexion while stepping up and down resulted in knee joint injuries. A small trunk flexion angle in the entire cycle of step workout shut down dorsal muscles, which stopped suppressing the load put on the spine.

Changes in anteroposterior position and inclination of the maxillary incisors after surgical-orthodontic treatment of skeletal class III malocclusions.

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Zou, Bingshuang; Zhou, Yang; Lowe, Alan A; Li, Huiqi; Pliska, Benjamin

2015-12-01

The purpose of this study was to evaluate and compare the anteroposterior (AP) position and inclination of the maxillary incisors in subjects with class I normal occlusion and a harmonious profile with patients with skeletal class III malocclusions, and to investigate the changes in maxillary incisor inclination and AP position after surgical-orthodontic treatment in class III patients. Sixty-five subjects (35 female and 30 male; mean age: 21.8 ± 3.89 years) with normal profiles and class I skeletal and dental patterns were selected as a control sample. Sixty-seven patients (38 female and 29 male; mean age: 21.3 ± 3.31 years) with skeletal and dental class III malocclusions who sought surgical-orthodontic treatment were used as the study sample. Subjects were asked to smile and profile photographs were taken with the head in a natural position and the maxillary central incisors and the forehead in full view; cephalograms were taken and superimposed on the profile pictures according to the outline of the forehead and nose. Forehead inclination, maxillary incisor facial inclination and the AP position of the maxillary central incisor relative to the forehead (FAFFA) were measured on the integrated images and statistical analyses were performed. In both groups, there were no significant male/female differences in either the maxillary central incisor inclination or AP position. Female subjects had a significantly steeper forehead inclination compared with males (P 0.05). In the control group, 84.6% had the facial axial point (FA) of their maxillary central incisors positioned between lines through the forehead facial axis (FFA) point and the glabella. In the study group, however, 79.1% had the maxillary central incisors positioned posterior to the line through the FFA point and the difference with the control group was statistically significant (P 0.05). With the integrated radiograph-photograph method, the lateral cephalogram was reoriented, which makes it possible

Video fluoroscopic techniques for the study of Oral Food Processing

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Matsuo, Koichiro; Palmer, Jeffrey B.

2016-01-01

Food oral processing and pharyngeal food passage cannot be observed directly from the outside of the body without instrumental methods. Videofluoroscopy (x-ray video recording) reveals the movement of oropharyngeal anatomical structures in two dimensions. By adding a radiopaque contrast medium, the motion and shape of the food bolus can be also visualized, providing critical information about the mechanisms of eating, drinking, and swallowing. For quantitative analysis of the kinematics of oral food processing, radiopaque markers are attached to the teeth, tongue or soft palate. This approach permits kinematic analysis with a variety of textures and consistencies, both solid and liquid. Fundamental mechanisms of food oral processing are clearly observed with videofluoroscopy in lateral and anteroposterior projections. PMID:27213138

Spectrum of human tails: A report of six cases

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Biswanath Mukhopadhyay

2012-01-01

Full Text Available Human tail is a curiosity, a cosmetic stigma and presents as an appendage in the lumbosacral region. Six patients of tail in the lumbosacral region are presented here to discuss the spectrum of presentation of human tails. The embryology, pathology and treatment of this entity are discussed along with a brief review of the literature.

Anteroposterior condylar position: a comparative study between subjects with normal occlusion and patients with Class I, Class II Division 1, and Class III malocclusions.

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Fraga, Marcelo Reis; Rodrigues, Andréia Fialho; Ribeiro, Luiz Claudio; Campos, Marcio José da Silva; Vitral, Robert Willer Farinazzo

2013-10-29

The present study aimed to determine and compare the anteroposterior position of the condyle in the mandibular fossa between groups of asymptomatic subjects with normal occlusion and asymptomatic subjects with Class I, Class II Division 1, and Class III malocclusions. Thirty persons with normal occlusion, 30 with Class I malocclusion, 30 with Class II Division 1, and 30 with Class III had computed tomography scans of their temporomandibular joints. The anterior joint space/posterior joint space (AJS/PJS) ratio was determined for the right and left joints. The paired t test was used to analyze the AJS/PJS ratio between both sides for each group. The ANOVA test was applied to verify the differences between the groups for the measurements of the right and left sides. In case the ANOVA test confirmed significance, the Dunnett's t test was performed to compare the groups of malocclusion with that of normal occlusion. The paired t test between the AJS/PJS relationships in the right and left sides showed the following p values: Class I (0.168), Class II Division 1 (0.662), Class III (0.991), and normal occlusion (0.390). The ANOVA test showed a p value of 0.445 for the comparisons of the right side and 0.040 for the left side. The Dunnett's t test demonstrated a statistically significant difference between the Class II group and the normal occlusion group (p value of 0.026) in the joints of the left side. Bilateral symmetry and lack of condyle centralization were common characteristics among all groups. The greatest condylar decentralization was observed in the Class II group, whereas the least condylar decentralization was found in the normal occlusion group.

The Free-Hand Technique for S2-Alar-Iliac Screw Placement: A Safe and Effective Method for Sacropelvic Fixation in Adult Spinal Deformity.

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Shillingford, Jamal N; Laratta, Joseph L; Tan, Lee A; Sarpong, Nana O; Lin, James D; Fischer, Charla R; Lehman, Ronald A; Kim, Yongjung J; Lenke, Lawrence G

2018-02-21

Spinopelvic fixation is an integral part of achieving solid fusion across the lumbosacral junction, especially in deformity procedures requiring substantial correction or long-segment constructs. Traditional S2-alar-iliac (S2AI) screw-placement techniques utilize fluoroscopy, increasing operative time and radiation exposure to the patient and surgeon. We describe a novel free-hand technique for S2AI screw placement in patients with adult spinal deformity. We reviewed the records of 45 consecutive patients who underwent spinopelvic fixation performed with use of S2AI screws by the senior surgeon and various fellows or residents over a 12-month period (2015 to 2016). In each case, the S2AI screws were placed utilizing a free-hand technique without fluoroscopic or image guidance. Screw position and accuracy were assessed by intraoperative O-arm imaging and analyzed using 3-dimensional interactive manipulation of computed tomography images. A total of 100 screws were placed, 51 by the senior surgeon and 49 by trainees. The mean patient age was 57.4 ± 12.7 years at the time of surgery; 37 (82.2%) of the patients were female. Preoperative diagnoses included adult idiopathic scoliosis (n = 19), adult degenerative scoliosis (n = 15), flatback syndrome (n = 2), fixed sagittal imbalance (n = 6), and distal junctional kyphosis (n = 3). Five (5%) of the screws were placed with moderate to severe cortical breaches, all of which perforated the pelvis posteriorly, with no clinically notable neurovascular or visceral complications. The breach rate did not differ significantly between the senior surgeon and trainees. The free-hand technique for S2AI screw placement, when performed in a standardized manner, was demonstrated to be safe and reliable in constructs requiring spinopelvic fixation. The accuracy of screw placement relies on visible and palpable anatomic landmarks that obviate the need for intraoperative fluoroscopy or image guidance, potentially reducing operative time

LATERAL CEPHALOMETRIC RADIOGRAPHY FOR EVALUATION OF UPPER AIRWAY

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Miesje Karmiati Purwanegara

2015-06-01

Full Text Available The influenced of respiration to dentocraniofacial growth and development is still controversial. The accurate radiologic examination is important factor for proper diagnosis. Deviation of upper airway (i.e. nasopharynx, oropharymx and nasal cavity could be evaluated by lateral and anteroposterior cephalometric projection technique. This paper explains several methods to evaluate upper respiratory tract by lateral radiograph.

A radiological study on lumbar disc herniation in Korean

International Nuclear Information System (INIS)

Seol, Hae Young; Park, In Sik; Suh, Won Hyuk; Lee, Min Jae

1979-01-01

Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

A radiological study on lumbar disc herniation in Korean

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Seol, Hae Young; Park, In Sik; Suh, Won Hyuk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

1979-12-15

Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

The Effect of Reduction Mammaplasty on the Vertebral Column: A Radiologic Study

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Onder Karaaslan

2013-01-01

Full Text Available Some studies emphasized that anatomic mechanisms of vertebral aberrations could be associated with large breasts. The effect of mammaplasty operation on the vertebral column and body posture seems to be beneficial; in this trial, it was planned to investigate the objective radiologic effect of reduction mammaplasty on the posture of the vertebral column in a group of patients operated due to the large breasts. Thirty-four white women with large breasts were enrolled in this study. The patients were divided into three groups according to their breast cup sizes. Anteroposterior and lateral radiographs of the lumbosacral and thoracic spine were taken at baseline preoperatively, and the same radiographic images were taken in an average of 12 months later than the reduction mammaplasty operation. All were evaluated and compared for thoracic kyphosis angle and lumbar lordosis angle both preoperatively and postoperatively. The mean thoracic kyphosis angle was 40,53 preoperatively and 39,38 postoperatively. However, there was no statistically significant difference between the preoperative and postoperative measurements in all groups (P>0,05. The mean lumbar lordosis angle was 54,71 preoperatively and 53,18 postoperatively. Regarding the preoperative and postoperative measurements of lumbar lordosis angles, no statistically significant difference was found between the groups (P>0,05. Although breast size may be an important factor that affects body posture, reduction mammaplasty operations have little or no radiologic effect on the vertebral column.

Anterioposterior spinal curvatures and magnitude of asymmetry in the trunk in musicians playing the violin compared with nonmusicians.

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Barczyk-Pawelec, Katarzyna; Sipko, Tomasz; Demczuk-Włodarczyk, Ewa; Boczar, Agata

2012-05-01

Playing an instrument often requires a certain posture and asymmetric position that may affect the anteroposterior spinal curvatures and may lead to postural asymmetry. The aim of the study was to evaluate the spinal curvatures in the sagittal plane and the magnitude of asymmetries in the trunk in the frontal plane in a group of music students in comparison with a control group. The group of 67 students aged 20 to 26 years was made up of 2 subgroups: the musicians (violin playing students of the Academy of Music in Wroclaw) and the control group (physical therapy students who played no instruments). The examination included an interview, measuring of somatic characteristics, and evaluation of body posture by means of the photogrammetric method. The spinal curvatures of the instrumentalists in the sagittal plane differ from the control group mainly in terms of length and depth parameters. Compared with the control group, the musicians were characterized by statistically more significantly longer and deeper thoracic kyphosis (P < .01) and more shallow lumbar lordosis (P < .05), a greater angle of thoracic kyphosis (P < .005), and a smaller inclination angle of the thoracolumbar and lumbosacral section of the spine (P < .01). In the group of musicians, the asymmetries in the area of shoulders and waist triangles as well as the distance of the spinous processes from the C7 to S1 line were more frequent. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

A radiological study on lumbar disc herniation in Korean

Energy Technology Data Exchange (ETDEWEB)

Seol, Hae Young; Park, In Sik; Suh, Won Hyuk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

1979-12-15

Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

A new technique for radiographic measurement of acetabular cup orientation.

Science.gov (United States)

Derbyshire, Brian; Diggle, Peter J; Ingham, Christopher J; Macnair, Rory; Wimhurst, James; Jones, Henry Wynn

2014-02-01

Accurate radiographic measurement of acetabular cup orientation is required in order to assess susceptibility to impingement, dislocation, and edge loading wear. In this study, the accuracy and precision of a new radiographic cup orientation measurement system were assessed and compared to those of two commercially available systems. Two types of resurfacing hip prostheses and an uncemented prosthesis were assessed. Radiographic images of each prosthesis were created with the cup set at different, known angles of version and inclination in a measurement jig. The new system was the most accurate and precise and could repeatedly measure version and inclination to within a fraction of a degree. In addition it has a facility to distinguish cup retroversion from anteversion on anteroposterior radiographs. © 2013.

Post-operative Salmonella surgical site infection in a dog.

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Kent, Marc; Boozer, Lindsay; Glass, Eric N; Sanchez, Susan; Platt, Simon R; Freeman, Lisa M

2017-09-01

Following decompressive surgery for degenerative lumbosacral stenosis, a 6-year-old German shepherd dog developed a subcutaneous infection at the surgical site and discospondylitis at the lumbosacral intervertebral disc. Salmonella enterica subsp. enterica, serotype Dublin was recovered from the surgical site. Salmonella of a different serovar was isolated from a sample of the raw meat-based diet that the owner fed the dog.

Unsuspected reason for sciatica in Bertolotti's syndrome.

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Shibayama, M; Ito, F; Miura, Y; Nakamura, S; Ikeda, S; Fujiwara, K

2011-05-01

Patients with Bertolotti's syndrome have characteristic lumbosacral anomalies and often have severe sciatica. We describe a patient with this syndrome in whom standard decompression of the affected nerve root failed, but endoscopic lumbosacral extraforaminal decompression relieved the symptoms. We suggest that the intractable sciatica in this syndrome could arise from impingement of the nerve root extraforaminally by compression caused by the enlarged transverse process.

Lumbosacral spine CT

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... M. Computed tomography. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic ... MRI, and ultrasound. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic ...

Isotropic resolution diffusion tensor imaging of lumbosacral and sciatic nerves using a phase-corrected diffusion-prepared 3D turbo spin echo.

Science.gov (United States)

Cervantes, Barbara; Van, Anh T; Weidlich, Dominik; Kooijman, Hendrick; Hock, Andreas; Rummeny, Ernst J; Gersing, Alexandra; Kirschke, Jan S; Karampinos, Dimitrios C

2018-08-01

To perform in vivo isotropic-resolution diffusion tensor imaging (DTI) of lumbosacral and sciatic nerves with a phase-navigated diffusion-prepared (DP) 3D turbo spin echo (TSE) acquisition and modified reconstruction incorporating intershot phase-error correction and to investigate the improvement on image quality and diffusion quantification with the proposed phase correction. Phase-navigated DP 3D TSE included magnitude stabilizers to minimize motion and eddy-current effects on the signal magnitude. Phase navigation of motion-induced phase errors was introduced before readout in 3D TSE. DTI of lower back nerves was performed in vivo using 3D TSE and single-shot echo planar imaging (ss-EPI) in 13 subjects. Diffusion data were phase-corrected per k z plane with respect to T 2 -weighted data. The effects of motion-induced phase errors on DTI quantification was assessed for 3D TSE and compared with ss-EPI. Non-phase-corrected 3D TSE resulted in artifacts in diffusion-weighted images and overestimated DTI parameters in the sciatic nerve (mean diffusivity [MD] = 2.06 ± 0.45). Phase correction of 3D TSE DTI data resulted in reductions in all DTI parameters (MD = 1.73 ± 0.26) of statistical significance (P ≤ 0.001) and in closer agreement with ss-EPI DTI parameters (MD = 1.62 ± 0.21). DP 3D TSE with phase correction allows distortion-free isotropic diffusion imaging of lower back nerves with robustness to motion-induced artifacts and DTI quantification errors. Magn Reson Med 80:609-618, 2018. © 2018 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2018 The Authors Magnetic Resonance

Diagnostic lumbosacral segmental nerve blocks with local anesthetics: a prospective double-blind study on the variability and interpretation of segmental effects.

Science.gov (United States)

Wolff, A P; Groen, G J; Crul, B J

2001-01-01

Selective spinal nerve infiltration blocks are used diagnostically in patients with chronic low back pain radiating into the leg. Generally, a segmental nerve block is considered successful if the pain is reduced substantially. Hypesthesia and elicited paresthesias coinciding with the presumed segmental level are used as controls. The interpretation depends on a standard dermatomal map. However, it is not clear if this interpretation is reliable enough, because standard dermatomal maps do not show the overlap of neighboring dermatomes. The goal of the present study is to establish if dissimilarities exist between areas of hypesthesia, spontaneous pain reported by the patient, pain reduction by local anesthetics, and paresthesias elicited by sensory electrostimulation. A secondary goal is to determine to what extent the interpretation is improved when the overlaps of neighboring dermatomes are taken into account. Patients suffering from chronic low back pain with pain radiating into the leg underwent lumbosacral segmental nerve root blocks at subsequent levels on separate days. Lidocaine (2%, 0.5 mL) mixed with radiopaque fluid (0.25 mL) was injected after verifying the target location using sensory and motor electrostimulation. Sensory changes (pinprick method), paresthesias (reported by the patient), and pain reduction (Numeric Rating Scale) were reported. Hypesthesia and paresthesias were registered in a standard dermatomal map and in an adapted map which included overlap of neighboring dermatomes. The relationships between spinal level of injection, extent of hypesthesia, location of paresthesias, and corresponding dermatome were assessed quantitatively. Comparison of the results between both dermatomal maps was done by paired t-tests. After inclusion, data were processed for 40 segmental nerve blocks (L2-S1) performed in 29 patients. Pain reduction was achieved in 43%. Hypesthetic areas showed a large variability in size and location, and also in comparison to

[Features of the new minimally invasive techniques facet fixation system «Facet Wedge» in the treatment of degenerative diseases of the lumbar spine in elderly patients.

Science.gov (United States)

Byvaltsev, V A; Kalinin, A A; Okoneshnikova, A K

2017-01-01

The aim of the study was a comparative analysis of the clinical and radiographic effectiveness of the use of interbody fusion and open pedicle screw stabilization of simultaneous and new minimally invasive techniques facet fixation system «Facet Wedge» in the treatment of degenerative diseases of the lumbar spine in elderly patients. The study included 39 elderly patients (older than 60), which carries out the transforaminal interbody fusion Cage «T-pal»: open transpedicaular stabilization was used in 1st group (n=23), ipsilateral open transpedicular stabilization with contralateral transfaset installing titanium Cage «facet Wedge» -in 2nd group (n=16). We used intraoperative interventions and specific post-operative patient management, clinical data and radiographic outcomes for a comparative analysis of the parameters. Dynamic assessment was made in a period of 8 to 36 months after surgery (median 24 mo.). As a result, it found that the use of the system «facet Wedge» allows you to achieve the best clinical outcomes and fewer postoperative complications compared with open transpedicular stabilization in similar radiographic findings of bone block formation. Low traumatic facet fixation makes it possible to use methods for the treatment of elderly patients with degenerative diseases of the lumbosacral spine.

Managing per Member per Month (PMPM). Findings Regarding Variation and Drivers of Cost

Science.gov (United States)

2011-01-25

DYSFUNC LUMBAR REG 6.92 3.50 8.78 5.36 1.87 27.0% 7210 CERVICAL SPONDYLOSIS 2.66 0.68 4.49 0.98...42.7% 7213 LUMBOSACRAL SPONDYLOSIS 4.38 1.17 8.42 1.69 4.05 92.5% 7295 PAIN IN LIMB 13.79 8.04...302.3% 72210 LUMBAR DISC DISPLACEMENT 14.77 3.85 18.14 5.15 3.38 22.9% 7244 LUMBOSACRAL NEURITIS NOS 8.87

Center edge angle measurement for hip preservation surgery: technique and caveats.

Science.gov (United States)

Anderson, Lucas A; Gililland, Jeremy; Pelt, Christopher; Linford, Samuel; Stoddard, Gregory J; Peters, Christopher L

2011-01-01

Anterior and lateral center edge angles have traditionally been used to determine acetabular coverage, and thereby strongly influence the decision to perform acetabular reorientation versus osteochondroplasty in patients with dysplasia and/or femoroacetabular impingement. We propose templating the center of the contained articular femoral head in aspherical hips to provide reliable assessment of acetabular coverage. Digital radiographs of 30 patients with various combinations of femoral and acetabular morphologies were evaluated using 2 methods to identify the anterior center edge angle and lateral center edge angle. The control method used an estimated femoral head center for angle apex. The study technique determined the center of the femoral head by templating the congruent aspect of the femoral head contained by the acetabulum while ignoring the increasing lateral and anterior radius associated with cam deformities. Four readers measured lateral center edge angles on anteroposterior radiographs and anterior center edge angles on false-profile radiographs. Two reads were performed by each reader using both the estimated and the templated methods for a total of 4 reads. Interobserver reliability using the proposed method compared to the standard was much improved for anterior center edge angles (intraclass correlation coefficient of 0.76 vs 0.55) as well as with lateral center edge angles (ICC of 0.80 vs 0.42). Decreased correlation was most commonly associated with abnormal sourcil morphology, posterior wall deficiency combined with calcified labra, and os acetabuli. Including the anterolateral cam deformity in identifying the center of the femoral head for measuring center edge angles leads to an underestimation of acetabular coverage, which may negatively affect hip preservation surgical decision making. Copyright 2011, SLACK Incorporated.

Cephalometric assessment of lips in skeletal class ii patients by steiner's line

International Nuclear Information System (INIS)

Bokhari, F.; Amin, F.; Asad, S.

2013-01-01

Introduction: Steiner's (S) Line has been used as reference line to assess anteroposterior position of lips cephalometrically and has been an effective diagnostic aid in this era of soft tissue paradigm. Norms for Sline has been established for different populations and it has been used widely to assess treatment outcomes in Skeletal Class II malocclusion, however anteroposterior position of lips and determinants of lip position in Skeletal Class II has not been explored. Study Design: This Prospective study was aimed to find out the anteroposterior position of lips on cephalograph using S-line in patients with retrognathic pro-file and to establish correlation between determinants of lip prominence. Data was collected using nonprobability convenience sampling technique following the selection criteria. Materials and Methods: The study was conducted on 65 subjects, with retrognathic profile as judged by orthodontists in consensus and confirmed by lateral cephalogram (ANB > 4 degree). S-Line was drawn on lateral cephalograph to assess the prominence of upper Lip and lower lip. SPSS 17.0 was used for statistical evaluation. Results: Antero-posterior position of upper and lower lip in patients with retrognathic profile with reference to S-line was 1.96 +- 2.6 mm and 3.09 +- 3.16 mm respectively. Moreover it was found that statistically significant correlation existed between lower lip prominence as assessed by S-line and upper lip prominence using the same reference line (r = 0.411), Lower incisor inclination (r = 0.535) and Skeletal Class II as assessed by ANB angle (r = 0.27). Upper lip prominence as assessed S-line was found to be statistically significantly correlated with lower incisor inclination and lower lip prominence. Discussion: Results were compliant with the previous studies.Conclusion: In the present study both upper and lower lips were more prominent in Skeletal Class II patients as compared to Steiner's norms for skeletal class I. (author)

Evolution of Technique in Endoscopic Transsphenoidal Surgery for Pituitary Adenoma: A Single Institution Experience from 220 Procedures.

Science.gov (United States)

Hansasuta, Ake; Pokanan, Siriwut; Punyawai, Pritsana; Mahattanakul, Wattana

2018-01-01

Introduction Endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma (PA) has been a recent shift from the traditional microscopic technique. Although some literature demonstrated superiority of ETSS over the microscopic method and some evaluated mono- vs. binostril access within the ETSS, none had explored the potential influence of dedicated instrument, as this procedure had evolved, on patients' outcomes when compared to traditional microscopic tools. Objective To investigate our own clinical and radiographic outcomes of ETSS for PA with its technical evolution over time as well as a significance of, having vs. lacking, the special endoscopic tools. Methods Included patients underwent ETSS for PA performed by the first author (AH). Prospectively recorded patients' data concerning pre-, intra- and postoperative clinical and radiographic assessments were subject to analysis. The three groups of differently evolving ETSS techniques, beginning with mononostril (MN) to binostril ETSS with standard microsurgical instruments (BN1) and, lastly, binostril ETSS with specially-designed endoscopic tools (BN2), were examined for their impact on the intra- and, short- and long-term, postoperative results. Also, the survival after ETSS for PA, as defined by the need for reintervention in each technical group, was appraised. Results From January 2006 to 2012, there were 47, 101 and 72 ETSS, from 183 patients, in the MN, BN1 and BN2 cohorts, respectively. Significant preoperative findings were greater proportion of patients with prior surgery (p=0.01) and tumors with parasellar extension (p=0.02) in the binostril (BN1&2) than the MN group. Substantially shorter operative time and less amount of blood loss were evident as our technique had evolved (psurgery, Knosp grade, and firm tumor while BN1, BN2 and percentages of anteroposterior dimension PA removal had positive effect on longer survival. Conclusion The evolution of technique for ETSS for PA from MN to BN2 has shown

Antero-posterior (AP) pelvis x-ray imaging on a trolley: Impact of trolley design, mattress design and radiographer practice on image quality and radiation dose

International Nuclear Information System (INIS)

Tugwell, J.R.; England, A.; Hogg, P.

2017-01-01

Introduction: Physical and technical differences exist between imaging on an x-ray tabletop and imaging on a trolley. This study evaluates how trolley imaging impacts image quality and radiation dose for an antero-posterior (AP) pelvis projection whilst subsequently exploring means of optimising this imaging examination. Methods: An anthropomorphic pelvis phantom was imaged on a commercially available trolley under various conditions. Variables explored included two mattresses, two image receptor holder positions, three source to image distances (SIDs) and four mAs values. Image quality was evaluated using relative visual grading analysis with the reference image acquired on the x-ray tabletop. Contrast to noise ratio (CNR) was calculated. Effective dose was established using Monte Carlo simulation. Optimisation scores were derived as a figure of merit by dividing effective dose with visual image quality scores. Results: Visual image quality reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired on the trolley using identical acquisition parameters to the reference image. The trolley image with the highest optimisation score was acquired using 130 cm SID, 20 mAs, the standard mattress and platform not elevated. A difference of 12.8 mm was found between the image with the lowest and highest magnification factor (18%). Conclusion: The acquisition parameters used for AP pelvis on the x-ray tabletop are not transferable to trolley imaging and should be modified accordingly to compensate for the differences that exist. Exposure charts should be developed for trolley imaging to ensure optimal image quality at lowest possible dose. - Highlights: • Acquisition parameters used for AP pelvis imaging on a trolley need adapting from those used on the x-ray tabletop. • Radiation dose significantly increases for trolley imaging. • An increase in SID can reduce radiation dose and magnification for trolley imaging

Sensory Loss Mimicking Cauda Equina Syndrome due to Cervical Spinal Lesion in a Patient with Clinically Isolated Syndrome

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Vinceti, Giulia; Zini, Andrea; Nichelli, Paolo; Mandrioli, Jessica

2012-01-01

We describe the case of a 39-year-old woman with signs and symptoms suggesting cauda equina syndrome. Lumbosacral magnetic resonance imaging (MRI) demonstrated no lesion at this level, while cervical MRI showed a T2-hyperintense lesion in the middle-right anterolateral region of the cervical spinal cord, which may explain the symptoms by involving the anterior spinothalamic tract. We suggest that in cases with cauda equina syndrome presentation and normal lumbosacral MRI, a cervicodorsal lesi...

Locomotor-like leg movements evoked by rhythmic arm movements in humans.

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Francesca Sylos-Labini

Full Text Available Motion of the upper limbs is often coupled to that of the lower limbs in human bipedal locomotion. It is unclear, however, whether the functional coupling between upper and lower limbs is bi-directional, i.e. whether arm movements can affect the lumbosacral locomotor circuitry. Here we tested the effects of voluntary rhythmic arm movements on the lower limbs. Participants lay horizontally on their side with each leg suspended in an unloading exoskeleton. They moved their arms on an overhead treadmill as if they walked on their hands. Hand-walking in the antero-posterior direction resulted in significant locomotor-like movements of the legs in 58% of the participants. We further investigated quantitatively the responses in a subset of the responsive subjects. We found that the electromyographic (EMG activity of proximal leg muscles was modulated over each cycle with a timing similar to that of normal locomotion. The frequency of kinematic and EMG oscillations in the legs typically differed from that of arm oscillations. The effect of hand-walking was direction specific since medio-lateral arm movements did not evoke appreciably leg air-stepping. Using externally imposed trunk movements and biomechanical modelling, we ruled out that the leg movements associated with hand-walking were mainly due to the mechanical transmission of trunk oscillations. EMG activity in hamstring muscles associated with hand-walking often continued when the leg movements were transiently blocked by the experimenter or following the termination of arm movements. The present results reinforce the idea that there exists a functional neural coupling between arm and legs.

Comparative sonographic evaluation of the anteroposterior ...

African Journals Online (AJOL)

2015-09-21

Sep 21, 2015 ... also significantly smaller in the Type 1 diabetics compared to Type 2 (P ... the duodenal loop and splenic hilum over a length of ... have demonstrated a decrease in beta cell mass.[4] ... also becomes resistant to insulin, thereby causing the blood ... DM poses a devastating negative economic impact and.

Efficient CT simulation of the four-field technique for conformal radiotherapy of prostate carcinoma

International Nuclear Information System (INIS)

Valicenti, Richard K.; Waterman, Frank M.; Croce, Raymond J.; Corn, Benjamin; Suntharalingam, Nagalingam; Curran, Walter J.

1997-01-01

Purpose: Conformal radiotherapy of prostate carcinoma relies on contouring of individual CT slices for target and normal tissue localization. This process can be very time consuming. In the present report, we describe a method to more efficiently localize pelvic anatomy directly from digital reconstructed radiographs (DRRs). Materials and Methods: Ten patients with prostate carcinoma underwent CT simulation (the spiral mode at 3 mm separation) for conformal four-field 'box' radiotherapy. The bulbous urethra and bladder were opacified with iodinated contrast media. On lateral and anteroposterior DRRs, the volume of interest (VOI) was restricted to 1.0-1.5 cm tissue thickness to optimize digital radiograph reconstruction of the prostate and seminal vesicles. By removing unessential voxel elements, this method provided direct visualization of those structures. For comparison, the targets of each patient were also obtained by contouring CT axial slices. Results: The method was successfully performed if the target structures were readily visualized and geometrically corresponded to those generated by contouring axial images. The targets in 9 of 10 patients were reliable representations of the CT-contoured volumes. One patient had 18 mm variation due to the lack of bladder opacification. Using VOIs to generate thin tissue DRRs, the time required for target and normal tissue localization was on the average less than 5 min. Conclusion: In CT simulation of the four-field irradiation technique for prostate carcinoma, thin-tissue DRRs allowed for efficient and accurate target localization without requiring individual axial image contouring. This method may facilitate positioning of the beam isocenter and provide reliable conformal radiotherapy

[Regularities of fixation of brain serum antibodies from patients with lateral amyotrophic sclerosis in rabbit CNS].

Science.gov (United States)

Musaeva, L S; Gannyshkina, I V; Zavalishin, I A; Markova, E D; Ivanova-Smolenskaia, I A

2002-01-01

Kuhns' indirect immunofluorescent test was used to study fixation of serum brain antibodies (Ab) of patients with bulbar, cervicothoracic, lumbosacral lateral amyotropic sclerosis (LAS) on brain sections of rabbits. The disease is characterized by formation of brain Ab complementary to various structures of nervous and glial cells, myelin of fibers from different conducting systems, vessels which exhibit both common and individual antigenic properties. It was found that fixation of antineuronal, antimyelin brain Ab of patients with bulbar, cervicothoracic and lumbosacral LAS in different CNS structures varies.

Reducing radiation doses to the breast, thyroid and gonads during diagnostic radiography

International Nuclear Information System (INIS)

Weatherburn, G.C.

1983-01-01

The measurement of doses to the gonads during radiography of the pelvis is discussed. Phantom measurements to estimate doses to the ovaries in antero-posterior (AP) and postero-anterior (PA) projections of the pelvis showed that the dose is 15% of the skin entry dose in the AP projection and 9% in the PA projection. The air gap technique and its applications in reducing radiation doses to the gonads, breast and thyroid is described. A summary of dose reduction factors for these radiosensitive organs achieved by modified radiographic techniques in radiography of the chest, pelvis, spine and skull is given. (U.K.)

Intraoperative neurophysiology of the conus medullaris and cauda equina.

Science.gov (United States)

Kothbauer, Karl F; Deletis, Vedran

2010-02-01

Intraoperative neurophysiological techniques are becoming routine tools for neurosurgical practice. Procedures affecting the lumbosacral nervous system are frequent in adult and pediatric neurosurgery. This review provides an overview of the techniques utilized in cauda and conus operations. Two basic methodologies of intraoperative neurophysiological testing are utilized during surgery in the lumbosacral spinal canal. Mapping techniques help identify functional neural structures, namely, nerve roots and their respective spinal levels. Monitoring is referred to as the technology to continuously assess the functional integrity of pathways and reflex circuits. For mapping direct electrical stimulation of a structure within the surgical field and recording at a distant site, usually a muscle is the most commonly used setup. Sensory nerve roots or spinal cord areas can be mapped by stimulation of a distant sensory nerve or skin area and recording from a structure within the surgical field. Continuous monitoring of the motor system is done with motor evoked potentials. These are evoked by transcranial electrical stimulation and recorded from lower extremity and sphincter muscles. Presence or absence of muscle responses are the monitored parameters. To monitor the sensory pathways, sensory potentials evoked by tibial, peroneal, or pudendal nerve stimulation and recorded from the dorsal columns with a spinal electrode or as cortical responses from scalp electrodes are used. Amplitudes and latencies of these responses are measured for interpretation. The bulbocavernosus reflex, with stimulation of the pudendal nerve and recording from the external anal sphincter, is used for continuous monitoring of the reflex circuitry. The presence of absence of this response is the pertinent parameter monitored. Stimulation of individual dorsal nerve roots is used to identify those segments that generate spastic activity and which may be cut during selective dorsal rhizotomy

Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction A radioanatomic analysis of the nondiscal structures of the spinal column and perispinal soft tissues

International Nuclear Information System (INIS)

Jinkins, J. Randy

2004-01-01

A review of the imaging features of normal and degenerative anatomy of the spine on medical imaging studies shows features that have been largely overlooked or poorly understood by the imaging community in recent years. The imaging methods reviewed included computed tomography (CT) with multiplanar reconstructions and magnetic resonance imaging (MRI). A routine part of the MRI examination included fat-suppressed T2 weighted fast-spin- or turbo-spin-echo acquisitions. As compared to the normal features in asymptomatic volunteers, alterations in the observed CT/MRI morphology and MR signal characteristics were sought in symptomatic individuals. Findings in symptomatic subjects which departed from the normal anatomic features of the posterior spinal elements in asymptomatic volunteers included: rupture of the interspinous ligament(s), neoarthrosis of the interspinous space with perispinous cyst formation, posterior spinal facet (zygapophyseal joint) arthrosis, related central spinal canal, lateral recess (subarticular zone) and neural foramen stenosis, posterior element alterations associated with various forms of spondylolisthesis, and perispinal muscle rupture/degeneration. These findings indicate that the posterior elements are major locations of degenerative spinal and perispinal disease that may accompany or even precede degenerative disc disease. Although not as yet proven as a reliable source of patient signs and symptoms in all individuals, because these observations may be seen in patients with radicular, referred and/or local low back pain, they should be considered in the evaluation of the symptomatic patient presenting with a clinical lumbosacral syndrome. Imaging recommendations, in addition to the usual close scrutiny of these posterior spinal elements and perispinal soft tissues on CT and MRI, include the acquisition of high-resolution multiplanar CT reconstructions, and fat-suppressed T2 weighted fast-spin- or turbo-spin-echo sequence MRI in at least

Acquired degenerative changes of the intervertebral segments at and suprajacent to the lumbosacral junction A radioanatomic analysis of the nondiscal structures of the spinal column and perispinal soft tissues

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Jinkins, J. Randy E-mail: jrjinkins@aol.com

2004-05-01

A review of the imaging features of normal and degenerative anatomy of the spine on medical imaging studies shows features that have been largely overlooked or poorly understood by the imaging community in recent years. The imaging methods reviewed included computed tomography (CT) with multiplanar reconstructions and magnetic resonance imaging (MRI). A routine part of the MRI examination included fat-suppressed T2 weighted fast-spin- or turbo-spin-echo acquisitions. As compared to the normal features in asymptomatic volunteers, alterations in the observed CT/MRI morphology and MR signal characteristics were sought in symptomatic individuals. Findings in symptomatic subjects which departed from the normal anatomic features of the posterior spinal elements in asymptomatic volunteers included: rupture of the interspinous ligament(s), neoarthrosis of the interspinous space with perispinous cyst formation, posterior spinal facet (zygapophyseal joint) arthrosis, related central spinal canal, lateral recess (subarticular zone) and neural foramen stenosis, posterior element alterations associated with various forms of spondylolisthesis, and perispinal muscle rupture/degeneration. These findings indicate that the posterior elements are major locations of degenerative spinal and perispinal disease that may accompany or even precede degenerative disc disease. Although not as yet proven as a reliable source of patient signs and symptoms in all individuals, because these observations may be seen in patients with radicular, referred and/or local low back pain, they should be considered in the evaluation of the symptomatic patient presenting with a clinical lumbosacral syndrome. Imaging recommendations, in addition to the usual close scrutiny of these posterior spinal elements and perispinal soft tissues on CT and MRI, include the acquisition of high-resolution multiplanar CT reconstructions, and fat-suppressed T2 weighted fast-spin- or turbo-spin-echo sequence MRI in at least

[Elsberg syndrome].

Science.gov (United States)

Nielsen, Kristine Esbjerg; Knudsen, Troels Bygum

2013-12-16

A syndrome involving acute urinary retention in combination with sacral radiculitis and cerebrospinal fluid pleocytosis was first described by the American neurosurgeon Charles Elsberg in 1931. In many instances the aetiology is herpes simplex virus type 2 (HSV-2) reactivation from sensory neurons. In this case report we present a 34-year-old pregnant woman with previous undiagnosed sensory lumbosacral symptoms. She was hospitalized with HSV-2 meningitis and lumbosacral radiculitis but no genital rash. A week after the onset of symptoms she developed acute urinary retention, thus indicating Elsberg syndrome.

Estudo da confiabilidade da força aplicada durante a mobilização articular ântero-posterior do tornozelo Reliability study on the force applied during anteroposterior mobilization of the ankle joint

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MA Resende

2006-01-01

Full Text Available INTRODUÇÃO: Os fatores que contribuem para a eficiência da manobra de mobilização articular são a intensidade e a reprodutibilidade da força aplicada durante a mobilização, por um ou por diferentes examinadores. OBJETIVO: Avaliar a confiabilidade intra e interexaminador da força de mobilização ântero-posterior da articulação do tornozelo, grau III e IV de Maitland. MÉTODO: Os dois tornozelos de 35 voluntários assintomáticos foram mobilizados por dois examinadores experientes com o procedimento. Uma miniplataforma de força foi posicionada sob a perna do voluntário a fim de captar as forças obtidas durante as manobras de mobilização e seu sinal foi convertido e armazenado em um software DasyLab4.0, o que permitiu o registro dos picos mínimo e máximo das curvas da força aplicada. A análise da confiabilidade foi realizada através do coeficiente de correlação intraclasse (CCI. Para avaliar o erro sistemático das medidas foi utilizado o teste t pareado e o teste t independente, para as condições intra e interexaminadores, respectivamente. O método de Bland e Altman avaliou os limites de concordância das medidas entre os examinadores. RESULTADOS: Os dados demonstraram alta confiabilidade intra-examinador. A confiabilidade inter-examinador foi baixa e moderada para a força máxima e mínima respectivamente, durante a mobilização ântero-posterior da articulação do tornozelo. CONCLUSÃO: Esses dados sugerem que a força aplicada durante a mobilização articular grau III e IV de Maitland no tornozelo, apresenta alta confiabilidade intra-examinador e baixa para interexaminador.BACKGROUND: Factors that contribute towards the efficiency of joint mobilization maneuvers is the intensity and reproducibility of the force applied during mobilization, by one or more examiners. OBJECTIVE: To evaluate the intra and inter-examiner reliability of Maitland grade III and IV anteroposterior mobilization force on the ankle joint

Imaging of sciatica; A short historical review and the present situation. Bildediagnostikk ved isjas; En kort historisk oversikt og status presens

Energy Technology Data Exchange (ETDEWEB)

Anda, S. (Trondheim Regional Hospital (Norway))

1993-02-01

Cotugno described the clinical entity of sciatica in 1764. However, the association between sciatica and compression of lumbar nerve roots was not realized until the 1920s. Back surgery for herniated nucleus pulposus then became fashionable, and plain radiography and myelography enabled preoperative mapping. Recently other imaging techniques have emerged, such as computerized tomography and magnetic resonance imaging. This has increased the knowledge of the etiology of lumbar root compressions, and invasive therapies for sciatica have become more diversified. It is easy to lose perspective among the available imaging procedures and therapeutic techniques. The aim of this paper is to present the current status from a historical point of view, with special emphasis on the most common imaging methods for the investigation of lumbosacral radiculopathies. 48 refs., 4 figs.

Imaging of sciatica

International Nuclear Information System (INIS)

Anda, S.

1993-01-01

Cotugno described the clinical entity of sciatica in 1764. However, the association between sciatica and compression of lumbar nerve roots was not realized until the 1920s. Back surgery for herniated nucleus pulposus then became fashionable, and plain radiography and myelography enabled preoperative mapping. Recently other imaging techniques have emerged, such as computerized tomography and magnetic resonance imaging. This has increased the knowledge of the etiology of lumbar root compressions, and invasive therapies for sciatica have become more diversified. It is easy to lose perspective among the available imaging procedures and therapeutic techniques. The aim of this paper is to present the current status from a historical point of view, with special emphasis on the most common imaging methods for the investigation of lumbosacral radiculopathies. 48 refs., 4 figs

Usefulness of the combination of imaging techniques to evaluate the influence of the association of osteoporosis and atherosclerosis, in the appearance of fractures, during the course of metastatic disease of the skeleton

International Nuclear Information System (INIS)

Casacó, CA.; Prats, A.; Torres, LA.; Sánchez, Y.; Masquida, E.; Valladares, L.; Romero, S; Marrero, L.O.; Alonso, M

2016-01-01

Introduction: Atherosclerosis and osteoporosis; Cause the majority of morbidity and mortality in older adults and their prevalence continues to increase. The clinical coincidence of vascular disease and osteoporosis indicates that there are common mediators that adversely affect and resemble bone metabolism and vascular integrity. Atherosclerosis and osteoporosis are part of a shared diagnosis. We intend to work with the use of two combined imaging techniques to precociously assess the state of bone mass in patients with advanced neoplasia who live with osteoporosis and atherosclerosis in order to be able to take appropriate medical and therapeutic behaviors that help to improve the quality of life of these patients. Purpose: To determine the morpho functional status of bone in patients with osteoporosis and atherosclerosis with metastatic bone disease, through two noninvasive and combined imaging techniques, at different stages of disease progression. Method: A prospective, descriptive and longitudinal study will be carried out on 100 patients referred from the Orthopedics and Oncology Service of the Frank Paíz Hospital and the Oncology Institute, with a confirmed diagnosis of metastatic neoplastic disease in bones and with a history of osteoporosis and Vascular arteriosclerosis, or with clinical suspicion of them. With ages between 35 and 60 years and both sexes. In the period between 2010 and 2014. The BMD values will be determined through Densitometry at the lumbo-sacral column and hips level, at the beginning, at six months and at the first year, in each of the patients . Bone scintigraphy with MDP will also be performed at the beginning, six months and the year of the first one performed equally on all patients in the sample.

Comparison of Ground Reaction Forces, Center of Pressure and Body Center of Mass Changes in the Voluntary, Semi-Voluntary and Involuntary Gait Termination in Healthy Young Men

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behrooz teymourian

2016-03-01

Full Text Available Objective: The aim of this study was comparing the ground reaction forces, center of pressure and body center of mass changes in voluntary, semi-voluntary and involuntary gait termination in healthy young men. Methods: In this study, 12 young men performed termination of gait in three different patterns. The variable of peak antero-posterior and vertical forces in two directions at both limbs, the time to reach peak and average forces in every limb in both directions, the center of pressure displacement of medio-lateral and antero-posterior direction for each limb and the net center of pressure and the displacement of the center of mass motion in all three motion plates were recorded using motion analysis system and force plate.The repeated measurements test was used to compare three patterns of gait termination at significance level of p&le0.5. Results: The results showed a significant difference in variables of peak antero-posterior force, the time to reach peak antero-posterior force and mean antero-posterior forces of the leading limb, the peak antero-posterior force of the trialing limbs, the depth force of leading limbs, medio-lateral cop of leading limbs displacement and vertical displacement of the center of mass, among different patterns of gait termination. Conclusion: While walking, the probability of a fall or collision damage, when a sudden or unexpected stop is required, increases. Therefore, more coordination between neuromuscular systems is required.

The use of the lumbosacral enlargement as an intrinsic imaging biomarker: feasibility of grey matter and white matter cross-sectional area measurements using MRI at 3T.

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Marios C Yiannakas

Full Text Available Histopathological studies have demonstrated the involvement of spinal cord grey matter (GM and white matter (WM in several diseases and recent research has suggested the use of magnetic resonance imaging (MRI as a promising tool for in vivo assessment of the upper spinal cord. However, many neurological conditions would benefit from quantitative assessment of tissue integrity at different levels and relatively little work has been done, mainly due to technical challenges associated with imaging the lower spinal cord. In this study, the value of the lumbosacral enlargement (LSE as an intrinsic imaging biomarker was determined by exploring the feasibility of obtaining within it reliable GM and WM cross-sectional area (CSA measurements by means of a commercially available MRI system at 3 tesla (T. 10 healthy volunteers (mean age 27.5 years, 6 female gave written informed consent and high resolution images of the LSE were acquired and analysed using an optimised MRI acquisition and analysis protocol. GM and WM mean CSA measurements were obtained from a 15 mm section at the level of the LSE and the reproducibility of the measurements was determined by means of scan-rescan, intra- and inter-observer assessments. Mean (±SD LSE cross-sectional area (LSE-CSA was 62.3 (±4.1 mm2 and mean (±SD LSE grey matter cross-sectional area (LSE-GM-CSA was 19.8 (±3.3 mm2. The mean scan-rescan, intra- and inter-observer % coefficient of variation (COV for measuring the LSE-CSA were 2%, 2% and 2.5%, respectively and for measuring the LSE-GM-CSA were 7.8%, 8% and 8.6%, respectively. This study has shown that the LSE can be used reliably as an intrinsic imaging biomarker. The method presented here can be potentially extended to study the LSE in the diseased state and could provide a solid foundation for subsequent multi-parametric MRI investigations.

False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

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Kwang-Soon Song

2013-01-01

Full Text Available Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER stage IV (Lauge-Hansen ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59% patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS and tibiofibular overlapping (TFO on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.

Lethal Consequences in an Infant with Myelomeningocele Following an Inadvertent Treatment

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Xuemei Wu

2016-01-01

Full Text Available Myelomeningocele (MMC is a protrusion of spinal cord contents and meninges through a vertebral defect. Iatrogenic deaths of patients with MMC are rarely encountered in forensic practice. In our case, a 3-month-old female was born with a lumbosacral cyst, the size of which had been increasing gradually over age. There was no neurological, orthopedic, or urologic dysfunction. On the day of her death, she received a repetitive and rapid lumbosacral cyst puncture drainage procedure, performed by an illegal medical practitioner. Postmortem autopsy findings confirmed a diagnosis of MMC and the cause of death to be cerebellar tonsillar herniation. This is a pathetic case of preventable infant death. This report suggests that the possibility of MMC should be considered in infants born with a lumbosacral cyst, and aspiration is inadvisable. Besides, forensic autopsy has a valuable role in determining the exact cause of death, identifying, or excluding iatrogenic factors that may be relevant to death following a medical procedure. A final point is that prevention programs should be developed, especially by the health care sectors to reduce such tragedy.

Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

International Nuclear Information System (INIS)

Knirsch, Walter; Kurtz, Claudia; Langer, Mathias; Haeffner, Nicole; Kececioglu, Deniz

2005-01-01

The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

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Knirsch, Walter [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany); University Children' s Hospital Zurich, Division of Paediatric Cardiology, Zurich (Switzerland); Kurtz, Claudia; Langer, Mathias [University Hospital Freiburg, Department of Radiology, Freiburg (Germany); Haeffner, Nicole; Kececioglu, Deniz [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany)

2005-04-01

The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

Analgesia preemptiva nas cirurgias da coluna lombossacra: estudo prospectivo e randomizado Analgesia preventiva en las cirugías de la columna lumbosacra: estudio prospectivo y aleatorio Preemptive analgesia in lumbosacral spine surgeries: prospective randomized study

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Augustin Malzac

2009-06-01

recibieron alguna sustancia analgésica (control. Veinte y dos en el segundo (B que fueron sometidos a la inyección epidural, 20 minutos antes de la incisión quirúrgica, conteniendo 10 mL de marcaína y morfina. En el tercer grupo, y último (C, con 20 pacientes que fueron inyectados con auxilio de un catéter, en el espacio epidural, las mismas drogas del grupo B, por medio de la incisión antes de cerrar la herida operatoria. Los pacientes fueron examinados durante las primeras 24 horas, con auxilio de la escala verbal de dolor. RESULTADOS: los tres grupos fueron comparados según la edad, sexo, nivel y tiempo quirúrgico. Como los datos no obedecieron a una distribución Gausiana, el test paramétrico de Mann-Whitney fue entonces adoptado para análisis estadístico. De esta forma, los valores de la escala verbal de dolor, en todos los intervalos de tiempo fueron significativamente bajos (pOBJECTIVE: To analyze the efficacy of the preemptive analgesia with a method of epidural analgesic administration before and after the surgical painful stimulation, as comparing them. Its role in postoperative pain relief after lumbosacral spinal surgery, by the posterior approach, has not been fully investigated. METHODS: Sixty two patients who underwent microdiscectomy or microdecompression in a single level of the lumbosacral spine were divided into three groups: 20 patients that had not received any analgesic medication in the first one (A (control; 22 that had been submitted to the epidural injection containing 10 mL of marcaína and morphine 20 minutes before the surgical incision in the second one (B. In the third and last group (C, 20 patients received the same drugs of group B, with the aid of a catheter positioned in the epidural space, through the incision before the closing of the surgical wound. The patients were examined during the first 24 hours, with the use of the verbal scale of pain. RESULTS: The three groups were compared concerning age, sex, level and surgical

Class III malocclusion with severe anteroposterior discrepancy

Directory of Open Access Journals (Sweden)

Susana Maria Deon Rizzatto

2012-10-01

Full Text Available This study aims at reporting the clinical case of a patient with Class III skeletal malocclusion with severe maxillary deficiency, producing a reduced midface associated with severe mandibular prognathism. The pre-surgical orthodontic preparation was composed mainly by dentoalveolar expansion and repositioning of the incisors in the lower arch. Then, a combined maxillary and mandibular orthognathic surgery was performed. The treatment objectives were achieved, with significant improvement in facial esthetics and occlusion, followed by post-treatment stability. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO, as part of the requirements for obtaining the title of Diplomate by BBO.O objetivo deste artigo é relatar o caso clínico de um paciente portador de má oclusão de Classe III esquelética com acentuada deficiência maxilar, causando redução do terço médio da face, associada a severo prognatismo mandibular. O preparo ortodôntico pré-cirúrgico foi composto, principalmente, pela expansão dentoalveolar da maxila e o reposicionamento dos incisivos na arcada inferior. Depois, foi realizada a cirurgia ortognática combinada maxilomandibular. Os objetivos do tratamento foram atingidos, com significativa melhora da oclusão e da estética facial, seguida de estabilidade pós-tratamento. Esse caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO, como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

A sit-ski design aimed at controlling centre of mass and inertia.

Science.gov (United States)

Langelier, Eve; Martel, Stéphane; Millot, Anne; Lessard, Jean-Luc; Smeesters, Cécile; Rancourt, Denis

2013-01-01

This article introduces a sit-ski developed for the Canadian Alpine Ski Team in view of the Vancouver 2010 Paralympic games. The design is predominantly based on controlling the mass distribution of the sit-ski, a critical factor in skiing performance and control. Both the antero-posterior location of the centre of mass and the sit-ski moment of inertia were addressed in our design. Our design provides means to adjust the antero-posterior centre of mass location of a sit-ski to compensate for masses that would tend to move the antero-posterior centre of mass location away from the midline of the binding area along the ski axis. The adjustment range provided is as large as 140 mm, thereby providing sufficient adaptability for most situations. The suspension mechanism selected is a four-bar linkage optimised to limit antero-posterior seat movement, due to suspension compression, to 7 mm maximum. This is about 5% of the maximum antero-posterior centre of mass control capacity (151 mm) of a human participant. Foot rest inclination was included in the design to modify the sit-ski inertia by as much as 11%. Together, these mass adjustment features were shown to drastically help athletes' skiing performance.

Radiation myelopathy

International Nuclear Information System (INIS)

Berlit, P.

1987-01-01

After a review of the world literature, the case histories of 43 patients with radiation myelopathy are analyzed. In 1 patient there was a radiation injury of the medulla oblongata, in 2, cervical, in 28, thoracic, and in 12, lumbosacral. In the medulla oblongata lesion an alternans syndrome resulted. The patients with cervical and thoracic radiation myelopathies presented with a Brown-Sequard syndrome, a spinalis anterior syndrome or a transversal syndrome with pyramidal and spinothalamic tract involvement as the most prominent signs. For this group the term 'pyramidal-spinothalamic radiation myelopathy' is proposed. In lumbosacral radiation lesions a pure anterior horn syndrome may lead to spinothalamic tract involvement and the development of a cauda conus syndrome. The clinical presentation of these cases suggests that the location of the radiation lesion is most likely the region of the conus medullaris. The most frequent initial symptom was dysesthesia; the patients complained of burning pain or a feeling of coldness. Usually the neurological deficits were progressive, in pyramidal-spinothalamic radiation myelopathy over 12 months in average, in lumbosacral radiation lesions up to 10 years. The latent period between the finish of radiation therapy and the first neurological signs was 8 months (median) in cervical and thoracic myelopathy and 33 months in lumbosacral lesions. For the entire group of 43 patients there was an inverse relationship between the radiation dose (ret) and the latent period. A positive relation could be demonstrated between the age of patients at the time of radiation therapy and the latent period. Patients simultaneously receiving cytostatic drugs presented after a longer latent period than the remaining group. (orig./MG)

Radiation myelopathy. Analysis of the clinical picture. Die Strahlenmyelopathie. Klinische Analyse des Krankheitsbildes

Energy Technology Data Exchange (ETDEWEB)

Berlit, P

1987-01-01

After a review of the world literature, the case histories of 43 patients with radiation myelopathy are analyzed. In 1 patient there was a radiation injury of the medulla oblongata, in 2, cervical, in 28, thoracic, and in 12, lumbosacral. In the medulla oblongata lesion an alternans syndrome resulted. The patients with cervical and thoracic radiation myelopathies presented with a Brown-Sequard syndrome, a spinalis anterior syndrome or a transversal syndrome with pyramidal and spinothalamic tract involvement as the most prominent signs. For this group the term 'pyramidal-spinothalamic radiation myelopathy' is proposed. In lumbosacral radiation lesions a pure anterior horn syndrome may lead to spinothalamic tract involvement and the development of a cauda conus syndrome. The clinical presentation of these cases suggests that the location of the radiation lesion is most likely the region of the conus medullaris. The most frequent initial symptom was dysesthesia; the patients complained of burning pain or a feeling of coldness. Usually the neurological deficits were progressive, in pyramidal-spinothalamic radiation myelopathy over 12 months in average, in lumbosacral radiation lesions up to 10 years. The latent period between the finish of radiation therapy and the first neurological signs was 8 months (median) in cervical and thoracic myelopathy and 33 months in lumbosacral lesions. For the entire group of 43 patients there was an inverse relationship between the radiation dose (ret) and the latent period. A positive relation could be demonstrated between the age of patients at the time of radiation therapy and the latent period. Patients simultaneously receiving cytostatic drugs presented after a longer latent period than the remaining group. With 17 figs.

Entrance skin dose on patients undergoing X-ray examinations at ...

African Journals Online (AJOL)

survey was conducted on the Entrance Skin Dose (ESD) in patients undergoing X-ray examinations [Skull Postero-Anterior (PA), Skull Lateral (LAT), Chest Postero-Anterior (PA), Chest Lateral (LAT), Abdomen Antero-Posterior (AP) and Pelvis Antero-Posterior (AP)] in five hospitals/Xray centres in Yaba, Lagos State, Nigeria ...

Reliability of tunnel angle in ACL reconstruction: two-dimensional versus three-dimensional guide technique.

Science.gov (United States)

Leiter, Jeff R S; de Korompay, Nevin; Macdonald, Lindsey; McRae, Sheila; Froese, Warren; Macdonald, Peter B

2011-08-01

To compare the reliability of tibial tunnel position and angle produced with a standard ACL guide (two-dimensional guide) or Howell 65° Guide (three-dimensional guide) in the coronal and sagittal planes. In the sagittal plane, the dependent variables were the angle of the tibial tunnel relative to the tibial plateau and the position of the tibial tunnel with respect to the most posterior aspect of the tibia. In the coronal plane, the dependent variables were the angle of the tunnel with respect to the medial joint line of the tibia and the medial and lateral placement of the tibial tunnel relative to the most medial aspect of the tibia. The position and angle of the tibial tunnel in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken 2-6 months postoperatively. The two-dimensional and three-dimensional guide groups included 28 and 24 sets of radiographs, respectively. Tibial tunnel position was identified, and tunnel angle measurements were completed. Multiple investigators measured the position and angle of the tunnel 3 times, at least 7 days apart. The angle of the tibial tunnel in the coronal plane using a two-dimensional guide (61.3 ± 4.8°) was more horizontal (P guide (64.7 ± 6.2°). The position of the tibial tunnel in the sagittal plane was more anterior (P guide group compared to the three-dimensional guide group (43.3 ± 2.9%). The Howell Tibial Guide allows for reliable placement of the tibial tunnel in the coronal plane at an angle of 65°. Tibial tunnels were within the anatomical footprint of the ACL with either technique. Future studies should investigate the effects of tibial tunnel angle on knee function and patient quality of life. Case-control retrospective comparative study, Level III.

In vivo kinematics of healthy male knees during squat and golf swing using image-matching techniques.

Science.gov (United States)

Murakami, Koji; Hamai, Satoshi; Okazaki, Ken; Ikebe, Satoru; Shimoto, Takeshi; Hara, Daisuke; Mizu-uchi, Hideki; Higaki, Hidehiko; Iwamoto, Yukihide

2016-03-01

Participation in specific activities requires complex ranges of knee movements and activity-dependent kinematics. The purpose of this study was to investigate dynamic knee kinematics during squat and golf swing using image-matching techniques. Five healthy males performed squats and golf swings under periodic X-ray images at 10 frames per second. We analyzed the in vivo three-dimensional kinematic parameters of subjects' knees, namely the tibiofemoral flexion angle, anteroposterior (AP) translation, and internal-external rotation, using serial X-ray images and computed tomography-derived, digitally reconstructed radiographs. During squat from 0° to 140° of flexion, the femur moved about 25 mm posteriorly and rotated 19° externally relative to the tibia. Screw-home movement near extension, bicondylar rollback between 20° and 120° of flexion, and medial pivot motion at further flexion were observed. During golf swing, the leading and trailing knees (the left and right knees respectively in the right-handed golfer) showed approximately five millimeters and four millimeters of AP translation with 18° and 26° of axial rotation, respectively. A central pivot motion from set-up to top of the backswing, lateral pivot motion from top to ball impact, and medial pivot motion from impact to the end of follow-through were observed. The medial pivot motion was not always recognized during both activities, but a large range of axial rotation with bilateral condylar AP translations occurs during golf swing. This finding has important implications regarding the amount of acceptable AP translation and axial rotation at low flexion in replaced knees. IV. Copyright © 2015 Elsevier B.V. All rights reserved.

Transpedicular fixation for the espondilolistesis treatment, espondilolisis and channel lumbar narrow of the lumbosacral column

International Nuclear Information System (INIS)

Matta Javier Ernesto; Diaz, Cesar Jacobo; Gamba S, Cesar Enrique

2002-01-01

A descriptive, prospective study was designs with the objective of analyzing the experience with the technique of transpedicular fixation, for the treatment of degenerative espondilolistesis, espondilolisis and channel lumbar narrow. Eighty patients (42 men and 38 women) they were intervened between February of 1992 and February of 2002; the age average was of 46,3 years and the minimum pursuit of 7 months. The cases were tabulated according to the diagnostic, clinical presentation, previous interventions, descompressive procedures associated to the fixation, anatomical level of lesion, number of fixed vertebras, number of placed screws, type of bony implants and complications. In 33 patients (41,3%) it diagnose degenerative espondilolistesis, espondilolisis in 24 (30%), channel lumbar narrow in 20 (25%), displasic espondilolistesis in 2,5% and espondiloptosis in 1%. the clinical presentations more frequent were radicular and lumbar pain, with 33,8 each one; one carries out arthrodesis 15-S1 in 38 patients (47,5%) and 14 15 in 15 patients (18,7%). as complications we find deep infection in 7,5% of the cases, neurological deficit in 5%, rupture of duramadre 3,8%, false route of screws, bony failure and material rupture in 2,5% each one and seroma in 1,3%. Doesn't present seudoarthrosis. The transpedicular fixation is a sure technique for the treatment of the degenerative espondilolistesis, espondilolisis and channel lumbar narrow. With the transpedicular fixation the average of fixed vertebras is smaller than with the Harrington and Luque techniques, preserving in more degree the mobility to articulate. The association of the transpedicular fixation with arthrodesis and coalition by means of placement of autogenous implants diminishes the seudoarthrosis incidence

Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

Science.gov (United States)

Liu, Ning; Wood, Kirkham B

2017-03-01

OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

An Unusual Case Report of Bertolotti's Syndrome: Extraforaminal Stenosis and L5 Unilateral Root Compression (Castellvi Type III an LSTV).

Science.gov (United States)

Kapetanakis, Stylianos; Chaniotakis, Constantinos; Paraskevopoulos, Constantinos; Pavlidis, Pavlos

2017-01-01

Castellvi Type III lumbosacral transitional vertebrae (LSTV) is an unusual case of Bertolotti's syndrome (BS) due to extraforaminal stenosis, especially manifesting in elderly patients. We report a case of BS in a 62 years old Greek female. The signs of the clinical examination are low back pain, sciatica, hypoesthesia, and pain to the contribution of L5 nerve. Imaging techniques revealed an LSTV Type III a (complete sacralization between LSTV and sacrum). Despite the fact that LSTV is a congenital lesion, the clinical manifestation of BS may present in the elderly population. The accumulative effect of the gradual degeneration of intervertebral foramen (stenosis) may lead to the compression of extraforaminal portion of the nerve root.

Tratamento dos desarranjos da articulação radio-ulnal distal pela técnica de Sauvé-Kapandji. Resultados preliminares Treatment of the distal radioulnar articulation disorders by the Sauvé-Kapandji technique

Directory of Open Access Journals (Sweden)

Nilton Mazzer

2001-03-01

Full Text Available Foi realizado um estudo retrospectivo de 10 casos de desarranjo da articulação radio-ulnal distal tratados pela técnica de Sauvé-Kapandji. Os desarranjos eram resultantes de trauma (7, degeneração (2 e doença congênita (1 e as principais queixas pré-operatórias eram a dor, limitação da prono-supinação e deformidade. A idade média dos pacientes na época da operação era de 37,8 anos. Os pacientes foram submetidos a avaliação clínico-funcional e radiografica com um seguimento pós-operatório médio de 28,3 meses, particular atenção tendo sido dada a uma incidência radiográfica anteroposterior sob esforço de preensão manual. Todos os pacientes obtiveram melhora de suas queixas e o resultado final foi considerado satisfatório (excelente e bom em 8, e insatisfatório (regular 2. A artrodese da articulação radio-ulnal consolidou em 9 casos, independentemente do tipo de fixação empregado. O exame radiográfico sob esforço mostrou que todos os pacientes apresentavam deslocamento radial da ulna, mas isso aparentemente não interferiu com a função. Concluiu-se que a técnica de Sauvé-Kapandji é eficiente para o tratamento dos desarranjos da articulação radio-ulnal distal, pois ela não implica em perda funcional importante.A retrospective study of 10 cases of derrangement of the distal radioulnar joint treated with the technique of Sauvé-Kapandji was carried out. Derrangements resulted from trauma (7, degeneration (2 and congenital disease (1 and the main preoperative complaints were pain, limitation of pronation and supination and deformity. The patients' average age by the time of the operation was 37.8 years (range: 19 - 68 years. All were submitted to clinical, functional and radiographic evaluation at 28.3 months after the operation on average, particular attention being paid to an anteroposterior X-ray view with the hand in a moderate hand grip effort. All patients improved from their complaints and the final

Rapid high resolution MR neurography with a diffusion-weighted pre-pulse

International Nuclear Information System (INIS)

Yoneyama, Masami; Nakamura, Masanobu; Tabuchi, Takashi; Takahara, Taro; Kwee, T.C.

2013-01-01

The purpose of this study was to introduce, optimize, and assess the feasibility of a new scheme to rapidly acquire high-resolution volumetric neurographic images using a three-dimensional turbo spin-echo sequence combined with a diffusion-weighted pre-pulse called improved motion-sensitized driven equilibrium (iMSDE): Diffusion-prepared magnetic resonance (MR) Neurography (D-prep MRN). In order to optimize the signal suppression of blood vessels and muscle at D-prep MRN, coronal lumbosacral plexus images were acquired in five volunteers at 3T, and the following parameters were examined: iMSDE gradient-strength (b-value) of 0, 2 and 10 s/mm 2 (with the aim to suppress blood vessels) and iMSDE preparation duration (iMSDE prep-time ) of 18, 50 and 100 ms (with the aim to suppress muscle signal). Subsequently, the feasibility of the optimized D-prep MRN sequence in visualizing the brachial plexus, lumbosacral plexus, and cranial nerves was evaluated in 5 healthy volunteers. A higher b-value of 10 s/mm 2 was better in signal suppression of blood vessels, whereas an intermediate iMSDE prep-time of 50 ms provided the best compromise between suppression of muscle signal and minimization of signal loss of nerves. With these parameters, the normal nerve structures showed high signal intensity, while the blood vessels and muscles were effectively suppressed. The optimized D-prep MRN sequence clearly showed the three-dimensional trajectory of the brachial plexus, lumbosacral plexus, and cranial nerves. D-prep MRN was introduced and optimized, and clearly showed detailed anatomy of the brachial plexus, lumbosacral plexus, and cranial nerves. These results suggest that the D-prep MRN can be used for fast, high-resolution, volumetric imaging of the peripheral nervous system. (author)

STRUCTURE AND COMPLEX THERAPY OF DORSALGIA IN CHILDREN

Directory of Open Access Journals (Sweden)

A. A. Smirnova

2014-01-01

Full Text Available The article presents results of back pain syndrome screening in a population of children according to the poll of 600 students of classes 1–11. The spread of dorsalgiae is 19%. According to the examination, nosological and clinical structure of dorsalgiae was determined in 35 children of 3–18 years of age hospitalized due to back pain. Lumbalgia was revealed in 55 (52% patients; cervicalgia — in 31 (30% patients; thoracalgia — in 19 (18% patients. Juvenile osteochondrosis of lumbosacral spine is the cause of lumbosacral pain syndrome in most patients. The authors analyzed complex treatment efficacy and demonstrated that affective disorders are a prognostically significant factor of back pain onset. 

Determining loads acting on the pelvis in upright and recumbent birthing positions: A case study.

Science.gov (United States)

Hemmerich, Andrea; Geens, Emily; Diesbourg, Tara; Dumas, Geneviève A

2018-05-24

The biomechanics of mothers' birthing positions and their impact on maternal and newborn health outcomes are poorly understood. Our objectives were to determine the loads applied to the female pelvis during dynamic movement that may occur during childbirth; findings are intended to inform clinical understanding and further research on birth positioning mechanics. An optical motion capture system and force platforms were used to collect upright and supine movement data from two pregnant and three non-pregnant participants. Using an inverse dynamics approach, normalized three-dimensional hip and sagittal plane lumbosacral joint moments were estimated during squatting, all-fours, and supine activities. During squatting, peak hip abduction moments were greater for our pregnant (compared with non-pregnant) participants and lumbosacral extension moments substantially exceeded those during walking. The all-fours activity, conversely, generated flexion moments at the L5/S1 joint throughout most of the cycle. In supine, the magnitude of the ground reaction force reached 100% body weight with legs and upper body raised (McRoberts' position); the centre of pressure remained cranial to the sacrum. Squatting generated appreciable moments at the hip and lumbosacral joints that could potentially affect pelvic motion during childbirth. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cogeneration techniques; Les techniques de cogeneration

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-10-01

This dossier about cogeneration techniques comprises 12 parts dealing successively with: the advantages of cogeneration (examples of installations, electrical and thermal efficiency); the combustion turbine (principle, performances, types); the alternative internal combustion engines (principle, types, rotation speed, comparative performances); the different configurations of cogeneration installations based on alternative engines and based on steam turbines (coal, heavy fuel and natural gas-fueled turbines); the environmental constraints of combustion turbines (pollutants, techniques of reduction of pollutant emissions); the environmental constraints of alternative internal combustion engines (gas and diesel engines); cogeneration and energy saving; the techniques of reduction of pollutant emissions (pollutants, unburnt hydrocarbons, primary and secondary (catalytic) techniques, post-combustion); the most-advanced configurations of cogeneration installations for enhanced performances (counter-pressure turbines, massive steam injection cycles, turbo-chargers); comparison between the performances of the different cogeneration techniques; the tri-generation technique (compression and absorption cycles). (J.S.)

A randomized, placebo-controlled trial of repetitive spinal magnetic stimulation in lumbosacral spondylotic pain.

Science.gov (United States)

Lo, Yew L; Fook-Chong, Stephanie; Huerto, Antonio P; George, Jane M

2011-07-01

Lumbar spondylosis is a degenerative disorder of the spine, whereby pain is a prominent feature that poses therapeutic challenges even after surgical intervention. There are no randomized, placebo-controlled studies utilizing repetitive spinal magnetic stimulation (SMS) in pain associated with lumbar spondylosis. In this study, we utilize SMS technique for patients with this condition in a pilot clinical trial. We randomized 20 patients into SMS treatment or placebo arms. All patients must have clinical and radiological evidence of lumbar spondylosis. Patients should present with pain in the lumbar region, localized or radiating down the lower limbs in a radicular distribution. SMS was delivered with a Medtronic R30 repetitive magnetic stimulator (Medtronic Corporation, Skovlunde, Denmark) connected to a C-B60 figure of eight coil capable of delivering a maximum output of 2 Tesla per pulse. The coil measured 90 mm in each wing and was centered over the surface landmark corresponding to the cauda equina region. The coil was placed flat over the back with the handle pointing cranially. Each patient on active treatment received 200 trains of five pulses delivered at 10 Hz, at an interval of 5 seconds between each train. "Sham" SMS was delivered with the coil angled vertically and one of the wing edges in contact with the stimulation point. All patients tolerated the procedure well and no side effects of SMS were reported. In the treatment arm, SMS had resulted in significant pain reduction immediately and at Day 4 after treatment (P lumbar spondylosis in a randomized, double-blind, placebo-controlled setting. The novel findings support the potential of this technique for future studies pertaining to neuropathic pain. Wiley Periodicals, Inc.

Direct and indirect pathways to lamina I in the medulla oblongata and spinal cord of the cat

Science.gov (United States)

Holstege, Gert

1988-01-01

The pathways to lamina I in the medulla oblongata and spinal cord of the cat were traced using horse-radish-peroxidase (HRP) and autoradiographic techniques. The HRP results indicated that several neuronal cell groups in the brain stem and hypothalamus project to the spinal cord throughout its total length. The autoradiographic tracing results demonstrated that the strongest projections to lamina I are derived from the following four areas: the caudal nucleus raphe magnus (NRM), the ventral part of the caudal pontine and NRM, the contralaterally projecting lateral pontine or paralemniscal tegmentum, and the paraventricular nucleus of the hypothalamus. In addition, a limited, especially at lumbosacral levels, distinct projection to lamina I was found to originate in the most caudal part of the medullary tegmentum.

An Unusual Case Report of Bertolotti’s Syndrome: Extraforaminal Stenosis and L5 Unilateral Root Compression (Castellvi Type III an LSTV)

Science.gov (United States)

Kapetanakis, Stylianos; Chaniotakis, Constantinos; Paraskevopoulos, Constantinos; Pavlidis, Pavlos

2017-01-01

Introduction: Castellvi Type III lumbosacral transitional vertebrae (LSTV) is an unusual case of Bertolotti’s syndrome (BS) due to extraforaminal stenosis, especially manifesting in elderly patients. Case Report: We report a case of BS in a 62 years old Greek female. The signs of the clinical examination are low back pain, sciatica, hypoesthesia, and pain to the contribution of L5 nerve. Imaging techniques revealed an LSTV Type III a (complete sacralization between LSTV and sacrum). Conclusion: Despite the fact that LSTV is a congenital lesion, the clinical manifestation of BS may present in the elderly population. The accumulative effect of the gradual degeneration of intervertebral foramen (stenosis) may lead to the compression of extraforaminal portion of the nerve root. PMID:29051870

Does a mineral wristband affect balance? A randomized, controlled, double-blind study.

Science.gov (United States)

Hansson, Eva Ekvall; Beckman, Anders; Persson, Liselott

2015-06-26

Having good balance is a facilitating factor in the performance of everyday activities. Good balance is also essential in various sport activities in order to both get results and prevent injury. A common measure of balance is postural sway, which can be measured both antero-posteriorly and medio-laterally. There are several companies marketing wristbands whose intended function is to improve balance, strength and flexibility. Randomized controlled trials have shown that wristbands with holograms have no effect on balance but studies on wristbands with minerals seem to be lacking. The aim of this study was to investigate if the mineral wristband had any effect on postural sway in a group of healthy individuals. Randomized, controlled, double-blind study. The study group consisted of 40 healthy persons. Postural sway was measured antero-posteriorly and medio-laterally on a force plate, to compare: the mineral wristband, a placebo wristband, and without any wristband. The measurements were performed for 30 s, in four situations: with open eyes and closed eyes, standing on a firm surface and on foam. Analyses were made with multilevel technique. The use of wristband with or without minerals did not alter postural sway. Closed eyes and standing on foam both prolonged the dependent measurement, irrespective if it was medio-lateral or antero-posterior. Wearing any wristband (mineral or placebo) gave a small (0.22-0.36 mm/s) but not statistically significant reduction of postural sway compared to not wearing wristband. This study showed no effect on postural sway by using the mineral wristband, compared with a placebo wristband or no wristband. Wearing any wristband at all (mineral or placebo) gave a small but not statistically significant reduction in postural sway, probably caused by sensory input.

21 CFR 890.3490 - Truncal orthosis.

Science.gov (United States)

2010-04-01

... fractures, strains, or sprains of the neck or trunk of the body. Examples of truncal orthoses are the following: Abdominal, cervical, cervical-thoracic, lumbar, lumbo-sacral, rib fracture, sacroiliac, and...

An unusual presentation of Brown-Sequard syndrome.

Science.gov (United States)

Herr, R D; Barrett, J

1987-11-01

We report the case of a man with Brown-Sequard syndrome following a fall in which he sustained fractures of the thoracic and lumbosacral spine. Despite characteristic neurological findings, the diagnosis was delayed due to the absence of history of penetrating spinal trauma and incorrect attribution of unilateral-like weakness and numbness to lumbosacral trauma. A directed history and examination revealed that the patient was stabbed in the back with a penknife while leaving a bus and stepped down onto a paralyzed leg, which collapsed beneath him. The patient was given an antibiotic, underwent a negative peritoneal lavage, and had myelography and nerve conduction velocity confirmatory for Brown-Sequard syndrome. With rehabilitation he became ambulatory with a cane one month after the stabbing.

The anatomy of the first sacral nerve root sheath shown by computed tomography.

Science.gov (United States)

Moore, N R; Dixon, A K; Freer, C E

1989-08-01

Analysis of 25 patients with normal computed tomographic appearances at the lumbosacral junction revealed wide variation in the anatomical level at which the first sacral nerve root sheaths were seen emerging from the theca. In nine patients (36%), the S1 nerve root sheaths were first recognized at the level of the lumbosacral disc. In 14 patients (56%), the sheaths emerged cranial to the disc; it is possible that these patients may be more prone to neurological complications related to disc or facet joint disease, especially if the sheath is laterally sited within the lateral recess. Conversely, that minority of patients (two, 8%) in whom the root sheaths emerge caudal to the disc level may be relatively protected from neurological complications.

Three-Dimensional Reconstruction of Post-Traumatic Deficient Anterior Maxilla.

Science.gov (United States)

Rachmiel, Adi; Shilo, Dekel; Aizenbud, Dror; Pen, Mark; Rachmiel, Dana; Emodi, Omri

2017-12-01

Maxillary retrognathism appears in 14.3% of patients exhibiting malocclusion after trauma treatment. This report describes the application of alveolar distraction osteogenesis (ADO) for treating the severely deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes. This is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency after trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy after ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations. Twelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, 1 or 2 distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5 mm/day to a mean total of 13.9 mm (12 to 15 mm). In 4 of 12 cases, there was a severe anteroposterior discrepancy larger than 8 mm that could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le Fort I advancement was performed. Thirty-eight dental implants were inserted, with a survival rate of 97.37% (median follow-up, 6.2 yr). This report describes treatment of the deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, considerably higher vertical augmentation compared with other methods, and minimal relapse. Using an additional Le Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior

Combined videofluoroscopy and manometry in the diagnosis of oropharyngeal dysphagia: examination technique and preliminary experience.

Science.gov (United States)

Cappabianca, S; Reginelli, A; Monaco, L; Del Vecchio, L; Di Martino, N; Grassi, R

2008-09-01

Dysphagia is a symptom of different pathological conditions characterised by alteration of the swallowing mechanism, which may manifest at different levels. We report our experience in the evaluation of the swallowing mechanism with combined videofluoroscopy and manometric recordings. For the combined study, we used a Dyno Compact computerised system (Menfis Biomedical s.r.l., Bologna, Italy) equipped with: (1) graphics card for the management of ultrasonographic or radiological images; (2) A.VI.U.S. dedicated software package, which enables digital-quality recording (PAL/NTSC, composite video or S-Video) of the videofluoroscopy study in AVI format with 320 x 240 resolution and 25 Hz acquisition frequency. The delay introduced by the process of image digitalisation is in the order of 200 ms, so for analysis purposes, the images can be considered synchronised with the manometric recordings. The videomanometry study was performed with the administration of contrast material either in bolus form or diluted. Data were collected on a specifically designed grid for the evaluation of 46 videofluoroscopic items, of which 34 are derived from the laterolateral view (seven in the oral preparatory phase, 15 in the oral transport phase and 12 in the pharyngeal phase) and 12 in the anteroposterior view (six in the oral preparatory phase and six in the oropharyngeal phase). A positive finding for the individual parameters is expressed in a binary fashion. Manometric evaluation was based on 11 items divided into four major and seven minor criteria. Dynamic videofluoroscopy swallow study combined with concurrent manometry enabled the simultaneous recording of anatomical alterations and the functional data of oropharyngeal pressure, thus providing a picture of the anatomical, biomechanical and physiological conditions of swallowing and the manner of bolus propulsion and transit. An early and effective diagnosis of oropharyngeal dysphagia means being able to effectively implement

Isolated lipoma of filum terminale in adults: MRI findings and clinical correlation

International Nuclear Information System (INIS)

Al-Omari, Ma'moon H.; Qudseih, Hana' M.; Al-shinag, Mohammad K.; Eloqayli, Haytham M.

2011-01-01

Fat within the filum terminale is frequently seen on routine magnetic resonance imaging (MRI) of the lumbosacral spine (LSS), with prevalence of 1–5%. The objective of this study was to determine the prevalence and MRI features of isolated lipoma of filum terminale (LFT) in adult population and its correlation with the patient clinical presentations. Prospective analysis of all lumbosacral MRI performed at King Abdullah University Hospital during a 21-month period. A total of 37 patients with LFT were included. Patients were divided into two groups. Group A patients have neurological deficit manifested by either motor, sensory or sphincter abnormality. Group B patients have normal neurological examination. Clinical findings were correlated with: A: thickness of LFT, B: length of LFT, C: distance of LFT from conus medullaris (CM), D: age of the patient. The prevalence of isolated LFT in our study was 3.2%. There was no significant correlation between the thickness or length of LFT and the presence of neurological deficit. The distance of LFT from CM was also not correlated with the patient clinical presentation. No significant difference in the age between the two groups. LFT in adult likely represent an incidental finding on routine lumbosacral MRI. Special attention for LFT in children is mandatory as it may indicate clinical tethering in otherwise normal appearing LSS.

Evidence that central pathways that mediate defecation utilize ghrelin receptors but do not require endogenous ghrelin.

Science.gov (United States)

Pustovit, Ruslan V; Callaghan, Brid; Ringuet, Mitchell T; Kerr, Nicole F; Hunne, Billie; Smyth, Ian M; Pietra, Claudio; Furness, John B

2017-08-01

In laboratory animals and in human, centrally penetrant ghrelin receptor agonists, given systemically or orally, cause defecation. Animal studies show that the effect is due to activation of ghrelin receptors in the spinal lumbosacral defecation centers. However, it is not known whether there is a physiological role of ghrelin or the ghrelin receptor in the control of defecation. Using immunohistochemistry and immunoassay, we detected and measured ghrelin in the stomach, but were unable to detect ghrelin by either method in the lumbosacral spinal cord, or other regions of the CNS In rats in which the thoracic spinal cord was transected 5 weeks before, the effects of a ghrelin agonist on colorectal propulsion were significantly enhanced, but defecation caused by water avoidance stress (WAS) was reduced. In knockout rats that expressed no ghrelin and in wild-type rats, WAS-induced defecation was reduced by a ghrelin receptor antagonist, to similar extents. We conclude that the ghrelin receptors of the lumbosacral defecation centers have a physiological role in the control of defecation, but that their role is not dependent on ghrelin. This implies that a transmitter other than ghrelin engages the ghrelin receptor or a ghrelin receptor complex. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Varicella zoster virus infection causing urinary retention in a child ...

African Journals Online (AJOL)

2012-11-02

Nov 2, 2012 ... Varicella zoster virus (VZV) of the human herpes virus family .... VZV, cytomegalovirus and Epstein-Barr virus. Radiculomyelitis causing transient urinary retention and sensory lumbosacral symptoms is known as Elsberg ...

Midcarpal instability: a diagnostic role for dynamic ultrasound?

Science.gov (United States)

Toms, A; Chojnowski, A; Cahir, J

2009-06-01

The aim of this study was to describe the technique of dynamic ultrasound (US) examination of the triquetral clunk, and to illustrate the range of findings in four patients with midcarpal instability (MCI). Four patients were identified (3 men, 1 woman). The case notes, plain radiographs, MRI and dynamic US for each patient were reviewed. Digital video files recording the dynamic US of the triquetral clunks were analysed for the following features of abnormal triquetral mobility: direction and speed of triquetral snap, amount of anteroposterior translocation, and flexion or extension during the snap. Five different triquetral clunks were recorded in 4 patients. In four out of five cases the clunk occurred during ulnar translocation of the wrist, and in one during radial translocation. Anteroposterior translocation was anterior (3.4 - 4.7 mm) in three of the clunks and posterior (1 - 10 mm) in two. The degree of flexion or extension varied between 1 and 16 degrees . The snapping phase of the clunk lasted between 0.17 and 0.25 seconds. Dynamic US can be used to confirm the diagnosis of midcarpal instability by identifying a triquetral catch-up clunk. Quantification of carpal mobility with US may lead to further insights into the mechanics of MCI.

A Review of the Segmental Diameter of the Healthy Human Spinal Cord.

Science.gov (United States)

Frostell, Arvid; Hakim, Ramil; Thelin, Eric Peter; Mattsson, Per; Svensson, Mikael

2016-01-01

Knowledge of the average size and variability of the human spinal cord can be of importance when treating pathological conditions in the spinal cord. Data on healthy human spinal cord morphometrics have been published for more than a century using different techniques of measurements, but unfortunately, comparison of results from different studies is difficult because of the different anatomical landmarks used as reference points along the craniocaudal axis for the measurements. The aim of this review was to compute population estimates of the transverse and anteroposterior diameter of the human spinal cord by comparing and combining previously published data on a normalized craniocaudal axis. We included 11 studies presenting measurements of spinal cord cross-sectional diameters, with a combined sample size ranging from 15 to 488 subjects, depending on spinal cord level. Based on five published studies presenting data on the lengths of the segments of the spinal cord and vertebral column, we calculated the relative positions of all spinal cord neuronal segments and vertebral bony segments and mapped measurements of spinal cord size to a normalized craniocaudal axis. This mapping resulted in better alignment between studies and allowed the calculation of weighted averages and standard deviations (SDs) along the spinal cord. These weighted averages were smoothed using a generalized additive model to yield continuous population estimates for transverse and anteroposterior diameter and associated SDs. The spinal cord had the largest transverse diameter at spinal cord neuronal segment C5 (13.3 ± 2.2), decreased to segment T8 (8.3 ± 2.1), and increased slightly again to 9.4 ± 1.5 at L3. The anteroposterior diameter showed less variation in size along the spinal cord at C5 (7.4 ± 1.6), T8 (6.3 ± 2.0), and L3 (7.5 ± 1.6). All estimates are presented in millimeters ± 2 SDs. We conclude that segmental transverse and anteroposterior

Novel use of the Wii Balance Board to prospectively predict falls in community-dwelling older adults.

Science.gov (United States)

Kwok, Boon-Chong; Clark, Ross A; Pua, Yong-Hao

2015-06-01

The Wii Balance Board has received increasing attention as a balance measurement tool; however its ability to prospectively predict falls is unknown. This exploratory study investigated the use of the Wii Balance Board and other clinical-based measures for prospectively predicting falls among community-dwelling older adults. Seventy-three community-dwelling men and women, aged 60-85years were followed-up over a year for falls. Standing balance was indexed by sway velocities measured using the Wii Balance Board interfaced with a laptop. Clinical-based measures included Short Physical Performance Battery, gait speed and Timed-Up-and-Go test. Multivariable regression analyses were used to assess the ability of the Wii Balance Board measure to complement the TUG test in fall screening. Individually, the study found Wii Balance Board anteroposterior (odds ratio 1.98, 95% CI 1.16 to 3.40, P=0.01) and mediolateral (odds ratio 2.80, 95% CI 1.10 to 7.13, p=0.03) sway velocity measures predictive of prospective falls. However, when each velocity measure was adjusted with body mass index and Timed-Up-and-Go, only anteroposterior sway velocity was predictive of prospective falls (odds ratio 2.21, 95% CI 1.18 to 4.14). A faster anteroposterior velocity was associated with increased odds of falling. Area-under-the-curves for Wii Balance Board sway velocities were 0.67 and 0.71 for anteroposterior and mediolateral respectively. The Wii Balance Board-derived anteroposterior sway velocity measure could complement existing clinical-based measures in predicting future falls among community-dwelling older adults. Australian New Zealand Clinical Trials Registry number: ACTRN12610001099011. Copyright © 2015 Elsevier Ltd. All rights reserved.

Expanding the spectrum of congenital anomalies of the diencephalic-mesencephalic junction

Energy Technology Data Exchange (ETDEWEB)

Severino, Mariasavina; Tortora, Domenico; Rossi, Andrea [Istituto Giannina Gaslini, Neuroradiology Unit, Genova (Italy); Pistorio, Angela [Istituto Giannina Gaslini, Epidemiology and Biostatistics Unit, Genoa (Italy); Ramenghi, Luca Antonio [Istituto Giannina Gaslini, Neonatal Intensive Care Unit, Genoa (Italy); Napoli, Flavia [Istituto Giannina Gaslini, Endocrinology Unit, Genoa (Italy); Mancardi, Maria Margherita [Istituto Giannina Gaslini, Neuropsychiatry Unit, Genoa (Italy); Striano, Pasquale [Istituto Giannina Gaslini, Paediatric Neurology and Muscular Diseases Unit, Genoa (Italy); Capra, Valeria [Istituto Giannina Gaslini, Genetic Unit, Genoa (Italy)

2016-01-15

We aimed to describe the clinico-radiological findings of patients with disorders of diencephalic-mesencephalic junction (DMJ) formation and midbrain anteroposterior patterning. We reviewed the DMJ anatomy of 445 patients with brain malformations. Associated supra/infratentorial abnormalities and clinical findings were noted. Craniocaudal and anteroposterior diameters of midbrain, pons, medulla, vermis, and transverse cerebellar diameter were compared with age-matched controls. Post hoc tests were corrected according to Bonferroni (p{sub B}). Two patterns of DMJ anomaly were identified in 12 patients (7 females, mean age 41 months). Type A was characterized by hypothalamic-mesencephalic fusion on axial plane, with possible midbrain ventral cleft (7 patients). Anteroposterior (p{sub B} =.006) and craniocaudal (p{sub B} =.027) diameters of the pons, craniocaudal diameter of the vermis (p{sub B} =.015), and transverse cerebellar diameter (p{sub B} =.011) were smaller than the controls. Corticospinal tract, basal ganglia, and commissural anomalies were also associated. Clinical findings included spastic-dystonic tetraparesis, hypothalamic dysfunction, epilepsy, and severe developmental delay. Type B was characterized by incomplete thalamic-mesencephalic cleavage on sagittal plane, with parenchymal bands connecting the interthalamic adhesion with the midbrain (five patients). Anteroposterior diameters of midbrain (p{sub B} =.002), pons (p{sub B} =.0004), and medulla (p{sub B} =.002) as well as the vermian anteroposterior (p{sub B} =.040) and craniocaudal diameters (p{sub B} =.014) were smaller than the controls. These patients were less neurologically impaired, most presenting mild developmental delay. The spectrum of DMJ patterning defects is wide and may be associated with several brain malformations. Infratentorial brain structures should be carefully evaluated to better define the type of associated midbrain-hindbrain anomalies. (orig.)

Frequency of spondylolysis and chronic low back pain in young soccer players

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Marcos Vaz De Lima

2014-01-01

Full Text Available Objective: To demonstrate the safety of soccer for adolescents in terms of chronic lesions of the lumbar spine, particularly spondylolysis. Methods: 54 young players underwent a pre-season assessment. The athletes were submitted to radiography of the lumbosacral spine. Players complaining of chronic low back pain were later submitted to more specific tests. Results: only 1 athlete (1.85 % of our sample had complaints of chronic low back pain. In this case, the radiograph showed olisthesis grade I spondylolysis at the L5 level. Conclusion: Soccer proved to be a very safe sport in terms of the risk of developing chronic lesions of the lumbosacral spine. However, the actual incidence of spondylolysis in these athletes was not determined because only plain radiographs were used in this study.

Epidural steroid injection in patients with lumbosacral radiculopathy in Abuja, Nigeria

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Ahidjo A Kawu

2012-01-01

Full Text Available Objective : This prospective-controlled observational study looked at well-matched patients with spinal pain and radicular symptoms, caused by lumbar intervertebral disc herniation to compare the short-term clinical outcome of transforaminal and interlaminar epidural steroid injection (ESI in a resource challenged tertiary institution in Nigeria. Materials and Methods : 49 patients with radicular symptoms who were matched for age, symptom duration, magnetic resonance imaging findings, and pre-injection revised Oswentry Disability Index (ODI score and Visual Analogue Scale (VAS were assigned into ESI technique. The ODI and VAS score were analyzed immediately after an injection and upon follow-up (average 178.5 days, also with the need for repeated injections and surgical interventions over a 1-year follow-up interval. Result: In the transforaminal group (25 patients, there was a statistically significant improvement in the ODI scores from before the injection (ODI mean 62.4 to immediately after the injection (ODI mean 24.4, P < 0.01, and upon follow-up (ODI mean 20.8, P < 0.01. 9 patients (18.4% required 1 or 2 repeated injections, 3 (6.1% patients underwent surgery and 2 (4% patients lost to follow-up. In the interlaminar group (24 patients, there was a statistically significant improvement in the ODI scores from before the injection (ODI mean 60.7 to immediately after the injection (ODI mean 30.1, P < 0.01, but not upon follow-up (ODI mean 43.2, P = 0.09. 11 (22.4% patients required 1 or 2 repeated injection, 4 (8% patients underwent surgery and 3 (6.1% patients were lost to follow-up. There is an average of 2 fold improvement of transforaminal ESI over interlaminar ESI in a 40 point scale of ODI score on follow-up, which was statistically significant (P < 0.01. The VAS showed similar pattern with the ODI scores in the study. Conclusion : Transforaminal ESI to treat symptomatic lumbar disc herniation resulted in better short-term pain

Functional Paraganglioma: A Rare Conus‑cauda Lesion

African Journals Online (AJOL)

Magnetic resonance imaging of the lumbosacral spinal segment, before and after gadolinium administration, demonstrated a lobulated lesion extending ... The role of MRI in the diagnosis and treatment of this condition is paramount, owing to ...

Vertebroplasty in the Treatment of Spine Disease

OpenAIRE

Ambrosanio, G.; Lavanga, A.; Vassallo, P.; Izzo, R.; Diano, A.A.; Muto, M.

2005-01-01

We report our experience in the treatment of thoracic and lumbosacral spinal pain due to vertebral bone fractures. This pathology can be related to osteoporosis but also to metastatic disease and less frequently vertebral haemangioma.

Localized plexiform neurofibromatosis of the lumbar region

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Chhang W

1990-01-01

Full Text Available A 13-year-old boy had a localized plexiform neurofibroma situated on a large cafe-au-lait spot in the lumbo-sacral region. Histopathology was characteristic, The result of surgical excision was satisfactory.

Determination of bone mineral density in the third lumbar vertebral body using photon absorptiometry techniques

International Nuclear Information System (INIS)

Swanpalmer, Janos; Kullenberg, Ragnar; Hansson, Tommy

1998-01-01

Dual-photon absorptiometry and triple-energy X-ray absorptiometry were used to investigate the total bone mineral content and density as well as the trabecular bone mineral density in the third lumbar vertebral body. Both anteroposterior (AP) and lateral (LAT) measurements were performed. By combining the two projections it was found that the mean trabecular bone mineral density for all 202 subjects included in the study was 52% (SD±20%) of the total bone mineral density in the third lumbar vertebral body. The mean trabecular bone mineral density as a fraction of the total vertebral body bone mineral density decreased as a function of age. The relative annual change in this fraction differed between males and females. It was also found that neither trabecular nor total bone mineral density differed significantly between male and female subjects aged 25-35 years, and bone mineral density (BMD), expressed in g/cm 3 , showed no correlation to subject height, body weight or body mass index (BMI). Male and female individuals showed different rates of change of trabecular bone mineral density with age

Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique

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Suomalainen P

2014-08-01

Full Text Available Piia Suomalainen,1 Tommi Kiekara,2 Anna-Stina Moisala,1 Antti Paakkala,2 Pekka Kannus,3 Timo Järvelä4 1Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, 2Medical Imaging Centre, Tampere University Hospital, Tampere, 3Injury and Osteoporosis Research Center, UKK Institute, Tampere, 4Arthroscopic and Sports Medicine Center Omasairaala, Helsinki, Finland Purpose: The purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI findings of a reconstructed anterior cruciate ligament (ACL have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee. Methods: This study is a level II, prospective clinical and MRI study (NCT02000258. The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used. Results: We found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations. Conclusion: Anterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this

The geometric curvature of the lumbar spine during restricted and unrestricted squats.

Science.gov (United States)

Hebling Campos, Mário; Furtado Alaman, Laizi I; Seffrin-Neto, Aldo A; Vieira, Carlos A; Costa de Paula, Marcelo; Barbosa de Lira, Claudio A

2017-06-01

The main purpose of this study was to analyze the behavior of the geometric curvature of the lumbar spine during restricted and unrestricted squats, using a novel investigative method. The rationale for our hypothesis is that the lumbar curvature has different patterns at different spine levels depending on the squat technique used. Spine motion was collected via stereo-photogrammetric analysis in nineteen participants (11 males, 8 females). The reconstructed spine points at the upright neutral position and at the deepest position of the squat exercise were projected onto the sagittal plane of the trunk, a polynomial was fitted to the data, and were quantified the two-dimensional geometric curvature at lower, central and higher lumbar levels, besides the inclination of trunk and lumbosacral region, the overall geometric curvature and overall angle of the lumbar spine. The mean values for each variable were analysed with paired t-test (Psquat techniques and these effects are also reduced in unrestricted squats. The data collected in the study are evidence that during barbell squats the lumbar curvature has different patterns at different spinal levels depending on the exercise technique. The lower lumbar spine appears to be less overloaded during unrestricted squats.

Dismantling techniques

Energy Technology Data Exchange (ETDEWEB)

Wiese, E.

1998-03-13

Most of the dismantling techniques used in a Decontamination and Dismantlement (D and D) project are taken from conventional demolition practices. Some modifications to the techniques are made to limit exposure to the workers or to lessen the spread of contamination to the work area. When working on a D and D project, it is best to keep the dismantling techniques and tools as simple as possible. The workers will be more efficient and safer using techniques that are familiar to them. Prior experience with the technique or use of mock-ups is the best way to keep workers safe and to keep the project on schedule.

Dismantling techniques

International Nuclear Information System (INIS)

Wiese, E.

1998-01-01

Most of the dismantling techniques used in a Decontamination and Dismantlement (D and D) project are taken from conventional demolition practices. Some modifications to the techniques are made to limit exposure to the workers or to lessen the spread of contamination to the work area. When working on a D and D project, it is best to keep the dismantling techniques and tools as simple as possible. The workers will be more efficient and safer using techniques that are familiar to them. Prior experience with the technique or use of mock-ups is the best way to keep workers safe and to keep the project on schedule

Pathological lesions in the central nervous system and peripheral tissues of ddY mice with street rabies virus (1088 strain).

Science.gov (United States)

Kimitsuki, Kazunori; Yamada, Kentaro; Shiwa, Nozomi; Inoue, Satoshi; Nishizono, Akira; Park, Chun-Ho

2017-06-10

Most studies on rabies virus pathogenesis in animal models have employed fixed rabies viruses, and the results of those employing street rabies viruses have been inconsistent. Therefore, to clarify the pathogenesis of street rabies virus (1088 strain) in mice, 10 6 focus forming units were inoculated into the right hindlimb of ddY mice (6 weeks, female). At 3 days postinoculation (DPI), mild inflammation was observed in the hindlimb muscle. At 5 DPI, ganglion cells in the right lumbosacral spinal dorsal root ganglia showed chromatolysis. Axonal degeneration and inflammatory cells increased with infection progress in the spinal dorsal horn and dorsal root ganglia. Right hindlimb paralysis was observed from 7 DPI, which progressed to quadriparalysis. However, no pathological changes were observed in the ventral horn and root fibers of the spinal cord. Viral antigen was first detected in the right hindlimb muscle at 3 DPI, followed by the right lumbosacral dorsal root ganglia, dorsal horn of spinal cord, left red nuclei, medulla oblongata and cerebral cortex (M1 area) at 5 DPI. These results suggested that the 1088 virus ascended the lumbosacral spinal cord via mainly afferent fibers at early stage of infection and moved to cerebral cortex (M1 area) using descending spinal tract. Additionally, we concluded that significant pathological changes in mice infected with 1088 strain occur in the sensory tract of the spinal cord; this selective susceptibility results in clinical features of the disease.

Comparisons Of The Effects Of Medetomidine, Lidocaine And Their ...

African Journals Online (AJOL)

... with a one-week interval between subsequent injections. Lumbosacral epidural injection of medetomidine and medetomidine-lidocaine combinations induced behavioral changes characterized by ataxia, swaying movements, tail flaccidity, low head carriage, sternal and lateral recumbency posture coupled with salivation.

Comparison of parameters of spinal curves in the sagittal plane measured by photogrammetry and inclinometry.

Science.gov (United States)

Walicka-Cupryś, Katarzyna; Drzał-Grabiec, Justyna; Mrozkowiak, Mirosław

2013-10-31

BACKGROUND. The photogrammetric method and inclinometer-based measurements are commonly employed to assess the anteroposterior curvatures of the spine. These methods are used both in clinical trials and for screening purposes. The aim of the study was to compare the parameters used to characterise the anteroposterior spinal curvatures as measured by photogrammetry and inclinometry. MATERIAL AND METHODS. The study enrolled 341 subjects: 169 girls and 172 boys, aged 4 to 9 years, from kindergartens and primary schools in Rzeszów. The anteroposterior spinal curvatures were examined by photogrammetry and with a mechanical inclinometer. RESULTS. There were significant differences in the α angle between the inclinometric and photogrammetric assessment in the Student t test (p=0.017) and the Fisher Snedecor test (p=0.0001), with similar differences in the β angle (Student's t p=0.0001, Fisher Snedecor p=0.007). For the γ angle, significant differences were revealed with Student's t test (p=0.0001), but not with the Fisher Snedecor test (p = 0.22). CONCLUSIONS. 1. Measurements of inclination of particular segments of the spine obtained with the photogrammetric method and the inclinometric method in the same study group revealed statistically significant differences. 2. The results of measurements obtained by photogrammetry and inclinometry are not comparable. 3. Further research on agreement between measurements of the anteroposterior spinal curvatures obtained using the available measurement equipment is recommended.

Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

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Ana Paula Diniz Fortuna Poli

2016-02-01

Full Text Available Abstract Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation ( p = 0.037. A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction ( p = 0.045. Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

Scintigraphy In skeletal trauma

African Journals Online (AJOL)

1989-08-05

Aug 5, 1989 ... of unsuspected fractures in a patient with multiple injuries. S Atr MedJ 1989; 76: ... of left lumbosacral pain, bone scintigraphy was performed a. Department of ... Moreover, the scan demonstrated seven rib. • •. SAMJ VOL.

Gender determination from diagnostic factors on anteroposterior pelvic radiographs

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Azadeh Memarian

2017-03-01

Conclusion: The results of this study revealed that the evaluation of the radiographic images of pelvic bones by assessing the mentioned factors can be useful for sex determination from skeletal remains. However, ethical considerations should also be taken into account while using these factors.

Comparison of Natural Head Position in Different Anteroposterior Malocclusions

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Zohreh Hedayati

2013-01-01

Full Text Available Objective: The facial esthetics after orthodontic treatment and orthognathic surgery may be affected by the patient’s natural head position. The purpose of this study was to evaluate the natural head position for the three skeletal classes of malocclusion.Materials and Methods: Our sample consisted of 102 lateral cephalometric radiographs of patients aged 15 to 18 years; class I (n=32, class II (n=40 and class III (n=30. Nine landmarks of the craniofacial skeleton and three landmarks of the cervical vertebrae were determined. Variables consisted of two angles for cervical posture (OPT/Hor and CVT/Hor, three angles for craniofacial posture (SN/Ver, PNS-ANS/Ver, and ML/Ver and five for craniofacial angulation (SN/OPT, SN/CVT, PNS-ANS/OPT, PNS-ANS/CVT, ML/CVT. The data were analyzed statistically using ANOVA and post hoc tests.Results: PNS-ANS/Ver and SN/Ver differed significantly (p<0.05 among the three groups. There were no significant differences between class I and class II malocclusions for the indicator angles of cranial posture except for ML/Ver. The SN/CVT was significantly different for class I compared to class III patients. A head posture camouflaging the underlying skeletal class III was observed in our population.Conclusion: A more forward head posture was observed in skeletal class III participants compared to skeletal class I and II and that class III patients tended to incline their head more ventral compared to class I participants. These findings may have implications for the amount of jaw movements during surgery particularly in patients with a class III malocclusion

Hoxb1 controls anteroposterior identity of vestibular projection neurons.

Science.gov (United States)

Chen, Yiju; Takano-Maruyama, Masumi; Fritzsch, Bernd; Gaufo, Gary O

2012-01-01

The vestibular nuclear complex (VNC) consists of a collection of sensory relay nuclei that integrates and relays information essential for coordination of eye movements, balance, and posture. Spanning the majority of the hindbrain alar plate, the rhombomere (r) origin and projection pattern of the VNC have been characterized in descriptive works using neuroanatomical tracing. However, neither the molecular identity nor developmental regulation of individual nucleus of the VNC has been determined. To begin to address this issue, we found that Hoxb1 is required for the anterior-posterior (AP) identity of precursors that contribute to the lateral vestibular nucleus (LVN). Using a gene-targeted Hoxb1-GFP reporter in the mouse, we show that the LVN precursors originate exclusively from r4 and project to the spinal cord in the stereotypic pattern of the lateral vestibulospinal tract that provides input into spinal motoneurons driving extensor muscles of the limb. The r4-derived LVN precursors express the transcription factors Phox2a and Lbx1, and the glutamatergic marker Vglut2, which together defines them as dB2 neurons. Loss of Hoxb1 function does not alter the glutamatergic phenotype of dB2 neurons, but alters their stereotyped spinal cord projection. Moreover, at the expense of Phox2a, the glutamatergic determinants Lmx1b and Tlx3 were ectopically expressed by dB2 neurons. Our study suggests that the Hox genes determine the AP identity and diversity of vestibular precursors, including their output target, by coordinating the expression of neurotransmitter determinant and target selection properties along the AP axis.

Hoxb1 controls anteroposterior identity of vestibular projection neurons.

Directory of Open Access Journals (Sweden)

Yiju Chen

Full Text Available The vestibular nuclear complex (VNC consists of a collection of sensory relay nuclei that integrates and relays information essential for coordination of eye movements, balance, and posture. Spanning the majority of the hindbrain alar plate, the rhombomere (r origin and projection pattern of the VNC have been characterized in descriptive works using neuroanatomical tracing. However, neither the molecular identity nor developmental regulation of individual nucleus of the VNC has been determined. To begin to address this issue, we found that Hoxb1 is required for the anterior-posterior (AP identity of precursors that contribute to the lateral vestibular nucleus (LVN. Using a gene-targeted Hoxb1-GFP reporter in the mouse, we show that the LVN precursors originate exclusively from r4 and project to the spinal cord in the stereotypic pattern of the lateral vestibulospinal tract that provides input into spinal motoneurons driving extensor muscles of the limb. The r4-derived LVN precursors express the transcription factors Phox2a and Lbx1, and the glutamatergic marker Vglut2, which together defines them as dB2 neurons. Loss of Hoxb1 function does not alter the glutamatergic phenotype of dB2 neurons, but alters their stereotyped spinal cord projection. Moreover, at the expense of Phox2a, the glutamatergic determinants Lmx1b and Tlx3 were ectopically expressed by dB2 neurons. Our study suggests that the Hox genes determine the AP identity and diversity of vestibular precursors, including their output target, by coordinating the expression of neurotransmitter determinant and target selection properties along the AP axis.

Comparison between conventional tomography and computer tomography in diseases of the sacroiliac joints

International Nuclear Information System (INIS)

Moritz, J.D.; Ganter, H.; Winter, C.; Evangelisches Krankenhaus, Giessen

1990-01-01

16 patients with diseases of the sacroiliac joints were examined both with computer tomography and with conventional tomography. Both techniques were characterized by a high sensitivity. Computer tomography was superior in exactly delineating the extent of the pathologic changes. In conventional tomography the joint surface was more blurred, erosions were larger, and signs of ankylosis were more expanded, so that the joints seemed to be more altered in 8 cases than demonstrated by computer tomography. Very accurate changes like subchondral cysts were recognized only in the computer tomograms. In all cases in which anteroposterior radiographs revealed no clear result, the authors recommend to additionally employ computer tomography. (orig.) [de

Lumbosacral lipoma : gadolinium-enhanced fat saturation T1 weighted MR image is necessary?

International Nuclear Information System (INIS)

Yoon, Man Won; Kim, Hyun Chul; Chung, Tae Woong; Seo, Jeong Jin; Chung, Gwang Woo; Kim, Yun Hyeon; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun

1999-01-01

To evaluate the usefulness of contrast-enhanced fat saturation T1-weighted imaging for the evaluation of spinal lipoma, compared with clinical symptoms and surgical findings. Ten patients with lipomyelomeningocele, confirmed by surgery, were included in this study. In all cases, conventional spin echo T1-and T2-weighted MR imaging, and contrast-enhanced fat saturation T1-weighted imaging was performed to evaluate clinical symptoms, the position of the conus medullaris, the presence of cord tethering, and associated anomalies, and to compare the relative usefulness of the techniques. All ten patients were suffering from lipomyelomeningocele without filum terminale fibrolipoma or intradural lipoma. All cases were associated with cord tethering. As associated anomalies, there were seven cases of syringomyelia without hydrocephalus or anorectal anomaly. To evaluate the position of the spinal conus and the presence of cord tethering, conventional T1-weighted imaging was more useful than the contrast-enhanced fat saturation equivalent. In patients with early-stage spinal lipoma, MRI is useful for evaluation of the causes and position of cord tethering and associated anomalies Our results suggest that contrast-enhanced fat saturation T1-weighted images do not provide additional information concerning spinal lipoma, and that for the diagnosis of this condition, conventional T1 and T2-weighted images are more useful than those obtained by contrast-enhanced fat saturation T1-weighted imaging

The sacroiliac part of the iliolumbar ligament

NARCIS (Netherlands)

A.L. Pool-Goudzwaard (Annelies); G.J. Kleinrensink (Gert Jan); C.J. Snijders (Chris); C.A. Entius; R. Stoeckart (Rob)

2001-01-01

textabstractThe iliolumbar ligament has been described as the most important ligament for restraining movement at the lumbosacral junction. In addition, it may play an important role in restraining movement in the sacroiliac joints. To help understand its presumed restraining

Neuroradiology of the spinal canal

International Nuclear Information System (INIS)

Lehmann, R.; Molsen, H.P.

1985-01-01

Radiodiagnostics of the vertebral column and of the spinal cord under normal conditions and under different pathological alterations are elaborated. Especially cervical and thoracal myelography, lumbosacral myeloradiculography, spinal arteriography and phlebography as well as spinal computerized tomography are discussed in detail

Myocardium scanning with 201TL-chloride in ischemic heart disease

International Nuclear Information System (INIS)

Shejretova, E.; Beloev, J.; Kaloyanova, A.; Trindev, P.

1979-01-01

Results of myocardial scanning with 210 TL-chloride in ischemic herart disease are repoorted. An avearge dose of 500 microcurie and antero-posterior or lateral projection scanning with coloured registration are recommended. The scintigraphic pattern of the normal myocardium and the pathological changes, manifested by reduced isotope fixation, depending on the severity of the damage, are described. The diffuse pathological changes in the myocardium in ischemic heart disease are manifested by diffuse hypofixation of the radionuclide. The focal lesions in ischemic heart disease were manifested by characteristic changes: the infarctions of the posterior wall show a relatively clear scanographic picture on antero-posterior projection, with cold or cool zones in the median sections of the myocardium picture. Infarctions of the anterior myocardial wall, depending on how sizable they are, on antero-posterior projection are seen to occupy the lateral and central parts of the heart muscle. In the left oblique projection the pathologic process is projected frontally and centrally. (A.B.)

Methods on simple radiogaphy of impingement syndrome in shoulder joint

International Nuclear Information System (INIS)

Kweon, Dae Cheol; Kim, Moon Sun; Kim, Yong Seob; Chung, Kyung Mo

2000-01-01

To evaluation of patients who have shoulder impingement syndrome is by diagnostic radiography. Shoulder impingement is a problem which occurs in young, active individuals as well as older individuals. In fact, the pain is probably caused by repetitive stress placed on the shoulder joint either through recreational activities of your occupation. Impingement series approach to radiographic examination of the shoulder is take five projections. First anteroposterior oblique projection. Second standard anteroposterior projection. Third superoinferior axial projection. Fourth supraspinatus outlet projection offers a view of the outlet of the supraspinatus tendon unit as it passes under the coraacromial arch. Fifth anteroposterior 30 deg caudal projection will adequately demonstrate the anterior acromial spur or ossification in the coraacromial ligament and more reliable to demonstrate spurring of the anterior acromion than supraspinatus outlet projection. This decreased the need for additional radiographic veiws, reduces the patient's exposure to x-ray radiation and decreases use of film. This can lower the cost of the evaluation and improve patient satisfaction.=20

Methods on simple radiogaphy of impingement syndrome in shoulder joint

Energy Technology Data Exchange (ETDEWEB)

Kweon, Dae Cheol; Kim, Moon Sun; Kim, Yong Seob; Chung, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

2000-06-01

To evaluation of patients who have shoulder impingement syndrome is by diagnostic radiography. Shoulder impingement is a problem which occurs in young, active individuals as well as older individuals. In fact, the pain is probably caused by repetitive stress placed on the shoulder joint either through recreational activities of your occupation. Impingement series approach to radiographic examination of the shoulder is take five projections. First anteroposterior oblique projection. Second standard anteroposterior projection. Third superoinferior axial projection. Fourth supraspinatus outlet projection offers a view of the outlet of the supraspinatus tendon unit as it passes under the coraacromial arch. Fifth anteroposterior 30 deg caudal projection will adequately demonstrate the anterior acromial spur or ossification in the coraacromial ligament and more reliable to demonstrate spurring of the anterior acromion than supraspinatus outlet projection. This decreased the need for additional radiographic veiws, reduces the patient's exposure to x-ray radiation and decreases use of film. This can lower the cost of the evaluation and improve patient satisfaction.=20.

The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures.

Science.gov (United States)

Forman, Jordanna M; Urruela, Adriana M; Egol, Kenneth A

2011-12-01

The purpose of this retrospective chart and radiographic review is to describe an effective reduction technique during intramedullary nailing of distal metaphyseal tibia fractures with the use of a pointed percutaneous clamp. Between 2007 and 2010, 100 patients who sustained 102 tibia fractures were definitively treated with an intramedullary nail at one of two medical centers. Diaphyseal fractures and injuries with an associated disruption of the distal tibiofibular joint were excluded from our study. A total of 27 patients with 27 distal metaphyseal tibia fractures (OTA types 42-A, 43-A, and 43-B) were included. All 27 patients underwent IM nailing of their fractures with anatomic reduction achieved using a percutaneously placed pointed reduction clamp prior to insertion of the IM implant. Fracture alignment and angular deformity was assessed using goniometric measurement functions on the PACS system (GE, Waukeshau, WI) obtained from preoperative and postoperative anteroposterior and lateral images for all subjects. Malalignment was defined as more than 5 degrees of angulation in any plane. Fourteen of the fractures were classified as OTA 42-A, 9 were OTA 43-A, and 4 were OTA 43-B. Analysis of post-closed reduction, preoperative anteroposterior radiographs revealed a mean of 7.9 degrees of coronal plane (range: 0.9 degrees-26 degrees) angulation. Post closed reduction preoperative lateral radiographs revealed a mean of 6.8 degrees sagittal plane (range: 0 degrees-24.6 degrees) angulation. Postoperative anteroposterior and lateral radiographs showed the distal segment returned to its anatomical alignment with a mean angulation of 0.5 degrees (range, 0 degrees-3.5 degrees) and 0.7 degrees (range, 0 degrees-4.2 degrees) of varus/ valgus and apex anterior/posterior angulation, respectively. These results showed an acceptable postopertative alignment in all 27 distal third fractures. No intra-operative or postoperative complications were noted in the study group. This

Probabilistic somatotopy of the spinothalamic pathway at the ventroposterolateral nucleus of the thalamus in the human brain.

Science.gov (United States)

Hong, J H; Kwon, H G; Jang, S H

2011-08-01

The STP has been regarded as the most plausible neural tract responsible for pathogenesis of central poststroke pain. The VPL nucleus has been a target for neurosurgical procedures for control of central poststroke pain. However, to our knowledge, no DTI studies have been conducted to investigate the somatotopic location of the STP at the VPL nucleus of the thalamus. In the current study, we attempted to investigate this location in the human brain by using a probabilistic tractography technique of DTI. DTI was performed at 1.5T by using a Synergy-L SENSE head coil. STPs for both the hand and leg were obtained by selection of fibers passing through 2 regions of interest (the area of the spinothalamic tract in the posterolateral medulla and the postcentral gyrus) for 41 healthy volunteers. Somatotopic mapping was obtained from the highest probabilistic location at the ACPC level. The highest probabilistic locations for the hand and leg were an average of 16.86 and 16.37 mm lateral to the ACPC line and 7.53 and 8.71 mm posterior to the midpoint of the ACPC line, respectively. Somatotopic locations for the hand and leg were different in the anteroposterior direction (P .05). We found the somatotopic locations for hand and leg of the STP at the VPL nucleus; these somatotopies were arranged in the anteroposterior direction.

Normal Corpus Callosum Dimensions Measured by MRI

International Nuclear Information System (INIS)

Kim, Ham Gyum

2008-01-01

As a result of measuring the size of corpus callosum in normal Korean people by using MRI, the following conclusions were obtained. 1. Maximum, minimum, and mean values by the region in whole subjects 1) Anteroposterior length amounted to the mean with 69.30 mm, the minimum with 50.70 mm, and the maximum with 80.40 mm. 2) Diameter of genu amounted to the mean with 11.93 mm, the minimum with 6.00 mm, and the maximum with 18.50 mm. 3) Diameter of mid body amounted to the mean with 7.00 mm, the minimum with 3.40 mm, and the maximum with 10.40 mm. 4) Diameter of narrowing portion amounted to the mean with 4.51 mm, the minimum with 0.80 mm, and the maximum with 9.50 mm. 5) Diameter of splenium amounted to the mean with 12.17 mm, the minimum with 6.90 mm, and the maximum with 17.20 mm. 2. Comparison by region according to the gender in the whole subjects 1) Anteroposterior length was bigger in men than in women, and showed the significant difference depending on gender. 2) Diameter of genu, diameter of mid body, and diameter of narrowing portion were bigger in men than in women, but there was no significant difference. 3) Diameter of splenium was bigger in men than in women, and showed the statistically significant difference. 3. Comparison by region according to the age in the whole subjects 1) Anteroposterior length was the biggest in the 50s at the age, and was smaller in heir 10s than other age levels. In addition, the significant difference was indicated depending on age. 2) Diameter of genu and diameter of mid body were the biggest in their 30s, and were smaller in the 60s than other age levels. And, the statistically significant difference was indicated. 3) Diameter of narrowing portion was the thickest in their 20s, and was thinner in their 60s than other age levels. And, the significant difference was indicated depending on age. 4) Diameter of splenium was the thickest in their 30s, and was thinner in their 10s than other age levels. And, the statistically

Maximum Acceptable Weight of Lift reflects peak lumbosacral extension moments in a Functional Capacity Evaluation test using free style, stoop, and squat lifting

NARCIS (Netherlands)

Kuijer, P.P.F.M.; van Oostrom, S.H.; Duijzer, K.; van Dieen, J.H.

2012-01-01

It is unclear whether the maximum acceptable weight of lift (MAWL), a common psychophysical method, reflects joint kinetics when different lifting techniques are employed. In a within-participants study (n = 12), participants performed three lifting techniques - free style, stoop and squat lifting

Maximum acceptable weight of lift reflects peak lumbosacral extension moments in a functional capacity evaluation test using free style, stoop and squat lifting

NARCIS (Netherlands)

Kuijer, P. P. F. M.; van Oostrom, S. H.; Duijzer, K.; van Dieën, J. H.

2012-01-01

It is unclear whether the maximum acceptable weight of lift (MAWL), a common psychophysical method, reflects joint kinetics when different lifting techniques are employed. In a within-participants study (n = 12), participants performed three lifting techniques - free style, stoop and squat lifting

Surface science techniques

CERN Document Server

Bracco, Gianangelo

2013-01-01

The book describes the experimental techniques employed to study surfaces and interfaces. The emphasis is on the experimental method. Therefore all chapters start with an introduction of the scientific problem, the theory necessary to understand how the technique works and how to understand the results. Descriptions of real experimental setups, experimental results at different systems are given to show both the strength and the limits of the technique. In a final part the new developments and possible extensions of the techniques are presented. The included techniques provide microscopic as well as macroscopic information. They cover most of the techniques used in surface science.

Bilateral herpes zoster

OpenAIRE

Singh K; Bajaj A; Dwivedi N; Merchery A

1993-01-01

A case of bilateral herpes zoster of lumbosacral region is reported in association with diabetes mellitus in a 55 years old female. The case is of interest due to bilateral distribution which is rare and sacral region involvement which is quite uncommon.

Urinary tract infection in patients with spinal cord injury in Bushehr Province

Directory of Open Access Journals (Sweden)

Hooman Salimipour

2005-02-01

Full Text Available Urinary tract infection (UTI is a common problem in patients with spinal cord injury (SCI. UTI is an important cause of morbidity and mortality among these patients. In a cross-sectional study, 957 cases with SCI were evaluated for UTI. The mean of age of the subjects (35 females & 62 males was 26.74 years and the mean duration of SCI was 8.5 years. The prevalence of UTI was 63.9 percent. The most frequent isolated bacteria was E. coli (71.7% and had susceptibility to ceftizoxime and a high level of resistance to nitrofurantoin. The most common locus of SCI was in lumbosacral area (70.1%. The lumbosacral area was the most prevalent lesion in patients with SCI and UTI. In conclusion, there is a high prevalence of UTI in patients with SCI, therefore intermittent catheterization and the other strategies including using local disinfectants are recommended.

Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

Energy Technology Data Exchange (ETDEWEB)

Poli, Ana Paula Diniz Fortuna, E-mail: anapaulafortuna@yahoo.com.br [Universidade Estadual de Campinas (CAISM/UNICAMP), Campinas, SP (Brazil). Centro de Atencao Integrada a Saude da Mulher. Divisao de Radioterapia; Dias, Rodrigo Souza; Giordani, Adelmo Jose; Segreto, Helena Regina Comodo; Segreto, Roberto Araujo [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Divisao de Radioterapia

2016-01-15

Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation (p = 0.037). A baseline rectal volume superior to 70 cm{sup 3} had a significant influence on the prostate motion in the anteroposterior direction (p = 0.045). Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm{sup 3}. Therefore, the treatment of patients with a rectal volume > 70 cm{sup 3} should be re-planned with appropriate rectal preparation. Keywords: Rectal volume; Prostate cancer; Three-dimensional conformal radiotherapy. (author)

Computed tomographic method for measurement of inclination angles and motion of the sacroiliac joints in German Shepherd Dogs and Greyhounds.

Science.gov (United States)

Saunders, Fritha C; Cave, Nick J; Hartman, Karl M; Gee, Erica K; Worth, Andrew J; Bridges, Janis P; Hartman, Angela C

2013-09-01

To develop an in vivo CT method to measure inclination angles and motion of the sacroiliac joints in dogs of performance breeds. 10 German Shepherd Dogs and 12 Greyhounds without signs of lumbosacral region pain or neurologic problems. CT of the ilium and sacrum was performed in flexed, neutral, and extended hind limb positions. Lines were drawn on volume-rendered images acquired in the flexed and extended positions to measure motion of the ilia relative to the sacra. Inclination angles of the synovial and ligamentous components of the sacroiliac joints were measured on transverse-plane CT images acquired at cranial and caudal locations. Coefficients of variance of measurements were calculated to determine intraobserver variability. Coefficients of variance of measurements ranged from 0.17% to 2.45%. A significantly higher amount of sacroiliac joint rotational motion was detected for German Shepherd Dogs versus Greyhounds. The cranial synovial joint component had a significantly more sagittal orientation in German Shepherd Dogs versus Greyhounds. No significant differences were detected between breeds for x- or y-axis translational motion or caudal synovial or ligamentous joint component inclination angles. The small amounts of sacroiliac joint motion detected in this study may buffer high-frequency vibrations during movement of dogs. Differences detected between breeds may be associated with the predisposition of German Shepherd Dogs to develop lumbosacral region signs of pain, although the biological importance of this finding was not determined. Future studies are warranted to compare sacroiliac joint variables between German Shepherd Dogs with and without lumbosacral region signs of pain.

The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

Science.gov (United States)

Blizzard, Daniel J; Sheets, Charles Z; Seyler, Thorsten M; Penrose, Colin T; Klement, Mitchell R; Gallizzi, Michael A; Brown, Christopher R

2017-05-01

Concomitant spine and hip disease in patients undergoing total hip arthroplasty (THA) presents a management challenge. Degenerative lumbar spine conditions are known to decrease lumbar lordosis and limit lumbar flexion and extension, leading to altered pelvic mechanics and increased demand for hip motion. In this study, the effect of lumbar spine disease on complications after primary THA was assessed. The Medicare database was searched from 2005 to 2012 using International Classification of Diseases, Ninth Revision, procedure codes for primary THA and diagnosis codes for preoperative diagnoses of lumbosacral spondylosis, lumbar disk herniation, acquired spondylolisthesis, and degenerative disk disease. The control group consisted of all patients without a lumbar spine diagnosis who underwent THA. The risk ratios for prosthetic hip dislocation, revision THA, periprosthetic fracture, and infection were significantly higher for all 4 lumbar diseases at all time points relative to controls. The average complication risk ratios at 90 days were 1.59 for lumbosacral spondylosis, 1.62 for disk herniation, 1.65 for spondylolisthesis, and 1.53 for degenerative disk disease. The average complication risk ratios at 2 years were 1.66 for lumbosacral spondylosis, 1.73 for disk herniation, 1.65 for spondylolisthesis, and 1.59 for degenerative disk disease. Prosthetic hip dislocation was the most common complication at 2 years in all 4 spinal disease cohorts, with risk ratios ranging from 1.76 to 2.00. This study shows a significant increase in the risk of complications following THA in patients with lumbar spine disease. [Orthopedics. 2017; 40(3):e520-e525.]. Copyright 2017, SLACK Incorporated.

Decomposition techniques

Science.gov (United States)

Chao, T.T.; Sanzolone, R.F.

1992-01-01

Sample decomposition is a fundamental and integral step in the procedure of geochemical analysis. It is often the limiting factor to sample throughput, especially with the recent application of the fast and modern multi-element measurement instrumentation. The complexity of geological materials makes it necessary to choose the sample decomposition technique that is compatible with the specific objective of the analysis. When selecting a decomposition technique, consideration should be given to the chemical and mineralogical characteristics of the sample, elements to be determined, precision and accuracy requirements, sample throughput, technical capability of personnel, and time constraints. This paper addresses these concerns and discusses the attributes and limitations of many techniques of sample decomposition along with examples of their application to geochemical analysis. The chemical properties of reagents as to their function as decomposition agents are also reviewed. The section on acid dissolution techniques addresses the various inorganic acids that are used individually or in combination in both open and closed systems. Fluxes used in sample fusion are discussed. The promising microwave-oven technology and the emerging field of automation are also examined. A section on applications highlights the use of decomposition techniques for the determination of Au, platinum group elements (PGEs), Hg, U, hydride-forming elements, rare earth elements (REEs), and multi-elements in geological materials. Partial dissolution techniques used for geochemical exploration which have been treated in detail elsewhere are not discussed here; nor are fire-assaying for noble metals and decomposition techniques for X-ray fluorescence or nuclear methods be discussed. ?? 1992.

Application of an artificial neural network and morphing techniques in the redesign of dysplastic trochlea.

Science.gov (United States)

Cho, Kyung Jin; Müller, Jacobus H; Erasmus, Pieter J; DeJour, David; Scheffer, Cornie

2014-01-01

Segmentation and computer assisted design tools have the potential to test the validity of simulated surgical procedures, e.g., trochleoplasty. A repeatable measurement method for three dimensional femur models that enables quantification of knee parameters of the distal femur is presented. Fifteen healthy knees are analysed using the method to provide a training set for an artificial neural network. The aim is to use this artificial neural network for the prediction of parameter values that describe the shape of a normal trochlear groove geometry. This is achieved by feeding the artificial neural network with the unaffected parameters of a dysplastic knee. Four dysplastic knees (Type A through D) are virtually redesigned by way of morphing the groove geometries based on the suggested shape from the artificial neural network. Each of the four resulting shapes is analysed and compared to its initial dysplastic shape in terms of three anteroposterior dimensions: lateral, central and medial. For the four knees the trochlear depth is increased, the ventral trochlear prominence reduced and the sulcus angle corrected to within published normal ranges. The results show a lateral facet elevation inadequate, with a sulcus deepening or a depression trochleoplasty more beneficial to correct trochlear dysplasia.

Comparison of two ultrasound-guided injection techniques targeting the sacroiliac joint region in equine cadavers.

Science.gov (United States)

Stack, John David; Bergamino, Chiara; Sanders, Ruth; Fogarty, Ursula; Puggioni, Antonella; Kearney, Clodagh; David, Florent

2016-09-20

To compare the accuracy and distribution of injectate for cranial (CR) and caudomedial (CM) ultrasound-guided injections of equine sacroiliac joints. Both sacroiliac joints from 10 lumbosacropelvic specimens were injected using cranial parasagittal (CR; curved 18 gauge, 25 cm spinal needles) and caudomedial (CM; straight 18 gauge, 15 cm spinal needles) ultrasound-guided approaches. Injectate consisted of 4 ml iodinated contrast and 2 ml methylene blue. Computed tomographical (CT) scans were performed before and after injections. Time for needle guidance and repositioning attempts were recorded. The CT sequences were analysed for accuracy and distribution of contrast. Intra-articular contrast was detected in sacroiliac joints following 15/40 injections. The CR and CM approaches deposited injectate ≤2 cm from sacroiliac joint margins following 17/20 and 20/20 injections, respectively. Median distance of closest contrast to the sacroiliac joint was 0.4 cm (interquartile range [IQR]: 1.5 cm) for CR approaches and 0.6 cm (IQR: 0.95 cm) for CM approaches. Cranial injections resulted in injectate contacting lumbosacral intertransverse joints 15/20 times. Caudomedial injections were perivascular 16/20 times. Safety and efficacy could not be established. Cranial and CM ultrasound-guided injections targeting sacroiliac joints were very accurate for periarticular injection, but accuracy was poor for intra-articular injection. Injectate was frequently found in contact with interosseous sacroiliac ligaments, as well as neurovascular and synovial structures in close vicinity of sacroiliac joints.

Translation Techniques

OpenAIRE

Marcia Pinheiro

2015-01-01

In this paper, we discuss three translation techniques: literal, cultural, and artistic. Literal translation is a well-known technique, which means that it is quite easy to find sources on the topic. Cultural and artistic translation may be new terms. Whilst cultural translation focuses on matching contexts, artistic translation focuses on matching reactions. Because literal translation matches only words, it is not hard to find situations in which we should not use this technique.  Because a...

Cirugía de la columna lumbar degenerativa

OpenAIRE

López-Sastre Núñez, Antonio; Menéndez Díaz, D.; Vaquero Morillo, F.

1998-01-01

En una realidad la gran demanda actual de fusiones de la columna lumbar. Los resultados clínicos obtenidos con la fusión posterolateral se ven claramente superados con las fusiones anteroposteriores. Se realiza una revisión bibliográfica de las diferentes formas de fusión de la columna lumbar y la reaparición del concepto de soporte de columna anterior. Se establecen las indicaciones y las ventajas de la fusión anteroposterior lumbar, describiéndose las posibles vías de abordaje posterior y a...

Evaluation of Patient Skin Effective Dose Due to Diagnostic ...

African Journals Online (AJOL)

The common procedures are the plain radiographs of the chest, skull, cervical spine, sinus, lumbosacral spine, pelvis, abdomen, shoulder and foot and hysterosalpingography (HSG), intravenous urography, barium meal and barium enema are the special or contrast procedures. 1977 procedures were monitored in some ...

Sacroiliac part of the iliolumbar ligament

NARCIS (Netherlands)

Pool-Goudzwaard, A.L.; Kleinrensink, G.J.; Snijders, C.; Stoeckart, R.

1999-01-01

The iliolumbar ligament has been described as the most important ligament for restraining movement at the lumbosacral junction. In addition, it may play an important role in restraining movement in the sacroiliac joints. To help understand its presumed restraining effect, the anatomy of the ligament

Bilateral herpes zoster

Directory of Open Access Journals (Sweden)

Singh K

1993-01-01

Full Text Available A case of bilateral herpes zoster of lumbosacral region is reported in association with diabetes mellitus in a 55 years old female. The case is of interest due to bilateral distribution which is rare and sacral region involvement which is quite uncommon.

Effects of ageing on adaptation during vibratory stimulation of the calf and neck muscles.

Science.gov (United States)

Patel, M; Fransson, P A; Magnusson, M

2009-01-01

The ability to adapt and habituate based on prior experiences is important for human movement control, fall prevention and for the ability to enhance performance during various human activities. However, little is known about the ability for the elderly to adapt to balance perturbations in the lateral direction. To determine whether adaptation, i.e., the ability to adjust postural control to handle balance perturbations better over time, differed in the elderly subjects compared with young subjects in the anteroposterior and lateral directions, and whether the site of the balance perturbation or the presence or absence of vision affected the response. Postural stability was measured as anteroposterior and lateral torque variance in a young group (n = 18 (9 female and 9 male), average age = 29.1 years) and an elderly group (n = 16 (5 female and 11 male), average age = 71.5 years) with eyes open and closed during balance perturbations from calf and neck vibrations. After a 30-s period of quiet stance, these vibrations were repeated over a period of 200 s, so the adaptive responses could be analyzed by splitting the data into 50-s periods. The adaptive responses in the anteroposterior and lateral directions were different. Adaptation in the anteroposterior direction occurred to an almost equal extent in the elderly and young, whereas adaptation in the lateral direction was markedly larger in the elderly in all tests except for neck vibration with eyes closed. Age, vision and vibration site were all influential factors for recorded body movements, but no significant combined effects were found. Balance perturbation instigates an adaptive response in the elderly in both the anteroposterior and lateral directions. However, during perturbation, age and vision are both very influential factors for the stability, thus associating the previously documented age-related decline in visual functioning with a higher risk of falls in this age range. (c) 2008 S. Karger AG, Basel.

[Ultrasound measurement of fetal posterior fossa at 11 to 13⁺⁶ gestational weeks for screening open spina bifida].

Science.gov (United States)

Qin, Feng-Zhen; Li, Sheng-Li; Wen, Hua-Xuan; Ouyang, Yu-Rong; Zheng, Qiong; Bi, Jing-Ru

2014-06-01

To establish the normal reference ranges of transabdominal ultrasound measurements of the posterior fossa structure in fetuses at 11 to 13⁺⁶ gestational weeks and explore their clinical value in screening open spina bifida (OSB). Between January, 2013 and September, 541 randomly selected normal fetuses underwent nuchal translucency at the gestational age 11 to 13⁺⁶ weeks. The parameters of the posterior fossa were measured in mid-sagittal view of the fetal face and the axial view of the transverse cerebellum insonated through the anterior fontanel by transabdominal ultrasound to establish the normal reference ranges. The measurements were obtained from 3 fetuses with OSB for comparison with the reference ranges. In normal fetuses, the parameters of the posterior fossa measured in the two views showed no significant differences (P>0.05). Two high echogenic lines were observed in normal fetuses, as compared with one in fetuses with OSB representing the posterior border of the brain stem and the anterior border of the fourth ventricle. The line between the posterior border of the fourth ventricle and the anterior border of the cisterna magna was not displayed in fetuses with OSB. The anteroposterior diameters of the brain stem, the fourth ventricle, and cisterna magna all increased in positive correlation with the crown-lump length in normal fetuses. In the 3 OSB fetuses, the anteroposterior diameter of the brain stem exceeded the 95th percentile and the anteroposterior diameter of fourth ventrical-cisterner magena was below the 5th percentile of the reference range for CRL; the brain stem to fourth ventrical-cisterner magena anteroposterior diameter ratio was increased to above 1. The established normal reference ranges of the parameters of fetal posterior fossa may provide assistance in early OSB detection. The absence of the posterior border of the fourth ventricle and the anterior border of the cisterna magna and a brainstem to fourth ventrical

Aplicação da técnica de emissão em tempo máximo de fonação em paciente com disfonia espasmódica adutora: relato de caso Applying the technique of sustained maximum phonation time in a female patient with adductor spasmodic dysphonia: case report

Directory of Open Access Journals (Sweden)

Luiz Alberto Alves Mota

2012-01-01

and strained-strangled voice. The aim of this study was to describe the vocal, acoustic and laryngeal parameters measured for a female patient with ADS pre and post speech therapy using the Technique of Sustained Maximum Phonation Time (SMPT. This technique aims to promote increase in glottal resistance, improve phonatory stability, and enhance glottal coaptation. A 66-year-old female patient with ASD took part in this study. She was submitted to otorhinolaryngologic and speech-language assessment before and after the application of the SMPT technique. The results showed modification of vocal, acoustic and laryngeal parameters, such as re-classifying her dysphonia from G3R1B1A0S3I3 to G2R1B1A0S2I2, her pitch from severe to adequate, her spectrographic trace from unstable to more stable, and an expressive increase in mean fundamental frequency and mean vocal intensity, besides improvement of her glottal efficiency, with closure of the anteroposterior glottal opening. Speech therapy using the SMPT technique was considered a suitable treatment option for this case, given the good results obtained, especially the improvements in vocal quality and phonatory stability. The importance of further studies with the aim to provide greater scientific evidence for the effectiveness of the technique when treating ASD is emphasized.

Specific radiography technique

International Nuclear Information System (INIS)

Abdul Nassir Ibrahim; Azali Muhammad; Ab. Razak Hamzah; Abd. Aziz Mohamed; Mohamad Pauzi Ismail

2008-01-01

Beside radiography testing using x-ray machine and gamma source, there are several technique that developed specifically to complete the testing that cannot be done with the two earlier. This technique was specific based on several factor, for the example, the advantages of neutron and electron using to show the image was unique compare to x-ray and gamma. Besides that, these special radiography techniques maybe differ in how to detect the radiation get through the object. These technique can used to inspect thin or specimen that contained radioactive material. There are several technique will discussed in this chapter such as neutron radiography, electron radiography, fluoroscopy and also autoradiography.

Axonal sprouting of a brainstem-spinal pathway after estrogen administration in the adult female rhesus monkey

NARCIS (Netherlands)

Vanderhorst, VGJM; Terasawa, E; Ralston, HJ

2002-01-01

The nucleus retroambiguus (NRA) is located in the caudal medulla oblongata and contains premotor neurons that project to motoneuronal cell groups in the brainstem and spinal cord. NRA projections to the lumbosacral cord are species specific and might be involved in mating behavior. In the female

Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation.

Science.gov (United States)

Kraus, Natascha; Haas, Norbert P; Scheibel, Markus; Gerhardt, Christian

2013-10-01

The arthroscopically assisted Double-TightRope technique has recently been reported to yield good to excellent clinical results in the treatment of acute, high-grade acromioclavicular dislocation. However, the orientation of the transclavicular-transcoracoidal drill holes remains a matter of debate. A V-shaped drill hole orientation leads to better clinical and radiologic results and provides a higher vertical and horizontal stability compared to parallel drill hole placement. This was a cohort study; level of evidence, 2b. Two groups of patients with acute high-grade acromioclavicular joint instability (Rockwood type V) were included in this prospective, non-randomized cohort study. 15 patients (1 female/14 male) with a mean age of 37.7 (18-66) years were treated with a Double-TightRope technique using a V-shaped orientation of the drill holes (group 1). 13 patients (1 female/12 male) with a mean age of 40.9 (21-59) years were treated with a Double-TightRope technique with a parallel drill hole placement (group 2). After 2 years, the final evaluation consisted of a complete physical examination of both shoulders, evaluation of the Subjective Shoulder Value (SSV), Constant Score (CS), Taft Score (TF) and Acromioclavicular Joint Instability Score (ACJI) as well as a radiologic examination including bilateral anteroposterior stress views and bilateral Alexander views. After a mean follow-up of 2 years, all patients were free of shoulder pain at rest and during daily activities. Range of motion did not differ significantly between both groups (p > 0.05). Patients in group 1 reached on average 92.4 points in the CS, 96.2 % in the SSV, 10.5 points in the TF and 75.9 points in the ACJI. Patients in group 2 scored 90.5 points in the CS, 93.9 % in the SSV, 10.5 points in the TF and 84.5 points in the ACJI (p > 0.05). Radiographically, the coracoclavicular distance was found to be 13.9 mm (group 1) and 13.4 mm (group 2) on the affected side and 9.3 mm (group 1

A comparative study of the skeletal morphology of the temporo-mandibular joint of children and adults.

Science.gov (United States)

Meng, F; Liu, Y; Hu, K; Zhao, Y; Kong, L; Zhou, S

2008-01-01

The skeletal morphology of the temporo-mandibular joint (TMJ) is constantly remodeled. A comparative study was undertaken to determine and characterize the differences in the skeletal morphology of TMJ of children and adults. The study was conducted on 30 children cadavers and 30 adult volunteers. Parameters that could reflect TMJ skeletal morphology were measured with a new technology combining helical computed tomography (CT) scan with multi-planar reformation (MPR) imaging. Significant differences between children cadavers and adults were found in the following parameters (P<0.05): Condylar axis inclination, smallest area of condylar neck/largest area of condylar process, inclination of anterior slope in inner, middle, and outer one-third of condyle, anteroposterior/mediolateral dimension of condyle, length of anterior slope/posterior slope in inner and middle one-third of condyle, anteroposterior dimension of condyle/glenoid fossa, mediolateral dimension of condyle/glenoid fossa, inclination of anterior slope of glenoid fossa, depth of glenoid fossa, and anteroposterior/mediolateral dimension of glenoid fossa. There are significant differences of TMJ skeletal morphology between children and adults.

Changes of the hip joints associated with chronic subluxation and dislocation: CT and plain radiography analysis

International Nuclear Information System (INIS)

Yang, Ik; Ryu, Kyung Nam; Lee, Sun Wha; Choi, Woo Suk; Lee, Eil Seong

1993-01-01

Secondary osteoarthritis of the hip joint is a common disease and is frequently followed by chronic subluxation and dislocation. Twenty four cases of the secondary osteoarthritis associated with chronic subluxation and dislocation of the hip joints were evaluated with plain radiography and computed tomography. We retrospectively analyzed 1) the osteoarthritis and calcification of the acetabular labrum, 2) the thickness of the quadrilateral plate of the ilium, and 3) anteroposterior diameter of the acetabulum. The changes of the hip joints in subluxation (n=14) revealed ossification of the acetabular labrum in 12 cases (86%), thickening of the quadrilateral plate of the ilium in 11 cases (78%) but anteroposterior diameter of the acetabulum was not changed. The changes of the hip joints in dislocation (n=10) revealed no evidence of the ossification of the acetabular labrum, thickening of the quadrilateral plate of the ilium in 10 cases (100%) and decreased anteroposterior diameter of the acetabulum. We conclude that CT findings of subluxation and dislocation of the hip joints can be helpful in the evaluation of the secondary osteoarthritis of the hip joints

Radio-morphometric Analysis of Sella Turcica in the South Indian Population: A Digital Cephalometric Study

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Ch. Sai Kiran

2017-06-01

Results: A higher percentage of both males (70.0% and females (67.7% were presented with normal sella. The second best sella presentation was the shallow sella in males (16.2%. The mean antero-posterior diameter was significantly higher in females (12.25 mm than males (11.74 mm. The mean depth of sella turcica was greater in females (8.08 mm than males (7.68mm. Discriminant function analysis was done with gender as a grouping variable and antero-posterior dimensions and sella depth as independent variables. The formula obtained was D = 0.452 (x +0.295(y-7.753. (Where “D” is the discriminant score “x” is antero-posterior diameter of sella “y” is sella depth.The present study revealed an overall accuracy rate of58.1% in identifying correct gender using sella measurements. Conclusion: The present study was the first of its kind in the South Indian population and has presented results that justify the use of sella turcica for sex determination.

Analysis in measurements of gastric emptying time

International Nuclear Information System (INIS)

Lee, Choon Ho; Lee, Man Koo

1997-01-01

Scintigraphic measurement of gastric emptying time has been reported to be influenced by the variation in depth of radionuclide within the stomach. This study was designed to clarify whether a part of the variability in gastric emptying could be ascribed to a relationship between anterior image, the total anteroposterior image and the tissue attenuation correction(geometric mean). A dual-head scintillation camera(ADAC, USA) was used to investigate effect of such changes. We were performed 16 normal subject gastric emptying studies with 99 mTC labelled scramble egg, milk and solid meal(610 Kcal, 300 g). The results are as follows; On anterior image, T 1/2 emptying time was delayed by 5 min, 6.5%(range : 3 ∼ 18 min, 5∼31.4%) compared with the geometric mean. But there was no different gastric emptying time between the total anteroposterior image and geometric mean. Therefore, if will be useful to use the method of geometric mean or the total anteroposterior image to evaluate the gastric emptying time accurately

Analysis in measurements of gastric emptying time

Energy Technology Data Exchange (ETDEWEB)

Lee, Choon Ho [College of Medicine, Wonkwang Univ., Iksan (Korea, Republic of); Lee, Man Koo [Wonkwang Health Science College, Iksan (Korea, Republic of)

1997-02-01

Scintigraphic measurement of gastric emptying time has been reported to be influenced by the variation in depth of radionuclide within the stomach. This study was designed to clarify whether a part of the variability in gastric emptying could be ascribed to a relationship between anterior image, the total anteroposterior image and the tissue attenuation correction(geometric mean). A dual-head scintillation camera(ADAC, USA) was used to investigate effect of such changes. We were performed 16 normal subject gastric emptying studies with {sup 99}mTC labelled scramble egg, milk and solid meal(610 Kcal, 300 g). The results are as follows; On anterior image, T{sub 1/2} emptying time was delayed by 5 min, 6.5%(range : 3 {approx} 18 min, 5{approx}31.4%) compared with the geometric mean. But there was no different gastric emptying time between the total anteroposterior image and geometric mean. Therefore, if will be useful to use the method of geometric mean or the total anteroposterior image to evaluate the gastric emptying time accurately.

Fractures of the proximal humerus involving the intertubercular groove

International Nuclear Information System (INIS)

Ahovuo, J.; Paavolainen, P.; Bjoerkenheim, J.M.; Helsinki Univ. Central Hospital

1989-01-01

The purpose of this study was to analyse the involvement of the gliding surface of the biceps tendon in fractures of the proximal humerus. Fifteen patients had a fracture of the proximal humerus verified with antero-posterior and axillary radiographs. Tangential radiographs of the intertubercular groove, obtained from the shoulder joint, showed involvement of the intertubercular groove in 13 patients (87%), which could not be shown with other projections. Groove radiographs revealed in 3 patients a dislocation of the fragments of the greater tuberosity large enough to require surgical treatment, but which had not been found using conventional techniques. Therefore, a groove radiograph should be used to precise fractures of the proximal humerus. (orig.)

The Spine in Patients With Osteogenesis Imperfecta.

Science.gov (United States)

Wallace, Maegen J; Kruse, Richard W; Shah, Suken A

2017-02-01

Osteogenesis imperfecta is a genetic disorder of type I collagen. Although multiple genotypes and phenotypes are associated with osteogenesis imperfecta, approximately 90% of the mutations are in the COL1A1 and COL1A2 genes. Osteogenesis imperfecta is characterized by bone fragility. Patients typically have multiple fractures or limb deformity; however, the spine can also be affected. Spinal manifestations include scoliosis, kyphosis, craniocervical junction abnormalities, and lumbosacral pathology. The incidence of lumbosacral spondylolysis and spondylolisthesis is higher in patients with osteogenesis imperfecta than in the general population. Use of diphosphonates has been found to decrease the rate of progression of scoliosis in patients with osteogenesis imperfecta. A lateral cervical radiograph is recommended in patients with this condition before age 6 years for surveillance of craniocervical junction abnormalities, such as basilar impression. Intraoperative and anesthetic considerations in patients with osteogenesis imperfecta include challenges related to fracture risk, airway management, pulmonary function, and blood loss.

Point of Technique

African Journals Online (AJOL)

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Minimally invasive techniques are becoming popular choice for the recent times. These techniques are lowering the cost and giving the best cosmetic results. For cardiovascular surgery these techniques are much more newer and much more unknown. Open lumbar sympathectomy for certain indications is a very well ...

Uranium exploration techniques

International Nuclear Information System (INIS)

Nichols, C.E.

1984-01-01

The subject is discussed under the headings: introduction (genetic description of some uranium deposits; typical concentrations of uranium in the natural environment); sedimentary host rocks (sandstones; tabular deposits; roll-front deposits; black shales); metamorphic host rocks (exploration techniques); geologic techniques (alteration features in sandstones; favourable features in metamorphic rocks); geophysical techniques (radiometric surveys; surface vehicle methods; airborne methods; input surveys); geochemical techniques (hydrogeochemistry; petrogeochemistry; stream sediment geochemistry; pedogeochemistry; emanometry; biogeochemistry); geochemical model for roll-front deposits; geologic model for vein-like deposits. (U.K.)

Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

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David Ruiz Picazo

2016-01-01

Full Text Available Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR. At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis.

Acute and chronic lumbosacral pain: Topical problems

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Ekaterina Vladimirovna Podchufarova

2012-01-01

Full Text Available The paper gives an account of approaches to treating patients with acute and chronic back pain in the context of evidence-based medicine and current clinical guidelines. In the vast majority, acute back pain is a benign self-limiting condition (nonspecific musculoskeletal pain and most patients need additional instrumental examinations. An active approach to treatment is considered to be optimal. It is expedient to apply a more differential approach involving the refinement of mechanisms for development of the pain syndrome and the elaboration of treatment strategy in relation to the leading pathophysiological mechanism when examining the patients with chronic back pain.

Mortality and Morbidity Following Repair for Lumbosacral ...

African Journals Online (AJOL)

Nigerian Journal of Surgical Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 3 (2000) >. Log in or Register to get access to full text downloads.

Anthropometric measurements of tibial plateau and correlation with the current tibial implants.

Science.gov (United States)

Erkocak, Omer Faruk; Kucukdurmaz, Fatih; Sayar, Safak; Erdil, Mehmet Emin; Ceylan, Hasan Huseyin; Tuncay, Ibrahim

2016-09-01

The aim of the study was to make an anthropometric analysis at the resected surfaces of the proximal tibia in the Turkish population and to compare the data with the dimensions of tibial components in current use. We hypothesized that tibial components currently available on the market do not fulfil the requirements of this population and a new tibial component design may be required, especially for female patients with small stature. Anthropometric data from the proximal tibia of 226 knees in 226 Turkish subjects were measured using magnetic resonance imaging. We measured the mediolateral, middle anteroposterior, medial and lateral anteroposterior dimensions and the aspect ratio of the resected proximal tibial surface. All morphological data were compared with the dimensions of five contemporary tibial implants, including asymmetric and symmetric design types. The dimensions of the tibial plateau of Turkish knees demonstrated significant differences according to gender (P < 0.05). Among the different tibial implants reviewed, neither asymmetric nor symmetric designs exhibited a perfect conformity to proximal tibial morphology in size and shape. The vast majority of tibial implants involved in this study tend to overhang anteroposteriorly, and a statistically significant number of women (21 %, P < 0.05) had tibial anteroposterior diameters smaller than the smallest available tibial component. Tibial components designed according to anthropometric measurements of Western populations do not perfectly meet the requirements of Turkish population. These data could provide the basis for designing the optimal and smaller tibial component for this population, especially for women, is required for best fit. II.

SENSITIVITY OF BODY SWAY PARAMETERS DURING QUIET STANDING TO MANIPULATION OF SUPPORT SURFACE SIZE

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Sarabon Nejc

2010-09-01

Full Text Available The centre of pressure (COP movement during stance maintenance on a stable surface is commonly used to describe and evaluate static balance. The aim of our study was to test sensitivity of individual COP parameters to different stance positions which were used to address size specific changes in the support surface. Twenty-nine subjects participated in the study. They carried out three 60-second repetitions of each of the five balance tasks (parallel stance, semi-tandem stance, tandem stance, contra-tandem stance, single leg stance. Using the force plate, the monitored parameters included the total COP distance, the distance covered in antero-posterior and medio-lateral directions, the maximum oscillation amplitude in antero-posterior and medio-lateral directions, the total frequency of oscillation, as well as the frequency of oscillation in antero-posterior and medio-lateral directions. The parameters which describe the total COP distance were the most sensitive to changes in the balance task, whereas the frequency of oscillation proved to be sensitive to a slightly lesser extent. Reductions in the support surface size in each of the directions resulted in proportional changes of antero-posterior and medio- lateral directions. The frequency of oscillation did not increase evenly with the increase in the level of difficulty of the balance task, but reached a certain value, above which it did not increase. Our study revealed the monitored parameters of the COP to be sensitive to the support surface size manipulations. The results of the study provide an important source for clinical and research use of the body sway measurements.

Persian fencing techniques

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Manouchehr Moshtagh Khorasani

2012-07-01

Full Text Available There are numerous manuscripts, poems and stories that describe, specifically and in detail, the different techniques used in Persian swordsmanship. The present article explains the origins and the techniques of Persian swordsmanship. The article also describes the traditional code of conduct for Persian warriors. Additionally, it describes an array of techniques that were deployed in actual combat in Iran’s history. Some of these techniques are represented via the miniatures that are reproduced herein. This is the first article on Persian swordsmanship published in any periodical.

Radiation scattering techniques

International Nuclear Information System (INIS)

Edmonds, E.A.

1986-01-01

Radiation backscattering techniques are useful when access to an item to be inspected is restricted to one side. These techniques are very sensitive to geometrical effects. Scattering processes and their application to the determination of voids, thickness measuring, well-logging and the use of x-ray fluorescence techniques are discussed. (U.K.)

Preference for different relaxation techniques by COPD patients: comparison between six techniques

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Hyl

2016-09-01

Full Text Available Michael E Hyland,1 David MG Halpin,2 Sue Blake,3 Clare Seamark,3 Margaret Pinnuck,3 David Ward,3 Ben Whalley,1 Colin J Greaves,4 Adam L Hawkins,5 Dave Seamark3 1School of Psychology, University of Plymouth, Plymouth, 2Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, 3Honiton Group Practice, Honiton, 4University of Exeter Medical School, Exeter, 5GSK House, Brentford, UK Background: A review of the effectiveness of relaxation techniques for chronic obstructive pulmonary disease patients has shown inconsistent results, but studies have varied in terms of technique and outcome measures. Aim: To determine patient preference for different relaxation techniques. Methods: Chronic obstructive pulmonary disease patients were presented with six techniques via a DVD and asked to rate the techniques in terms of effectiveness, rank in order of likely use, and comment. Results: Patients differed in the technique preferred and reason for that preference, but the most commonly preferred technique both for effectiveness and ease of use was “thinking of a nice place” followed by progressive relaxation and counting. Familiarity and ease of activity were commonly given reasons for preference. Conclusion: Rather than providing patients with a single technique that they might find difficult to implement, these results suggest that it would be better to give a choice. “Thinking of a nice place” is a popular but under-investigated technique. Keywords: COPD exacerbation, anxiety, relaxation techniques

Human spinal locomotor control is based on flexibly organized burst generators

OpenAIRE

Danner, Simon M.; Hofstoetter, Ursula S.; Freundl, Brigitta; Binder, Heinrich; Mayr, Winfried; Rattay, Frank; Minassian, Karen

2015-01-01

Understanding the organisation of human spinal locomotor circuitry after severe CNS damage is essential for improving neurorehabilitation strategies. Danner et al. present evidence of flexibly organised burst-generating elements within the functionally isolated human lumbosacral spinal cord that generate rhythmic patterns in response to constant, repetitive epidural stimulation.

Descending Projections From The Nucleus Retroambiguus To The Iliopsoas Motoneuronal Cell Groups In The Female Golden Hamster : Possible role in reproductive behavior

NARCIS (Netherlands)

Gerrits, Peter O.; Holstege, Gert

1999-01-01

In the cat, the nucleus retroambiguus (NRA) projects to expiratory motoneurons in the brainstem and spinal cord. Recently, it has been demonstrated that the NRA sends fibers to a specific set of motoneurons in the lumbosacral cord, which pathway is thought to play a crucial role in mating behavior.

Alexandria Journal of Medicine - Vol 48, No 3 (2012)

African Journals Online (AJOL)

Somatosensory-evoked potentials as an add-on diagnostic procedure to imaging studies in patients with lumbosacral spinal canal stenosis · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. GA Eltantawi, MM Hassan, HE Sultan, AA Elnekiedy, HM Naby, 207–214.

Organization of the motoneurons innervating the pelvic muscles of the male rat

DEFF Research Database (Denmark)

Schrøder, H D

1980-01-01

The cytoarchitecture of the motoneuron pool of the male rat was studied at the lumbo-sacral transition area, particularly in L6. In the latter segment a dorso-medial (DM), ventral (V), dorso-lateral (DL), and retrodorso-lateral group (RDL) could be defined. The DL group was associated...

Atypical feline sporotrichosis resembling vaccine-induced sarcoma: clinical and histopathological aspects.

Science.gov (United States)

dos Santos, Isabele Barbieri; Quintella, Leonardo Pereira; de Miranda, Luisa Helena Monteiro; de Sousa Trotte, Marcele Nogueira; Schubach, Tânia Maria Pacheco; Tortelly, Rogerio

2013-06-01

A 7-year-old Siamese cat presenting with three ulcerated cutaneous nodules in the lumbosacral region was seen at the Laboratory for Clinical Research on Dermatozoonoses in Domestic Animals in Rio de Janeiro, Brazil. Histopathological analysis showed that the lesions consisted of polyhedral and spindle-shaped voluminous mononuclear cells with loose chromatin and clearly visible nucleoli, few giant cells, and foci of coagulative and caseous necrosis -- findings suggestive of a vaccine-induced sarcoma. No significant mitotic rate, cytological atypias or asteroid bodies were observed. Special histopathological staining with periodic acid-Schiff and Grocott's silver stain demonstrated the presence of small yeast cells characterized by simple and narrow-base budding compatible with Sporothrix schenckii. Mycological culture grew S schenckii. Cytopathology was negative for yeast cells. These atypical clinical and histopathological signs support the importance of histopathological analysis with special staining techniques, in addition to mycological culture in the diagnosis of feline sporotrichosis.

Maximum Acceptable Weight of Lift reflects peak lumbosacral extension moments in a Functional Capacity Evaluation test using free style, stoop, and squat lifting

OpenAIRE

Kuijer, P.P.F.M.; van Oostrom, S.H.; Duijzer, K.; van Dieen, J.H.

2012-01-01

It is unclear whether the maximum acceptable weight of lift (MAWL), a common psychophysical method, reflects joint kinetics when different lifting techniques are employed. In a within-participants study (n = 12), participants performed three lifting techniques - free style, stoop and squat lifting from knee to waist level - using the same dynamic functional capacity evaluation lifting test to assess MAWL and to calculate low back and knee kinetics. We assessed which knee and back kinetic para...

Dysplastic spondylolysis is caused by mutations in the diastrophic dysplasia sulfate transporter gene.

Science.gov (United States)

Cai, Tao; Yang, Liu; Cai, Wanshi; Guo, Sen; Yu, Ping; Li, Jinchen; Hu, Xueyu; Yan, Ming; Shao, Qianzhi; Jin, Yan; Sun, Zhong Sheng; Luo, Zhuo-Jing

2015-06-30

Spondylolysis is a fracture in part of the vertebra with a reported prevalence of about 3-6% in the general population. Genetic etiology of this disorder remains unknown. The present study was aimed at identifying genomic mutations in patients with dysplastic spondylolysis as well as the potential pathogenesis of the abnormalities. Whole-exome sequencing and functional analysis were performed for patients with spondylolysis. We identified a novel heterozygous mutation (c.2286A > T; p.D673V) in the sulfate transporter gene SLC26A2 in five affected subjects of a Chinese family. Two additional mutations (e.g., c.1922A > G; p.H641R and g.18654T > C in the intron 1) in the gene were identified by screening a cohort of 30 unrelated patients with the disease. In situ hybridization analysis showed that SLC26A2 is abundantly expressed in the lumbosacral spine of the mouse embryo at day 14.5. Sulfate uptake activities in CHO cells transfected with mutant SLC26A2 were dramatically reduced compared with the wild type, confirming the pathogenicity of the two missense mutations. Further analysis of the gene-disease network revealed a convergent pathogenic network for the development of lumbosacral spine. To our knowledge, our findings provide the first identification of autosomal dominant SLC26A2 mutations in patients with dysplastic spondylolysis, suggesting a new clinical entity in the pathogenesis of chondrodysplasia involving lumbosacral spine. The analysis of the gene-disease network may shed new light on the study of patients with dysplastic spondylolysis and spondylolisthesis as well as high-risk individuals who are asymptomatic.

Training techniques for industry

International Nuclear Information System (INIS)

Jones, D.W.

1978-01-01

The advantages and disadvantages of commonly used training techniques in relation to cost-effective, prevention-oriented Quality Assurance are examined. Important questions are whether training techniques teach cost effectiveness and whether the techniques are, themselves, cost effective. To answer these questions, criteria for evaluating teaching techniques for cost effectiveness were developd, and then commonly used techniques are evaluated in terms of specific training program objectives. Motivation of personnel is also considered important to the success of a training program, and methods are outlined by which recognition of the academic quality of industrial training can be used as a motivational technique

A limited, low-dose computed tomography protocol to examine the sacroiliac joints

International Nuclear Information System (INIS)

Friedman, L.; Silberberg, P.J.; Rainbow, A.; Butler, R.

1993-01-01

Limited, low-dose, three-scan computed tomography (CT) was shown to be as accurate as a complete CT series in examining the sacroiliac joints and is suggested as an effective alternative to plain radiography as the primary means to detect sacroiliitis. The advantages include the brevity of the examination, a 2-fold to 4-fold reduction in radiation exposure relative to conventional radiography and a 20-fold to 30-fold reduction relative to a full CT series. The technique was developed from studies of anatomic specimens in which the articular surfaces were covered with a film of barium to show clearly the synovial surfaces and allow the choice of the most appropriate levels of section. From the anteroposterior scout view the following levels were defined: at the first sacral foramen, between the first and second sacral foramina and at the third sacral foramen. In the superior section a quarter of the sacroiliac joint is synovial, whereas in the inferior section the entire joint is synovial. The three representative cuts and the anteroposterior scout view are displayed on a single 14 x 17 in. (36 x 43 cm) film. Comparative images at various current strengths showed that at lower currents than conventionally used no diagnostic information was lost, despite a slight increase in noise. The referring physicians at the authors' institution prefer this protocol to the imaging routine previously used. (author). 21 refs., 1 tab., 4 figs

A cephalometric study of antero-posterior skeletal jaw relationship in ...

African Journals Online (AJOL)

Fulani children in Nigeria. Setting:This study was carried out in 1998 at the Maxillo-facial unit of the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Materials and methods: 100 subjects aged 11 –13 years of Hausa-Fulani ancestry ...

38 CFR 4.66 - Sacroiliac joint.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Sacroiliac joint. 4.66... DISABILITIES Disability Ratings The Musculoskeletal System § 4.66 Sacroiliac joint. The common cause of disability in this region is arthritis, to be identified in the usual manner. The lumbosacral and sacroiliac...

Disseminated Mycobacterium avium infection in a cat

OpenAIRE

Barry, Maureen; Taylor, Judith; Woods, Paul

2002-01-01

A domestic shorthair cat was presented for lethargy and ataxia. Clinical findings included an abdominal mass, lumbosacral pain, ataxia. Aspirates from the liver and lymph nodes revealed intracellular, negative-staining rods. Treatment for presumptive mycobacterium infection was unsuccessful and the cat was euthanized. Disseminated Mycobacterium avium was confirmed on culture.

Disseminated Mycobacterium avium infection in a cat.

Science.gov (United States)

Barry, Maureen; Taylor, Judith; Woods, J Paul

2002-05-01

A domestic shorthair cat was presented for lethargy and ataxia. Clinical findings included an abdominal mass, lumbosacral pain, ataxia. Aspirates from the liver and lymph nodes revealed intracellular, negative-staining rods. Treatment for presumptive mycobacterium infection was unsuccessful and the cat was euthanized. Disseminated Mycobacterium avium was confirmed on culture.

[A therapeutic effect analysis of femur first principle and combined anteversion technique during total hip arthroplasty].

Science.gov (United States)

Wang, X Q; Wu, C S; Sun, S; Wang, J; Li, W; Zhang, W

2018-04-01

Objective: To investigate the situation of hip dislocation with the application of "femur first" principle and "combined anteversion technique" during total hip arthroplasty. Methods: A retrospective analysis has been done on the clinical data about 104 patients(133 hips)who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016, and all the prostheses applied in the operation were cementless ones.Among them, 65 patients were males, 39 females and their age was 46.6 years (ranging from 23 to 76 years) .And 29 of them underwent bilateral hip operations and 75 unilateral ones.Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage, 28 cases of hip dysplasia and osteoarthritis.Surgical approach: of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach.During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured.After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle.The patients' prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record.One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination.Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation. Results: All the patients had been operated on smoothly, with the operation time of(57.6±14.5)minutes(36-115 minutes)and hemorrhage amount of (336.5±50.8)ml(180-620 ml). The operation finding showed that the combined anteversion by employing

Pulse holographic measurement techniques

International Nuclear Information System (INIS)

Kim, Cheol Jung; Baik, Seong Hoon; Hong, Seok Kyung; Kim, Jeong Moog; Kim, Duk Hyun

1992-01-01

With the development of laser, remote inspection techniques using laser have been growing on. The inspection and measurement techniques by pulse holography are well-established technique for precise measurement, and widely used in various fields of industry now. In nuclear industry, this technology is practically used because holographic inspection is remote, noncontact, and precise measurement technique. In relation to remote inspection technology in nuclear industry, state-of-the art of pulse HNDT (Holographic non-destructive testing) and holographic measurement techniques are examined. First of all, the fundamental principles as well as practical problems for applications are briefly described. The fields of pulse holography have been divided into the HNDT, flow visualization and distribution study, and other application techniques. Additionally holographic particle study, bubble chamber holography, and applications to other visualization techniques are described. Lastly, the current status for the researches and applications of pulse holography to nuclear industry which are carried out actively in Europe and USA, is described. (Author)

SEM-based characterization techniques

International Nuclear Information System (INIS)

Russell, P.E.

1986-01-01

The scanning electron microscope is now a common instrument in materials characterization laboratories. The basic role of the SEM as a topographic imaging system has steadily been expanding to include a variety of SEM-based analytical techniques. These techniques cover the range of basic semiconductor materials characterization to live-time device characterization of operating LSI or VLSI devices. This paper introduces many of the more commonly used techniques, describes the modifications or additions to a conventional SEM required to utilize the techniques, and gives examples of the use of such techniques. First, the types of signals available from a sample being irradiated by an electron beam are reviewed. Then, where applicable, the type of spectroscopy or microscopy which has evolved to utilize the various signal types are described. This is followed by specific examples of the use of such techniques to solve problems related to semiconductor technology. Techniques emphasized include: x-ray fluorescence spectroscopy, electron beam induced current (EBIC), stroboscopic voltage analysis, cathodoluminescnece and electron beam IC metrology. Current and future trends of some of the these techniques, as related to the semiconductor industry are discussed

Reducing radiation doses to the breast, thyroid and gonads during diagnostic radiography

International Nuclear Information System (INIS)

Weatherburn, G.C.

1983-01-01

The skin entry and exit doses on patients undergoing routine radiographic examinations of areas in which the breast, thyroid and gonads are included in the primary beam were measured using thermoluminescent dosimeters. To obtain further information about patient doses, measurements were also made on a phantom at similar skin positions and at the positions of these organs. Comparisons of the doses to these radiosensitive organs were made for the antero-posterior and postero-anterior projections. In cases where it was found that the doses were reduced by the use of non-conventional relationship between the relative positions of the patient and the film, suggestions are made for the adaptations which would have to be made to X-ray equipment to enable these projections to be taken routinely. Other techniques, such as air gap techniques and thyroid shielding, whereby patient doses can be reduced during routine radiography are also examined. Finally the implications of these results for radiation protection of patients are considered. (author)

Nuclear techniques in hydrology

International Nuclear Information System (INIS)

Moser, H.

1976-01-01

The nuclear techniques used in hydrology are usually tracer techniques based on the use of nuclides either intentionally introduced into, or naturally present in the water. The low concentrations of these nuclides, which must be detected in groundwater and surface water, require special measurement techniques for the concentrations of radioactive or of stable nuclides. The nuclear techniques can be used most fruitfully in conjunction with conventional methods for the solution of problems in the areas of hydrology, hydrogeology and glacier hydrology. Nuclear techniques are used in practice in the areas of prospecting for water, environment protection and engineering hydrogeology. (orig.) [de

Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil

Directory of Open Access Journals (Sweden)

Alessandra Carvalho Goulart

Full Text Available CONTEXT AND OBJECTIVE: Noninvasive strategies for evaluating non-alcoholic fatty liver disease (NAFLD have been investigated over the last few decades. Our aim was to evaluate the diagnostic accuracy of a new hepatic ultrasound score for NAFLD in the ELSA-Brasil study. DESIGN AND SETTINGS: Diagnostic accuracy study conducted in the ELSA center, in the hospital of a public university. METHODS: Among the 15,105 participants of the ELSA study who were evaluated for NAFLD, 195 individuals were included in this sub-study. Hepatic ultrasound was performed (deep beam attenuation, hepatorenal index and anteroposterior diameter of the right hepatic lobe and compared with the hepatic steatosis findings from 64-channel high-resolution computed tomography (CT. We also evaluated two clinical indices relating to NAFLD: the fatty liver index (FLI and the hepatic steatosis index (HSI. RESULTS: Among the 195 participants, the NAFLD frequency was 34.4%. High body mass index, high waist circumference, diabetes and hypertriglyceridemia were associated with high hepatic attenuation and large anteroposterior diameter of the right hepatic lobe, but not with the hepatorenal index. The hepatic ultrasound score, based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe, presented the best performance for NAFLD screening at the cutoff point ≥ 1 point; sensitivity: 85.1%; specificity: 73.4%; accuracy: 79.3%; and area under the curve (AUC 0.85; 95% confidence interval, CI: 0.78-0.91]. FLI and HSI presented lower performance (AUC 0.76; 95% CI: 0.69-0.83 than CT. CONCLUSION: The hepatic ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe has good reproducibility and accuracy for NAFLD screening.

Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Science.gov (United States)

Goulart, Alessandra Carvalho; Oliveira, Ilka Regina Souza de; Alencar, Airlane Pereira; Santos, Maira Solange Camara dos; Santos, Itamar Souza; Martines, Brenda Margatho Ramos; Meireles, Danilo Peron; Martines, João Augusto dos Santos; Misciagna, Giovanni; Benseñor, Isabela Martins; Lotufo, Paulo Andrade

2015-01-01

Noninvasive strategies for evaluating non-alcoholic fatty liver disease (NAFLD) have been investigated over the last few decades. Our aim was to evaluate the diagnostic accuracy of a new hepatic ultrasound score for NAFLD in the ELSA-Brasil study. Diagnostic accuracy study conducted in the ELSA center, in the hospital of a public university. Among the 15,105 participants of the ELSA study who were evaluated for NAFLD, 195 individuals were included in this sub-study. Hepatic ultrasound was performed (deep beam attenuation, hepatorenal index and anteroposterior diameter of the right hepatic lobe) and compared with the hepatic steatosis findings from 64-channel high-resolution computed tomography (CT). We also evaluated two clinical indices relating to NAFLD: the fatty liver index (FLI) and the hepatic steatosis index (HSI). Among the 195 participants, the NAFLD frequency was 34.4%. High body mass index, high waist circumference, diabetes and hypertriglyceridemia were associated with high hepatic attenuation and large anteroposterior diameter of the right hepatic lobe, but not with the hepatorenal index. The hepatic ultrasound score, based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe, presented the best performance for NAFLD screening at the cutoff point ≥ 1 point; sensitivity: 85.1%; specificity: 73.4%; accuracy: 79.3%; and area under the curve (AUC 0.85; 95% confidence interval, CI: 0.78-0.91)]. FLI and HSI presented lower performance (AUC 0.76; 95% CI: 0.69-0.83) than CT. The hepatic ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe has good reproducibility and accuracy for NAFLD screening.

The neck shaft angle: CT reference values of 800 adult hips

Energy Technology Data Exchange (ETDEWEB)

Boese, Christoph Kolja; Jostmeier, Janine; Oppermann, Johannes; Dargel, Jens; Eysel, Peer [University Hospital of Cologne, Department of Orthopaedic and Trauma Surgery, Cologne (Germany); Chang, De-Hua [University Hospital of Cologne, Department of Radiology and Neuroradiology, Cologne (Germany); Lechler, Philipp [University of Giessen and Marburg, Center of Orthopedic and Trauma Surgery, Marburg (Germany)

2016-04-15

A precise understanding of the radiological anatomy and biomechanics as well as reliable reference values of the hip are essential. The primary goal of this study was to provide reference values of the neck-shaft angle (NSA) for adult patients based on the analysis of rotation corrected computed tomography (CT) scans of 800 hips. The secondary aim was to compare these measurements with simulated anteroposterior roentgenograms of the pelvis. Pelvic CT scans of 400 patients (54.3 years, range 18-100 years; 200 female) were reconstructed in the derotated coronal plane of the proximal femur and as CT-based simulated anteroposterior roentgenograms of the pelvis in the anterior pelvic plane. Femora were categorized as coxa vara (<120 ), physiologic (≥120 to <135 ), and coxa valga (≥135 ). Intra- and inter-rater reliability were analyzed. Primary research question: Mean NSA for male adults was 129.6 (range 113.2 -148.2 ; SD 5.9 ) and 131.9 (range 107.1 -151.9 ; SD 6.8 ) for females in derotated coronal reconstructions. Age (p < 0.001 in both views) and sex influenced the NSA significantly (p = 0.002 and p < 0.001); no significant differences were found between sides (p = 0.722 and p = 0.955). Overall, an excellent reliability of repeated measurements of one or two observers was found (ICC 0.891-0.995). Secondary research question: NSA values measured in the simulated anteroposterior roentgenogram and the rotation corrected coronal reconstruction differed significantly (p < 0.001). While anteroposterior pelvis radiographs are susceptible to rotational errors, the coronal reconstruction of the proximal femur in the femoral neck plane allows the correct measurement of the NSA. (orig.)

The neck shaft angle: CT reference values of 800 adult hips

International Nuclear Information System (INIS)

Boese, Christoph Kolja; Jostmeier, Janine; Oppermann, Johannes; Dargel, Jens; Eysel, Peer; Chang, De-Hua; Lechler, Philipp

2016-01-01

A precise understanding of the radiological anatomy and biomechanics as well as reliable reference values of the hip are essential. The primary goal of this study was to provide reference values of the neck-shaft angle (NSA) for adult patients based on the analysis of rotation corrected computed tomography (CT) scans of 800 hips. The secondary aim was to compare these measurements with simulated anteroposterior roentgenograms of the pelvis. Pelvic CT scans of 400 patients (54.3 years, range 18-100 years; 200 female) were reconstructed in the derotated coronal plane of the proximal femur and as CT-based simulated anteroposterior roentgenograms of the pelvis in the anterior pelvic plane. Femora were categorized as coxa vara (<120 ), physiologic (≥120 to <135 ), and coxa valga (≥135 ). Intra- and inter-rater reliability were analyzed. Primary research question: Mean NSA for male adults was 129.6 (range 113.2 -148.2 ; SD 5.9 ) and 131.9 (range 107.1 -151.9 ; SD 6.8 ) for females in derotated coronal reconstructions. Age (p < 0.001 in both views) and sex influenced the NSA significantly (p = 0.002 and p < 0.001); no significant differences were found between sides (p = 0.722 and p = 0.955). Overall, an excellent reliability of repeated measurements of one or two observers was found (ICC 0.891-0.995). Secondary research question: NSA values measured in the simulated anteroposterior roentgenogram and the rotation corrected coronal reconstruction differed significantly (p < 0.001). While anteroposterior pelvis radiographs are susceptible to rotational errors, the coronal reconstruction of the proximal femur in the femoral neck plane allows the correct measurement of the NSA. (orig.)

Protaper--hybrid technique.

Science.gov (United States)

Simon, Stephane; Lumley, Philip; Tomson, Phillip; Pertot, Wilhelm-Joseph; Machtou, Pierre

2008-03-01

Crown down preparation is the most known and described technique since the introduction of Nickel Titanium (NiTi) rotary instruments in endodontics. This technique gives good results but has limitations, such as not addressing the initial anatomy of oval or dumb-bell shaped canals. The specific design of the Protaper instruments allows use of them with a different technique and, specifically, with a brushing motion in the body of the canal. The recent introduction of hand Protaper files has expanded the range of application of this system, especially in curved canals. The 'hybrid technique', using rotary and hand files, and the advantages of the combination of both instruments, are clearly described in this article. Used with this technique, the Protaper is a very safe system to use, and more controllable, for both inexperienced and experienced practitioners alike, than other systems. To understand the precautions needed with rotary files, and how to use them to preserve the anatomy of the canal and get a tapered shaping, even in severely curved canals.

ECAJS 2009 VOL 14 No 1 FINAL EDIT doc

African Journals Online (AJOL)

user

Methods and Patients: A prospective study of all spinal injury patients treated in our service in ... There were neurological deficits in 49(79%) and cervical cord injuries were the ... and treatment was non-operative in all cases. ... most frequently injured part of the spine (42-50%), followed by thoracic (31%) and lumbosacral.

Somatosensory-evoked potentials as an add-on diagnostic ...

African Journals Online (AJOL)

Introduction: Lumbo-sacral spinal stenosis (LSS) is a frequent cause for chronic low back pain. The diagnosis is primarily radiological. Neural insult is not frequent in every case. Although the degree and type of LSS can exactly be described with the current imaging studies, the extent of neural impairment cannot be ...

Meningeal dissemination of a pituitary carcinoma to the cauda equina in a dog.

Science.gov (United States)

Sheehan, Nora K; Rylander, Helena; Christensen, Neil; Nafe, Laura A

2017-08-01

An 8-year-old spayed female border collie dog was diagnosed with an invasive pituitary macrotumor. Five months after radiation therapy, the patient developed paraparesis and lumbosacral pain. Necropsy revealed a pituitary carcinoma with cauda equina drop metastasis. In cases of pituitary masses, meningeal dissemination should be considered if neurologic status declines.

A comparative study of the skeletal morphology of the temporo-mandibular joint of children and adults

Directory of Open Access Journals (Sweden)

Meng F

2008-01-01

Full Text Available Background: The skeletal morphology of the temporo-mandibular joint (TMJ is constantly remodeled. Aims and Objectives: A comparative study was undertaken to determine and characterize the differences in the skeletal morphology of TMJ of children and adults. Materials and Methods: The study was conducted on 30 children cadavers and 30 adult volunteers. Parameters that could reflect TMJ skeletal morphology were measured with a new technology combining helical computed tomography (CT scan with multi-planar reformation (MPR imaging. Results: Significant differences between children cadavers and adults were found in the following parameters ( P < 0.05: Condylar axis inclination, smallest area of condylar neck/largest area of condylar process, inclination of anterior slope in inner, middle, and outer one-third of condyle, anteroposterior/mediolateral dimension of condyle, length of anterior slope/posterior slope in inner and middle one-third of condyle, anteroposterior dimension of condyle/glenoid fossa, mediolateral dimension of condyle/glenoid fossa, inclination of anterior slope of glenoid fossa, depth of glenoid fossa, and anteroposterior/mediolateral dimension of glenoid fossa. Conclusion: There are significant differences of TMJ skeletal morphology between children and adults.

Head position affects the direction of occlusal force during tapping movement.

Science.gov (United States)

Nakamura, K; Minami, I; Wada, J; Ikawa, Y; Wakabayashi, N

2018-05-01

Despite numerous reports describing the relationship between head position and mandibular movement in human subjects, the direction and magnitude of force at the occlusal contacts have not been investigated in relation to head position. The objective was to investigate the effect of head position on the direction of occlusal force while subjects performed a tapping movement. Twenty-three healthy adult subjects were asked to sit on a chair with their back upright and to perform 15 tapping movements in five different head positions: natural head position (control); forward; backward; and right and left rolled. The direction and magnitude of force were measured using a small triaxial force sensor. The Wilcoxon signed-rank test and Bonferroni test were used to compare head positions in each angle of the anteroposterior axis direction and the lateral axis direction with respect to the superior axis. The force element in the anteroposterior axis shifted to the forward direction in the head position pitched backward, compared with control, pitched forward and rolled left positions (P = .02, tapping movement can be performed in a relaxed position without anteroposterior and lateral loading. © 2018 John Wiley & Sons Ltd.